Implications of conscious AI in primary healthcare.

The conversation about consciousness of artificial intelligence (AI) is an ongoing topic since 1950s. Despite the numerous applications of AI identified in healthcare and primary healthcare, little is known about how a conscious AI would reshape its use in this domain. While there is a wide range of ideas as to whether AI can or cannot possess consciousness, a prevailing theme in all arguments is uncertainty. Given this uncertainty and the high stakes associated with the use of AI in primary healthcare, it is imperative to be prepared for all scenarios including conscious AI systems being used for medical diagnosis, shared decision-making and resource management in the future. This commentary serves as an overview of some of the pertinent evidence supporting the use of AI in primary healthcare and proposes ideas as to how consciousnesses of AI can support or further complicate these applications. Given the scarcity of evidence on the association between consciousness of AI and its current state of use in primary healthcare, our commentary identifies some directions for future research in this area including assessing patients', healthcare workers' and policy-makers' attitudes towards consciousness of AI systems in primary healthcare settings.

Feasibility of a new clinical journal club implementation and its association with knowledge, attitudes, and application of evidence-based practice among chiropractic students and trainees: a before-and-after healthcare education improvement study.

BACKGROUND: Evidence-based practice (EBP) is the integration of best research evidence with clinical expertise and patients' values and preferences. Little is known about knowledge, attitudes, and application of EBP among chiropractic students and trainees. Our aims were to (1) examine the feasibility of implementing a new journal club format within a Swiss university chiropractic healthcare education setting, and (2) assess the associations between the new journal club implementation and EBP characteristics among chiropractic students. METHODS: A before-and-after study was conducted through a newly implemented journal club with 5th and 6th year chiropractic students and postgraduate trainees between 1 and 2021 and 31 July 2021. The journal club was developed based on the "community of practice" and "team-based learning" conceptual frameworks. EBP knowledge, attitudes, personal application, and future use, were assessed with a validated questionnaire. We summarised participant characteristics using descriptive statistics, estimated before-and-after EBP total and subscale scores (i.e., knowledge, attitudes, personal application, and future use), and conducted an exploratory subgroup analysis based on journal club attendance (Group A: 3-5 sessions attended; Group B: ≤ 2 sessions attended). RESULTS: Among 32 eligible students and trainees, 29 participants (mean age 26 years; 79% women) were enrolled: 25 (78%) responded to the pre- and 29 (91%) to the post-assessment surveys. Most (80%) were chiropractic students and 20% were postgraduate trainees. Group A consisted of 12 (41%) and Group B of 17 (59%) participants, respectively. We found reasonable feasibility for the new journal club format and our findings were compatible with no difference in before-and-after EBP scores (median EBP total score before: 72.6 [IQR, 63.7-77.4], and after: 73.4 [IQR, 61.3-78.2]). Exploratory subgroup analyses based on journal club attendance were consistent with our overall findings. CONCLUSION: Our study suggests that the newly implemented journal club and embedding chiropractic educational research within the journal club were feasible and acceptable. Small before-and-after differences in the EBP subscale scores for knowledge, attitudes, personal application, and future use were observed in chiropractic students and postgraduate trainees. The small study size and short timeframe during a single semester limit potential inferences.

Revolutionizing nursing education through Ai integration: A reflection on the disruptive impact of ChatGPT.

Artificial intelligence (AI) is driving global change. An AI language model like ChatGPT could revolutionize the delivery of nursing education in the future. ChatGPT is an AI-enabled text generator that has garnered significant attention due to its ability to engage in conversations and answer questions. Nurse educators play a crucial role in preparing nursing students for a technology-integrated healthcare system, and the emergence of ChatGPT presents both opportunities and challenges. While the technology has limitations and potential biases, it also has the potential to benefit students by facilitating learning, improving digital literacy, and encouraging critical thinking about AI integration in healthcare. Nurse educators can incorporate ChatGPT into their curriculum through formative or summative assessments and should prioritize faculty development to understand and use AI technologies effectively. Collaboration between educational institutions, regulatory bodies, and educators is crucial to establish provincial and national competencies and frameworks that reflect the increasing importance of AI in nursing education and practice. It is paramount that nurses and nurse educators be open to AI-enabled innovations as well as continue to critically think about their potential value to advance the profession so nurses are better prepared to lead the digital future.

Unravelling Vaccine Scepticism in South Tyrol, Italy: A Qualitative Analysis of Personal, Relational, and Structural Factors Influencing Vaccination Decisions.

Low vaccine uptake in South Tyrol, particularly for non-coronavirus and SARS-CoV-2 vaccines, poses a significant public health challenge in the northernmost province of Italy. This qualitative study conducted in-depth interviews with a purposive sample of vaccine-sceptical parents to examine the factors that contribute to their vaccination decisions. The ten participants' children had varied vaccination statuses, ranging from unvaccinated to partially vaccinated or vaccinated as late as possible. Only one adult participant received the SARS-CoV-2 vaccine. Using Grounded Theory analysis, the emergent meta-category of 'self-relatedness' was identified, highlighting the importance of individual experiences and the social context. The study found that participants' social circles consisted of individuals with similar vaccination attitudes, often characterized by a shared affinity for nature. Although they accepted individuals with different views, they remained uninfluenced. Participants perceived healthcare professionals as one-sided and uncritical, expressing distrust toward state orders. They believed that parents should be responsible for their children's well-being rather than the state. Distrust in the state and healthcare system, exacerbated by the SARS-CoV-2 pandemic, was rooted in negative experiences. In contrast, the participants had positive experiences with natural healing, homeopathy, and trusting the natural course of events. They perceived themselves as tolerant, non-radical, curious, health-conscious, yet critical and questioning. Participants resisted coercion, fear-mongering, and state sanctions and sought alternatives to mandatory vaccination. To address the complex social and behavioural factors underlying vaccination refusal, this study suggests that vaccination advocates, policymakers, and information providers should engage in appreciative, personal, and well-founded information exchanges with vaccine-hesitant individuals. Broad and comprehensible information dissemination, flexibility, and freedom of decision are essential for increasing informed decision making. Further research is required to better understand the epistemic basis of vaccine hesitancy.

