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OBJECTIVES: This study examined dentists’ moving patterns in Iowa from 2000 to 2019 to identify potential trends in movement between urban and rural areas., METHODS: The source of data was the Iowa Dentist Tracking System (IDTS). All active dentists in Iowa in 2000 (n=1424) were used as a baseline. The final sample (n=616) included dentists who remained in private practice in Iowa during the study period. Movers were identified based on a change in the year 2000 street address as of 2019. Urbanicity of practice locations was measured at the county level using the 2013 Rural-Urban Continuum Codes (RUCC). Multivariable logistic regression was used to identify characteristics associated with relocation and subsequent change in urbanicity over the study period., RESULTS: Only 22.2% of the final sample moved during 2000-2019. Among dentists who moved (n=137), 74.5% moved with no change in urbanicity of their practice locations, 13.9% moved to more urban counties, and 11.7% moved to more rural counties. Eighty percent of those movers with no change in urbanicity relocated from one metro (RUCCs 1-3) location to another metro location. Younger (p, CONCLUSIONS: Iowa private practice dentists who moved during 2000-2019 tended to be younger and work part-time. Given that only two-tenths of the final sample of dentists moved and nearly three-quarters of those movers remained within the same urbanicity, the initial practice location may play an important role in geographic distribution of dentists across the state.

Polychlorinated biphenyls (PCBs), a group of persistent and carcinogenic chemicals, have been suspected to contribute to diabetes risk by acting as endocrine disruptors. Despite a ban on the manufacture of PCBs in 1978 in the U.S., people are still exposed to PCBs through contaminated food and air. The goal of this study was to identify the determinants of serum PCBs, and to identify serum PCB congener profiles associated with diabetes. Specific Aim 1 sought to explore the relation between diet and serum concentrations of PCBs among a total of 76 children and their mothers, by assessing dietary exposure through the Dietary History Questionnaire II (DHQII) and measuring all PCB congeners in their serum and in food from where they shop. The analyses were performed by linear mixed models with households included as the random effect. We estimated a 10-fold decrease in dietary exposure to PCBs over the past two decades. We found that higher diet quality with less processed food, presented by Healthy Eating Index (HEI), was associated with higher serum concentrations of PCBs. Data from the National Health and Nutrition Examination Survey (NHANES) was used for Specific Aims 2 and 3. Specific Aim 2 sought to examine the association between dietary intake and serum levels of PCBs, and whether the association was modified by BMI, by utilizing linear regressions. We found that the association between dietary PCBs intake and serum levels of PCB was modified by BMI, with stronger associations in normal/underweight individuals and no statistically significant association in obese individuals. Specific Aim 3 sought to identify serum PCB congener profiles associated with diabetes, by utilizing classification tree and logistic regression methods. We revealed the combined associations of serum PCBs with diabetes., In conclusion, this study provides evidence suggesting that the relationships between diet and serum PCB concentrations can vary in time and by BMI and PCB congeners. It also provides new insights into the combined associations of PCBs with diabetes. The findings of this dissertation support further avenues of research including how serum PCBs are associated with inhalation exposure, PCB sulfate metabolites, and PCBs in adipose tissues. Prospective studies with more detailed diabetes information (e.g., type of diabetes) are also needed to confirm the combined associations of PCBs with diabetes.

Introdução: O conceito de paternidade e parentalidade tem mudado ao longo do tempo, com uma visão mais inclusiva e ativa da figura paterna. No entanto, ainda existem barreiras políticas, sociais e educacionais que limitam o envolvimento dos pais nos cuidados com os filhos, inclusive durante a hospitalização. A participação paterna durante a internação é essencial para o desenvolvimento saudável da criança, e os profissionais de saúde têm um papel fundamental nesse processo. Objetivo: Apresentar um protocolo de revisão de escopo para mapear e descrever os estudos existentes na literatura sobre qual o papel do pai no cuidado ao filho hospitalizado para os profissionais de saúde e familiares Método: Protocolo de scoping review fundamentado pelo Joanna Briggs Institute. Pretende responder à seguinte questão: fundamentada pela estratégia População-Conceito-Contexto (PCC): Quais estudos disponíveis na literatura sobre o papel do pai no cuidado a criança hospitalizada para profissionais de saúde e familiares? Serão incluídos estudos que respondam à pergunta de pesquisa, disponíveis na íntegra, sem delimitação temporal nos idiomas, inglês, português e espanhol. Resultados: A descrição dos achados ocorrerá de forma descritiva, por meio de um quadro, no qual estarão os principais resultados de cada estudo incluído. Considerações finais: Este protocolo norteará o desenvolvimento da revisão de escopo para descrição das evidencias disponíveis acerca do papel do pai no cuidado ao filho hospitalizado para os familiares e profissionais de saúde.

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Funder: Infectious Diseases Institute, Makerere University, Funder: John Hopkins University, INTRODUCTION: The evaluation of the patterns of liver injury, derived from liver chemistry panels, often may narrow on probable causes of the liver insult especially when coupled with clinical history, examination, and other diagnostic tests. METHODS: Among people living with and without HIV and attending care, we used the R ratio to evaluate for liver injury patterns. Liver injury patterns were defined as cholestatic (R < 2), mixed (R = 2-5), and hepatocellular (R > 5). RESULTS: Overall, the proportions of participants with cholestatic liver injury, mixed liver injury, and hepatocellular liver injury were 55%, 34%, and 4%, respectively, with similar distribution when stratified by HIV status. Alcohol use among participants without HIV was associated with all patterns of liver injury (cholestatic liver injury (OR = 4.9 CI (1.0-24.2); p = 0.054), mixed liver injury (OR = 5.3 CI (1.1-27.3); p = 0.043), and hepatocellular liver injury (OR = 13.2 CI (1.0-167.3); p = 0.046)). Increasing age was associated with cholestatic liver injury among participants with HIV (OR = 2.3 CI (1.0-5.3); p = 0.038). Despite a high hepatitis B prevalence among participants with HIV, there was no association with liver injury. CONCLUSIONS: Liver injury is prevalent among both people living with and without HIV in care, and cholestatic liver injury is the most common pattern. Alcohol is associated with all patterns of liver injury and increasing age associated with cholestatic liver injury among people living without HIV and people living with HIV, respectively.

Following the 2011 Arab Spring, autocrats have sought to limit citizens’ ability to publicize offline protests over social media. In this article, we explore how users adjust to these restrictions. To do so, we analyse 33 million tweets sent from Egypt during the “Day of Anger” protests in September 2020. We find evidence of online tactical evasion in a highly repressive context. Compared to neutral users, regime opponents are more likely to issue calls for offline protests using new or dedicated accounts that contain no personal information. Users are also more likely to delete tweets calling for mobilization ex-post in a bid to conceal their activism. We find weaker evidence suggesting that regime opponents try to evade laws targeting critical accounts with over 5000 followers. The findings illustrate how activists in autocracies use social media to mobilize street-level contention while attempting to mitigate the risk of state repression.

Background Water fluoridation was introduced in the UK against a background of high dental decay within the population. Levels of decay have dramatically reduced over the last 40 years following widespread use of fluoride toothpaste. Objective The aim of the CATFISH (Cumbrian Assessment of Teeth a Fluoride Intervention Study for Health) study was to address the question of whether or not the addition of fluoride to community drinking water, in a contemporary population, lead to a reduction in the number of children with caries and, if so, is this reduction cost-effective? Design A longitudinal prospective cohort design was used in two distinct recruited populations: (1) a birth cohort to assess systemic and topical effects of water fluoridation and (2) an older school cohort to assess the topical effects of drinking fluoridated water. Setting The study was conducted in Cumbria, UK. Broadly, the intervention group (i.e. individuals receiving fluoridated drinking water) were from the west of Cumbria and the control group were from the east of Cumbria. Participants Children who were lifetime residents of Cumbria were recruited. For the birth cohort, children were recruited at birth (2014–15), and followed until age 5 years. For the older school cohort, children were recruited at age 5 years (2013–14) and followed until the age of 11 years. Intervention The provision of a ‘reintroduced fluoridated water scheme’. Main outcome measures The primary outcome measure was the presence or absence of decay into dentine in the primary teeth (birth cohort) and permanent teeth (older school cohort). The cost per quality-adjusted life-year was also assessed. Results In the birth cohort (n = 1444), 17.4% of children in the intervention group had decay into dentine, compared with 21.4% of children in the control group. The evidence, after adjusting for deprivation, age and sex, with an adjusted odds ratio of 0.74 (95% confidence interval 0.56 to 0.98), suggested that water fluoridation was likely to have a modest beneficial effect. There was insufficient evidence of difference in the presence of decay in children in the older school cohort (n = 1192), with 19.1% of children in the intervention group having decay into dentine, compared with 21.9% of children in the control group (adjusted odds ratio 0.80, 95% confidence interval 0.58 to 1.09). The intervention was found to be likely to be cost-effective for both the birth cohort and the older school cohort at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. There was no significant difference in the performance of water fluoridation on caries experience across deprivation quintiles. Conclusions The prevalence of caries and the impact of water fluoridation was much smaller than previous studies have reported. The intervention was effective in the birth cohort group; however, the importance of the modest absolute reduction in caries (into dentine) needs to be considered against the use of other dental caries preventative measures. Longer-term follow-up will be required to fully understand the balance of benefits and potential risks (e.g. fluorosis) of water fluoridation in contemporary low-caries populations. Limitations The low response rates to the questionnaires reduced their value for generalisations. The observed numbers of children with decay and the postulated differences between the groups were far smaller than anticipated and, consequently, the power of the study was affected (i.e. increasing the uncertainty indicated in the confidence intervals). Study registration This study is registered as Integrated Research Application System 131824 and 149278. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.

