General-domain sentiment models have been found ineffective in distinguishing positivity and negativity in Intensive Care Unit (ICU) clinical notes and domain-specific sentiment models are recommended. Although there are multiple common approaches to sentiment analysis, there has been little work comparing and evaluating the effectiveness of specialized models, largely due to the difficulty of recruiting clinical annotators and of accessing clinical sentiment data. This study has three contributions: (1) MIMIC-III-Ext-Notes-Sentiment: the first public ICU-specific ground- truth dataset labeled by clinicians for investigating clinical sentiment polarity in ICU clinical notes. (2) SentimentICUModel: an effective model for classifying clinical sentiment in ICU narratives on the ground truth. (3) A guiding comparison of the effectiveness of a range of approaches to clinical sentiment classification on the dataset. We recruited five clinicians to annotate notes for the ground truth. Annotators indicated which pieces of note text influenced their labeling. Six clinical-specific models were compared on the ground truth. The task of annotation was challenging due to clinicians' workload and spanned 15 months. The ground truth data was formed based on inter-annotator agreement analysis. Clinicians' extracts similarity aligned with their agreement level. Clinical language models provide comparable accuracy (up to 82%), with top score achieved by ClinicalT5 which is being released as SentimentICUModel. They outperform keyword-based lexicon (p[Formula: see text], [95% CI, -0.47, -0.28]). Clinical language models have demonstrated effectiveness in identifying clinical sentiment within clinical notes, enabling early detection of sudden changes and exploring different patterns in patients' ICU stays.
The purpose of this research was to pilot a methodology for integrating portable X-ray fluorescence (pXRF), personal air sampling, and ethnographic field notes during an agrichemical fumigation event in a commercial avocado orchard in Michoacán, Mexico. Portable exposure-assessment technologies are increasingly used in field research; however, there remains limited methodological demonstration of how ethnographers can integrate these instruments into real-time observation and analysis. Instrument outputs were aligned with ethnographic documentation of movement, labor practices, and routine activities during fumigation. This approach revealed short-duration exposure dynamics linked to specific practices across environmental matrices, including airborne particulates and orchard surfaces. The field deployment also revealed substantial workflow and ergonomic constraints, particularly related to time-stamping observations, synchronizing instrument outputs with field notes, and managing cognitive load while operating multiple devices. This study is not intended to offer a comprehensive exposure characterization. Instead, it provides a methodological demonstration based on data from a single fumigation event. These findings demonstrate the feasibility of integrating portable analytical instruments into ethnographic fieldwork while highlighting practical considerations for researchers conducting environmental and occupational exposure assessments.
The objective of this study was to identify the Burkholderia cepacia complex in patients with cystic fibrosis in northwestern Iran using conventional culture. Additionally, the study aimed to evaluate the efficacy of molecular identification via PCR and a preliminary ELISA, and to determine the correlation between laboratory findings and clinical presentations. The Burkholderia cepacia complex was not identified in oral mucosal swab samples from 100 cystic fibrosis patients using conventional culture media, including MacConkey agar and blood agar, followed by biochemical tests. However, the complex was identified with high precision by targeting the recA gene locus in PCR analysis. Furthermore, an optimized indirect ELISA using native antigens identified five and 12 positive cases, respectively. In the five PCR-positive cases, symptoms included growth delay, productive cough, and digital clubbing, accompanied by radiological findings such as bronchiolar involvement, airway wall thickening, and bronchiectasis. All five cases responded positively to co-trimoxazole treatment. These findings suggest that molecular analyses and ELISA assays using native species could be promising candidates for establishing efficient and appropriate methods for the diagnosis of the Burkholderia cepacia complex.
To describe psychomotor development in children aged 12 to 23 months from rural and urban communities in southern Ecuador using the Abbreviated Development Scale (EAD-1). A total of 138 children were evaluated in the cantons of Calvas and Gonzanamá (56.5% male; mean age 17.75 months [95% CI: 17.14-18.36]). Most participants were classified in the medium developmental category (51.4%), while 24.6% were categorized in the alert level. The personal-social domain showed the highest proportion of alert classifications (42.8%), followed by the hearing-language and gross motor domains (28.3% each). Fine motor-adaptive performance showed more favorable distributions, with most children classified in the medium and medium-high categories. These findings reflect developmental performance within a non-probabilistic sample and should be interpreted as descriptive.
