Preventing burnout: Community health worker perspectives on professional development and emotional labor overload - A qualitative descriptive study

by Meshack Achore, Martine Hackett, Tatiana Ramirez

Introduction

Community health workers (CHWs) play a critical role in advancing health equity by bridging underserved communities with health and social services. However, expanding responsibilities, emotional labor, and fragmented service systems contribute to burnout. While prior research has examined CHW burnout in urban, rural, and crisis contexts, little is known about how burnout is experienced and mitigated in suburban settings characterized by geographic dispersion and administrative fragmentation. This study explored how CHWs in suburban Long Island, New York, experience emotional labor overload and the strategies they use, individually and organizationally, to prevent burnout.

Methods

We conducted a qualitative descriptive study using purposive and snowball sampling and recruited 10 CHWs from Nassau and Suffolk counties in New York. Data were collected through ten semi-structured interviews and five participant observations. Participants were primarily women aged 35–44 years, most of whom (86%) worked in Nassau County and reported 2–5 years of experience. Transcripts were analyzed thematically using Braun and Clarke’s six-step framework in ATLAS.ti.

Results

Two overarching themes emerged: (1) Creating a healthy work-life balance, in which CHWs managed burnout by setting boundaries and practicing self-care; and (2) Building support structures in the workplace, where organizational supports such as supervision, peer collaboration, and ongoing training promoted resilience. Participants emphasized the importance of self-care rituals, spiritual grounding, and collegial networks as protective factors against emotional exhaustion.

Conclusions

Burnout among suburban CHWs is shaped by the interaction of individual coping practices and organizational conditions within fragmented service systems. Strengthening supervision, peer support infrastructure, and professional development opportunities may enhance workforce resilience and sustainability. Investments in organizational support structures are critical to sustaining CHWs’ capacity to promote health equity.

Prevalence and determinants of unintended pregnancy among female sex workers (FSW) in Jashore, Bangladesh

by Md. Masud Reza, Hasibul Hasan Shanto, Samira Dishti Irfan, A. K. M. Masud Rana, Mohammad Niaz Morshed Khan, Golam Sarwar, Mohammad Sha Al Imran, Mahbubur Rahman, Md. Safiullah Sarker, Muntasir Alam, Md. Abu Hena Chowdhury, Mustafizur Rahman, Sharful Islam Khan

Background

Unintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.

Methods

A cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.

Result

The lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.

Conclusion

This study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.

Physiological responses of <i>Cucurbita pepo</i> seeds to cadmium and copper stress: Differential impacts on reserve mobilization, metabolic efficiency, and growth

by Smail Acila, Nora Allioui, Samir Derouiche

Heavy metal contamination poses a significant threat to agricultural productivity. This study investigated the physiological and biochemical responses of Cucurbita pepo seeds to cadmium (Cd) and copper (Cu) stress (100–200 µM) during germination. Although germination rates remained high (86.67–93.33%), seed vigor indices declined significantly under metal stress. Cadmium exhibited stronger growth inhibition, reducing total seedling length by 63.02% at 200 µM, whereas copper primarily affected biomass accumulation, reducing the seedling weight-based vigor index (SVI_W) by 40.4%. Biochemical analyses revealed metal-specific impacts on reserve mobilization. Cadmium exposure (200 µM) decreased soluble sugars in cotyledons by 16%, while maintaining protein content at 106% of control levels, indicating inhibition of protein degradation and impaired reserve utilization. In contrast, copper at 100 µM increased cotyledonary sugars by 63%, reflecting its dual role as both a micronutrient and stressor. Principal component analysis confirmed the greater toxicity of Cd, which explained 79.7% of the variance in metabolic disruption. These findings demonstrate that cadmium consistently impairs seedling establishment by disrupting nutrient mobilization pathways, while copper exhibits concentration-dependent effects, being stimulatory at low concentrations but inhibitory at higher levels. This study provides crucial insights into heavy metal phytotoxicity mechanisms and underscores the importance of monitoring metal pollution in agricultural systems to enhance crop resilience.

Effects of breathing exercise and thoracic techniques on pain and disability in low back pain: A systematic review and meta-analysis

by Tahere Seyedhoseinpoor, Ramin Jafari, Zohreh Shafizadegan, Maryam Abbaszadeh-Amirdehi

Purpose

The objective of this study was to systematically review the effectiveness of thoracic-focused interventions, including breathing exercises and thoracic manual techniques (mobilization, high-velocity low-amplitude manipulation, and release techniques), on pain and disability in patients with low back pain (LBP).

