Enhancing nursing education for Indigenous students: Indigenous nursing students' insights and strategies.

BACKGROUND: Indigenous nursing students contended with far-reaching challenges during the pandemic that significantly altered their experiences of nursing education. These experiences are poorly understood by nursing educators and strategies for Indigenous nursing student success rarely involve the insights of current Indigenous nursing students. AIM: The aim of this article is to offer Indigenous-student derived recommendations regarding strategies for improving their experiences and success within nursing education during the pandemic and beyond. DESIGN AND METHODS: This qualitative study employed an Indigenous methodology including land-based learning, ceremony, and sharing circles. PARTICIPANTS AND SETTING: Indigenous nursing students (n = 17) from a Western Canadian school of nursing participated in one of three sharing circles. RESULTS: Indigenous nursing students recommended institutional and program adaptations along with increases to cultural safety for enhancing their experience in nursing education. Institutional and program strategies included: decreasing course loads and class sizes; an Indigenous-specific cohort; a transition program after course failure; increasing academic supports such as additional clinical skills and academic writing practice. Recommendations for increasing cultural safety included: mandatory and recurrent cultural safety training for faculty, staff and students; differential learning and evaluation strategies; and increased inclusion of Indigenous ceremonies and practices. CONCLUSION: The findings of this study provide insights that can help guide curriculum development, pedagogical approaches, and policy development to improve nursing education for Indigenous students.

Forgone healthcare for medically vulnerable groups during the pandemic era: experiences of family caregivers of young adults with substance use disorders in Zambia.

Introduction: Scholars worldwide have defined the COVID-19 pandemic as a mass-disabling event of our time. The situation is grave for families experiencing financial hurdles while caring for young adults in recovery from addiction problems. Methods: Using semi-structured interviews with 30 purposively selected family caregivers (FCGs) of young adults with substance use disorders (SUDs) in Lusaka, Zambia, this study reveals several factors influencing forgone healthcare for this medically vulnerable group. Results: Financial challenges and huge out-of-pocket bills; caregivers' perceived far-fetched recovery of the young adult; the cost of medication and transportation; the young adult's little perceived need for healthcare service use, their runaway and treatment elusive tendencies; caregiver concerns about contracting the virus, and the stigma associated with it; and a fragmented child and adolescent mental health system influenced forgone healthcare. The young adults were often unavailable for days and months, posing challenges to the continuity of care. Despite caregivers' acknowledgment of the availability of healthcare professionals, young adults with problematic substance use had limited access to SUD recovery services, resulting in adverse health outcomes. Results also show that most family caregivers encountered challenges in accessing and purchasing psychotropic medications, which were difficult to find during the lockdowns. Some family caregivers lost their sources of income by being laid off from work due to the pandemic and skipping work to attend to caregiving responsibilities. Most of those in self-employment had to close their business and stay home to look after their youth. Several caregivers kept their youth at home because they failed to access private residential SUD recovery services. Family caregivers mostly relied on outpatient public health services, alternative medicine from traditional healers, and faith-based healing, all of which some young adults rarely accessed because of their problematic behaviors of escaping healthcare. Conclusion: These identifiable risk factors, and their detrimental consequences highlight the need for interventions to improve healthcare access for this vulnerable population. Supporting FCGs of addicted young adults is crucial in ensuring the well-being of both the caregivers and care recipients. Further research is warranted to explore potential solutions, such as peer support programs, policy changes, and education initiatives for carers and recipients in the (post) pandemic era.

Updating Factors Influencing Nurse Work Engagement in the Hospital Settings: A Systematic Review.

Background: Understanding the factors influencing work engagement among nurses is crucial for ensuring high-quality care and positive patient outcomes. Despite numerous factors associated with nurse work engagement, many were explored before the pandemic, potentially overlooking aspects relevant to the current context. Aim: To explore and update factors related to nurse work engagement in the new normal era. Design: Systematic review. Data Sources: The search was restricted to articles published from 2019 to 2024 in CINAHL, PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest, with full English text. The search was conducted from September 13th to 15th, 2023. Quantitative research articles that examined factors related to work engagement were included. Review Methods: Data extraction, quality appraisal, and data analysis were performed in all included studies. Manual content analysis method was used to classify and group the factors. Results: Sixty-one research articles were included in the final review. Five key groups of factors were generated from content analysis, including 1) individual-related factors, 2) organizational-related factors, 3) job and role-related factors, 4) work-life balance, and 5) work environment. Conclusion: Understanding and addressing these multifaceted factors holistically is essential to develop strategies to sustain optimal engagement levels among nursing staff and improve overall patient care outcomes. Further studies are needed to confirm the findings.