Enhancing wellbeing in educational settings is a challenging endeavour as wellbeing education is inherently complex. This interdisciplinary conceptual paper aims to bridge the gap between psychological interventions and educational contexts by adopting a complexity lens to consider the puzzle of wellbeing in educational settings. We draw on the fields of positive psychology, educational theory, complexity thinking, and indigenous worldviews to conceptualise wellbeing education and illustrate the need to weave approaches together. Embracing a complexity lens, we offer ways of prompting emergent wellbeing change: incorporating diverse perspectives, trialling nudges, and attending to interactions across the system. We argue that complexity-informed approaches to wellbeing education have the potential to create emergent change in and across complex educational systems.

Background Community pharmacists are highly accessible for advice, as most pharmacies are open long hours and no appointment is needed. Community pharmacists, as essential community health workers, play a critical role in the fight against coronavirus disease 2019 (COVID-19). This study aimed to determine the general wellbeing and work impacts of pharmacists and the factors important for adaptability and resilience during the COVID-19 pandemic. Methods This study adopted a cross-sectional design. Community pharmacists from various professional networks in Australia were invited through emails and social media posts to complete an anonymous online survey during the second wave of the COVID-19 pandemic in Victoria, Australia. Results Sixty-five community pharmacists completed the online survey. The respondents reported fair levels of general wellbeing during the COVID-19 pandemic, with a mean self-related health score of 33.57 (s.d. = 13.19) out of a maximal of 96, despite relatively high levels of job stress and emotional labour. Lower levels of general wellbeing were correlated with higher levels of job stress (r = 0.645, P

Nursing students' knowledge deficits, lack of experience, personal biases, and anxiety can ultimately create vulnerability, avoidance, and discriminatory behaviours toward people experiencing a mental health disruption. Nursing students express the need for more innovative educational opportunities to refine skills and enhance knowledge specific to suicidal identification and risk assessment. Virtual simulation has increased significantly within healthcare education to supplement, enhance, and support learning since the beginning of the COVID-19 pandemic. A virtual simulation education module focused on suicidal ideation and assessment of risk was designed and implemented to strengthen the learning, preparedness, and confidence of nursing students providing care in a mental health setting. The purpose of this study is to explore the perceived effectiveness of a suicidal ideation – assessment of risk virtual simulation module for undergraduate nursing students. The sample consisted of third-year nursing students enrolled in a mental health in nursing course from Ottawa, Ontario (N = 130). The research design is a mixed methods explanatory sequential design whereby the dominant data resides in the quantitative portion of the research study. The research study was divided into Phase I, referred to as the quantitative portion, and Phase II, referred to as the qualitative portion. In Phase I, the effectiveness of the virtual simulation focused on suicidal ideation and assessment of risk and were measured using the Simulation Effectiveness Tool-Modified (SET-M). The SET-M is a 19-item quantitative Likert scale tool used to measure the effectiveness of a simulation and its components after its completion. In Phase II, semi-structured interviews were the primary method for qualitative data collection to provide greater insight into Phase I of the research study. The quantitative findings demonstrated a simulation experience that was supportive of the nursing students’ learning, specifically in relation to nursing skills and assessments, problem- solving, clinical decision-making, and communication skills. The quantitative results demonstrated the importance of structure and guidance to achieve the desired outcomes of the simulation. Thematic analysis of the semi-structured interviews revealed that the virtual simulation on suicidal ideation and assessment of risk was associated with increases in learning, preparedness, confidence, knowledge, critical reflection, and a decrease in anxiety regarding suicide ideation and assessment of risk. The virtual simulation module on suicidal ideation and assessment of risk reinforces the need for various educational modalities to engage and increase the preparedness of nursing students entering clinical placement.

Paper highlightsthe need to create a safe structured space for foundation doctors to discuss topics like DNACPR - in particular the legal and ethical elements.&nbsp

The COVID-19 pandemic has brought challenges in all spheres of society, which have included significant changes in teachers' work environments, bringing additional individual and family psycho-emotional factors. The study aimed to identify stressors and describe the challenges faced by nursing faculty at two Brazilian higher education institutions during the COVID-19 pandemic. This is a descriptive, cross-sectional study with a qualitative approach; data collection occurred in the state of Rio de Janeiro, and was carried out in two higher education institutions. The study population consisted of 41 teachers. The sample corresponded to the professors who answered the online questionnaire, 20 from a public institution and 12 from a private institution. It was identified that the majority were female (75%). The analyses were performed with the IRAMUTEQ® software using the Analysis of Similitude and the Word Cloud. Two categories were found: "The fears experienced by teachers in the COVID-19 pandemic" and "Challenges in adapting teachers to the pandemic period." The results indicated that the demands attributed by remote teaching overloaded the teachers due to the need for the work to have been considerably increased and the mixed character of the work and home environment to be associated. It is believed that the present study reflects contributions to the scientific and academic community, while enabling a better understanding of teacher coping with the pandemic period, aiming at future analyses and interventions of other public health emergencies to protect the psychoemotional and social balance of teachers.

The COVID-19 pandemic has led to greater societal divides based on alignment with vaccine mandates and social distancing requirements. This paper briefly lays out the experiences of individuals in Aotearoa New Zealand related to public health messaging.Adults in Aotearoa New Zealand participated in a mixed-methods study involving a survey (n=1,010 analysed results) and then semi-structured interviews with a subset of surveyed participants (38 participants). Results were thematically analysed.Participants highlighted two key areas related to public health messaging, these related to message consistency and the impact of messaging on wellbeing. Conclusions and public health implications: As the COVID-19 pandemic continues and further disrupts health service delivery and normal societal functioning, forward planning is needed to deliver more targeted messaging.

In 2019, the COVID-19 Pandemic emerged as a significant worldwide health issue, bringing with it some urgent concerns. Hospitalizations, the requirement for life support systems, and COVID-19 disease mortality rates were all high globally [1]. It also meant an increased amount of work required by healthcare workers. Nurses who continued to provide care over extended shifts while using inadequate protective equipment were negatively impacted during this time due to the uncertainties brought on by the pandemic [2-4]. Studies show that nurses had a high level of stress, anxiety, depression, burnout, and PTSD symptoms early in the COVID-19 Pandemic [5-9]. In the later stages of the pandemic, on the other hand, they experienced mental health symptoms. A study conducted in Italy showed that nurses diagnosed with sleep disorders suffered from reduced self-efficacy during the later stages of the COVID-19 Pandemic [10]. The findings demonstrate that the pandemic has detrimental impacts on nurses' mental health as it has on society, politics, and the economy. Overall health and quality of life are strongly influenced by mental health. In addition to being free from mental illnesses and issues, having coping mechanisms, feeling secure, and maintaining a sense of balance are also considered indicators of good mental health. The intricate interaction between social and psychological elements that protect mental health and the risk factors that imperil it is the foundation of mental health. Nurses have been exposed to various risk factors during the COVID-19 Pandemic process. Social support and lack of resources might further compound the psychological effects of exposure to risk variables [4, 11]. According to the literature, the COVID-19 Pandemic negatively impacts nurses' mental health and well-being and cost-efficient, simple, quick, easy-to-apply, and successful interventional studies considering the pandemic circumstances must therefore be planned [12-23]. Health authorities, professional organizations, and universities have vital roles in preserving the mental health of nurses, providing the care and counseling they require, and coordinating resources and opportunities. Interventional studies with a high level of evidence carried out under pandemic circumstances provide valuable theoretical information resources for nurses. Thus, nurses will be able to take advantage of preventive interventions with successful outcomes in any endemics and pandemics in the future. This systematic review aims to investigate the interventional studies conducted to support nurses' mental health during the COVID-19 Pandemic and to discuss what kind of studies and plans are needed in this area. Systematic review question: • What are the interventional studies to protect and improve the mental health of nurses during the COVID-19 Pandemic?

Background Verinurad is a human uric acid (UA) transporter (URAT1) inhibitor known to decrease serum UA (sUA) levels and that may reduce albuminuria. In a Phase 2a study (NCT03118739), treatment with verinurad + febuxostat lowered urine albumin-to-creatinine ratio (UACR) at 12 weeks by 39% (90% confidence interval 4–62%) among patients with Type 2 diabetes mellitus, hyperuricaemia and albuminuria. The Phase 2b, randomized, placebo-controlled Study of verinurAd and alloPurinol in Patients with cHronic kIdney disease and hyperuRicaEmia (SAPPHIRE; NCT03990363) will examine the effect of verinurad + allopurinol on albuminuria and estimated glomerular filtration rate (eGFR) slope among patients with chronic kidney disease (CKD) and hyperuricaemia. Methods Adults (≥18 years of age) with CKD, eGFR ≥25 mL/min/1.73 m2, UACR 30–5000 mg/g and sUA ≥6.0 mg/dL will be enrolled. Approximately 725 patients will be randomized 1:1:1:1:1 to 12, 7.5 or 3 mg verinurad + allopurinol, allopurinol or placebo. An 8-week dose-titration period will precede a 12-month treatment period; verinurad dose will be increased to 24 mg at Month 9 in a subset of patients in the 3 mg verinurad + allopurinol arm. The primary efficacy endpoint the is change from baseline in UACR at 6 months. Secondary efficacy endpoints include changes in UACR, eGFR and sUA from baseline at 6 and 12 months. Conclusions This study will assess the combined clinical effect of verinurad + allopurinol on kidney function in patients with CKD, hyperuricaemia and albuminuria, and whether this combination confers renoprotection beyond standard-of-care.