Institutional delivery is an evidence-based option that substantially reduces risks to mothers and newborns. However, the existing literature provides an incomplete account of the determinants that influence individuals' choices about institutional delivery. This study explores the determinants (facilitators, barriers) of health-seeking behavior for institutional delivery in Nepal. This study employed a focused ethnographic design, which allowed for an in-depth understanding of participants lived experiences in relation to health seeking behavior to institutional delivery. 60 in-depth interviews were conducted among mothers of children under two years, followed by transect walk, informal discussion with community people and field observations. Purposeful sampling included mothers who delivered in health facilities to explore facilitators of institutional delivery and mothers who delivered at home to identify barriers. Primary data were collected from both rural and urban sites across seven provinces of Nepal. All interviews were audio-recorded, transcribed in Nepali, and subsequently translated into English. Codes were generated from the translated transcripts, and those codes were then organized into overarching themes and sub-themes. An inductive approach was employed for data analysis, and R-based Qualitative Data Analysis (RQDA) software was used for data management. The study revealed broad support for antenatal care and health facilities, emphasizing their safety and benefits. Information about institutional delivery was disseminated through multiple channels, although some participants lacked comprehensive knowledge, leading to decisions influenced by personal intuition and cultural beliefs. Household decision-making dynamics, geographic accessibility, and financial considerations were significant factors influencing the selection of delivery location. While some participants valued free services, others experienced financial hardships. Infrastructure limitations and behaviours of health workers also affected health-seeking behaviors. Antenatal care and facility-based childbirth are widely accepted among women in Nepal; however, utilization of institutional delivery remains constrained by multiple barriers, including limited maternal knowledge, family decision-making dynamics, distance and transport challenges, hidden costs, shortages of facilities and personnel, disrespectful care, and COVID-19-related disruptions. Addressing these barriers is important to improve access to safe facility-based delivery.
Child and adolescent mental health is increasingly recognized as a major public health concern worldwide. However, access to timely and coordinated mental health care remains uneven, particularly for children experiencing psychosocial, developmental or learning difficulties. Fragmentation across health, social care and education systems often contributes to discontinuous care pathways, especially in resource-constrained and rural settings. While a substantial body of literature on child mental health services originates from high-income countries, the organization of services differs significantly across national systems. In France, Child and Adolescent Medico-Social Centres (Centres Médico-Psycho-Pédagogiques, CMPP) are publicly funded outpatient services operating at the interface of healthcare, disability support and education sectors. Despite their central role in organizing care pathways, little is known about how these pathways are shaped and sustained in everyday practice. This qualitative study adopted an interpretive case study design within a French CMPP located in a predominantly rural territory. Data were collected as part of a collaborative action-research project and included 50 semi-structured interviews with families, CMPP professionals and territorial partners, as well as approximately 250 h of participant and non-participant observations. Data were analyzed using an abductive thematic approach supported by the qualitative coding software Taguette. Coding and interpretation were conducted collaboratively within an interdisciplinary research team combining perspectives from public health and management sciences. Regular analytic meetings were recorded and documented, enabling the research team to retrace the iterative development of codes and themes and to compare insights across interviews, observations and reflexive notes. Ten main themes were identified, highlighting organizational, relational and territorial mechanisms shaping child mental health care pathways over time. Results show that pathways are rarely linear and are marked by delays, uncertainty and discontinuities, particularly in contexts of limited resources. Families play a central role in sustaining continuity of care through coordination, information sharing and engagement, often compensating for systemic fragmentation. Professional practices rely on situated adjustments and informal coordination to manage constraints, while territorial characteristics such as rurality influence access to specialized resources and intensify reliance on local networks. This study provides an empirically grounded analysis of child mental health care pathways within a French medico-social service. The findings highlight how organizational constraints, territorial characteristics and intersectoral coordination practices shape care trajectories in practice. By examining pathways as lived and negotiated processes, the study contributes to health services research on care coordination and equity in child mental health systems, while highlighting the specific role of medico-social organizations such as CMPPs within the French context.
