Risky Business. Interventions to Prevent Aggression Against Health Workers From Patients at Risk: An Integrative Review.

AIM: To identify best practices to prevent violence against healthcare workers by patients at risk for aggression in the adult inpatient setting. DESIGN: An integrative review. METHODS: Conducted using the Johns Hopkins Evidence-based Practice for Nurses and Healthcare Professionals Model. Title and abstract screening on 4186 articles resulted in 156 for full text review. Full text screening yielded 14 articles that met inclusion criteria. DATA SOURCES: A search of the databases PubMed, CINAHL, Embase, and JBI from January 2019 to February 2023. RESULTS: The review revealed behavioural intervention teams, environmental changes, and coordinated communication plans were the most used strategies, however none demonstrated significant decreases in violence. CONCLUSIONS: Health systems can implement strategies shown to decrease the incidence of violence in healthcare settings globally. Lack of consistency in the evidence suggests the need for further research to assess mitigating strategies for violence against healthcare workers in inpatient hospital settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Patient safety is a cornerstone of nursing practice; however, healthcare workers need to feel safe in their work environment. Violent events are chronically underreported, ill defined, and when reported, do not address change in the practice setting. Identifying strategies to address escalating behaviour before it results in violence is crucial for everyone's safety. IMPACT: This integrative review exposes the scarcity of evidence available to address rising concerns about patients on healthcare provider violence (Type II) in the workplace. Although several assessment tools for identifying violent patients exist, evidence regarding prevention is woefully absent. The review highlights potential interventions for further study to equip healthcare workers to manage patients safely and effectively before an escalation occurs. REPORTING METHOD: PRISMA checklist for integrative reviews. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was part of this review.

The influence of occupational noise exposure on blood pressure and hearing loss among female workers of childbearing age.

OBJECTIVES: Women exposed to occupational noise experience adverse pregnancy outcomes. Therefore, we initiated a large, population-based, cross-sectional study to further investigate the effects of occupational noise on hearing and blood pressure among female workers of childbearing age. STUDY DESIGN AND SETTING: A total of 6981 childbearing-aged female workers were selected for this cross-sectional study. Basic characteristics of participants were analyzed by comparing the exposed and control groups. Logistic regression models were employed to calculate the odds ratios (ORs) and 95% confidences intervals (CIs) for the associations of occupational noise with levels of hearing loss and blood pressure. The associations were further explored through stratification by age and duration of noise exposure. RESULTS: Compared with participants not exposed to occupational noise, increasing years of occupational noise exposure were independently associated with an elevated risk of hypertension after adjustment of age, industry classification, enterprise size and economic type. Compared to participants not exposed to occupational noise, only the prevalence of bilateral hearing loss was significantly higher after adjustments for age, industry classification, enterprise size and economic type. Compared with those with normal hearing, the ORs and 95% CIs were 1.97 (0.95-4.07), 2.22 (1.05-4.68) and 1.29 (1.06-1.57) for bilateral, unilateral and any ear hearing loss, respectively. CONCLUSIONS: Occupational noise exposure is positively associated with both hypertension and bilateral hearing loss among female workers of childbearing age. Those exposed to occupational noise show an increased risk of hypertension after adjusting for potential confounders.

The requirements of providing health education for rural people through electronic methods: the experiences and perspectives of community health workers.

BACKGROUND: Reliance solely on traditional approaches in health education is no longer considered sufficient, and electronic/digital education can be a complementary approach. Implementing electronic methods in health education requires identifying the requirements from the perspective of the service providers. Therefore, this study aimed to elucidate the experiences and perspectives of community health workers (Behvarzan) regarding the requirements for providing health education for rural people through electronic/digital means. METHODS: This descriptive qualitative study was conducted in 2022 at Alborz University of Medical Sciences. Data were collected through semi-structured interviews with 14 Behvarzan from Health Houses (HH) in Karaj City. The data were analyzed using the inductive Elo & Kyngas approach and conventional content analysis facilitated with MAXQDA software. RESULTS: After analyzing the results, we extracted 139 open codes, and by merging them for more precise coding and to facilitate the research process, we formed three main themes and ten subthemes. The themes included Technology (technical infrastructure, content production, content delivery methods, and content delivery channels), Facilities and equipment (communication equipment and electronic content repositories), and Stakeholders (training of providers, motivating providers, persuading learners and target groups, and reference groups). CONCLUSION: From the perspective of rural healthcare workers, the implementation of electronic education requires necessary technology, equipment, facilities, processes, and content should be pursued and provided through specialized working groups, extending from the Ministry of Health and Medical Education to local HHs. These resources should be available to the healthcare workers and their target populations. Concurrently, educational programs and incentives should be defined and offered at the university level and within health networks for rural healthcare workers and their populations.