Delivery of acupuncture in clinical trials: Research acupuncturists' perspectives.

Delivery of acupuncture in the setting of a clinical trial is a unique practice that diverges significantly from the delivery of acupuncture in a real-world clinical setting. Research acupuncturists, particularly those trained in traditional Chinese medicine (TCM), are often required to set aside valued precepts of traditional care, including diagnosing imbalances, individualizing treatment, and forging a therapeutic relationship with patients. TCM-trained acupuncturists express mixed feelings about participating in clinical trials. Many are eager to play a vital role in the advancement of acupuncture science and appreciate the need for strict protocol adherence to minimize bias. However, the acupuncturist(s) may also have concerns about clinical trial methodology, including but not limited to the delivery of a control condition, e.g., sham acupuncture. Investigators should anticipate certain questions and even a level of resistance to the requirements of research among acupuncturists and be prepared to address them. This manuscript presents a brief review of the subjective experience of the research acupuncturist within the available scientific literature as it pertains to the delivery of active and sham clinical research protocols. Our goals are to better understand the perspectives of acupuncturists who may participate in clinical research, so that their concerns may be addressed in study design and methodology. To that end, we suggest the creation of a novel training program specifically for clinical trial acupuncturists, intended for qualified TCM- and Western-trained practitioners, that would help to standardize the research acupuncturist's role and help to strengthen the design and execution of acupuncture studies. Please cite this article as: Anastasi JK, Capili B, Neumaier J, Hackett L. Delivery of acupuncture in clinical trials: Research acupuncturists' perspectives. J Integr Med. 2023; 21(4):315-319.

Creencias-prácticas culturales de pacientes con cuidados paliativos domiciliarios, desde la teoría Leininger

Introducción: La cultura del paciente tiene influencia en la selección de sus tratamientos, las expresiones emocionales, la toma de decisiones y en la forma de comunicarse de los pacientes. Los cuidados paliativos permiten el abordaje holístico a personas y familias en sufrimiento por enfermedades potencialmente mortales. Objetivo: Describir las creencias y las prácticas culturales relacionadas con la salud en pacientes adultos de un programa domiciliario de cuidados paliativos en la ciudad de Bogotá. Materiales y Métodos: Estudio cualitativo, de tipo etnografía. Se realizaron entrevistas semiestructuradas virtuales a 9 pacientes requirentes de cuidados paliativos, determinada por saturación teórica. Para el análisis de la información, se consideraron las orientaciones de la teoría de los cuidados culturales de Leininger bajo el modelo del sol naciente. Se realizó la codificación y categorización en el software Nvivo v12. Resultados: Se obtuvieron 3 categorías principales: prácticas culturales, creencias para mantener la poca salud y aliviar síntomas y experiencias en la adaptación a la enfermedad y muerte y se dio lugar a 13 subcategorías Discusión: Tras describir y analizar los resultados obtenidos, se observó que los participantes poseen conocimientos sobre prácticas-creencias culturales, que han sido transmitidas de generación en generación y juegan un papel importante en el proceso de la enfermedad Conclusiones: Se evidenció que existen prácticas consideradas protectoras y otras que generan conductas de riesgo, las cuales deberán reestructurarse, negociarse o preservarse, con el objetivo de fortalecer el proceso de cuidado y así mantener un enfoque culturalmente competente.

Introduction: Patient culture influences treatment selection, emotional expressions, decision making, and patients' communication. Palliative care allows a holistic approach to individuals and families suffering from life-threatening illnesses. Objective: To describe the beliefs and health- related cultural practices of adult patients in a palliative home care program in the city of Bogotá. Materials and methods: Qualitative ethnographic study. Semi-structured online interviews were conducted with 9 patients requiring palliative care, until theoretical saturation was reached. For data analysis, the guidelines of Leininger's Cultural Care Theory based on the Sunrise Model were considered. Results: Three main categories were identified: cultural practices, beliefs about maintaining poor health and alleviating symptoms, and experiences adapting to illness and death, resulting in 13 subcategories. Discussion: After describing and analyzing the results obtained, it was observed that the participants have knowledge of cultural practices-beliefs that have been passed down from generation to generation and play an important role in the disease process. Conclusions: It became clear that there are practices that are considered protective and others that create risky behaviors that should be restructured, negotiated, or maintained in order to strengthen the care process and thus maintain a culturally competent approach.

