Fatores clínicos do bem-estar de mulheres em parturição: perspectivas deontológicas e da bioética principialista / Clinical factors of women in labor well-being: deontological and bioethical principlism perspectives / Factores clínicos del bienestar de la mujer en trabajo de parto: perspectivas deontológicas y de la bioética principialista

Objetivo: avaliar os fatores clínicos associados ao bem-estar das mulheres durante o trabalho de parto e parto à luz da bioética principialista e da deontologia. Método: estudo transversal com abordagem quantitativa. Participaram 396 puérperas internadas em um hospital municipal do sudoeste da Bahia, e os dados foram coletados no período de janeiro a maio de 2023, após aprovação do comitê de ética em pesquisa. Os dados foram organizados no software Excel e analisados via SPSS v.25. a partir da regressão logística multinomial. Resultados: a maior parte da amostra apresentou bem-estar com assistência em saúde, mulheres que tiveram parto realizado por profissionais não médicos apresentaram mais chances de níveis de bem-estar "adequado". E mulheres que não tiveram a via de parto cesárea apresentaram aumento de chances de bem-estar. Conclusão: é necessário que os profissionais reflitam sobre suas ações, condicionando-as à humanização no parto, em observância aos princípios bioéticos.

Objective: to evaluate the clinical factors associated with women's well-being during labor and delivery in the light of bioethics principlism and deontology. Method: a cross-sectional study with a quantitative approach was conducted. It involved 396 postpartum women admitted to a municipal hospital in the southwest of Bahia. Data were collected from January to May 2023, after approval from the research ethics committee. The data were tabulated using Excel software and analyzed using SPSS v.25 through Multinomial Logistic Regression. Results: majority of the sample exhibited well-being with health care assistance. Women who underwent delivery performed by non-medical professionals showed higher chances of "adequate" levels of well-being. Additionally, women who did not undergo cesarean delivery showed increased chances of well-being. Conclusion: It is necessary for professionals to reflect on their actions, conditioning them to the humanization of childbirth, according to bioethical principles.

Objetivo: evaluar los factores clínicos asociados al bienestar de la mujer durante el trabajo de parto y parto a la luz de la bioética y la deontología principialista. Método: estudio transversal con enfoque cuantitativo. Incluyó 396 puérperas ingresadas en un hospital municipal del suroeste de Bahía. Recolección de datos de enero a mayo de 2023, con aprobación del comité de ética en investigación. Los datos se tabularon en el software Excel y se analizaron mediante SPSS v.25. utilizando regresión logística multinomial. Resultados: la mayoría de las participantes de la muestra presentó bienestar con la atención para la salud; las que tuvieron partos realizados por profesionales no médicos tenían más probabilidades de tener niveles "adecuados" de bienestar; las que no tuvieron parto por cesárea tenían mayores probabilidades de tener bienestar. Conclusión: es necesario que los profesionales reflexionen sobre sus acciones y las adecuen para humanizar el parto, respetando los principios bioéticos.

Examining the impact of self-stigma on workplace well-being: an empirical investigation of medical students with physical disabilities in China and the moderating role of trait mindfulness.

BACKGROUND: As societal evolution unfolds in China, individuals with physical disabilities are increasingly provided opportunities in higher education, particularly in the field of medicine. However, these medical students often encounter bias in their work environments, including during internships, which fosters self-stigma and impedes their experience for workplace well-being (WWB). Such a decrease in WWB detrimentally affects not only their mental health in the workplace but also hinders their sense of personal worth and assimilation into broader society. This study aims to examine the challenges faced by medical students with physical disabilities in China as they aspire to achieve WWB, and to explore potential intervention strategies. METHODS: Leveraging cognitive consistency theory (CCT), we introduces a conceptual framework to examine the relationships among self-stigma, perceived discrimination, and WWB. It also investigates the role of trait mindfulness as a potential mitigating factor in this dynamic. We employed the Internalized Stigma of Mental Illness Scale (ISMIS), Discrimination Perception Questionnaire (DPQ), Workplace Well-being Subscale (WWBS), and Mindful Attention Awareness Scale (MAAS) to survey 316 medical students with physical disabilities. Statistical analyses, including correlation, regression, and moderated mediation effect assessments, were conducted using SPSS 22.0 and AMOS 24.0. RESULTS: A notable negative correlation exists between self-stigma and WWB (r = -0.56, p < 0.01). Perceived discrimination partially mediates the relationship between self-stigma and WWB. The direct effect of self-stigma and its mediating effect through perceived discrimination account for 60.71% and 21.43% of the total effect, respectively. Trait mindfulness moderates the latter part of this mediating pathway. Moderation models indicate that trait mindfulness has a significant negative moderating effect on the impact of perceived discrimination on WWB (ß = -0.10, p < 0.001). CONCLUSIONS: Self-stigma adversely affects the positive work experiences of medical students with physical disabilities by eliciting a heightened sensitivity to discriminatory cues, thereby undermining their WWB. Trait mindfulness can effectively counter the detrimental effects of perceived discrimination on WWB. Consequently, this study advocates for the systematic incorporation of mindfulness training into educational services and workplace enhancement programs for medical students with disabilities, aiming to foster an inclusive and supportive external environment.