It is challenging and time-intensive to assess fidelity to complex evidence-based interventions in the homeless service sector. We describe a multi-component procedure to assess fidelity to Critical Time Intervention (CTI)-an evidence-based, time-limited case management practice for homeless-experienced persons undergoing housing transitions-developed for a large-scale pragmatic trial conducted with homeless-experienced Veterans. Using literature review, expert consultation, and pilot testing, we developed a pragmatic, scalable CTI fidelity assessment procedure. We integrated data from: a CTI implementation self-assessment designed to enhance provider practice; 90-minute videoconferences with case managers to collaboratively review charts from ≥2 randomly selected "exemplar cases" assessed for CTI's core components; and field notes from case manager narratives during these videoconferences. At 12- and 18-month timepoints after CTI implementation began with 17 case managers across 15 homeless service agencies, we employed this procedure to assess fidelity to CTI. We used field notes to contextualize differences between self-assessment and expert-rated findings. All case managers self-assessed their CTI practice as well- or ideally-implemented. Expert-rated assessments suggested that all case managers had limited fidelity to at least one of CTI's core components; 4 agencies had inadequate fidelity to the overall practice. Field notes provided explanations for disparate results between the self- and expert-rated assessments, including skill deficits, staff turnover (resulting in limited understanding of CTI's core components), and agency mandates (e.g. for case management visit frequency that were misaligned with CTI). The effectiveness of CTI is contingent on adherence to its core components. Streamlined approaches to fidelity assessment across EBPs in the homeless service sector is important for pragmatic, large-scale implementation efforts. The integration of self-assessment and expert-rated assessments can be applied to other multifaceted EBPs in the homeless service sector. Supplementing fidelity assessments with field notes may be useful to contextualize disparate findings between self- and expert-rated assessments, and to shape feedback to providers that enhances practice fidelity and improves housing outcomes. This project was registered with ClinicalTrials.gov as "Implementing and sustaining Critical Time Intervention in case management programs for homeless-experienced Veterans." Trial registration NCT05312229, registered 4/4/2022.
As telemedicine becomes a core component of modern healthcare, its effective application involves more than just the use of digital tools. An evolving skill set is required for current and future clinicians to adapt to this environment. Telementoring is a subset of telemedicine that involves clinician-to-clinician interaction, providing remote expert guidance in clinical care and medical education, with the potential to reduce global disparities. Yet, how trainees and mentors adapt to this virtual setting for effective learning remains unclear. To generate transferable insights across contexts, research on technology-enhanced environments must use designs that are both practice-oriented and theoretically grounded. Therefore, to investigate how telementoring shapes clinicians' competency development, this study adopts a theory-informed case study of a telementoring Point-of-Care Ultrasound (POCUS) program in a resource-limited setting. We applied a design-based research approach to bridge educational theory and practice and to enhance understanding of complex learning in authentic environments. This project took place in two healthcare centers in Uganda. Three design principles (authentic learning, deliberate practice, and scaffolding complexity) guided a two-cycle iterative design, evaluation, and re-design of telementoring sessions following initial in-person POCUS training, attended by 24 clinicians. Data sources included field notes, observations, and semi-structured interviews with seven POCUS trainees, two department heads, and two POCUS mentors collected over the twenty-one-month project duration. Data were analyzed using reflexive thematic analysis. Our findings capture the adaptive, iterative learning trajectories of clinician trainees and mentors engaged in telementored POCUS training in real-world contexts, characterized by participants as "building a boat while sailing." Their adaptive capacity developed through (1) cultivating an enhanced situational and socio-cultural awareness, (2) refining feedback and mentorship practices, and (3) scaffolding technological and task complexities. Our project also showed a limit to adaptability and competency development via telementoring in relation to task complexity. We introduce the concept of 'telementoring literacy' as the adaptive capacity of clinicians -- at both ends of the digital connection -- to effectively engage with clinical skill training and patient care through telementored interactions. Refining the components of telementoring literacy will further enable trainees and mentors to enhance telementoring implementation across different settings.