Introdugáo: A cultura do paciente influencia na escolha de seus tratamentos, nas expressóes emocionáis, na tomada de decisóes e na forma como os pacientes se comunicam. Os cuidados paliativos permitem uma abordagem holística para individuos e familias que sofrem de doengas que ameagam a vida. Objetivo: Descrever as crengas e práticas culturais relacionadas a saúde em pacientes adultos de um programa domiciliar de cuidados paliativos na cidade de Bogotá. Materiais e Métodos: Estudo qualitativo, do tipo etnográfico. Foram realizadas entrevistas semiestruturadas virtuais com 9 pacientes em cuidados paliativos, determinadas pela saturagao teórica. Para a análise das informagóes, foram consideradas as orientagóes da teoria do cuidado cultural de Leininger sob o modelo do sol nascente. A codificagao e categorizagao foram realizadas no software Nvivo v12. Resultados: Obtiveram-se 3 categorias principais: práticas culturais, crengas para manter a saúde precária e aliviar sintomas e experiencias de adaptagao a doenga e a morte, dando origem a 13 subcategorias. Discussao: descrevendo e analisando os resultados obtidos, observou-se que os participantes possuem conhecimento sobre as práticas-crengas culturais, que foram transmitidas de geragao em geragao e desempenham um papel importante no processo de adoecimento. Condusdes: ficou evidenciado que existem práticas consideradas protetoras e outras que geram comportamentos de risco, que devem ser reestruturadas, negociadas ou preservadas, a fim de fortalecer o processo de cuidar e, assim, manter uma abordagem culturalmente competente.

Delivery of acupuncture in clinical trials: Research acupuncturists' perspectives / 中西医结合学报

Delivery of acupuncture in the setting of a clinical trial is a unique practice that diverges significantly from the delivery of acupuncture in a real-world clinical setting. Research acupuncturists, particularly those trained in traditional Chinese medicine (TCM), are often required to set aside valued precepts of traditional care, including diagnosing imbalances, individualizing treatment, and forging a therapeutic relationship with patients. TCM-trained acupuncturists express mixed feelings about participating in clinical trials. Many are eager to play a vital role in the advancement of acupuncture science and appreciate the need for strict protocol adherence to minimize bias. However, the acupuncturist(s) may also have concerns about clinical trial methodology, including but not limited to the delivery of a control condition, e.g., sham acupuncture. Investigators should anticipate certain questions and even a level of resistance to the requirements of research among acupuncturists and be prepared to address them. This manuscript presents a brief review of the subjective experience of the research acupuncturist within the available scientific literature as it pertains to the delivery of active and sham clinical research protocols. Our goals are to better understand the perspectives of acupuncturists who may participate in clinical research, so that their concerns may be addressed in study design and methodology. To that end, we suggest the creation of a novel training program specifically for clinical trial acupuncturists, intended for qualified TCM- and Western-trained practitioners, that would help to standardize the research acupuncturist's role and help to strengthen the design and execution of acupuncture studies. Please cite this article as: Anastasi JK, Capili B, Neumaier J, Hackett L. Delivery of acupuncture in clinical trials: Research acupuncturists' perspectives. J Integr Med. 2023; 21(4):315-319.

Rabies research in Ethiopia: A systematic review.

Rabies is an important zoonosis in Ethiopia, where lack of research is cited as a constraint to implementation of the national rabies control strategy. We conducted a systematic review of publications and theses on rabies in Ethiopia, to document research gaps and areas of knowledge saturation in relation to geographic and species focus, methods and findings. We also examined funding sources and extent of local researcher participation. After screening titles and abstracts, the full text of 119 publications was included in data extraction. More than 40% of publications involved data collection in one region (Oromia); no publications reported findings from Benishangul-Gumuz, Dire Dawa or Gambella. Dogs and wildlife (especially Canis simensis) were the focus of research in 45% and 24% publications, respectively. Descriptive epidemiology (N = 39 publications), ethno-medicine/-pharmacology (N = 17) and knowledge, attitude, and practice surveys (KAP, N = 15) were amongst the most common study designs, while studies involving economic methods (N = 3) and experimental epidemiology to test interventions (N = 3) were under-represented. Incidence surveys (N = 9) commonly used post-exposure prophylaxis administration in humans as a proxy for exposure without laboratory confirmation of the rabies status of the animal. KAP surveys tended to highlight reasonable levels of knowledge of rabies and poor practices, including overreliance on medicinal plants. International researchers were the first or last (senior) author on 42% and 58% of publications, respectively, most of which were funded by international organizations (45/72 publications reporting funding source). Based on this systematic review, we suggest more applied research is needed to address gaps in laboratory surveillance (including in humans, domestic and wild animals); identify effective ways to overcome socio-cultural and other barriers to accessing effective rabies treatments; inform best approaches to incentivizing mass dog vaccination programs; and generate local estimates of the cost-benefit and cost-effectiveness of different control strategies to improve financing and political buy-in for rabies control in Ethiopia.

Women's knowledge, attitudes and views of preconception health and intervention delivery methods: a cross-sectional survey.

