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.

Weight-Inclusive Approaches to Nutrition and Dietetics: A Needed Paradigm Shift.

This Perspective article encourages the field of nutrition and dietetics to move away from a weight-centric paradigm that emphasizes weight loss and weight management as primary health outcomes. This approach can perpetuate weight stigma, which is associated with poorer health behaviors, poorer mental health, disordered eating, and even increased mortality risk. We propose an alternative approach-adopting a weight-inclusive paradigm-that focuses on providing care across the weight spectrum by centering health behaviors rather than weight. This approach allows individuals of all sizes to have equitable access to high-quality nutrition and dietetics care.

Starch molecular structure and diabetes.

Starch is a primary source of food energy for human beings. Its chain-length distribution (CLD) is a major structural feature influencing physiologically-important properties, such as digestibility and palatability, of starch-containing foods. Diabetes, which is of epidemic proportions in many countries, is related to the rate of starch digestion in foods. Isoforms of three biosynthesis enzymes, starch synthase, starch branching enzymes and debranching enzymes, control the CLDs of starch, which can be measured by methods such as size-exclusion chromatography and fluorophore-assisted carbohydrate electrophoresis. Fitting observed CLDs to biosynthesis-based models based on the ratios of the activities of those isoforms yields biosynthesis-related parameters describing CLD features. This review examines CLD measurement, fitting CLDs to models, relations between CLDs, the occurrence and management of diabetes, and how plant breeders can develop varieties to optimize digestibility and palatability together, to develop starch-based foods with both a lower risk of diabetes and acceptable taste.

Information seeking and subsequent affective well-being in Chinese young adults: the mediating effects of worry.

OBJECTIVE: This study aimed to unravel micro-processes that link information seeking to subsequent affective well-being (i.e., positive and negative affect) at the within-person level, as well as the role of worry as a mediator in this relationship. METHODS AND MEASURES: Within the initial weeks following the Chinese government's relaxation of its epidemic control measures, 184 participants completed experience sampling methods on information seeking, COVID-related worry, and affective well-being three times a day for 14 days. RESULTS: According to dynamic structural equation models, information seeking was associated with high negative affect but not with low positive affect. COVID-related worry acted as a full mediator between information seeking at the previous time point (approximately 5 h ago) and the current negative affect, but not in positive affect. CONCLUSION: These findings suggested that the impact of information seeking on affective well-being was different for the two dimensions of affect. Furthermore, the persistent impact of information seeking on negative affect was attributed to the indirect effect of worry, suggesting that worry should be a point of focus for intervention to mitigate the potentially negative effects of information seeking within the context of the public health crises.

Applying health promotion knowledge to self-care: healthy eating and weight management for nurses.

Promoting health in the workplace is a national and international public health priority, and health promotion is a central aspect of the nursing role. However, nurses' knowledge of health promotion does not always translate to self-care and there are barriers to some aspects of self-care at work, such as healthy eating. Evidence suggests that rates of overweight and obesity in nurses are relatively high and commensurate with the general population, which has implications for their health and well-being and their delivery of health promotion to patients. This article discusses health in the workplace and some of the evidence on overweight and obesity among nurses, including how this may influence their health promotion practice. The author also considers barriers and enablers to nurses' healthy eating at work and suggests some approaches that individual nurses and healthcare organisations can take to improve healthy eating.

Lessons Learned from a Community-led, Pilot Teletherapy Group for Older Women Living with Depression and HIV.

Older women with HIV face challenges to their quality of life, including neurocognitive decline, early-onset menopause, and chronic health issues. Chief among these concerns is depression, the most common psychiatric comorbidity among people living with HIV, with rates twice as high among women as men. However, tailored interventions among older women living with HIV and depression are lacking. Following the ADAPT-ITT framework to adapt existing interventions for cultural relevance among groups of people living with HIV, the study team revised an evidence-based intervention, the 'Stress Management and Relaxation Training/Expressive Supportive Therapy Women's Project (SMART/EST),' for online implementation. Working with two community stakeholders, the study team conducted focus groups, theater testing, and manual adaptation. This resulted in the development of e-SMART/EST, an online teletherapy group co-facilitated by a Licensed Psychologist and a credentialed Peer Counselor. The adapted, eight-session weekly intervention was tested with an exploratory pilot sample of eight older women (55 years and older) with HIV and depression. Participants rated the acceptability, feasibility, and appropriateness of the intervention, as well as symptoms of depression and HIV-related quality of life before and after the group. The e-SMART/EST Women's Project demonstrated high acceptability, feasibility, and appropriateness. Engagement was high, as women attended an average of 6.8 sessions. In qualitative interviews, participants reported peer co-facilitation, culturally relevant themes (e.g., HIV-related minority stress, critical consciousness, grief, and sex and pleasure), mindfulness techniques, and cohesion with other women as main favorable elements of the intervention. Barriers to online implementation included technological issues, distractions due to remote participation, and hindered emotional attunement compared with in-person group therapy. Findings support further research to test similar interventions in full-scale trials with older women living with depression and HIV.

