Youth perspectives on mental health during COVID-19 lockdown in a Small Island Developing State: implications for emergency response.

Introduction: Evidence exploring the relationship between COVID-19 mitigation measures and mental health has primarily been from quantitative studies in large, developed countries. A qualitative study to explore the knowledge, attitudes and behaviors of young people living in Trinidad and Tobago was conducted to engage and collaborate with youth on matters affecting them during the pandemic. Methods: Ten virtual focus groups were conducted with 64 participants aged 18 to 24 in 2021 when partial lockdown measures were in effect for COVID-19 prevention. Groups were stratified by geographic location and socioeconomic status. The recordings were transcribed and analyzed to explore themes of importance to youth. Results: Negative impacts on mental health emerged as a strong theme. Lack of timelines for restrictions led to wide ranging mental health impacts, conflict and tension existed in home environments, longer restrictions led to erosion of the social culture, and young people experienced stress about the changing face of education and job security due to the pandemic. Discussion: Measures taken to address one serious public health concern, COVID-19, led to the aggravation of another serious public health concern, mental ill-health. Mental health initiatives to help young people navigate issues specific to their generation must be developed. In low resourced Small Island Developing States settings. The increased need for mental health services during and because of the COVID-19 pandemic highlights the need for strengthening the capacity and resilience of these to respond to environmental and health emergencies. Building the resilience of educational and employment services is also needed.

Core competencies and challenges among nurses transitioning into positions of leadership - a Caribbean perspective.

PURPOSE: Nurses are a significant part of the professional workforce, but leaders may be promoted without the requisite competencies. This study aims to explore the perspectives of nurse managers about the core competencies necessary for promotion as leaders in health. DESIGN/METHODOLOGY/APPROACH: This was a mixed-methods study that targeted nurses (N = 126) who were promoted in four Caribbean countries over the past five years. A 30-item questionnaire was used for quantitative data collection and analyzed using SPSS version 25. Interviews yielded the qualitative data, which were analyzed using open coding and thematic analysis. Ethical approvals were received from ethics committees at the university and country level. FINDINGS: Most participants were female (n = 112), had 15 or more years' experience (n = 71) and an associate degree/diploma in nursing (n = 62). Leadership was the most important competency required of nurse leaders in spite of their position within the organization, followed by team building and motivation. Challenges to the transitioning into leadership positions included the prevailing culture and a lack of a systematic approach to building capacity in leadership. There was also between-group statistical significance, as determined by one-way ANOVA for delegation, motivation and leadership as core competencies based on occupations roles. RESEARCH LIMITATIONS/IMPLICATIONS: Notwithstanding the importance of the findings from this research, there were some limitations. While the researchers considered implementing this study in eight Caribbean countries, approvals were received for only four countries. This will affect the ability to generalize the findings to the wider Caribbean countries. One of the strengths of this research was the use of mixed methods for data collection. However, the qualitative component of the findings may be limited by the number of focus groups conducted, notwithstanding the richness of the data collected. PRACTICAL IMPLICATIONS: The findings can be used as a framework from which the health system in developing countries can begin to examine practical solutions to developing 21st century leadership competencies in nursing. While there may be remanence of the colonial past in the way systems function, the complexity of health systems requires leadership that is rooted in competence that is multidimensional. ORIGINALITY/VALUE: This paper provides an important contribution to the literature on leadership and competencies from the perspective of low- to middle-income resource settings. The qualitative component of the research added richness to the nuances and understanding of the phenomenon of competencies for nurse leaders.

Core competencies and challenges among nurses transitioning into positions of leadership ­ a Caribbean perspective

Purpose ­ Nurses are a significant part of the professional workforce, but leaders may be promoted without the requisite competencies. This study aims to explore the perspectives of nurse managers about the core competencies necessary for promotion as leaders in health. Design/methodology/approach ­ This was a mixed-methods study that targeted nurses (N= 126) who were promoted in four Caribbean countries over the past five years. A 30-item questionnaire was used for quantitative data collection and analyzed using SPSS version 25. Interviews yielded the qualitative data, which were analyzed using open coding and thematic analysis. Ethical approvals were received from ethics committees at the university and country level. Findings ­ Most participants were female (n= 112), had 15 or more years' experience (n= 71) and an associate degree/diploma in nursing (n= 62). Leadership was the most important competency required of nurse leaders in spite of their position within the organization, followed by team building and motivation. Challenges to the transitioning into leadership positions included the prevailing culture and a lack of a systematic approach to building capacity in leadership. There was also between-group statistical significance, as determined by oneway ANOVA for delegation, motivation and leadership as core competencies based on occupations roles.