COVID-19 Linked Social Stigma Among Arab Survivors: A Cross-Sectional Experiences from the Active Phase of the Pandemic.

Objective: This study aimed to explore the magnitude and variability of the disease-linked stigma among COVID-19 survivors and their experiences of social stigma, coping strategies, contextual challenges, and preferences for support. Methods: An Arabic version of the social stigma survey questionnaire was designed and validated to obtain socio-demographic characteristics and quantitative measures of stigma encountered by the survivors. 482 COVID-19 survivors completed the survey, and the data were analyzed using descriptive statistics and thematic analysis. Results: The results of this study revealed the prevalence of high levels of both perceived external stigma and enacted stigma among participants. Enacted and Internalized stigma were associated with survivors' educational background/ status. The participants suggested three levels of support: organizational, social, and personal. Establishing an online stigma reduction program and national psychological crisis interventions at the organizational level. It is crucial to assist coping mechanisms and societal reintegration techniques at the social level. Conclusion: These results provide valuable insights for holistic health policy formation and preparedness strategies for future pandemics, helping survivors promote health and reintegrate into society, where stigma reduction and psychological crisis interventions are underdeveloped.

A complementary medicine student-led telehealth clinic: evaluating learning & teaching perceptions.

OBJECTIVES: This study evaluates a multi-centered complementary medicine (CM) student-led telehealth clinic during the COVID-19 pandemic. Likert and qualitative responses explore student and educator learning and teaching perceptions of the implementation of a successful telehealth clinic. RESULTS: 51 students and 17 educators completed the survey. Respondents agreed that support from educators (90%) and orientation (70%) assisted effective performance. Over 90% (93%) of all respondents supported telehealth in student-led clinics, whilst 87% encountered barriers such as technical and infrastructure issues. Respondents agreed that telehealth practice skills improved in case history taking (90%), treatment (90%) and building patient rapport (60%). Respondents (61%) disagreed that physical examination was effectively performed, and 100% of respondents agreed telehealth was a valuable learning experience. This study is the first to explore student and educator perceptions of telehealth in an Australian University multi-centered CM student-led clinic. To be successful in an educational environment, students and educators require digital literacy and adequate telehealth practice infrastructure. Whilst some in-person practice skills are transferable to telehealth, educators need to adapt curriculum to ensure counselling and physical examination skills are specifically taught for virtual consultations. Telehealth in clinical practice requires continued investigation and educational development.

"It was classed as a nonemergency": Women's experiences of kidney disease and preconception decision-making, family planning, and parenting in the United Kingdom during COVID-19.

OBJECTIVES: To investigate the experiences of women with kidney disease, residing in the United Kingdom (UK), living through the first 18 months of the COVID-19 pandemic with specific focus on preconception decision-making, family planning, and parenting. METHODS: We conducted a mixed-methods study, comprising an online survey and follow-up interviews, with UK-resident women aged 18-50. RESULTS: We received 431 surveys and conducted 30 interviews. Half (n = 221, 51%) of the survey respondents considered that COVID-19 influenced the quality of communication with healthcare professionals and 68% (n = 295) felt that the pandemic disrupted their support networks. Interview participants indicated that delayed and canceled appointments caused anxiety, grief, and loss of pregnancy options. Women's perception of themselves as (good) mothers as well as their capacity to have and raise a child, meet partners, and sustain healthy relationships was negatively affected by the "clinically extremely vulnerable" label. Women's trust in their healthcare was dismantled by miscommunication and variation in lockdown rules that caused confusion and increased worry. Women reported that COVID-19 contributed to postnatal depression, excessive concern over infant mortality, preoccupation over others following rules, and catastrophising. CONCLUSION: Some women in the UK with chronic kidney disease lost or missed their opportunity to have children during the pandemic. Future pandemic planners need to look more holistically and longer term at what is and is not classed as an emergency, both in how services are reconfigured and how people with chronic conditions are identified, communicated with, and treated.

Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences.

BACKGROUND: Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers. OBJECTIVE: This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention. METHODS: The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach. RESULTS: Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation. CONCLUSIONS: The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial.

