Notch2-dependent classical dendritic cells orchestrate intestinal immunity to attaching-and-effacing bacterial pathogens.

Defense against attaching-and-effacing bacteria requires the sequential generation of interleukin 23 (IL-23) and IL-22 to induce protective mucosal responses. Although CD4(+) and NKp46(+) innate lymphoid cells (ILCs) are the critical source of IL-22 during infection, the precise source of IL-23 is unclear. We used genetic techniques to deplete mice of specific subsets of classical dendritic cells (cDCs) and analyzed immunity to the attaching-and-effacing pathogen Citrobacter rodentium. We found that the signaling receptor Notch2 controlled the terminal stage of cDC differentiation. Notch2-dependent intestinal CD11b(+) cDCs were an obligate source of IL-23 required for survival after infection with C. rodentium, but CD103(+) cDCs dependent on the transcription factor Batf3 were not. Our results demonstrate a nonredundant function for CD11b(+) cDCs in the response to pathogens in vivo.

Factors influencing sexual interest in postmenopausal Asian women.

BACKGROUND: The sexual interest of postmenopausal women is a crucial aspect of their overall well-being. Despite its importance, factors influencing postmenopausal sexual interest, particularly in Asian women, remain understudied and poorly understood. AIMS: To investigate the various factors influencing sexual interest in postmenopausal women in Malaysia. METHODS: A cross-sectional study was conducted of postmenopausal women attending a gynecology or primary care clinic in a teaching hospital in Malaysia. OUTCOMES: We investigated how interpersonal dynamics and cultural norms-including the physical and mental health of women and their partners, as well as their sexual values-affect menopausal sexual interest as measured by the Menopausal Sexual Interest Questionnaire. RESULTS: Women in the study reported an average sexual interest, with a mean score of 32.8 (SD, 9.4) out of 70 on the Menopausal Sexual Interest Questionnaire. Multivariable analysis results showed that higher personal sexual values (odds ratio [OR], 2.65; 95% CI, 1.26-5.61) and spousal sexual values (OR, 2.68; 95% CI, 1.22-5.86) were significantly associated with higher menopausal sexual interest. There was a positive correlation between the physical fitness of spouses and menopausal sexual interest, with women who rated their spouses as very fit or fit (OR, 3.22; 95% CI, 1.15-9.00) or moderately fit (OR, 2.63; 95% CI, 1.05-6.63) showing higher menopausal sexual interest as compared with those whose spouses were very unfit or unfit. Women with normal stress levels (OR, 5.89; 95% CI, 1.03-33.62) and mild to moderate stress levels (OR, 8.13; 95% CI, 1.53-43.22) reported higher menopausal sexual interest. CLINICAL IMPLICATIONS: This study emphasizes a holistic approach to postmenopausal sexual health, highlighting the significance of promoting positive sexual values, improving physical fitness, and managing stress. Health care providers should educate, counsel, and collaborate interdisciplinarily, ensuring culturally sensitive care tailored to individual needs. STRENGTH AND LIMITATIONS: The study's strength lies in its provision of valuable insights into factors affecting sexual interest among postmenopausal Asian women, enhancing comprehension of holistic sexual health approaches. However, reliance on self-assessments may introduce response bias influenced by social desirability, and limited generalizability stems from single-site data collection. CONCLUSION: Our study highlights the significance of adopting a holistic approach to addressing sexual health in postmenopausal women, which includes promoting positive sexual values, improving physical fitness, and managing stress.

Patients' Technology Readiness and eHealth Literacy: Implications for Adoption and Deployment of eHealth in the COVID-19 Era and Beyond.