ET/WOC nursing ­ leadership lessons learned from the COVID-19 pandemic: an opinion

The coronavirus disease 2019 (COVID-19) pandemic has brought uncertainty and opportunity to nurses and healthcare. As part of the nursing profession, enterostomal therapy (ET) / wound, ostomy, continence (WOC) nurses offer specialised care that is critical to the health of persons with wounds, ostomies and continence. ET/WOC nurses' knowledge and practice have positioned these nurses as integral partners in leadership and the delivery of care during these challenging times. The aim of this paper is to highlight five leadership themes for ET/WOC nurses that have evolved during the pandemic, namely interprofessional practice, emotional intelligence, ethical practice, advocacy, and self-care.

Nurses' preparation for transitioning into positions of leadership-A Caribbean perspective.

AIM: To explore perspectives of nurse managers about their preparation for transitioning into positions of leadership. BACKGROUND: There have been serious concerns about the level of preparation as well as availability of support systems for transitioning of nurses into positions of authority. METHODS: This was a quantitative study conducted in four Caribbean countries targeting nurses promoted to leadership positions within the last 5 years. Data were collected using a 30-item questionnaire. Ethical approvals were received from the University of the West Indies and the participating countries. RESULTS: Most participants were female, had 15 or more years' experience and an associate degree/diploma in nursing. They felt prepared through training and acting opportunities although many were not preceptored/mentored into the position. Preparation by training was positively correlated to acting opportunities, preceptorship programme and having a preceptor. CONCLUSION: Transitioning into positions of leadership requires readiness from a personal as well as an organisational perspective. There must be investment in the development opportunities to support nurses' transition into leadership positions. IMPLICATIONS FOR NURSING MANAGEMENT: Organisational continuity and effectiveness will be dependent on a balance between investing in experienced nursing personnel while encouraging personal development of less-experienced nurses. Peer mentorship must be utilized to facilitate nurse transition.

Nurses' preparation for transitioning into positions of leadership­A Caribbean perspective

Aim: To explore perspectives of nurse managers about their preparation for transitioning into positions of leadership. Background: There have been serious concerns about the level of preparation as well as availability of support systems for transitioning of nurses into positions of authority. Methods: This was a quantitative study conducted in four Caribbean countries targeting nurses promoted to leadership positions within the last 5 years. Data were collected using a 30-item questionnaire. Ethical approvals were received from the University of the West Indies and the participating countries. Results: Most participants were female, had 15 or more years' experience and an associate degree/diploma in nursing. They felt prepared through training and acting opportunities although many were not preceptored/mentored into the position. Preparation by training was positively correlated to acting opportunities, preceptorship programme and having a preceptor. Conclusion: Transitioning into positions of leadership requires readiness from a personal as well as an organisational perspective. There must be investment in the development opportunities to support nurses' transition into leadership positions. Implications for Nursing Management: Organisational continuity and effectiveness will be dependent on a balance between investing in experienced nursing personnel while encouraging personal development of less-experienced nurses. Peer mentorship must be utilized to facilitate nurse transition.

Cross-sectional description of nursing and midwifery pre-service education accreditation in east, central, and southern Africa in 2013.

BACKGROUND: In 2013, the World Health Organization issued guidelines, Transforming and Scaling Up Health Professional Education and Training, to improve the quality and relevance of health professional pre-service education. Central to these guidelines was establishing and strengthening education accreditation systems. To establish what current accreditation systems were for nursing and midwifery education and highlight areas for strengthening these systems, a study was undertaken to document the pre-service accreditation policies, approaches, and practices in 16 African countries relative to the 2013 WHO guidelines. METHODS: This study utilized a cross-sectional group survey with a standardized questionnaire administered to a convenience sample of approximately 70 nursing and midwifery leaders from 16 countries in east, central, and southern Africa. Each national delegation completed one survey together, representing the responses for their country. RESULTS: Almost all countries in this study (15; 94%) mandated pre-service nursing education accreditation However, there was wide variation in who was responsible for accrediting programs. The percent of active programs accredited decreased by program level from 80% for doctorate programs to 62% for masters nursing to 50% for degree nursing to 35% for diploma nursing programs. The majority of countries indicated that accreditation processes were transparent (i.e., included stakeholder engagement (81%), self-assessment (100%), evaluation feedback (94%), and public disclosure (63%)) and that the processes were evaluated on a routine basis (69%). Over half of the countries (nine; 56%) reported limited financial resources as a barrier to increasing accreditation activities, and seven countries (44%) noted limited materials and technical expertise. CONCLUSION: In line with the 2013 WHO guidelines, there was a strong legal mandate for nursing education accreditation as compared to the global average of 50%. Accreditation levels were low in the programs that produce the majority of the nurses in this region and were higher in public programs than non-public programs. WHO guidelines for transparency and routine review were met more so than standards-based and independent accreditation processes. The new global strategy, Workforce 2030, has renewed the focus on accreditation and provides an opportunity to strengthen pre-service accreditation and ensure the production of a qualified and relevant nursing workforce.

Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction.

BACKGROUND: The world is short of 7.2 million health-care workers and this figure is growing. The shortage of teachers is even greater, which limits traditional education modes. eLearning may help overcome this training need. Offline eLearning is useful in remote and resource-limited settings with poor internet access. To inform investments in offline eLearning, we need to establish its effectiveness in terms of gaining knowledge and skills, students' satisfaction and attitudes towards eLearning. METHODS: We conducted a systematic review of offline eLearning for students enrolled in undergraduate, health-related university degrees. We included randomised controlled trials that compared offline eLearning to traditional learning or an alternative eLearning method. We searched the major bibliographic databases in August 2013 to identify articles that focused primarily on students' knowledge, skills, satisfaction and attitudes toward eLearning, and health economic information and adverse effects as secondary outcomes. We also searched reference lists of relevant studies. Two reviewers independently extracted data from the included studies. We synthesized the findings using a thematic summary approach. FINDINGS: Forty-nine studies, including 4955 students enrolled in undergraduate medical, dentistry, nursing, psychology, or physical therapy studies, met the inclusion criteria. Eleven of the 33 studies testing knowledge gains found significantly higher gains in the eLearning intervention groups compared to traditional learning, whereas 21 did not detect significant differences or found mixed results. One study did not test for differences. Eight studies detected significantly higher skill gains in the eLearning intervention groups, whilst the other 5 testing skill gains did not detect differences between groups. No study found offline eLearning as inferior. Generally no differences in attitudes or preference of eLearning over traditional learning were observed. No clear trends were found in the comparison of different modes of eLearning. Most of the studies were small and subject to several biases. CONCLUSIONS: Our results suggest that offline eLearning is equivalent and possibly superior to traditional learning regarding knowledge, skills, attitudes and satisfaction. Although a robust conclusion cannot be drawn due to variable quality of the evidence, these results justify further investment into offline eLearning to address the global health care workforce shortage.

Online eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction.

BACKGROUND: Health systems worldwide are facing shortages in health professional workforce. Several studies have demonstrated the direct correlation between the availability of health workers, coverage of health services, and population health outcomes. To address this shortage, online eLearning is increasingly being adopted in health professionals' education. To inform policy-making, in online eLearning, we need to determine its effectiveness. METHODS: We performed a systematic review of the effectiveness of online eLearning through a comprehensive search of the major databases for randomised controlled trials that compared online eLearning to traditional learning or alternative learning methods. The search period was from January 2000 to August 2013. We included articles which primarily focused on students' knowledge, skills, satisfaction and attitudes toward eLearning and cost-effectiveness and adverse effects as secondary outcomes. Two reviewers independently extracted data from the included studies. Due to significant heterogeneity among the included studies, we presented our results as a narrative synthesis. FINDINGS: Fifty-nine studies, including 6750 students enrolled in medicine, dentistry, nursing, physical therapy and pharmacy studies, met the inclusion criteria. Twelve of the 50 studies testing knowledge gains found significantly higher gains in the online eLearning intervention groups compared to traditional learning, whereas 27 did not detect significant differences or found mixed results. Eleven studies did not test for differences. Six studies detected significantly higher skill gains in the online eLearning intervention groups, whilst 3 other studies testing skill gains did not detect differences between groups and 1 study showed mixed results. Twelve studies tested students' attitudes, of which 8 studies showed no differences in attitudes or preferences for online eLearning. Students' satisfaction was measured in 29 studies, 4 studies showed higher satisfaction for online eLearning and 20 studies showed no difference in satisfaction between online eLearning and traditional learning. Risk of bias was high for several of the included studies. CONCLUSION: The current evidence base suggests that online eLearning is equivalent, possibly superior to traditional learning. These findings present a potential incentive for policy makers to cautiously encourage its adoption, while respecting the heterogeneity among the studies.

Molecular systematics of Allium subgenus Amerallium (Amaryllidaceae) in North America.

