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Ayer — Octubre 2nd 2025Tus fuentes RSS

Bacteria isolated from the grape phyllosphere capable of degrading guaiacol, a main volatile phenol associated with smoke taint in wine

by Claudia Castro, Jacquelyn Badillo, Melissa Tumen-Velasquez, Adam M. Guss, Thomas S. Collins, Frank Harmon, Devin Coleman-Derr

Recent wildfires near vineyards in the Pacific United States have caused devastating financial losses due to smoke taint in wine. When wine grapes (Vitis vinifera) are exposed to wildfire smoke, their berries absorb volatile phenols derived from the lignin of burning plant material. Volatile phenols are released during the winemaking process giving the finished wine an unpleasant, smokey, and ashy taste known as smoke taint. Bacteria are capable of undergoing a wide variety of metabolic processes and therefore present great potential for bioremediation applications in many industries. In this study, we identify two strains of the same species that colonize the grape phyllosphere and are able to degrade guaiacol, a main volatile phenol responsible for smoke taint in wine. We identify the suite of genes that enable guaiacol degradation in Gordonia alkanivorans via RNAseq of cells growing on guaiacol as a sole carbon source. Additionally, we knockout guaA, a cytochrome P450 gene involved in the conversion of guaiacol to catechol; ΔguaA cells cannot catabolize guaiacol in vitro, providing evidence that GuaA is necessary for this process. Furthermore, we analyze the microbiome of berries and leaves exposed to smoke in the vineyard to investigate the impact of smoke on the grape microbial community. We found smoke has a significant but small effect on the microbial community, leading to an enrichment of several genera belonging to the Bacilli class. Collectively, this research shows that studying microbes and their enzymes has the potential to identify novel tools for alleviating smoke taint.

MINMON-J: a hybrid implementation pilot study evaluating a low-barrier hepatitis C treatment model in a jail setting

Por: Berk · J. · Fu · E. S. · Murphy · M. · Akiyama · M. J. · Sulkowski · M. · Rich · J. D. · Frank · H. E.
Introduction

Hepatitis C virus (HCV) remains a leading cause of infectious disease-related morbidity in the USA, disproportionately affecting people who inject drugs and people who are incarcerated. Despite the availability of highly effective, highly tolerated direct-acting antivirals, treatment uptake in jails remains limited due to short stays, unpredictable release dates and system-level barriers. The original MINMON trial demonstrated that a low barrier ‘minimal monitoring"’ model can achieve high cure rates in community settings. This study, MINMON-J, aims to adapt and evaluate a modified version of the MINMON model for use in a jail setting, addressing the urgent need for scalable, low-barrier treatment approaches among justice-involved individuals.

Methods and analysis

MINMON-J is a single-arm, hybrid effectiveness-implementation pilot study protocol planned to recruit at the Rhode Island Department of Corrections. 40 people who are incarcerated with positive HCV RNA, who are treatment-naïve, without cirrhosis and awaiting trial, will receive 12 weeks of sofosbuvir/velpatasvir with no required lab monitoring during treatment. If released before treatment completion, participants will receive their remaining medication at discharge. Community health workers will provide post-release support. Mixed-methods evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance/Practical, Robust Implementation and Sustainability Model framework. Primary outcomes include feasibility, acceptability and adherence. Data will be collected through administrative records, surveys (Acceptability of Intervention Measure, Feasibility of Intervention Measure, Brief Adherence Rating Scale) and qualitative interviews with participants and other relevant parties. This study was reviewed and approved by the Brown University Health Institutional Review Board (2240400) and the Rhode Island Department of Corrections Medical Research Advisory Group.

Ethics and dissemination

This study was reviewed and approved by the Brown University Health Institutional Review Board (2240400) and the Rhode Island Department of Corrections (RIDOC) Medical Research Advisory Group. All participants will provide written informed consent prior to enrolment. People who are incarcerated will be assured that participation is voluntary, will not impact their clinical care and that they may withdraw at any time without penalty. Study procedures follow ethical principles outlined in the Declaration of Helsinki and comply with federal regulations regarding research involving vulnerable populations.

Dissemination of findings will include peer-reviewed publications and presentations at national conferences focused on infectious diseases, implementation science and/or correctional health. Lay summaries will be shared with RIDOC leadership and community partners. De-identified data and associated metadata may be archived in a publicly accessible repository in accordance with National Institutes of Health data sharing policies, contingent on final institutional review board approval and participant protections.