The effects of smartphone addiction on the body in young adults in Turkey.

OBJECTIVES: The frequency of smartphone usage is increasing day by day in Turkey. This study was planned to reveal the level of smartphone addiction and the factors affecting smartphone addiction in young adults in Turkey. DESIGN: In the study, how long the young people had been using the smartphone and their daily usage times were recorded. The Smartphone Addiction Scale (SAS), Neck Disability Index (NDI), Body Awareness Scale (BAS), and Sedentary Behavior Questionnaire (SBQ) scales were employed as data collection tools. RESULTS: The study was conducted with 1000 participants aged 18-45, and 807 were female. 85.6% of the participants have been using smartphones for at least 3 years and 77.3% of all participants use smartphones for more than 4 hours a day. According to the SAS scale, 34.8% of the participants had smartphone addiction. Smartphone addiction is higher especially in those who have a sedentary life or individuals with neck disabilities (p = 0.005; p < 0.001 respectively). No significant difference was found between body awareness and smartphone addiction (p = 0.380). However, body awareness scores were higher in the group without smartphone addiction. There was a significant difference between the groups in terms of the SAS, BAS, NDI, and SBQ scores in the participants classified by smartphone usage time. CONCLUSION: Female gender, daily usage of a smartphone for more than 4 hours a day, having a smartphone for at least 3 years, presence of sedentary behavior, and neck disability were the factors affecting smartphone addiction in young people. No relationship was found between body awareness and smartphone addiction. Further studies on the awareness of the effects of intensive smartphone usage on the body should be conducted among young people in Turkey.

Growth mindset and well-being in social interactions: countering individual loneliness.

Introduction: Loneliness is a prevalent negative emotion experienced by college students. This study explores the relationship between a growth mindset and loneliness among college students. Methods: A total of 560 college students completed the Growth Mindset Scale (GMS), UCLA Loneliness Scale (UCLA), Interpersonal Relationships Assessment Scale (IRS), and two measures assessing distinct facets of well-being the Satisfaction with Life Scale (SWLS) and the revised Positive Affect and Negative Affect Scale (PANAS). Results and discussion: The results found a significant negative correlation between a growth mindset and loneliness. A growth mindset negatively predicted loneliness through the chain-mediated effects of interpersonal distress and well-being. These findings underscore the important role of a growth mindset in influencing loneliness, providing teachers and practitioners a new perspective to understand and intervene college students' psychological challenges.

Parents/primary caregivers' perspectives on the well-being, and home-based learning of children with neurodevelopmental disorders during COVID-19 in Bangladesh.

