Exploring progress in iron supplement formulation approaches for treating iron deficiency anemia through bibliometric and thematic analysis.

Anemia is a severe health issue that affects around one-third of the global population. Therefore, the present study aims to conduct a bibliometric analysis to investigate the research trends regarding advancements on iron formulations in treating iron deficiency anemia via oral or parenteral route. This study adopts thematic and bibliometric methods on existing research on novel iron formulations. It also provides perspective into the existing understanding on treatment strategies for iron deficiency anemia. This study is conducted on 543 papers on various ferrous and ferric formulations used in the treatment of iron deficiency anemia. The study period is from 1977 to 2022, and the papers are identified from the Scopus database. The bibliometric analysis was carried out using the R tool's Bibliometrix package. The study discusses performance analysis, including annual publications, geographic analysis, relevant affiliations, journal analysis, and citation analysis. In addition, the conceptual structure, including the co-occurrence network, thematic map, thematic evolution, intellectual structure highlighting co-citation analysis, and social structure depicting the collaboration network and collaboration world map, are presented. The results showed increased research on formulation strategies for the treatment of iron deficiency anemia from 2010 onwards. The top 5 contributing countries are the USA, Italy, India, Germany, and the UK, and peer-reviewed journals from the area of nutrition. The most trending areas of study are iron deficiency anemia in pregnancy, chronic kidney diseases, inflammatory bowel diseases, and various intravenous formulations used in its treatment. The authors from Europe collaborate the most with authors from other countries. The study concludes that a safer and more effective iron formulation is needed to reduce the prevalence of anemia. The findings of the study are helpful in advancing research on innovative formulations for treating iron deficiency anemia. The insights from the study are helpful to policymakers in designing specific health policies and investing more in research and development of novel formulations for the treatment of iron deficiency anemia.

A Qualitative Analysis of Urbanization and Menstrual Health Among Young Women.

This qualitative study, grounded in theory, employed inductive coding for analysis, focusing on menstrual health among urban women aged 10-25. The research aims to explore the menstrual health status, practices, and beliefs of participants. The research delves into the impact of recent government initiatives on menstrual health and assesses the role of urbanization in shaping evolving menstrual health practices among young girls. Employing in-depth qualitative methods such as interviews and focus group discussions, the study seeks a comprehensive understanding of participants' experiences and perceptions related to menstrual health. The dynamics of women's menstrual experiences are significantly influenced by urbanization, heightened exposure to social media, evolving lifestyles, and government initiatives like the distribution of menstrual products in schools and the enhancement of water, sanitation, and hygiene (WASH) facilities in government institutions. Positive shifts have been observed, including reduced restrictions on menstruating individuals, enhanced access to affordable hygiene products, and improved disposal facilitated by municipal garbage collection services. However, notable gaps persist in basic knowledge about menstruation, hygienic practices, effective interpersonal communication with schoolteachers or community health care workers, and compliance with government programs promoting weekly iron-folic acid supplementation and biannual Albendazole intake, calling for substantial improvement.

Managing acoustic noise within MRI: A qualitative interview study among Swedish radiographers.

INTRODUCTION: Acoustic noise from magnetic resonance imaging (MRI) can cause hearing loss and needs to be mitigated to ensure the safety of patients and personnel. Capturing MR personnel's insights is crucial for guiding the development and future applications of noise-reduction technology. This study aimed to explore how MR radiographers manage acoustic noise in clinical MR settings. METHODS: Using a qualitative design, we conducted semi-structured individual interviews with fifteen MR radiographers from fifteen hospitals around Sweden. We focused on the clinical implications of participants' noise management, using an interpretive description approach. We also identified sociotechnical interactions between People, Environment, Tools, and Tasks (PETT) by adopting a Human Factors/Ergonomics framework. Interview data were analyzed inductively with thematic analysis (Braun and Clarke). RESULTS: The analysis generated three main themes regarding MR radiographers' noise management: (I) Navigating Occupational Noise: Risk Management and Adaptation; (II) Protecting the Patient and Serving the Exam, and (III) Establishing a Safe Healthcare Environment with Organizational Support. CONCLUSION: This study offers insights into radiographers' experiences of managing acoustic noise within MRI, and the associated challenges. Radiographers have adopted multiple strategies to protect patients and themselves from adverse noise-related effects. However, they require tools and support to manage this effectively, suggesting a need for organizations to adopt more proactive, holistic approaches to safety initiatives. IMPLICATIONS FOR PRACTICE: The radiographers stressed the importance of a soundproofed work environment to minimize occupational adverse health effects and preserve work performance. They acknowledge noise as a common contributor to patient distress and discomfort. Providing options like earplugs, headphones, mold putty, software-optimized "quiet" sequences, and patient information were important tools. Fostering a safety culture requires proactive safety efforts and support from colleagues and management.