Trial registration number

NCT06953479.

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Co‐Designing a Model of Brilliant Care for Older People

ABSTRACT

Aim

This study aimed to co-design a model of brilliant care for older people that provides clear, actionable principles to guide how brilliant care for older people can be realised.

Background

As the demand for and international importance of care for older people grows, so too does the negative discourse about care for older people. This ongoing focus on deficiencies can have implications for patients, carers, clinicians, health services, and policymakers, overshadowing opportunities for innovation and positive change.

Design

Experience-based co-design informed this study, grounded in the lived experiences of key stakeholders.

Methods

Three scaffolded co-design workshops were facilitated, involving lived experience experts, managers, professionals, clinicians, and an academic (n= 13). The data collected during these workshops were analysed using a qualitative descriptive method and documented according to COREQ guidelines to optimise rigour and transparency.

Results

The participants co-designed a model of brilliant care for older people, comprising principles to promote connection and innovation. To promote connection, the model includes protecting staff member time to deliver meaningful care and demonstrating that everyone matters. To promote innovation, it encourages role flexibility, curiosity, small improvements, and the recognition of brilliant practices.

Conclusions

This article presents a co-designed model of brilliant care for older people, incorporating principles of connection and innovation that can be enacted through simple, resource-efficient practices.

Relevance to Clinical Practice

For those who manage and deliver care for older people, the model encompasses simple, accessible, and cost-effective principles to: positively deviate from norms within the sector, offering care to older people; and to deliver brilliant care for older people. Furthermore, given that the model was co-designed with lived experience experts, managers, professionals, and clinicians, its principles are imbued with their experiential insights, which served to bring particular priorities to the fore.

Patient or Public Contribution

The co-designers, who included lived experience experts, were invited to participate in workshops to co-design a model of brilliant care for older people, during which they discussed and critiqued the findings constructed from the data and co-designed the model.

Development of Core Health Indicators and Integrated Health Assessment Toolkit for Older Adults With Dementia

ABSTRACT

Background

The interaction between dementia and changes in health status accelerates the progression of dementia and health deterioration. Although health indicators exist for older adults, comprehensive ones for dementia are lacking.

Objective

To (1) establish core health indicators for older adults with dementia, (2) develop an integrated health assessment toolkit for older adults with dementia, and (3) test the feasibility and applicability of the integrated health assessment toolkit.

Methods

This study involved two phases. In the first phase, using the Delphi method, opinions from 10 experts were synthesized to establish core health indicators for older adults with dementia. In the second phase, with a descriptive research approach, an integrated health assessment toolkit was developed, evaluated by 10 daycare case managers for feasibility, and then pilot tested with 50 older adults with dementia across three daycare centers.

Results

The core health indicators for older adults with dementia covered 18 indicators in five domains: (1) cognitive and behavioral impairment, (2) sensory and perceptual impairment, (3) disease and dysfunction, (4) functional fitness deterioration, and (5) social isolation. After two rounds of assessments, experts rated the criteria's importance and clarity at 0.94 and 0.89 on the scale-level content validity index/universal agreement (S-CVI/UA), respectively. In the second phase, the integrated health assessment toolkit was developed, which integrated five observational assessment scales and six physical function measures. The average applicability scores ranged from 7.80 to 9.90 out of 10. In the pilot test, the assessment process proceeded smoothly without any adverse events. However, 10 participants did not comply with wearing the actigraphy device.

Linking Action to Evidence

The core health indicators and the corresponding health assessment toolkit are feasible to assess the health of older adults with dementia that could provide valuable insights and guide future interventions to enhance their well-being.

Screening for depression among Spanish-speaking patients in primary care settings within the USA: a scoping review protocol to inform clinical practices

Por: Guzman · L. E. · Littlewood · A. · Creamer · A. · Frank · H. E.
Introduction

In 2016, the United States Preventive Services Task Force (USPSTF) recommended depression screening for all adults in the public sector, with screening frequency determined by clinical judgement and patient circumstances. This practice aims to enable timely diagnosis and treatment, reducing long-term healthcare costs associated with this chronic health condition. However, the USPSTF offered no written recommendations for primary care settings serving non-English-speaking populations, particularly where providers speak English and patients speak Spanish. While some research exists on depression screening in linguistically diverse settings, the use of validated Spanish-language screenings in primary care settings is underexplored when it comes to implementing the USPSTF’s recommendation. This scoping review addresses this knowledge gap by (1) assessing the extent to which Spanish-speaking patients in the USA receive depression screening in Spanish and (2) using the Consolidated Framework for Implementation Research (CFIR) 2.0 to categorise barriers and facilitators to implementing Spanish-language depression screening tools in USA primary care settings. The findings will identify areas needing further research to improve depression screening guidelines for primary care practices serving Spanish-speaking patients.

