Economic analysis of a health system strengthening program in the Democratic Republic of the Congo / Analyse économique d'un programme de renforcement du système de santé en République démocratique du Congo.

INTRODUCTION: Due to the Democratic Republic of the Congo's (DRC) precarious health system that provides only limited access to health care, the European Union, via Memisa Belgium, implemented a program to strengthen provision of and access to health care (known as PRO DS) in the provinces of Kongo Central and Ituri. This program took a holistic approach, seeking to improve equitable access and combat malnutrition. METHODS: To measure the program's social return on investment and to estimate the cost per capita and effectiveness per euro invested (efficiency), a 61-month (1 July 2017 to 31 July 2022) cost-effectiveness evaluation with a societal perspective was carried out. The double-difference method was used to compare the results of PRO DS and non-PRO DS zones. The social return on investment was assessed via the ratio of effectiveness to costs. RESULTS: Analyses revealed the program cost between 3.72 and 3.96 euros per capita per year (2022) in Kongo Central, and between 3.12 and 3.36 euros in Ituri. Importantly, it was cost-effective in the areas of reproductive health, nutrition, and the use of health and nutrition services. CONCLUSIONS: The program's strong nutritional component and overall holistic vision may explain why it was so efficient. PRO DS stands out from other programs that focus solely on one specific problem or population. Although the program has some limitations, it would be worthwhile for the government to invest in it.

Introduction: Face à l'accès limité aux soins et à la précarité des structures sanitaires en République démocratique du Congo, l'Union européenne par l'intermédiaire de Memisa Belgique avait mis en œuvre le Programme de renforcement de l'offre et développement de l'accès aux soins de santé (PRO DS) dans les provinces du Kongo-Central et de l'Ituri. Ce programme se caractérisait par une approche holistique d'équité d'accès et de lutte contre la malnutrition. Méthodes: Pour mesurer le retour social sur investissement du programme et estimer son coût par habitant et son efficacité par euros investis (efficience), une évaluation coûts-efficacité avec une perspective sociétale de 61 mois (1er juillet 2017 au 31 juillet 2022) a été réalisée. La méthode de double différence, qui compare les résultats des zones PRO DS et des zones non PRO DS, a été utilisée. Le retour social sur investissement a été évalué par le biais du rapport entre l'efficacité et les coûts. Résultats: Les analyses ont montré que le programme coûtait par année et par habitant entre 3,72 et 3,96 euros (2022) au Kongo-Central, et entre 3,12 et 3,36 euros en Ituri. De plus, il était coût-efficace dans plusieurs domaines, telles la santé de la reproduction, la nutrition, l'utilisation des services de santé et nutritionnels. Conclusions: L'efficience du programme pourrait s'expliquer par sa vision holistique avec un fort volet « Nutrition ¼. PRO DS se démarque d'autres programmes qui agissent uniquement sur une problématique ou population spécifique. Malgré ses quelques imperfections, le gouvernement mériterait d'y investir.

Family-centred care and breastfeeding self-efficacy determined how ready mothers were for their infants to be discharged from a neonatal intensive care unit.

AIM: We examined if a range of factors were associated with how ready mothers were for their infants to be discharged from a neonatal intensive care unit (NICU). METHODS: This was a secondary analysis of a study on the well-being of mothers whose infants were hospitalised in the level 3 NICU at the Jewish General Hospital in Canada. We studied 132 mother-infant dyads: 70 from an open ward NICU and 62 from the purpose-built NICU with pods or single-family rooms that replaced it in 2016. The mothers completed a questionnaire on NICU stress and their perceptions of family-centred care on enrolment and another on breastfeeding self-efficacy and readiness to go home a week before discharge. The infants' characteristics were retrieved from the medical files. RESULTS: The infants were born at a mean age of 29.8 ± 3.1 weeks. Greater family-centred care during early hospitalisation (p = 0.01) and greater breastfeeding self-efficacy in the period before discharge (p = 0.04) were significantly associated with higher readiness for discharge. The unit design was not significantly associated with readiness for discharge. CONCLUSION: The quality of early family-centred care and breastfeeding self-efficacy were significantly associated with how ready mothers were for their preterm infant to be discharged from the NICU.