Objectives: To perform a multi-institutional investigation of incidence and outcomes of urethral trauma sustained during attempted catheterization. Patients & Methods: A prospective, multi-center study was conducted over a designated 3-4month period, incorporating seven academic hospitals across the UK and Ireland. Cases of urethral trauma arising from attempted catheterization were recorded. Variables included sites of injury, management strategies and short-term clinical outcomes. The catheterization injury rate was calculated based on the estimated total number of catheterizations occurring in each center per month. Anonymised data were collated, evaluated and described. Results: Sixty-six urethral catheterization injuries were identified (7 centers; mean 3.43months). The mean injury rate was 6.2±3.8 per 1000 catheterizations (3.18–14.42/1000). All injured patients were male, mean age 76.1±13.1years. Urethral catheterization injuries occurred in multiple hospital/community settings, most commonly Emergency Departments (36%) and medical/surgical wards (30%). Urological intervention was required in 94.7% (54/57), with suprapubic catheterization required in 12.3% (n=7). More than half of patients (55.56%) were discharged with an urethral catheter, fully or partially attributable to the urethral catheter injury. At least one further healthcare encounter on account of the injury was required for 90% of patients post-discharge. Conclusions: This is the largest study of its kind and confirms that iatrogenic urethral trauma is a recurring medical error seen universally across institutions, healthcare systems and countries. In addition, urethral catheter injury results in significant patient morbidity with a substantial financial burden to healthcare services. Future innovation to improve the safety of urinary catheterization is warranted.

Aim: The aim of this study was to design, deliver and evaluate an interprofessional education programme for healthcare professionals on how to implement a modified version of the safe recovery programme to prevent falls in hospitalized patients. Design: Mixed methods design incorporating pre- and post education surveys and individual semi-structured interviews. Methods: Thirty-four health professional participants attended a 1-h face-to-face or Zoom® interprofessional education session to learn how to deliver an evidence-based patient falls prevention education strategy, the modified Safe Recovery Programme. Results: A 1-hour education session was insufficient to build full confidence to deliver the Safe Recovery Programme. There was no statistically significant change in participant views on interprofessional collaboration. Participants recommended prior consultation and preparation before delivery of IPE, with additional opportunities for discussion and feedback during implementation with patients. The findings highlight the importance of interprofessional education for evidence-based interventions in hospitals. Health professionals value education that is timely, interactive, realistic and engaging.

The continuous development in telecommunication tech­nologies has created opportunities for health professionals to optimise healthcare delivery by adopting digital tools into rehabilitation programs (i.e., telerehabilitation). These tech­nological advances, along with the demographic and social characteristics of each country, have made the implementa­tion of telerehabilitation a disparate process across regions. We have gathered the experience of four countries (Australia, Chile, Brazil, and Colombia) in two different regions (Ocea­nia and South America) to recompile the history pre- and post-Covid-19 outbreak until January of 2021, the barriers to, and facilitators of telerehabilitation, and outline the future challenges for these countries.

Adult day services (ADS) are one of the more popular long-term care options for racial and ethnic minority older Americans. Focusing on minority older adults, this study aims to (a) identify both the individual and structural/organizational levels factors associated with ADS use and to (b) examine ADS’ effect on health and well-being. Using the integrative review approach of Whittemore and Knafl, we found 14 studies published between 2010 to 2021. Findings concluded that individual-level needs and enabling factors were associated with ADS use and outcomes among minority older adults centered mostly on quality of life. Organizational/structural characteristics of ADS were never empirically examined in relation to service use or health outcomes. Future research should move beyond the individual level to identify and address the impact of the institutional structure, culture and practice on access, quality, and use.

Electrically conductive bio-scaffolds are explored in the field of tissue engineering (TE) as a solution to address the clinical need of electroactive tissues, finding applications in nervous, cardiac, and spinal cord injury repair. In this work, we synthesise polypyrrole nanoparticles (PPy NP) via the mini-emulsion method with further combination with a gelatin/hyaluronic acid (HA) hydrogel to create electroconductive Gel:HA:PPy-NP TE scaffolds. Electroconductive Gel:HA:PPy-NP scaffolds possess excellent mechanical properties at 1.08 ± 0.26 MPa, closely matching the reported mechanical performance of the spinal cord. Scaffolds were designed with controlled porosity of 526.2 ± 74.6–403.9 ± 57.4 µm, and conductivities of 4.3 × 10–6 ± 1.1 × 10–6 S.cm−1 were reached. Rheological studies show that prior to lyophilisation, the Gel:HA:PPy-NP hydrogels display a shear-thinning behaviour. These gels were subsequently 3D printed into predefined 2 layer lattice geometries and displayed excellent post-printing shape fidelity. In vitro studies show that the Gel:HA:PPy-NP scaffolds are cytocompatible with mesenchymal stem cells and neuronal stem cells and display encouraging cell attachment and proliferation profiles. Based on these results, the incorporation of PPy NPs into Gel:HA biomaterial scaffolds enhances the conductive capabilities of the material, while showcasing biocompatible behaviour with cell cultures. Hence, Gel:HA:PPy-NP scaffolds are a promising TE option for stimulating regeneration following nervous tissue injury.

Background Clinically, neck pain disorders (NPD) and non-specific low back pain (NS-LBP) are respectively the fourth and first most common conditions associated with the greatest number of years lived with disability. Remote delivery of care may benefit healthcare sustainability, reduce environmental pollution, and free up space for those requiring care non-virtual care. Methods A retrospective analysis was performed on 82 participants with NS-LBP and/or NPD who received exercise therapy delivered solely in the metaverse using virtually reality. The study was to determine if this was achievable, safe, had appropriate outcome measures that could be collected, and if there was any early evidence of beneficial effects. Results The study demonstrated that virtual reality treatment delivered via the metaverse appears to be safe (no adverse events or side effects). Data for more than 40 outcome measures were collected. Disability from NS-LBP was significantly reduced (Modified Oswestry Low Back Pain Disability Index) by 17.8% (p p = 0.02). Conclusions The data suggest that this method of providing exercise therapy was feasible, and safe (no adverse events reported), that complete reports were obtained from a large selection of patients, and that software acquired outcomes were obtainable over a range of time points. Further prospective research is necessary to better understand our clinical findings.