Reducing the particles generated by flushing institutional toilets. Part II: Assessing a portable and reusable toilet cover in U.S. hospitals.

Flushing uncovered toilets in hospitals has been shown to produce toilet plume aerosols (TPA) in a wide size ranging from nanometers to micrometers. Studies have shown that TPA can carry infectious pathogens and hazardous drugs used in cancer treatment. To mitigate the risk of exposure, some researchers have recommended covering the toilet during flushing, and guidelines from the Oncology Nursing Society have specifically recommended covering the toilet when flushing excreta from patients receiving chemotherapy. Because existing literature primarily focused on controlled laboratory settings or small case studies, there has been a need for a real-world, multi-center study in clinical settings to measure TPA by flushing both covered and un-covered toilets. To address this gap, the authors initiated a multicenter study to measure TPA in clinical settings and to assess the effectiveness of a commercially available, portable, and reusable toilet cover. The study enrolled 15 hospital centers (145 toilets) in nine U.S. states which included seven National Cancer Institute (NCI)-designated comprehensive cancer centers. The particle number concentrations were measured using a TSI optical particle counter (TSI 9306) with six size bins (0.3 to 25.0 µm) positioned 22 inches above the floor. The results showed that the ambient particle number concentrations in the HEPA-filtered floor bathrooms (376 ± 857#/L) are significantly lower than the non-HEPA-filtered ones (7,432 ± 9,207#/L). The mean particle number concentrations generated by flushing are 3,951 ± 8,606#/L with a median of 1,916#/L, ranging from 136#/L to 71,959#/L. Results with cover demonstrated a reduction in the total number of particles of 101 ± 11% regardless of the HEPA filter usage (p = 0.0002 in the Mann-Whitney U test). Mixed-effects modeling revealed that the overall level of particle reduction is substantial regardless of state (nine total), floor levels, flush volumes, and inpatient versus outpatient. This study provides evidence supporting the use of the tested portable toilet cover as an intervention to reduce healthcare workers', patients', and visitors' exposure to toilet plume aerosols in clinical settings.

An ICT-enabled community oriented primary care intervention in mining communities during COVID-19 (2019-2022): perceived changes in the role and place of community health workers.

BACKGROUND: This is a study of service provider perceptions of the place, role and practices of CHWs in a four-year, large-scale private sector funded, public service ICT-enabled COPC intervention with rural and remote mining communities. Like all South African communities, apart from large mining house employees and some contractors, most people use available public healthcare services and private traditional as well as limited allopathic private sector providers. In addition to the limitations of facility centred primary healthcare and a fragmented health care system, the many negative health effects of mining on the communities, go unattended. METHODS: This is a rapid, qualitative pragmatic study. Using site and participation convenience sampling, 37 semi-structured individual or group interviews were conducted with 57 stakeholders from 38 of the 135 intervention PHC facilities. Using a data driven, inductive approach, the results were analysed thematically in terms of perceived changes in the role and place of CHWs. RESULTS: CHWs registered 42 490 households and captured the demographic and social profiles as well as the health status of over 154 910 individuals using AitaHealth™. These data provided healthcare professionals and managers with knowledge about community demographics, at-risk groups and vulnerable individuals. The intervention changed the locational focus of CHW practice and expanded their scope of work and competencies in household comprehensive health education, advice and care. It led to a growth in community and professional confidence in CHWs as trusted members of mining community PHC teams and to more focused and efficient clinic work. CONCLUSION: This ICT-enabled COPC intervention adopted a comprehensive approach to healthcare delivery that started by including CHWs in PHC teams and locating them in communities. Inclusive and systematic continuous learning, clinically-led CHW service support and ICT-enabled information technology engendered trust in CHWs as competent PHC members, and grew community confidence in them and the PHC system as a whole. Although health, care and other professionals and workers valued the changes the intervention brought to their work as well as people's lives in underserved and vulnerable mining communities, its sustainability is contingent on the vagaries of political will and financial commitment.