Mental health nurses' empathy experiences towards consumers with dual diagnosis: A thematic analysis.

WHAT IS KNOWN ON THE SUBJECT?: Dual diagnosis is one of the leading causes of disability globally. Consumers with dual diagnosis have complex needs and are at risk of relapse of their psychiatric symptoms. Mental health nurses require essential skills, including empathy, to manage consumers with dual diagnosis. No studies have explored mental health nurses' empathy towards consumers with dual diagnosis. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Developing empathy towards consumers with dual diagnosis is complex. Mental health nurses' unemotional empathy experiences with consumers with dual diagnosis are related to their lack of ability to connect to their consumers' choices and feelings. Negative attitudes towards consumers with dual diagnosis contributed to nurses' poor empathy experiences. The unemotional responses of mental health nurses can be caused by factors such as novelty, insufficient information, and neutral evaluation of a consumer's situation. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study results benefit researchers, teachers, clinicians, and administrators when designing, developing, and delivering empathy training packages for mental health nurses. Improving the empathy of mental health nurses towards consumers with dual diagnosis should be a top priority for healthcare leaders and educators. A core curriculum containing holistic awareness of the biopsychosocial components of dual diagnosis makes it easier for mental health nurses to understand and develop empathy towards consumers with dual diagnosis. Future studies must address the relationship between attitude, stress, burnout, compassion fatigue and empathy among mental health nurses in relation to consumers with dual diagnosis. ABSTRACT: INTRODUCTION: There is a lack of evidence regarding mental health nurses' empathy towards consumers with dual diagnosis. AIMS: This qualitative study aimed to describe mental health nurses' empathy towards consumers with dual diagnosis in Australian mental health settings. METHOD: Through purposeful sampling, interviews were conducted with 17 mental health nurses who have experience in caring for consumers with dual diagnosis. Thematic analysis, as an inductive approach was used, to generate codes and themes from participant data. To report on this qualitative study, we adhered to the ENTREQ guidelines. RESULTS: Four themes emerged: challenges to develop empathy with consumers, lack of conducive attitude of nurses towards consumers, appraising consumers' emotions accurately and holistically responding to the appraised emotions. The findings indicated that developing empathy towards consumers with dual diagnosis is a complex task. DISCUSSION: Mental health nurses may struggle to empathize with consumers when encountering confrontational situations. Interventional studies are required to address the relationship between mental health nurses' attitudes, stress, burnout, compassion fatigue and empathy in relation to consumers with dual diagnosis. IMPLICATIONS FOR PRACTICE: Understanding why mental health nurses emotional experiences differ about a similar challenging situation experienced by their consumers is vital. Further research on strategies to address empathy issues among mental health nurses could enhance nursing practice and consumer care.

Utilization of Cultural Formulation Interview to understand the factors affecting treatment adherence and help-seeking in mood disorders: A qualitative study from Western India.

Introduction: Treatment adherence rates among patients of affective disorders remain sub-par across the world. Sociocultural factors affecting the same remain poorly understood. The current study aimed to explore and conceptualize the same. Methodology: The study utilized a qualitative grounded and phenomenological approach study design. The patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (DSM-5) criteria of unipolar depression or bipolar affective disorder, and were presently under our treatment for at least three months and currently in remission, aged 18-60 years, and were able to understand Hindi or English, scored less than 6 on the Medication Adherence Rating Scale were included. Furthermore, key caregivers were also included in the study. Using purposive sampling and data saturation, a total of 30 participants were recruited. In-depth interviews were conducted using the cultural formulation interview as given in DSM-5, which was used as the interview tool. Thematic analysis of data was performed using Atlas.ti version 8.4.3. Results: A total of 14 themes (deductive and inductive) emerging from 171 codes were identified. Some of the important inductive themes included cultural and societal attitude toward illness and treatment-seeking, trust, experience, and expectations from available health care, faith healing-related practices and beliefs. The implicit themes such as cultural understanding of the problem and cultural factors affecting help-seeking, also showed prudent findings. Conclusion: The study findings demonstrate the various features of the sociocultural milieu and identity of an individual and family that have an influence on treatment-seeking behavior.