[Português] Introdução: A linha de pesquisa Recriar-se: arte, lúdico e educação para a saúde, pertencente ao Núcleo de Estudos em Educação e Promoção da Saúde (Recriar-se/NESPROM/CEAM/UnB), dedica-se à produção de tecnologias lúdico-educativas voltadas para estudantes, profissionais de políticas públicas e interessados nas questões de gênero em geral, desde 2010. Dentre os jogos produzidos estão os de tabuleiro (IN)DICA-SUS (2011), BANFISA (2011), VIOLETAS (2016), VIOLETAS 2ed (2019) e o jogo de cartas VIDAS VIOLETAS (2020), lançado recentemente. Concebidos a partir da metodologia Recriar-se Lúdico, método desenvolvido ao longo de 12 anos de pesquisas especializadas, esses jogos estão disponíveis para aquisição do público interessado. Haja vista o estágio atual de consolidação da linha de pesquisa e a necessidade de aprimoramento constante das investigações, este estudo objetiva: identificar a quantidade de cada um dos jogos adquiridos ao longo dos 12 anos da linha Recriar-se; caracterizar o perfil das/os adquirentes dos Jogos (IN)DICA-SUS, BANFISA e VIOLETAS; identificar as potencialidades desses jogos para práticas educativas; construir um banco de dados com informações dos interessados para subsidiar o aperfeiçoamento dos produtos Recriar-se. Metodologia: Pesquisa exploratória, quantitativa e qualitativa, com aplicação de questionário e análise de conteúdo. Fez-se um levantamento comparativo do percentual de jogos adquiridos no período de 2010 a 2022, por tipo de jogo. Em seguida, um questionário on-line foi aplicado aos 104 adquirentes, com 17 respondentes, o que permitiu traçar um perfil preliminar do público-alvo interessado pelos produtos da linha de pesquisa Recriar-se, bem como avaliar a potencialidade de tecnologias lúdico-educativas produzidas no período. Resultados/Discussão: o perfil das/os adquirentes é composto majoritariamente por mulheres (n=15; 88%), na faixa etária entre 24-31 anos (n=6; 35%), que cursaram pós-graduação (n=13; 76%) e trabalham como docentes (n=7; 41%), vinculadas a instituições de ensino de diversos níveis. O jogo preferido foi o (IN)DICA-SUS, por ser considerado mais “educativo”. Dentre os cenários de utilização, as/os participantes referiram utilizá-los em sala de aula e oficinas pedagógicas. Com relação à aplicação dos jogos, prevaleceu o público-alvo das/os estudantes de graduação da área da saúde. A avaliação dos produtos Recriar-se foi positiva dentre todas/os adquirentes e a principal sugestão foi a necessidade de atualização de cartelas do jogo (IN)DICA-SUS e BANFISA. Considerações finais: A investigação oportunizou a identificação de um perfil preliminar, das preferências e da avaliação dos jogos pelas/os adquirentes, subsidiando o constante aperfeiçoamento das pesquisas da Linha Recriar-se/NESPROM/CEAM. Constatou-se adequabilidade entre a concepção dos jogos produzidos e sua potencialidade como ambiência lúdico-educativa para reflexões críticas. [English] Introduction: The research line Recriar-se: arte, lúdico e educação para a saúde, belonging to the Center for Studies in Education and Health Promotion (Recriar-se/NESPROM/CEAM/UnB), is dedicated to the production of ludic-educational technologies aimed at students, public policy professionals and those interested in gender issues in general, since 2010. Among the games produced are the board games (IN)DICA-SUS (2011), BANFISA (2011), VIOLETAS (2016), VIOLETAS 2ed (2019) and the card game VIDAS VIOLETAS (2020), recently released. Designed through the Recriar-se Lúdico (Ludic Recreate) methodology, a method developed over 12 years of specialized research, these games are available for acquisition by the interested public. Given the current stage of consolidation of the research line and the need for constant improvement of investigations, this study aims to: identify the amount of each of the games acquired over the 12 years of the Recriar-se line; characterize the profile of the purchasers of the games (IN)DICA-SUS, BANFISA and VIOLETAS; identify the potential of these games for educational practices; build a database with information about the interested public to support the improvement of Recriar-se products. Methodology: Exploratory, quantitative and qualitative research, with the application of questionnaires and content analysis. We carried out a comparative survey of the percentage of games purchased between 2010 and 2022, by type of game. Then, an online questionnaire was applied to the 104 purchasers, with 17 respondents, which enabled us to draw a preliminary profile of the target audience interested in the products of the Recriar-se research line, as well as to evaluate the potential of ludic-educational technologies produced in that period. Results/Discussion: the profile of the purchasers consists mostly of women (n=15; 88%), with age between 24-31 years (n=6; 35%), who attended graduate school (n=13; 76%) and work as teachers (n=7; 41%), linked to educational institutions of various levels. The preferred game was (IN)DICA-SUS, because it is considered more “educational”. Among the scenarios of use, the participants reported using them in classes and pedagogical workshops. Regarding the application of the games, the target audience of undergraduate health students prevailed. The evaluation of Recriar-se products was positive among all purchasers and the main suggestion was the need to update the game cards for (IN)DICA-SUS and BANFISA. Final considerations: The investigation enabled the identification of a preliminary profile, preferences and evaluation of games by purchasers, supporting the constant improvement of the Recriar-se/NESPROM/CEAM research line. Adequacy was found between the conception of the games produced and their potentiality as a ludic-educational environment for critical reflections. [Español] Introducción: La línea de investigación Recriar-se: arte, juego y educación para la salud, perteneciente al Centro de Estudios en Educación y Promoción de la Salud (Recriar-se/NESPROM/CEAM/UnB), se dedica a la producción de tecnologías lúdico-educativas dirigidas a estudiantes, profesionales de políticas públicas e interesados en temas de género en general, desde 2010. Entre los juegos producidos se encuentran los juegos de mesa (IN)DICA-SUS (2011), BANFISA (2011), VIOLETAS (2016), VIOLETAS 2ed (2019) y el juego de cartas VIDAS VIOLETAS (2020), de reciente lanzamiento. Concebidos a partir de la metodología de la Recreación Lúdica, método desarrollado a lo largo de 12 años de investigación especializada, estos juegos están disponibles para su adquisición por el público interesado. Considerando la etapa actual de consolidación de la línea de investigación y la necesidad de perfeccionamiento constante de las investigaciones, este estudio tiene como objetivos: identificar la cantidad de cada uno de los juegos adquiridos a lo largo de los 12 años de la línea Recriar-se; caracterizar el perfil de los compradores de los juegos (IN)DICA-SUS, BANFISA y VIOLETAS; identificar el potencial de estos juegos para las prácticas educativas; construir una base de datos con informaciones de los interesados para apoyar el perfeccionamiento de los productos Recriar-se. Metodología: Investigación exploratoria, cuantitativa y cualitativa, con aplicación de cuestionario y análisis de contenido. Se realizó un estudio comparativo del porcentaje de juegos adquiridos en el período de 2010 a 2022, por tipo de juego. A continuación, se aplicó un cuestionario online a 104 compradores, con 17 encuestados, que permitió trazar un perfil preliminar del público objetivo interesado por los productos de la línea de investigación Recriar-se, así como evaluar la potencialidad de las tecnologías lúdico-educativas producidas en el período. Resultados/Discusión: el perfil de los adquirentes está compuesto principalmente por mujeres (n=15; 88%), de edades comprendidas entre los 24 y los 31 años (n=6; 35%), que cursaron estudios de posgrado (n=13; 76%) y trabajaron como docentes (n=7; 41%), vinculadas a instituciones de enseñanza de diversos ámbitos. El juego preferido fue el (IN)DICA-SUS, por considerarlo más "educativo". Entre los escenarios de uso, los participantes informaron haberlos utilizado en el aula y en talleres pedagógicos. En cuanto a la aplicación de los juegos, prevaleció el público objetivo de estudiantes universitarios de salud. La evaluación de los productos Recriar-se fue positiva entre todos/os los adquirentes y la principal sugerencia fue la necesidad de actualización de las cartelas de los juegos (IN)DICA-SUS y BANFISA. Consideraciones finales: La investigación permitió identificar un perfil preliminar, las preferencias y la evaluación de los juegos por los compradores, subsidiando el constante perfeccionamiento de la investigación de la línea Recriar-se/NESPROM/CEAM. Fue constatada la adecuación entre la concepción de los juegos producidos y su potencialidad como ambiente lúdico-educativo para reflexiones críticas., Revista do CEAM, 9, 2023.

[Português] O presente estudo tem como objetivo questionar a história oficial da enfermagem, analisando a perspectiva de gênero e raça na origem do cuidado atrelado às práticas das mulheres curandeiras. A pesquisa é um estudo teórico com revisão de literatura. Como resultado, elaborou-se um quadro referencial com questões norteadoras para análise da abordagem dos saberes ancestrais do cuidado em saúde na enfermagem, sob a perspectiva de gênero e raça. A revisão de literatura evidenciou a marginalização dos saberes das curandeiras ao longo da história da enfermagem no Brasil, desde a profissionalização da medicina, com a discriminação das artes de curar até a profissionalização da enfermagem, com a produção da “Enfermeira Padrão” – símbolo que reedita desigualdades de gênero, raça e classe na profissão, acriticamente. [English] The present study aims to question the official history of nursing, analyzing the gender and race perspective in the origin of care tied to the practices of women healers. The research is a theoretical study with a literature review. As a result, a referential framework with guiding questions was elaborated to analyze the approach of ancestral knowledge of health care in nursing, from the perspective of gender and race. The literature review evidenced the marginalization of healers' knowledge throughout the history of nursing in Brazil, from the professionalization of medicine, with the discrimination of healing arts, to the professionalization of nursing, with the production of the "Standard Nurse" - a symbol that uncritically reedits gender, race, and class inequalities in the profession. [Español] Este estudio pretende cuestionar la historia oficial de la enfermería, analizando la perspectiva de género y raza en el origen de los cuidados vinculados a las prácticas de las mujeres curanderas. La investigación es un estudio teórico con revisión bibliográfica. Como resultado, se desarrolló un marco referencial con preguntas orientadoras para analizar el abordaje de los saberes ancestrales del cuidado de la salud en enfermería, desde la perspectiva de género y raza. La revisión bibliográfica evidenció la marginalización de los saberes de los curanderos a lo largo de la historia de la enfermería en Brasil, desde la profesionalización de la medicina, con la discriminación de las artes curativas, hasta la profesionalización de la enfermería, con la producción de la "Enfermera Estándar" - símbolo que reedita acríticamente las desigualdades de género, raza y clase en la profesión., Revista do CEAM, 9, 2023.

Introduction: university studies are spaces for the new professional, in health sciences, the dynamics of the Nursing career can distance the student from healthy lifestyles, which encourages research to generate corrective measures. Objective: to describe the lifestyles of nursing students. Method: it is of a documentary type, a search was made related to lifestyles in nursing students in articles, theses and books in Google Scholar, SciELO, Redalyc and Latindex, with keywords such as "lifestyles", "Students", "Nursing" from the year 2017 to 2022. Results: the studies reveal the interest in investigating the theme of lifestyles of the nursing student, The works demonstrate the reality of the lifestyles of nursing students, studies indicate that the curricular luxuriance of the career interferes with students' time. Conclusions: it is necessary to continue searching for alternatives aimed at modifying and improving the quality of life of the nursing student, encouraging the faculties of health sciences to carry out diagnostic, descriptive and experimental studies related to the lifestyles of nursing students. Nursing career tending to carry out the respective orientations to this professional future.

Appointment keeping and self-report within 7-day or and 30-days recall periods are non-objective measures of antiretroviral treatment (ART) adherence. We assessed incidence of virological failure (VF), predictive performance and associations of these adherence measures with VF among adults on long-term ART. Data for persons initiated on ART between April 2004 and April 2005, enrolled in a long-term ART cohort at 10-years on ART (baseline) and followed until December 2021 was analyzed. VF was defined as two consecutives viral loads ≥1000 copies/ml at least within 3-months after enhanced adherence counselling. We estimated VF incidence using Kaplan-Meier and Cox-proportional hazards regression for associations between each adherence measure (analyzed as time-dependent annual values) and VF. The predictive performance of appointment keeping and self-reporting for identifying VF was assessed using receiver operating characteristic curves and reported as area under the curve (AUC). We included 900 of 1,000 participants without VF at baseline: median age was 47 years (Interquartile range: 41-51), 60% were women and 88% were virally suppressed. ART adherence was ≥95% for all three adherence measures. Twenty-one VF cases were observed with an incidence rate of 4.37 per 1000 person-years and incidence risk of 2.4% (95% CI: 1.6%-3.7%) over the 5-years of follow-up. Only 30-day self-report measure was associated with lower risk of VF, adjusted hazard ratio (aHR)=0.14, 95% CI:0.05–0.37). Baseline CD4 count ≥200cells/ml was associated with lower VF for all adherence measures. The 30-day self-report measure demonstrated the highest predictive performance for VF (AUC=0.751) compared to appointment keeping (AUC=0.674), and 7-day self-report (AUC=0.687). The incidence of virological failure in this study cohort was low. Whilst 30-day self-report was predictive, appointment keeping and 7-day self-reported adherence measures had low predictive performance in identifying VF. Viral load monitoring remains the gold standard for adherence monitoring and confirming HIV treatment response.

