Exploring the impact mechanism of executives' environmental attention on corporate green transformation: evidence from the textual analysis of Chinese companies' management discussion and analysis.

The allocation of executives' environmental attention (EEA) is of great significance in promoting the green upgrading of industrial structures and achieving corporate green transformation. Based on upper echelon theory and the attention-based view, we use panel data of Chinese manufacturing companies from 2015 to 2020 to construct a two-way fixed effects model to explore the impact mechanism of EEA on corporate green transformation performance (CGTP). Baseline regression shows that EEA significantly improves CGTP. The reliability of findings is verified by reducing time windows, replacing the independent variable, expanding the data source, and adding missing variables. In the heterogeneity analysis, the positive effect of EEA on CGTP is significant for eastern companies and does not differ in the property rights grouping. After propensity score matching, environmental attribute grouping shows that the positive effect of EEA on CGTP is more significant for non-heavy polluters. Extended research shows that government subsidies have a positive moderating effect, while female executives play only a symbolic role. Moreover, green innovation activities have positive partial mediating effects. Green innovation is the best way to address environmental pollution and achieve corporate green transformation. Our research provides implications for decision-makers to allocate their attention, and thereby achieve green development appropriately.

Using the socio-ecological model to appraise perspectives on health workforce retention and intention to leave in Malawi and Tanzania: a qualitative longitudinal study.

INTRODUCTION: The chronic health workforce shortage poses a significant setback to achieving universal health coverage. Health authorities continually develop and implement human resources for health policies and interventions to alleviate the crisis, including retention policies. However, the success of such policies and interventions is tangential to the alignment with health workers' expectations. The aim of this study was to explore perspectives on health workforce retention and intention to leave among health workers and policy-makers from rural and remote areas of Malawi and Tanzania. METHODS: Semi-structured interviews were conducted with 120 participants - 111 rural and remote mid-level health workers, and nine policy-makers in Malawi and Tanzania - for a period of 3 years, 2014-2017. The semi-structured interviews were conducted face to face, and follow-up interviews were conducted through emails or social media. By using the socio-ecological model as a framework for analysis, the emerging themes were mapped out and linked. RESULTS: Health workers related their perspectives on retention and intention to leave to the individual (intrapersonal), family (interpersonal/microsystem), and community (institutional/mesosystem) factors, whereas policy-makers focused their views mainly on the individual (intrapersonal) factors and retention policies at the national level (macrosystem). CONCLUSION: Policy-makers and health workers in rural and remote settings in Malawi and Tanzania recognise the factors influencing health workforce retention, and intention to leave at the individual level. However, while policy-makers focus mainly on national-level retention policies, health workers focus on retention aspects related to the family and the surrounding community - a clear misalignment. Therefore, health authorities need to align health policies to health workers' expectations to bridge this gap, improve access to the health workforce in rural and remote populations, and improve health outcomes.

Managers' awareness of mental health measures for their employees in small and medium-sized enterprises in a depopulated mountainous area in Japan: A qualitative study.

ABSTRACT: The local economy is often supported by small and medium-sized enterprises. There is a need to consider effective promotion methods for mental health measures in these enterprises in depopulated mountainous areas. It is important to understand managers' awareness when considering effective mental health measures in these enterprises. The study's aim is to explore managers' awareness of mental health measures for employees in small and medium-sized enterprises in depopulated mountainous areas in Japan.Qualitative semi-structured interviews were conducted with 6 managers in 2019. The primary issues addressed by the interview were regarding the awareness among managers about mental health promotion measures for employees. These are the primary prevention measures. The interview also addressed issues related to the awareness of measures for mental health problems that are fundamental to the secondary and tertiary prevention measures. A qualitative descriptive analysis was conducted.Three categories and 8 subcategories emerged regarding the managers' awareness of mental health promotion measures for employees. The 3 categories were: "Individual support, including their life's aspect, while taking advantage of formal and informal relationships," "The difficulty of drawing out an employees' motivation to work, due to the changes over time in the work size or in their working relationships," and "Creating a comfortable working environment for employees, by complying with the labor standards and adjusting relationships." Regarding managers' awareness of the measures for mental health problems, four categories and 8 subcategories emerged. The 4 categories were: "Prevention and awareness of the incidence of mental health problems," "Individual support based on the enterprise's or employee's characteristics," "A lack of support for the manager to address employees' mental health problems," and "Employees quitting the job, due to the lack of appropriate support."Though managers in depopulated mountainous areas were well aware of the mental health activities offered, the categories showed the need to foster social capital. It also showed the need to collaborate with external support organizations, and the difficulties faced by small and medium-sized enterprises.