Background and Aims: The coronavirus pandemic (CP) leading to prolonged lockdown, and restriction of movement for almost two years in Bangladesh severely affected not only the well-being (physical and mental health) of both children and adults but also their access to home-based learning. The present study aimed to explore the mental, and physical health problems of children with neurodevelopmental disorders (NDDs), their use of telehealth services, and the status of their home-based learning by asking questions to their parents/primary caregivers (N = 149) during the second year of lockdown (November and December 2021). Methodology: The present study was a cross-sectional self-reported survey covering as many parents/primary caregivers as possible within Bangladesh. The survey questions were selected from a larger study by Masi et al. named 'COVID-19 impact survey' with permission. A total of 149 parents/primary caregivers with one or more children (mean age = 5.54) having any of the NDDs took part in the survey. Data were collected via physical sitting, telephone interview, and anonymous Google form. Results: Almost one-third of parents/caregivers felt that the NDD symptoms of their children were worsening with time, and half of them reported that their children's health and well-being were negatively impacted. More than 90% of the caregivers felt that their children are facing challenges following the rules of social distancing. Whereas more than 80% of parents agreed that their children's learning was disrupted during covid-19, and they were not getting enough online/offline support from the authorities. Conclusions: The outcome of this study suggested that CP had a significant impact on the wellbeing and home-based learning of children with NDDs and their families in Bangladesh. Most of the caregivers reported that the NDDs symptoms of their children are worsening with disrupted routine, facing problems following social distancing and maintaining fruitful relationships. In terms of home-based learning, most caregivers reported insufficient support from school authorities. The parents recommended the development of an adequate system for telehealth services and policies to help the vulnerable individuals in the future.

Strain and serenity: exploring the interplay of stress, burnout, and well-being among healthcare professionals.

Introduction: Stress and burnout can negatively affect performance, mental health, and the overall well-being of healthcare workers. The study aims to examine the prevalence of stress and burnout, and investigate links between stress, burnout, mental state, and well-being among healthcare workers in the Czech Republic. Methods: A cross-sectional survey was conducted in the Czech Republic, focusing on healthcare professionals working in various healthcare settings. A total of 1,064 healthcare workers participated in the study. A standardized questionnaire battery was used, consisting of the Maslach Burnout Inventory (MBI), Perceived Stress Scale (PSS) and Supso-7 measuring mental state. Separate correlation and multiple regression analyses were conducted. Results: 46.24% of the healthcare workers reported high levels of emotional exhaustion, 25.56% reported high levels of depersonalization, 24.15% reported low levels of personal accomplishment, while 11.18% reported high levels of perceived stress. The findings revealed that emotional exhaustion, a core component of burnout, was associated with increased feelings of anxiety and depression. Perceived stress was also linked to anxiety and depression, while personal accomplishment appeared to mitigate depression and support positive psychological well-being. Conclusion: The study provides promising evidence suggesting that addressing stress and emotional exhaustion, while fostering a sense of personal achievement, could lead to improvements in the mental health and work performance of healthcare workers. These findings highlight the importance of addressing burnout and stress management strategies to support the overall well-being of healthcare professionals.

Challenges of parenting children born before 24 weeks of gestation.

AIM: To assess experience of care, well-being of parents and children's development in a cohort of extremely premature infants born <24 weeks of gestation in Sweden from 2007 to 2018. METHODS: A survey based on multiple questionnaires answered by 124/349 (35.5%) parents. RESULTS: The median age of parents and children was 43 and 9 years, respectively; 74.2% were mothers. Parents expressed high healthcare satisfaction. Following discharge from neonatal care, the satisfaction with the infant's treatment, support from personnel and being respected as a parent significantly declined but remained high. The criteria for suspected developmental deviation according to the screening test early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire was fulfilled by 84.3%, 55.6% had suspected avoidant restrictive food intake disorder and 47.9% had visual perception problems. Parents experienced severe fatigue (48.6%) despite strong social support and family self-efficacy. Economic support was provided to 30.6%, and 37.9% of children were enrolled in habilitation services. CONCLUSION: This study highlighted the substantial challenges faced by parents of infants born before 24 weeks of gestation, including decreased satisfaction post-discharge, fatigue and concerns about children's well-being. The findings underscore the need for comprehensive family-centred support and long-term multi-professional follow-up centres.

Do aversive well-being comparisons mediate the effects of childhood adversity on anxiety and depression?

