Acesso ampliado ao dispositivo intrauterino: impacto de um processo de trabalho promotor da autonomia na anticoncepção / Expanded access to intra-uterine devices: impact of a work process promoting autonomy in contraception / Acceso ampliado al dispositivo intrauterino: impacto de un proceso de trabajo que promueve la autonomía en la anticoncepción

Introdução: O dispositivo intrauterino (DIU) é uma das estratégias contraceptivas mais eficazes. Porém, apesar de ser amplamente distribuído pelo Sistema Único de Saúde (SUS), há baixa adesão ao método. São constatadas diversas barreiras para esse quadro, tais como desconhecimento acerca do dispositivo, além da reduzida oferta para inserção do contraceptivo por parte das Equipes de Saúde da Família (eSF). Tendo em vista que a ampliação do acesso ao DIU pode contribuir para a diminuição das gravidezes não planejadas, bem como para a autonomia e para o empoderamento das mulheres, algumas estratégias foram desenvolvidas por uma eSF para facilitar o acesso ao DIU. Objetivo: Refletir a respeito do impacto da incorporação de estratégias de educação em saúde para divulgar o método dentro da própria equipe, de sua área de cobertura e da diminuição de barreiras para a inserção, na ampliação do acesso ao DIU, no quantitativo de dispositivos inseridos, no número de gestações não planejadas e na possibilidade de aumento do empoderamento feminino. Métodos: Os dados coletados foram extraídos das informações presentes em planilhas e relatórios produzidos pela própria eSF. Utilizou-se da estatística descritiva para apresentar e analisar os dados obtidos, a partir de ferramentas de formulação de gráficos e tabelas. Resultados: Após mudança no processo de trabalho, visando ao acesso ampliado à inserção do DIU, observou-se um aumento no quantitativo do procedimento assim como na percentagem de gravidezes desejadas. Conclusões: O DIU surge como um instrumento para possibilitar o exercício dos direitos sexuais e reprodutivos e para alavancar atitudes emancipatórias das mulheres. Quanto menos barreiras as mulheres encontram para a inserção do DIU, maior é a escolha por este método, sendo a inserção por demanda espontânea, ou seja, no momento em que a mulher procura a eSF para fazê-la. Nesse sentido, as atividades de educação continuada tornam-se potentes ferramentas para possibilitar maior acesso ao método. Fazem-se necessários estudos de longa duração para que essas hipóteses sejam avaliadas, todavia, parece haver uma ligação positiva entre essas duas variáveis.

Introduction: Intrauterine device (IUD) is one of the most effective contraceptive strategies. Despite being widely distributed by the Brazilian Unified Health System (Sistema Único de Saúde ­ SUS), there is low adherence to the method. There are several barriers to this situation, such as lack of knowledge about the device, in addition to the reduced offer for contraceptive insertion by primary health care providers. Given that increased access to the IUD can contribute to reducing unplanned pregnancies, as well as empowering women, some strategies have been developed by a primary health care team to facilitate access to IUDs. Objective: This research reflected on the impact of incorporating health education strategies to disseminate the method and reduction of barriers to insertion, broadening IUD access, the number of devices inserted, the number of unplanned pregnancy and the possibility of increased female empowerment. Methods: Data were extracted from information present in spreadsheets and reports produced by the team itself. Descriptive statistics were used to present and analyze the data obtained, using tools for formulating graphics and tables. Results: After changing the work process to expanded access to IUD insertion, an increase in the number of procedures and the percentage of planned pregnancies was observed. Conclusions: The IUD appears as an instrument to enable the exercise of sexual and reproductive rights and to leverage women's emancipatory attitudes. The fewer barriers women encounter when inserting an IUD, the greater the choice for this method, with insertion being on spontaneous demand and continuing education activities, powerful tools to enable greater access to it. Long-term studies are necessary for these hypotheses to be evaluated, however, there appears to be a positive link between these two variables.

Introducción: El dispositivo intrauterino (DIU) es una de las estrategias anticonceptivas más efectivas. Sin embargo, a pesar de su amplia distribución a través del Sistema Único de Salud, existe una baja adhesión a este método. Se han identificado diversas barreras para esta situación, como el desconocimiento sobre el dispositivo y la oferta limitada de su inserción por parte de los equipos de salud familiar (eSF). Con el objetivo de ampliar el acceso al DIU y reducir los embarazos no deseados, así como promover la autonomía y empoderamiento de las mujeres, algunos equipos de eSF han desarrollado estrategias para facilitar su acceso. Objetivo: Reflexionar sobre el impacto de la incorporación de estrategias de educación en salud para difundir el método dentro del propio equipo y su área de cobertura, así como la eliminación de barreras para la inserción, en la ampliación del acceso al DIU, en la cantidad de dispositivos insertados, en el número de embarazos no planeados y en la posibilidad de aumentar el empoderamiento femenino. Métodos: Los datos recopilados se extrajeron de las hojas de cálculo e informes producidos por el propio eSF. Se utilizó estadística descriptiva para presentar y analizar los datos obtenidos mediante herramientas de creación de gráficos y tablas. Resultados: Después de un cambio en el proceso de trabajo destinado a ampliar el acceso a la inserción del DIU, se observó un aumento en la cantidad de procedimientos realizados. También se registró un aumento en el porcentaje de embarazos deseados. Conclusiones: El DIU se presenta como una herramienta que permite el ejercicio de los derechos sexuales y reproductivos y promueve actitudes emancipatorias en las mujeres. Cuantas menos barreras encuentren las mujeres para la inserción del DIU, mayor será la elección de este método, con la inserción a demanda, es decir, cuando la mujer lo solicita al eSF, y las actividades de educación continua como poderosas herramientas para facilitar un mayor acceso. Se necesitan estudios a largo plazo para evaluar estas hipótesis, aunque parece existir una relación positiva entre estas dos variables.