Factors Influencing Mothers' Quality of Sleep during Their Infants' NICU Hospitalization.

STUDY OBJECTIVES: The purpose of this study is to identify factors associated with Neonatal Intensive Care Unit (NICU) mothers' quality of sleep as measured with the General Sleep Disturbance Scale (GSDS). METHODS: Recruitment took place in a level 3 NICU. At enrollment, mothers completed a socio-demographic questionnaire, described their presence in the unit and their breast milk expression behavior. They also completed online or paper questionnaires about NICU-related stress, symptoms of postpartum depression, family-centered care, perception of noise and light in the unit, and sleep disturbances. Data regarding the infant's clinical condition were collected from their medical file. Pearson correlations were performed to identify associations between mothers' quality of sleep and other study variables. Subsequently, to compare mothers with a clinically significant GSDS score to mothers with a non-significant score, a binary logistic regression model was conducted. RESULTS: 132 mothers participated. Sleep disturbances of mothers with an infant hospitalized in the NICU was positively correlated with stress (r = 0.40; p = .00), depressive symptoms (r = 0.51; p = .00), and breast milk expression (r = 0.23; p = .01). In addition, for mothers with significant levels of depressive symptoms (OR = 1.19; p = .00), with greater presence in the unit (OR = 1.36; p = .04), or with other children at home (OR = 3.12; p = .04), the likelihood of clinically significant sleep disturbances was increased. CONCLUSIONS: These results improve our understanding of the factors influencing the quality of sleep of mothers whose premature infant is hospitalized for 2 weeks or more in the NICU. In addition, these results allow the identification of mothers having a higher possibility for sleep disturbance, which enables the implementation of targeted interventions to promote adequate sleep.

The interaction between oxytocin receptor gene methylation and maternal behavior on children's early theory of mind abilities.

Theory of mind, the ability to represent the mental states of others, is an important social cognitive process, which contributes to the development of social competence. Recent research suggests that interactions between gene and environmental factors, such as oxytocin receptor gene (OXTR) polymorphisms and maternal parenting behavior, may underlie individual differences in children's theory of mind. However, the potential influence of DNA methylation of OXTR remains unclear. The current study investigated the roles of OXTR methylation, maternal behavior, and their statistical interaction on toddlers' early emerging theory of mind abilities. Participants included a community sample of 189 dyads of mothers and their 2- to 3-year-old children, whose salivary DNA was analyzed. Results indicated that more maternal structuring behavior was associated with better performance, on a battery of three theory of mind tasks, while higher OXTR methylation within exon 3 was associated with poorer performance. A significant interaction also emerged, such that OXTR methylation was related to theory of mind among children whose mothers displayed less structuring, when controlling for children's age, sex, ethnicity, number of child-aged siblings, verbal ability, and maternal education. Maternal structuring behavior may buffer the potential negative impact of hypermethylation on OXTR gene expression and function.

A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design.

BACKGROUND: The well-being of mothers of infants requiring Neonatal Intensive Care Unit (NICU) hospitalization may be affected by the architectural design of the unit. A few recent studies suggest there may be some drawbacks of single-family rooms (SFRs) for infants and their mothers, such as isolation of mothers and reduced exposure to auditory stimulation for infants. PURPOSE: To compare NICU-stress, symptoms of depression, perceptions of nurse-parent support and family-centered care, sleep disturbances, breastfeeding self-efficacy and readiness for discharge in mothers of infants cared for in an open ward (OW) to those cared for in a unit that includes both pods and SFRs. METHODS: A pre-post quasi-experimental study was conducted in a Canadian level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW data were collected in 2014 and pod/SFR data 1 year after the transition in 2017 to 2018. Mothers of infants hospitalized for at least 2 weeks completed questionnaires about stress, depressive symptoms, support, family-centered care, and sleep disturbances. In the week prior to discharge, they responded to breastfeeding self-efficacy and readiness for discharge questionnaires. They described their presence in the NICU at enrollment and again prior to discharge. RESULTS: Pod/SFR mothers reported significantly less NICU-stress compared to OW mothers. OW mothers had greater sights and sounds stress and felt more restricted in their parental role. Pod/SFR mothers reported greater respect from staff. Controlling for maternal education, pod/SFR mothers perceived their infant's readiness for discharge to be greater than OW mothers. There were no significant differences between groups in depressive symptoms, nurse-parent support, sleep disturbances, and breastfeeding self-efficacy. At enrollment and again in the weeks preceding discharge, pod/SFR mothers were present significantly more hours per week than OW mothers, controlling for maternal education. CONCLUSIONS: Further study of small pods is indicated as these units may be less stressful for parents, and enhance family-centered care, as well as maternal presence, compared to OWs.