BACKGROUND: Several preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, few studies have investigated women's knowledge of and attitudes towards preconception health, and the acceptability of potential intervention methods. METHODS: Seven primary care centres in the West of England posted questionnaires to 4330 female patients aged 18 to 48 years. Without providing examples, we asked women to list maternal preconception exposures that might affect infant and maternal outcomes, and assessed their knowledge of nine literature-derived risk factors. Attitudes towards preconception health (interest, intentions, self-efficacy and perceived awareness and importance) and the acceptability of intervention delivery methods were also assessed. Multivariable multilevel regression examined participant characteristics associated with these outcomes. RESULTS: Of those who received questionnaires, 835 (19.3%) responded. Women were most aware of the preconception risk factors of diet (86.0%) and physical activity (79.2%). Few were aware of weight (40.1%), folic acid (32.9%), abuse (6.3%), advanced age (5.9%) and interpregnancy intervals (0.2%), and none mentioned interpregnancy weight change or excess iron intake. After adjusting for demographic and reproductive covariates, women aged 18-24-years (compared to 40-48-year-olds) and nulligravid women were less aware of the benefit of preconception folic acid supplementation (adjusted odds ratios (aOR) for age: 4.30 [2.10-8.80], gravidity: aOR 2.48 [1.70-3.62]). Younger women were more interested in learning more about preconception health (aOR 0.37 [0.21-0.63]) but nulligravid women were less interested in this (aOR 1.79 [1.30-2.46]). Women with the lowest household incomes (versus the highest) were less aware of preconception weight as a risk factor (aOR: 3.11 [1.65-5.84]) and rated the importance of preconception health lower (aOR 3.38 [1.90-6.00]). The most acceptable information delivery methods were websites/apps (99.5%), printed healthcare materials (98.6%), family/partners (96.3%), schools (94.4%), television (91.9%), pregnancy tests (91.0%) and doctors, midwives and nurses (86.8-97.0%). Dentists (23.9%) and hairdressers/beauticians (18.1%) were the least acceptable. CONCLUSIONS: Our findings demonstrate a need to promote awareness of preconception risk factors and motivation for preconception health changes, particularly amongst younger and nulligravid women and women with lower incomes. Interventions to improve preconception health should focus on communication from healthcare professionals, schools, family members, and digital media.

Percepción sobre las vacunas y nivel de conocimientos, actitudes y prácticas hacia la COVID-19 en adultos mayores de Lima, Perú / Perception about vaccines and level of knowledge, attitudes and practices towards COVID-19 in older adults in Lima, Peru

RESUMEN El objetivo fue describir la percepción sobre las vacunas y el nivel de conocimientos, actitudes y prácticas hacia la COVID-19 en adultos mayores que acuden a un hospital en Lima, Perú. Estudio descriptivo y transversal de marzo a noviembre del 2021. Se adaptó y validó un instrumento para medir el nivel de conocimientos, actitudes y prácticas, y se evaluó la percepción sobre vacunas con un cuestionario exploratorio. Se encuestaron a 83 adultos mayores, la media de edad fue 74,0 años y el 62,7% fueron mujeres. La mayoría conoce la causa y síntomas, y el 50,6% cree que puede transmitirse por alimentos contaminados. El 61,7% usa medicina tradicional para prevenirla, y el 65,4% considera insuficiente el nivel de conciencia social. El 91,5% se vacunó contra la COVID-19, y el 65,4% considera que estas vacunas son seguras. En conclusión, la mayoría de los adultos mayores presenta un alto nivel de conocimientos, actitudes y prácticas y una percepción positiva sobre la vacuna contra la COVID-19.

ABSTRACT This study aimed to describe the perception about vaccines and the level of knowledge, attitudes and practices towards COVID-19 in older adults from a hospital in Lima, Peru. Descriptive and cross-sectional study carried out from March to November 2021. An instrument was adapted and validated to measure the level of knowledge, attitudes and practices; the perception about vaccines was evaluated with an exploratory questionnaire. Eighty-three older adults were surveyed, the mean age was 74.0 years and 62.7% were women. Most of the participants knew the cause and symptoms, and 50.6% believed that it could be transmitted by contaminated food. Additionally, 61.7% used traditional medicine to prevent it, and 65.4% considered that the level of social awareness was insufficient; 91.5% were vaccinated against COVID-19, and 65.4% considered these vaccines to be safe. In conclusion, most older adults showed a high level of knowledge, attitudes and practices and a positive perception about the vaccine against COVID-19.

Midwives perceptions of managing pregnancies complicated by obesity: A mixed methods study.

OBJECTIVE: The growing prevalence of obesity is a concern for midwives. In Canada, the absence of regulatory standards, varying protocols and consultant preferences shape clinical decision making for the midwife and may lead to inconsistent practice. Our aim was to understand the barriers, enablers, and knowledge gaps that influenced experiences of midwives in Ontario, Canada when providing care to clients impacted by obesity. METHODS: Mixed methods design using a sequential, explanatory approach. Surveys conducted with midwives were administered using an online platform, followed by semi-structured interviews to understand the perspectives elicited in the survey in greater detail. Interviews were audio recorded and transcribed verbatim. Survey data were analyzed using descriptive statistics, and thematic analysis was used for generating codes, categories and themes from the interview data. RESULTS: 144 midwives completed the survey and 20 participated in an interview. The participants described their clinical management when caring for those with obesity which included considerations regarding additional tests/investigations, consultation and transfer of care, and place of birth. Up to 93% of surveyed midwives believed that clients with obesity were appropriate for midwifery-led care however there was less certainty about suitability as BMI increased to higher ranges such as > 45). The care management was influenced by beliefs and attitudes, knowledge, and system-level factors. Midwives experienced barriers such as inconsistent practices and role confusion, and felt ill equipped to care for pregnancies affected by obesity due to unclear guidelines. CONCLUSIONS: Overall, midwives believe clients with obesity are suitable for midwifery-led care due to its individualized, non-judgmental approach to care. Additional training for midwives and other obstetric care providers would be beneficial to help overcome barriers in providing effective care to pregnancies affected by obesity.