The effect of laughter therapy on self-efficacy and psychological well-being in nursing students.

BACKGROUND: Academic self-efficacy and psychological well-being play a crucial role in the mental health of nursing students and influence whether they decide to remain in the nursing profession. AIMS: This study aimed to determine the effect of laughter therapy on self-efficacy and psychological well-being in nursing students. METHODS: In this randomized controlled study, 208 nursing students were randomly assigned to an experimental (n = 102) and a control (n = 106) group. The experimental group received laughter therapy face-to-face once a week for eight weeks. No intervention was applied to the control group. In both groups, data were collected at the beginning of the study and the end of the eighth week using a Sociodemographic Questionnaire Form, the Academic Self-Efficacy Scale, and the Psychological Well-Being Scale. RESULTS: In the post-study group comparisons, there was a statistically significant difference in the scores for the total Academic Self-Efficacy Scale, the external emotion management and collegiality subscales, and the total Psychological Well-Being Scale (p > 0.05). With regard to all the scale scores, no statistically significant difference was found in the groups in the pre- and post-comparisons (p > 0.05). CONCLUSIONS: It was determined that laughter therapy increased the mean psychological well-being score in the experimental group. It was also found that after the laughter therapy, distraction and loss of interest in lectures decreased, stress and anxiety levels decreased, eating and sleeping habits were regulated, and social media use decreased. Laughter therapy can be used to increase self-efficacy and psychological well-being.

Evaluating the Impact of Gender and Race on Otolaryngology Resident Experiences Across the United States.

OBJECTIVE: Otolaryngology residents often encounter work-related stress and challenges during training. Sociodemographic factors influence experiences during residency; however, the impact of race and gender on otolaryngology trainee well-being during residency remains understudied. STUDY DESIGN: Online survey. SETTING: US residency programs. METHODS: An anonymous online survey consisting of 59 multiple-choice questions was sent to 104 directors of Accreditation Council for Graduate Medical Education otolaryngology residency programs to distribute to residents. Respondents were queried regarding demographics and experiences with bias. Residents self-identified gender and race. Black, Hispanic/Latinx, Middle Eastern/North African, and multiracial residents were categorized as underrepresented minorities (URM). RESULTS: Sixty-one US otolaryngology residents responded to the survey, the majority of whom were women (60.7%) and white (62%). Many residents endorsed a belief that receipt of research and training opportunities was negatively impacted by bias due to race (29.5%) or gender (45.9%). More women (27%) than men (13%) reported maximal burnout, and fewer men (17.4%) than women (40.5%) expressed low confidence in ability to independently care for patients. More male (47.8%) and white (31.6%) residents strongly agreed they were thriving. 94.6% of women and 33.3% of URM residents reported being mistaken for a nonphysician, compared to 0% of white male respondents. CONCLUSION: Otolaryngology residents perceived differential treatment based on race and gender, with women and URM residents experiencing greater exclusion and bias, as well as increased misidentification and decreased ability to thrive. Future work includes increasing sample size for generalizability and developing interventions that uphold equity in residency training environments.

Reducing the risk of HIV/AIDS transmission using intervention mapping: a systematic review.

Intervention mapping (IM) is a planning approach that reflects the intricate decision-making process involved in the design of behavior interventions. The development and implementation of IM is complex in preventing HIV/AIDS transmission. Therefore, it is significant to conduct a perfect preliminary work to successfully implement HIV/AIDS prevention. The objectives of this review were to collect and evaluate the data of the first three steps using IM to prevent HIV/AIDS transmission, and summarize the key points in the preliminary steps of IM. A total of 18 studies were identified, and six studies completely described the tasks in the first three steps of IM. Three studies described the logic model of the problem (n = 3). Six studies reported the matrix of behavior changes (n = 6), including personal and environmental determinants. Among the selected determinants, most studies reported the personal level determinants (self-efficacy and skills, knowledge, attitudes, and norms). The most used practical applications in reducing HIV/AIDS risk behaviors were video roles (n = 8) and role-model stories (n = 5). The review may be helpful for healthcare professionals to carefully design and implement the key procedures of the first three steps of the IM programs for people with HIV/AIDS in preventing HIV/AIDS transmission.