The COVID-19 pandemic has rerouted the healthcare ecosystem by accelerating digital health, and rapid adoption of eHealth is partly influenced by eHealth literacy (eHL). This study aims to examine patients' eHL in relation to their "technology readiness"-an innate attitude that is underexplored in clinical research. A total of 276 adult inpatients with hypertension, diabetes mellitus, and coronary heart disease were surveyed cross-sectionally in 2019 using self-reported questionnaires: eHealth Literacy Scale and Technology Readiness Index (2.0). The study found moderate eHL (mean, 27.38) and moderate technology readiness (mean, 3.03) among patients. The hierarchical regression model shows that lower eHL scores were associated with patients of minor ethnicity (Malaysian Chinese), with an unemployed status, and having >1 cardiovascular risk (ß = -0.136 to -0.215, R2 = 0.283, Ps < .005). Technology readiness is a strong determinant of eHL (ΔR2 = 0.295, P < .001) with its subdomains (optimism, innovativeness, and discomfort) significantly influencing eHL (|ß| = 0.28-0.40, Ps < .001), except for the insecurity subdomain. Deployment of eHealth interventions that incorporate assessment of patients' eHL and technology readiness will enable targeted strategies, especially in resource-limited settings hit hard by the pandemic crisis.

Missed nursing care in the Malaysian context: A cross-sectional study from nurses' perspective.

AIM: To determine the occurrence, factors and outcome of missed nursing care from the perspective of Malaysian nurses. BACKGROUND: Missed nursing care is an important issue in the global health care sector. However, little is known on the extent of missed nursing care in the Malaysian context and its contributing factors. METHODS: A cross-sectional design was adopted for data collection using the MISSCARE Survey instrument. Participants comprised 364 nurses from medical and surgical wards of a large teaching hospital. Data were analysed using descriptive, binomial logistic and hierarchical regression analyses. RESULTS: The overall occurrence of missed nursing care was 1.88 (on a scale of 1.00-5.00), which differed across 24 nursing care elements. Basic nursing care and communication-related care were the most frequently missed elements. Types of ward and labour resources were identified as contributing factors to missed nursing care (p < .001). No significant association was found between missed nursing care and nurses' intention to leave (p > .05). CONCLUSION: The occurrence of missed nursing care was noted to be low. IMPLICATIONS FOR NURSING MANAGEMENT: Practical strategies such as an acuity-based staffing system, close monitoring of rendered care and strengthening of teamwork are recommended to minimize missed nursing care.

The forward-backward and dual-panel translation methods are comparable in producing semantic equivalent versions of a heart quality of life questionnaire.

AIM: To investigate semantic equivalence between two translated versions of the heart quality of life (HeartQoL) questionnaire produced by the forward-backward and dual-panel methods. METHODS: The forward-backward and dual-panel versions of HeartQoL were self-administered among 60 participants who met the inclusion criteria of being a native Bahasa Malaysia-speaking Malay, aged 18 and older, having an indexed diagnosis of ischaemic heart disease and being cognitively fit. The administration sequence of the two versions was randomized. Additionally, three sociolinguists, who were blinded to translation processes and survey findings, rated the translated versions against the source version on three aspects of semantic equivalence. RESULTS: Textual content in both translated versions was considerably similar (n = 9/14 items, ≈64%). The overall results from weighted kappa, raw agreement, intraclass correlations, and Wilcoxon signed-rank as well as experts' ratings were confirmative of semantic equivalence between the forward-backward and dual-panel versions of the HeartQoL. However, some mixed findings were indicative of potential gaps in both translated versions against the source version. CONCLUSION: Both the forward-backward and dual-panel methods produced semantically equivalent versions of HeartQoL; but translation alone is insufficient to narrow the subtle gaps caused by differences in culture and linguistic style.

Compensatory dendritic cell development mediated by BATF-IRF interactions.