Clinical Evidence on the Potential Beneficial Effects of Diet and Dietary Supplements against COVID-19 Infection Risk and Symptoms' Severity.

BACKGROUND: Diet and dietary supplements aim to add trace elements, vitamins, and minerals to the body to improve human health and boost the immune system. In the previous few years, the new SARS-CoV-2 coronavirus strain has been threatening the health of individuals and public health more broadly, with rates of intensive care unit cases on the rise, while long-term COVID-19 complications are persisting until today. In the peculiar circumstances of the COVID-19 pandemic, in combination with disease prevention techniques, the strengthening of the immune system is considered particularly important to enable it to effectively respond to and eliminate the SARS-CoV-2 viral pathogen in the event of infection. The purpose of the current literature review is to thoroughly summarize and critically analyze the current clinical data concerning the potential beneficial effects of diet and dietary supplements against COVID-19 infection risk and symptoms' severity. The micronutrients/supplements examined in this study in relation to COVID-19 infection are vitamins A, B, C, and D, zinc, selenium, magnesium, iron, omega-3 fatty acids, glutamine, resveratrol, beta-glucans, and probiotics. The potential effects of dietary patterns such as the Mediterranean diet against SARS-CoV-2 infection risk and symptoms' severity were also analyzed. Our literature review suggests that micro- and macronutrient supplementation and a healthy diet and lifestyle may provide support to immune system function, with beneficial effects both before and during SARS-CoV-2 infection. However, additional studies are recommended to draw safe conclusions and formulate dietary recommendations concerning dietary supplements and their possible effects on preventing and co-treating COVID-19 disease.

Identifying dynamic risk spillovers between crude oil and downstream industries: China's futures market perspective.

Interactions between crude oil and its downstream products are crucial but complex. The main purpose of this study is to examine the risk spillover relationships between the crude oil futures market and the petrochemical downstream futures market in the context of the COVID-19 epidemic in China. By combining the dynamic conditional correlation-generalized autoregressive conditional heteroskedasticity (DCC-GARCH) model and the Diebold-Yilmaz spillover index based on time-varying parameter-vector autoregression (TVP-VAR-DY), we investigate the dynamic correlations between Shanghai crude oil futures (INE) and the downstream futures in China's petrochemical industry chain. At the same time, we also incorporate the representative global crude oil futures (BRENT and WTI) in our study as a comparative analysis. Our results show a significant positive correlation between three crude oil futures and China's downstream future products, with a more pronounced link observed between INE and the downstream futures market. Moreover, the correlation between crude oil futures and various downstream products exhibits heterogeneity; that is, direct derivatives of crude oil show higher sensitivity to price fluctuations compared to products with longer production chains. Furthermore, the spillover results indicate that the international crude oil futures, particularly BRENT, primarily function as spillover transmitters, while INE mainly serves as the recipient. In the post-pandemic period, the international crude oil market still exhibits a high spillover effect, and the spillover effect of INE to polyvinyl chloride, pure terephthalic acid, and bitumen futures increased, reflecting market recovery in China to some extent. These results provide potential insights for policymakers, financial institutions, industry participants, and investors, emphasizing the importance of enhanced risk management, diversified investment strategies, and attention to market dynamics.

Prevalence of abnormal urine drug tests during COVID-19 pandemic in the cancer patient population: retrospective study.

Background: Opioid misuse is a persistent concern, heightened by the COVID-19 pandemic. This study examines the risk factors contributing to elevated rates of abnormal urine drug tests (UDTs) in the cancer pain patient population during COVID-19. Materials & methods: A retrospective chart review of 500 patient encounters involving UDTs at a comprehensive cancer center. Results: Medication adherence rates increase when UDTs are incorporated into a chronic cancer pain management protocol. Higher positive tests for illicit or nonprescribed substances in patients with specific risk factors: current smokers (tobacco), no active cancer and concurrent benzodiazepine use. Conclusion: This research emphasizes the increased risk of opioid misuse during COVID-19 among cancer pain patients with specific risk factors outlined in the results.

This study looked at how the COVID-19 pandemic has affected opioid use among people with cancer-related pain. The researchers checked the records of 500 patients who had had tests to see if they used opioids correctly. They found that when these tests were part of the treatment plan, patients were more likely to take their medicines correctly. However, they also noticed that certain patients, such as those who smoke, do not have active cancer or are taking another type of medication (i.e., benzodiazepines), are more likely to use opioids or other drugs in ways that deviated from the original intention. This study shows that during the pandemic, which continues to exist, it is even more important to watch how these patients use their painkillers and help them avoid misuse.