Empoderamento estrutural: potencializando as competências dos enfermeiros de um hospital de alta complexidade / Structural empowerment: enhancing the skills of nurses in a high-complexity hospital / Empoderamiento estructural: potenciar las competencias de los enfermeros en un hospital de alta complejidad

Objetivo: analisar o empoderamento estrutural de enfermeiros em um hospital de alta complexidade. Métodos: estudo quantitativo, analítico e transversal, realizado com 93 enfermeiros, utilizando um questionário sociodemográfico e ocupacional e o Questionário de Condições de Eficácia no Trabalho II. Os dados foram coletados entre fevereiro e março de 2023. A análise dos dados deu-se por meio de estatística descritiva, teste de Kolgomorov-Smirnov, teste do qui-quadrado e regressão de Poisson. Resultados: os enfermeiros apresentaram nível moderado de empoderamento estrutural, com média de 20,67 (p<0,000). O componente mais pontuado foi a oportunidade (4,22 dp±0,80). Não foram encontradas diferenças significativas nos níveis de empoderamento estrutural relacionadas às unidades de trabalho (p-Valor 0,381), vínculo empregatício (p-Valor 0,352) e grau de instrução (p-Valor 0,839). O modelo de regressão de Poisson indica que tanto pode haver altos ou baixos níveis de empoderamento a depender do setor. Conclusão: os enfermeiros demonstraram possuir níveis moderados de empoderamento estrutural.

Objective: to analyze the structural empowerment of nurses in a high-complexity hospital. Methods: a quantitative, analytical, cross-sectional study was carried out with 93 nurses, using a sociodemographic and occupational questionnaire and the Questionnaire of Conditions of Effectiveness at Work II. The data was collected between February and March 2023. The data was analyzed using descriptive statistics, the Kolgomorov-Smirnov test, the chi-square test, and Poisson regression. Results: the nurses had a moderate structural empowerment level, with a mean of 20.67 (p<0.000). The highest scoring component was opportunity (4.22 sd±0.80). No significant differences were found in the structural empowerment levels related to work units (p-Value 0.381), employment relationship (p-Value 0.352) and education level (p-Value 0.839). The Poisson regression model indicates that there can be either high or low empowerment levels depending on the sector. Conclusion: nurses showed moderate structural empowerment levels.

Objetivo: analizar el empoderamiento estructural del enfermero en un hospital de alta complejidad. Métodos: estudio cuantitativo, analítico y transversal, realizado con 93 enfermeros, utilizando un cuestionario sociodemográfico y ocupacional y el Cuestionario de Condiciones de Efectividad en el Trabajo II. Los datos se recolectaron entre febrero y marzo de 2023. El análisis de los datos se realizó mediante estadística descriptiva, prueba de Kolgomorov-Smirnov, prueba de chi-cuadrado y regresión de Poisson. Resultados: los enfermeros presentaron un nivel moderado de empoderamiento estructural, la media fue de 20,67 (p<0,000). El componente con mayor puntaje fue oportunidad (4,22 DE±0,80). No se encontraron diferencias significativas en los niveles de empoderamiento estructural relacionados con las unidades de trabajo (valor p 0,381), la relación laboral (valor p 0,352) y el nivel de formación (valor p 0,839). El modelo de regresión de Poisson indica que pueden existir niveles altos o bajos de empoderamiento dependiendo del sector. Conclusión: los enfermeros demostraron niveles moderados de empoderamiento estructural.

Patients' knowledge about renal secondary effects of anti-tumoral drugs and renal protection measures.

PURPOSE: Onco-nephrology is an emerging subspecialty aiming to better understand and prevent renal events in cancer patients. We assessed patients' knowledge about (1) oncological/hematological treatments induced renal toxicity and (2) kidney protective measures. METHODS: Adult patients receiving systemic anti-tumor treatments in multiple day hospital units in France answered a self-administered questionnaire about their knowledge and expectations related to treatment-associated renal toxicity. RESULTS: In total, 621 questionnaires were collected in 8 units from November 2021 to January 2022. Among respondents, 84.5% were treated for a solid tumor. Overall, 34.3% (n = 208) patients reported they had some knowledge about potential renal adverse events related to their anticancer treatment, and 38.5% (n = 234) about kidney protection measures. Their referring oncologist or hematologist represented the commonest source of knowledge (67.8%). Sufficient hydration was cited as a kidney protection measure by 93.2% (n = 218) of patients declaring some knowledge about renal toxicity; prevention of nausea/vomiting by 52.6% (n = 123). Consumption of still and alkaline water was chosen by respectively 64.4% (n = 400) and 16.8% (n = 104) of participants to correct dehydration. A majority of patients expressed strong interest for receiving more information about renal toxicity and prevention: median Likert scale score was 10/10 (Q1-Q3, 5-10), with online resources mentioned as the most desired source of information. CONCLUSION: One-third of patients declared they had some knowledge about potential renal toxicity of their oncologic treatment and the ways to prevent them, especially regarding hydration. However, a majority expressed interest for dedicated information, which conducted to the elaboration of free online educational sheets for patients.