RNA viruses are abundant, highly diverse, and infect all or most eukaryotic organisms. However, only a tiny fraction of the number and diversity of RNA virus species have been catalogued. To cost effectively expand the diversity of known RNA virus sequences we mined publicly available transcriptomic datasets. We developed 77 family-level Hidden Markov Model profiles for the viral RNA dependent RNA polymerase – the only universal “hall-mark” gene of RNA viruses. By using these to search the NCBI Transcriptome Shotgun Assembly database, we identified 5,867 contigs encoding RNA virus RdRps or fragments thereof and analysed their diversity, taxonomic classification, phylogeny and host associations. Our study expands the known diversity of RNA viruses, and the 77 curated RdRp pHMMs provide a useful resource for the virus discovery community.

Background: We previously determined a nonlinear relationship between connexin 43 (Cx43) function and craniofacial phenotypic variation in the mutant mouse model G60S/+, and that this variation was driven by nasal bone deviation. While nonlinearities in the genotype-phenotype map appear to be common, few studies have looked at the developmental processes that underlie this nonlinearity. Here, we investigated the potential tissue-level developmental determinants of the variation in nasal bone phenotype in G60S/+ mice through postnatal development. Results: The deviated nasal bone phenotype arises by postnatal day 21 and becomes more severe by 3 months in G60S/+ mice. Measures of nasal bone remodeling including the number of osteoclasts, mineralizing surface, mineral apposition rate, and bone formation rate are significantly greater in G60S/+ mice compared to wild-type mice at 2 months, but these differences do not correspond with nasal bone deviation. The degree of nasal bone deviation does significantly and negatively correlate with the ratio between nasal bone and cartilaginous nasal septum length. Conclusions: Our findings indicate that the mean phenotypic changes observed between G60S/+ and wild-type mice are due to reduced bone growth, but the increased phenotypic variation found within mutant mice is due to discordant growth between nasal cartilage and bone.

Nowadays, cancer is one of the leading causes of death worldwide. Ongoing research proves the complexity of improving its prevention and treatment. The dissertation focuses on genetic testing, biomedical research, pharmacogenetics: how they are being implemented, how their potential can be ethically advanced and what legal challenges may arise. An in-depth literature review is conducted to analyse the technical, ethical and regulatory aspects around innovations for cancer prevention and treatment and intertwine them. Next generation sequencing technologies favour early diagnosis for some types of cancer, such as the BRCA positive ovarian and breast cancer. However, genetic testing gives rise to challenges related to incidental findings, storage of data in biobanks, gene patenting, privacy, and public health among others. Ethical and legal issues concerning biomedical research are discussed, with a focus on experimental care as well as questions on permissibility concerning cancer research conducted on animals, and the case of the Oncomouse. Breakthrough innovations in personalized medicine such as gene therapy are also considered from an ethical and legal point of view, with respect to global justice and human dignity. Inarguably, technology evolves at a faster pace than legislation; and the implementation of new therapies need to be done in an equitable way to ensure a just, safe and ethical advancement of care. The set of these elements around cancer prevention and treatment encompasses a shift in the relationship between healthcare practitioner and patient; a need for genetic counsellors; trustworthiness of the healthcare system and trust from patients in order to find an equilibrium between autonomy and paternalism to ensure optimal decision-making. To enforce quality standards in the development of novel solutions for cancer prevention and treatment in the clinical setting, appropriate legislation must accompany and protect the individual, society, and the human species.

Patient safety is central to modern healthcare; breach of patient safety significantly impacts the health of individuals, societies, and economies (1-3). Patient safety incidents (PSIs) are common in healthcare facilities; roughly ten per cent of hospitalised patients end up with a safety incident (4). When safety incidents happen, patients expect the health care professionals (HCPs) to apologise, express sympathy, brief them on details of the incident, and promise investigation so the incident does not happen again in a process known as open disclosure (OD); unfortunately, OD is not offered to patients voluntarily in many cases. Previous work on the health care culture in Ireland concluded that 55% of hospital staff acknowledged barriers surrounding OD, and 24% of respondents identified fear of litigation as the main barrier (5). Our knowledge of HCPs’ compliance with OD policies and laws in Ireland and Bahrain is limited; hence, it was decided to carry out this literature search to explore this issue. The literature search identified a significant lack of research on OD in Bahrain. In addition, the search identified a lack of information on the degree of engagement of HCPs in the process of OD after the Health Service Executive (HSE) in Ireland introduced its OD guidelines in 2013. This study supports the need for more research on the knowledge, attitudes, and the practice of OD in Ireland and Bahrain. Further research is required to assess the impact of introducing OD on healthcare safety in the two countries.

Vaccines approved for routine childhood immunization are safe and effective but sometimes there are Adverse Events Following Immunization (AEFI) which often result in ill health, various forms of deformities when it is wrongly administered and eventually forfeiture of public trust in immunization programmes. This study examined Nursing Mothers: Adverse Events Following Immunization and its Implication for Counselling. A multistage sampling procedure was used to choose 300 nursing mothers. Data were collected with the aid of a questionnaire and analyzed using means, frequency counts, percentages, Chi-square, and Pearson Product Moment Correlation (PPMC). Results revealed that the mean age of the respondents was 30 years. Pain or swelling at the injection site (85.7%) was the major existing AEFI. The majority (80.7%) of the respondents were highly knowledgeable about AEFI, while 74.0% had negative attitude to the incidence of AEFI. The majority (68.7%) had unfavourable perception on the continuation of immunization for their children after an AEFI. The major counselling services available for nursing mothers were adherence to immunization schedules as advised by health counsellors (Mean= 2.67) and pre-counselling for nursing mothers on AEFI before child immunization (Mean =2.63). Correlation results showed that order of birth (r= 0.12), counselling services (r =0.15); awareness of nursing mothers on immunization (r=0.29) had significant relationships (p, {"references":["Abdulraheem, I., Onajole, A., & Oladipo A. (2011). Reasons for Incomplete Vaccination and Factors for Missed Opportunities among Rural Nigerian Children. Semanticscholar.org/paper/","Aderibigbe, S.A., Osagbemi, G.K., & Bolarinwa, O.A. (2010). Adverse event following immunization in a Nigerian tertiary health institution. American Journal Science and Industrial Resolution, 1(3), 496-499.","Akunuri, S. & Dayal, A. (2016). What do parents think? Knowledge and awareness about newer vaccines: A cross-sectional study in South Indian City. International Journal of Contemporary Pediatrics.","Baghdadi, L. R., Younis A., Al Suwaidan, H.I., Hassounah M.M., & Al Khalifah R. (2021). Impact of Covid-19 pandemic lockdown on routine childhood immunization: A Saudi Nationwide Cross Sectional Study. Frontiers in Pediatrics, 9, 692877. https://doi.org/10.3389/fped.2021.692877","Bardenheier, B., Yusuf, H., Schwartz, B., Gust, D., Barker, L. Rodewald, L. (2014). Are Parental Vaccine Safety Concerns Associated with Receipt of Measles-Mumps-Rubella, Diphtheria and Tetanus Toxoids with Acellular Pertussis, or Hepatitis B Vaccines by Children? Archives Pediatric Adolescent Medicine, Vol.158, 569-575","Bertakis, K.D. & Azari, R. (2011). Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med, 24, 229-39.","Champion, V. L., & Skinner, C. S. (2008). The health belief model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (pp. 45-65). San Francisco: Jossey-Bass.","Constantine, M., Cremance, T., Juru, T.P., Gerald, S., Notion, G.T., Peter, N., & Mufuta, T. (2018). Evaluation of the Adverse Events Following Immunization Surveillance System in Guruve District, Mashonaland Central 2017. The Pan African Medical Journal, 29. doi: 10.11604/pamj.2018.29.233.14550","Elsevier, B.V. (2023). Health Belief Model. Science Direct, Commentary","Ekwueme, O. (2009). Adverse Events Following Immunization: Knowledge and experience of mothers in immunization centres in Enugu State, Nigeria. International Journal of Medicine and Health Development. DOI: 10.4314/JCM.V14|1.44854","Ghebreyesus, T. A. (2021). Even as countries clamour to get their hands on Covid-19 vaccines… World Health Organization. https://www.who.int/director-general/speeches/detail/even-as-countries-clamour-to-get-their-hands-on-covid-19-vaccines","Immunization Advisory Centre. (2015). Adverse Events Following Immunization (AEFI). University of Auckland. Retrieved from http://www.immune.org.nz/adverse-events-following-immunization-aefi.John Pope and Adam Husney, (2020). Importance of Immunization. University of Michigan Health. Michigan Medicine.","Kimmel, S.R. (2012). Vaccine adverse events: separating myth from reality. American Family Physician, 66, 2113-2120.","Leask, J., Kinnersley, P., Jackson, C., Cheater, F., Bedford, H., & Rowles, G. (2012). Communicating with parents about vaccination: A framework for health professionals. BMC Pediatrics, 12, 154. https://doi.org/10.1186/1471-2431-12-154","Maurici, M., Arigliani, M., Dugo, V., Leo, C., Pettinicchino, V., Arigliani, R., & Franco, E. (2019). Empathy in vaccination counselling: A survey on the impact of a three-day residential course. Human Vaccines & Immunotherapeutics, 15(3), 682-688. https://doi.org/10.1080/21645515.2018.1554172","Nnenna, T. B., Davidson, U. N., & Babatunde, O. I. (2013). Mothers' knowledge and perception of Adverse Events Following Immunization in Enugu, South- East, Nigeria. Journal of Vaccines and Vaccination, 4(2), 202.","Ogunyemi, R. A. & Odusanya, O. O. A. (2016). Survey of knowledge and reporting practices of primary healthcare workers on adverse experiences following immunization in Alimosho local government area, Lagos. Nigeria Postgraduate Medicine Journal, 23, 79-85.","Omer, S.B., Salmon, D.A., Orenstein, W.A., deHart, M.P., & Halsey, N. (2014). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981-1988.","Patil, S.P., Tambe, M.P., & Patil, P J. (2015). Effect of immunization counselling skills training in third-year medical students. International Journal of Medical Science Public Health, 4","Sadoh, A.E. & Eregie, C. O. (2017). Continuing barriers to optimum immunization uptake in Nigerian Children: the role of missed immunization opportunities and inappropriately timed immunizations. Nigerian Journal of Paediatrics, 34, 57-61.","Sharma, R. & Bhasin, S. (2008). Routine immunization - Do people know about it? A study among caretakers of children attending pulse polio immunization in East Delhi. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine. https://doi.org/10.4103/0970-0218.39240","Simone, B., et al. (2012). Healthcare workers' role in keeping MMR vaccination uptake high in Europe: A review of evidence. Eurosurveillance, 17(26). WHO. (2013). The guide to tailoring immunization programmes (TIP). Increasing coverage of infant and child vaccination in the WHO European Region.","Shillitoe, R. W. & Christie, M. J. (1989). Determinants of self-care: The health belief model, Holistic Medicine, 4, 3-17.","Tagbo, B.N. & Onwuasigwe, C. (2015). Missed opportunity among children in Enugu. Nigerian Journal of Paediatrics, 32, 73-76.","UNICEF. (2021). Covid-19 pandemic leads to major backsliding on childhood vaccination. https://www.unicef.org.","World Health Organization (2013). Adverse Events Following Immunization","World Health Organization. (2017). World health statistics 2017: Monitoring health for the SDGs, sustainable development goals. https://apps.who.int/iris/handle/10665/255336 (CC BY-NC-SA 3.0 IGO)","World Health Organization. (2018). SAGE issues its 2018 assessment report of the Global Vaccine Action Plan. Immunization, Vaccines and Biologicals. https://www.who.int/immunization/global_vaccine_action_plan/SAGE_GVAP_Assessment_report_2018.pdf","World Health Organization. (2021). Vaccines and Immunization. https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1","Zvanaka, S., Tsitsi, J., Chonzi, P., Shambira, G., Gombe, N.T., & Tshimanga, M. (2017). Evaluation of the Adverse Events Following Immunizations surveillance system in Harare City, Zimbabwe, 2016: A descriptive cross-sectional study. Pan African Medical Journal, 28, 308."]}