Searching the Internet for Infertility Information: A Survey of Patient Needs and Preferences.

BACKGROUND: Given the complexity of infertility diagnoses and treatments and the convenience of the internet for finding health-related information, people undergoing infertility treatments often use Web-based resources to obtain infertility information and support. However, little is known about the types of information and support resources infertility patients search for on the internet and whether these resources meet their needs. OBJECTIVE: The aims of this study were to (1) examine what individual factors, namely, demographic characteristics and distress, are associated with searching the internet for different types of infertility-related information and support resources and (2) determine whether Web-based resources meet the needs of patients. METHODS: Men and women seeking infertility care responded to a survey assessing use of Web-based resources for accessing infertility-related information and support. The survey further assessed satisfaction with Web-based resources as well as perceived stress and depressive symptomatology. RESULTS: A total of 567 participants, including 254 men and 313 women, completed the survey. Most participants (490/558, 87.8%) had searched the internet for infertility information and support. Searchers were more likely to be women (P<.001), highly educated (P=.04), long-term patients (P=.03), and more distressed (P=.04). Causes of infertility, treatment options, and scientific literature about infertility were the three most frequently searched topics, whereas ways to discuss treatment with family and friends as well as surrogacy and ways to find peer support were the three least searched topics. Of those who searched the internet, 70.9% (346/488) indicated that their needs were met by Web-based information, whereas 29.1% (142/488) said that their needs were not met. Having unmet needs was related to greater levels of perceived stress (P=.005) and depressive symptomatology (P=.03). CONCLUSIONS: This study provides evidence for the important role of the internet in accessing infertility information and support and for the ability of Web-based resources to meet patients' needs. However, although distressed patients reported particularly high rates of searching, their needs were not always met, suggesting that they may benefit from alternative sources of information and support or guidance from health care providers when searching the internet.

NICU Nurses' Stress and Work Environment in an Open Ward Compared to a Combined Pod and Single-Family Room Design.

BACKGROUND: The architectural design of a neonatal intensive care unit may affect the quality of the work environment for nurses, yet few studies have been conducted using reliable and valid measures. Recent studies have suggested some drawbacks of single-family rooms (SFRs) for both infants and parents. Research is needed to explore nurses' work environment in units combining pods and SFRs. PURPOSE: To compare neonatal intensive care unit nurses' work stress, satisfaction, obstacles, support, team effectiveness, ability to provide family-centered care, and satisfaction with noise, light, and sightlines in an open ward with a new unit of pods and SFRs. METHODS: A pre-post occupancy study was conducted in a level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. RESULTS: There were no significant differences in nurse stress, satisfaction, support from colleagues, perceptions of team effectiveness, and ability to provide family-centered care between the open ward and the pod/SFR unit. Organizational obstacles, such as difficulties obtaining information from colleagues, were significantly lower in the pod/SFR. In contrast, environmental and technology obstacles were greater in the new pod/SFR unit. IMPLICATIONS FOR PRACTICE: Some specific aspects of the pod/SFR unit are optimal for neonatal intensive care unit nurses, while other aspects of the open ward are perceived more favorably. IMPLICATIONS FOR RESEARCH: Studies are needed to examine the isolation the nurses may experience in SFR units, as well as strategies to reduce isolation.

