Conectar
To identify client and provider perspectives on contraceptive counselling in Pakistan and inform the development of an effective, rights-based counselling intervention package.
A formative, multimethod qualitative study was conducted using in-depth interviews, non-participant observations of counselling encounters and thematic analysis. The study was embedded within a WHO-led multiphase complex intervention.
Primary care-level family planning facilities (public and private) in the urban and peri-urban districts of Islamabad and Rawalpindi.
The analysis reported in this paper includes 72 married family planning clients (36 women and 36 men), 15 frontline healthcare providers and 72 observed counselling sessions across three facilities. Broader stakeholder interviews with programme managers, public-sector officials and donor/development partners were collected for the wider multiphase study but are not analysed in this paper.
Three overarching themes were identified: (1) counselling was often understood as basic method-related information rather than a structured, rights-based decision-making process; (2) public and private facilities differed in counselling depth, method choice, privacy and use of visual/couple-centred approaches; and (3) system constraints, including time pressure, commodity limitations, limited follow-up mechanisms, weak privacy arrangements and inconsistent training, shaped the quality of counselling. Observation data supported interview findings by showing variation in privacy, side-effect discussion, client engagement and follow-up advice across facilities.
Findings from participating facilities suggest that the current counselling model in these settings inadequately supports informed, autonomous reproductive choices. A redesigned, context-sensitive counselling package is needed to address these gaps. This should be supported by improved training, supportive supervision, inclusive tools, systemic reforms and enhanced follow-up mechanisms that are essential to increase decision-making autonomy and contraceptive continuation.
by Koki Nambu, Naoki Kaneko, Shiho Yokomizo, Hu Chen, Lijing Yan, Wang Shiyao, Ryusei Shizuma, Eiji Iwata, Yukiko Ohyama, Shohei Akagawa, Soichiro Ibaragi, Shintaro Kawano, Masafumi Moriyama
Oral lichen planus is a chronic inflammatory disease of the oral mucosa characterised by immune dysregulation, but its pathogenesis remains incompletely understood and no curative treatment has been established. Our previous work showed that patients with oral lichen planus exhibit gut dysbiosis, including reduced microbial diversity and depletion of butyrate-producing bacteria. Because butyrate promotes regulatory T-cell differentiation and supports immune homeostasis, targeting this dysbiosis may represent a microbiota-directed approach for immune modulation in oral lichen planus. This study aims to investigate the effects of inulin supplementation on the gut microbiota and related immune markers in patients with oral lichen planus. This multicentre, double-blind, randomised, placebo-controlled parallel-group trial will enrol 80 patients with oral lichen planus. Participants will be randomly assigned in a 1:1 ratio to receive either inulin (8 g/day) or a maltose placebo for 4 weeks, in addition to standard care. The primary outcome is the change in the relative abundance of prespecified butyrate-producing gut bacteria from baseline to the end of intervention at Week 6. Secondary outcomes include changes in gut microbiota diversity, salivary microbiota composition, faecal short-chain fatty acid concentrations, peripheral blood regulatory T-cell counts, blood test parameters, and clinical symptoms of oral lichen planus. Analyses will follow the intention-to-treat principle, and between-group differences will be assessed using appropriate statistical methods. This trial is designed to evaluate, in a randomised placebo-controlled setting, whether a microbiota-directed intervention can modify gut microbial profiles and related immune markers in patients with oral lichen planus. The findings are expected to clarify whether inulin supplementation can modify gut microbial profiles and related immunological markers in patients with oral lichen planus. Trial registration: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000060840, registered on 1 April 2026 (https://rctportal.mhlw.go.jp/detail/um?trial_id=UMIN000060840#).by Hirotaka Eguchi, Kiyohito Hosokawa, Ryota Kawano, Yukinori Takenaka, Hiroshi Kato, Toshihiro Kishikawa, Masami Suzuki, Motoyuki Suzuki, Takeshi Tsuda, Ryohei Oya, Hidenori Inohara
BackgroundReduced skeletal muscle mass may impair outcomes of immune checkpoint inhibitors in recurrent or metastatic head and neck squamous cell carcinoma. We evaluated whether temporal muscle thickness (TMT) on routine head computed tomography was associated with treatment response and survival.
MethodsWe retrospectively analyzed 109 patients treated with nivolumab or pembrolizumab between 2017 and 2023 (89 men [81.7%], 20 women [18.3%]; median age 69 years [range 21–88]). TMT was measured on CT images at the level where the Sylvian fissure was most clearly visualized, perpendicular to the temporalis muscle long axis, on both sides, and the mean of the bilateral values was used. Sex-specific cutoffs were defined by time-dependent receiver operating characteristic analysis for 12-month overall survival (5.53 mm for men; 3.92 mm for women). Associations with objective response and survival were assessed using logistic regression and Cox proportional hazards models.