The AP1 transcription factor Batf3 is required for homeostatic development of CD8α(+) classical dendritic cells that prime CD8 T-cell responses against intracellular pathogens. Here we identify an alternative, Batf3-independent pathway in mice for CD8α(+) dendritic cell development operating during infection with intracellular pathogens and mediated by the cytokines interleukin (IL)-12 and interferon-γ. This alternative pathway results from molecular compensation for Batf3 provided by the related AP1 factors Batf, which also functions in T and B cells, and Batf2 induced by cytokines in response to infection. Reciprocally, physiological compensation between Batf and Batf3 also occurs in T cells for expression of IL-10 and CTLA4. Compensation among BATF factors is based on the shared capacity of their leucine zipper domains to interact with non-AP1 factors such as IRF4 and IRF8 to mediate cooperative gene activation. Conceivably, manipulating this alternative pathway of dendritic cell development could be of value in augmenting immune responses to vaccines.

Test-retest reliability of HeartQoL and its comparability to the MacNew heart disease health-related quality of life questionnaire.

OBJECTIVES: Heart Quality of Life (HeartQoL) is a new "hybrid" developed from the MacNew and two condition-specific questionnaires measuring health-related quality of life (HRQoL) in patients with ischemic heart disease (IHD). This study investigates test-retest reliability of HeartQoL (English version) according to international criteria (e.g., COSMIN, GRRAS). Findings on HeartQoL are compared to the published data on MacNew in view that both serve as the core IHD-specific HRQoL instrument. METHODS: Out of 105 patients with IHD, 76 completed self-administration of HeartQoL at the clinic followed by at home within a 2-week interval. In retest, patients responded using non-interview methods (phone messaging, email, fax, and post). Phone interviewing was reserved for non-respondents to reminder. RESULTS: Reliability of HeartQoL was good (intraclass correlation coefficients = 0.78-0.82), was supported in the Bland-Altman plot, and was comparable to five studies on MacNew of similar retest interval (MacNew-English = 0.70-0.75; translated MacNew = 0.72-0.91). Applicability of its standard error of measurement (0.20-0.25) and smallest detectable change (0.55-0.70) will depend on availability of normative data in future. CONCLUSION: The reliability of HeartQoL is comparable to its parent instrument, the MacNew. The HeartQoL is a potentially reliable core IHD-specific HRQoL instrument in measuring group change.

The AP-1 transcription factor Batf controls T(H)17 differentiation.

Activator protein 1 (AP-1, also known as JUN) transcription factors are dimers of JUN, FOS, MAF and activating transcription factor (ATF) family proteins characterized by basic region and leucine zipper domains. Many AP-1 proteins contain defined transcriptional activation domains, but BATF and the closely related BATF3 (refs 2, 3) contain only a basic region and leucine zipper, and are considered to be inhibitors of AP-1 activity. Here we show that Batf is required for the differentiation of IL17-producing T helper (T(H)17) cells. T(H)17 cells comprise a CD4(+) T-cell subset that coordinates inflammatory responses in host defence but is pathogenic in autoimmunity. Batf(-/-) mice have normal T(H)1 and T(H)2 differentiation, but show a defect in T(H)17 differentiation, and are resistant to experimental autoimmune encephalomyelitis. Batf(-/-) T cells fail to induce known factors required for T(H)17 differentiation, such as RORgamma t (encoded by Rorc) and the cytokine IL21 (refs 14-17). Neither the addition of IL21 nor the overexpression of RORgamma t fully restores IL17 production in Batf(-/-) T cells. The Il17 promoter is BATF-responsive, and after T(H)17 differentiation, BATF binds conserved intergenic elements in the Il17a-Il17f locus and to the Il17, Il21 and Il22 (ref. 18) promoters. These results demonstrate that the AP-1 protein BATF has a critical role in T(H)17 differentiation.

Viral infections associated with Kawasaki disease.