INTRODUCTION: Levels of anxiety, stress, panic syndrome, depression, among others, have increased significantly in the general population around the world during the New Coronavirus pandemic (COVID-19). Likewise, the scenario generated by COVID-19 affected the mental health of health professionals, who, surrounded by uncertainties, needed to perform their supportive care while also becoming ill. In this work, we give prominence to the professionals of the Nursing team. OBJECTIVE: This research aims to identify in the scientific literature, the factors that have compromised the mental health of nursing professionals, active in the period of the COVID-19 pandemic. METHODS: This is a descriptive study of integrative review of the literature of a qualitative nature. The following electronic bibliographic bases were consulted for literature research: Latin American Health Sciences Literature (LILACS), Medical Literature and Retrieval System Online (Medline/PubMed), Nursing Database (BDENF), Scientific Electronic Library Online (Scielo) and Virtual Health Library (CidSaúde/BVS). The time clipping was from the year 2020. The first selection of texts was made by reading the titles and abstracts of articles published in full text, in English and Portuguese. Twenty-seven articles were selected, based on the complete reading of the articles. RESULTS: Articles categorized by order of identification: MEDLINE/PUBMED (60- 72.28%); LILACS (23 - 27.72%); BDENF (0 - 0%), Scielo (0 - 0%), CidSaúde/BVS (0 - 0%). The major publications were: the impact of routine on the mental health of nurses, increased working hours, lack of individual protection equipment, uncertainties related to the disease, removal from the family, social isolation and the main strategies that were implemented in the services to minimize psychological effects of professionals. CONCLUSION: Interventions by health organizations are necessary in order to provide psychological and social support, follow-up and daily planning to each member of the Nursing team during and after the COVID-19 pandemic, {"references":["ZERBINI, G. et al. Psychosocial burden of healthcare professionals in times of COVID-19 – a survey conducted at the University Hospital Augsburg. GMS German Medical Science. ISSN 1612-3174. v. 18, 2020.","PRETI, E. et al. The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence. Current Psychiatry Reports. 22:43. 2020. DOI: https://doi.org/10.1007/s11920-020-01166- z.","HOSEINABADI, T.S. et al. Burnout and its influencing factors between frontline nurses and nurses from other wards during the outbreak of Coronavirus Disease (COVID-19). Iran. Invest. Educ. Enferm. v.38, n. 2. :e03, 2020","NASCIMENTO, V.F. et al. Dificuldades e medos dos enfermeiros frente ao Pandemia de COVID-19 no Brasil. Humanidades Médicas. ISSN 1727-8120; v.20 (2): 312-333, 2020","HOU T, Z. et al. Apoio social e saúde mental entre trabalhadores de saúde durante o surto da doença de Coronavírus 2019: modelo de mediação amoderada. PLoS ONE. v.15, n.5 e:0233831, 2020","ALVAREZ, A.K.G. et al. Gestión de seguridad psicológica delpersonalsanitarioensituaciones de emergencia por COVID-19 enel contexto hospitalario o de aislamiento. Revista Cubana de Enfermería., v.36, n.2: e: 3704, 2020","BARBOSA, D.J. et al. Fatores de estresse nos profissionais de enfermagem no combate à pandemia da COVID-19: Síntese de Evidências. Com. Ciências Saúde, v. 31, n.1, p: 31-47, 2020","KANG, L. et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. The Lancet (Correspondence). Published Online February 5, 2020 DOI: https://doi.org/10.1016/ S2215- 0366(20)30047-X"]}

The Irish Paediatric Critical Care Audit (IPCCA) collects personal, organisational, and clinical data on all infants and children with a clinically determined need for paediatric critical care. The audit database is provided by the Paediatric Intensive Care Audit Network (PICANet), which aims to support the continual improvement of paediatric intensive care provision throughout the United Kingdom (UK) and the Republic of Ireland (ROI) by providing detailed information on paediatric intensive care activity and outcomes. The quality of care delivered is measured against the Paediatric Critical Care Society (PCCS) standards, which cover the entire patient pathway from initial referral to paediatric critical care, specialist transport, and inpatient care.

Purpose Meals on Wheels (MOW) support older people to live in their own homes and communities. The purpose of this paper is to explore MOW experiences from a multi-stakeholder level to inform and better equip this valuable service. Design/methodology/approach A qualitative approach was undertaken utilising semi-structured interviews and focus groups with current, former and potential MOW service users and MOW stakeholders. Findings Qualitative analysis explored MOW perspectives and experiences, highlighting a lack of MOW information and awareness, the importance of a client-centred approach the multiple roles of MOW and service transition. Originality/value This research explores MOW from the perspective of different groups directly involved in this community service, offering unique multi-stakeholder insights to understand and guide the future of this service.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) catalyzed the development of vaccines and antivirals. Clinically approved drugs against SARS-CoV-2 target the virus directly, which makes them susceptible to viral mutations, which in turn can attenuate their antiviral activity. Here we report a host-directed antiviral (HDA), piperlongumine (PL), which exhibits robust antiviral activity as a result of selective induction of reactive oxygen species in infected cells by GSTP1 inhibition. Using a transgenic K18-hACE2 mouse model, we benchmarked PL against plitidepsin, a HDA undergoing phase III clinical trials. We observed that intranasal administration of PL is superior in delaying disease progression and reducing lung inflammation. Importantly, we showed that PL is effective against several variants of concern (VOCs), making it an ideal pan-variant antiviral. PL may display a critical role as an intranasal treatment or prophylaxis against a range of viruses, expanding the arsenal of tools to fight future outbreaks.

Embedded into Victoria's mental health legislation as part of the 2014 Mental Health Act suite of reforms, advance statements are designed to convey an individuals' preferences for treatment during times when the ability to communicate or make decisions may be impaired. This study investigated Victorian mental health clinicians' knowledge and attitudes of advance statements as well as their experience with training and implementation. We used an online Qualtrics survey of Victorian mental health clinicians (n = 190) to achieve this aim. Instrument validity was determined using the Content Validity Index (CVI) with field experts rating each item for relevance. A value of 80% or higher was sought and computed for each individual item on the scale, as well as for the overall scale. The Cronbach's Alpha coefficient was conducted to determine internal consistency reliability with a value of α = 0.721 for the survey, suggesting that the scale had acceptable internal consistency and reliability. Despite widespread support and positive attitudes towards advance statements existing among mental health clinician participants, the level of knowledge and perception of barriers continues to significantly affect the wide-spread uptake of advance statements. The quality and extent of training in legal and clinical aspects of advance statement varied widely among the study participants, with the quality and benefits of the training affecting participant reported confidence level as well as their practical experience with advance statements. Three recommendations can be made: that advance statements are embed into routine mental health practice to identify individuals who have existing advance statements and support those who do not to prepare one; that regular co-produced and facilitated training be provided to increase understanding, promotion, and overall use and uptake of advance statements; and finally, for local mental health service to develop a culture for positive engagement and promotion of autonomy through inclusive practices around decision-making.