Evidence for the use of complementary and alternative medicines during fertility treatment: a scoping review.

BACKGROUND: Complementary and alternative medicines (CAM) are sometimes used by individuals who desire to improve the outcomes of their fertility treatment and/or mental health during fertility treatment. However, there is little comprehensive information available that analyzes various CAM methods across treatment outcomes and includes information that is published in languages other than English. METHOD: This scoping review examines the evidence for 12 different CAM methods used to improve female and male fertility outcomes as well as their association with improving mental health outcomes during fertility treatment. Using predefined key words, online medical databases were searched for articles (n = 270). After exclusion criteria were applied, 148 articles were analyzed in terms of their level of evidence and the potential for methodological and author bias. RESULTS: Surveying the literature on a range of techniques, this scoping review finds a lack of high quality evidence that complementary and alternative medicine (CAM) improves fertility or mental health outcomes for men or women. Acupuncture has the highest level of evidence for its use in improving male and female fertility outcomes although this evidence is inconclusive. CONCLUSION: Overall, the quality of the evidence across CAM methods was poor not only because of the use of research designs that do not yield conclusive results, but also because results were contradictory. There is a need for more research using strong methods such as randomized controlled trials to determine the effectiveness of CAM in relation to fertility treatment, and to help physicians and patients make evidence-based decisions about CAM use during fertility treatment.

Perinatal depression and DNA methylation of oxytocin-related genes: a study of mothers and their children.

The present study investigated the association of perinatal depression (PD) with differential methylation of 3 genomic regions among mother and child dyads: exon 3 within the oxytocin receptor (OXTR) gene and 2 intergenic regions (IGR) between the oxytocin (OXT) and vasopressin (AVP) genes. Maternal PD was assessed at 5 time-points during pregnancy and postpartum. Four groups were established based on Edinburgh Postnatal Depression Scale (EPDS) cut-off scores: no PD, prenatal or postpartum depressive symptoms only and persistent PD (depressive symptoms both prenatally and postpartum). Salivary DNA was collected from mothers and children at the final time-point, 2.9years postpartum. Mothers with persistent PD had significantly higher overall OXTR methylation than the other groups and this pattern extended to 16/22 individual CpG sites. For the IGR, only the region closer to the AVP gene (AVP IGR) showed significant differential methylation, with the persistent PD group displaying the lowest levels of methylation overall, but not for individual CpG sites. These results suggest that transient episodes of depression may not be associated with OXTR hypermethylation. Validation studies need to confirm the downstream biological effects of AVP IGR hypomethylation as it relates to persistent PD. Differential methylation of the OXTR and IGR regions was not observed among children exposed to maternal PD. The consequences of OXTR hypermethylation and AVP IGR hypomethylation found in mothers with persistent PDS may not only impact the OXT system, but may also compromise maternal behavior, potentially resulting in negative outcomes for the developing child.

Intrapartum Synthetic Oxytocin and Its Effects on Maternal Well-Being at 2 Months Postpartum.

BACKGROUND: Synthetic oxytocin (synOT) is commonly used in labor management to induce and augment labor, and to prevent postpartum hemorrhage. However, its long-term consequences for maternal health and behavior are largely understudied. We examined the relationship between synOT and maternal oxytocin levels, breastfeeding, and maternal mental health at 2 months postpartum. METHODS: Women were recruited during pregnancy or within 48 hours of giving birth through obstetric practices and hospitals. A total of 386 women were visited in their homes at 2 months postpartum, where they completed questionnaires assessing breastfeeding, depression, anxiety, posttraumatic stress, and somatization. Oxytocin levels were obtained from blood samples and synOT dosage information was gathered from hospital charts. RESULTS: Intrapartum synOT dose was positively correlated with endogenous oxytocin levels at 2 months postpartum. Women who were exclusively breastfeeding at 2 months postpartum had received significantly less synOT compared with their nonexclusively breastfeeding counterparts. Higher synOT dose was associated with greater depressive, anxious, and somatization symptoms. SynOT dose was not associated with perinatal posttraumatic stress. CONCLUSIONS: The widespread use of synOT in managed labor warrants caution, as the influence of synOT on a new mother's well-being is evident at 2 months postpartum.

Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

Addressing All Heads of the Hydra: Reframing Safeguards for Mentally Impaired Detainees in Immigration Removal Proceedings.

This article concerns the constitutional rights of detained, mentally impaired non-citizens in defending against deportation. Due process requires that such detainees receive a full and fair hearing. However, until recently, they were not provided an attorney to assist them in navigating our extremely complicated immigration system. Mentally impaired detainees were expected to proceed alone in proving the elements of their claims against skilled government attorneys--a daunting task even for those unencumbered by a mental disorder. On December 31, 2013, the Department of Justice ("DOJ") released guidelines detailing new procedures for how immigration courts should handle these cases, including the provision of counsel upon a finding of mental incompetence. The guidelines were issued as a direct response to Franco-Gonzales v. Holder, a class action lawsuit brought by the American Civil Liberties Union in federal district court in California seeking appointed counsel for detained, unrepresented, mentally impaired non-citizens. The guidelines created a three-stage process for assessing competency. Only at the end of this process--and after an individual is declared incompetent--is counsel appointed. This article argues that the DOJ guidelines fall far short of Franco's promise of due process for this particularly vulnerable population. It proposes an alternative model wherein counsel is appointed the moment the court is presented with "indicia" of incompetence, rather than after an adjudication of incompetence. "Indicia" should create a presumption of incompetency that can be rebutted only after a forensic evaluation is conducted and the court holds a robust hearing into the matter. This article reveals, through empirical evidence, the critical role that counsel plays in the investigation of a respondent's ability to participate in the proceedings, and how an attorney is often the only party positioned to marshal all the evidence relevant to the question of competency. Additionally, where a lack of competence is found, the court should appoint a guardian ad litem ("GAL") to assist the attorney in the individual's defense. Counsel and the GAL should work in tandem to achieve the outcome most favorable to the individual, which could be termination, the pursuit of relief, or even deportation in some instances. The expanded use of existing "Deferred Action" categories offers an additional remedy when none of the above proposed options are adequate. The article concludes that the DOJ guidance must be amended in accordance with these recommendations. This proposal best ensures vigorous and informed examination of an individual's competency, while safeguarding the individual against the inherent limits of immigration courts, conflicts of interest, and undue harm.

The Impact of COVID-19 Health Measures on Adults With Multiple Chemical Sensitivity: Cross-Sectional Study.

BACKGROUND: Multiple chemical sensitivity (MCS) develops in response to repeated small-level chemical exposures or a major exposure in a subset of people, who then experience symptoms that can range from mild to debilitating when exposed to chemicals. The arrival of the COVID-19 pandemic and the stringent health measures put in place may have increased the burden for those living with MCS, as it became more challenging to avoid chemicals that trigger their condition. OBJECTIVE: This study aimed to better understand the lived experience of Canadians living with MCS during the first year of the COVID-19 pandemic. METHODS: An online questionnaire was created to ask participants to compare daily living during the pandemic to before March 11, 2020. Data were collected in January and February 2021. Three areas were investigated: (1) environmental exposures to chemical triggers from ambient air (pollution from industry, farming, and traffic) and indoor air (the smell of cleaning products, cooking odors, and smoke); (2) access to, and satisfaction with, health care visits; and (3) how people experiencing MCS rated contact with their social network. RESULTS: In all, 119 Canadians who had lived with MCS for more than a year completed the questionnaire. The participant sample was mostly female (86.6%, n=103) and highly educated, with 57.1% (n=68) having a university degree. Slightly more than half (57.1%, n=68) were older than 55 years. McNemar chi-square and Wilcoxon signed rank tests were used to evaluate if there were statistically significant changes before ("prepandemic period") and after ("postpandemic period") March 11, 2020. Perceived exposure to pollution from a highway or a road was significantly decreased from the prepandemic to postpandemic period (z=-3.347; P<.001). Analysis of industry or power plants also suggested a significant decrease in the perceived exposure from the prepandemic to postpandemic period (z=-2.152; P=.04). Participants reported an increase in exposure to odors from disinfectants or sanitizers that entered their living environment (P<.001). There was a significant decrease between prepandemic and postpandemic levels of satisfaction when attending in-person meetings with a physician (z=-2.048; P=.04), yet there were no significant differences between prepandemic and postpandemic levels of satisfaction for online or telephone meetings with a physician. Although people with MCS experienced increased social isolation (P<.001), they also reported an increase in understanding from family (P=.03) and a decrease in stigma for wearing personal protective equipment (P<.001). CONCLUSIONS: During the first year of the COVID-19 pandemic, people with MCS were impacted by inaccessibility, loss of social support, and barriers to accessing health care. This study highlights unique challenges and possible benefits associated with the COVID-19 pandemic public health measures for individuals living with MCS. These findings can guide decision makers to improve policies on accessibility through appropriate accommodation measures.