BACKGROUND/PURPOSE: Kawasaki disease (KD) is a disease of unknown cause. To investigate the infectious etiology of Kawasaki disease, we initiated a prospective case-control study to investigate possible links between common viral infections and Kawasaki disease. METHODS: We enrolled 226 children with KD and 226 age- and sex-matched healthy children from February 2004 to March 2010. Throat and nasopharyngeal swabs were taken for both viral isolation and polymerase chain reaction (PCR) for various viruses. RESULTS: The mean age of the 226 KD cases was 2.07 years, and the male to female ratio was 1.43 (133 boys to 93 girls). Their mean fever duration was 7.5 days with a mean peak temperature of 39.7°C. In addition to the typical symptoms of fever, neck lymphadenopathy, lip fissure and/or strawberry tongue, skin rash, nonpurulent bulbar conjunctivitis, palm/sole erythema, and induration followed by periungual desquamation, these KD cases also exhibited cough (69%), rhinorrhea (58%), and diarrhea (45%). Cases of KD had a significantly higher positive rate of viral isolation in comparison with the control group (7.5% vs. 2.2%, p = 0.02). Compared with the control group, cases of KD were more likely to have overall positive rates of viral PCR (50.4% vs. 16.4%, p < 0.001) and for various viruses including enterovirus (16.8% vs. 4.4%, p < 0.001), adenovirus (8.0% vs. 1.8%, p = 0.007), human rhinovirus (26.5% vs. 9.7%, p < 0.001), and coronavirus (7.1% vs. 0.9%, p = 0.003). CONCLUSION: We found that some common respiratory viruses, such as adenoviruses, enteroviruses, rhinoviruses, and coronaviruses, were associated with KD cases.

Multimodality Imaging of Bi-Coronary and Aortic to Pulmonary Fistulas With Saccular Aneurysms.

A 69-year-old man had fistulas arising from the left main, conus and aortic arch complicated by 2 saccular aneurysms with one draining into the pulmonic trunk seen during computed tomography and invasive angiography. These were treated conservatively but required repeat computed tomography and cardiac magnetic resonance imaging 2 years later for new heart failure.

Evaluation of Wrist-Worn Photoplethysmography Trackers with an Electrocardiogram in Patients with Ischemic Heart Disease: A Validation Study.

PURPOSE: Photoplethysmography measurement of heart rate with wrist-worn trackers has been introduced in healthy individuals. However, additional consideration is necessary for patients with ischemic heart disease, and the available evidence is limited. The study aims to evaluate the validity and reliability of heart rate measures by a wrist-worn photoplethysmography (PPG) tracker compared to an electrocardiogram (ECG) during incremental treadmill exercise among patients with ischemic heart disease. METHODS: Fifty-one participants performed the standard incremental treadmill exercise in a controlled laboratory setting with 12-lead ECG attached to the patient's body and wearing wrist-worn PPG trackers. RESULTS: At each stage, the absolute percentage error of the PPG was within 10% of the standard acceptable range. Further analysis using a linear mixed model, which accounts for individual variations, revealed that PPG yielded the best performance at the baseline low-intensity exercise. As the stages progressed, heart rate validity decreased but was regained during recovery. The reliability was moderate to excellent. CONCLUSIONS: Low-cost trackers AMAZFIT Cor and Bip validity and reliability were within acceptable ranges, especially during low-intensity exercise among patients with ischemic heart disease recovering from cardiac procedures. Though using the tracker as part of the diagnosis tool still requires more supporting studies, it can potentially be used as a self-monitoring tool with precautions.

Development and usability evaluation of a culturally adapted stroke prevention educational programme on WeChat apps.

Background: The persistently high incidence of stroke in many nations is suggestive of an area for further improvement on existing strategies of primary stroke prevention. Although the era of digitalisation has led to the increasing use of mobile applications (apps) in healthcare, more studies are needed to determine the efficacy of apps in producing the desired health outcomes across different nations and cultures. Objective: To describe the development and evaluate the usability of a mobile app in delivering a culturally adapted stroke prevention educational programme for middle-aged adults in the Republic of China. Methods: The educational programme was developed in three phases. In Phase 1, the process involved analysing requirements and designing structured modules. Phase 2 concentrated on expert consultation and technical development to deliver the educational programme. Phase 3 included a usability trial and refinement of the educational program based on trial results. Results: Educational content was derived from the Chinese Guidelines for the Prevention and Treatment of Stroke and the Dietary Guidelines for Residents. The WeChat platform was used to deliver the educational programme. Participants expressed satisfaction with the content, interface, and functions of the apps, indicating that the apps have good usability. Conclusions: The development process of the Educational Programme was designed to maximise the culturally appropriate, and impact of lifestyle changes and stroke prevention. An app-based educational programme that has demonstrated good usability is a vital factor prior to deploying it in an intervention to evaluate its effects on health outcomes.