Empowerment through technology: domestic violence acceptance among Iraqi women in an intersectional context.

BACKGROUND: Acceptance of domestic violence against women refers to the belief that violence can be justified. Women's attitudes towards domestic violence shape societal acceptance, victimization, disclosure, and help-seeking behaviors. This study explored the role of gender, socio-economic status, regional disparities, and empowerment in domestic violence acceptance among Iraqi women. METHODS: Using data from the 2018 Iraq Multiple Indicator Cluster Survey (MICS 6) with 19,443 married Iraqi women, this cross-sectional study employed logistic regression analyses to investigate individual, interpersonal, community, and societal determinants of domestic violence acceptance. RESULTS: 48.4% of married Iraqi women accepted domestic violence, with higher acceptance in South/Central regions (62-73%). Factors associated with higher acceptance included lower education (aOR = 0.39, 95% CI: 0.35-0.45 for upper secondary education compared to preprimary or non), functional difficulties (aOR = 1.60, 95% CI: 1.40-1.83), marriage to blood-related spouses (aOR = 1.45, 95% CI: 1.36-1.54), and rural residence (aOR = 1.20, 95% CI: 1.15-1.33). Conversely, owning a mobile phone (aOR = 0.47, 95% CI: 0.44-0.50) and using a computer/tablet (aOR = 0.34, 95% CI: 0.30-0.38) were associated with lower acceptance. CONCLUSION: These findings, given the lack of research on domestic violence among Iraqi women, highlight the urgent need for policy discussions supporting Sustainable Development Goals on gender equity and well-being. Enhanced access to technology could help women have better access to resources, support systems, and information, which would lower acceptance for domestic violence.

Mapping the intellectual structure of microfinance and women's empowerment: A bibliometric analysis.

The Sustainable Development Goals (SDGs) emphasize promoting and protecting women's rights and privileges. As a result, an increasing body of academic literature describes the various actions taken by different stakeholders to empower women. Amongst the initiatives implemented in many nations, microfinance and financial inclusion programs play a major role. This article aims to present an overview and synthesis of the research on the notion and practices of microfinance and its influence on entrepreneur women's empowerment. In order to do so, this study uses bibliometric techniques over a selection of papers extracted from the Web of Science database, to disentangle the knowledge structure of this academic field. According to our findings, the study of microfinance and women's empowerment is growing, with 470 publications, 963 authors, 67 nations and 36 research areas. Research topics include poverty reduction, gender issues in entrepreneurship, microfinance and women empowerment, and women in microcredit. An additional bibliographic coupling analysis has revealed the hottest research topics, showing the main gaps in the literature that suggest potential directions for future research.

Development of a Framework of Leadership in Academic Medicine (FLAM).

OBJECTIVES: Leadership within medical academic institutions often adheres to hierarchical structures, relying on factors like seniority and context, with limited focus on leadership development. This study aims to develop a structured framework by examining the traits, aspirations, and pre-requisites of academic leaders within medical school faculties. METHODS: A cross-sectional study collected input from regular medical faculty and those in leadership roles through an online questionnaire, followed by quantitative and qualitative analyses. Data was curated, analyzed, and triangulated to establish subdomains, domains, and themes for the framework. RESULTS: Among 229 respondents, 121 held formal academic leadership roles, the remaining 108 were regular medical faculty. And 92% of regular faculty cited lack of experience and training as significant barriers to effective leadership. Both groups agreed on the need for intensive leadership training, as 85% of leaders and 66% of regular faculty lacked formal academic leadership training. The concept of affiliative leadership was favored by 45% of leaders. Qualitative analysis and subtheme triangulation led to the development of the 6 Es Framework for Leadership in Academic Medicine (FLAM). This framework encompasses: ethics (accountability and role modeling), education (structured curriculum and training), envision (clear path and talent identification), engagement (structural foundation and attainable goals), empowerment (fostering passion), and encouragement (financial incentives). CONCLUSION: This research reinforces the necessity of structured leadership development in academic medicine. The unique attributes of the 6Es FLAM have the potential to enhance leadership in this field.

The Usefulness of Peer Tutoring and its Impact on Nursing Students' Academic Performance, Psychological Empowerment, and Satisfaction: Pre-Post Design.