Impact of secondary health conditions on the quality of life and wellbeing of Canadians living with spinal cord injury: A comparison of preference-weighted index scores derived from generic standardized instruments.

CONTEXT/OBJECTIVES: To compare the assessment of the impact of secondary health conditions (SHCs) on the quality of life and wellbeing of Canadians living with spinal cord injury (SCI) using four preference-based outcome measures. DESIGN: Secondary analysis of data from a cross-sectional, online survey. SETTING: Community. PARTICIPANTS: Community-dwelling adults (n = 364) living with traumatic or non-traumatic spinal cord injury at least one year post-injury (70% at least 10 years post-injury). OUTCOME MEASURES: A modified version of the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); three health-related instruments (EQ-5D-5L, Health Utilities Index Mark 3 (HUI3), and the Assessment of Quality of Life 8-dimension questionnaire (AQoL-8D)) and a capability wellbeing instrument (ICEpop CAPability measure for Adults (ICECAP-A)). RESULTS: Across unadjusted and controlled analyses (i.e. controlling for associations between index scores and sociodemographic and impairment characteristics), trends were observed that identified lower levels of quality of life/wellbeing with higher problem ratings for each of the SHCs. Despite the trends, there was considerable variation in mean index scores across instruments, with HUI3 scores the lowest of the health-related instruments and ICECAP-A scores the highest overall. Respiratory problems, depression/mood problems, pressure sores, and autonomic dysreflexia were associated with the lowest levels of quality of life and wellbeing. CONCLUSIONS: Higher problem ratings for SHCs are negatively associated with scores derived from preference-based quality of life and wellbeing instruments. Variation in index scores across instruments - including across the health-related instruments alone - highlights the critical importance of assessing the relative merits of preference-based instruments when using (or considering using) these instruments/estimates in comparative effectiveness research and economic evaluation.

Estimating levels of mental health service need by small geographic area: A case study for Aboriginal and Torres Strait Islander adults living in South East Queensland.

OBJECTIVE: The objective of this study was to determine regional variation in need for mental health care for Aboriginal and Torres Strait Islander adults (18+ years). METHODS: Three Australian Indigenous health surveys were analysed, and prevalence rates of high/very high psychological distress (as per the Kessler-5 tool) by the Index of Relative Socio-economic Disadvantage were computed and combined via meta-analysis. These estimates were applied to census population data to estimate regional needs and summed to geographic planning regions. Final estimates were assessed for face validity by comparing with other existing estimates of mental health need. RESULTS: The Index of Relative Socioeconomic Disadvantage had a dose-response relationship with high/very high psychological distress, whereby the more disadvantaged an area, the greater the levels of reported distress. This methodology resulted in varying levels of need within South East Queensland. CONCLUSIONS: The approach was found to have good face validity and provides a data-driven method to determine relative levels of need. IMPLICATIONS FOR PUBLIC HEALTH: To ensure equity of mental health service provision, planners should account for variation in levels of need within a catchment. This method may be used throughout Australia to determine regional variation in need for care where other data are lacking to ensure evidence-based investment planning decisions at the local level.

The role of perceived social support in subjective wellbeing among working-age U.S. adults with and without limitations in activities of daily living.

BACKGROUND: Perceived social support may enhance subjective wellbeing (SWB) for adults with activities of daily living (ADL) limitations. However, little is known about how social support may mediate (explain) and/or moderate SWB differences among U.S. working-age adults with versus without ADL limitations. OBJECTIVE: This study examines the role of perceived emotional and instrumental support in hedonic, eudaimonic, and evaluative wellbeing among adults with and without ADL limitations. METHODS: Data were from the 2021 National Wellbeing Survey - a national survey of U.S. working-age adults aged 18-64 (N = 3775). We used regression analyses to investigate differences in hedonic, eudaimonic, and evaluative wellbeing between individuals with versus without ADL limitations, as well as the roles of emotional and instrumental social support in explaining observed differences. We used interaction terms to examine whether social support moderated the observed associations. RESULTS: Adults with ADL limitations reported lower SWB than those without limitations across all three dimensions. Depending on the degree of limitations, the associations between ADL limitations and SWB decreased in magnitude or were no longer statistically significant after accounting for emotional and instrumental support. While both types of support were associated with better SWB among the three ADL groups, those with ADL limitations may benefit less from emotional support on both eudaimonic and evaluative wellbeing than those without limitations. CONCLUSIONS: Lower social support may contribute to worse SWB among adults with ADL limitations. Although this subpopulation may benefit from high social support, improving their SWB may require systemic interventions beyond simply enhancing social support.