Systematic Review On Major Antiviral Phytocompounds from Common Medicinal Plants Against SARS-CoV-2.

Viral infections are rising around the globe and with evolving virus types and increasing varieties of viral invasions; the human body is developing antimicrobial resistance continuously. This is making the fight of mankind against viruses weak and unsecured. On the other hand, changing lifestyle, globalization and human activities adversely affecting the environment are opening up risks for new viral predominance on human race. In this context the world has witnessed the pandemic of the human Coronavirus disease (COVID-19) recently. The disease is caused by the Coronavirus namely Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV- 2). METHOD AND MATERIAL: Developing potential and effective vaccine is also time consuming and challenging. The huge resource of plants around us has rich source of potent antiviral compounds. Some of these molecules may serve as tremendously potent lead molecules whose slight structural modifications may give us highly bioactive antiviral derivatives of phytocompounds. Every geographical region is rich in unique plant biodiversity and hence every corner of the world with rich plant biodiversity can serve as abode for potential magical phytocompounds most of which have not been extensively explored for development of antiviral drug formulations against various viruses like HIV, HPV etc., and the Coronavirus, also known as SARS-CoV-2 which causes the disease COVID-19. RESULT: Several phytocompounds from various medicinal plants have already been screened using in silico tools and some of them have yielded promising results establishing themselves as potent lead molecules for development of drugs against the highly mutating SARS-CoV-2 virus and thus these phytocompounds may be beneficial in treating COVID-19 and help human to win the life threatening battle against the deadly virus. CONCLUSION: The best advantage is that these phytocompounds being derived from nature in most of the cases, come with minimum or no side effects compared to that of chemically synthesized conventional bioactive compounds and are indigenously available hence are the source of cost effective drug formulations with strong therapeutic potentials.

"I Just Know if I Keep Going, I'll End Up Hating Nursing." Lived Experiences of Emergency Nurses Three Years Into the Global COVID-19 Pandemic.

INTRODUCTION: As the coronavirus disease 2019 pandemic continues globally, the personal and professional pressure on health care workers continues to accumulate. Literature suggests that as the pandemic evolves, nurses are experiencing increased levels of anxiety, depression, and post-traumatic stress, ultimately leading them to voice intentions to leave the profession, if they have not done so already. METHODS: Informed by an interpretive hermeneutic phenomenological approach, this longitudinal study was designed to capture how the lived experiences of 9 emergency nurses evolved over the coronavirus disease 2019 pandemic, highlighting their feelings, attitudes, and perceptions toward working in the emergency department at this time in history. Interviews were undertaken in June 2022 and were analyzed using a thematic analysis approach. RESULTS: Data analysis resulted in a total of 2 major themes and 8 minor themes. The 2 major themes included "exposed wounds" and "Band-Aid solutions." Levels of burnout increased during the pandemic, with most of the emergency nurse participants dropping their hours, moving roles within the profession, or leaving the profession entirely. Findings elucidate where and how concerns may arise in clinical practice and holistic well-being among emergency nurses, particularly surrounding professional boundaries and protecting work-life balance and professional identity. DISCUSSION: As the world moves to managing coronavirus disease 2019 as a recognized common respiratory illness, providing time and space for emergency nurses to voice their concerns, design their well-being interventions, set professional boundaries, and reconnect with their professional passion may see lower attrition rates and higher levels of professional satisfaction in emergency nurses globally.

(Over)crowded house: exploring asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers in Sweden.

BACKGROUND: The COVID-19 pandemic has made visible the scale of health disparities in society, highlighting how the distribution of infection and deaths differs between population subgroups within countries. Asylum seekers represent a potentially vulnerable group; early in the pandemic, concerns were raised about their housing situation, usually involving overcrowded, camp-like accommodations, and the effects of COVID-19 in relation to this. Hence, this study aimed to explore asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers. METHODS: In this qualitative study, 14 semi-structured interviews were conducted with asylum seekers at two accommodation centers in Sweden. Participants represented a diverse group of asylum seekers in regard to age, educational background, and gender. Data were analyzed using qualitative content analysis. RESULTS: Experiences related to COVID-19 were highly dependent on the living situation at the accommodation centers and the experience of feeling unsafe in shared spaces. This was enhanced by the experiences of a challenging mix of COVID-19 messages where different understandings of COVID-19 and related measures existed, together with a feeling of loss of control and safety in shared rooms. Additionally, participants felt more isolated from the outside society and missed prior social activities. Adding to this experience of isolation was an increasing mistrust regarding the authorities' pandemic response. CONCLUSION: This study highlights the importance of understanding the specific challenges and vulnerabilities of asylum seekers at accommodation centers during the pandemic, shaped by their housing situation and legal status. The findings underscore the need for context-specific support, holistic disease prevention approaches, and tailored health communication strategies using diverse formats. Additionally, the findings emphasize the crucial need to identify and mobilize existing community resources in planning and implementing pandemic control measures. Furthermore, the study emphasizes governmental responsibility in providing secure housing, and to address long-term vulnerabilities beyond pandemics.