Proteomic biomarkers of long-term lung function decline in textile workers: a 35-year longitudinal study.

BACKGROUND: Occupational exposures contribute significantly to obstructive lung disease among textile workers. However, biomarkers associated with such declines are not available. OBJECTIVES: We conducted a large-scale proteomic study to explore protein biomarkers potentially associated with long-term lung function decline. METHODS: Shanghai Textile Workers Cohort was established in 1981 with 35 years of follow-up, assessing textile workers' lung functions every five years. Quantitative serum proteomics was performed on all 453 workers at 2016 survey. We employed four distinct models to examine the association between forced expiratory volume in one second (FEV1) and proteins, and consolidated the findings using an aggregated Cauchy association test. Furthermore, proteomic data of UK Biobank (UKB) was used to explore the associations of potential protein markers and decline of FEV1, and the interactions of these proteins were examined through STRING database. Associations were also externally validated using two-sample Mendelian randomizations (MR). RESULTS: 15 of 907 analyzed proteins displayed potential associations with long-term FEV1 decline, including two hemoglobin subunits: hemoglobin subunit beta (HBB, FDR-qACAT = 0.040), alpha globin chain (HBA2, FDR-qACAT = 0.045), and four immunoglobulin subunits: immunoglobulin kappa variable 3-7 (IGKV3-7, FDR-qACAT = 0.003), immunoglobulin heavy chain variable region (IgH, FDR-qACAT = 0.011). Five proteins were significantly associated with the rate of decline of FEV1 in UKB, in which RAB6A, LRRN1, and BSG were also found to be associated with proteins identified in Shanghai Textile Workers Cohort using STRING database. MR indicated bidirectional associations between HBB and FEV1 (P < 0.05), while different immunoglobulin subunits exhibited varying associations with FEV1. IMPACT STATEMENT: We performed a large-scale proteomic study of the longest-follow-up pulmonary function cohort of textile workers to date. We discovered multiple novel proteins associated with long-term decline of FEV1 that have potential for identifying new biomarkers associated with long-term lung function decline among occupational populations, and may identify individuals at risk, as well as potential pharmaceutical targets for early intervention.

Digital entanglements: Medical drones in African healthcare systems.

The intensified scramble for the digitalisation of healthcare across Africa, coupled with the general drive for digital economies, has ushered in digital health innovations that are reconfiguring national discourses on humanitarian and development contexts. Through these innovations, imaginaries of health have become entangled with aspirations for universal health coverage (UHC) and the actualisation of the health-related sustainable development goals (SDGs). Among these innovations, drones promise to leapfrog and transform conventional African healthcare systems, which have suffered from structural bottlenecks for years, offering citizens on the margins of care critical biomedical gazes. By using drones, African states hope to improve revenue collection, curb corruption, redress health insecurities and deliver life-saving medicines, vaccines and laboratory diagnostics through a last-mile distribution schedule. Ethnographic fieldwork from 2022 to 2023 in Ghana and Malawi on the use of drones found distortions to the health workforce, disruptions to health work, and a pervasive internal brain drain, all exacerbating health-worker shortages. This paper explores how drones are reconfiguring health work and its available labour force in practice amid persistent shortages of health-workers.

Moral distress and protective work environment for healthcare workers during public health emergencies.

BACKGROUND: Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors. OBJECTIVES: The current study aimed to examine: [1] risk factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic. METHODS: We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic. RESULTS: About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30-2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0-10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress. CONCLUSIONS: Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs' work environment.