Methods

PubMed, Scopus, Web of Sciences, ProQuest, Ovid, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Clinical Trials (CENTRAL), and Google Scholar were searched without language restrictions. Clinical trials with control groups on pain and disability in low back pain patients focusing on the efficacy of breathing exercises or thoracic technique were included. In total, 31 studies contributed to the meta-analysis for pain and 24 for disability.

Results

Pooled analyses using Morris’ dppc demonstrated a statistically significant, small effect for pain reduction (dppc = −0.35, 95% CI = −0.46 to −0.23) and a large effect for disability improvement (dppc = −0.71, 95% CI = −0.86 to −0.57) when compared with control groups. Thoracic manual techniques showed larger effects on both pain and disability compare to breathing exercises. However, substantial statistical heterogeneity (I² > 85%) persisted in most analyses.

Conclusion

Breathing and thoracic manual techniques may be effective in reducing disability and, to a lesser extent, pain in patients with LBP, but the overall certainty of evidence is low. However, the quality of the evidence is low. Variability in treatment protocols, study quality, blinding, and outcome measures likely contributed to inconsistencies. Further high-quality trials with standardized protocols are needed to confirm these findings and inform clinical practice.

Clinical and social determinants of cardiovascular risk in a population with chronic noncommunicable diseases in Maicao, La Guajira, Colombia: 2024

by Paula Tatiana Angarita-Melo, Karen Panche-Castellanos, Víctor Zein Rizo-Tello, Ana Yibby Forero-Torres, Alexandra Porras-Ramírez

Aim

To determine the independent association and quantify the magnitude of influence of clinical and social determinants on the ten-year cardiovascular disease risk (estimated using the Framingham scale) in individuals diagnosed with arterial hypertension or type 2 diabetes mellitus in Maicao, La Guajira.

Methods

A cross-sectional analytical study was conducted among 273 adults enrolled in noncommunicable disease programs. Anthropometric, biochemical, and sociodemographic data were collected using standardized instruments. Multivariable logistic regression was used to identify and quantify factors associated with high cardiovascular disease risk (defined as 10% or greater Framingham score).

Results

The prevalence of high ten-year cardiovascular disease risk was 16.9%, being significantly higher in women (23.5%) compared to men (3.3%). The multivariable analysis quantified the influence of the determinants. Key clinical factors associated with the highest magnitude of risk were Type 2 Diabetes Mellitus (Adjusted Odds Ratio: 21.87) and High Blood Pressure (Adjusted Odds Ratio: 16.04). The independent effect of a social determinant, receiving a monthly salary, was also strongly associated with high risk (Adjusted Odds Ratio: 4.62). Conversely, being male and having normal High Density Lipoprotein cholesterol levels were identified as protective factors.

Conclusion

This study quantifies that, in addition to the strong influence of traditional clinical factors (T2DM and HBP), social determinants such as income-related work status exert a significant and independent effect on cardiovascular risk in this vulnerable population. The findings underscore the critical need for integrated public health strategies in Maicao, La Guajira, that not only target metabolic control but also effectively address structural social and gender inequalities to achieve a meaningful reduction in the cardiovascular disease burden.

Preclinical safety and burn wound healing activity of “Novostron”, a novel topical iodine-based therapeutic

by Nailya Ibragimova, Arailym Aitynova, Seitzhan Turganbay, Marina Lyu, Alexandr Ilin, Tamari Gapurkhaeva, Galina Ponomareva, Karina Vassilyeva, Diana Issayeva, Amirkan Azembayev, Serzhan Mombekov, Aralbek Rsaliyev, Nurgul Sikhayeva, Yergali Abduraimov, Saki Raheem