Physician resilience and perceived quality of care among medical doctors with training in psychosomatic medicine during the COVID-19 pandemic: a quantitative and qualitative analysis.

BACKGROUND: At an individual level, physician resilience protects against burnout and against its known negative effects on individual physicians, patient safety, and quality of care. However, it remains uncertain whether physician resilience also correlates with maintaining a high level of healthcare quality during crises such as a pandemic. This study aimed to investigate whether higher resilience among physicians, who had received training in resilience-related competences in the past, would be associated with higher quality of care delivered during the COVID-19 pandemic. METHODS: This study enrolled physicians working in family medicine, psychiatry, internal medicine, and other medical specialties, who had obtained at least one of three consecutive diplomas in psychosomatic medicine in the past. Participants completed a quantitative and qualitative anonymous online survey. Resilience was measured using the Connor-Davidson Resilience Scale, and healthcare quality was assessed through single-item quality indicators, including perceived quality of care, professional autonomy, adequate time for patient care, and job satisfaction. RESULTS: The study included 229 physicians (70 males/159 females) with additional training in psychosomatic medicine, working in family medicine (42.5%), psychiatry (28.1%), internal medicine (7.0%), or other medical specialties (22.4%). Participants represented four intensity levels of training background (level 1 to level 4: 9.2%, 32.3%, 46.3%, and 12.2% of participants). Training background in psychosomatic medicine was positively associated with resilience (B = 0.08, SE = 0.04, p <.05). Resilience and training background independently predicted perceived quality of care, even after controlling for variables such as own health concerns, involvement in the treatment of COVID-19 patients, financial strain, percentage of working hours spent on patient care, age, and gender (resilience: B = 0.33, SE = 0.12, p <.01; training background: B = 0.17, SE = 0.07, p <.05). Both resilience and training background predicted job satisfaction (resilience: B = 0.42, SE = 0.12, p <.001; training background: B = 0.18, SE = 0.07, p <.05), while resilience alone predicted professional autonomy (B = 0.27, SE = 0.12, p <.05). In response to an open question about their resources, resilient physicians more frequently reported applying conscious resilient skills/emotion regulation (p <.05) and personal coping strategies (p <.01) compared to less resilient medical doctors. CONCLUSION: Physician resilience appears to play a significant role in the perceived quality of patient care, professional autonomy, and job satisfaction during healthcare crises.

Practice and proficiency of Isha Yoga for better mental health outcomes: insights from a COVID-19 survey.

Introduction: The COVID-19 pandemic has brought about unparalleled suffering on a global scale, affecting both physical and mental well-being. In such challenging times, it becomes crucial to identify interventions that can alleviate negative mental health outcomes, such as stress, while promoting positive mental health outcomes, like well-being. We report the effectiveness of a mind-body practise, Isha Yoga, in promoting well-being. Methods: We conducted an online survey, during the COVID-19 pandemic, with Yoga practitioners (n = 1,352) from the Isha Yoga tradition in Karnataka, India. We evaluated stress and well-being attributes using conventional psychometric questionnaires. Subsequently, we requested the Isha Yoga practitioners to share another survey with their friends and family members, assessing similar outcomes. From the respondents of this shared survey (n = 221), we identified individuals who currently did not engage in any form of Yoga or meditation, constituting the non-Yoga control group (n = 110). To enhance the reliability and validity of our study and minimize the limitations commonly associated with online surveys, we adhered to the CHERRIES guidelines for reporting survey studies. Results: Isha Yoga practitioners had significantly lower levels of stress (p < 0.001, gHedges = 0.94) and mental distress (p < 0.001, gHedges = 0.75) while reporting significantly higher levels of well-being (p < 0.001, gHedges = 0.78) and affective balance (p < 0.001, gHedges = 0.80) compared to the control group. Furthermore, expertise-related improvements were observed in these outcomes, and a dose-response relationship was found between regularity of Isha Yoga practice and outcome changes. A minimum 3-4 days of weekly practice showed significant differences with the control group. In addition, we investigated the effect of Isha Yoga on stress and well-being among the healthcare workers (HCWs) in our sample and observed better mental health outcomes. Discussion: These findings collectively underscore the benefits of Mind and Body practices like Isha Yoga on various aspects of mental health and well-being, emphasizing its potential as an effective and holistic approach for promoting a healthy lifestyle among diverse populations, including healthcare workers, even in difficult circumstances such as the COVID-19 pandemic.