ResultsObjective response was evaluable in 105 patients (complete response 12, partial response 30, stable disease 18, progressive disease 45), yielding a response rate of 40.0% and a disease control rate of 57.1%. High temporal muscle thickness was associated with response (univariable odds ratio 2.64, 95% confidence interval 1.18–5.90; p = 0.018) and remained significant after adjustment for chemotherapy (adjusted odds ratio 2.42, 95% confidence interval 1.05–5.58; p = 0.038). One-year progression-free survival was 36.5% in the high group versus 15.8% in the low group (absolute difference 20.7%; p = 0.010; adjusted hazard ratio 0.57, 95% confidence interval 0.36–0.90; p = 0.017). One-year overall survival was 73.1% versus 47.4% (absolute difference 25.7%; p = 0.001; adjusted hazard ratio 0.54, 95% confidence interval 0.34–0.86; p = 0.010).
ConclusionTemporal muscle thickness, obtainable from routine head computed tomography, was independently associated with response and survival in patients receiving immune checkpoint inhibitors and may serve as a practical host-related imaging marker for prognostic risk stratification.
To determine the pattern and determinants of exclusive breastfeeding (EBF) among infants visiting a tertiary care hospital of underprivileged population.
Cross-sectional study.
The Department of Pediatrics, Pakistan Railway Hospital, Rawalpindi, Pakistan.
A total of 385 infants, born with gestational age between 34–42 weeks, were analysed. Data collection was performed through a structured questionnaire designed to capture relevant demographic and clinical details. The pattern of breastfeeding (BF), including EBF, formula milk, animal milk (cow/buffalo/goat milk) or mixed methods was determined. The collected data were entered and analysed using IBM-SPSS V.26.
In a total of 385 infants, EBF was reported in 206 (53.5%) infants, while 36 (9.4%) were exclusively formula-fed (FF), 122 (31.7%) received a combination of BF and formula feeding (mixed FF and BF), 14 (3.6%) were given a mix of BF and animal milk, and 7 (1.8%) received BF along with water. Age (p=0.033), birth weight (p=0.050), mode of delivery, neonatal intensive care unit (NICU) admission (p=0.028), BF initiation timing (p
Despite the well-established benefits of EBF, only around half of the infants were exclusively breastfed, highlighting the need for targeted interventions. Cesarean delivery, NICU admission and pre-lacteal feeding practices were significant barriers to EBF, while early BF initiation, antenatal counselling and maternal education played pivotal roles in promoting EBF.
Learning health systems (LHS) are an approach to translate patient data into actionable clinical insights, empower healthcare teams to drive quality improvement and reduce health inequalities. Here we present a protocol for a realist evaluation to explore what works to implement a learning health system approach in primary care settings in Thailand, for whom does it work, how, why and in what circumstances.
A mixed-methods realist evaluation will run in parallel with an interventional trial [Reg No: NCT06873243] in Northern Thailand which aims to improve the management of hypertension (HTN), type 2 diabetes mellitus (T2DM) and chronic kidney diseases (CKDs) using a data-supported learning health systems approach. As part of the trial, 16 primary care units (PCUs) in Chiang Mai and Lamphun provinces will be randomly selected to receive a learning health system intervention to support quality improvement for care of HTN, T2DM and CKD. Performance will be compared between intervention PCUs and all other PCUs in the region. Participants of the realist evaluation will include clinical and other professional staff involved in the development and implementation of the LHS. This realist evaluation will use both quantitative and qualitative data, including semi-structured interviews, surveys and documents from participating sites. Quantitative and qualitative findings will be systematically integrated to test, refine and validate context-mechanism-outcomes to identify consistencies, contradictions and explanatory mechanisms as part of a final programme theory for the successful implementation of the LHS.
Ethical approval has been granted by all collaborating university Research Ethics Committees (ref: 1090, 0321, 32540). Results will be disseminated to stakeholders, including patients and the public, health providers, the Thai government and WHO office. Our methods and dissemination will be guided by National Institute for Health Research and Guidelines International Network reporting standards for Patient and Public Involvement and Engagement.
Intense workloads and irregular scheduling put global nursing work–life balance at risk. While healthcare systems frequently try to implement and evaluate strategies to mitigate this, the existing evidence base is limited by conceptual ambiguity, intervention heterogeneity and a lack of nurse-specific designs.