Methods and analysis

This scoping review follows the Joanna Briggs Institute Manual for Evidence Synthesis and the Arksey and O’Malley scoping review methodology, updated by Levac and colleagues. The reporting protocol adheres to PRISMA-ScR. A systematic search will be conducted in PubMed, Embase, APA PsycINFO, CINAHL and Web of Science Core Collection for studies on Spanish-language depression screening for adults in non-Veterans Affairs Medical Centers in the USA, excluding those focused on youth or adolescents. We will extract data from qualitative, quantitative and mixed-methods studies on screening. We will also examine studies addressing provider-reported comfort and competency in screening Spanish-speaking patients. We hypothesise that primary care clinics have implemented strategies for screening Spanish-speaking patients for depression driven by healthcare provider initiatives, local policies, research funding or community needs. The review will extract data on sample size, study methodology, primary care settings, patient and provider demographics, depression screeners used, and barriers and facilitators to screening. The quality of the studies will be appraised using the Mixed Methods Appraisal Tool (MMAT).

Ethics and dissemination

At Brown University, scoping reviews that analyse and synthesise existing research do not require Institutional Review Board (IRB) approval, provided they do not involve primary data collection or direct interaction with human subjects. Findings will be disseminated through peer-reviewed journals, conference presentations and community workshops to improve practices and policies addressing language barriers in depression screening and care.

Registration details

This scoping review protocol is registered with the Open Science Framework (OSF) at https://osf.io/dyru5.

The changing role of substances: trends, characteristics of individuals and prior healthcare utilization among individuals with accidental substance-related toxicity deaths in Ontario Canada

by Shaleesa Ledlie, Alice Holton, Pamela Leece, Bisola Hamzat, Joanna Yang, Gillian Kolla, Nikki Bozinoff, Rob Boyd, Mike Franklyn, Ashley Smoke, Paul Newcombe, Tara Gomes

Objective

To investigate trends and the circumstances surrounding fatal substance-related toxicities directly attributed to alcohol, stimulants, benzodiazepines or opioids and combinations of substances in Ontario, Canada.

Methods

We conducted a population-based cross-sectional study of all accidental substance-related toxicity deaths in Ontario, Canada from January 1, 2018 to June 30, 2022. We reported monthly rates of substance-related toxicity deaths and investigated the combination of substances most commonly involved in deaths. Demographic characteristics, location of incident, and prior healthcare encounters for non-fatal toxicities and substance use disorders were examined.

Results

Overall, 10,022 accidental substance-related toxicity deaths occurred, with the annual number of deaths nearly doubling between the first and last 12 months of the study period (N = 1,570–2,702). Opioids were directly involved in the majority of deaths (84.1%; N = 8,431), followed by stimulants (60.9%; N = 6,108), alcohol (13.4%; N = 1,346) and benzodiazepines (7.8%; N = 782). In total, 56.9% (N = 5,698) of deaths involved combinations of substances. Approximately one-fifth of individuals were treated in a hospital setting for a substance-related toxicity in the past year, with the majority being opioid-related (17.4%; N = 1,748). Finally, 60.9% (N = 6,098) of people had a substance use disorder diagnosis at time of death.

Conclusions

Our study shows not only the enormous loss of life from substance-related toxicities but also the growing importance of combinations of substances in these deaths. A large proportion of people had previously interacted within an hospital setting for prior substance-related toxicity events or related to a substance use disorder, representing important missed intervention points in providing appropriate care.

Factors Contributing to Well‐Being Among Hospital‐Based Nurses

ABSTRACT

Background

Nationally and in Hawaii, nurses are in crisis with high rates of distress, burnout, and intent to change jobs. Organizations need evidence-based strategies to support nurse well-being.

Purpose

Informed by the National Academy of Medicine Factors Affecting Clinician Well-Being Model, this study aimed to identify individual and external factors associated with nurses' well-being.