Iodine-based antiseptics are essential in wound care but are often limited by cytotoxicity, instability, and rapid iodine release. Novostron is a novel polymer–iodine complex incorporating dextrin, polyvinyl alcohol, and metal ions, designed to enable controlled iodine release. Structural integrity and composition were confirmed by ¹H and ¹³C NMR spectroscopy and physicochemical analysis, indicating a molecular weight of ~9500 g/mol, a pH of 4.23, and an iodine content of 8.13%. Pharmacokinetic analysis in rabbits demonstrated that following a single dermal application, systemic iodine absorption was minimal, with peak blood iodine concentrations remaining within physiological limits and rapid elimination within 24 hours. Evaluation of thyroid function revealed no significant changes in serum T₃, T₄, or TSH levels compared with those of the controls, confirming that topical application of Novostron does not disrupt thyroid homeostasis. In compliance with OECD guidelines in rabbits, guinea pigs, and rats, Novostron showed no signs of dermal irritation, skin sensitization, or systemic toxicity (LD₅₀ > 2000 mg/kg). In a rat cotton pellet granuloma model, Novostron significantly reduced the inflammatory mass (23.65% inhibition), supporting its anti-inflammatory potential. In a murine burn model, Novostron accelerated wound contraction (25.95% at day 10), increased epidermal thickness, and enhanced collagen deposition (~44%), outperforming controls and matching or exceeding betadine. These findings suggest that Novostron promotes tissue repair by modulating inflammation. Overall, Novostron demonstrated a favourable preclinical safety and efficacy profile, and its polymer–iodine composition, which enables controlled release and localized activity highlights its potential as a promising topical therapeutic. However, the study was limited to animal models and short-term observation; further long-term and clinical investigations are needed to confirm its translational potential in human wound healing.

Defining upper extremity dominance: The contributions of hand preference and grip strength

by Mohamadreza Hatefi, Seyedeh Feriyal Mahdavi, Amirreza Abbasi, Farideh Babakhani

Background

Upper extremity (UE) dominance is often defined by self-reported hand preference; however, this may not accurately reflect true functional or strength-based dominance. This study examined the relationship between writing hand, throwing hand, and maximal grip strength to assess how these measures align.

Methods

Thirty-four healthy, recreationally active college-aged individuals reported their preferred writing and throwing hands and completed standardized grip strength testing. Associations among the variables were analyzed using Phi coefficients and chi-square tests.

Results

A moderate, significant relationship was found between writing and throwing hand preference (φ = 0.456; p = 0.008), indicating general consistency across these subjective measures. However, no significant association emerged between grip strength dominance and either writing (φ = 0.027; p = 0.876) or throwing hand (φ = 0.096; p = 0.574).

Conclusion

These results suggest that grip strength dominance may not correlate with commonly used indicators of hand preference, highlighting the need for task-specific definitions of dominance in clinical and athletic contexts. Consequently, employing such task-specific definitions allows for more accurate assessments and enhances the translational relevance of research findings in practical settings.

Cultural stress, family functioning, hazardous alcohol use, and mental health among Latin American parents in the United States: A latent profile analysis

by Andrea Lopez-Soto, Esmeralda Ramírez, Duyen H. Vo, Aigerim Alpysbekova, Seo Woo Lee, Maria Duque, Lawrence Watkins, Cory L. Cobb, Beyhan Ertanir, Alejandra Garcia Isaza, Evelyn Gualdron, Sumeyra Sahbaz, Collette Steed, Neel Devan Youts, Shriya Senapathi, Seth J. Schwartz, Pablo Montero-Zamora

There is a limited understanding of how different subgroups of Latin American immigrant parents experience cultural stressors, as well as its impact on family dynamics, health behaviors, and mental health. The present study aimed to (1) identify latent cultural stress profiles among Latin American immigrant parents in the U.S. and (2) examine differences among these profiles concerning family intimacy, democratic parenting style, family conflict, hazardous alcohol use, and depressive and anxiety symptoms. Participants consisted of a sample of 1,351 parents (61.9% female; M age = 39.83, 62% first-generation; North America [61%], Central America and the Caribbean [21%], and South America [19%]) of children aged 8–16. We used latent profile analysis to identify subgroups of cultural stress, defined by perceived discrimination (PDS) and negative context of reception (NCR). Multinomial logistic regression was conducted to examine key correlates of profile membership. Five latent profiles were identified (1) Low PDS/NCR (22.2%), (2) Low PDS/Elevated NCR (14.8%), (3) Moderate PDS/NCR (18.7%), (4) Elevated PDS/NCR (33.5%), and (5) Highest PDS/NCR (10.8%). Compared with Profile 1 (Low PDS/NCR), parents in Profiles 2–5 generally reported lower family intimacy (RRR = 0.93–0.97). Parents in Profile 5 (Highest PDS/NCR) reported more family conflict (RRR = 1.13), hazardous alcohol use (RRR = 1.20), depressive symptoms (RRR = 1.31), and anxiety symptoms (RRR = 1.29), with markedly elevated depressive (RRR = 22.94) and anxiety symptomatology (RRR = 17.48) compared with Profile 1. Our findings suggest the presence of vulnerable subgroups due to cultural stress among Latin American parents in the United States. A better understanding of cultural stress patterns may improve current and future interventions tailored for Latin American families, addressing health disparities within this population.