The effectiveness of e-mental health interventions on stress, anxiety, and depression among healthcare professionals: a systematic review and meta-analysis.

BACKGROUND: Many healthcare professionals are experiencing psychological distress. Electronic mental health (e-mental health) interventions are convenient and multifunctional. This review aimed to examine the effectiveness of e-mental health interventions in enhancing the well-being of healthcare professionals and to identify moderating factors. METHODS: A comprehensive and systematic retrieval of randomized controlled trial (RCT) studies was conducted across eight databases. Population, intervention, comparison, and outcome (PICO) were used to define eligibility criteria. Stress, anxiety, and depression were included as the main outcomes. The overall effect was calculated based on the random effect model, and the effect size was presented using the standardized mean difference. The characteristics of the research design, intervention object, and intervention design were further selected as potential moderating factors for subgroup analysis. Meta-regression analyses were finally performed, incorporating intervention duration and sample size as independent variables. RESULTS: A total of 20 studies were included in the systematic review, and 17 were included in the meta-analysis. A large effect on relieving stress and anxiety and a small-to-medium effect on reducing depression were observed. Subgroup analyses showed that features including mindfulness approaches, online courses, computer use, group interventions, and professional guidance were more favorable in the design of services. Meta-regression revealed that intervention duration only affected anxiety symptoms. Caution should be exercised, as some subgroups had fewer studies and higher heterogeneity. For the secondary outcomes, a large effect on emotional exhaustion and a small-to-medium effect on well-being were observed. CONCLUSION: In general, e-mental health interventions significantly improve the psychological health of healthcare staff. Future high-quality, large-scale studies targeting healthcare professionals and specific intervention scenarios are warranted.

Qualitative inquiry of a community dance program for older adults in Singapore.

Dance programs promote physical and psychosocial well-being. However, studies focusing on the experiences of older adults in dancing are limited. This study aims to develop a community dance program (CDP) for older adults at senior activity centers in Singapore, as well as to explore the older adults' and student instructors' experiences of the CDP. A qualitative inquiry of semi-structured and in-depth focus group discussions was conducted. In total, 20 older adults and 10 student dance instructors participated in the study. Student instructors who were undergraduate students from a dance society were trained in how to provide step-by-step instructions for the older adults. An inductive approach of thematic analysis was undertaken. Three main themes were identified: (i) promotion of physical, cognitive, and psychosocial health with dance; (ii) imagination is power-travel through dance; and (iii) further enhancement of the dance program. The themes highlighted the prominence of CDP in improving memory, physical health, mood, and social interactions-thus mitigating the risk of social isolation. The findings illustrated the benefits of CDP in cultivating intergenerational bonds amongst older adults and student instructors.

Community-based end-of-life care in Singapore and nursing care implications for older adults in the post-COVID-19 world.

PURPOSE OF REVIEW: To render holistic overview on community-based end-of-life care in the context of Singapore, with analysis of nursing care implications for older adults requiring end-of-life care services. RECENT FINDINGS: Healthcare professionals caring for older adults with life-limiting conditions had to play an active role in the constantly evolving healthcare landscape during the coronavirus disease 2019 (COVID-19) pandemic. Usual meetings and community-based end-of-life care interventions were converted to online mode, utilizing digital technology. In order to provide value-based and culturally relevant care, further studies are warranted to evaluate healthcare professionals, patients and family caregivers' preferences whilst utilizing digital technology. As a result of COVID-19 pandemic restrictions to minimize infection transmissions, animal-assisted volunteering activities were conducted virtually. Regular healthcare professionals' engagement in wellness interventions is necessary to boost morale and prevent potential psychological distress. SUMMARY: To strengthen the delivery of end-of-life community care services, the following recommendations are proposed: active youth engagement via inter-collaborations and connectedness of community organizations; improving support for vulnerable older adults in need of end-of-life care services; and enhancing healthcare professionals well-being through the implementation of timely support interventions.

Family Role in Care of Patients With Neurological Conditions: International Neuroscience Nursing Research Symposium Proceedings.