Methods

In December 2023, an online survey of hospital-based nurses from two major hospitals, representing various unit types, was conducted in Hawaii. Survey measures included individual (role, personal characteristics, skills/abilities) and external factors (organizational, environmental) that support clinician well-being. The outcome (well-being) was measured using the well-being index (scores ranged from −2 [excellent] to 9 [very poor]). The analysis included general linear modeling with stepwise backward selection.

Results

The final sample included 552 nurses. Years of experience were evenly distributed, and the majority worked ≥ 36 h/week (85.9%), worked in intensive-focused or other specialties units (53.8%), and identified as female (87.3%). The nurses identified their race/ethnicity as 27% Filipino, 23% White, 14% Japanese, 11% Other Asian, 6.1% Hispanic, 5.1% Native Hawaiian/Pacific Islander (NHPI), and 14% mixed or other race. The average well-being score was 2.8 (SD = 2.3). NHPI had the lowest (Mean ± SD = 2.2 ± 2.2), and Filipino and White nurses had the highest well-being scores (3.0 ± 2.2; 3.0 ± 2.0, respectively), although no significant racial/ethnic difference was found. Several internal and external factors were significantly associated with well-being. For example, working ≥ 36 h/week, reports of experienced burnout, having primary caregiving responsibility outside of work, lower self-reported physical health, and the experience of workplace violence all increased average well-being scores (worsened well-being). In contrast, having higher personal resilience, no leadership responsibilities, the belief that their organization is responsive to complaints and concerns, and appropriate ancillary staff to support their work all decreased average well-being scores (improved well-being).

Linking Evidence to Action

Healthcare organizational leaders and policymakers must urgently correct system issues contributing to burnout, suboptimal mental health, decreased well-being, and attrition among nurses. Healthcare organizations should cultivate wellness cultures and provide infrastructure that offers evidence-based interventions to support nurses' well-being.

Development of Paediatric‐Friendly Care Assessment Scale in Emergency Department: A Cross‐Sectional Study

ABSTRACT

Aim

To validate the psychometric properties of the Paediatric-Friendly Care Assessment Scale in the Emergency Department (PFCAS-ED) among clinical nurses.

Design

A cross-sectional study.

Methods

A total of 463 emergency nurses participated in the study between May and September 2023. The participants were randomly divided into two groups to assess the psychometric properties of the PFCAS-ED, including its reliability, construct validity, convergent validity, discriminant validity, and criterion-related validity.

Results

Exploratory factor analysis on data from the first group revealed six components of the PFCAS-ED: paediatric/adolescent timely care and resources, child protection mechanisms and safety, paediatric emergency care competency training and practice, paediatric emergency consultation information and space, paediatric crisis management and response, and a harmless environment and actions for toddlers. These factors explained 69.408% of the total variance and exhibited strong internal consistency. This six-factor structure and its 28 items were further validated using confirmatory factor analysis on data from the second group, yielding satisfactory fit indices and convergent and discriminant validity. Additionally, the scale exhibited excellent 2-week test–retest reliability and criterion-related validity.

Conclusion

The PFCAS-ED had excellent psychometric properties when used with clinical nurses and was proven to be a reliable instrument for evaluating emergency nurses' perceptions of the importance of providing paediatric-friendly care to children and their families.

Implications for the Profession and Patient Care

This standardised scale enables nurses to assess their perceptions of the importance of paediatric-friendly care and design targeted interventions on the basis of available resources. Additionally, hospital administrators can use the PFCAS-ED to identify priorities, strengths, and areas requiring improvement in paediatric emergency care, thereby informing the development of effective strategies and comprehensive policies.

Reporting Method

This study adhered to the STROBE guidelines.

Patient or Public Contribution

No patient or public involvement.

Risk and protective factors for the mental health of displaced Ukrainian families in the Netherlands: study protocol of a 4-year longitudinal study

Por: Missler · M. · Karaban · I. · Cheliuskina · K. · Frankova · I. · Dobrova-Krol · N. · Sijbrandij · M. · Olff · M. · Schoorl · M. · Duckers · M. L. · Mooren · T.
Background

Over 6 million people have fled their homes in response to the full-scale invasion of Russian armed forces into Ukraine and are forcibly displaced since the start on 4 February 2022. Refugees, both adults and children, have a high risk of developing mental health disorders, in particular post-traumatic stress disorder, depression and anxiety disorders. Research into the mental health of Ukrainian families and their needs is urgently needed. The primary aim of this study is to increase our understanding of the consequences of potentially traumatic events for the mental health of parents and children. This may inform the development of mental health and psychosocial support interventions which can be readily implemented in the family context.