Accelerating Success of HIV/AIDS Control Programs: The Significance of Health-Care Workers' Competence.

Background: - Despite the competence-building framework and interventions, the success of HIV/AIDS prevention and treatment programs remains unsatisfactory with scanty empirical evidence on the significance of professional competence to the success of HIV/AIDS control programs. Methods: - Using a triangulation of quantitative and qualitative data, from 40 health-care workers and 9 managers of the HIV/AIDS program in Kagadi District, this article analyzes the professional and cultural competencies among health-care workers and the significance of the competencies to the success of HIV/AIDS control programs. Descriptive statistics were generated to describe health-care workers' opinions on their competence and success of HIV/AIDS control programs. In addition, a regression model was fitted to estimate the contribution of health-care workers' competence to the success of HIV/AIDS control programs. This quantitative analysis was triangulated with a thematic analysis of key informants' views. Results: - Findings indicate that health-care workers' competence bears a positive statistically significant contribution to the success of HIV/AIDS control programs. Employee competence is necessary but not sufficient to foster the full realization of desired results from HIV/AIDS control programs. Conclusion: - Managers of HIV/AIDS control programs need to prioritize and continuously train health-care workers to boost their professional and cultural skills to effectively deliver interventional activities under HIV/AIDS control programs. Additionally, improving the working environment of health-care workers is critical to improve their motivation towards greater success of HIV/AIDS control programs.

COVID-19-Related Risk Factors for Developing Occupational Contact Dermatitis Along With Its Incidence, Prevention, and Management: A Systematic Review.

Occupational contact dermatitis (OCD) is an eczematous local inflammatory skin irritation caused by repeated use of hand sanitizer and other chemical substances. Occupational irritant contact dermatitis (OICD) and occupational allergic contact dermatitis (OACD) are the two variants of CD that cannot be identified clinically. Hand dermatitis (HD) is typically assessed as a clinical consequence because it affects the hands most frequently at work as per epidemiological studies on OCD. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards were followed when conducting this umbrella review. We used the search terms "Occupational Contact Dermatitis AND COVID-19" to search for the most pertinent papers in full text on the databases PubMed/MedLine, ScienceDirect, and PubMed Central (PMC). Additionally, the reference section of the papers was used to find more articles. A total of 11,646 results were found, and eight papers remained after applying the inclusion criteria (full-text papers, English language, studies published in the previous 10 years, involving humans, and only systematic reviews). After completing the title and abstract screening, we obtained five papers. Next, the full-text screening and AMSTAR quality check were completed, yielding the same five papers. After searching ScienceDirect, five papers that met the inclusion criteria were included, and six papers were selected from the references, yielding a total of 11 papers. The causes of occupational dermatitis from protective face masks are discussed in this review. We anticipate an increase in the incidence of occupational dermatitis linked to face mask use given that a large segment of healthcare workers (HCWs) wear protective face masks. To understand the prevalence and available therapies for mask-related occupational dermatitis, further well-designed research is required.

Aging With Emerging Social Welfare and Disappearing Filial Piety: Chinese Migrant Workers' Pathways Toward Financial Retirement Planning.

This study examines the pathways and mechanisms linking Chinese migrant workers' migration experiences and their financial retirement planning. Using a mixed-methods approach with 1083 surveys and 32 interviews, this study finds that having a good financial status and social support system and maintaining a hopeful attitude toward retirement are direct pathways toward good financial retirement planning. Good health and hope for retirement are further enhanced by a good financial status and social support. Conversely, poor health and negative employment experiences are linked to poor financial retirement planning. The qualitative findings provide a contextual understanding of the pathways identified in the quantitative analyses. Migrant workers often face a dilemma between self-reliance for retirement and relying on filial piety. These findings apply not only to Chinese migrant workers but also to all migrant workers with limited access to healthcare and public pensions for retirement.

'Pain free if I ever will be': lived experience of workers seeking care for pain attributed to musculoskeletal disorders.