Introduction: The entry to a professional course such as nursing is challenging for the students, due to its multifaceted curriculum and learning expectations. Objectives: This study investigates the impact of peer tutoring on academic performance, psychological empowerment, and satisfaction among first-year nursing students. Methods: A quantitative approach with one-group pre-test post-test design was utilized. The study participants were 104 students, with 98 completing both pre- and post-test assessments. Results: Findings revealed a significant increase in academic performance following peer tutoring (t = 8.97, p < .001), particularly among female participants (t = 4.14, p < .001). Analysis of perceived usefulness showed higher ratings among peer tutors compared to tutees (t = 4.380, p =< .000). Additionally, students with lower GPAs (Grade Point Average) demonstrated significant improvement in academic performance post-tutoring in the ANOVA (F = 6.214, p < .001). A positive correlation was found between psychological empowerment and the perceived usefulness of peer tutoring. Peer tutors reported high levels of satisfaction and positive experiences (r = 0.639, p = 0.001). Conclusion: This study emphasises the value of peer tutoring in enhancing academic outcomes and highlights the significance of demographic variables in educational interventions. The need for widespread implementation of peer tutoring programs, personalized approaches addressing gender biases, and comprehensive support for students with diverse academic backgrounds would enhance academic outcomes. The correlation between psychological empowerment and the perceived usefulness of peer tutoring climaxes the importance of addressing students' psychological needs in educational interventions.

Translation, Reliability and Development of a Calculator for the Brazilian Portuguese Version of the Family Empowerment Scale (FES) in Caregivers of Individuals With Cerebral Palsy.

INTRODUCTION: Care for patients with cerebral palsy (CP) poses significant challenges, with emphasis on the crucial role of family involvement in patients' well-being. The Family Empowerment Scale (FES) assesses parents/caregivers' perception of their ability to promote and influence their children's development in three domains: family, service system and community. OBJECTIVES: The objectives of this study were to translate the FES into Brazilian Portuguese, to develop a calculator for data transformation and analysis and to evaluate the psychometric properties of the scale with Brazilian caregivers of children and adolescents with CP. METHODS: Translation occurred in four stages: translation, synthesis, back-translation and review of the translated version. A calculator was then developed in the Excel program, to present data in absolute values and graphically for each subscale. Statistical analysis included Bland-Altman, Intraclass Correlation Coefficient (ICC), Internal Consistency, and Floor and Ceiling Effect. RESULTS: In total, 50 parents and caregivers participated to the measurement properties investigation, and the scale demonstrated good reliability for the family (ICC = 0.80) and services (ICC = 0.81) subscales, as well as for the overall scale (ICC = 0.88). The community subscale showed moderate reliability (ICC = 0.68), with an adequate Cronbach's alpha (0.89). The FES showed no ceiling or floor effects and a small limit of agreement. The data of all participants were analysed using the calculator. CONCLUSION: The FES-Brazilian Portuguese presented good reliability for assessing family empowerment in caregivers of children and adolescents with CP in Brazil, offering insights into this construct and guiding family-centred interventions. In addition, the calculator could be viable for adequate management and dissemination of data.

Advancing Digital Education Technologies by Empowering Nurses With Point-of-Care Ultrasound: Protocol for a Mixed Methods Study.

BACKGROUND: Bedside ultrasonography, also known as point-of-care ultrasound (PoCUS), is a promising technological tool that enhances clinical assessment, enriching diagnostic capabilities and clinical reasoning. Its use in nursing spans various patient populations and health care settings, providing nurses with a valuable health assessment tool to improve care quality and patient safety. Despite its growing integration into clinical practice, PoCUS training has mainly focused on physicians, leaving a gap for trained nurses who demonstrate similar proficiency in conducting scans and interpreting images. Previous research highlights the value of digital tools in PoCUS training, showing their role in improving professionals' and students' knowledge, image interpretation skills, and clinical acumen. OBJECTIVE: This study aimed to (1) establish an assessment instrument gauging nurses' competency milestones in PoCUS and evaluate its content and appearance validity, (2) develop a series of 5 educational videos focused on PoCUS and assess their content and appearance validity, and (3) construct an online learning environment tailored to nurses' PoCUS training needs and evaluate its content and appearance validity. METHODS: We will conduct a methodological study of technological production guided by Rogers' diffusion of innovations theory. Subproject 1 will design and validate a comprehensive assessment tool for evaluating nurses' competency milestones in PoCUS use. For this purpose, a scoping review will be conducted. The review will be based on JBI Collaboration guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews (PRISMA-ScR) checklist. Subproject 2 involves an evaluation of content and appearance validity for a series of 5 educational videos on PoCUS, designed specifically for nurses about applying peripherally inserted central catheter lines, inserting nasogastric feeding tubes, assessing gastric residual volume, assessing pressure injuries and soft tissue conditions, and assessing muscle mass to monitor patient nutritional status. In subproject 3, a comprehensive online learning environment dedicated to PoCUS training for nurses will be developed and validated. The launch of an online learning environment represents a cornerstone of our dissemination strategy, scheduled to coincide with the inaugural Brazilian PoCUS symposium for nurses, an event organized by the project members. This platform will serve as a pivotal resource for continuous learning and professional development. RESULTS: Subproject 1 will start in the second half of 2024 and is expected to be completed by mid-2025. Subproject 2 is currently ongoing and is expected to be completed in early 2026. Subproject 3 is set to begin in early 2025 and is planned to be completed by 2026. CONCLUSIONS: Through these concerted efforts, the project aims to bridge the existing gap in PoCUS training for nurses, thereby fostering their proficiency and enhancing patient care outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/58030.