Knowledge, attitude, and practices of stakeholders involved in healthcare financing programs on economic evaluations in Cameroon.

There are many healthcare financing programs (HFPs) in Cameroon; however, there is a lack of information on these programs' economic effectiveness and efficiency. Involvement of local stakeholders in the economic evaluations (EEs) of HFPs is critical for ensuring contextual factors are considered prior to program implementation. We conducted a cross-sectional study to assess the need for EEs of Cameroonian HFPs. Regular staff in supervisory roles aged 18 years and above were recruited in four Cameroonian cities. Data were collected via face-to-face surveys between June 15 and August 1, 2022. Descriptive analyses summarized participants' knowledge, attitudes, and practices in relation to performing EEs of HFPs. Principal component analyses identified organizational, individual, and contextual factors that could influence participants' involvement. The total sample included 106 participants. On average, 65% of participants reported being aware of the listed HFPs; however, of these, only 28% said that they had been involved in the HFPs. Of the 106 participants, 57.5% knew about EEs; yet, almost 90% reported that the HFP in question had never been subject to an EE, and 84% had never been involved in an EE. Most participants indicated that they had intended or would like to receive EE training. Using principal component analyses, the organizational factors were classified into two components ('policy and governance' and 'planning and implementation'), the individual factors were classified into two components ('training' and 'motivation'), and the contextual factors were classified into three components ('funding,' 'political economy,' and 'public expectations'). The findings of this study highlight the need to invest in EE training to improve participation rates of Cameroonian stakeholders in the EEs of HFPs. Improved knowledge, diversified skills, and increased participation of stakeholders from all levels of the Cameroonian healthcare system are critical to the effective and efficient development, implementation, and EE of the country's HFPs.

Determination of a safe and effective ultraviolet B radiant dose in budgerigars (Melopsittacus undulatus): a pilot study.

The object of this study was to establish a minimum dose of ultraviolet B (UVB) radiation capable of producing an erythemal reaction in budgerigars (Melopsittacus undulatus), to determine a threshold dose of UVB for vitamin D photoconversion, and to investigate the use of safer UVB wavelengths. In each of 5 experiments of this study, 20 birds were divided into a control group (n = 10) and a UVB irradiated group (n = 10). Light sources that provide broadband UVB wavelengths (280-315 nm) and narrowband UVB (310-320 nm) were used. Varied doses of UVB radiation were administered to budgerigars by altering exposure time and irradiance. Safety was determined by observing body weight and incidence of photokeratitis and photodermatitis. Efficacy was evaluated by measuring changes in serum 25-hydroxycholecalciferol levels. Serum corticosterone was measured in 1 experiment to monitor stress levels. The results demonstrated that exposure to 180 mJ/cm2 broadband UVB induced vitamin D photoconversion, decreased body weights, and increased serum corticosterone levels. At these wavelengths, UVB-induced lesions were observed. A broadband UVB of 150 to 300 mJ/cm2 was determined as the minimum erythema dose, and the threshold dose for vitamin D photoconversion was calculated to be in the range of 113-225 mJ/cm2. No erythemal lesions or vitamin D photoconversion took place after exposure to up to 1730 mJ/cm2 narrowband UVB radiation. A minimum erythema dose and a threshold dose for vitamin D conversion need to be determined for each species if phototherapy is to be considered as a safe and effective therapeutic or husbandry tool.