Blessing as a health resource: cross-sectional study with elderly residents of rural areas / Benzeção como recurso em saúde: estudo transversal com idosos moradores de área rural

ABSTRACT OBJECTIVE To estimate the prevalence and factors associated with the search for folk healers for the treatment of health problems among elderly living in the rural area of the city of Rio Grande-RS. METHODS Cross-sectional, p opulation-based study with random sampling, carried out in 2017. The outcome was analyzed in three categories (never used/used in the last 12 months/used for more than 12 months). Multinomial logistic regression was used to analyze theassociated factors. RESULTS A total of 1,030 elderly individuals were interviewed. The prevalence of demand for folk healers in the last 12 months and for more than 12 months was 9.5% and 15.8%, respectively. In the adjusted analysis, the characteristics associated with the use of a folk healer for more than 12 months were: being in the age group of 80 years or more and having back problems and arthrosis. Following the evangelical religion was identified as a protective factor for using this resource. On the other hand, the demand for blessing in the last year was related to the age group of 70-79 years, following spiritual religions, presence of disease in the last 12 months, back problems and arthrosis, and preference for the use of urgency and emergency services. Being female was associated only with the use for more than 12 months. CONCLUSION This study brings an original contribution to a topic poorly evaluated in epidemiological studies, because the knowledge of the frequency and determinants of the search for this type of popular therapy can be used to improve the quality and access to health services offered to the elderly population in rural areas.

RESUMO OBJETIVO Estimar a prevalência e os fatores associados à procura de benzedeiras para tratamento de problemas de saúde entre idosos residentes na área rural do município do Rio Grande-RS. MÉTODOS Estudo transversal, de base populacional com amostragem aleatória, realizado no ano de 2017. O desfecho foi analisado em três categorias (nunca usou/usou nos últimos 12 meses/usou há mais de 12 meses). Para análise dos fatores associados foi utilizada regressão logística multinomial. RESULTADOS Foram entrevistados 1.030 idosos. As prevalências da procura por benzedeira nos últimos 12 meses e há mais de 12 meses foram de 9,5% e 15,8%, respectivamente. Na análise ajustada, as características associadas à utilização de benzedeira há mais de 12 meses foram: estar na faixa etária de 80 anos ou mais e ter problemas de coluna e artrose. Seguir a religião evangélica foi identificado como fator de proteção para a utilização desse recurso. Já a procura por benzedeira no último ano esteve relacionada com a faixa etária dos 70-79 anos, seguir religiões espiritualistas, presença de doença nos últimos 12 meses, problemas na coluna e artrose e preferência por utilização de serviços de urgência e emergência. Sexo feminino permaneceu associado apenas à utilização há mais de 12 meses. CONCLUSÃO Este estudo traz uma contribuição original a um tema pouco avaliado em estudos epidemiológicos, pois o conhecimento da frequência e dos determinantes da busca por esse tipo de terapia popular, pode ser utilizado para melhorar a qualidade e o acesso aos serviços de saúde oferecidos à população idosa de áreas rurais.

Exploring the Use of Herbal Treatments During Pregnancy Among Saudi Women: An application of the knowledge-attitude-practice model.

OBJECTIVES: Herbal treatments are commonly used by Saudi women during pregnancy. However, the inappropriate use of some herbs can have side-effects for both the mother and the fetus. Thus, a comprehensive understanding of their use during pregnancy is crucial. This study aimed to explore the use of herbal treatments by Saudi women during pregnancy using the knowledge-attitude-practice model. METHODS: This cross-sectional study was conducted from September 2019 and April 2020 in Riyadh, Saudi Arabia, on a convenience sample using an online Arabic-language questionnaire. Saudi women aged between 18-58 years who were pregnant or had been pregnant and were living in the Riyadh were included. RESULTS: A total of 400 individuals participated in this study. All participants lacked knowledge about the side-effects of herbal treatment but 63% knew about unsafe herbs in general. Most participants (66%) had a neutral attitude towards herbal treatments. Almost half of the participants (48%) did not use herbs during pregnancy and a similar number (47%) sometimes used herbal treatments during pregnancy. There was a significant positive correlation between attitude and practice and a negative correlation between knowledge and attitude as well as between knowledge and practice (P <0.0001 each). CONCLUSION: While the participants' knowledge were generally poor, their attitudes and practices regarding the use of herbal treatments during pregnancy were good. It is recommended that more efforts be made by healthcare providers to target attitudes towards herbal treatments by providing accurate knowledge and reinforcing healthy practices among Saudi women.

Development and validation of a questionnaire for assessing preventive practices and barriers among health care workers in COVID-19 pandemic.

OBJECTIVES: COVID-19 has affected thousands of health care workers worldwide. Suboptimal infection control practices have been identified as important risk factors. The objective of this study was to develop and validate a questionnaire to holistically assess the preventive practices of health care workers related to COVID-19 and identify the reasons for shortcomings therein. METHODS: The development of the questionnaire involved item generation through literature review, focus group discussions and in-depth interviews with health care workers and experts, followed by validation through expert opinion, pilot testing and survey. A cross-sectional survey on 147 healthcare workers was done using an online platform and/or interviews in August 2020 in New Delhi, India. Exploratory factor analysis using principal component extraction with varimax rotation was performed to establish construct validity. Internal consistency of the tool was tested using Cronbach's alpha coefficient. RESULTS: The developed questionnaire consists of two sections: Section A contains 29 items rated on a five-point Likert scale to assess preventive practices and Section B contains 27 semi-structured items to assess reasons for suboptimal practices. The first section has good validity (CVR = 0.87, S-CVI/Av = 0.978) and internal consistency (Cronbach's alpha coefficient = 0.85) CONCLUSIONS: This questionnaire is a valid and reliable tool for holistic assessment of preventive practices and barriers to it among health care workers. It will be useful to identify vulnerable practices and sections in health care settings which would assist policymakers in designing appropriate interventions for infection prevention and control. This will also be useful in future pandemics of similar nature.