BACKGROUND: Childhood adversity (CA) is strongly associated with depression and anxiety in later life. Many adults with a history of CA may have internalized an insecure self-concept, which may contribute to negative evaluations of one's current well-being relative to different standards. Yet, there is lack of research on well-being comparisons in adults with a history of CA. OBJECTIVE: We examined aversive well-being comparisons (i.e., comparisons threatening the comparer's motives) in the context of CA and their predictive value in depression and anxiety beyond self-esteem, emotion regulation, and external control beliefs. Further, we investigated whether well-being comparison processes mediate the relationship between CA and depression and anxiety. PARTICIPANTS AND SETTING: We conducted a two-wave longitudinal study with 942 adult participants (mean age: 31.56 years, SD = 10.49, 18-75 years). METHODS: Participants completed measures of CA, aversive well-being comparisons (social, temporal, counterfactual, and criteria-based comparisons), self-esteem, emotion regulation, and locus of control at two time points, three months apart. RESULTS: CA was significantly linked to more frequent aversive well-being comparisons. These comparisons were associated with greater discrepancies relative to the comparison standard and a more negative affective impact, ultimately contributing to higher levels of subsequent anxiety and depression symptoms. Comparison frequency emerged as key mediator, highlighting potential pathways through which CA affects adult mental health. These associations emerged despite controlling for established variables in this context, namely self-esteem, emotion regulation, and external locus of control. CONCLUSION: Our findings underscore the unique importance of aversive well-being comparisons in individuals with a history of CA.

Mental distress and well-being in geriatric professionals: The role of job satisfaction.

BACKGROUND: As limited evidence is available on health professionals' experience during the post-pandemic period, the interplay between job satisfaction components, mental distress and well-being was investigated among workers of an Italian geriatric institution. METHODS: In Spring 2022, 205 participants (females =75.6%), primarily healthcare assistants (36.6%), nurses (16.6%), and rehabilitation professionals (14.1%), completed the General Health Questionnaire (GHQ), the Mental Health Continuum-Short Form (MHC-SF), and the Job Satisfaction Questionnaire. Data analyses comprised Multiple Regressions, Relative Weight Analyses, and ANOVA. FINDINGS: Satisfaction with working conditions and leadership exhibited negative associations with distress, while satisfaction with patients, colleagues, results, and leadership were positively correlated with well-being. Participants with high well-being levels scored significantly lower across mental distress dimensions than participants reporting poor well-being levels. CONCLUSIONS: Results showed that specific job satisfaction components relate differently to distress and well-being, suggesting the need for implementing organizational resources, psychological support, and interprofessional collaboration in healthcare services.

Vigour as a marker of positive mental health among social media respondents.

BACKGROUND: Quantitative research on vigour as a therapeutically responsive marker of positive mental health, has become possible by virtue of the validation of the Vigour Assessment Scale (VAS). Considering that its validation and therapeutic responsiveness were examined in an avolitional schizophrenia population, using the VAS outside these constraints requires that its psychometric properties be investigated in a more general non-clinical population. METHOD: Social media respondents (n = 787) were recruited on social media through snowball sampling and data were obtained for statistical analyses through an online questionnaire comprising the VAS and measures of work-place vigour, active involvement in personal growth, behavioural activation, procrastination, and fatigue. RESULTS: Convergent validity was confirmed in moderate to strong positive correlations between the VAS and measures approximate to vigour including physical strength (r = 0.805), cognitive liveliness (r = 0.676), planfulness (r = 0.61), and intentional behaviour (r = 0.595). Discriminant validity was evident in negative correlations with procrastination (r = -0.593) and fatigue (r = -0.786). The VAS showed good internal consistency (Cronbach α = 0.951), split-half reliability (r = 0.892), test-retest reliability (r = 0.861), and a low standard error of measurement of 3.73 within a theoretical range of 82 points. Exploratory factor analysis yielded a clear two-factor structure. LIMITATIONS: Results are limited to willing participants who responded through social media. CONCLUSIONS: Vigour may now be measured clinically as an indication of positive mental health and well-being. It may also be further investigated for its relations to other parameters of health, personality, and the efficacy of professional and self-enhancing interventions that aim for the cultivation of vigour.

Imposter phenomenon: recognising and addressing it among nurses.