Assessing port service quality: An application of the extension fuzzy AHP and importance-performance analysis.

It is argued that ports are playing a crucial role in developing nations' economy. Still, solutions to improving port service quality (PSQ) to boost ports' competitive capacity is questionable. Hence, this study aims to investigate port service quality (PSQ) by using integration of the extension Fuzzy Analytic Hierarchy Process and Importance-Performance Analysis (IPA) from port users' perspectives. From the relevant literature and expert interview, the hierarchical structure of PSQ embracing six dimensions with 29 criteria was first established. To test the research model, the Dong Nai port joint stock company (DNPC) and their port-service users were empirically investigated. It is found that: (1) the importance degree of dimensions is ranked as follow: empathy (21.07%), tangibles (20.15%), assurance (15.97%), reliability (15.54%), responsiveness (12.53%), diversity (14.74%); (2) for criteria of PSQ, top five criteria concerned by shipping companies and ocean freight forwarders comprise: "proactive provision of vessel schedules", "cargo handling facilities and equipment", "detailed schedule", "accuracy and consistency of schedules", and "geographical location"; (3) there are four service attributes (SAs) needing to prioritize for improvement, including "perfect transportation of cargos", "ability in dealing with cargo damage", "willingness in helping customers", "provision of special cargo-related services". The practical policy is that port authorities should transfer the limited resources from SAs in Quadrant IV to Quadrant II to enhance the PSQ.

Policy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science.

BACKGROUND: Supervision by surgical specialists is beneficial because they can impart skills to district hospital-level surgical teams. The SURG-Africa project in Zambia comprises a mentoring trial in selected districts, involving two provincial-level mentoring teams. The aim of this paper is to explore policy options for embedding such surgical mentoring in existing policy structures through a participatory modeling approach. METHODS: Four group model building workshops were held, two each in district and central hospitals. Participants worked in a variety of institutions and had clinical and/or administrative backgrounds. Two independent reviewers compared the causal loop diagrams (CLDs) that resulted from these workshops in a pairwise fashion to construct an integrated CLD. Graph theory was used to analyze the integrated CLD, and dynamic system behavior was explored using the Method to Analyse Relations between Variables using Enriched Loops (MARVEL) method. RESULTS: The establishment of a provincial mentoring faculty, in collaboration with key stakeholders, would be a necessary step to coordinate and sustain surgical mentoring and to monitor district-level surgical performance. Quarterly surgical mentoring reviews at the provincial level are recommended to evaluate and, if needed, adapt mentoring. District hospital administrators need to closely monitor mentee motivation. CONCLUSIONS: Surgical mentoring can play a key role in scaling up district-level surgery but its implementation is complex and requires designated provincial level coordination and regular contact with relevant stakeholders.

Provider and administrator-level perspectives on strategies to reduce fear and improve patient trust in the emergency department in times of heightened immigration enforcement.