This study was performed to evaluate the effectiveness of a hybrid, telephone-based cardiac rehabilitation (TBCR) program implemented early in the COVID-19 pandemic compared with in-person, center-based programming offered prior to the pandemic. The focus was on older adults’ engagement and outcomes. Matched groups of hybrid and in-person cardiac rehabilitation (CR) participants were created from existing data and compared using t-tests and repeated measures ANOVAs. Qualitative interviews were conducted with participating CR staff then transcribed, coded, and analyzed for key themes. There were significant differences in body mass index and weight from pre-to post-CR within both hybrid and in-person groups. Despite this, CR staff believed exercise adherence was reduced in the hybrid group when compared to those in the in-person program. In the future, TBCR should be considered as an adjunct to in-person CR. Reluctance to prescribe exercise needs to be addressed through CR staff training.

PURPOSE: To assess the change in individual outcomes for people with disability and complex needs after moving into newly built, individualised apartments in the community. METHODS: People with disability (neurological disorder or cerebral palsy) and complex needs (n = 15, aged 18-65 years) completed quantitative self-report measures over two time-points (pre-move and 6-24 months post-move). Pre-move living arrangements included group homes, residential aged care, private rentals, and living with parents. Post-move living arrangements were individualised apartments built for people with disability. Health, wellbeing, community integration, and support needs were compared across pre- and post-move timepoints. RESULTS: Paired sample t-tests showed significant improvements consistent with large effects in wellbeing (p = 0.031, Eta2=0.29) and community integration (p = 0.008, Eta2=0.41), particularly home integration, and a trend towards improved health (p = 0.077, Eta2=0.21). A Wilcoxon signed rank test demonstrated a trend towards reduced support needs (z= -1.941, p = 0.052) consistent with a medium effect (r = 0.35) and an average decrease of 2.4 support hours per participant per day. CONCLUSIONS: Well-located housing with appropriate design, technology and support provision makes a positive contribution to wellbeing, community integration, and health for people with complex disability. Implications for rehabilitationPeople with disability who move into individualised apartments experience significant positive change in health, wellbeing, and participation.Findings highlight the benefits of housing that foster independence and enable personal choice and control.Evidence suggests that investment in appropriately designed and well-located housing has positive outcomes for people with disability.Evidence collected within this outcome framework has the potential to ensure models of housing and support that are responsive to the diverse and changing needs of people with disability.

Aim: To assess the effectiveness of two graduate nurse programs on new graduate nurses’ overall competence at 3, 6, 9 and 12 months. Secondary aims were to assess new nurses’ job satisfaction at 12 months and explore their experiences of support. Background: Most clinical settings have implemented transition programs to help new nurses to adapt to their new environments and expand their competences. To this day, very few studies have assessed the effectiveness of these programs. Design: Longitudinal mixed-methods study. Methods: The study was conducted at two teaching hospitals in Australia. New nurses were recruited during orientation. Data were collected at baseline (T0; n = 88), 3 (T1; n = 29), 6 (T2; n = 15), 9 (T3; n = 11) and 12 months (T4; n = 9). At each time point, the questionnaire included demographic and the Nurse Competence Scale. At T4, the questionnaire also included the Nurse Satisfaction Scale. Semi-structured interviews were conducted from T1 to T4. This study conforms to the STROBE guidelines. Results: Competence increased significantly at T1, with participants stating that they learned by “getting out” of student mode. At T2, despite no significant difference in competence, participants expressed they were more confident and in control, because they felt supported. Again, at T3, there was no significant increase in competence. Finally, at T4, competence increased significantly, with participants acknowledging that they still had a lot to learn. Conclusion: This study supports that 12-month transition programs are necessary for NGNs to expand their competence. One major factor influencing NGNs during their first year was how well they felt supported and encouraged to seek help when they needed it. Relevance: There is a need to understand how new NGNs enrolled in transition programs expand their competences. Their professional development depends on a supportive environment where NGNs feel confident in asking questions or for help.

Artificial nutrition and hydration (ANH) may be provided to individuals in the home environment, and family caregivers are often involved in the management of this intervention. This experience can have multiple consequences for families.The aim of this meta-ethnography is to explore and synthesize the personal experiences of family caregivers providing care to a person receiving home ANH.A comprehensive search of the literature was conducted without any time limitations applied. Seven stages of meta-ethnography were followed. Public and patient involvement was incorporated into the development of the line of argument synthesis in this review. This review is reported following the eMERGe guidelines and it was registered in PROSPERO.A total of 22 studies were included representing the experiences of 336 family caregivers. Two main themes emerged: (1) sink or swim, being thrown in at the deep end; and (2) professional support as a bedrock. The first theme represents the experiences from the very start of home ANH when the family caregivers may be overwhelmed with the level of skills they have to acquire. With time, family caregivers perceived the benefits, but also the challenges, associated with managing home ANH. If a person receiving home ANH was able to continue with some oral intake, it had a positive impact on family caregivers' experiences. The second theme represents the influence of professional support on the lived experience of family caregivers managing home ANH. This support should be individualized, comprehensive, and co-created with the family caregiver and the person receiving home ANH.This review concluded that caring for a person receiving home ANH can be very challenging for family caregivers. Family caregivers require personalized support from a multidisciplinary team of healthcare professionals to acquire skills, competence and confidence in this new role. Speech and language therapists are important members of this multidisciplinary team because they can facilitate a continuation of oral intake as appropriate.What is already known on the subject ANH has an impact not only on the person receiving it but also on the wider family and family caregivers. Healthcare professionals have a role in supporting people living with ANH. What this paper adds to existing knowledge This review presents a rigorous qualitative evidence synthesis that adheres fully to the eMERGe guidance for reporting of meta-ethnography. Within this meta-ethnography a current caregiver was consulted during the creation of the line of argument synthesis to provide a unique perspective to the review process. This review synthesized the current body of evidence that explores the lived experience of home ANH (any type) for family caregivers, identifies where professional support is required and highlights current gaps. What are the potential or actual clinical implications of this work? Family caregivers require personalized support from a multidisciplinary team of healthcare professionals to adjust to living with home ANH. This support assists people living with home ANH in perceiving benefits and developing more positive experiences. Speech and language therapists are important members of the multidisciplinary team supporting individuals with home ANH and their family caregivers as they can facilitate a continuation of oral intake as appropriate.

Background Despite many advances, patients with a poor ovarian response to stimulation are one of the most important and challenging factors of infertility. Chronological and ovarian ages are two effective factors in poor response to assisted reproductive treatment. The purpose of this study was to determine the effect of age and AMH level on the In vitro fertilization (IVF) outcomes in participants with a reduced ovarian reserve. Methods In this retrospective cross-sectional study, 210 participants with anti-Mullerian hormone (AMH) Results The number of dominant follicle (p Conclusion It has been concluded that the higher clinical pregnancy and live birth rate in participants younger than 35 years can be due to the higher AMH level in this group. Also, under the same conditions of AMH and other variables, age can affect the number of retrieved oocytes.

Purpose\ud This review aimed to collate and summarize available research literature about wheelchair service provision education available to healthcare professional students, healthcare personnel and educators across low- to high-resourced settings.\ud \ud Methods\ud The Joanna Briggs Institute methodological steps for scoping reviews were followed. Included studies were mainly sourced from Medline, Embase, CINAHL, Scopus, Academic Search Complete and ProQuest. Independent title, abstract and full-text screening with defined inclusion and exclusion criteria was performed. All screening and extraction were performed independently by two authors. A thematic approach was used to synthesize results. Data extracted from included studies were charted according to a template that we created. The study quality was also appraised.\ud \ud Results\ud A total of 25 articles were included (11, 36% from high-income settings) with 12 (48%) observational studies and 13 (52%) experimental studies. The literature addressed three main topics: (1) assessing wheelchair service provision knowledge, (2) implementing training interventions using in-person, online and/or hybrid learning approaches and (3) describing current wheelchair service provision education globally. The most frequently reported training programs used were the Wheelchair Skills Program and the World Health Organization Wheelchair Service Training Package – Basic Level.\ud \ud Conclusion\ud Limited information has been published about the integration of wheelchair content into the curricula of professional rehabilitation programs. Efforts to build international partnerships, improve the quality and currency of training programs and build resources that can assist educators in the integration of wheelchair-related content into professional rehabilitation programs should be prioritized.\ud \ud Implications for Rehabilitation\ud This is the first review that examined and synthesized the current state of wheelchair service provision education for rehabilitation students and personnel across low- to high-income countries.\ud \ud Findings from this review indicate that there is limited information about the integration of wheelchair-related content into professional rehabilitation programs.\ud \ud Efforts to build international partnerships, standardize wheelchair service provision content and evaluation and integrate training into professional rehabilitation programs worldwide should be prioritized.

Through an exploration of the origins of dietetics in the West, and specifically in Australia, we problematise the lack of diversity within the profession through the lens of intersectionality. Dietetics in Australia continues to be dominated by Australian-born women, and ideologies about dietitians perpetuate narratives of white, young, slim, women. Intersectional approaches to critiquing diversity in dietetics provides a useful framework to extend critical studies of health disparities into disparities in the dietetics professional workforce, which is advanced through structural, political and representational intersectionality guided critique. Through the analysis, a dialog is prompted in order to chart paths forward to find ‘how differences will find expression’ within the professional group. To do this, dietetics as a profession must reckon with its historical roots and step forward, out of a perceived position of objective neutrality regarding people and diversity, and into a position that can recognise that professional institutions have the power to exclude and marginalise, along with the power to include and transform.