To synthesise interventions designed to improve work–life balance and explore their effectiveness in enhancing work–life balance among nursing professionals.
A scoping review.
Scopus, Web of Science, CINAHL, PubMed, EMBASE and PsycINFO. Grey literature was searched on ProQuest.
This review adhered to the five-stage framework established by Arksey & O'Malley. Articles published from inception up to October 2024 were searched. Studies were eligible if they involved registered nurses or nursing professionals as the primary population, evaluated or described interventions aimed at improving work–life balance or related constructs (e.g., work–life conflict), reported empirical findings and were published in English. Data were charted with a standardised form created iteratively by the review team. Extracted variables included study characteristics, participant demographics, intervention type and duration, work–life balance outcome measures and key findings. Reporting followed the PRISMA-ScR Checklist guidelines.
This review included twenty-two studies. Findings were categorised into the following four intervention types: (1) wellness programme, (2) training programme, (3) work digitalisation and (4) work flexibility.
This paper highlighted the complex nature of work–life balance and the importance of a comprehensive approach to help nurses manage their professional and personal roles.
Insights from this review can guide administrators, managers, educators and policymakers in developing work-life balance interventions, particularly through AI-enabled digitalisation of nursing work and greater flexibility in work arrangements, while also informing future research to advance this underdeveloped concept.
by Nesreen Alqaissi, Mohammad Qtait, Khalaf Awwad, Zeenat Mesk, Fuad Farajalla, Yasmeen Ziad, Farah Abu-Salameh, Amani Hmedat, Rawan Halayka, Maysam Ajlouni, Yasmeen Shareef
BackgroundArtificial intelligence (AI) is increasingly integrated into healthcare education and clinical practice. Understanding health sciences students’ knowledge, attitudes, and practices (KAP) toward AI is important for informing curriculum development, particularly in resource-limited educational settings.
ObjectiveTo assess knowledge, attitudes, and practices toward artificial intelligence among health sciences students at a Palestinian university.
MethodsA cross-sectional study was conducted during the 2024–2025 academic year among 666 undergraduate students from nursing, medicine and health sciences, and dentistry programs. Data were collected using a structured questionnaire assessing AI knowledge (7 items), attitudes (10 items), and practices (7 items). Descriptive statistics were calculated. Independent-samples t-tests and one-way analysis of variance (ANOVA) were used to examine group differences. Effect sizes were reported using Cohen’s d and eta squared (η²). Statistical significance was set at p Results
The overall AI knowledge accuracy rate was 42.9% (mean 3.00 ± 1.61), indicating limited foundational understanding, particularly regarding machine learning and deep learning concepts. Attitudes toward AI were generally positive (mean 3.60 ± 0.44), with high endorsement of ethical awareness. AI practice levels were moderate (mean 3.32 ± 0.70), with frequent use for assignments and research activities. Formal AI training was associated with higher knowledge scores (t(664)=7.45, p Conclusion
Health sciences students demonstrated positive attitudes and regular academic use of AI tools despite limited foundational knowledge. These findings suggest the potential benefit of structured AI literacy integration within health sciences curricula.
Guided by the Andersen Behavioural Model of Healthcare Utilisation, this study investigated the relationship between socioeconomic status, enabling factors and need factors in predicting hospital admission.
Data were analysed from the first wave of the Malaysia Ageing and Retirement Survey (MARS), a longitudinal cohort study.
5612 Malaysian adults aged 40 and older participated in MARS.
A Generalised Structural Equation Modelling was applied to test associations between socioeconomic status (financial well-being and education levels), enablers and need factors with hospital admission. The weighted coefficients, SEs and 95% CIs were reported. The role of the enablers as mediators was tested. Analysis was performed using STATA v.18.
Socioeconomic status did not affect hospital admission. Better financial well-being lowered functional impairment (β=–0.006, 95% CI –0.009 to –0.003) and better cognitive status (β=0.130, 95% CI 0.109 to 0.152) with no significant effect on the number of chronic diseases. Higher education improved cognitive function (β=2.387, 95% CI 2.081 to 2.693) but was not associated with functional impairment or the number of chronic diseases. Worsening functional impairment and a higher number of chronic conditions predicted higher hospital admissions. A better cognitive status reduces it. Outlook on life mediated the effect between financial well-being and education levels with hospital admission (β=–0.002, 95% CI –0.004 to –0.001 for financial well-being and β=–0.019, 95% CI –0.036 to –0.006 for education).
Hospital admissions were driven by health needs, regardless of socioeconomic status, highlighting the importance of promoting primary prevention of diseases.