When western concept meets eastern culture: Exploring the impact of Confucianism on shared decision-making in China.

This commentary explores how Confucian values influence shared decision-making (SDM) in Chinese healthcare, particularly in oncology. It highlights two key cultural foundations: Family Harmony and Filial Piety, which underscore the deep-rooted involvement of families in medical decision-making, often prioritizing collective decisions over individual autonomy; and Ritual Governance, which explains the cultural roots of power imbalances in healthcare relationships, where patients typically defer to the authority of doctors, and the role of nurses in SDM is limited. The paper argues that for SDM to be effectively integrated into Chinese healthcare, strategies must be adapted to align with cultural norms while encouraging patient empowerment. It also calls for a nuanced understanding of the evolving Chinese culture and emphasizes the need for global healthcare providers to develop cultural competence to better support Chinese patients, especially in the context of oncology, both domestically and internationally.

Capturing Potential Interventions for the Empowerment of Older People and Informal Caregivers in Transitional Care Decision-Making: A Qualitative Study Using Focus Groups.

AIM: To capture older people's, informal caregivers' and health professionals' ideas on potential interventions for empowering older people and informal caregivers in transitional care decision-making. DESIGN: A descriptive qualitative design was adopted. METHODS: The study was conducted between February and May 2022 in the region of Flanders, Belgium, as part of the TRANS-SENIOR consortium's collaborative research. Data were collected using focus groups, including older people, informal caregivers and healthcare professionals involved in any physical relocation of the older person across home, hospital or nursing home settings. Thematic data analysis was performed based on Braun and Clarke's six-step method. RESULTS: A total of 40 people participated in the focus groups. Four main themes were identified, which describe ideas on how to empower older people and informal caregivers in transitional care: Providing clear and timely information, preparing people for what is to come, person-centredness and providing professional and peer support for informal caregivers. CONCLUSIONS: Healthcare (professionals) should facilitate older people's and informal caregivers' empowerment in transitional care decision-making by setting them at the core and inception of the decision-making process. While informal caregivers support their loved ones in decision-making processes, they should also be supported and monitored for burdensome issues. IMPLICATIONS TO PATIENT CARE: Multicomponent, well-planned and personalised interventions are needed to empower older people and informal caregivers in transitional care decision-making. The ideas raised by all stakeholders who participated in this study can inform these interventions. REPORTING METHOD: Adhered to consolidated criteria for reporting qualitative research checklist. PATIENT OR PUBLIC CONTRIBUTION: Organisations advocating for the interests of older people and informal caregivers played a pivotal role in shaping the TRANS SENIOR project. Furthermore, the study benefitted from the collaborative input of AGE Platform Europe, which amplified the voices and representation of older people during the project design phase.

Psychological resilience in patients with primary Sjögren's syndrome: effect of involvement of major salivary and lacrimal glands.

The aim of this study was to assess whether the involvement of major salivary and lacrimal glands in primary Sjögren's syndrome (pSS) affected the psychological resilience of patients. This cross-sectional study included 116 patients with pSS. Data were collected through clinical examinations, measurement of salivary flow rates (SFRs), and from Schirmer's test, as well as from patient-reported outcome measures (PROMs), such as the European League Against Rheumatism (EULAR) Sjögren's Syndrome Patient Reported Index (ESSPRI), Brief Resilience Scale (BRS), Work Productivity and Activity Impairment (WPAI), Oral Health Impact Profile-14 (OHIP-14), and the Hospital Anxiety and Depression Scale (HADS). Hyposalivation was defined as an unstimulated SFR of ≤0.1 mL/min. The BRS score (mean ± SD = 2.60 ± 0.69) was lower in patients with recurrent parotitis (2.11 ± 0.37) than in those without recurrent parotitis (2.67 ± 0.86), in the whole group. In patients with an unacceptable symptom state (ESSPRI score ≥ 5 points), a lower BRS score was observed in patients with both hyposalivation and ocular dryness (2.59 ± 0.69) than in patients with isolated hyposalivation (2.84 ± 0.84). The BRS score was also negatively associated with the WPAI-Daily Impairment and OHIP-14 scores in patients with hyposalivation as well as with HADS-A (the seven items of HADS relating to the anxiety dimension) and HADS-D (the seven items of HADS relating to the depression dimension) in the whole group. The results suggest that psychological resilience in pSS may be affected by recurrent parotitis, the levels of anxiety and depression, as well as hyposalivation with ocular dryness.

Participatory Surveillance and Candidacy: A Discourse Analysis of Views on Self-Testing for Proteinuria in Pregnancy.