O padrão de consumo de fibras entre adultos brasileiros: percepções de um inquérito nacional online / Patterns of fiber intake among brazilian adults: perceptions from an online nationwide survey

ABSTRACT BACKGROUND: Adequate fiber intake is associated with digestive health and reduced risk of several noncommunicable diseases and is recognized as essential for human health (World Health Organization, 2003). The World Health Organization (WHO) recommends a daily fiber consumption of ≥25 g, but previous studies observed a fiber intake in Brazil lower than recommended. OBJECTIVE: We aimed to describe fiber intake among adults in Brazil and also respondents' knowledge and perceptions about their fiber intake. METHODS: National online survey with community-dwelling Brazilian individuals. The survey was conducted during September 2018, using an online platform with closed-ended questions. A representative sample of Brazilian internet users stratified by sex, age, socioeconomic status and geographic region was adopted. Sample size was calculated using a 2% error margin and 95% confidence interval (n=2,000). Data was descriptively analyzed using measures of frequency, central tendency and dispersion. RESULTS: Sample included 2,000 individuals who were well-balanced in terms of sex (51.2% female), with mean age of 35.9 years (most represented age group was 35-54 years, 39.6%) and from all country geographic regions (49.4% from Southeast). A total of 69.7% of them consider their usual diet as healthy and 78.4% reported consuming fibers regularly. Fibers from natural sources are consumed at least once a day by 69.5% of the sample, while daily fiber supplements were reported by 29.9%. Absence of regular fiber intake was reported by 21.7% of respondents and the most common reason was "lack of knowledge about fiber sources" (39.3%). When informed about the food sources of each type of fiber (soluble and insoluble) and asked about the regular intake, only 2.5% answered that they do not consume any of them regularly (as opposed to 21.7% before receiving information about specific fiber sources). CONCLUSION: Our findings indicate that fiber intake in Brazil is probably insufficient with a high proportion of individuals reporting irregular or absent ingestion of fiber sources in their daily lives. Lack of knowledge about fiber sources and fiber types seems to play a role in this inadequate intake, highlighting the need for nutritional education to achieve healthy dietary patterns in the country.

RESUMO CONTEXTO: A adequada ingestão de fibras está diretamente associada à saúde digestiva e é reconhecida como essencial à saúde humana (World Health Organization, 2003). A Organização Mundial da Saúde (OMS) recomenda consumo diário de fibras de ≥25 g, mas estudos prévios observaram uma ingesta de fibras no Brasil abaixo do recomendado. OBJETIVO: Descrever a ingestão, o conhecimento e as percepções sobre o consumo de fibras entre adultos brasileiros. MÉTODOS: Inquérito nacional online com indivíduos brasileiros na comunidade. O inquérito foi conduzido em setembro de 2018, usando uma plataforma online com questões fechadas. Uma amostra representativa dos usuários de internet no Brasil estratificada por sexo, idade, status socioeconômico e região geográfica foi utilizada. O tamanho da amostra foi calculado usando uma margem de erro de 2,0% em um intervalo de confiança de 95% (n=2.000). Os dados foram analisados descritivamente usando medidas de frequência, tendência central e dispersão. RESULTADOS: A amostra incluiu 2.000 indivíduos equilibrados em termos de sexo (51,2% mulheres), com idade média de 35,9 anos (faixa etária mais representada foi 35-54 anos, 39,6%) e de todas as regiões geográficas do país (49,4% do Sudeste). Dos respondentes, 69,7% consideram sua dieta usual como saudável e 78,4% relataram consumir fibras regularmente. Fibras de fontes naturais são consumidas pelo menos uma vez ao dia por 69,5% da amostra, enquanto que suplementos de fibras, por 29,9%. O não consumo regular de fibras foi relatado por 21,7% dos respondentes e a causa mais comum para tal foi "falta de conhecimento sobre fontes de fibras" (39,3%). Quando informados sobre fontes de fibra de cada tipo (solúvel e insolúvel) e interrogados sobre a ingestão regular, apenas 2,5% responderam não consumir nenhuma delas regularmente (por oposição a 21,7% antes de receberem informação sobre fontes específicas de fibras). CONCLUSÃO: Nossos achados indicam que a ingestão de fibras no Brasil é provavelmente insuficiente com uma alta proporção de indivíduos relatando consumo ausente ou irregular de fontes de fibras no cotidiano. Falta de conhecimento sobre fontes e tipos de fibras parece desempenhar um papel relevante nesta ingestão inadequada, reforçando a necessidade de educação nutricional para alcançar padrões alimentares saudáveis no país.

Conhecimento de estudantes portugueses de enfermagem sobre doação de sangue / Conocimientos de estudiantes portugueses de Enfermería sobre donación de sangre / Knowledge of Portuguese nursing students about blood donation

Resumo Objetivo Avaliar o nível de conhecimento de estudantes de Enfermagem face à doação de sangue; identificar a importância atribuída às barreiras para a doação de sangue; e, identificar os meios de comunicação digital mais utilizados. Métodos Trata-se de uma pesquisa realizada numa Instituição de Ensino Superior da Região Centro de Portugal no ano letivo de 2018/2019. O estudo é descritivo, de natureza transversal, através de dois questionários ad hoc, preenchido on-line por 165 estudantes de Enfermagem. Resultados Os conhecimentos podem ser considerados de muito baixos (intervalo entre as doações; tempo de espera depois de fazer uma tatuagem ou um piercing; tempo de espera entre a ingestão de ferro; baixos (quantidade de sangue e alimentação prévia), médios (idade e peso mínimo, dador universal) e altos (casos em que o sangue é analisado). Os motivos para não doar sangue que assumiram bastante e muita importância foram "Porque tenho alguma condição física ou médica que me impede doar" e "Porque mantive práticas sexuais de risco". Conclusão A falta de conhecimentos sobre as condições de elegibilidade pode fazer com que uma pessoa considere, de forma errada, que não pode doar sangue. Tendo em conta os resultados obtidos e o acesso aos meios de comunicação digital, sugere-se que sejam implementados programas de e-saúde que promovam o aumento de conhecimentos e a redução de barreiras à doação de sangue.