ABSTRACT: BACKGROUND: Discussions during the 2022 International Neuroscience Nursing Research Symposium highlighted the impact of family in the care of neuroscience patients. This sparked conversations about the need for understanding global differences in family involvement in the care of patients with neurological conditions. METHODS: Neuroscience nurses from Germany, India, Japan, Kenya, Singapore, Saudi Arabia, the United States, and Vietnam collaborated to provide a short summary of family involvement in caring for patients with neurological conditions in their respective countries. RESULTS: Family roles for neuroscience patients vary across the globe. Caring for neuroscience patients can be challenging. Family involvement in treatment decisions and patient care can be affected by sociocultural beliefs and practices, economic factors, hospital policies, manifestation of the disease, and long-term care requirements. CONCLUSION: Understanding the geographic, cultural, and sociopolitical implications of family involvement in care is of benefit to neuroscience nurses.

Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review.

BACKGROUND: Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS: We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS: Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION: This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.

Effect of lactic acid fermented foods on glycemic control in diabetic adults: a systemic review and meta-analysis of randomized controlled trials.

Lactic acid bacteria (LAB) fermented foods are reported to have potential in managing glycemic control. This systematic review aimed to evaluate the effectiveness of LAB-fermented foods on improving glycemic control in adults with prediabetics or type 2 diabetes mellitus (T2DM). Randomized controlled trials (RCTs) on LAB fermentation-related foods were searched on PubMed, Cochrane, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Sixteen RCTs were included, and the results concluded LAB-fermented food had significant effects in HbA1c (Z = 6.24, MD = -0.05, CI: -0.07 to -0.04, p ≤ 0.00001), fasting plasma glucose (Z = 2.50, MD = -0.16, CI: -0.29 to -0.04, p = 0.01) and fasting serum insulin (Z = 2.51, MD = -0.20, CI: -0.35 to -0.04, p = 0.01). There were significant effects on lipid profile, inflammatory markers, and body mass index in secondary analyses. Subgroup analysis suggests LAB-fermented consumption with a longer duration, younger age group and adults with T2DM, had a larger effect size. Clinicians could offer LAB-fermented food as dietary recommendations for prediabetic and diabetic adults. Larger trials are warranted to verify LAB-fermented food benefits on glycemic control. Systematic Review Registration: PROSPERO Registration No. CRD42022295220.

Re-orienting healthcare for healthy living communities: A qualitative exploration of nursing students utilising the salutogenic theory for community health practice.

BACKGROUND: Salutogenesis is a resource-oriented approach that focuses on health creation. With the shift in focus from healthcare to health, there is a need to develop salutogenic inquiry and capacity of future nurses to promote good health and well-being in the community. OBJECTIVE: This study explored nursing students' perspectives on utilising the salutogenic theory in the community for health promotion, including the scope, perceived benefits, and challenges of theory application. DESIGN: A qualitative study using framework analysis. SETTING: A tertiary institution in Singapore. PARTICIPANTS: Nursing students who were taught the salutogenic theory for 'Healthy Community Living' module. METHODS: Data were gathered from four focus group discussions (n = 18) and 32 students' written assignments. They were analysed based on five components of knowledge framework. RESULTS: Four themes were identified: re-orienting healthcare for healthy living communities; ambivalent learning experiences; attracting early adopters of salutogenic paradigm; and practices for positive health development in complex systems: future directions. Findings reflected the value, versatility, and usefulness of introducing the salutogenic paradigm into the curriculum of healthcare education. Practical know-hows of applying the theory in community practice and development of health intervention were elicited. CONCLUSION: Much work is needed to future-proof the next generation of nurses in embracing and unifying the concept of salutogenic science into the existing pathogenic-driven care model. The real challenge would be the continual support of nursing education and health system to provide salutogenic care in the community.

Challenges and Opportunities in Stroke Nursing Research: Global Views From a Panel of Nurse Researchers.

ABSTRACT: INTRODUCTION: A diverse group of neuroscience nurse experts discussed stroke nursing research at the 5th International Neuroscience Nursing Research Symposium. Panel experts from Singapore, India, Australia, New Zealand, the Philippines, Malawi, Germany, Palestine, Kenya, Japan, and the United States collaborated to examine similarities and differences in nurse-led stroke research conducted in their home countries. This article reflects panel insights on challenges and opportunities for nurse-led stroke research. DISCUSSION: The research challenges discussed include nursing independence, the processes of informed consent and randomization process, obtaining adequate independent funding, recruiting research subjects, and working with vulnerable groups. The major opportunities to leverage and improve stroke nursing research include facilitating the nurse investigator role, information digitalization, improving health literacy, and collaboration between nurse researchers. SUMMARY: We are living in a volatile, uncertain, complex, and ambiguous world, and the COVID-19 pandemic has accentuated many challenges. There is a need to allow for creativity around recruitment and conducting stroke research. The use of technology reduces travel needs and mitigates many safety, financial, and transportation-related problems. Although the pandemic has highlighted the challenges faced when conducting stroke-related research, there are remarkable similarities in opportunities to improve outcomes.