Mental health nurses aim to provide high-quality care that is safe and person-centred. Service users require individualized care, responsive to their preferences, needs, and values. The views of service users, mental health nurses, nurse academics, psychiatrists, and nurse managers about the core competencies of mental health nurses have not been explored. Our study aimed to describe and contrast the views of multiple stakeholder groups on the core competencies of mental health nurses. Concept mapping is a six-step mixed-methods study design that combines qualitative data with principal component analysis to produce a two-dimensional concept map. Forty-eight people participated in the study from five stakeholder groups that included service users and clinicians. The final concept map had eight clusters: assessment and management of risk; understanding recovery principles; person- and family-centred care; good communication skills; knowledge about mental disorders and treatment; evaluating research and promoting physical health; a sense of humour; and physical and psychological interventions. There were important differences in how service users and health professionals ranked the relative importance of the clusters. Service users reported the understanding recovery principles cluster as the most important, whilst health professionals ranked the assessment and management of risk group the most important. There may be a disconnect between what service users and other stakeholders perceive to be the core competencies of mental health nurses. There is a need for more research to examine the differing perspectives of service users and health professionals on the core competencies of mental health nurses. Refereed/Peer-reviewed

Irritable bowel syndrome (IBS) and functional constipation (FC) are among the most common disorders of gut-brain interaction, affecting millions of individuals worldwide. Most patients with disorders of gut-brain interaction perceive food as a trigger for their gastrointestinal symptoms, and specific dietary manipulations/advice have now been recognized as a cornerstone therapeutic option for IBS and FC. We discuss in detail the 2 most common dietary interventions used for the management of IBS-general dietary advice based on the National Institute for Health and Care Excellence guidelines and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). We summarize the literature around the possible mechanisms of FODMAP-mediated IBS pathophysiology, the current 3-step, top-down approach of administering a low FODMAP diet (LFD) (restriction phase, followed by reintroduction and personalization), the efficacy data of its restriction and personalization phases, and possible biomarkers for response to an LFD. We also summarize the limitations and challenges of an LFD along with the alternative approach to administering an LFD (e.g., bottom-up). Finally, we discuss the available efficacy data for fiber, other dietary interventions (e.g., Mediterranean diet, gluten-free diet, and holistic dietary interventions), and functional foods (e.g., kiwifruit, rhubarb, aloe, and prunes) in the management of IBS and FC.

Aims: The negative role of anger expression in chronic pain has been described. However, there is a poor understanding of the impact of anger and perceived injustice in the therapeutic alliance in this setting. The aim was to review the current literature examining anger and perceived injustice and its impact on the therapeutic alliance in the context of chronic pain. Methods: In July 2020 a search was carried out of electronic databases [Academic Search Complete, Allied and Complementary Medicine Database (AMED), Biomedical Reference Collection, General Science, Medline, PsycArticles, PsycInfo, Social Sciences Full Text and SPORTDiscus]. Further results were obtained from reference lists. Inclusion and exclusion criteria were applied using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Results: The initial search yielded 255 results, and after duplicates were removed and inclusion and exclusion criteria applied, the final result was three papers to be reviewed. In total 225 patients were analyzed. Of the papers reviewed, all showed a negative correlation between perceived injustice and patient rating of the therapeutic alliance. Anger expression is the mediator of the proposed perceived injustice and therapeutic alliance relationship. Conclusion: The review addresses the potential role of anger expression in the modulation of the therapeutic alliance. The assessment of anger expression in chronic pain patients may be beneficial. Clinicians should be aware of its implications on the therapeutic alliance. The review highlights the need for further research which could lead to potential therapeutic interventions for such patient groups.

Parkinson’s disease is a neurodegenerative disorder, no cure and progressive disease worsens gradually. The caregivers' QOL, support, and caregiving appraisal is essential to ensure the quality of life to the Individuals with Parkinson's disease (IWPD). Hundred three caregivers of IWPD involve in this study. The caregivers' QOL was significantly associated with the caregivers’s comorbidities, duration of caregiving, living arrangement, the IWPD's gender and comorbidities, and found significant correlate with the caregiving appraisal. The importance of identifying the risk factors, education needs, and caregiving appraisal in developing intervention program to improve their QOL among caregivers. Keywords: social support; caregiving appraisal; quality of life; Parkinson's disease. eISSN: 2398-4287 © 2022. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v7i19.3132

Aims/hypothesis Mortality has declined in people with type 1 diabetes in recent decades. We examined how the pattern of decline differs by country, age and sex, and how mortality trends in type 1 diabetes relate to trends in general population mortality. Methods We assembled aggregate data on all-cause mortality during the period 2000–2016 in people with type 1 diabetes aged 0–79 years from Australia, Denmark, Latvia, Scotland, Spain (Catalonia) and the USA (Kaiser Permanente Northwest). Data were obtained from administrative sources, health insurance records and registries. All-cause mortality rates in people with type 1 diabetes, and standardised mortality ratios (SMRs) comparing type 1 diabetes with the non-diabetic population, were modelled using Poisson regression, with age and calendar time as quantitative variables, describing the effects using restricted cubic splines with six knots for age and calendar time. Mortality rates were standardised to the age distribution of the aggregate population with type 1 diabetes. Results All six data sources showed a decline in age- and sex-standardised all-cause mortality rates in people with type 1 diabetes from 2000 to 2016 (or a subset thereof), with annual changes in mortality rates ranging from −2.1% (95% CI −2.8%, −1.3%) to −5.8% (95% CI −6.5%, −5.1%). All-cause mortality was higher for male individuals and for older individuals, but the rate of decline in mortality was generally unaffected by sex or age. SMR was higher in female individuals than male individuals, and appeared to peak at ages 40–70 years. SMR declined over time in Denmark, Scotland and Spain, while remaining stable in the other three data sources. Conclusions/interpretation All-cause mortality in people with type 1 diabetes has declined in recent years in most included populations, but improvements in mortality relative to the non-diabetic population are less consistent. Graphical abstract

An undergraduate laboratory was developed as part of the Drugs for Neglected Diseases initiative's Open Synthesis Network. This activity aimed to develop new compounds efficacious against visceral leishmaniasis. Students successfully synthesized, purified, and characterized ten different benzoxazole amides that were sent for biological testing against several protozoan parasites. Although all the benzoxazole amides had poor activity against L. donovani, several (2, 4, and 9) showed moderate activity against T. cruzi, T. b. rhodesiense, and T. b. brucei paired with low cell cytotoxicity. This drug discovery laboratory activity made a measurable contribution to neglected tropical disease research and was an engaging and research-orientated experience for undergraduate students. Implementation of drug discovery laboratories across a range of student levels and backgrounds is highly achievable using existing laboratory equipment and a short investment in activity preparation and can be a sustainable course component.

Objective: To determine the contextual factors influencing research and research capacity building in rural health settings. Design: Qualitative study using semi-structured telephone interviews to collect data regarding health professionals’ research education and capacity building. Analysis involved inductive coding using Braun and Clark’s thematic analysis; and deductive mapping to the Consolidated Framework for Implementation Research (CFIR). Setting: Victorian rural health services and university campuses. Participants: Twenty senior rural health managers, academics and/or research coordinators. Participants had at least three years’ experience in rural public health, health-related research or health education settings. Main outcome measures: Contextual factors influencing the operationalisation and prioritisation of research capacity building in rural health services. Results: Findings reflected the CFIR domains and constructs: intervention characteristics (relative advantage); outer setting (cosmopolitanism, external policies and incentives); inner setting (implementation climate, readiness for implementation); characteristics of individuals (self-efficacy); and process (planning, engaging). Findings illustrated the implementation context and the complex contextual tensions, which either prevent or enhance research capacity building in rural health services. Conclusions: Realising the Australian Government’s vision for improved health service provision and health outcomes in rural areas requires a strong culture of research and research capacity building in rural health services. Low levels of rural research funding, chronic workforce shortages and the tension between undertaking research and delivering health care, all significantly impact the operationalisation and prioritisation of research capacity building in rural health services. Effective policy and investment addressing these contextual factors is crucial for the success of research capacity building in rural health services.

BackgroundThe co-occurrence of domestic violence with alcohol and other drugs significantly increases the severity of abuse and violence experienced by family members. Longitudinal studies indicate that substance use is one of few predictors of men’s continued use of, or desistance from, violence. Recent developments in men’s behaviour change programs have focused on men’s attitudes and behaviour towards their children, and the exploration of interventions that address the needs of all family members. However, the research evidence is limited on the most effective elements of men’s behaviour change programs in promoting the safety and wellbeing of child and women victim survivors.This study aims to build on the existing evidence by trialling the KODY program which addresses harmful substance use by men who also perpetrate domestic violence; the safety and wellbeing of women and children; the needs of children in their own right, as well as in relationship with their mothers; and the development of an ‘all-of-family’ service response. The evaluation of these innovations, and the ramifications for policy development to support less fragmented service system responses, provide the rationale for the study.Methods/DesignA quasi-experimental design will be used to assess the primary outcomes of improving the safety and wellbeing of mothers and children whose (ex)partners and fathers respectively participate in KODY (the trial program), when compared with ‘Caring Dadsstandard’ (the comparison group). Psychometric tests will be administered to fathers and mothers at baseline, post-program and at 3-month follow up. Data collection will occur over three years.DiscussionBy building the evidence base about responses to co-occurring domestic violence and substance use, this study aims to develop knowledge about improving safety outcomes for women and children, and to better understand appropriate support for children in families living at the intersection of domestic violence and substance use. It is anticipated that study findings will point to the ramifications for policy development to support less fragmented service system responses.Trial registrationAn application for registration with the Australian and New Zealand Clinical Trials Registry (https://www.anzctr.org.au/) was lodged on 20 December 2021 (Request number: 383206)—prospectively registered.