Methods and analysis

We will conduct a four-wave longitudinal online survey study among Ukrainian families displaced to the Netherlands. This study is a part of the Nadiya data collection, intended to assess the mental health responses of Ukrainian refugee families to the stress of war, forced migration, family separation and adaptation to new circumstances in their hosting country. Participants are assessed at four time points, approximately 6 months apart. Data collection for T1 started in May 2023. We aim to recruit a total of n=1500 participants at T1, of which n=1000 adults (18 years and older) and n=500 children (8–11 years) and teenagers (12–17 years). To investigate symptom profiles and associated risk and protective factors among parents and children, we will use latent class growth modelling.

Ethics and dissemination

The data collection procedure has been approved by the Ethical Committee of the Faculty of Social Sciences of Utrecht University. Data will be deposited, stored and shared using Utrecht University’s institutional research data repository Yoda. This research project is part of the Global Collaboration on Traumatic Stress; all authors are affiliated with this network. The findings will be published in peer-reviewed, open access journals and further disseminated through conference presentations, news updates at the project website and on the websites of the Dutch Society for Traumatic Stress Studies (www.ntvp.nl), and the European Society of Traumatic Stress Studies, as well as through media contributions.

Trial registration number

The current study was registered on 26 March 2024 on The Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/9FP7U.

Factors Influencing Nurses' Culturally Competent Cancer Care for LGBT Individuals in Taiwan: A Qualitative Study Applying the Socio‐Ecological Model

ABSTRACT

Aims

This study explored the factors associated with oncology nurses' behaviour and intention to provide cancer care to lesbian, gay, bisexual, and transgender (LGBT) individuals in Taiwan.

Design

A qualitative descriptive study.

Methods

Semi-structured interviews were conducted with 25 oncology nurses between August and October 2023. The interview data were analysed using the framework method (the socio-ecological model) and constant comparative techniques.

Results

Factors associated with oncology nurses' behaviour and intentions to provide cancer care for LGBT individuals were categorised and presented by the levels of the social-ecological model: (1) intrapersonal level: oncology nurses' attitudes toward LGBT populations and their experiences, confidence, and beliefs in providing cancer care for LGBT individuals; (2) interpersonal level: concerns or interactions with oncology nurses' colleagues, other heterosexual cancer patients, and managers; (3) community and organisation levels: organisational climate and related training courses; and (4) societal and policy level: policy regarding sexual orientation, gender identity collection, and social atmosphere.

Conclusion

Multilevel barriers associated with oncology nurses' behaviours and intentions to provide cancer care to LGBT individuals were identified. The study findings emphasised the importance of related training courses offered by organisations to reduce cancer care disparities among LGBT individuals. These courses also aim to enhance oncology nurses' confidence and comfort in delivering holistic and patient-centred cancer care for this population.

Impact

The study findings can be employed to assist in developing related training courses and understand the challenges oncology nurses face when providing cancer care to LGBT individuals.

Patient or Public Contribution

No patient or public contributions.

Expanding access to maggot containment dressings through redesign and innovation

Abstract

There are two major styles of maggot debridement dressings: (1) confinement dressings that form a cage around the wound, and (2) containment dressings that completely surround the maggots within a sealed porous bag. For producers and clinicians wanting to prepare containment dressings using readily available polyester bags, it is currently difficult to seal these bags without expensive high-temperature plastic welders. This study aimed to identify simple and affordable methods for sealing maggots within polyester net bags. Heat sealing was the most effective and simplest method to seal the polyester net bags, but the high melting point of polyester required industrial grade heat sealers. An inner lining of polyethylene or polypropylene film at the open side of the bag allowed for complete sealing using low-cost hand-actuated impulse heat sealers. This design even facilitated the addition of plastic zipper-locks, allowing secure closure of the bag without electricity or special equipment. Other sealing methods were identified, but most were time-consuming, required practice or not consistently successful. The maggot containment bag designs and closure methods described herein should prove useful to clinicians without access to contained maggots and to maggot producers without the resources to seal polyester containment bags. Clinical trials are expected to follow.