Actively involving people in self-monitoring and management during their pregnancy is an emerging clinical and social practice. Self-monitoring of blood pressure and self-testing for proteinuria, key diagnostic tests for pre-eclampsia, are becoming commonplace in hypertensive pregnancies. While evidence exists on the acceptability and feasibility of self-monitoring blood pressure, evidence for self-testing for proteinuria in pregnancy is thin, with little knowledge of how it might affect the traditional structures of maternity care. As part of a diagnostic accuracy study on self-testing for proteinuria, pregnant people and healthcare professionals were recruited to a qualitative study to understand their experiences of, and attitudes to, self-testing. Multiple qualitative methods were used, including interviews, focus groups, and free text postcards. A discourse analysis was conducted to understand how self-testing might inform and reshape routine antenatal care. Analysis revealed a tension between the empowering concept of participatory surveillance, which pregnant people and healthcare professionals were broadly positive about, and the adjudications made by healthcare professionals about the candidacy, or suitability, of certain pregnant people to self-test. Candidacy is a framework for understanding what influences access to healthcare for socially disadvantaged groups, including professional judgments that impact access to interventions. While participatory surveillance was felt to have the potential to empower pregnant people in antenatal care, the loss of the traditional clinical gaze was disquieting for some, and pregnant people and healthcare professionals were reluctant to cede professional responsibility.

The Cancer Patient Empowerment Program: A Comprehensive Approach to Reducing Psychological Distress in Cancer Survivors, with Insights from a Mixed-Model Analysis, Including Implications for Breast Cancer Patients.

BACKGROUND/OBJECTIVES: Psychological distress is a significant concern among cancer patients, negatively affecting their quality of life and adherence to treatment. The Cancer Patient Empowerment Program (CancerPEP) was developed as a comprehensive, home-based intervention aimed at reducing psychological distress by incorporating physical activity, dietary guidance, and social support. This study aimed to evaluate the feasibility, accrual and attrition rates, safety, and effectiveness of the CancerPEP intervention, with and without the biofeedback device, on psychological distress from baseline to 6 months, specifically focusing on the effects of group randomization and the difference between pre- and post-intervention results. METHODS: This single-site, crossover randomized clinical trial included 104 cancer patients who were randomized to receive the CancerPEP intervention, with or without a Heart Rate Variability (HRV) biofeedback monitor. At 6 months, participants who did not receive the device were allowed to use one until the end of the year, while those who did receive the device were followed up to 12 months. Randomization was stratified by the presence or absence of clinically significant psychological distress and metastatic status. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10) at baseline, 6 months, and 12 months. The primary endpoint was the presence of nonspecific psychological distress, as measured by the K10 scale at 6 months from the trial start, based on group randomization. A secondary exploratory analysis assessed psychological distress at baseline, 6 months, and 12 months for both groups, while controlling for group randomization and prognostic covariates. Prognostic covariates included age; comorbidities; time between diagnosis and randomization; treatment modality; relationship status; and use of prescribed medications for anxiety, depression, or both. An exploratory sub-analysis was conducted for the breast cancer subgroup, based on the sample size available after recruitment. The trial is registered at ClinicalTrials.gov (NCT05508412). RESULTS: The provision of the HRV biofeedback monitor in conjunction with the CancerPEP intervention did not significantly affect the primary outcome in either the full sample or the breast cancer subgroup, indicating that the HRV biofeedback provision was not beneficial in this trial. No self-reported or otherwise discovered adverse events at the 6-month mark were observed. About 10% of participants were lost to follow-up in both the early and late HRV monitor provision groups. Participation in the CancerPEP program led to a significant reduction in psychological distress over time. The odds of psychological distress were significantly higher at the start of the trial than at the end of the intervention (aOR = 2.64, 95% CI: 1.53-4.56) or 6 months after the intervention (aOR = 2.94, 95% CI: 1.62-5.30). Similarly, in the breast cancer subgroup, distress was higher at the trial's start than at 6 months, i.e., after the intervention (aOR = 2.25, 95% CI: 1.24-4.08), or at the end of the trial at 12 months (aOR = 2.73, 95% CI: 1.35-5.52). CONCLUSIONS: CancerPEP significantly reduces psychological distress in cancer patients, with consistent improvements noted across various cancer types and stages, including benefits specifically for breast cancer patients. These findings build upon the success of the Prostate Cancer Patient Empowerment Program (PC-PEP), indicating that a similar comprehensive intervention can be advantageous for all cancer patients and may be further tailored to address specific needs. With its holistic approach-encompassing physical, dietary, and psychosocial support-CancerPEP shows promise as a vital component of survivorship care. Ongoing 24-month evaluations will yield critical data on its long-term benefits. Additionally, a randomized trial with a control group (usual care without intervention) for breast cancer patients is currently under way and could potentially guide the integration of CancerPEP into standard oncology care to enhance patient outcomes and quality of life.

Enhancing patient-centered care: a randomized study on G-CSF administration preferences in chemotherapy-induced neutropenia.