Barriers and facilitators of access to sexual and reproductive health services among migrant, internally displaced, asylum seeking and refugee women: A scoping review.

INTRODUCTION: Migrant, internally displaced, asylum seeking and refugee women experience ongoing risks of having their reproductive healthcare rights violated. This ever-increasing population also has limited access to sexual and reproductive health services. We conducted a scoping review to identify the barriers and facilitating factors when accessing sexual and reproductive health services for this specific population. METHODS: We searched the grey literature and queried eight bibliographic databases (Embase, Medline, Cinahl, Scopus, Science Direct, Web of Science, Hinari, and Cochrane Library) to extract articles published between January, 2000, and October, 2021. The extracted data were organized in a framework adapted from Peters et al. and then categorized as facilitators or barriers. We followed the Arksey and O'Malley framework and wrote the report according to the PRISMA-Scr recommendations. RESULTS: The search identified 4,722 records of which forty-two (42) met eligibility criteria and were retained for analysis. Ten (10) groups of factors facilitating and/or limiting access to sexual and reproductive health care emerged from the synthesis of the retained articles. The main barriers were lack of knowledge about services, cultural unacceptability of services, financial inaccessibility, and language barriers between patients and healthcare providers. Facilitators included mobile applications for translation and telehealth consultations, patients having a wide availability of information sources, the availability health promotion representatives, and healthcare providers being trained in cultural sensitivity, communication and person-centered care. CONCLUSION: Ensuring the sexual and reproductive rights of migrant, internally displaced, asylum-seeking and refugee women requires that policymakers and health authorities develop intervention strategies based on barriers and facilitators identified in this scoping review. Therefore, considering their mental health in future studies would enable a better understanding of the barriers and facilitators of access to sexual and reproductive health services.

Profiles of socially isolated community-dwelling older adults during the COVID-19 pandemic: A latent class analysis.

OBJECTIVE: To identify different profiles of socially isolated older adults during the first wave of COVID-19 in Quebec, Canada. STUDY DESIGN: Cross-sectional data were obtained through a telehealth socio-geriatric risk assessment tool, ESOGER, administered to adults aged 70 years or more between April and July 2020 in Montreal, Canada. MEASURES: Those living alone with no social contacts in the last few days were considered socially isolated. Latent class analysis was performed to identify profiles of socially isolated older adults based on: age, sex, polypharmacy, use of home care, use of a walking aid, recall of current year/month, anxiety level (scale 0-10), and need for follow-up from a healthcare provider. RESULTS: Three-hundred and eighty (380) older adults identified as socially isolated were analyzed, of whom 75.5 % were female and 56.6 % were over 85. Three classes were identified: Class 1 ("physically frail older females") had the highest proportion of polypharmacy, walking aid, and home care use. Class 2 ("anxious, relatively younger males") were predominantly males who used the least home care but had the highest anxiety levels. Class 3 ("seemingly well older females") had the highest proportion of females, lowest proportion of polypharmacy, lowest anxiety level, and none used a walking aid. Recall of current year/month was similar across the three classes. CONCLUSIONS: This study found heterogeneity among socially isolated older adults during the first wave of the COVID-19 pandemic with varying levels of physical and mental health. Our findings may contribute to the development of targeted interventions to support this vulnerable population during and after the pandemic.

Evaluating Methylation of the Oxytocin Receptor Gene and the Oxytocin Intergenic Region.