Perceptions and self-management of a healthy diet among middle-aged adults with risk of stroke in North China: a qualitative exploration.

OBJECTIVE: Although stroke is prevalent among older people, there is a rising incidence among the younger subpopulations, particularly middle-aged adults. A healthy diet is one of the key modifiable factors to primary prevention of stroke among these subpopulations, yet there is limited understanding of the dietary habits among middle agers who have the risk factor(s) but no occurrence of stroke. This study aims to explore the views on perceptions and the self-management of middle-aged adults at risk of stroke on a healthy diet and to identify the enablers and barriers that could inform the future development of dietary interventions. DESIGN: This study used an interpretive descriptive qualitative design, employing semistructured purposive sampling for focus group discussions. Thematic analysis was conducted on the transcribed interviews and field notes, facilitated by NVivo 12.0 Plus software. SETTING: Community settings in Zhengzhou City, Henan Province. PARTICIPANTS: Middle-aged adults (aged 45-59) were identified as at risk of stroke due to the presence of one or more modifiable risk factors. RESULT: A total of seven focus group discussions were audio recorded. Four main themes emerged, which were: (1) cognitive understanding of a healthy diet; (2) dietary practices; (3) knowledge acquisition and (4) barriers to dietary adherence. CONCLUSIONS: The middle-aged adults at risk of stroke were generally aware of the risk and attempted to practise healthy eating. The existing educational programmes on following a healthy diet in the prevention of disease need to be made more comprehensible, accessible and equitable, especially for those from socioeconomically disadvantaged communities.

Effect of Video-Assisted Isometric Strengthening Exercise Program on Pain and Muscle Strength Poststabilization of Lower Limb Fracture.

The benefits of isometric strengthening exercises (ISEs) are compromised when patient teaching on ISEs is delayed and/or ineffectively delivered due to healthcare resources constraint, especially when health resources are stretched, as occurred during the COVID-19 pandemic. This study aims to examine the effect of a video-assisted ISE program on pain and muscle strength of patients following surgical stabilization of lower limb fracture. A quasi-experimental study with repeated measures was employed. Primary study outcomes were assessed using the Brief Pain Inventory and Manual Muscle Test. Effects over time were analyzed using generalized estimating equations. In comparison with usual care group (n = 32), the intervention group (n = 33) showed better pain reduction over time (p < .001, effect size [ES] = 0.39-1.77) and muscle strength preservation (p < .05; ES = 0.8-0.9). Patient acceptance of the intervention was favorable. Integration of video clips into patient teaching on ISEs is potentially beneficial in managing pain and muscle strength; it can be easily deployed to aid early ISE initiation.

Is the Blood Pressure-Enabled Smartwatch Ready to Drive Precision Medicine? Supporting Findings From a Validation Study.