BACKGROUND: Pain attributed to musculoskeletal disorders are a significant hinderance to work ability and economic growth, especially in developing countries. Quality of life and lived experience of workers with musculoskeletal disorders have not been explored enough to determine whether person-centred care is provided. There is a wealth of evidence for using the biomedical approach in the management of workers with musculoskeletal disorders, which has proved ineffective in reducing absenteeism and symptoms experienced by workers. The purpose of this study was to explore the lived experience of workers seeking care for musculoskeletal disorders and how their pain attitudes and beliefs influenced their experience. METHODS: A qualitative approach with thematic analysis was used. Purposive sampling was used to recruit six participants for semi-structured interviews. All participants were either experiencing pain attributed to a musculoskeletal disorder or had received care for a musculoskeletal disorder. RESULTS: Pain attitudes and beliefs of workers with a musculoskeletal disorder and healthcare professionals greatly influenced the care and recovery process of musculoskeletal disorders. There is a primary biomedical lens informing care of workers with musculoskeletal disorders received. Workers expect healthcare professionals to explore their concerns further, but the focus of care for most participants was their presenting complaint. There is also a need for the autonomy of workers to be preserved, and communication between healthcare professionals and workers with musculoskeletal disorders needs to improve. CONCLUSIONS: Many stakeholders are involved in the recovery process from musculoskeletal disorders. There is a need for a biopsychosocial informed practice to improve return-to-work (RTW) in workers with musculoskeletal disorders. Change is needed at all healthcare system levels to reduce the negative experiences of workers and maladaptive pain beliefs that is associated with persisting symptoms and extended absenteeism.

Exploring Empathic Communication Among Community Health Workers: Applying the ENACT Tool in Two South African Sites.

Introduction. Effective empathic communication between health care providers and patients is an essential part of health care. In resource-poor contexts, evidence is needed to understand the quality and content of health care communication within real-life clinical engagements. We used the existing Enhancing Assessment of Common Therapeutic Factors (ENACT) tool to measure empathic communication skills among a group of community health workers (CHWs) receiving a novel quality improvement intervention called Nyamekela4Care in South Africa. Methods. In two resource-limited sites in the Western Cape, South Africa, we audio-recorded CHWs, with consent, in routine client consultations at baseline and postintervention. All sessions were in Afrikaans. We used the adapted ENACT tool to rate recordings at both timepoints, assessing 11 items including communication skills, emotional engagement, process and interaction. We used ANOVA to assess preimplementation and postimplementation differences in empathic communication, and analyzed coders' feedback on the coding process itself. Results. We analyzed n = 66 recordings from 11 CHWs, observing positive directionality overall, with most skills improving over time. Despite near-significant improvements in communication delivery (p = .083), self-confidence/groundedness (p = .029) significantly changed but in the opposite direction. Large effect sizes were observed in verbal communication, responsiveness to client, and identifying external resources, with no significant difference between timepoints. ENACT was feasible to apply to audio recordings; inter-coder reliability was suboptimal despite coder training and ongoing monitoring and support. Discussion. Quality improvement interventions may improve empathic skills in diverse contexts, and our results demonstrate how empathic skills could be more routinely assessed in low-resource health care settings.

First responders' occupational injury and disease associated with periods of extreme bushfires.

There has been limited research on the health impacts of extreme bushfire exposure among emergency responders (ER) involved in suppressing extreme bushfires. This study aimed to evaluate the associations between extreme bushfires and ER's compensated injury and illness in Victoria, Australia. State-wide ER compensation claims from January 2005 to April 2023 were analysed. Logistic regression modelling was used to identify factors associated with compensation claims during the extreme bushfire periods in 2009 and 2019/20, compared to all other claims, adjusting for seasonality (summer). Of the 44,164 included claims, 1105 (2.5%) had recorded injury/disease onset dates within extreme bushfire periods, and 11,642 (26.4%) occurred in summer months. Over half of claims were made by police (52.4%), followed by ambulance officers/paramedics (27.2%) and firefighters (20.5%). Extreme bushfire period claims were associated with older workers (odds ratio/OR = 1.58,95%CI = 1.30-1.92, ages ≥ 55 vs. 35-44 years). Mental disorders (OR = 1.61,95%CI = 1.25-2.07), intracranial injuries (OR = 3.04,95%CI = 1.69-5.48) and infections/parasites (OR = 3.11,95%CI = 1.61-5.98) vs. wounds were associated with extreme bushfire period claims. Given the expected increase in extreme bushfire events and the ageing workforce, study findings underscore the importance of primary and secondary prevention in ER. This can include periodic health surveillance for older workers, access to early treatment, and ongoing support for mental health conditions.