`It's not just linguistically, there's much more going on': The experiences and practices of bilingual paediatric speech and language therapists in the UK.

BACKGROUND: Despite the high prevalence of bilingualism in the United Kingdom, few speech and language therapists (SLTs) are bilingual themselves. Most SLT research on bilingualism has generated knowledge to inform service delivery for bilingual clients, but few studies have investigated how being a bilingual SLT influences one's professional experiences and practices. Better understanding the unique positionality of bilingual SLTs can yield critical insights to meaningfully address issues of diversity, inclusion and equity in the profession. AIMS: To investigate the experiences and practices of bilingual paediatric SLTs in the United Kingdom through the lens of Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF), a new theoretical framework developed to conceptualise the activities of professionals working in the field of disability. METHODS: In this qualitative study, 19 bilingual paediatric SLTs practising in the United Kingdom were interviewed individually. Participants were recruited through a snowball sampling strategy, and semi-structured interviews conducted online. The data were analysed using reflexive thematic analysis and following a hybrid inductive-deductive approach to map the results onto the CHAT-ICF framework. RESULTS: Six overarching components of the CHAT-ICF framework hosted the 12 sub-themes identified to capture the experiences and practices of bilingual SLTs: (1) Subject (intersectionality); (2) Tools (language skills, education, clinical resources); (3) Rules (systemic barriers, sense of responsibility); (4) Community (sense of inclusion); (5) Division of labour (parents, colleagues); and (6) Practice (empathy with children, holistic mindset, flexible approaches). The use of the CHAT-ICF theoretical lens revealed two fundamental structural phenomena: (1) the distribution of sub-themes across many components of CHAT-ICF demonstrated that being a bilingual SLT is a multifactorial experience; and (2) the chain reactions between sub-themes illustrated the dynamic nature of bilingual SLTs' experiences which can be harnessed to challenge marginalisation and promote equity in the profession. CONCLUSION & IMPLICATIONS: This is the first qualitative study to date to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. These insights can be mobilised to inform the meaningful inclusion of bilingual SLTs in workforce planning efforts and service development. Recommendations include using intersectional lenses, providing cultural and anti-racism awareness training to SLTs, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in recruitment processes and increasing accountability at the leadership level. Research giving voice to bilingual SLTs, and other underrepresented demographics in the SLT workforce, can catalyse action to promote a more diverse and inclusive profession in line with the Royal College of Speech and Language Therapists' strategic vision 2022-2027. WHAT THIS PAPER ADDS: What is already known on the subject Most research on bilingualism in speech and language therapy is focused on issues related to service provision and delivery for bilingual clients with little consideration for bilingual speech and language therapists' (SLTs) unique positionality. A few survey studies have shown that bilingual SLTs report significantly higher competency and greater confidence when working with clients who speak multiple languages, but there are significant gaps in understanding how bilingualism impacts other aspects of their professional experiences. What this paper adds to existing knowledge This is the first study to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. We show that being bilingual profoundly impacts many aspects of their professional experiences, including their clinical identity, skillset, sense of inclusion in the workplace, work relationships and clinical approaches. Bilingual SLTs expressed developing trust relationships with bilingual families and adopting flexible approaches to account for their clients' environmental factors, all of which can contribute to more equitable SLT services. This study also makes a novel contribution by proposing and using the Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF) framework to conceptualise and investigate SLTs' experiences and practices. What are the potential or actual clinical implications of this work? This study provides evidence-based recommendations to inform progress towards the Royal College of Speech and Language Therapists' strategic vision 2022-2027 and the diversification of the profession. Actions to support bilingual SLTs and diversify the profession include shifting a rigid mindset of linguistic and cultural `competence' to self-growth and awareness, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in SLT recruitment processes and career progression and increasing accountability and leadership around issues of diversity in the workplace. The novel CHAT-ICF framework has the potential to be used to support therapists' reflexivity in their practice or structure audits of rehabilitation services. Intersectionality theories and transformative processes can catalyse positive change in clinical services and research around bilingualism.

Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers' experiences.

BACKGROUND: In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women's Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers' perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia. METHODS: A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women's Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed. RESULTS: In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: 'Being committed to quality care: taking a holistic approach', 'Surmounting challenges: being an abortion provider is difficult', and 'Meeting external roadblocks: deficiencies in the wider healthcare system'. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care. CONCLUSIONS: Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.

Digital Triage Tools for Sexually Transmitted Infection Testing Compared With General Practitioners' Advice: Vignette-Based Qualitative Study With Interviews Among General Practitioners.

BACKGROUND: Digital triage tools for sexually transmitted infection (STI) testing can potentially be used as a substitute for the triage that general practitioners (GPs) perform to lower their work pressure. The studied tool is based on medical guidelines. The same guidelines support GPs' decision-making process. However, research has shown that GPs make decisions from a holistic perspective and, therefore, do not always adhere to those guidelines. To have a high-quality digital triage tool that results in an efficient care process, it is important to learn more about GPs' decision-making process. OBJECTIVE: The first objective was to identify whether the advice of the studied digital triage tool aligned with GPs' daily medical practice. The second objective was to learn which factors influence GPs' decisions regarding referral for diagnostic testing. In addition, this study provides insights into GPs' decision-making process. METHODS: A qualitative vignette-based study using semistructured interviews was conducted. In total, 6 vignettes representing patient cases were discussed with the participants (GPs). The participants needed to think aloud whether they would advise an STI test for the patient and why. A thematic analysis was conducted on the transcripts of the interviews. The vignette patient cases were also passed through the digital triage tool, resulting in advice to test or not for an STI. A comparison was made between the advice of the tool and that of the participants. RESULTS: In total, 10 interviews were conducted. Participants (GPs) had a mean age of 48.30 (SD 11.88) years. For 3 vignettes, the advice of the digital triage tool and of all participants was the same. In those vignettes, the patients' risk factors were sufficiently clear for the participants to advise the same as the digital tool. For 3 vignettes, the advice of the digital tool differed from that of the participants. Patient-related factors that influenced the participants' decision-making process were the patient's anxiety, young age, and willingness to be tested. Participants would test at a lower threshold than the triage tool because of those factors. Sometimes, participants wanted more information than was provided in the vignette or would like to conduct a physical examination. These elements were not part of the digital triage tool. CONCLUSIONS: The advice to conduct a diagnostic STI test differed between a digital triage tool and GPs. The digital triage tool considered only medical guidelines, whereas GPs were open to discussion reasoning from a holistic perspective. The GPs' decision-making process was influenced by patients' anxiety, willingness to be tested, and age. On the basis of these results, we believe that the digital triage tool for STI testing could support GPs and even replace consultations in the future. Further research must substantiate how this can be done safely.

Physician perspective on the implementation of risk mitigation strategies when prescribing opioid medications: a qualitative analysis.

OBJECTIVE: To understand the physician perspective on the barriers and facilitators of implementing nine different opioid risk mitigation strategies (RMS) when prescribing opioid medications. METHODS: We created and dispersed a cross-sectional online survey through the Qualtrics© data collection platform among a nationwide sample of physicians licensed to practice medicine in the United States who have prescribed an opioid medication within the past year. The responses were analyzed using a deductive thematic analysis approach based on the Consolidated Framework for Implementation Research (CFIR) to ensure a holistic approach to identifying the barriers and facilitators for each RMS assessed. In concordance with this method, the themes and codes for the thematic analysis were defined prior to the analysis. The five domains within the CFIR were used as themes and the 39 nested constructs were treated as the codes. Two members of the research team independently coded the transcripts and discussed points of disagreement until consensus was reached. All analyses were conducted in ATLAS.ti© V7. RESULTS: The completion rate for this survey was 85.1% with 273 participant responses eligible for analysis. Intercoder reliability was calculated to be 82%. Deductive thematic analysis yielded 2,077 descriptions of factors affecting implementation of the nine RMS. The most salient code across all RMS was Knowledge and Beliefs about the Intervention, which refers to individuals' attitudes towards and value placed on the intervention. Patient Needs and Resources, a code referring to the extent to which patient needs are known and prioritized by the organization, also emerged as a salient code. The physicians agreed that the patient perspective on the issue is vital to the uptake of each of the RMS. CONCLUSIONS: This deductive thematic analysis identified key points for actionable intervention across the nine RMS assessed and established the importance of patient concordance with physicians when deciding on a course of treatment.