To improve assessment of and communication for delirium to 85% of eligible patients and to improve nurses' knowledge of and self-efficacy for delirium. Detection and prevention of delirium have become a high priority safety and quality issue globally. However, inadequate screening and objective assessment by nurses remains ongoing problems, often attributed to an inadequate knowledge base. A repeated cross-sectional audit study, incorporating the 4Es implementation model and a multimodal education program for nurses, was undertaken across four wards of a rural hospital between March 2023 and March 2024. Bimonthly clinical practice audits using a point prevalence approach were undertaken with a pre-determined benchmark of 85%. The 3-module education program (1. Face to face; 2. Self-directed online; 3. Objective Structured Clinical Examination OSCE) was delivered in a new ward every 2 months. Nursing knowledge of (22 items) and self-efficacy (12 items) for delirium practices were collected before the education program (T0), after program (T1) and 6 weeks following program (T2). 378 patient notes were audited across 7 audits. Practice outcomes for 6 key practices reached and remained at the benchmark over the study period and for three months after. 187 knowledge surveys were submitted by 90 participants across all three time points, with 30 participants submitting all three. 86% were RNs with a mean age of 41.03 and 15.86-years' experience. Knowledge outcomes were satisfactory and remain unchanged over time [T0 16.62 [SD 2.96]; T1 17.07 [SD 2.01]; T2 17.67 [SD 1.62]). Participant self-efficacy for detection and management of delirium improved significantly between T0 and T2. Participant feedback indicated that the education program, especially module 3-OSCE, contributed significantly to this self-efficacy CONCLUSION: This study demonstrated that pairing an evidence-based education program with an implementation strategy created synergies that led to sustainable improvements in key delirium assessment and communication practices. Nursing leaders, including nursing managers, nurse educators, and specialised expert nurses, play an integral role in ensuring successful translation of research into practice and quality improvement projects. For such projects to be successful, nurse managers need to be highly visible to legitimise the project and implementation team and to facilitate processes. Not applicable.
The integration of Problem-Based Learning (PBL) and Knowledge Scaffolding in postgraduate immunology education has been shown to enhance the quality of adult learning. This process supports the development of problem-solving skills in learners through critical thinking, self-direction, and practical application of knowledge. This study aims to improves the postgraduate immunology teaching to strengthen lifelong learning capacities by incorporating PBL and knowledge scaffolding. In this study, PBL was implemented with thirty postgraduate students enrolled in the Immunity to Infectious Diseases course. Students were divided into three small groups and engaged in collaborative problem-solving by analyzing immunology research papers and constructing domain-specific mind maps. These were later integrated into a comprehensive class-wide mind map, with data collected through structured feedback forms. Out of the 30 feedback forms distributed to participants, 29 (97%) were returned and used for analysis. The majority reported that small-group activities encouraged idea sharing (87%), class-wide integration boosted confidence (83%), and the exercise enhanced problem-solving skills (80%). Moreover, students also valued teacher guidance (90%) and recommended continuation of the activity (93%). Further the facilitator's notes confirmed higher engagement compared with lecture-based sessions. The findings suggest PBL supported by scaffolding promotes confidence, collaboration, and self-directed learning in postgraduate immunology.
Climate change represents a global challenge with unequal impacts on vulnerable populations, particularly women living in vulnerable urban contexts. This study examines, from the perspective of women residing in an urban occupation within the metropolitan region of São Paulo, how climate change exacerbates social and gender inequalities, affecting living conditions and health. This qualitative study was guided by Emancipatory Action Research and conducted in the Lélia Gonzalez occupation, linked to the Homeless Workers' Movement (MTST), in Santo André (São Paulo, Brazil), between March and August 2025. Thirteen women participated, including both cisgender and transgender individuals. Data were generated through six emancipatory workshops and a complementary questionnaire, supported by audio recordings, full transcription, and field notes. Data were analyzed using open coding and the development of emergent categories, interpreted through the Social Determination of Health framework and the 4 S principles: sustainability, security, solidarity, and sovereignty. Participants associated climate change with everyday experiences such as extreme heat, flooding, respiratory diseases, food insecurity, and precarious housing conditions. These phenomena were perceived as intensifying gender inequalities, increasing work and care burdens, exacerbating situations of violence, and reinforcing processes of social exclusion. Climate change deepens social and gender inequalities, directly affecting the health and daily lives of women in vulnerable urban settings. Emancipatory Action Research was a useful approach for articulating experiences, fostering critical reflection, and supporting collective action. The findings highlight the relevance of gender-sensitive, intersectoral public policies guided by the principles of sustainability, sovereignty, solidarity, and security, particularly in such contexts. Mudanças Climáticas; Equidade de Gênero; Vulnerabilidade em Saúde; Saúde; Mulheres; Desigualdades de Saúde. Climate Change; Gender Equity; Health Vulnerability; Health; Women; Health Inequalities. Cambio climático; Equidad de Género; Vulnerabilidad in Salud; Salud; Mujeres; Inequidades in Salud.