Imposter phenomenon is described as persistently doubting one's accomplishments, leading to an internalised fear of being exposed as a 'fraud'. This article identifies the nature and prevalence of imposter phenomenon among nursing students, newly registered nurses and senior nurses. It also explores the effects of this phenomenon for nurses and healthcare organisations, including its potential association with burnout, suboptimal performance and a lack of career development. Evidence suggests that addressing imposter phenomenon is not something individuals can accomplish by themselves, but that it requires system-level interventions from healthcare organisations and higher education institutions. This could raise awareness, promote recognition and improve resources and training to mitigate the detrimental effects of this phenomenon on healthcare provision.

Symptom Distress Before and After Heart Transplantation - A Longitudinal 5-Year Follow-Up.

INTRODUCTION: Symptom distress after heart transplantation (HTx) is a significant problem causing uncertainty, low self-efficacy, and psychological distress. Few studies have addressed self-reported symptoms. The aim was to explore self-reported symptom distress from time on the waiting list to 5 years after HTx and its association with self-reported psychological well-being, chronic pain, and fatigue in order to identify possible predictors of psychological or transplant specific well-being. METHODS: This multicenter, longitudinal cohort study includes 48 heart recipients (HTRs), 12 women, and 36 men, with a median age of 57 years followed from pretransplant to 5 years post-transplant. Symptom distress was explored by means of four instruments measuring psychological general wellbeing, transplant specific wellbeing, pain, and fatigue. RESULTS: Transplant specific well-being for the whole improved in a stepwise manner during the first 5 years compared to pretransplant. Heart transplant recipients with poor psychological wellbeing were significantly more burdened by symptom distress, in particular sleep problems and fatigue, for up to 5 years after HTx, and their transplant-specific well-being never improved compared to baseline. The prevalence of pain varied from 40% to 60% and explained a significant proportion of the variance in transplant-specific well-being, while psychological general well-being was mainly predicted by overall symptom distress. CONCLUSION: The presence of distressing symptoms explains a significant proportion of poor psychological wellbeing both among HTRs reporting chronic pain and those without pain.

The impact of financial stress on student wellbeing in Lebanese higher education.

BACKGROUND: The financial crisis has indirectly affected Lebanese university students, leading to economic distress. Accordingly, this study aimed to assess the substantial negative impact of financial stress on the mental health and well-being of Lebanese college students. METHODS: A quantitative research approach was applied and took place from June 13th to July 25th, 2023, targeting 1272 university students aged 17 and above from private and public universities across Lebanon through convenience sampling. The InCharge Financial Distress/Financial Well-Being scale (IFDFW), Pittsburgh Sleep Quality Index (PSQI), Beirut Distress Scale (BDS-10), Perceived Stress Scale (PSS-10), and Well-Being Index (WHO-5) were used to assess the students' well-being. Descriptive analyses of the data was performed using SPSS software version 25. RESULTS: 1272 university students participated in this study, mostly females, with a mean age of 21.64 (± 4.43) years. Participants reported a lack of financial independence, unemployment, and no income. Positive associations were obtained between the BDS total scale as well as the PSS total and PSQI scores, while there was a significant negative relationship between IFDFW and PSQI scores. Those with a higher GPA, majoring in science/health and medicine, living in rural areas, and graduate students were linked to lower PSQI and BDS-10 scores. Financial aid and financial independence were associated with lower PSQI and BDS-10 scores. PSS-10 scores were higher among students majoring in science/health and medicine. Higher scores on the IFDFW scale correlated with lower BDS-10 and PSS-10 scores. In contrast, females had higher BDS-10 and PSS-10 scores. Scoring higher on the PSS-10 and PSQI scales, living off campus, or majoring in science/health and medicine, were associated with higher on the WHO-5 scale. CONCLUSIONS: A significant impact of financial stress on college students in Lebanon was obtained, affecting their well-being and mental health aspects. Marital status, gender, academic major, region of living, and financial independence also influences students' experiences. Tailored support and further research are needed to address these multifaceted challenges.

Emotion regulation skills as a mediator of STEM teachers' stress, well-being, and burnout.