A bibliometric and thematic analysis of the trends in the research on ginkgo biloba extract from 1985 to 2022.

Background: Ginkgo biloba extract (GBE), a complementary and alternative medicine, has been widely used for disorders such as brain infarction, dementia, and coronary heart disease, in recent decades. Given its widespread clinical use, GBE has always been a vital research topic. However, there are no bibliometric analyses on this topic; furthermore, published reviews of GBE focus only on a specific research field or lack scientific and systematic evaluation. This study combined bibliometrics with thematic reviews by visual analysis to identify the current status of GBE research and to better identify research hotspots and trends in the past 40 years to understand future developments in basic and clinical research. Methods: Articles and reviews on GBE were retrieved by topic from the Web of Science Core Collection from inception to 2022.12.01. Countries, institutions, authors, journals, references, and keywords in the field were visually analyzed using CiteSpace, Scimago Graphica, and VOSviewer software; then, these visualization results for references and keywords were clarified in detail by thematic reviews in subdivisions of the fields. Results: In total, 2015 publications were included. The GBE-related literature has high volumes of publications and citations. The majority of literature is from China, and the USA cooperates most closely with other countries. In GBE research, Christen Yves is the most cited author, Phytotherapy Research is the most prolific journal, and the Journal of Ethnopharmacology is the most co-cited journal. Through a comprehensive analysis of keywords, references, and reviews, the quality of the meta-analysis of randomized controlled clinical trials of GBE in treating dementia was evaluated by the Risk of Bias in Systematic Reviews scale (ROBIS). Current research on GBE focuses on its pharmacological mechanisms, and neuroprotective application in diseases such as Alzheimer's disease, and glaucoma. Randomized controlled trials are the current research hotspot. Conclusion: Research on GBE is flourishing; using bibliometric and thematic analysis, we identified its hotspots and trends. The pharmacological mechanisms and clinical applications of GBE are the focus of present and likely future research.

Importance of Inclusive Education in General Medicine Through the Perception of Medical Trainees: A Thematic Analysis.

Background General medical education plays a pivotal role in ensuring holistic care in the context of rapidly aging populations. Japan's demographic trends underscore the significance of general medicine in elevating community care standards. Understanding and catering to the aspirations, perceptions, and ideals of medical students and residents can significantly augment the effectiveness of general medicine education. This research aimed to explore the perspectives of medical students on the ideal tenets of general medicine education in rural Japan. Method A qualitative approach was employed, focusing on medical students and residents with a keen interest in general medicine, all of whom underwent training at a rural-based Japanese hospital. Through semi-structured interviews, insightful data were garnered and subsequently subjected to a comprehensive thematic analysis. Results The thematic analysis unearthed three core themes: commitment of educators in valuing learner diversity, promotion and understanding of general medicine, and inclusivity and diversity in educational institutions. The first highlighted the centrality of educators' sincerity, emphasizing the importance of genuine, sustained interactions that foster mutual respect and collaborative learning. The second theme underscored the need to elucidate the intrinsic value and modern-day relevance of general medicine, emphasizing its deep roots in community-based practices and its continuity with long-standing medical traditions. The third theme spotlighted the crucial role of comprehensive medical education in fostering enriching dialogues, embracing varied learning experiences, and capitalizing on the distinctive strengths of educational institutions. Conclusion These findings underscore the pivotal shift required in pedagogical approaches to comprehensive medical education. A genuine collaborative educator-learner relationship, the reframing of general medicine's significance rooted in community welfare, and a strong emphasis on inclusivity and dialogue form the cornerstones of these insights. This study provides a touchstone for restructuring educational strategies, aiming for a more integrated, genuine, and encompassing framework that is particularly vital for the effective propagation of general medicine in regions such as Japan.