Resumen Objetivo Evaluar el nivel de conocimiento de estudiantes de Enfermería sobre la donación de sangre, identificar la importancia atribuida a las barreras para la donación de sangre e identificar los medios de comunicación digital más utilizados. Métodos Se trata de un estudio realizado en una Institución de Enseñanza Superior de la región centro de Portugal en el año lectivo 2018/2019. El estudio es descriptivo, de naturaleza transversal, a través de dos cuestionarios ad hoc que fueron completados en línea por 165 estudiantes de Enfermería. Resultados Los conocimientos pueden considerarse muy bajos (intervalo entre las donaciones, tiempo de espera después de hacerse un tatuaje o piercing, tiempo de espera después de la ingesta de hierro); bajos (cantidad de sangre y alimentación previa); medios (edad y peso mínimo, donante universal) y altos (casos en que se analiza la sangre). Los motivos para no donar sangre que tuvieron bastante y mucha importancia fueron "Porque tengo alguna condición física o médica que me impide donar" y "Porque mantuve prácticas sexuales de riesgo". Conclusión La falta de conocimientos sobre las condiciones de elegibilidad puede provocar que una persona considere, de forma equivocada, que no puede donar sangre. Teniendo en cuenta los resultados obtenidos y el acceso a los medios de comunicación, se sugiere implementar programas de eSalud que promuevan el aumento de conocimientos y la reducción de barreras para la donación de sangre.

Abstract Objective To assess the level of knowledge of nursing students regarding blood donation, to identify the importance consider challenges for blood donation, and to determine the most used digital communication channels. Methods This research was performed at University of Central Portugal in 2018/2019. This was a descriptive cross-sectional study. A total of 165 nursing students completed online two ad hoc questionnaires. Results The level of knowledge can be classified as very low (interval between donations, waiting time after getting a tattoo or piercing, waiting time after taking iron supplements), low (amount of blood, eating before donation), medium (age and minimum weight, universal donor) and high (cases in which the blood was analyzed). The reasons for not donating blood that gained considerable and great importance were: "Because I have a physical or medical condition that makes me ineligible to donate" and "Because I had a risky sexual behavior". Conclusion The lack of knowledge about the eligibility requirements can make someone wrongly consider that he or she cannot donate blood. Considering the results obtained and the access to digital communication channels, the implementation of eHealth programs is recommended to promote more knowledge, and to reduce the barriers for blood donation.

Indigenous perspectives on health: Integration with a Canadian model of practice.

BACKGROUND.: The Canadian Association of Occupational Therapists and the Truth and Reconciliation Commission recommend change within the Canadian health care system, respecting and valuing Indigenous health and healing practices. Adjusting the lens through which occupational therapists practice to incorporate Indigenous views of health and wellness is one potential change. PURPOSE.: This critical interpretive synthesis of the literature incorporates Indigenous perspectives on health and wellness into the Canadian Model of Occupational Performance and Engagement (CMOP-E) framework, strengthening that model to better serve all peoples in Canada. KEY ISSUES.: Integrating Indigenous worldviews can add to the CMOP-E the importance of balance among physical, emotional, spiritual, and mental health; the inseparability of person, community, and land; and understanding occupations as dimensions of meaning. These are incorporated in a proposed integrated model (ICMOP-E). IMPLICATIONS.: Effectively integrating Indigenous perspectives may be an important first step in a longer journey toward engaging more respectfully with Indigenous perspectives on health and wellness.

Questionnaire on the Midwives' Knowledge About Oral Emergency Contraception.

The aim of the study was to assess the level of knowledge of midwives working in different clinical settings about oral emergency contraception. The study included 225 midwives; during the period from December 2015 to February 2016, they completed a 16-item web-based survey using the SurveyMonkey software available on the Croatian Midwives Chamber site. In total 277 participants started to fill out the survey and 225 participants responded to all 16 questions. Demographic, educational and professional characteristics of the participants in this survey are provided. Distri-bution of participant responses to questions regarding basic reproductive endocrinology, unplanned pregnancies and emergency contraception clearly revealed important gaps in the group knowledge. There was evident gap in the knowledge about emergency contraception in the study group of Croa-tian midwives. Having in mind the study group grounds in gynecology and obstetrics, and their public health relevance, targeted educational activities both during midwife formal education and on-job are required to improve the group knowledge about emergency contraception. National guidelines on oral emergency contraception are an at hand learning tool and the most appropriate local source of information on emergency contraception. Various initiatives should be considered for this document to become an integral part of formal midwife education and regular part of their on-job trainings.