STUDY OBJECTIVES: Heightened immigration enforcement may induce fear in undocumented patients when coming to the Emergency Department (ED) for care. Limited literature examining health system policies to reduce immigrant fear exists. In this multi-site qualitative study, we sought to assess provider and system-level policies on caring for undocumented patients in three California EDs. METHODS: We recruited 41 ED providers and administrators from three California EDs (in San Francisco, Oakland, and Sylmar) with large immigrant populations. Participants were recruited using a trusted gatekeeper and snowball sampling. We conducted semi-structured interviews and analyzed the transcripts using constructivist grounded theory. RESULTS: We interviewed 10 physicians, 11 nurses, 9 social workers, and 11 administrators, and identified 7 themes. Providers described existing policies and recent policy changes that facilitate access to care for undocumented patients. Providers reported that current training and communication around policies is limited, there are variations between who asks about and documents status, and there remains uncertainty around policy details, laws, and jurisdiction of staff. Providers also stated they are taking an active role in building safety and trust and see their role as supporting undocumented patients. CONCLUSIONS: This study introduces ED-level health system perspectives and recommendations for caring for undocumented patients. There is a need for active, multi-disciplinary ED policy training, clear policy details including the extent of providers' roles, protocols on the screening and documentation of status, and continual reassessment of our health systems to reduce fear and build safety and trust with our undocumented communities.

Rational emotive occupational health coaching for quality of work-life among primary school administrators.

BACKGROUND: This study aimed at investigating the effect of rational emotive occupational health coaching on quality of work-life among primary school administrators. METHOD: This is a double blinded and randomized control design study. A total of 158 administrators were sampled, half of them were exposed to rational emotive occupational health treatment package that lasted for 12 sessions. Two self-report measures were utilized in assessing the participants using quality of work life scale. Data collected were analyzed using MANOVA statistical tool. RESULT: The results showed that rational emotive occupational health coaching is effective in improving perception of quality of work-life among public administrators. A follow-up result showed that rational emotive occupational health coaching had a significant effect on primary school administrators' quality of work life. CONCLUSION: This study concluded rational emotive occupation health coaching is useful therapeutic strategy in improving quality of work of primary school administrators, hence, future researchers and clinical practitioners should adopt cognitive-behavioral techniques and principles in helping employers as well as employees. Based on the primary findings and limitations of this study, future studies, occupational psychotherapists should qualitatively explore the clinical relevance of rational emotive occupational health practice across cultures using different populations.

Managerial overconfidence in capital structure decisions and its link to aggregate demand: An agent-based model perspective.

OBJECTIVE: This study aims to connect two strands of the psychology and economics literature, i.e., behavioural finance and agent-based macroeconomics, to assess the impact of managerial overconfidence at the micro and macro levels of the economy as a whole. METHOD: We build a macroeconomic stock-flow consistent agent-based model that is calibrated for the specific case of Poland to explore whether the overconfidence of top corporate managers in the context of their initial capital structure decisions is detrimental for the firms being managed in this way, the financial market dynamics, and the selected macroeconomic indicators. We model heterogeneous firms with different capital structure decision criteria depending on their degree of managerial overconfidence. Our model also includes a complete macroeconomic closure with aggregated households, capital producers, banking, and a public sector. RESULTS: We find that firms with overconfident managers outperform in terms of investment and size but are also more fragile, thereby making them more likely to default. Finally, we run policy shocks and show that while investors' flight to liquidity creates financial turmoil and increases the probability of default. CONCLUSIONS: This paper contributes to the knowledge base by linking behavioural corporate finance and agent-based macroeconomics. In general, the excess overconfidence on the micro level, either an increase in the proportion of overconfident firms or a higher degree of overconfidence among managers, has a strong destabilizing impact on the economy as a whole on the macro level.

Managers of micro-sized enterprises and Covid-19: impact on business operations, work-life balance and well-being.

The aim of this study is to identify how managers of micro-sized enterprises experience the impact of the Covid-19 pandemic on their business operations, work-life balance and well-being. Further, the study aims to make comparisons between managers of micro-sized businesses and managers of small-sized businesses. This mixed-method study is based on qualitative interviews with ten managers of micro-sized enterprises and a questionnaire answered by 95 managers of micro-sized and small-sized enterprises in regions in the north of Sweden. Managers of micro-sized enterprises reported significantly worse scores for mental well-being, job satisfaction and life satisfaction in comparison with managers of small-sized enterprises. Three themes emerged from the qualitative analysis: Changed leadership role, Impact on private life and Impact on well-being. In the interviews, the managers of micro-sized enterprises reported that the pandemic had increased their workload and forced them to mobilise strategies for enterprise survival. This study indicates that managers of micro-sized enterprises had changed their leadership role and increased their workload and number of work tasks, including supporting the employees, developing strategies for business survival and applying for governmental support. However, the managers demonstrated creativity in finding new solutions for their enterprises.