The management framework of upright position in the second stage of labour: A qualitative study.

BACKGROUND: Upright positions, as a non-pharmacological, have been well documented in multiple studies to promote normal labor, facilitate favourable birth outcomes and positive childbirth experience. Yet, the application status of upright positions in China, and even globally, is unfavourable. Thus, we have developed the Program for Upright Positions in the Second Stage of Labor (UPSSL program) for the widespread application of upright positions. While there is limited research evidence on the areas of improvement and corresponding strategies for embedding the evidence into midwifery practice. OBJECTIVES: To explore perspectives of health care providers on improvement areas of upright positions in the second stage of labor, and to identify corresponding strategies in order to develop a management framework for successful implementation of upright positions. METHODS: A qualitative descriptive design with semi-structured interviews was conducted in the study. The participants involving 13 midwives, six obstetricians and six department managers were selected from three hospitals in Beijing, China. ATLAS.TI 8 software was utilized to manage, identify the transcript data, and the thematic analysis method guided the data analysis. RESULTS: A management framework of upright positions in the second stage of labor was developed based on our study, which included five improvement areas : (1) promoting the renewal of midwifery notions and the professional training;(2) strengthening maternal health education based on the "trinity" approach; (3) promoting multidisciplinary cooperation and refining the labor procedures in upright positions; (4) optimizing midwifery human resource allocation and formulating incentive policies; (5) encouraging partner involvement and improving the birth environment. CONCLUSIONS: The study findings could provide a comprehensive view to promote UPSSL Program to be utilized in practice. Our study also provided a way for midwives, obstetricians, and other healthcare providers to work together to facilitate high quality maternal care. IMPLICATIONS FOR PRACTICE: Our findings will be useful for nursing managers to carry out the UPSSL program through several strategies, such as strengthening the professional training for assisting labor in the upright positions, reallocating midwifery human resources, and developing the childbirth education on the upright positions.

Addressing the elephant in the room: understanding functional neurological symptom disorder through the lens of culture and religion.

Owing to the dearth of scholarly works to understand the presence of Functional Neurological Symptom Disorder (FNSD) among mental health patients in Pakistan, this study sought to understand how cultural and religious conflicts are implicated in the aetiology of FNSD. The study recruited 22 participants, comprising five men and 17 women. The participants were recruited from the Department of Psychiatry at Services Hospital, Lahore, Pakistan. Semi-structured interviews were conducted and analyzed through Thematic Analysis. The two main themes identified in this study were cultural and religious values and beliefs about romantic relationships. Within the cultural and religious values theme, subthemes of self-perception, a conviction in religious beliefs, and sexual suppression were identified. Furthermore, the subthemes of beliefs about romantic relationships were family's approval, engagement against wishes, and fear of exposure. The two main themes are interconnected: beliefs about romantic relationships were interpreted and experienced through the perspective of religion and culture. To summarize, this study concluded that stressors related to culture and religion are significant contributing factors in the development of FNSD. This study has important implications for mental health professionals, as awareness around the interplay of cultural as well as religious beliefs and FNSD will enable them to devise effective and holistic therapeutic intervention.

A thematic analysis of staff perspectives on the impact of a mental health nurse (RMN) in a critical care unit.

Background: Recent guidelines in the UK have shaped Critical Care Units (CCUs) to bring the mental health needs of patients, and staff wellbeing to the forefront of service provision. A health board based in NHS Wales has trialled the secondment of a Mental Health Nurse (RMN) within a CCU to help service provision adhere to such guidelines. Methods: Critical care staff were invited to attend focus groups to share their experiences of how the RMN influenced service provision. Results: Thematic analysis identified five main themes; including 'smoother care pathways', 'a holistic approach to care', 'co-production', 'knowledge and confidence' and 'staff wellbeing'. Each of these themes reflected how the RMN had both direct and indirect benefits on patient and staff wellbeing. Conclusion: This qualitative exploration suggests that staff perceived value in the role of the RMN for both staff and patient outcomes, although further measures were considered necessary to improve staff-wellbeing within a critical care environment. This service evaluation supports recommendations for commissioning a RMN permanently in a CCU.