Elite athletes' subjective wellbeing trajectories throughout the retirement transition: an analysis using Ruthven's (2022) transition model.

AIMS: Utilizing Ruthven's (2022) transition model, we explored how identity, voluntariness, and reason for retirement are related to subjective wellbeing throughout an athlete's retirement. METHODS: 541 participants completed an anonymous, online survey and estimated their wellbeing starting before retirement and up to the present. A set of linear mixed models regressed the seven wellbeing outcomes on the three measures, with education, gender, and time since retirement as covariates. RESULTS: Identity: Athletic Identity wellbeing was significantly and consistently lower than Diversified Identity. Voluntariness: Surprise retirement was significantly more difficult and contributed to a sharper decline on the day of transition. Reason for retirement: Pursue Something Else and Right Time experienced no significant wellbeing changes, while Injury had a significant decline on their transition day. Motivation Loss experienced significantly lower wellbeing prior to retirement, and a significant, gradual rise on the day of and throughout their transition. CONCLUSIONS: There are wellbeing benefits for a diverse identity, voluntary retirement, and retiring due to pursuing something else, or feeling ready to retire. At risk groups include retiring due to injury, low motivation, and loss of eligibility/graduation. Findings support the benefit of utilizing a theoretical model to explain elite athlete outcomes.

Factors affecting UK anaesthetic trainees' wellbeing and stress: a scoping review.

BACKGROUND: Poor wellbeing and stress in UK anaesthetic trainees impacts significantly on clinical performance, workforce retention and patient care. This study aimed to provide an overview of the evidence in this field and to explore the factors affecting wellbeing and stress in UK anaesthetic trainees. METHODS: MEDLINE, Embase, PsycINFO, and ERIC were searched, in addition to organisational websites. Literature reporting factors affecting wellbeing and stress in UK anaesthetic trainees from 2009 to present were included. RESULTS: Following exclusions, 45 studies were identified. Only five papers included qualitative analyses. Within these studies, 28 different phenomena related to wellbeing and stress were investigated. Thirty-one different factors affecting anaesthetic trainees' wellbeing and stress were identified in this review. These have been summarised as individual; training; clinical role; progression; work patterns; resources; rest; support; and cultural factors. External factors were described as affecting wellbeing and stress more frequently than internal factors. The most frequently cited individual factors were fatigue and pre-existing health status. CONCLUSIONS: The wide scope of phenomena of interest and measurement tools emphasises the challenge of defining and researching the concept of wellbeing. Despite these limitations, we have created a novel conceptual model of individual and external factors affecting UK anaesthetic trainees' wellbeing and stress. This supports an increased awareness and understanding of these factors, so that improvements can be made to practice and policy.

Modeling the Determinants of Subjective Well-Being in Schizophrenia.

BACKGROUND: The ultimate goal of successful schizophrenia treatment is not just to alleviate psychotic symptoms, but also to reduce distress and achieve subjective well-being (SWB). We aimed to identify the determinants of SWB and their interrelationships in schizophrenia. METHODS: Data were obtained from 637 patients with schizophrenia enrolled in multicenter, open-label, non-comparative clinical trials. The SWB under the Neuroleptic Treatment Scale (SWN) was utilized; a cut-off score of 80 indicated a high level of SWB at baseline and 6 months. Various machine learning (ML) algorithms were employed to identify the determinants of SWB. Furthermore, network analysis and structural equation modeling (SEM) were conducted to explore detailed relationship patterns. RESULTS: The random forest (RF) model had the highest area under the curve (AUC) of 0.794 at baseline. Obsessive-compulsive symptoms (OCS) had the most significant impact on high levels of SWB, followed by somatization, cognitive deficits, and depression. The network analysis demonstrated robust connections among the SWB, OCS, and somatization. SEM analysis revealed that OCS exerted the strongest direct effect on SWB, and also an indirect effect via the mediation of depression. Furthermore, the contribution of OCS at baseline to SWB was maintained 6 months later. CONCLUSIONS: OCS, somatization, cognition, and depression, rather than psychotic symptoms, exerted significant impacts on SWB in schizophrenia. Notably, OCS exhibited the most significant contribution not only to the current state of well-being but also to follow-up SWB, implying that OCS was predictive of SWB. The findings demonstrated that OCS management is critical for the treatment of schizophrenia.