Evaluation of Personal Protective Equipment Usage Among Construction Workers in Erbil City, Iraq.

Background and aim The construction industry is a high-risk environment where the use of personal protective equipment (PPE) is essential for worker safety. Despite the clear benefits of PPE, compliance rates among construction workers are often suboptimal. In response to these concerns, this study aimed to assess the knowledge and attitudes regarding PPE usage among construction workers in Erbil City, Iraq. Methods This cross-sectional study was conducted from December 15, 2022, to June 15, 2023, among construction workers in Erbil. Convenience sampling was used to collect data through a self-structured questionnaire. The questionnaire collected demographic information, as well as responses to a 15-item Knowledge Questionnaire and an 8-item Attitude Questionnaire. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York). Frequency and percentage were used to describe qualitative variables, while mean and standard deviation were calculated for quantitative variables. Parametric tests such as the independent sample t-test and ANOVA were used, along with multinomial logistic regression, to assess the relationships between knowledge, attitude, and various demographic factors. Results A total of 280 workers participated in the study. The mean knowledge score was 13.56 ± 1.17, indicating a good level of knowledge, while the mean attitude score was 6.86 ± 1.11, reflecting a fair attitude toward PPE usage. A significant majority of the participants, 97.9% (274), were categorized as having good knowledge, while 68.2% (191) exhibited a fair attitude towards PPE usage. The analysis showed that demographic factors such as age, marital status, working hours, work experience, and employment type did not significantly affect knowledge or attitude, with all odds ratios (ORs) near 1 and P-values above 0.05. Conclusion The findings indicate that construction workers in Erbil generally have good knowledge but only a fair attitude toward PPE usage. These results suggest that healthcare providers and policymakers should implement targeted educational interventions to improve workers' attitudes toward PPE, aiming to boost compliance and enhance workplace safety. Additionally, these interventions should address practical barriers to PPE usage, such as discomfort or lack of accessibility. By fostering more positive attitudes and ensuring the availability of necessary resources, overall safety in the construction industry can be significantly improved.

Transition and change: opportunities and challenges of CHW programme reform for community health systems and vertical disease programmes in Liberia.

BACKGROUND: Globally, community health worker (CHW) programmes are critical to addressing health worker shortages and have been recognised as critical pillars within the drive towards universal health coverage (UHC). In 2016, the Liberian Ministry of Health launched the National Community Health Services Policy 2016-2021, which included significant CHW programme reform to address ongoing health workforce capacity gaps in the country. However, little consideration was given to the impact of such reforms on ongoing health interventions that rely heavily on the use of CHW cadres. Our study explores how CHW programme reform in Liberia influenced performance of CHWs involved in the delivery of Neglected Tropical Disease (NTD) programmes to elucidate how health systems reform can impact the delivery of routine health interventions and vice versa. METHODS: We used a qualitative case study approach conducted between March 2017 and August 2018. Our instrumental case study approach uses qualitative methods, including document review of five CHW and NTD program-related policy documents; 25 key informant interviews with facility, county, and national level decision-makers; and 42 life and job histories with CHWs in Liberia. Data were analysed using a thematic framework approach, guided by Kok et al. framework of CHW performance. Data were coded in QRS NVIVO 11 Pro. RESULTS: Our findings show that CHW programme reform provides opportunities and challenges for supporting enhanced CHW performance. In relation to health system hardware, we found that CHW programme reform provides better opportunities for: formal recognition of CHWs; strengthening capacity for effective healthcare delivery at the community level through improved and formalised training; a more formal supervision structure; and provision of monthly incentives of 70 US dollars. Efficiency gaps in routine intervention delivery can be mitigated through the strengthening of these hardware components. Conversely, supervision deficits in routine CHW functioning can be supported through health interventions. In relation to systems software, we emphasise the ongoing importance of community engagement in CHW selection that is responsive to gendered power hierarchies and accompanied by gendered transformative approaches to improving literacy. CONCLUSIONS: This study shows how CHW programme reform provides opportunities and challenges for health system strengthening that can both positively and negatively impact the functioning of routine health interventions. By working together, CHW programmes and routine health interventions have the opportunity to leverage mutually beneficial support for CHWs, which can enhance overall systems functioning by enhancing CHW performance.