Factors Affecting Patient Adherence to Multivitamin Intake After Bariatric Surgery: Thematic Analysis of Qualitative Data From a Multicenter Study.

Introduction Adherence to daily intake of multivitamin supplementation (MVS) is a major challenge after bariatric surgery (BS). The aim of this study was to identify insights into patients' beliefs and experiences on adherence to MVS intake. Methods A thematic analysis of qualitative data from four high-volume bariatric centers in the Netherlands was conducted. A series of texts from the open-ended question of 1,246 patients were thematically analyzed for common or overarching themes, ideas, and patterns. Results Five key themes emerged regarding participants' suggestions on adherence to daily MVS intake: "gastrointestinal side effects to MVS intake" (n = 850, 68.2%), "negative features of MVS" (n = 296, 23.8%), "satisfaction with advice on MVS" (n = 272, 21.8%), "dissatisfaction with service provision" (n = 160, 12.8%), and "costs" (n = 93, 7.5%). Most problems were experienced when using specialized weight loss surgery (WLS) MVS. These supplements may cause gastrointestinal side effects, and costs are too high. After bariatric surgery, numerous patients strongly felt that information provision was poor in several aspects, and the aftercare pathway process did not provide sufficient support. Conclusion This study found five major themes involved in patient adherence to multivitamin intake after BS: gastrointestinal side effects to MVS intake, negative features of MVS, satisfaction with advice on MVS, dissatisfaction with service provision, and costs of specialized MVS. Challenges lie in stronger education for both patients and healthcare professionals. More personalized care could probably increase patient satisfaction, and MVS companies should look at further optimizing supplements for better tolerability and reducing costs.

Factors influencing the quality of acupuncture clinical trials: a qualitative interview of stakeholders.

OBJECTIVE: To investigate the influencing factors on the quality of acupuncture clinical trials from the stakeholders, and to provide references for improving the quality of acupuncture clinical trials. METHODS: A qualitative study based on semi-structured interviews was performed. Experts, acupuncturists, editors, and patients were interviewed. The interview results were thematically analyzed from transcribed audio recordings. RESULTS: A total of 38 stakeholders were interviewed, including 12 experts, 14 acupuncturists, 2 editors, and 10 patients. There were 25 tree nodes and 106 sub-nodes, with 1141 reference points. The key factors influencing the quality of acupuncture clinical trials could be divided into five core theme frameworks: a) trial design, b) trial conduction, c) research results reporting and publication, d) research evidence dissemination, and e) research evidence transformation and application. CONCLUSIONS: The results reveal that to improve the quality of acupuncture trials, it should consider each step of trial design, trial conduction, research results reporting and publication, research evidence dissemination, and research evidence transformation and application. A guideline for quality control of the whole process of acupuncture clinical trials is needed.

Patients' and next of kin's expectations and experiences of a mobile integrated care model with a home health care physician - a qualitative thematic study.

BACKGROUND: The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients' and next of kin's experiences of integrated care is however lacking, motivating exploration. METHOD: A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later. RESULTS: The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making. CONCLUSION: Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.

Between "a lot of room for it" and "it doesn't exist"-Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland.

BACKGROUND: Numerous studies show that negative birth experiences are often related to birthing people's loss of autonomy. We argue that a fetal-focused decision-making framework and a maternal-fetal conflict lens are often applied, creating a false dichotomy between autonomy and fetal beneficence. Given the high prevalence of autonomy-depriving decision-making, it is important to understand how autonomy can be enhanced. METHODS: We interviewed 15 Swiss perinatal care practitioners (eight midwives, five physicians, and two doulas) and employed reflexive thematic analysis. We offer a reflection on underlying assumptions and researcher positionality. RESULTS: We generated two descriptive themes: advancing and limiting factors of autonomy. Numerous subthemes, grouped at the levels of companion, birthing person, practitioners, birthing person-practitioner relationship, and structural determinants are also defined. The most salient advancing factors were practitioners' approaches to decision-making, antenatal contacts, and structural determinants. The most salient limiting factors were various barriers within birthing people (e.g., expertise, decisional capacity, and awareness of own rights), practitioners' attitudes and behavior, and structural determinants. DISCUSSION: The actualization of autonomy is multifactorially determined and must be understood against the background of power structures both underlying and inherent to decision-making in birth. Practitioners attributed a significant proportion of limited autonomy to birthing people themselves. This reinforces a "mother-blame" narrative that absolves obstetrics of primary responsibility. Practitioners' recognition of their contributions to upholding limits on autonomy should be leveraged to implement training towards rights-based practice standards. Most importantly, autonomy can only fully materialize if the underlying sociocultural, political, and medical contexts undergo a fundamental change.