Meta-synthesis of family communication patterns during post-stroke vascular aphasia: Evidence to guide practice.

BACKGROUND: Previous studies have predominantly focused on the needs of persons with aphasia (PWA), after a stroke diagnosis. However, aphasia is found to cause communication challenges in persons with stroke and their family caregivers as a unit. Evidence is inconclusive about the communication patterns of both persons with aphasia and their family caregivers after a stroke. Studies have not been synthesized on facilitators and barriers of communication patterns between PWA and family caregivers after a stroke. AIMS: A meta-synthesis of qualitative evidence was conducted to explore family communication patterns after post-stroke vascular aphasia. METHODS: An electronic literature search of PubMed, CINAHL, Cochrane Library, PsyINFO, and Scopus was performed from January to March 2021. The methods of qualitative meta-synthesis were underpinned by Sandelowski and Barosso's guidelines. Data analysis was facilitated by Braun and Clarke thematic analysis, using NVivo 11 software. RESULTS: A total of twenty studies were included for meta-synthesis. Three themes with corresponding subthemes were identified: (1) changes in family communication patterns (subthemes: adapting to the changes in PWA after a stroke, striving toward communication recovery); (2) facilitators of family communication patterns (subthemes: supportive communication techniques, hope of recovery, time to re-adjust, and community engagement [recreational activities]); and (3) barriers of communication (subthemes: emotional turmoil and daunting tasks of rehabilitation). LINKING EVIDENCE TO ACTION: Although persons with aphasia and family caregivers are striving to achieve normalcy in communication, they are often challenged by communication deficits and protective family behaviors. Therefore, to establish effective communication, it is of paramount importance for nursing professionals to educate PWAs and their caregivers on facilitators and barriers of family communication patterns. Technology-based family communication facilitation and support groups for PWA and their family caregivers are recommended to promote family communication. The review was registered with PROSPERO (CRD42021235519).

Effectiveness of Public Education Campaigns for Stroke Symptom Recognition and Response in Non-Elderly Adults: A Systematic Review and Meta-Analysis.

OBJECTIVES: The incidence of stroke is on the rise among younger adults. Stroke educational campaigns are often used to raise public knowledge of stroke warning signs and response actions, but their effectiveness in non-elderly adults is unclear. This study investigated the effectiveness of stroke campaigns in improving stroke symptom recognition and intention to call emergency medical services in adults aged < 65 years, and described the characteristics of public stroke education in this demographic group. MATERIALS AND METHODS: Seven databases (Cochrane Library, CINAHL, Embase, Medline, PsycINFO, Scopus, and ProQuest Dissertations and Theses) were searched from inception to 24 January 2021. A meta-analysis was conducted to synthesize the effects of stroke education campaigns on stroke symptom recognition and intention to call emergency medical services in adults < 65 years. A narrative synthesis approach was used to explore the types of educational content and campaign best suited to this demographic group. RESULTS: Thirteen studies from 2001 to 2019 were included in this review. Out of the thirteen studies, five were included in the meta-analysis to synthesize the effects of stroke education campaigns on symptom recognition and four were included for synthesizing the effects on intention to call emergency medical services. The estimated pooled risk ratio for post-campaign compared with pre-campaign in stroke symptom recognition and intention to call emergency medical services was 1.20 (95% CI: 1.07-1.36, p = 0.002) and 1.19 (95% CI: 1.11-1.28, p < 0.00001), respectively. Usage of acronyms in broadcast and digital media campaigns appears promising in enhancing recognition of and responsiveness to stroke symptoms. CONCLUSIONS: Public stroke education campaigns were found to have a significant impact on stroke symptom recognition and intention to call emergency medical services. The evidence generated from this review could be applied to inform future campaigns targeted at younger adults.

Seroprevalence of anti-SARS-CoV-2 antibodies in Africa: A systematic review and meta-analysis.

