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Tailoring Psychological First Aid for frontline healthcare workers to manage trauma and stress beyond emergency response to routine healthcare settings--- a qualitative multi-stakeholder consultation study in China
Get PDFBackground: Healthcare workers (HCWs) are frequently exposed to trauma, either by witnessing patients' suffering or directly experiencing workplace violence and responding to public health emergencies yet a historical lack of mental health preparedness existed for them. Although Psychological First Aid (PFA) has been widely advocated as a training approach to support HCWs, limited evidence on its' cultural adaptation and implementation in healthcare settings hinders its’ uptake.
Method: Guided by cultural adaptation and implementation science frameworks, this qualitative study employed a multi-step stakeholder consultation approach to adapt the PFA model and develop an implementation strategy tailored for Chinese HCWs. Diverse stakeholders, including mental health experts, key informants, medical education experts, scholars, and HCWs, participated in three phased activities: 1) In-depth individual expert consultations, 2) Focus group discussions, and 3) Expert workshops. Ethical approval was obtained in both the UK and China. Data was analysed using framework analysis.
Results: The original PFA model was adapted to make cultural, contextual, structural, delivery format, and implementation strategy changes. Through adapting PFA model, modifying the training format and developing implementation strategy, resulted in the development of the READ-Y PFA model: R-Rapport, E-Evaluation, A-Aid, D-Disposition, and Yourself-Self-Care for others. The model includes a flexible training protocol and implementation strategies, integrated into a logical framework, to enable its use in frontline routine healthcare settings in China.
Conclusion: This study presents a culturally adapted a READ-Y PFA model and training protocol extending PFA use beyond emergency response to routine healthcare. The stakeholder-informed approach offers a replicable framework for potentially scaling up PFA to better equip HCWs to manage trauma and stress
Children and young people’s (aged 10-24 years) accounts of their involvement in serious youth violence in the UK: systematic review and meta-ethnography
Get PDFAdapting the 2022 WHO verbal autopsy tool for use in Lagos State, Nigeria: insights from the LVASA-SRS project.
Get PDFOBJECTIVE: Accurate and routine cause-of-death data are essential for health planning, yet many low- and middle-income countries lack comprehensive systems for such data, resulting in undocumented maternal and perinatal deaths. This article details the adaptation of the 2022 WHO Verbal Autopsy (VA) tool for maternal mortality surveillance in a linguistically diverse urban setting with high rates of out-of-facility deaths as part of the Lagos Verbal and Social Autopsy Sample Registration System project in Nigeria. RESULTS: The adaptation process enhanced the tool’s cultural sensitivity, language clarity, and system compatibility. Impersonal or potentially disrespectful terms (e.g., “the deceased”) were replaced, complex medical terms simplified (e.g., “abdominal pain” to “tummy pain”), and locally relevant options added for care providers and death locations. Context-specific skip patterns improved efficiency by focusing on maternal deaths and a rigorous translation process (forward/back translation in Yoruba and Pidgin English) ensured linguistic fidelity and local resonance. Validation included face and content review, role-play simulations, and pilot-testing with bereaved families. The adapted tool improved respondent comfort, data accuracy, and digital integration, incorporating global positioning system coordinates and interviewer identification numbers. The adapted tool retained compatibility with automated VA coding platforms and was incorporated into training regimen for data collectors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13104-025-07560-1
Intersectional stigma and resilience in the uptake of cervical cancer prevention services in Nigeria: a qualitative study.
Get PDFBACKGROUND: Cervical cancer is one of the leading causes of death among women in Africa, but stigma often delays cervical cancer prevention. We explore the perceptions, enablers and nurturers through the lens of intersectional stigma in the uptake of cervical cancer prevention services in Nigeria.
METHOD: Indepth interviews and focus group discussions were conducted among women aged 30-65 years and girls aged 9-26 years in Lagos, Nigeria. Data were analysed thematically. Using the relationships and expectation domain of the PEN-3 cultural model, we identified perceptions, enablers and nurturers related to the uptake of primary and secondary cervical cancer prevention services in Nigeria. We also explored how social identities may intersect with health-related stigmas and affect the uptake of these services.
RESULT: We interviewed 31 women and 31 girls. 61% of the participants were Christians and 39% were Muslims and were from the three major ethnic groups in Nigeria: Igbo (34%), Hausa (38%) and Yoruba (28%). Themes emerging from the data: (1) positive perceptions (self-efficacy): many women understood the importance of protecting themselves and their daughters from cervical cancer and strongly believed that they could educate their partners/husbands and would not let other people's experiences with the vaccine influence them negatively. (2) Negative perceptions (anticipated stigma): some women expressed that because the human papillomavirus that causes cervical cancer is mainly sexually transmitted, they were concerned that they may be perceived as being promiscuous if they decide to commence routine cervical cancer screening. (3) Enablers (social support): nearly all women wanted the support of their spouses before receiving cervical cancer screening. (4) Nurturers (resilience): many clearly understood the complex social and economic realities faced by Nigerians that negatively affect their access to healthcare.