Background: The popular wrist-worn wearables recording a variety of health metrics such as blood pressure (BP) in real time could play a potential role to advance precision medicine, but these devices are often insufficiently validated for their performance to enhance confidence in its use across diverse populations. The accuracy of BP-enabled smartwatch is assessed among the multi-ethnic Malaysians, and findings is discussed in comparison with conventional automated upper-arm BP device. Methods: Validation procedures followed the guidelines by the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018). Quota sampling was employed to obtain eligible patients with normal and abnormal BP as per guideline. The measurements of BP were taken at wrist using HUAWEI WATCH D (test BP); and the readings were assessed against reference BP by the mercury sphygmomanometer. Agreement statistics and linear regression analyses were performed. Results: BP measurements (234 data pairs) from 78 patients that fulfilled AAMI/ESH/ISO protocol were analyzed. The BP readings taken by the HUAWEI WATCH D were comparable to reference BP by sphygmomanometer based on 1) Criterion 1: systolic blood pressure (SBP) = -0.034 (SD 5.24) and diastolic blood pressure (DBP) = -0.65 (SD 4.66) mm Hg; and 2) Criterion 2: SBPs = -0.034 (SD 4.18) and DBPs = -0.65 (SD 3.94) mm Hg. Factors of sociodemographic characteristics, anthropometric measurements, cardiovascular comorbidities, and wrist hair density were not significantly associated with the mean BP differences. Conclusions: HUAWEI WATCH D fulfilled criteria 1 and 2 of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) guidelines. It can be recommended for clinical use across a wider population. The rich data from real-time BP measurements in concurrent with other health-related parameters recorded by the smartwatch wearable offer opportunities to drive precision medicine in tackling therapeutic inertia by personalizing BP control regimen.

Developing and evaluating the usability of a web-based Diabetic Retinopathy Health Education Program for patients with type 2 diabetes mellitus.

OBJECTIVES: To describe the development of a webpage based on the Intervention Mapping (IM) protocol and usability testing of the Diabetic Retinopathy Health Education Profram (DRHEP). METHODS: The mixed methods pilot feasibility study was carried out between April and September 2021, involving 16 patients with type 2 diabetes mellitus and 5 experts. The usability score was rated according to the System Usability Scale (SUS). RESULTS: The average SUS score by the experts was 88. The patients gave a higher score of 85 for SUS, with 58 as the lowest. The average SUS score was 72. The findings indicate that the webpage is acceptable, good, and highly usable for users. CONCLUSION: The outcomes of this study signify the relationship between effective health applications and how their design might hamper their effectiveness in changing patients' behavior.

Characteristics and Resource Utilization Associated with Frequent Users of Emergency Departments.

Background: Frequent emergency department (ED) users place a huge influence and burden on healthcare systems and medical costs. In Taiwan, citizens have very easy access to medical services and the national health insurance (NHI) puts very few restrictions on the frequency and facilities which the patients go to. However, there is still a certain percentage of frequent ED users in Taiwan, and yet, there are few research studies investigating the features of such users and their impact on the healthcare system. We conducted this study to investigate the prevalence and characteristics of the repeated ED users in a tertiary care medical center with more than 80000 emergency visits in a year and hypothesized that frequent ED users have unique medical and social characteristics and results in increased medical expense. Methods: We searched the integrated medical database of an urban tertiary medical center in 2017. We compared frequent ED users (≧4 visits/year) with nonfrequent users (<4 visits/year) with regards to the medical history, distance from home to the hospital, main visiting purposes, whether patients had used outpatient care or other medical resources at the same time, and the charge to the patients for each visit. Results: In 2017, 2191 patients (3.37%) were listed as frequent users and accounted for 12166 visits (14.20%). Most of the frequent users were over 65 years old (53.1%) and more than half of them had suffered from cancer (55.1%). The most significant features of frequent ED users were male, educational attainment below university, low-income households, drug or food allergies, terminal stage of illness, possession of IC Cards for Severe Illness, hospitalization in the past year, multiple outpatient visits in same year, and with certain medical history including anemia, cerebrovascular accident, congestive heart failure, peptic ulcer disease, ileus, cirrhosis, chronic obstructive pulmonary disease, and psychiatric disease. There were significant differences between frequent and nonfrequent users in disposition and median charge per visit (US$137 vs. $117, p < 0.001). Conclusions: Frequent users of ED are a heterogeneous group who usually suffer from multiple chronic diseases. There were higher rates of hospital admission and medical costs among frequent ED users compared to nonfrequent users. In addition to emergency services, frequent users also utilized outpatient resources heavily.