The Visual Patient Avatar concept transforms conventional patient monitoring data into a dynamic, animated representation of the patient, enhancing situation awareness of vital signs and measurement status. Rapid recognition and response to cardiac pathologies are critical in anaesthesia and critical care. Visual Patient Heart (VPH) integrates cardiac data from the Philips "ST/AR algorithm", a feature in Philips patient monitors, into visual design elements inside the heart element of the Visual Patient Avatar, specifically aiming to improve situation awareness of arrhythmias and ST-segment deviations. Participants evaluated a randomized series of 12-lead ECGs alongside corresponding VPH visualizations, each shown briefly to assess the speed of information transfer. Immediately after the exercise, they were asked two open-ended questions and encouraged to speak freely about perceived advantages and areas for improvement of the VPH concept. Their verbal responses were transcribed through field notes and analyzed using a template-guided analysis. The analysis of correct responses in the ECG-avatar comparison test is reported separately in a dedicated paper. Analysis of 193 statements from 41 participants revealed that participants perceived VPH as intuitive, easy to learn, and cognitively less demanding than conventional ECG interpretation. Benefits reported by participants included improved situation awareness, faster rhythm recognition, and increased decision confidence. Suggestions for improvement addressed visual clarity, the need for more training, and integration with conventional ECG data. Concerns included over-reliance on the system and potential erosion of traditional ECG interpretation skills. The VPH system was well received, with participants highlighting its simplicity, clarity, and potential to enhance situation awareness. Feedback also raised important considerations around explainability, trust, and integration of the visuals with conventional ECGs. These findings support further development and evaluation in more complex, clinically realistic settings.
To create a public digital database centered on adult traumatic brachial plexus injury (TBPI). TBPI mainly affects young males, usually involved in motorcycle accidents, often leading to severe motor and sensory impairment in the affected upper limb. This initiative aimed at encouraging data sharing and reuse. Managing data from TBPI may enable the identification of functional markers associated with clinical improvement in individuals with TBPI and foster the development of new investigative tools to elucidate its mechanisms. Detailed electronic questionnaires were designed to collect epidemiological, physical, and clinical data. The free software Neuroscience Experiments System (NES) was employed to support data storage and management. Hence, data from 170 Brazilian adult individuals with TBPI with varying degrees of functional impairment were collected. The Unified Admission Assessment (Q44071_unified-admission-assessment) was devised to register the first evaluation by the TBPI research group. The Unified Follow-up Assessment (Q92510_unified-follow-up-assessment) was created to register subsequent follow-up visits. The Unified Surgical Evaluation (Q61802_unified-surgical-evaluation) was designed to record the surgical procedures used for brachial plexus reconstruction. Data collection occurred between 2014 and 2020.
The purpose of this dataset is to document familial patterns of some observable human phenotypes within an Indian population. The data are collected to support the study of inheritance mechanisms across both well-established Mendelian traits and phenotypes with uncertain or population-dependent inheritance, and to provide a pedigree-based resource for methodological and computational research. The dataset comprises phenotypic information from 250 parent-offspring triplets. Five observable traits are recorded: ABO blood group, Rhesus (Rh) factor, widow's peak, facial dimples, and facial freckles. Data are collected using a structured questionnaire administered to adult participants, who reported their own traits as well as those of their biological parents. Minimal preprocessing was applied, and no statistical imputation was performed; missing values are explicitly encoded. Data validation was conducted by comparing observed inheritance patterns and phenotype frequencies for ABO blood groups and the Rh factor against expected population values to assess biological plausibility and population representativeness. The dataset is suitable for studies of genetic inheritance, evaluation of computational inheritance models, and development or benchmarking of intelligent imputation techniques.