Novel Web-Based Drop-In Mindfulness Sessions (Pause-4-Providers) to Enhance Well-Being Among Health Care Workers During the COVID-19 Pandemic: Descriptive and Qualitative Study.

BACKGROUND: The COVID-19 pandemic exerted extraordinary pressure on health care workers (HCWs), imperiling their well-being and mental health. In response to the urgent demand to provide barrier-free support for the health care workforce, Pause-4-Providers implemented 30-minute live web-based drop-in mindfulness sessions for HCWs. OBJECTIVE: This study aims to evaluate the use, feasibility, satisfaction, and acceptability of a novel mindfulness program aimed at enhancing the well-being of HCWs during the COVID-19 pandemic. METHODS: Accrual for the study continued throughout the first 3 pandemic waves, and attendees of ≥1 session were invited to participate. The evaluation framework included descriptive characteristics, including participant demographics, resilience at work, and single-item burnout scores; feedback questionnaires on reasons attended, benefits, and satisfaction; qualitative interviews to further understand participant experience, satisfaction, benefits, enablers, and barriers; and the number of participants in each session summarized according to the pandemic wave. RESULTS: We collected descriptive statistics from 50 consenting HCWs. Approximately half of the participants (24/50, 48%) attended >1 session. The study participants were predominantly female individuals (40/50, 80%) and comprised physicians (17/50, 34%), nurses (9/50, 18%), and other HCWs (24/50, 48%), who were largely from Ontario (41/50, 82%). Of 50 attendees, 26 (52%) endorsed feeling burned out. The highest attendance was in May 2020 and January 2021, corresponding to the first and second pandemic waves. The participants endorsed high levels of satisfaction (43/47, 92%). The most cited reasons for attending the program were to relax (38/48, 79%), manage stress or anxiety (36/48, 75%), wish for loving kindness or self-compassion (30/48, 64%), learn mindfulness (30/48, 64%), and seek help with emotional reactivity (25/48, 53%). Qualitative interviews with 15 out of 50 (30%) participants identified positive personal and professional impacts. Personal impacts revealed that participation helped HCWs to relax, manage stress, care for themselves, sleep better, reduce isolation, and feel recognized. Professional impacts included having a toolbox of mindfulness techniques, using mindfulness moments, and being calmer at work. Some participants noted that they shared techniques with their colleagues. The reported barriers included participants' needing time to prioritize themselves, fatigue, forgetting to apply skills on the job, and finding a private place to participate. CONCLUSIONS: The Pause-4-Providers participants reported that the web-based groups were accessible; appreciated the format, content, and faculty; and had high levels of satisfaction with the program. Both novel format (eg, drop-in, live, web-based, anonymous, brief, and shared activity with other HCWs) and content (eg, themed mindfulness practices including micropractices, with workplace applications) were enablers to participation. This study of HCW support sessions was limited by the low number of consenting participants and the rolling enrollment project design; however, the findings suggest that a drop-in web-based mindfulness program has the potential to support the well-being of HCWs.