Simulated low-dose dark-field radiography for detection of COVID-19 pneumonia

by Rafael C. Schick, Henriette Bast, Manuela Frank, Theresa Urban, Thomas Koehler, Florian T. Gassert, Andreas P. Sauter, Bernhard Renger, Alexander A. Fingerle, Alexandra Karrer, Marcus R. Makowski, Daniela Pfeiffer, Franz Pfeiffer

Background

Dark-field radiography has been proven to be a promising tool for the assessment of various lung diseases.

Purpose

To evaluate the potential of dose reduction in dark-field chest radiography for the detection of the Coronavirus SARS-CoV-2 (COVID-19) pneumonia.

Materials and methods

Patients aged at least 18 years with a medically indicated chest computed tomography scan (CT scan) were screened for participation in a prospective study between October 2018 and December 2020. Patients were included if they had a CO-RADS (COVID-19 Reporting and Data System) score ≥ 4 (COVID-19 group) or if they had no pathologic lung changes (controls). A total of 89 participants with a median age of 60 years (interquartile range 48 to 68 yrs.) were included in this study. Dark-field and attenuation-based radiographs were simultaneously obtained by using a prototype system for dark-field radiography. By modifying the image reconstruction algorithm, low-dose radiographs were simulated based on real participant images. The simulated radiographs corresponded to 50%, 25%, and 13% of the full dose (41.9 μSv, median value). Four experienced radiologists served as blinded readers assessing both image modalities, displayed side by side in random order. The presence of COVID-19-associated lung changes was rated on a scale from 1 to 6. The readers’ diagnostic performance was evaluated by analyzing the area under the receiver operating characteristic curves (AUC) using Obuchowski’s method. Also, the dark-field images were analyzed quantitatively by comparing the dark-field coefficients within and between the COVID-19 and the control group.

Results

The readers’ diagnostic performance in the image evaluation, as described by the AUC value (where a value of 1 corresponds to perfect diagnostic accuracy), did not differ significantly between the full dose images (AUC = 0.86) and the simulated images at 50% (AUC = 0.86) and 25% of the full dose(AUC = 0.84) (p>0.050), but was slightly lower at 13% dose (AUC = 0.82) (p = 0.038). For all four radiation dose levels, the median dark-field coefficients within groups were identical but different significantly by 15% between the controls and the COVID-19 pneumonia group (p Conclusion

Dark-field imaging can be used to diagnose the Coronavirus SARS-CoV-2 (COVID-19) pneumonia with a median dose of 10.5 μSv, which corresponds to 25% of the original dose used for dark-field chest imaging.

Using Collective Intelligence to Develop Design Requirements for a Complex Intervention for Advance Care Planning in the Community

ABSTRACT

Background

Engaging people in advance care planning is a challenging systemic problem that requires a social innovation approach and a conceptual framework to guide behavioural and social change efforts.

Aim

To identify stakeholders' perspectives on barriers to advance care planning engagement, options for overcoming these barriers, and user needs. The findings will inform the design of a health behaviour change intervention for engaging older adults (50+) in advance care planning.

Design

To advance co-production and intervention design goals, the study used collective intelligence and scenario-based design methods.

Methods

Following a systematic stakeholder analysis, 22 participants were recruited to three online collective intelligence sessions. The socioecological perspective informed framing of integrated findings and specifying factors at the individual, interpersonal, service, and system levels.

Results

Identified barriers (n = 109) were grouped into seven categories: (i) Psychological, (ii) Advance Care Planning Literacy, (iii) Interpersonal and Interprofessional, (iv) Service-Related, (v) Resources and Supports, (vi) Advance Care Planning Process and Methods, (vii) Cultural and Societal. Stakeholders generated 222 options for overcoming these barriers and specified 230 service user needs. The need to change perceptions of advance care planning, increase psychological readiness, and target advance care planning literacy was highlighted (individual-level). Timely, focused, and meaningful interaction between the key ACP actors must be facilitated using creative strategies (interpersonal-level). Need- and value-based services, including high quality resources, support systems, and infrastructure, should be co-designed (service-level). Cultural and societal transformation is required (system-level).

Conclusion

Findings integration offered insight into the complexity of the design context and problem situation and identified directions for context-specific advance care planning intervention development. The use of design thinking methodologies is recommended for the next phase of complex intervention development.

Implications

The study presents a roadmap of actions required from policy-makers, practitioners, and researchers to ensure the design of adequate advance care planning interventions.

Reporting Method

Quality of reporting was assured by adherence to Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (International Journal for Quality in Health Care, 19, 2007, 349).