Interventions to promote resilience and passion for work in health settings: A mixed-methods systematic review.

Background: Resilience and passion for work are associated with better psychosocial wellbeing and professional quality of life for healthcare workers. Objective: To evaluate the characteristics and efficacy of interventions to promote resilience and passion for work in health settings. Methods: A comprehensive search was conducted across six databases (MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and PsycINFO) for articles published between January 2003 and February 2023. Studies utilizing both quantitative and qualitative methodologies were included. Methodological quality assessment was performed using the Mixed Methods Appraisal Tool. Data from the included studies were analyzed using a convergent mixed methods design. Results: A total of 33 studies met the inclusion criteria. All reported on interventions designed to enhance resilience for healthcare workers. None reported on interventions to enhance passion for work. Interventions included mindfulness-based programs, psychoeducation workshops, stress management techniques, and professional coaching. Interventions varied widely in terms of delivery modality, format, content, intensity, duration, and outcomes. Of the studies reporting quantitative data, most (21/29) reported statistically significant improvements in resilience. Of the studies reporting qualitative data, all reported a positive impact of the intervention on resilience and psychological well-being. Conclusions: Overall, interventions designed to enhance resilience in health care settings appear to be effective across a variety of healthcare settings. The diversity of effective intervention approaches, delivery formats, intensity and duration suggest that brief, light-touch or self-directed online interventions may be equally as effective as more intensive, lengthy, in-person or group-based interventions. This provides health care organisations with the opportunity to select and flexibly implement interventions that align with organisational, and staff needs and preferences. Future research needs to explore effective approaches to building passion for work.

Tailoring HIV Care for Black Populations: A Pilot Feasibility Prospective Cohort Study.

BACKGROUND: Research has shown that integrating community health workers (CHWs) into the formal health care system can improve outcomes for people living with HIV, yet there is limited literature exploring this framework among marginalized minority populations. OBJECTIVE: Herein, we discuss the feasibility of a clinic-embedded CHW strategy to improve antiretroviral therapy adherence among Black people living with HIV in Miami-Dade County, Florida, a designated priority region for the US Department of Health and Human Services' Ending the HIV Epidemic Initiative. METHODS: From December 2022 to September 2023, three CHWs were trained and integrated into the hospital workflow to provide support as members of the clinical team. Ten Black adults with an HIV viral load over 200 copies/mL were enrolled to received 3 months of CHW support focused on navigating the health system and addressing poor social determinants of health. Intervention feasibility was based on 4 criteria: recruitment rate, demographic composition, study fidelity, and qualitative feedback on CHW perceptions. RESULTS: Participants were recruited at a rate of 5.7 participants per month, with the sample evenly distributed between men and women. Retention was moderately strong, with 7 (70%) of the 10 participants attending more than 75% of CHW sessions. Qualitative feedback reflected CHW perceptions on clinical interactions and intervention length. CONCLUSIONS: Outcomes indicate that a clinic-integrated CHW approach is a feasible and acceptable methodology to address adverse social determinants and improve HIV treatment adherence. By offering targeted social and clinical support, CHWs may be a promising solution to achieve sustained viral suppression and care engagement for Black people living with HIV.

Factors predicting the level of vaccine protection against hepatitis B virus infection among physicians and nurses in Sabac, Serbia.