Effects of early intervention on the mental wellbeing and caregiving practices of preterm infant caregivers.

BACKGROUND: The rising incidence of preterm births worldwide presents a pressing public health challenge, affecting both infants and their preterm caregivers. Early Intervention (EI) programs aim to mitigate the negative impacts associated with preterm births on the physical, cognitive, and psychological health of both infants and their caregivers by providing personalized parental support and developmental monitoring. This study addressed the gap in research evaluating the long-term effects of community-based EI programs on the holistic coping mechanisms of families, encompassing mental wellbeing, caregiving competencies, and the transition process from hospital to home care. METHODS: This study evaluated the long-term effects of a community-based EI program (in-home only) and the added benefits of earlier Hospital-to-Home (H2H) support, focusing on preterm caregivers' mental wellbeing and caregiving practices. RESULTS: The findings highlight the extended benefits of EI, demonstrating that program duration and intensity significantly benefit families dealing with neonatal intensive care unit stays. For infants requiring extensive medical intervention, EI support markedly enhances caregiver mental wellbeing. Additionally, interventions initiated earlier yield a more substantial positive effect on preterm caregivers' mental wellbeing after discharge compared to those that commence later. CONCLUSION: These findings suggest the potential role of community-based EI programs and the benefits of supporting preterm caregivers before transitioning home. The study calls for future research to explore the effects of various EI program components to identify which interventions are most effective for addressing preterm infants' specific developmental challenges.

Impact of professional identity on learner well-being of undergraduate nursing students of "double tops" universities: Mediating effect of self-regulated learning.

OBJECTIVES: The pressure of internal competition at the college level has increased in recent years in China with an impact on nursing students' learning and well-being. This study aimed to investigate the current situation and factors affecting professional identity, learner well-being and self-regulated learning of undergraduate nursing students in the Neijuan ecology of the "double tops" universities, and to explore the relationships between these three variables. METHODS: A cross-sectional design was adopted to conduct an online survey of 322 Chinese undergraduate nursing students from seven "double tops" universities. The survey included socio-demographics characteristics, students' professional identity, learner well-being, and self-regulated learning. RESULTS: Results of Pearson correlation analysis showed that professional identity was significantly and positively correlated with learner well-being (R = 0.795, p < 0.001); professional identity was significantly and positively correlated with self-regulated learning (R = 0.843, p < 0.001); and, self-regulated learning was significantly and positively correlated with learner well-being (R = 0.852, p < 0.001). After mediation effect testing, self-regulated learning had a mediating effect between professional identity and learner well-being (95 % CI 0.366-0.548, p < 0.001). Professional identity had a positive predictive effect on self-regulated learning (a = 0.570, p < 0.001), and self-regulated learning also had a positive predictive effect on learner well-being (b = 0.798, p < 0.001). The direct effect of professional identity on learner well-being (0.225) and its mediating effect (0.455) account for 33.1 % and 66.9 % of the total effect (0.680), respectively. CONCLUSIONS: The learner well-being of undergraduate Chinese nursing students is in the middle to upper range, and it is crucial to enhance professional identity and develop students' self-regulated learning to improve their learner well-being. This study provides empirical evidence to support the mediating effect of self-regulated learning on the relationship between professional identity and learner well-being among undergraduate nursing students in "double tops" universities. Universities are expected to strengthen career planning guidance and professional competence training for students as early as possible in order to develop quality nursing education programs that produce graduates who enter and remain in the workforce.

Strabismic Adults' Experiences of Psychosocial Influence of Strabismus-A Qualitative Study.

Introduction: Strabismus influences health-related quality of life. Individuals may have functional and psychosocial consequences of strabismus that impact their well-being. As strabismus is prevalent in all age groups, patients are seen in varied specialties in healthcare organizations. Therefore, healthcare professionals need to be aware of the psychosocial consequences when caring for strabismic individuals. Objective: To describe strabismic adults' experiences of the psychosocial influence of strabismus. Methods: Twelve strabismic adults participated in face-to-face or online semistructured individual interviews to share their experiences of the psychosocial influence of strabismus. The participants were selected purposefully. The data were analyzed using inductive content analysis. Results: The participating adults described challenges with social environments, which showed stress in social situations and pressure in interactions. Strabismic adults had experienced staring from others, avoided social situations, and were uncomfortable with photography. They hid their strabismus, avoided eye contact, and struggled with intimate relationships. They also expressed struggles with mental well-being, which were emotional and psychological burdens. The adults described feeling negative emotions, worry, and irritation due to their condition. Struggles with self-confidence, difficulties with acceptance, negative thoughts about their appearance, experiences of bullying, and dealing with being different were described. Conclusion: Strabismic adults experience psychosocial consequences of strabismus, influencing their psychosocial health-related quality of life. Further studies should focus on how healthcare professionals could support strabismic individuals' psychosocial well-being.