This secondary analysis of a randomised controlled pilot study (n = 87 patients) examined how transdiagnostic factors-including emotion regulation mechanisms (emotion beliefs, cognitive reappraisal, emotion suppression and experiential avoidance) and negative affectivity-relate to depressive, anxiety and somatic symptoms in the primary care setting, and whether emotion regulation mechanisms provide potential screening relevance beyond negative affectivity, i.e., by explaining variance in symptom severity that is not accounted for by negative affectivity alone. All transdiagnostic factors were correlated with depressive, anxiety and somatic symptom scores. Negative affectivity showed the strongest associations across diagnosis-specific symptom scores, while small to moderate correlation estimates were observed for the emotion regulation mechanisms. In multiple regression analyses, negative affectivity remained the most consistent contributor to symptom variance; emotion regulation mechanisms showed limited incremental value. Lastly, across the respective symptom severity levels of depression, anxiety and somatic symptom scores, negative affectivity most closely reflected symptom gradients. These cross-sectional findings suggest that negative affectivity may serve as a particularly informative transdiagnostic indicator of overall symptom burden in primary care. While no incremental relevance of emotion-regulation mechanisms beyond negative affectivity was supported, their potential for guiding mechanism-based interventions and relation to symptom trajectories should be examined by future research. The pilot study has been registered with the German Clinical Trials Register: 18th of March 2024, https://drks.de/search/en/trial/DRKS00033386.
Proper removal of fluoride varnish (FV) residue is essential to avoid interference in fluoride uptake measurements in research studies. This study evaluated five FV removal protocols applied to inert slabs (n = 8 per group): (I) scalpel blade, (II) acetone-soaked cotton swab, (III) combination of I and II, (IV) II plus 30-s acetone wash, and (V) plastic spatula + II + three 10-s vortexed acetone washes. A water-soluble fluoride gel served as control. Alkali-soluble residual contaminant fluoride (RCF) was quantified. %RCF values were: I (3.35 ± 1.27)A, II (0.18 ± 0.20)B, III (0.10 ± 0.13)BC, IV (0.01 ± 0.01)C, V (0.03 ± 0.01)C, and control (0.02 ± 0.02)C. The combination of mechanical and chemical steps particularly with acetone and vortex washes minimize FV residues.
Tele-intensive care unit (TICU) networks have evolved quickly in recent years and have proved their value in providing care for the critically ill. Objective measures to assess performance and quantify success e.g. clinical and economic outcome parameters are desirable but not easily accessible in international collaboration with very diverse clinical settings and legal prerequisites. Therefore, we initiated a study to evaluate the performance in our tele-intensive care unit network. We conducted an online survey addressing clinical staff at ten spoke sites in four countries connected to one TICU hub to assess subjective clinical benefit, acceptance and potential for improvement. The majority of the 30 participants felt well supported clinically and personally, with a high acceptance and trust as well as a positive working relationship in tele-medical collaboration. Ethical principles and data protection were discovered to be persistently of utmost significance in tele-intensive care unit networks. International telemedicine in critical care is perceived positively without major differences between diverse health care systems when crossing borders, showing potential for improvement to guide future clinical and research approaches. Clinical trial registiry: The study was registered on August 11th, 2023 with the German Clinical Trials Register (DRKS-IDDRKS00032246; https://www.drks.de/search/de/trial/DRKS00032246/details ).