As healthcare workers run a high and constant occupational risk of hepatitis B virus (HBV) infection through exposure to biological material, vaccination is mandatory as well as the monitoring of antibody levels one to two months after complete immunisation. The aim of this descriptive cross-sectional study was to determine HBV vaccine coverage of 200 primary and secondary healthcare workers (100 each) from Sabac, Serbia and their blood anti-HBs titre. We also wanted to identify factors that could predict the titre. Anti-HBV vaccination covered all participants, of whom 89.5 % were fully vaccinated, and 85 % had a protective antibody titre. We found a statistically significant association between antibody titre and the number of received vaccine doses, chronic jaundice, autoimmune disease, and cancer in our participants. The fact that 15 % did not achieve the protective antibody titre confirms the necessity of its control after immunisation, which is not routinely carried out in most countries, Serbia included. It is, therefore, necessary to develop a detailed strategy for monitoring vaccination and serological status of healthcare workers in order to improve their safety at work. An important role should also be given to continuous education of healthcare workers from the beginning of schooling to the end of their professional career.

Waning immune response to CoronaVac in health care workers from different age groups.

Introduction: The waning of serum antibodies against severe acute respiratory syndrome coronavirus 2 observed in several studies raises questions about long-term immunity. Lower antibody levels are associated with new cases of COVID-19 even postvaccination, leading to the administration of booster doses. Objectives: To evaluate the postvaccination immune humoral response and the relationship between postvaccination seropositivity rates and demographic data among health care workers 6 months after CoronaVac vaccination. Methods: This was a cross-sectional study including health care workers vaccinated with two doses of CoronaVac after 6 months or more. The present study was conducted with the analysis of postvaccination serology test to assess the level of humoral response (anti-receptor binding domain IgG) after vaccination. Results: A total of 325 participants were enrolled, of whom 76% were female, with a median age of 42 years (20-85; interquartile range 31-53). Overall, 18.8% (61) of the participants results were seropositive for anti-receptor binding domain IgG; 81.2% did not have sufficient quantitative titers. The IgG titers obtained from female health care workers did not differ from those obtained from seropositive male health care workers, regardless of age. Conclusions: A group of positive quantitative titers was identified in the serology test for IgG antibodies against severe acute respiratory syndrome coronavirus 2. Further studies are needed to determine the durability of postvaccination antibodies and how serology testing can be used to determine the ideal timing for booster doses of the vaccine.

Introdução: O declínio dos anticorpos séricos contra a síndrome respiratória aguda grave do coronavirus 2 observado em vários estudos levanta questões sobre a imunidade a longo prazo. Níveis mais baixos de anticorpos estão associados a novos casos de covid-19 mesmo após a vacinação, levando à administração de doses de reforço. Objetivos: Avaliar a resposta imunitária humoral após a vacinação e a relação entre as taxas de soropositividade após a vacinação e dados demográficos em trabalhadores da saúde por mais de 6 meses após a imunização com CoronaVac. Métodos: Estudo transversal incluindo profissionais de saúde vacinados com duas doses de CoronaVac após 6 meses ou mais. O estudo foi realizado com a análise do teste sorológico após a vacinação para avaliar os níveis de resposta humoral (anti-domínio de ligação ao receptor IgG) após a vacinação. Resultados: Neste estudo foram incluídos 325 participantes, 76% do sexo feminino e a idade mediana foi de 42 anos (20-85; intervalo interquartil 31-53). No geral, 18,8% (61) dos resultados dos participantes foram soropositivos para IgG anti-domínio de ligação ao receptor; 81,2% não apresentaram títulos quantitativos suficientes. Os títulos de IgG obtidos para os profissionais de saúde do sexo feminino não foram diferentes daqueles obtidos para os participantes do sexo masculino com soropositividade, independentemente da idade. Conclusões: Foi possível identificar um grupo com títulos quantitativos positivos no teste sorológico para anticorpo IgG contra a síndrome respiratória aguda grave do coronavírus 2. Mais investigações são necessárias para determinar a durabilidade dos anticorpos após a vacinação e como os testes sorológicos podem determinar o momento ideal das doses de reforço da vacina.