The response of the Military Health System (MHS) to the COVID-19 pandemic: a summary of findings from MHS reviews.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic caused major disruptions to the US Military Health System (MHS). In this study, we evaluated the MHS response to the pandemic to understand the impact of the pandemic response in a large, national, integrated healthcare system providing care for ~ 9 million beneficiaries. METHODS: We performed a narrative literature review of 16 internal Department of Defense (DoD) reports, including reviews mandated by the US Congress in response to the pandemic. We categorized the findings using the Doctrine, Organization, Training, Materiel, Leadership, Personnel, Facilities, and Policy (DOTMLPF-P) framework developed by the DoD to assess system efficiency and effectiveness. RESULTS: The majority of the findings were in the policy, organization, and personnel categories. Key findings showed that the MHS structure to address surge situations was beneficial during the pandemic response, and the rapid growth of telehealth created the potential impact for improved access to routine and specialized care. However, organizational transition contributed to miscommunication and uneven implementation of policies; disruptions affected clinical training, upskilling, and the supply chain; and staffing shortages contributed to burnout among healthcare workers. CONCLUSION: Given its highly integrated, vertical structure, the MHS was in a better position than many civilian healthcare networks to respond efficiently to the pandemic. However, similar to the US civilian sector, the MHS also experienced delays in care, staffing and materiel challenges, and a rapid switch to telehealth. Lessons regarding the importance of communication and preparation for future public health emergency responses are relevant to civilian healthcare systems responding to COVID-19 and other similar public health crises.

The Silver Lining of Posttraumatic Growth around the Dark Side of the COVID-19 Pandemic: A School-Based Intervention with Mindfulness and Character Strengths Practices among Children.

The theory of posttraumatic growth (PTG) proposes that from life difficulties positive changes can happen, such as deepened personal relationships and an awareness of new possibilities in life. PTG can occur naturally or can be facilitated. This study aimed to promote PTG through a school-based intervention of eight sessions of 45 min each with mindfulness and character strengths practices (the so-called "The exploration of happiness during the COVID-19 pandemic"). The study conducted assessments at baseline, post-intervention, and follow-up (i.e., one month after the intervention). The post-intervention results showed that the participants in the intervention group experienced an improvement in PTG, well-being, mindfulness, strengths use, and PTS symptoms compared to the children in the control group. Furthermore, these positive changes were sustained at follow-up. The findings of this study highlight that mindfulness-based strengths practices can increase positive outcomes (i.e., well-being, posttraumatic growth) and reduce negative psychological symptoms (PTS) among children. The implications for theory and practice are discussed, and detailed appendices for practitioners are provided.

Pandemic Management: Health Data and Public Health Surveillance.

The inefficiency of the healthcare system in addressing pandemics is highlighted after COVID-19 which is mostly rooted in data availability and accuracy. As it is believed we might witness more pandemics in future, our research's main objective is to propose an integrated health system to support healthcare preparedness for future infectious outbreaks and pandemics. The system could support managers and authorities in healthcare and disaster management, and policymakers through data collection, sharing, and analysis.

Effectiveness of Drug Repurposing and Natural Products Against SARS-CoV-2: A Comprehensive Review.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a betacoronavirus responsible for the COVID-19 pandemic, causing respiratory disorders, and even death in some individuals, if not appropriately treated in time. To face the pandemic, preventive measures have been taken against contagions and the application of vaccines to prevent severe disease and death cases. For the COVID-19 treatment, antiviral, antiparasitic, anticoagulant and other drugs have been reused due to limited specific medicaments for the disease. Drug repurposing is an emerging strategy with therapies that have already tested safe in humans. One promising alternative for systematic experimental screening of a vast pool of compounds is computational drug repurposing (in silico assay). Using these tools, new uses for approved drugs such as chloroquine, hydroxychloroquine, ivermectin, zidovudine, ribavirin, lamivudine, remdesivir, lopinavir and tenofovir/emtricitabine have been conducted, showing effectiveness in vitro and in silico against SARS-CoV-2 and some of these, also in clinical trials. Additionally, therapeutic options have been sought in natural products (terpenoids, alkaloids, saponins and phenolics) with promising in vitro and in silico results for use in COVID-19 disease. Among these, the most studied are resveratrol, quercetin, hesperidin, curcumin, myricetin and betulinic acid, which were proposed as SARS-CoV-2 inhibitors. Among the drugs reused to control the SARS-CoV2, better results have been observed for remdesivir in hospitalized patients and outpatients. Regarding natural products, resveratrol, curcumin, and quercetin have demonstrated in vitro antiviral activity against SARS-CoV-2 and in vivo, a nebulized formulation has demonstrated to alleviate the respiratory symptoms of COVID-19. This review shows the evidence of drug repurposing efficacy and the potential use of natural products as a treatment for COVID-19. For this, a search was carried out in PubMed, SciELO and ScienceDirect databases for articles about drugs approved or under study and natural compounds recognized for their antiviral activity against SARS-CoV-2.