Impact of increased digital use and internet gaming on nursing students' empathy: A cross-sectional study.

BACKGROUND: The COVID-19 restrictions and quarantines had led to increased dependence and usage of digital devices for various human activities and internet gaming to the extent of risking vulnerable individuals to develop addiction towards it. Little is known on such risks among populations of nursing students and its impact on their empathy skills or trait. OBJECTIVE: Determining the impact of digital use and internet gaming on empathy of nursing students undergoing remote learning during closure of learning institutions nationwide. DESIGN: Cross-sectional online survey was conducted from October to December 2020. SETTINGS: Two established public institutions located in Malaysia. PARTICIPANTS: A total of 345 nursing students pursuing diploma and bachelor nursing programs. METHODS: Toronto Empathy Questionnaire (TEQ), Digital Addiction Scale (DAS) and Internet Gaming Disorder Scale-Short form (IGDS9-SF) were self-administered via Google Form™. Following principal component analysis of TEQ using IBM-SPSS™ (V-27), path analyses was performed using SmartPLS™ (V-3). RESULTS: Despite the increased time spent on digital devices (∆ 2.8 h/day) and internet gaming (∆ 1 h/week) before and during the pandemic, the proportion of high digital users (1.4 %) and gamers (20.9 %) were low; and sizable ≈75 % had higher-than-normal empathy. Digital-related emotions and overuse of them were associated with lower empathy (ß = -0.111, -0.192; p values < 0.05) and higher callousness (ß = 0.181, 0.131; p values < 0.05); internet gaming addiction predicted callousness (ß = 0.265, p < 0.001) but digital dependence correlated with higher empathy (ß = 0.172, p = 0.009). CONCLUSIONS: Digital and internet gaming addiction potentially impact empathy. The negative impact of digital dependence can be attenuated by "digital empathy" - an emerging phenomenon becoming increasingly vital in digital health and communication.

Nursing students' and faculty members' experiences of online education during COVID-19 across Southeast Asia: A Photovoice study.

BACKGROUND: The COVID-19 pandemic has caused extraordinary disruptions to education systems globally, forcing a rapid switch from conventional to online education. Although some qualitative studies have been carried out exploring the online education experiences of nursing students and faculty members during the COVID-19 pandemic, to our knowledge, no study has used the Photovoice approach. OBJECTIVES: To explore the experiences of nursing students and faculty members as related to online education during the COVID-19 pandemic. DESIGN: A descriptive qualitative design using Photovoice was adopted. SETTING: The study took place across five countries and one city in Southeast Asia (Indonesia, Malaysia, the Philippines, Thailand, Vietnam, and Hong Kong). PARTICIPANTS: Fifty-two nursing students and twenty-eight nursing faculty members who participated in online education during the COVID-19 pandemic. METHODS: Each participant submitted one photo substantiated with written reflections. Data were analysed using thematic analysis. Ethical approval was obtained from institution-specific ethics boards. RESULTS: Three themes and eleven sub-themes emerged from the data. The three main themes were: 1) Psychological roadblocks to online education; 2) Developing resilience despite adversities; and 3) Online education: What worked and what did not. CONCLUSION: Through Photovoice, the reflections revealed that nursing students and faculty members were generally overwhelmed with the online education experience. At the same time, participants were satisfied with the flexibility and convenience, opportunities for professional and personal development and safety afforded by online education. However, concerns over academic integrity, practical skills and clinical competencies, engagement and participation, the duality of technology and social isolation out-shadowed the advantages. It is worthwhile to explore the concerns raised to enhance online education across the nursing curriculum.

Salutogenesis and COVID-19 pandemic impacting nursing education across SEANERN affiliated universities: A multi-national study.

BACKGROUND: The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected. DESIGN: The descriptive cross-sectional quantitative design was used. SETTINGS: Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021. PARTICIPANTS: A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study. METHODS: Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic. RESULTS: Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels. CONCLUSIONS: While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better.