CONCLUSION: These findings offer intersectional insights into advancing public health and culturally anchored interventions to preventing cervical cancer-related stigma in Nigeria
Prevalence of Campylobacter and non-typhoidal Salmonella along broiler chicken production and distribution networks, Northern Vietnam.
Get PDFCampylobacter and non-typhoidal Salmonella (NTS) are among the most common foodborne pathogens found in chickens at any production stage and cause gastroenteritis in humans. This study aimed to estimate the prevalence of Campylobacter spp. (C. coli and C. jejuni) and NTS in broiler production and distribution networks (PDNs) using a Bayesian approach. It also investigated the NTS serotypes circulating in these PDNs. A cross-sectional study was conducted in four provinces in northern Vietnam between March 2021 and March 2022. A total of 102 sites, including live bird markets, slaughter facilities (slaughterhouses and slaughter points), and their supplying farms, were randomly selected for sampling. Cecal and environmental samples were cultured for isolation of Campylobacter and NTS, with serotypes of NTS determined by targeted analysis of whole genome sequences. Bayesian models were developed to estimate the prevalence of Campylobacter at two levels (bird-level and site-level) and NTS at site-level. The selected best-fitted models indicated that C. jejuni prevalence was primarily influenced by site type, while C. coli was affected by both province and site types. For NTS, only site type was included. The highest overall prevalence of infected broilers was estimated on farms for C. coli (26.2% [95% High Density Interval (HDI): 19.0-36.0%]) and C. jejuni (19.9% [95%HDI 13.0-27.0%]). Slaughter points (97.6% [95%HDI 63.3-99.9%]) and wholesale markets (91.7% [95%HDI 28.2-99.9%]) had the highest probability of C. coli and C. jejuni contamination, respectively, but retail markets had the highest proportion of infected broilers at contaminated sites. NTS contamination was more frequent in markets and slaughter facilities (42.8% [95%HDI 30.8-57.1%]) than on farms (18.6% [95%HDI 9.5-30.1%]). Among 16 detected NTS serotypes, S. Infantis and S. Kentucky were the most common. These findings highlight the widespread contamination of broiler PDNs with Campylobacter and NTS in northern Vietnam, emphasizing the need for enhanced surveillance and control measures in PDNs to mitigate the risk of foodborne transmission
Mortality impacts of long-term PM 2.5 and NO 2 exposure in Great Britain under national and international air quality limits
Get PDFPM2.5 and NO2 are two of the most dangerous air pollutants, contributing to substantial excess mortality across Europe. In 2021, the World Health Organization (WHO) revised its air quality (AQ) guidelines, decreasing the recommended annual limit from 10 μg/m3 to 5 μg/m3 for PM2.5, and from 40 μg/m3 to 10 μg/m3 for NO2.
In this study, we analysed concentrations and associated long-term premature mortality across Great Britain from 2008 to 2018 in relation to multiple AQ limits, as determined by WHO guidelines and international/national regulations.
The percentage of the population exposed to PM2.5 concentrations above 10 μg/m3 decreased from 67.6 % to 38.2 % over the study period, whereas those exposed to NO2 levels above 40 μg/m3 remained low. Levels below the new, lower WHO guidelines for PM2.5 and NO2 were reached in only a handful of locations.
Exposure to PM2.5 in 2018 resulted in 36,403 (30,422–42,640) premature deaths, whereas NO2 exposure contributed to 20,175 (7125–32,281) premature deaths. These numbers could be reduced by 46 % and 44 %, respectively, if exceedances beyond the lower cut-offs were avoided.
These findings indicate that complying with the new WHO recommendations would require considerable effort, but they can lead to substantial health benefits
Evaluation of dengue virus seroprevalence in four boroughs of Mexico City among persons aged 5-35 years in 2022.
Get PDFINTRODUCTION: Dengue is currently the most widespread vector-borne disease, and its transmission has been intensively studied in endemic/hyperendemic localities. However, to obtain a complete picture of dengue transmission, it is necessary to study nonendemic localities. Imported dengue cases have been reported in Mexico City, and the presence of eggs of the vector Aedes aegypti has been detected.
METHODOLOGY: In the present study, we determined the prevalence of IgG antibodies against Dengue virus in four city boroughs via random cluster sampling in individuals aged 5-35 years.
RESULTS: The weighted seroprevalence rate was 1.90% (95% CI 0.75-4.75) at Xochimilco, 1.81% (95% CI 0.64-5.00) at Venustiano Carranza, 1.81% (95% CI 0.54-5.83) at Tlahuac, and 5.48% (95% CI 1.96-14.43) at Gustavo A Madero; seropositivity was concentrated in the adult group, many of whom lived in dengue-endemic localities. The distribution of seroprevalence in the four boroughs is very homogeneous and unrelated to the number of vector eggs in the borough.