Predictors of women empowerment knowledge and attitude among Saudi academic and administrative staff: A cross-sectional study.

The KSA 2030 vision makes special reference to women's empowerment as an important strategy for Saudi community transformation. Studies related to women's empowerment, especially in the Saudi context, are still not enough and unclear. The current study explored the predictors of women empowerment knowledge and attitudes among Saudi academic and administrative staff. A cross-sectional study was conducted at 15 Saudi government-owned universities. A multistage cluster sampling technique was used to select 5587 participants during the period April to September 2020. The study instrument consisting of three main parts; basic demographic data, questionnaire assessed the knowledge regarding women's empowerment, and women empowerment attitude scale. The results showed good knowledge of empowerment among the women with 75.5% of the participants demonstrating good knowledge. The total women empowerment attitude was positive among 65.9% of the participants. The association between demographic data and women empowerment knowledge and attitude showed a significant association with marital status, residence, education, and occupation (p <0.05). Linear regression on marital status, education, residence, and occupation, are confirmed as significant predictors of women empowerment knowledge and attitude (p <0.05). Mother's education level is shown as a predictor for women empowerment attitude (p>0.005). Three-quarters of Saudi academic and administrative staff have a good women empowerment knowledge score, and more than two-thirds have a positive attitude. Demographic characteristics are important predictors for women empowerment knowledge and attitude. The results of this study will help decision-makers to design and implement goal-directed women empowerment programs.

Women empowerment among academic and administrative staff in Saudi universities: A cross-sectional study.

Women in Saudi Arabia constitute nearly 50% of the population, but their participation in economic and social activities are far below the kingdom's potential. According to the 2030 vision, women empowerment is an essential requirement for community transformation and development. The study aims to explore women empowerment among academic and administrative staff in Saudi Universities. A cross-sectional research design was conducted at 15 Saudi governmental universities. A multistage cluster sampling technique was followed to select 5587 participants. The data collection starts from April to September 2020. The current study results illustrate statistically significant differences between academic and administrative staff in the total women empowerment score and all of its dimensions (p <0.05). The majority of academic staff (84.4%) have high personal empowerment compared to 73.7% of the administrative staff. The study concluded that women empowerment is higher among academics compared to administrative staff in Saudi Universities.

Approach to Bartholin's abscesses and recurrences under office conditions.

OBJECTIVE: The aim of this study is to investigate the various treatment methods and recurrence rates regarding Bartholin's gland abscesses under office conditions in our clinic. METHODS: In our study, the data of 155 patients who applied to the gynaecology and obstetrics clinic of our hospital between January 2017 and November 2020 and had Bartholin's abscess that was treated with surgical methods under office conditions were analyzed retrospectively. RESULTS: Of the 155 patients included in the study, 111 underwent incision drainage, 22 underwent marsupialization, and 22 underwent incision drainage+ silver nitrate. Bartholin's abscess was localized on the right side in 48.4% of the patients and on the left side in 51.6% of the patients. Recurrence was detected in 53 of 155 patients included. Recurrence was detected in 39.6% of the patients who underwent incision drainage in the first treatment, 31.8% of those who underwent marsupialization, and 9.1% of those who underwent incision+silver nitrate. The difference in success, based on recurrence rates, was found to be statistically significantly in favour of silver nitrate (p<0.05). In secondary treatments for recurrent cases, marsupialization or incision+silver nitrate treatment was effective in over 90% of cases, while incision drainage was effective in 30% of patients. CONCLUSION: The findings of our study show that silver nitrate application led to a lower recurrence rate than the other two methods. In view of this, we recommend that marsupialization or silver nitrate be preferred, especially in the treatment of recurrent cases.