PREMISE OF THE STUDY: Early plant taxonomists formed hypotheses about relationships among taxa based on characters such as morphology, anatomy, phytochemistry, ecology, and geography. Modern molecular systematic methods, based on DNA sequence variation, augment early methods and provide an additional line of evidence by which to evaluate taxonomic hypotheses. In North America north of Mexico, wild onions (Allium, Amaryllidaceae) are represented by 84 native species, 81 of which belong to subgenus Amerallium. On the basis of morphology, these species have been divided into eight informal taxonomic "alliances" hypothesized to represent shared evolutionary history among species. The main aim of this research was to test the monophyly of the alliances with molecular phylogenetic methods. METHODS: We sampled 74 Amerallium species north of Mexico and two Mexican endemics and constructed a molecular phylogeny of subgenus Amerallium in North America based on predominantly noncoding sequences from two nuclear ribosomal RNA regions (ITS and ETS) and two plastid regions (trnL-F and rpL32-trnL). KEY RESULTS: Most clades are well supported in analyses of nuclear data and when nuclear and plastid data are combined. However, the plastid data alone did not produce a well-resolved or well-supported tree. Morphological alliances were sometimes congruent with groups recovered in the molecular phylogeny, but strict monophyly was observed in only three of eight alliances. CONCLUSIONS: We propose an infrageneric classification that recognizes two sections in New World Amerallium. Because there is substantial incongruence between morphological and molecular groups, we advocate retaining informal alliances rather than adopting formal subsections until further morphological and molecular analyses can be carried out.

Prevalence of severe mental and neurological disorders in Mozambique: a population-based survey.

BACKGROUND: The scarcity of information about the mental and neurological health of people in Mozambique has hindered policymaking and investment. We aimed to assess the prevalence of seizure disorders, psychoses, and mental retardation in urban and rural Mozambique. METHODS: 2739 households were randomly selected, 1796 of which were in Maputo city and 943 in the rural town of Cuamba. A key informant from each household was asked to identify household members with disorders that matched the descriptions given in case vignettes. Key informants were also asked about causes of disorders, and their treatment, and current state. FINDINGS: Lifetime prevalence rates for all three disorders were higher in rural than in urban settings. Prevalence of psychoses (in adults) was 4.4% in the rural town versus 1.6% in the city (standardised prevalence ratio 2.79); mental retardation 1.9% versus 1.3% (1.48); and seizure disorders 4.0% versus 1.6% (2.00). Of the three disorders, key informants most frequently attributed psychoses to supernatural causes, followed by seizure disorder. In about three-quarters of all cases, households had consulted a traditional medical practitioner. Nearly half the people with these disorders in rural areas were rated as being in poor health. INTERPRETATION: Advocacy to improve understanding of mental disorders; investment in mental-health resources in rural areas; and collaboration with traditional medical practitioners are urgently needed, especially in the poor rural areas of Mozambique.

A catch up growth chart

Severely malnourished children should stay in hospital for as short a time as possible to minimize the harmful effects of separation from their families and institutionalization and to ensure that scarce hospital beds are used efficiently. Repletion of wasting, that is, attainment of ideal or expected weight-for-height (EWH) has been recommended as the criterion for recovery from PEM. As it may be impractical to measure length, a simple visual means of monitoring the progress of children recovering from PEM is needed. A "catch up" growth chart was devised, based on the mean deficit in weight-for-height of 2-3 kg of 827 children admitted to the ward of the Tropical Metabolism Research Unit (TMRU) in 1958-1976. This deficit was restored in 10.3 (ñ3.95 SD) weeks by a subsample of 52 recent admissions, a rate of recovery similar to previous reports from the TMRU. In 1972/1973 a similar treatment regime using oil-fortified milk ("high energy feeding") was instituted in 4 rural hospitals in Jamaica. As the majority (72 percent) of the children who were measured attained 90 percent of EWH, the chart proposed will be practicable in any hospital. (Summary)

High energy feeding in protein-energy malnutrition

The use of high-fat diet in malnourished children produced accelerated growth of lean tissues as well as adipose tissue, and resulted in rapid nutrition rehabilitation in 25 seriously malnourished babies. Such diets are easy to prepare and relatively cheap, and they offer important advantages over conventional feeding in the hospital treatment of malnourished children.(AU)

Accelerated recovery from infant malnutrition with high calorie feeding

Rapid recovery from infant malnutrition with associated weight deficit can be expected if the calorie density of the milk formula is doubled by adding oil. An intake of 200 kcal per kg should result in a rate of weight gain 15 times that of a normal one year old. Nearly complete recovery of weight deficit can be expected in severe cases in around six weeks, on the average. Approximately 100 kcal per kg are required to maintain constant weight plus six excess kcal for each gm of weight gain. Of these six kcal, approximately 0.6 are oxidized, 0.9 wasted, and the remainder retained as stored energy, mostly fat. These observations are of considerable practical importance for efficient treatment of infant malnutrition. If the amount of diet offered is sufficent for rapid recovery (200 kcal/kg/day) the most likely cause of failure to gain weight is infection. These generally beneficial results tend to minimize the significance of many apparent functional abnormalities observed in acutely malnourished children (AU)