Patient or Public Contribution

Patient and public representatives participated in the collective intelligence sessions. Members of the All Ireland Institute of Hospice and Palliative Care Voices4Care facilitated that process. Findings from the first CI session (involving patients and caregivers) informed the content, format, and methods used in subsequent CI sessions.

A cross‐sectional study quantifies the independent contribution of nurses and midwives in child health outcomes

Abstract

Introduction

As the largest profession within the healthcare industry, nursing and midwifery workforce (NMW) provides comprehensive healthcare to children and their families. This study quantified the independent role of NMW in reducing under-5 mortality rate (U5MR) worldwide.

Design

A retrospective, observational and correlational study to examine the independent role of NMW in protecting against U5MR.

Methods

Within 266 “countries”, the cross-sectional correlations between NMW and U5MR were examined with scatter plots, Pearson's r, nonparametric, partial correlation and multiple regression. The affluence, education and urban advantages were considered as the potential competing factors for the NMW–U5MR relationship. The NMW–U5MR correlations in both developing and developed countries were explored and compared.

Results

Bivariate correlations revealed that NMW negatively and significantly correlated to U5MR worldwide. When the contributing effects of economic affluence, urbanization and education were removed, the independent NMW role in reducing U5MR remained significant. NMW independently explained 9.36% U5MR variance. Multilinear regression selected NMW as a significant factor contributing an extra 3% of explanation to U5MR variance when NMW, affluence, education and urban advantage were incorporated as the predicting variables. NMW correlated with U5MR significantly more strongly in developing countries than in developed countries.

Conclusion

NMW, indexing nursing and midwifery service, was a significant factor for reducing U5MR worldwide. This beneficial effect explained 9.36% of U5MR variance which was independent of economic affluence, urbanization and education. The NMW may be a more significant risk factor for protecting children from dying under 5 years old in developing countries. As a strategic response to the advocacy of the United Nations to reduce child mortality, it is worthy for health authorities to consider a further extension of nurses and midwives' practice scope to enable communities to have more access to NMW healthcare services.

Pediatric palliative care utilization by decedent children: A nationwide population‐based study, 2002–2017

Abstract

Purpose

This study aimed (1) to describe how trends in pediatric palliative care (PPC) utilization changed from 2002 to 2017, and (2) to examine factors predicting PPC utilization among decedent children in Taiwan.

Design

This retrospective, correlational study retrieved 2002–2017 data from three national claims databases in Taiwan.

Methods

Children aged 1 through 18 years who died between January 2002 and December 2017 were included. Pediatric palliative care utilization was defined as PPC enrollment and PPC duration, with enrollment described by frequency (n) and percentage (%) and duration described by mean and standard deviation (SD). Logistic regression was used to examine the associations of various demographic characteristics with PPC enrollment; generalized linear regression was used to examine associations of the demographic characteristics with PPC duration.

Findings

Across the 16-year study period, PPC enrollment increased sharply (15.49 times), while PPC duration decreased smoothly (by 29.41%). Cause of death was a continuous predictor of both PPC enrollment and PPC duration. The children less likely to be enrolled in PPC services were those aged 1 to 6 years, boys, living in poverty, living in rural areas, and diagnosed with life-threatening noncancer diseases.

Conclusion

This study used nationwide databases to investigate PPC enrollment and PPC duration among a large sample of deceased children from 2002 to 2017. The findings not only delineate trends and predictors of PPC enrollment and PPC duration but also highlight great progress in PPC as well as the areas still understudied and underserved. This information could help the pediatric healthcare system achieve the core value of family-centered care for children with life-threatening diseases and their families.

Clinical Relevance

Pediatric palliative care should be widely and continuously implemented in routine pediatric clinical practice to enhance quality of life for children and their families at the end of life.

Changing behaviour in pregnant women: a scoping review

Improving health and wellbeing is a major goal in healthcare all over the world (WHO, 2015). Midwives and other healthcare professionals play a key role in educating women about healthy pregnancies (WHO, 2013a). During the course of pregnancy, women may experience a variety of psychological changes, including developing the motivation to change their lifestyle habits (Lindqvist et al., 2017). To support “behaviour change through a life-course approach” and to implement the WHO strategy for strengthening nursing and midwifery towards the achievement of the “Health 2020” goals (WHO, 2015, p.4), it is important for healthcare professionals to increase their knowledge of behaviour change programmes (BCPs) during pregnancy.
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