We estimated the seroprevalence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in residents of African countries and explored its associated factors. We searched PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases for peer reviewed articles and pre-prints that reported anti-SARS-CoV-2 antibody seroprevalence of general or specific human populations resident in Africa. The eligible studies were evaluated using Joana Briggs Institute prevalence critical appraisal tool. Twenty-three studies involving 27,735 individuals were included in our paper. The pooled seroprevalence of anti-SARS-CoV-2 antibodies in Africa was 22% (95%CI: 14-31) with very high heterogeneity (I2  = 100%, p < 0.001). Seroprevalence was highest in studies conducted in Central Africa compared to Southern Africa, West Africa, North Africa and East Africa respectively. The number of days between the first reported coronavirus disease 2019 case in each country and when a seroprevalence study was conducted was a significant moderator of seroprevalence. Seropositivity was numerically influenced by gender and age of the participants with males and those aged below 50 years being most affected with SARS-CoV-2 infection. The highest pooled seroprevalence in Africa reported in this review should be interpreted cautiously due to high heterogeneity between studies. Continued seroprevalence surveillance is warranted to establish Africa's transition towards herd immunity.

Effectiveness of technology-based interventions on psychological morbidities, quality of life for informal caregivers of stroke survivors: A systematic review and meta-analysis.

AIMS: To evaluate the effectiveness of technology-based interventions in reducing psychological morbidities such as depressive symptomology, anxiety, burden and improving quality of life and self-efficacy in informal caregivers of stroke survivors. DESIGN: A systematic review and meta-analysis. DATA SOURCES: An extensive search was systematically undertaken at CENTRAL, PubMed, Embase, Scopus, CINHAL, Web of Science and PsycInfo until January 2021. Grey literature and dissertations were searched in Google Scholar, ProQuest & Scholarbank@NUS. Studies involving registered trials were retrieved from Clinicaltrials.gov and CENTRAL, respectively. REVIEW METHODS: Two reviewers independently screened the trials, conducted quality appraisal and extracted the data. Quality of the studies included in the review was assessed using Cochrane Risk of bias tool. Meta-analysis was conducted using RevMan 5.4. Narrative synthesis was performed for studies where results could not be pooled statistically. The results were reported abiding Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: This review included 15 trials with a total of 1276 informal caregivers of stroke survivors. Eleven trials were included in the meta-analysis. Subgroup analyses revealed that technology-based interventions with structured educational programs were statistically significant in reducing depressive symptoms (d = -0.27, 95% CI [-0.49 to -0.05], p = .02). Technology-based interventions with structured educational programs <3-month revealed significant effects (d = -0.31, 95% CI [-0.49 to -0.13], p = .0009). Results of narrative synthesis reported technology-based intervention with face-to-face training minimized depressive symptoms of informal caregivers. Notably, there were no statistically significant effects on anxiety, burden, quality of life and self-efficacy outcomes. CONCLUSION: Technology-based interventions had beneficial effects in alleviating depressive symptoms among informal caregivers. IMPACT: Technology-based interventions serve as a support mechanism for informal caregivers of stroke survivors who face time-constrains. Further high-quality randomized controlled trials are warranted to elucidate sustainability, optimal format and dosage of intervention.

Cultural Perspectives on Pain Assessment and Opioid Use: International Neuroscience Nursing Research Symposium Conference Proceedings.

ABSTRACT: INTRODUCTION: In August of 2020, the 4th International Neuroscience Nursing Research Symposium was held. The purpose of the symposium was to share neuroscience nursing research from around the world. One of the topics thought most notable that stimulated a crucial conversation was how different countries assessed pain and their use of opioids for pain management. BACKGROUND: Neuroscience nurses are global. What is not known is their experience with and what challenges exist with pain management for human beings in their country. Crossing geographic and cultural boundaries, pain affects all human beings. Each culture has unique values and beliefs regarding pain. Patient barriers, pivotal in this article, included poverty, poor health literacy, opioid phobia, and cultural as well as social beliefs. RESULTS: Neuroscience nurses from Australia, Brazil, Germany, Singapore, India, Ghana, Kenya, Philippines, South Africa, and the United States each collaborated to provide a short summary of assessing pain and use of opioids for pain management for the neuroscience patient. CONCLUSION: Neuroscience patients have varying degrees of pain based on many factors. Various countries have religious, spiritual, and cultural traditions that influence the reporting and management of pain. Pain assessment and management can be challenging, especially for the neuroscience nurses around the world.

COVID-19 Pandemic in Hong Kong and Gaza Strip: Lessons Learned from Two Densely Populated Locations in the World.