The teaching profession highly stressful, and teachers are often faced with challenging situations. This is particularly the case in STEM (science, technology, engineering, and math) education, which is a uniquely demanding and challenging field. This study examined the role of emotional regulation (ER) skills in STEM teachers' stress, well-being, and burnout. The sample included 165 STEM teachers in middle and high schools who completed standard online questionnaires on ER, stress, well-being, and burnout. They were also asked to comment on three videos depicting authentic mathematical and pedagogical situations. The results indicated that contrary to popular belief, seniority was not linked with levels of stress, difficulties in ER, lower levels of well-being, or higher levels of burnout. A structural equation model and bootstrapping analysis showed teachers' levels of stress predicted their well-being, and this link between stress and well-being was mediated by teachers' level of difficulty in ER. The study highlights the importance of STEM teachers' well-being and suggests the need to reduce stress and burnout by providing tools for teachers to regulate their emotions in the classroom.

A bibliometric review of positive psychology and well-being research in Africa.

Positive Psychology rapidly developed into an influential field of study and intervention, initially situated in Psychology, and later becoming multidisciplinary. Research interest in the study of (psychological) well-being has gained global popularity, with increasing salience in Africa. Although the global trends of these developments are relatively well-known, a bibliometric analysis of positive psychology research in Africa was necessary to shed light on the present hotspots and trends and future trajectories in this region of the world. The data source of the present bibliometric analysis study was Scopus, from which Positive Psychology and well-being research literature from Africa between 1983 and 2023 were searched. Using biblioshiny and VOSviewer, the 622 extracted articles were analysed, from which findings about the current condition, research hotspots, and thematic developmental patterns could be made. Africa experienced an initial slow growth period from 1983 until 2005, after which a rapid growth in research productivity, relevance and impact was experienced. In this regard, the results show that the focal point of scientific productivity is South Africa, with the dominance of South African institutions, particularly the North-West University, from where most positive psychology research is produced and cited. Even with potential access to international journal, African researchers seem to prefer to place their publications in the regional journals such as Journal of Psychology in Africa and South African Journal of Psychology. The research reviewed tends to be characterised by more dominant thematic clusters of positive psychology, psychological well-being, and subjective well-being, with a focus on human individuals. An increasing concern for contextual factors and potential antecedents and dynamics of well-being is also observed. The findings provide a good map from which identification of future research priorities can be deduced. As such, we speculate that future positive psychology research in Africa ought to be concerned with the following: greater distribution and intercountry collaborations across the continent, questions of conceptual clarity of terms, better understanding of contextual factors which influence well-being, and well-being research embracing the complexity of bio-psycho-social-ecological well-being, and science concerned with health-promotion interventions.

The psychological burden associated with metabolic syndrome: Evidence from UK and US older adults.

Introduction: We examined the psychological burden associated with metabolic syndrome (MetSyn). Methods: We used comparable longitudinal data of older adults (≥50 years) from the UK (English Longitudinal Study of Aging) and the US (Health and Retirement Study). We defined MetSyn based on biomarker assessments (e.g., blood pressure, impaired glycemic control). Using regression models, we tested a range of individual psychological outcomes (e.g., depressive symptoms) associated with MetSyn. We also examined whether these psychological outcomes may explain or moderate the link between MetSyn and non-communicable diseases (NCDs). Findings: MetSyn was associated cross-sectionally with a range of psychological outcomes, including depression, anxiety, loneliness, hopelessness, cynical hostility, social strain, negative affect and decreased positive affect, social support and purpose in life. There was no convincing evidence that psychological factors interacted with or explained (mediated) the relationship between MetSyn and increased risk of developing NCD over 10-year follow-ups. Conclusions: MetSyn and the psychological burden outcomes examined may have independent effects on NCD risk.

The parameter of the Sick Building Syndrome: A systematic literature review.

Sick Building Syndrome (SBS) is a collection of symptoms assumed to be related to spending time in a certain building, most typically a workplace, but no specific cause has been identified. The need to measure and assess various types of parameters of SBS is crucial and it is important to explore what parameter has been used in the previous studies of SBS. Therefore, this study aims to systematically review the parameter that has been used to monitor the SBS. This study was conducted using the PRISMA Statement and the search was conducted using two scientific databases which were Scopus and Web of Science. After a thorough and tight process, a total of 55 articles have been finalized and selected for thematic analysis. Two themes have been identified which were a) Indoor Environmental Quality (IEQ) and b) Occupant. This study also found that the spatial distribution pattern revealed that the Sick Building Syndrome research was spread over 26 nations, with the majority of articles originating from the United States and China. In terms of context, the majority of the selected publications employed the survey approach to investigate SBS parameters. Aside from that, the most researched form of building is the business building. This study has found that it would be more impactful for the SBS study if researchers could incorporate both indoor environmental quality and occupant factors into a study, resulting in more holistic conclusions.