CONCLUSIONS: These data suggest that there is still no autochthonous transmission of dengue in Mexico City. However, it is important to note that the structural conditions of the dwellings in these boroughs, which offer minimal barriers to vector infestation, could facilitate the establishment of local transmission under favorable conditions
Digital screen exposure in infants, children and adolescents: a systematic review of existing recommendations.
Get PDFOBJECTIVES: This review aimed to synthesise existing recommendations - issued by either United Nations agencies, scientific societies, governmental health authorities, non-profit organisations, or others - on digital screen exposure in infants, children, and adolescents.
STUDY DESIGN: Systematic review.
METHODS: A wide search strategy was utilised - including digital databases (PubMed, EMBASE, Web of Science), Google, ChatGPT, reference lists from and grey literature -up to July 2024. Identified documents were categorized by type, issuing institutions, audience, publication year, and age groups. A synthesis of recommendations on screen time quantity was provided, comparing recommendations from the World Health Organization (WHO) with those from other institutions/bodies.
RESULTS: Out of 85,425 records retrieved, 41 documents were identified. Of these, 23 were published by scientific societies, 13 by government/health authorities, two by the WHO, and three by non-profit organisations. In relation to digital screen quantity, most documents aligned: i) for children under 2 years, most documents recommended zero exposure (n = 20/22); ii) for children aged 2-5 years, the majority recommended limiting screen time to 1 h per day (n = 17/21); iii) for children over 5 years and adolescents, the most permissive guidelines suggested a maximum of 2 h per day (n = 8/10). Existing recommendations were either equally strict or more restrictive than WHO guidelines. In regard to the quality of digital screen exposure, 10 key points emerged, along with additional guidance for parents, schools, healthcare professionals, researchers, and industry.
CONCLUSIONS: There is consensus on the need to limit the quantity of digital screen time for infants, children and adolescents and to ensure good quality exposure. This alignment provides a strong basis for governments and other bodies to agree on local recommendations, as well as strategies to improve their implementation in practice
Monitoring depression with the PHQ-9 in primary care: a qualitative study.
No full textBACKGROUND: Primary care guidelines recommend general practitioners consider using depression symptom questionnaires as patient-reported outcome measures (PROMs) to monitor depression in adults to inform treatment and evaluate management strategies. The PROMDEP randomised controlled trial assessed the use of the Patient Health Questionnaire's (PHQ-9) effectiveness and cost-effectiveness for monitoring depression. We gathered qualitative evidence on the views and experiences of participating patients and practitioners to inform interpretation of the findings.
AIM: To explore the views and experiences of patients and practitioners of using the PHQ-9 in the PROMDEP trial of monitoring depression in primary care. DESIGN & SETTING: Nested qualitative study and process evaluation of the trial in primary care in England and Wales.
METHOD: Twenty-nine patients and 15 practitioners took part in semi-structured telephone or video interviews. Interview data were analysed using thematic analysis.
RESULTS: Patients and practitioners both valued the PHQ-9 and reported limitations in its use for monitoring depression. This included its role in improving understanding of depression, impact on consultation and care, and integration within current primary care processes. In the context of the PROMDEP trial, our findings highlight potential reasons for the mixed trial findings, including how resistance in its use in practice may be due to barriers that make it hard for practitioners to integrate the PHQ-9 in consultations.
CONCLUSION: Monitoring of depression using PROMs need to be considered within the context of current primary care processes and resources. Further research is warranted to understand how the PHQ-9 can be successfully integrated into consultations
Hygiene system modeling for toileting in schools.
Get PDFBACKGROUND: Hygienic toileting is associated with positive health outcomes; yet efforts to provide the necessary preconditions for this behavior, namely provision of anal cleansing materials, a well-maintained toilet facility, and handwashing, are often limited-especially in schools-by a complex set of determinants and upstream factors that hinder access to the materials and behavioral drivers required for effective practice. Systems thinking, and its associated tools, is one approach to understanding and developing interventions to address the complexity of an interconnected set of factors impacting hygiene program outcomes.
METHODS: This study modeled the interconnected factors influencing preconditions for hygienic toileting in schools using expert-based participatory systems modeling. Two global hygiene meetings were utilized to recruit participants for hygiene systems modeling, and to compare results across two distinct groups of model participants. Participants identified and prioritized hygiene system factors, created systems models, and performed structural analyses using influence maps and causal loop diagrams to compare key leverage points driving hygienic toileting in schools.
RESULTS: Participants prioritized nine factors. Three of the nine factors were found to be highly influential and to drive the core system dynamics across both groups of participants: WASH leadership, governance, and partnerships; resource mobilization; and human resource capacity.
DISCUSSION: Our study identified leverage points for system strengthening to deliver the preconditions for hygienic toileting in schools. Systems thinking should precede system strengthening to ensure the efficient and effective use of resources and to enhance the sustainability of outcomes