Oxytocin and its paralogue, vasopressin, are widely studied biomarkers in relation to pregnancy and birth, maternal and social behavior, and mental health. Epigenetics is a biological mechanism that mediates the link between environmental influences and behavioral patterns. In a candidate gene approach, we describe here a DNA methylation assay of two regions within the oxytocin system, using human buccal cells and next-generation sequencing. Two nanograms of DNA were sufficient to assess the DNA methylation status of 28 CpG sites (22 corresponding to the oxytocin receptor and 6 corresponding to the vasopressin/oxytocin intergenic region). This method proved to be non-invasive for the participants, and reproducible; its validity remains to be confirmed alongside other biomarkers of gene function.

Automated Intraoperative Short Messaging Service Updates: Quality Improvement Initiative to Relieve Caregivers' Worries.

BACKGROUND: Undergoing a surgical procedure is anxiety provoking for patients and their caregivers. During the intraoperative period, caregivers seek out informational updates from health care professionals, a situation complicated by COVID-19 health measures that require caregivers to wait outside the hospital. Short messaging service (SMS)-based communication that allows caregivers to follow their loved ones through surgery has shown promise in relieving anxiety and improving satisfaction with overall care. This form of communication is also well accepted by health care professionals and may be effective at relieving staff burden. OBJECTIVE: Here, we describe a quality improvement initiative of a standardized and integrated intraoperative SMS-based system to improve communication between surgical teams and caregivers. The main goal was to improve satisfaction with care, while the secondary goal was to reduce caregiver anxiety. METHODS: The initiative followed the framework of the Model for Improvement. A large tertiary care hospital offered the SMS to caregivers who were waiting for loved ones undergoing surgery. SMS messages were integrated into the clinical information system software and sent at key points during the surgical journey to phone numbers provided by caregivers. A satisfaction survey was sent to caregivers 1 business day after surgery. Data were collected between February 16 and July 14, 2021. RESULTS: Of the 8129 surgeries scheduled, caregivers waiting for 6149 (75.6%) surgeries agreed to receive SMS messages. A total of 34,129 messages were sent. The satisfaction survey was completed by 2088 (34%) of the 6149 caregivers. Satisfaction with messages was high, with the majority of respondents reporting that the messages received were adequate (1476/2085, 70.8%), clear (1545/2077, 74.4%), informative (1488/2078, 71.6%), and met their needs (1234/2077, 59.4%). The overall satisfaction score was high (4.5 out of 5), and caregivers reported that receiving text messages resulted in a reduction in anxiety (score=8.2 out of 10). Technical errors were reported by 69 (3.3%) caregivers. Suggestions for improvements included having messages sent more often; providing greater patient details, including the patient's health status; and the service being offered in other languages. CONCLUSIONS: This digital health initiative provided SMS messages that were systematically sent to caregivers waiting for their loved ones undergoing surgery, just as COVID-19 restrictions began preventing waiting onsite. The messages were used across 15 surgical specialties and have since been implemented hospital-wide. Digital health care innovations have the capacity to improve family-centered communication; what patients and their families find useful and appreciate will ultimately determine their success.

Factors associated with childhood chronic malnutrition in West and Central Africa: a scoping review.

Chronic malnutrition is a major public health concern that is the focus of a large body of scientific research. However, there is no synthesis of knowledge about the factors associated with this disease in West and Central Africa, where its prevalence is particularly high. We conducted a systematic search for scientific articles published between January 1st, 2000, and October 15th, 2020, that focus on chronic malnutrition in children in West and Central Africa. We queried CAIRN, PubMed, CINAHL, MEDLINE, Scopus, and Google Scholar databases for this purpose. The search process followed the recommendations of Arksey and O'Malley. Items reported in this review follow the PRISMA-ScR guidelines. Sixty articles involving children from a total of twenty (20) countries, mainly Ghana and Nigeria, were included in the final analysis. The data used were predominantly cross-sectional and were mainly drawn from demographic and health surveys. The analysis revealed that chronic malnutrition in children is associated with sociocultural, economic, and healthcare factors related to the characteristics of children, mothers, households, and communities. The association with children's vulnerability to disease, maternal education, purchasing power, and autonomy need to be further investigated in West and Central Africa. Further analysis using longitudinal data is also needed to better understand the factors associated with chronic malnutrition in West and Central Africa.