The impact of the COVID-19 pandemic on mental health among healthcare workers in ear-nose-throat clinics.

INTRODUCTION: During the first wave of the COVID-19 pandemic, it was established that otorhinolaryngologists were at a high risk of contracting the infection due to examinations of the upper airways. The aim of this study was to evaluate the impact of the COVID-19 pandemic on mental health among healthcare workers (HCWs) in primary ear-nose-throat (ENT) practices. METHODS: This was a cross-sectional questionnaire study among HCWs assessing symptoms of anxiety (Generalized Anxiety Disorder, ten-item scale) and depression (Patients Health Questionnaire, nine-item scale). The survey targeted otolaryngologists and staff in primary private practices in the Capital Region of Denmark during the COVID-19 lock-down in May 2020. RESULTS: For 30% of the participants, signs were observed of depressive symptoms and 13% had signs of anxiety symptoms. Seventy percent felt sufficiently protected by their available personal protective equipment. Fifty-two percent worried about becoming infected in relation to their work and 56% feared infecting their families. CONCLUSIONS: HCWs in Danish primary ENT practices did not display extraordinary stress reactions during the first wave of the pandemic. Noticeably, participants were concerned about acquiring the infection or transmitting it to their household. FUNDING: none. TRIAL REGISTRATION: not relevant.

Improving work-life balance among administrative officers in Catholic primary schools: Assessing the effect of a Christian religious rational emotive behavior therapy.

OBJECTIVE: Work-life balance (WLB) is an essential precursor of workers' mental health. The theory of rational emotive behaviour therapy proposes that an imbalance in work and family life may result from people's dysfunctional perceptions of their work and other aspects of their personal life. Also, the constructive philosophies of rational emotive behavior therapy are said to be congruent with most religious belief systems of Christian clients. Therefore, our research examined the efficacy of Christian religious rational emotive behaviour therapy (CRREBT) on WLB among administrative officers in Catholic primary schools. METHODS: This is a group randomized trial involving 162 administrative officers from Catholic primary schools in Southeast Nigeria. The treatment process involved an 8-session CRREBT programme. RESULTS: The scores for WLB of the administrative officers enrolled in the CRREBT programme were significantly improved compared to those in the control group at the end of the study. At the follow-up phase, the CRREBT programme proved to be effective over a 3-month period. CONCLUSION: CRREBT is an effective therapeutic strategy for managing WLB among Catholic school administrative officers.

Perfil MBTI e a Tipologia dos Quatro Temperamentos: relações possíveis entre cargos de gestão e não gestão / MBTI Profile and the Four Temperament Typology: possible relationships between management and non-management positions / Perfil MBTI y la tipología de cuatro temperamentos: posibles relaciones entre puestos gerenciales y no gerenciales

A presente pesquisa objetivou avaliar a existência de um perfil de personalidade e de temperamento que possa ser associado aos ocupantes de cargos de gestão. Para isso foi realizada a análise documentária de 240.233 protocolos do MBTI, do banco de dados da empresa representante da ferramenta no Brasil, emitidos no período de 2007 a 2015. Como a base de dados para este estudo foi documental, não houve necessidade de submetê-lo ao Comitê de Ética, mas apenas da autorização expressa da empresa. Para a análise do temperamento, utilizou-se a teoria de David Keirsey por permitir sua associação com o MBTI. Da totalidade de protocolos analisados, 12,55% ocupavam algum cargo de gestão quando avaliados. Os resultados apontaram que as tipologias de personalidade ESTJ (Extrovertido, Sensorial, Racional, Julgador) e ISTJ (Introvertido, Sensorial, Racional, Julgador) e o temperamento Guardião são as que mais se destacam para todos os tipos de cargos. Conclui-se que não há uma tipologia ou um de temperamento que diferencie pessoas que ocupam cargos de gestão das que não ocupam, porém, há tipologias e temperamentos mais frequentemente observados para os profissionais de diversos cargos.