Exploring the Impact of Social Media on Anxiety Among University Students in the United Kingdom: Qualitative Study.

BACKGROUND: The rapid surge in social media platforms has significant implications for users' mental health, particularly anxiety. In the case of social media, the impact on mental well-being has been highlighted by multiple stakeholders as a cause for concern. However, there has been limited research into how the association between social media and anxiety arises, specifically among university students-the generation that has seen the introduction and evolution of social media, and currently lives through the medium. Extant systematic literature reviews within this area of research have not yet focused on university students or anxiety, rather predominantly investigating adolescents or generalized mental health symptoms and disorders. Furthermore, there is little to no qualitative data exploring the association between social media and anxiety among university students. OBJECTIVE: The purpose of this study is to conduct a systematic literature review of the existing literature and a qualitative study that aims to develop foundational knowledge around the association of social media and anxiety among university students and enhance extant knowledge and theory. METHODS: A total of 29 semistructured interviews were conducted, comprising 19 male students (65.5%) and 10 female students (34.5%) with a mean age of 21.5 years. All students were undergraduates from 6 universities across the United Kingdom, with most students studying in London (89.7%). Participants were enrolled through a homogenous purposive sampling technique via social media channels, word of mouth, and university faculties. Recruitment was suspended at the point of data saturation. Participants were eligible for the study if they were university students in the United Kingdom and users of social media. RESULTS: Thematic analysis resulted in 8 second-order themes: 3 mediating factors that decrease anxiety levels and 5 factors that increase anxiety levels. Social media decreased anxiety through positive experiences, social connectivity, and escapism. Social media increased anxiety through stress, comparison, fear of missing out, negative experiences, and procrastination. CONCLUSIONS: This qualitative study sheds critical light on how university students perceive how social media affects their anxiety levels. Students revealed that social media did impact their anxiety levels and considered it an important factor in their mental health. Thus, it is essential to educate stakeholders, including students, university counselors, and health care professionals, about the potential impact of social media on students' anxiety levels. Since anxiety is a multifactorial condition, pinpointing the main stressors in a person's life, such as social media use, may help manage these patients more effectively. The current research highlights that there are also many benefits to social media, and uncovering these may help in producing more holistic management plans for anxiety, reflective of the students' social media usage.

Difficulties in Adapting at School Among Nepalese Immigrant Children in Japan.

Introduction: Japan has experienced a shift toward a multicultural society, and an increasing number of immigrant children have enrolled in its educational systems. Unforeseen experiences may affect the mental well-being of these children and undermine their holistic development; however, research is scarce. This article explores parents' concern on Nepalese children's experiences in Japanese schools. We aim to reveal the issues that may inform healthcare professionals and schools in best supporting immigrant students. Methods: Qualitative survey methods were adopted in an online survey tool to access and collect data from 13 Nepalese parents whose children (age 6-18 years) attended the schools (elementary or junior high school) in four prefectures of Japan. Thematic analysis was used to analyze the data. Results: The following four themes were identified: (i) interaction and relationship; (ii) feeling different and meals at school; (iii) academic exclusion-lack of assistance/review at home; and (iv) emotional distress, peer exclusion, and bullying. Conclusion: Our findings suggest that because of the linguistic and cultural differences, children had difficulty communicating, leading to poor interpersonal relationships. Subjects reported changes in daily living patterns at home and school, and children felt different, shy, and unable to make friends or get involved. There were problems with school meals as well, and parents expressed concern over a lack of academic assistance. Some noteworthy emotional aspects were inability to be happy at school and bullying or exclusion from peers. They did, however, express the impression that Japanese students and teachers are cooperative. Overall, these findings have implications for schoolteachers, nurses, health personnel, parents, and others who promote the mental well-being and holistic development of children. This study provides a basis for mental health educational programs targeting the relationship between migrant and native students to create an inclusive society for all.