Actitudes, conocimientos y prácticas frente a la automedicación con productos herbales y psicofármacos en estudiantes de medicina de Medellín-Colombia / Attitudes, knowledge, and practices regarding self-medication with herbal products and psychotropic drugs among medical students in Medellin, Colombia / Atitudes, conhecimentos e práticas frente à automedicação com produtos ervais e psicofármacos em estudantes de medicina de Medellín-Colômbia

Objetivo: la automedicación en estudiantes de medicina es una práctica común que representa importantes riesgos personales. El objetivo de este artículo es explorar las actitudes, conocimientos y prácticas frente a la automedicación de productos herbales y psicofármacos en estudiantes de medicina. Metodología: estudio descriptivo transversal que incluyó 625 estudiantes matriculados en los doce semestres del pregrado de medicina en una universidad privada de Medellín-Colombia. Se diseñó un cuestionario para el estudio que incluía variables sociodemográficas, un listado de psicofármacos y productos herbales y aspectos relacionados con las actitudes, los conocimientos y las prácticas frente a la automedicación durante el último año. Resultados: edad mediana 20 años. Rango intercuartílico 2 años, edad mínima 18 y máxima 28 años. El 67% fueron mujeres, la razón mujer: hombre fue 2:1. El 39.5% de los estudiantes se automedica con productos herbales o psicofármacos. El 16.7% se automedicó para dormir mejor. El 14.5% para disminuir el estrés y la ansiedad y el 8.3% para mejorar el ánimo. El 90.1% de los estudiantes consideraron la automedicación una práctica insegura. Sin embargo el 78.6% afirmó que continuaría haciéndolo. Conclusiones: cuatro de cada diez estudiantes de medicina encuestados (39.5%) se automedica con productos herbales o psicofármacos para mejorar síntomas mentales comunes como insomnio, depresión y ansiedad. El elevado uso de medicamentos sin supervisión profesional expone a los estudiantes a efectos secundarios indeseables, dependencia y manejo subóptimo de síntomas mentales que deterioran la calidad de vida de futuros profesionales de la salud.

Objective: Self-medication is a common practice among university students worldwide. The objective of this article is to explore the attitudes, knowledge, and practices regarding self-medication of herbal products and psychotropic drugs in medical students. Methodology: Cross-sectional, descriptive study that included 625 students from all twelve semesters offered at the medicine program at a private university in Medellin, Colombia. A questionnaire was designed for the study which included sociodemographic variables, a list of psychotropic drugs and herbal products, and aspects related to attitudes, knowledge, and practices regarding self-medication during the last year. Results: Median age was 20 years and interquartile range was 2 years; minimum age was 18 and maximum was 28 years. 67% were women; the female to male ratio was 2:1. 39.5% of the students self-medicated with herbal or psychoactive drugs. 16.7% self-medicated to sleep better, 14.5% to reduce stress and anxiety, and 8.3% for mood enhancement. 90.1% of the students considered self-medication an unsafe practice. However, 78.6% stated that they would continue self-medicating. Conclusion: Four out of ten (39.5%) medical students surveyed self-medicate with herbal products or psychotropic drugs to improve common mental symptoms such as insomnia, depression, and anxiety. The high use of medications without professional supervision exposes students to undesirable side effects, dependence, and suboptimal management of mental symptoms that deteriorate the quality of life of future health professionals.

Objetivo: a automedicação em estudantes de medicina é uma prática comum que representa importantes riscos pessoais. O objetivo deste artigo é explorar as atitudes, conhecimentos e práticas frente à automedicação de produtos ervais e psicofármacos em estudantes de medicina. Metodologia: estudo descritivo transversal que incluiu 625 estudantes matriculados nos doze semestres da graduação de medicina numa universidade privada de Medellín-Colômbia. Se desenhou um questionário para o estudo que incluía variáveis sócio-demográficas, um listado de psicofármacos e produtos ervais e aspectos relacionados com as atitudes, os conhecimentos e as práticas frente à automedicação durante o último ano. Resultados: idade média 20 anos. Faixa interquartílico 2 anos, idade mínima 18 e máxima 28 anos. 67% foram mulheres, a razão mulher: homem foi de 2:1. 39.5% dos estudantes se automedica com produtos ervais ou psicofármacos. 16.7% se automedicou para dormir melhor. 14.5% para diminuir o estresse e a ansiedade e 8.3% para melhorar o ânimo. 90.1% dos estudantes consideraram a automedicação uma prática insegura. Embora 78.6% afirmou que continuaria fazendo. Conclusões: quatro de cada dez estudantes de medicina entrevistados (39.5%) se automedica com produtos ervais ou psicofármacos para melhorar sintomas mentais comuns como insônia, depressão e ansiedade. O elevado uso de medicamentos sem supervisão profissional expõe aos estudantes a efeitos secundários indesejáveis, dependência e manejo em deficiência de sintomas mentais que deterioram a qualidade de vida de futuros profissionais da saúde.

Knowledge and Practical Attitudes of Surgeons-Dentists of Bamako District Facing the Septum Syndrome

Objective: To determine the knowledge and attitude of dental surgeons in Bamako regarding the management of septal syndromes. Material and Methods: It was a crosssectional and descriptive study conducted in the Bamako District, Mali. The following variables were collected: sociodemographic, training, knowledge of septal syndrome, therapeutic decisions and treatment. The data was collected from a survey sheet and processed by Epi-info Software version 3.5.3 and by the language R. Results: A total of 67 professionals participated in this study, of which 88.1% were men. Seventy-six point one percent of the Dental Surgeons have recognized septum syndrome as an emergency. The management of the emergency, followed by the completion of the comprehensive care later represents the attitude of 71.6% of the dentists. Sixty-four point two percent of dentists remove irritating elements under gingival, 80.6% prescribe an antiinflammatory, 38.8% prescribe chlorhexidine gel and 26.9% reconstruct the point of contact. Conclusion: This study demonstrates that Dental Surgeons in general have adequate average knowledge and attitude for their management of septal syndrome.