The present research aims to evaluate the existence of profiles from personality and temperament which can be associated with the occupants of management positions. In order to understand this relation, a documentary analysis has been made using 240,233 MBTI protocols, which represents the database of the company that owns the tool in Brazil from the period of 2007 to 2015. The theory of David Keirsey was used for this purpose and according to the characteristics of this study and the rules of the Ethics Committee, only the express authorization of the company was needed. The results indicate the ESTJ (Extroverted, Sensory, Rational, Judging) and ISTJ (Introverted, Sensory, Rational, Judging) personality typologies and the Guardian temperament are the ones that stand out the most for all types of positions and also 12.55% of the people analyzed in protocols occupied some management position. The conclusion presented there are no typology or temperament profiles that differentiate people who occupy management positions from those who do not. However, there are typologies and temperaments more frequently observed for professionals in different positions.

La presente investigación tuvo como objetivo evaluar la existencia de un perfil de personalidad y temperamento que puede asociarse a los ocupantes de los puestos de dirección. Para ello, se realizó un análisis documental de 240.233 protocolos MBTI de la base de datos de la empresa representante de la herramienta en Brasil, emitidos en el periodo de 2007 a 2015. Como la base de datos de este estudio era documental, no fue necesario presentarla al Comité de Ética, solamente de la autorización expresa de la empresa. Para el análisis del temperamento, se utilizó la teoría de David Keirsey porque permite su asociación con el MBTI. De todos los protocolos analizados, 12,55% ocupaba algún cargo directivo en el momento de la evaluación. Los resultados señalaron que las tipologías de personalidad ESTJ (Extrovertida, Sensorial, Racional, Juiciosa) e ISTJ (Introvertida, Sensorial, Racional, Juiciosa) y el temperamento Guardián son los más destacados para todos los tipos de trabajo. Se concluye que no existe una tipología o un temperamento que diferencie a las personas que ocupan cargos directivos de las que no lo hacen, sin embargo, hay tipologías y temperamentos que se observan con mayor frecuencia para profesionales de diversos cargos.

Interests, Motives, and Psychological Burdens in Times of Crisis and Lockdown: Google Trends Analysis to Inform Policy Makers.

BACKGROUND: In the face of the COVID-19 pandemic, the German government and the 16 German federal states implemented a variety of nonpharmaceutical interventions (NPIs) to decelerate the spread of the SARS-CoV-2 virus and thus prevent a collapse of the health care system. These measures comprised, among others, social distancing, the temporary closure of shops and schools, and a ban of large public gatherings and meetings with people not living in the same household. OBJECTIVE: It is fair to assume that the issued NPIs have heavily affected social life and psychological functioning. We therefore aimed to examine possible effects of this lockdown in conjunction with daily new infections and the state of the national economy on people's interests, motives, and other psychological states. METHODS: We derived 249 keywords from the Google Trends database, tapping into 27 empirically and rationally selected psychological domains. To overcome issues with reliability and specificity of individual indicator variables, broad factors were derived by means of time series factor analysis. All domains were subjected to a change point analysis and time series regression analysis with infection rates, NPIs, and the state of the economy as predictors. All keywords and analyses were preregistered prior to analysis. RESULTS: With the pandemic arriving in Germany, significant increases in people's search interests were observed in virtually all domains. Although most of the changes were short-lasting, each had a distinguishable onset during the lockdown period. Regression analysis of the Google Trends data confirmed pronounced autoregressive effects for the investigated variables, while forecasting by means of the tested predictors (ie, daily new infections, NPIs, and the state of economy) was moderate at best. CONCLUSIONS: Our findings indicate that people's interests, motives, and psychological states are heavily affected in times of crisis and lockdown. Specifically, disease- and virus-related domains (eg, pandemic disease, symptoms) peaked early, whereas personal health strategies (eg, masks, homeschooling) peaked later during the lockdown. Domains addressing social life and psychosocial functioning showed long-term increases in public interest. Renovation was the only domain to show a decrease in search interest with the onset of the lockdown. As changes in search behavior are consistent over multiple domains, a Google Trends analysis may provide information for policy makers on how to adapt and develop intervention, information, and prevention strategies, especially when NPIs are in effect.