PURPOSE: Chemotherapy-induced neutropenia poses a significant risk to cancer patients, with pegfilgrastim being commonly used for its prevention. While pegfilgrastim can be administered via prefilled syringe or pen device, patient preferences and experiences with these delivery methods remain unclear. METHODS: We conducted a prospective, open-label, randomized, observational trial (NCT05910164) at the Rafael Institute, France, comparing patient preferences for pegfilgrastim administration using a prefilled syringe versus a prefilled pen device. Patients undergoing chemotherapy and requiring pegfilgrastim were enrolled and randomized 1:1 to receive either syringe or pen first, with crossover administration. Questionnaires assessed patient preferences, learning experiences, autonomy, pain levels, emotional responses, satisfaction with nursing care, and empowerment. RESULTS: Among 150 randomized patients (mean age 58 years; 69% female), both groups showed a preference for the pen device, with significantly higher mean scores favoring pen administration (4.94 ± 1.70 vs. 4.27 ± 1.84; p = 0.00106). Patients reported significantly lower perceived pain with pen administration and stronger positive emotions compared to syringe use. Satisfaction with nursing care was higher with syringe use. Empowerment levels were similar across groups but significantly stronger when using the pen in complete autonomy. CONCLUSION: A preference for pegfilgrastim administration via the pen device was observed, though this may have been influenced by the administration sequence and the absence of syringe self-administration. The insights gained can help inform clinical decision-making and improve patient-centered care in managing chemotherapy-induced neutropenia. TRIAL REGISTRATION: NCT05910164 on June 15, 2023.

The effectiveness of peer support on the recovery and empowerment of people with schizophrenia: A systematic review and meta-analysis.

BACKGROUND: People with schizophrenia have a shorter life span and high mortality and morbidity rates. Peer support is an important strategy that can improve outcomes for people with schizophrenia. Peer support involves people with a lived experience of recovery who help and support others experiencing mental health problems. AIMS: The main aim of this systematic literature review was to examine the effectiveness of peer support on the recovery and empowerment outcomes of service users with schizophrenia disorders. The objectives were to contribute to evidence-based practice and promote peer support interventions in mental health services. DATA SOURCES: We searched for randomised controlled trials (RCTs) on peer support in MEDLINE, CINAHL, AMED, Academic Search Premier, PubMed, PsycArticles, PsycINFO, Cochrane, and Psychology and Behavioural Sciences Collection. We identified additional trials from the citations of previous studies. METHODS: We assessed the trials' methodological quality and biases using the risk of bias (RoB) and grading of recommendations, assessment, development, and evaluation (GRADE) tools. We performed a meta-analysis in the RevMan application and extracted data from the clinical trials using narrative synthesis. This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures. RESULTS: A total of 17 trials with 5974 participants were included in this review. The most common peer support was peer-led self-management interventions. The RE model (SMD = 0.29, 95 % CI = 0.13 to 0.45, p-value = 0.0004) shows that peer support interventions significantly improved the recovery outcome compared to standard care provided to service users with schizophrenia. The RE model (SMD = 0.22, 95 % CI = 0.11 to 0.33, p-value = 0.0001) also shows that peer support interventions significantly empowered service users with schizophrenia. However, the positive effects were small. A sub-group analysis found moderate effects on the recovery outcome among the emerging peer support interventions. The quality of the evidence was moderate. CONCLUSIONS: Peer support interventions effectively improved the recovery and empowerment outcomes. Current clinical trials indicate that peer support is an essential psychosocial intervention in improving empowerment and recovery in service users with schizophrenia.

Effects of Wab-WPPEP on post-intensive care syndrome-family in family caregivers of heart valve replacement patients: A randomized controlled trial.

OBJECTIVES: To evaluate the effects of a WeChat applet-based whole process psychological empowerment program (Wab-WPPEP) on post-intensive care syndrome-family in family caregivers of heart valve replacement patients. DESIGN: Two-arm, parallel, randomized controlled clinical trial. SETTINGS: A tertiary general hospital in Fuzhou, China. METHODS: Participants were randomly assigned to two groups. The intervention group received Wab-WPPEP, while the control group received routine care. The intervention was implemented from ICU admission to one month post-discharge. The primary outcome was anxiety, while secondary outcomes included depression, post-traumatic stress disorder (PTSD), and quality of life. Outcomes were assessed at baseline (T0), before ICU transfer (T1), pre-discharge (T2), and one month post-discharge (T3) using standardized questionnaires. Generalized estimating equations were used to analyze the repeated-measures data. RESULTS: The intervention group exhibited greater improvements in anxiety (T1: ß = -1.92, 95 % CI: -2.35 to -1.49, P < 0.001; T2: ß = -1.66, 95 % CI: -2.03 to -1.29, P < 0.001; T3: ß = -3.98, 95 % CI: -4.34 to -3.62, P < 0.001), depression (T1: ß = -1.32, 95 % CI: -1.79 to -0.85, P < 0.001; T2: ß = -1.70, 95 % CI: -2.08 to -1.32, P < 0.001), and quality of life (T2: ß = 31.16, 95 % CI: 21.35 to 40.98, P < 0.001) compared to the routine-care group. PTSD scores were also significantly lower in the intervention group (t = -6.454, P < 0.001). CONCLUSIONS: Wab-WPPEP significantly reduced anxiety and depression, improved quality of life, and alleviated PTSD symptoms in family caregivers of heart valve replacement patients. IMPLICATIONS FOR CLINICAL PRACTICE: Comprehensive psychological interventions should be implemented throughout the ICU stay and recovery period to improve family caregiver well-being.