Perceptions of a community-based HIV/STI testing program among Black gay, bisexual, and other MSM in Baltimore: a qualitative analysis.

Black gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by HIV and STIs. Safe Spaces 4 Sexual Health (SS4SH), a community-informed, status-neutral HIV/STI testing intervention combines online outreach via geo-social networking apps and social media with mobile van testing. During 2018-2019, we recruited 25 participants for interviews about their perceptions of SS4SH compared to clinic-based testing. Participants were aged 21-65 years (mean 35); 22 (88%) identified as Black/African American; 20 (80%) identified as gay; and 10 (40%) were living with HIV. Interviews were transcribed, coded, and analyzed using a modified thematic constant comparative approach. Five themes emerged; two related to perceptions of online outreach materials (participants were drawn to eye-catching and to-the-point messages and desired more diversity and representation in messages), and three related to preference for the mobile van (participants found SS4SH provided more comfort, more privacy/confidentiality, and increased accessibility and efficiency). GBM is increasingly using geo-social networking apps to meet sexual partners, and tailored online outreach has the potential to reach historically underserved populations. SS4SH is a barrier-reducing strategy that may serve as an entry to a status-neutral approach to services and help reduce stigma and normalize accessing HIV services.

Acceptability, feasibility and preliminary effectiveness of the mHealth intervention, InTSHA, on retention in care and viral suppression among adolescents with HIV in South Africa: a pilot randomized clinical trial.

We describe the results of a pilot randomized clinical trial of a mobile phone-based intervention, InTSHA: Interactive Transition Support for Adolescents with HIV, compared to standard care. Encrypted, closed group chats delivered via WhatsApp provided peer support and improved communication between adolescents with HIV, their caregivers, and healthcare providers. We randomized 80 South African adolescents ages 15 to 19 years with perinatally-acquired HIV to receive either the intervention (n=40) or standard of care (n=40). We measured acceptability (Acceptability of Intervention Measure [AIM]) and feasibility (Feasibility of Intervention Measure [FIM]) as primary outcomes. We evaluated impact on retention in care and viral suppression six months after randomization as secondary endpoints. We performed bivariable and multivariable analyses using logistic regression models to assess the effect of the InTSHA intervention compared to standard of care. Among the adolescents randomized to the InTSHA intervention, the median AIM was 4.1/5.0 (82%) and median FIM was 3.9/5.0 (78%). We found no difference in retention in care or in viral suppression comparing intervention and control groups. Among adolescents who attended three or more sessions, retention in care was 100% at 6 months. InTSHA is an acceptable and feasible mHealth intervention warranting further study in a larger population.

Association between maternal HIV status and postpartum depressive symptoms in Botswana.

Few studies have evaluated postpartum depression (PPD) in women living with HIV (WLHIV) in Botswana, a high prevalence HIV setting. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate PPD symptoms in WLHIV (n = 300) and women who are HIV-uninfected (n = 131) in the Tshilo Dikotla study, an observational cohort study with a nested randomized trial. The EPDS was administered at 2, 6, and 12 months postpartum. We assessed the association of (1) HIV infection and (2) antiretroviral therapy (ART) with odds of PPD symptoms (EPDS ≥ 10 or thoughts of self-harm) in the first year postpartum using generalized estimating equations. Of WLHIV, 24 (8.00%) had PPD symptoms at one or more follow-up time points, compared to 9 (6.9%) women who were HIV-seronegative. There was no association between HIV status and PPD symptoms (adjusted odds ratio [aOR]:1.69, 95% confidence interval [CI]: 0.73-3.93, p = 0.225); however, WLHIV on efavirenz-based ART regimens had higher odds of experiencing PPD symptoms compared to dolutegravir-based ART (aOR:3.05, 95% CI:1.16-8.03, p = 0.024).