Wound care is a critical aspect of nursing practice, yet nurses often face challenges related to limited knowledge, lack of structured training, and insufficient organizational support. The integration of specialist wound care nurses has been suggested to enhance clinical outcomes, continuity of care, and professional competence among nursing staff. This study aimed to explore nurses' experiences with a specialist wound care nurse in a hospital setting and to identify the impact of this role on clinical practice and team performance. A qualitative descriptive-exploratory study was conducted in 2024-2025 at a specialized surgical and trauma care center in Iran. Ten participants, including staff nurses, head nurses, a specialist wound care nurse, and a nursing instructor, were recruited through purposeful sampling with maximum variation. Data were collected via semi-structured interviews (average duration: 35 min) and field notes, and analyzed using Graneheim and Lundman's qualitative content analysis framework. Trustworthiness was ensured through credibility, dependability, transferability, and confirmability strategies. Four main categories emerged: Specialized Wound Care, Continuity of Wound Care, Empowerment of Nurses, and Challenges and Strategies for Improvement. Specialist nurses enhanced evidence-based decision-making, improved care quality, accelerated wound healing, and reduced complications. They facilitated continuous, coordinated care across wards and empowered other nurses through clinical education and experiential learning. Barriers included staff shortages, undefined organizational positions, and insufficient managerial support, highlighting the need for structural and policy interventions. The presence of a specialist wound care nurse positively influences patient outcomes, care continuity, and professional development of nursing staff. For sustainable implementation, organizational support, formalized positions, adequate staffing, and Interprofessional education are essential. Integrating this role into hospital systems can foster safe, evidence-based, and patient-centered wound management.
Influenza vaccination programs are critical in reducing the morbidity and mortality from seasonal influenza and bolstering pandemic preparedness. However, there is a notable lack of information about the factors contributing to resilient and response-ready influenza vaccination programs in middle-income countries (MICs). This study set out to identify determinants of resilient and response-ready seasonal influenza vaccination programs in MICs. This study used a collective case study design to analyze structural and programmatic elements of resiliency and response-readiness within MIC influenza vaccination programs. A multi-step process was used to select suitable countries for the case study analysis, including an initial literature landscaping of MICs, stakeholder mapping, and an online scoping survey. A conceptual framework was developed to guide analysis across six determinants of resilient and response-ready programs: political, economic, structural, communication & education, socio-behavioral, and COVID-19 response. Data for the selected case studies were gathered via a narrative literature review (initial search conducted January-September 2022) and stakeholder consultations with 27 stakeholders (held between June and September 2022). Findings from the literature review and stakeholder consultations were analyzed using the framework to identify key themes related to influenza vaccination program resiliency and response-readiness. Five countries - Albania, Bolivia, Brazil, South Africa, and Thailand - met the study selection criteria and were selected as geographically diverse case studies. Five key themes emerged as consistent indicators of resilient and response-ready influenza vaccination programs: 1) building research capacity and a clear pathway from evidence to policy creates resilient and responsive influenza programs; 2) diversified procurement mechanisms help ensure a reliable supply of influenza vaccines; 3) healthcare workers are essential partners for implementing resilient and response-ready influenza vaccination programs; 4) demand generation is key to driving and maintaining influenza vaccine uptake; and 5) building and maintaining seasonal influenza vaccine infrastructure contributes to pandemic preparedness. The findings offer valuable insights and actionable guidance to improve influenza vaccination program resiliency and response-readiness in MICs and more broadly. Strengthening areas highlighted in this evaluation can help countries improve influenza vaccination coverage while building greater program resilience and readiness to respond to future public health threats, including influenza pandemics.
Eosinophilia is a recognized hematological marker associated with helminthic infections, including strongyloidiasis which is caused by Strongyloides stercoralis. This case-control study, conducted in Mazandaran province from 2022 to 2023, aimed to determine and compare the seroprevalence of S. stercoralis infection between individuals with eosinophilia and healthy controls without eosinophilia. The ELISA test by a commercial kit was used for serological detection of anti-S. stercoralis IgG antibodies, and data were analyzed using SPSS software (version 23). There was analyzed 184 samples, divided into two groups, with and without eosinophilia, with 92 individuals each. In these groups, 36.96% (34/92) and 7.61% (7/92) were positive for anti-S. strongyloides IgG antibodies, respectively, which revealed a strong association (OR = 7.12, 95% CI [3.82, 13.27], P < 0.001) between S. stercoralis antibodies as eosinophilia, confirming eosinophilia as a important predictor of S. stercoralis exposure. Subgroup analyses revealed that males, farmers, individuals aged > 41 years, those with a history of soil contact, and residents of rural areas exhibited higher seroprevalence rates of S. stercoralis. The findings suggest that screening individuals with eosinophilia for anti-S. stercoralis IgG antibodies may improve diagnosis in endemic area.