Jitegemee (rely on yourself): a multi-phase process of co-creating a personal savings intervention with female sex workers in western Kenya to reduce their HIV risk.

BACKGROUND: HIV prevalence among female sex workers (FSW) is significantly higher than among women in the general population. Studies have shown that FSW engage in unprotected sex which provides higher compensation when they face emergency situations. We co-created a savings intervention - Jitegemee (rely on yourself) - with FSW to encourage them to save part of their earnings to withdraw in emergency situations in order to reduce risk. METHODS: We undertook a five-phase intervention development process between February 2021 and July 2023: 1) qualitative interviews with FSW to identify essential intervention features; 2) pilot trial to assess intervention feasibility; 3) literature review of studies on economic empowerment of FSW; 4) scoring of key components of Phases 1-3 on a scale of 1-5 (1 = definitely exclude, 5 = definitely include), for inclusion in the intervention package; 5) workshops with FSW and other key stakeholders to co-design the intervention. RESULTS: In phase 1, nearly all participants (99%) found the intervention acceptable to them and 95% believed it would be acceptable to other FSW. Participants suggested inclusion of financial literacy (75%), savings groups (38%) and goal-setting (24%). In the feasibility assessment, 41% saved, of whom 46% withdrew some savings. Condom use was higher among FSW who withdrew their savings compared to those who did not (χ2 7.52; p = 0.006). In Phase 3, we identified 14 intervention components. In phase 4, all suggested intervention components scored 4.5 on average. In phase 5, we held 3 workshops with FSW to co-design the intervention, which included instructions for how to save and make withdrawals, financial literacy training, and formation of savings groups. CONCLUSIONS: A savings intervention for and by FSW was highly acceptable and feasible. Involving end-users in the design process is likely to result in greater economic security among FSW and lower engagement in higher risk transactional sex.

Enhancing the learning experience by empowering medical students to co-create learning tools and classroom activities.

Objectives: This study aimed to enhance the learning experience among medical students by empowering them to co-create learning tools and classroom activities. Methods: A cross-sectional study was conducted with 10 participants from Year 2 of the new curriculum volunteering to participate in this study. Five were selected based on their diversities and empowered to design learning tools and class activities. Student satisfaction was presented as mean scores. A comparison of self-confidence scores in subjects learned before and after the class was analyzed using the paired t-test. Comparisons of multiple-choice question (MCQ) scores before and after the class between Years 2 (n = 96) and Year 3 of the previous curriculum attending inclass teaching (n = 98) were analyzed using the independent sample t-test. Results: A high level of satisfaction (M=87.5, SD=15.7%) and significant improvements in student self-confidence in subjects learned between before (M=46.4, SD=20.8%) and after (M=82.7, SD=16.9%) the class were noted (t (223) = -23.73, p<.001). Additionally, Year 2 students achieved significantly higher MCQ scores after the class (M=85.6, SD=19.0%) compared with the scores from Year 3 (M=77.3, SD=23.6%) (t (190) = 3.32, p<.001). Conclusions: Empowering medical students to co-create learning tools and class activities could positively enhance their learning experience. The result of this study addressed the importance of student empowerment with well-designed student-centered learning strategies based on their learning environment. Additional qualitative research is required to better understanding the "why" and "how" behind the findings of this study.

Psychometric properties of the Slovenian versions of the diabetes empowerment scale, long and short form, among the slovenian adults with type 2 diabetes.

AIMS: To determine the psychometric properties of the Slovenian versions of the Diabetes Empowerment Scale (DES), both the long form (S-DES-LF) and the short form (S-DES-SF). METHODS: Between April and September 2023, we recruited adults with type 2 diabetes (T2D) using convenient sampling in five primary health centres. We examined internal consistency, test-retest reliability, criterion validity, and discriminant validity. Confirmatory factor analysis (CFA) evaluated the fit of the one-and three-factor models for S-DES-SF and S-DES-LF, respectively. RESULTS: The results of 288 individuals, with a mean age of 67 ± 9.2 years, including 132 men and 156 women, showed excellent internal consistency and strong test-retest reliability for both the S-DES-LF (Cronbach's α=0.90; ICC=0.95) and S-DES-SF (α=0.91; ICC=0.92). Criterion validity of the S-DES-LF was confirmed through known-groups validity, with higher education (p=0.016) and absence of comorbid hypertension (p=0.034) associated with greater empowerment. Discriminant validity was demonstrated by the lack of significant correlations between the S-DES-LF and S-DES-SF scores with age or gender. CFA confirmed a good fit for the S-DES-SF's one-factor model but not for S-DES-LF three-factor model. CONCLUSIONS: S-DES-LF and S-DES-SF are valid and reliable tools for assessing diabetes empowerment in Slovenian people with T2D. Future research should further explore the convergent validity of scales.