Opposing objective and subjective wellbeing outcomes within an environmentally vulnerable delta: a case study of Volta Delta, Ghana.

Introduction: Despite a growing interest in the measurement and conceptualization of wellbeing, the integration within sustainability research, and the understanding of how different wellbeing outcomes relate, is limited. Many studies focus on singular, often objectively measured, outcomes, without acknowledging the breadth of available measures. This approach can result in crucial subjective information, which can be explored to understand actors' behaviors and responses, being omitted from research and policy. This study explores objective and subjective wellbeing outcomes, and how they relate, within an environmentally vulnerable context. Wellbeing and environmental services are intrinsically interlinked, therefore, appropriate policy solutions are required to address human needs and pressures on supporting ecosystems. Methods: This paper uses binary logistic regression modelling, and qualitative participatory rural appraisal methods, to understand the environmental conditions, including climatic hazards and landscape characteristics, associated with households experiencing different objective/subjective wellbeing outcomes within Volta Delta, Ghana. Results: The mixed method approach highlights a differing relationship between inland agricultural areas impacted by drought and erosion, and coastal/riverine, peri-urban landscapes exposed to flooding and salinization. Agricultural areas associate with "poor but happy" outcomes, whereas peri-urban landscapes associate with being "non-poor but unhappy." Drawing on existing literature, and both quantitative and qualitative results, these varying outcomes are hypothesized to be driven by differences in livelihood vulnerability, relative comparisons to others, responses to climatic hazards, and individualistic/collective wellbeing conceptualizations. Discussion: Our study concludes that environmental conditions influence objective and subjective wellbeing through different mechanisms. Sustainable development research should incorporate both objective and subjective measures when implementing and monitoring policy to more comprehensibly capture, and improve, wellbeing in environmentally vulnerable locations.

Behind the screen: exploring the effects of home working on 999 telephone clinicians during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic has significantly stretched global healthcare provisions since its commencement in 2019. From the outset, ambulance services in the UK had to adapt and change their working practices to meet distancing requirements, to increase staff numbers and to ease the effects of staff becoming unavailable for work due to self-isolation and illness. One strategy was moving clinicians from emergency operation centres (EOCs) to working from home. Like many international services, UK ambulance services use paramedics and nurses to undertake telephone and video assessments of patients calling the 999 emergency services line in a model known as virtual care or remote clinical decision making. Virtual care is any interaction between a patient and a clinician or clinicians, occurring remotely via information technologies.Increasing evidence is becoming available to suggest that the pandemic caused harm to the well-being of healthcare workers, primarily due to the severe stress of regular exposure to death and human suffering. However, there remains a dearth of literature focusing on the well-being of remote and virtual clinicians, especially those who moved from working in EOCs to working at home during the COVID-19 pandemic. Therefore, this study reports the findings of a qualitative analysis of these effects from the clinician's perspective. The authors hope that the findings from this study will inform the operating, well-being and leadership practices of those delivering such services. Methods: A convenience sample of telephone nurses and paramedics from one UK ambulance service where home working had been implemented were contacted. Fifteen clinicians with recent home-working experience responded to the invitation to participate out of a possible 31 (48%). All participants had previously practised remote assessment from within an EOC. Semi-structured interviews took place via video-conferencing software and were recorded, transcribed and thematically analysed. An inductive approach was taken to generating codes, and both researchers separately read the transcripts before re-reading them, assigning initial themes and determining frequency. Results: Five main themes were discovered, with further associated sub-themes. The main themes were: safety; financial implications; working relationships; home-working environment; and anxiety. Conclusions: Few studies explore remote clinicians' health and well-being. This study identified that home-working clinicians felt that there had been no detrimental impact on their health and well-being because of working from home during the initial phase of the COVID-19 pandemic. While some concerns were raised, these were mitigated through the support that clinicians received at home from family members, as well as from colleagues, some of whom had developed new working relationships. Financial implications appeared to have contributed to some concerns for participants initially, but these had been alleviated quickly despite requiring further exploration of the true financial impact of working from home.