Psychological impact of the COVID-19 pandemic on hospital workers over time: Relationship to occupational role, living with children and elders, and modifiable factors.

OBJECTIVE: The COVID-19 pandemic is expected to have a sustained psychological impact on healthcare workers. We assessed individual characteristics related to changes in emotional exhaustion and psychological distress over time. METHODS: A survey of diverse hospital staff measured emotional exhaustion (Maslach Burnout Inventory) and psychological distress (K6) in Fall 2020 (T1) and Winter 2021 (T2). Relationships between occupational, personal, and psychological variables were assessed using repeated measures ANOVA. RESULTS: Of 539 T1 participants, 484 (89.9%) completed T2. Emotional exhaustion differed by occupational role (F = 7.3, p < .001; greatest in nurses), with increases over time in those with children (F = 8.5, p = .004) or elders (F = 4.0, p = .047). Psychological distress was inversely related to pandemic self-efficacy (F = 110.0, p < .001), with increases over time in those with children (F = 7.0, p = .008). Severe emotional exhaustion occurred in 41.1% (95%CI 36.6-45.4) at T1 and 49.8% (95%CI 45.4-54.2) at T2 (McNemar test p < .001). Psychological distress occurred in 9.7% (95%CI 7.1-12.2) at T1 and 11.6% (95%CI 8.8-14.4) at T2 (McNemar test p = .33). CONCLUSIONS: Healthcare workers' psychological burden is high and rising as the pandemic persists. Ongoing support is warranted, especially for nurses and those with children and elders at home. Modifiable protective factors, restorative sleep and self-efficacy, merit special attention.

Rolling out the radical cure for vivax malaria in Asia: a qualitative study among policy makers and stakeholders.

BACKGROUND: Wide-spread implementation of treatment regimens for the radical cure of vivax malaria is hindered by a range of factors. This has resulted in an increase in the relative proportion of vivax malaria and is an important obstacle in the achievement of global malaria elimination by 2030. The main objective of this study was to explore the current policies guiding the treatment plans on vivax malaria, and the factors affecting the implementation of radical cure in South/South East Asian and Asian Pacific countries. METHODS: This was a qualitative study among respondents who represented national malaria control programmes (NMCPs) or had a role and influence in the national malaria policies. 33 respondents from 17 countries in South/South East Asia and Asia Pacific participated in interviews between October 15 and December 15, 2020. Semi-structured interviews were conducted virtually except for two face to face interviews and audio-recorded. Transcribed audio-records underwent thematic analysis using QSR NVivo. RESULTS: Policies against vivax malaria were underprioritized, compared with the focus on falciparum malaria and, in particular, drug resistant Plasmodium falciparum strains. Despite the familiarity with primaquine (PQ) as the essential treatment to achieve the radical cure, the respondents contested the need for G6PD testing. Optional G6PD testing was reported to have poor adherence. The fear of adverse events led health workers to hesitate prescribing PQ. In countries where G6PD was mandatory, respondents experienced frequent stockouts of G6PD rapid diagnostic kits in peripheral health facilities, which was compounded by a short shelf life of these tests. These challenges were echoed across participating countries to various degrees. Most respondents agreed that a shorter treatment regimen, such as single dose tafenoquine could resolve these problems but mandatory G6PD testing will be needed. The recommendation of shorter regimens including tafenoquine or high dose PQ requires operational evidence demonstrating the robust performance of point of care G6PD tests (biosensors). CONCLUSION: There was sparse implementation and low adherence to the radical cure in South/South East Asian and Asian pacific countries. Shorter treatment regimens with appropriate point of care quantitative G6PD tests may resolve the current challenges. Operational evidence on point of care quantitative G6PD tests that includes the feasibility of integrating such tests into the radical cure regimen are critical to ensure its implementation.