The emergence of the coronavirus pandemic led to the implementation of several precautionary measures across the globe. For densely populated regions in the world, this may have been challenging given the proximity of people to one other. Thus, this brief report sought to compare the measures across 2 densely populated locations, Hong Kong and Gaza. Epidemiological data was obtained from governmental online repositories and was compared with the data presented by the Johns Hopkins coronavirus map to ensure consistency. Descriptive statistics were used to interpret the data obtained over the period of the study. The data suggested that although Hong Kong and Gaza implemented similar strategies, Gaza recorded marginally higher cases compared with Hong Kong in the same timeframe. The strategies implemented in both settings included border closures, social distancing, proper hand hygiene, and mask usage. Cultural and socio-demographic differences may have played a part in this variation in case numbers, in addition to lessons Hong Kong had previously learned from a similar outbreak. As the pandemic is ongoing it is essential that public sensitization to adherence to precautionary measures at the personal/family level does not occur.

The Experiences and Evaluation of a Complex Intervention for Couples Coping With Stroke.

ABSTRACT: BACKGROUND: Globally, stroke is a leading cause of death and disability. With a strong sense of filial responsibility, Asian caregivers are committed to caring for their ill family members. In response, the 3H (Head, Heart, Hands) intervention was developed and implemented in Singapore to support couples in their coping after a stroke. The purpose of this study is to explore the experiences of the participants taking part in the 3H intervention and evaluate the intervention after they had participated in it. METHODS: An interpretive descriptive design was used. Semistructured qualitative interviews were conducted with 7 patients and 7 spousal caregivers. Data were analyzed using conventional content analysis. RESULTS: The participants' experience was described as one of becoming more prepared to face the storm. The "storm" resulted from a stroke, where the participants were worried and uncertain about their future. After participating in the intervention, the couples' coping processes had improved. They coped by breaking the silence and engaging in conversations, cultivating a sense of support, and conveniently fulfilling their educational needs. It was evaluated that extending the 3H intervention for community nursing is necessary to strengthen the care transition of couples from the hospital to home. CONCLUSION: New knowledge has been gained that the 3H intervention is useful and may be implemented in a clinical context before a patient's discharge from hospital. As a result of participating in the 3H intervention, effective coping was evident where participants engaged in conversations, cultivated a sense of support, and fulfilled their educational needs. Primary healthcare professionals should pay more attention to the difficulties and needs of this group of people, provide more resources to support them, and improve their quality of life.

The Experiences of Couples Affected by Stroke and Nurses Managing Patient Rehabilitation: A Descriptive Study in Singapore.

BACKGROUND: Stroke in a family affects both patients and their spousal caregivers. Despite advances in the medical management of stroke, less is known about the social and cultural factors that impact couples regarding stroke recovery. PURPOSE: The purpose of this study was to explore the experiences of stroke from the perspectives of couples affected by stroke and the nurses managing patient rehabilitation. METHODS: An interpretive descriptive study was conducted. Purposive sampling was used to enroll 17 participants, comprising eight nurses, five spousal caregivers, and four stroke survivors. Individual, in-depth interviews were performed at a rehabilitation hospital in Singapore in June 2018. RESULTS: The primary theme was the diverse meanings of stroke recovery attributed to limited conversations about the care decisions made by couples and rehabilitation nurses. The second theme was the challenges in nursing responsibilities that hindered the recovery of patients with stroke. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The meaning of recovery differs between patients and their informal and formal care providers. This issue should be explored in patient-provider conversations, as these conversations highlight the values and preferences that affect the stroke recovery trajectory. Enhancing shared decision making by patients, spousal caregivers, and healthcare providers during the stroke trajectory may promote the alignment of values that are critical to the stroke recovery experience. Further research into whether and how to incorporate shared decision making in rehabilitation hospital settings as an interventional component is warranted to better support stroke survivors before discharge.

Couples coping in the community after the stroke of a spouse: A scoping review.

Aim: To summarize evidence on the poststroke coping experiences of stroke patients and spousal caregivers living at home in the community. Design: A scoping review. Methods: Extensive searches were conducted in credible databases. Articles published in the English language were retrieved. Data were extracted based on study location, aims, study design, sample size, time after stroke and key findings. Results: Out of 53 identified articles, 17 studies were included in the review. Five key themes were as follows: (a) emotional challenges; (b) role conflicts; (c) lack of strategies in coping; (d) decreased life satisfaction of the couples; and (e) marriage relationship: at a point of change. Couples were not sufficiently prepared to cope and manage with stroke at home on discharge from the hospital. This review emphasized the need for hospitals to implement policies to address the inadequate preparation of couples in coping with stroke.