Chronic non-healing wounds represent a major global public health challenge. Their persistence is frequently attributed to localized biological deficits that cause them unresponsive to conventional therapeutic modalities. While Platelet-Rich Plasma (PRP) has demonstrated promising results as an adjunctive treatment by delivering highly concentrated growth factors, its clinical application is currently impeded by a lack of clinical standardization, particularly optimal injection frequency, interval, and dosage. The aim of this study is to rigorously evaluate the efficacy and safety of a specific, non-intensive two-dose PRP injection protocol for accelerating the reduction of wound area in patients with various types of refractory chronic wounds. We conducted a prospective, single-arm, pretest-posttest study enrolling 18 patients with refractory non-healing wounds, defined as lesions persisting for a minimum period of 4 weeks which had failed to achieve definitive closure under optimized standard care. Autologous high-concentration PRP was injected intradermally around the wound margin at baseline (Day 0) and again 3 weeks later (Day 21). Wound area was digitally measured at baseline and subsequently at 7, 11 and 15 weeks. The primary outcome was the mean reduction in wound area (cm2) at the 15-week follow-up, assessed using a Paired Samples t-test. The mean patient age was 57.89 ± 15.64 years, and wounds had a mean chronicity of 15.83 ± 19.05 months. The PRP preparation achieved a mean platelet concentration 8.5 times greater than the peripheral blood threshold (first injection) and 7.0 times greater than the threshold (second injection), confirming high therapeutic quality. Analysis of the total cohort demonstrated a statistically significant reduction in mean wound area from baseline 27.41 ± 70.38 cm2 to 15 weeks 21.5 ± 68.96 cm2. Three patients (16.67%) achieved complete epithelialization. Subgroup trends suggested diabetic and venous ulcers responded more favourably than radiation-induced ulcers. The protocol was safe, with no systemic or severe localized adverse events observed among participants. The defined two-dose PRP injection protocol provides a clinically effective and safe adjunctive therapy that significantly promotes wound area reduction in challenging chronic non-healing wounds. This reproducible, low-frequency protocol offers a rationale for standardization in advanced wound care, warranting validation through future large-scale Randomized Controlled Trials (RCTs).
In sub-Saharan Africa, young women face disproportionate challenges transitioning from school to employment, with high rates of those not in education, employment or training (NEET). Structural barriers—including unequal gender norms, early marriage and unpaid labour—limit their economic participation. The Campaign for Female Education (CAMFED) Livelihoods programme supports young women’s transition from school to independent adulthood through mentoring, life skills, business and agricultural training and access to financial resources.
This study will evaluate the impact, process and mechanisms of change, and cost-benefit of CAMFED Livelihoods programme in Tanzania and Zimbabwe (2024–2027), focusing on outcomes related to economic activity, empowerment, leadership, mental health, subjective well-being and sexual and reproductive health among adolescent and young women (aged 15–24 years).
We will conduct a mixed-method, longitudinal evaluation across five districts in Tanzania and three districts in Zimbabwe. The quantitative component includes a pre-post cohort with a comparison group in Tanzania (n=1520) and a single-cohort design in Zimbabwe (n=500), with data collected at baseline, midline and endline. Primary outcomes are NEET status and leadership, complemented by measures of well-being, empowerment and health. The qualitative component will explore mechanisms of change and programme delivery. A cost-benefit analysis will estimate social and economic returns using a provider perspective. Youth researchers will be engaged to enhance participatory learning.
We have received ethics approvals from the London School of Hygiene and Tropical Medicine (31266), the National Health Research Ethics Committee (6732) in Tanzania and the Medical Research Council of Zimbabwe (MRCZ/A/3239) in Zimbabwe. Results of this study will be published in peer-reviewed academic journals and shared with policymakers, study participants and the other stakeholders in Tanzania and Zimbabwe.
Spirituality is a crucial yet complex element of holistic nursing care, particularly when providing care for older adults with depression. In Thailand, depression poses a significant mental health challenge. Thai cultural values are deeply interwoven with individuals' beliefs, making spirituality a critical factor in addressing the care of older adults with depression. This study aimed to explore how older adults with depression experience spirituality and construct meaning from it in their daily lives.
An interpretative phenomenological study.
In-depth interviews of 30 older Thai adults living with depression (aged 60–85 years) from an outpatient psychiatric clinic in southern Thailand were conducted using semi-structured interview questionnaires. Interpretive phenomenological analysis was employed. Data were collected from June to August 2024.
Five themes emerged from the phenomenological data analysis: (1) elusiveness of spiritual meaning, (2) holding oneself together through inner power, (3) finding acceptance through faith in a higher power, (4) family ties shaping peace and despair, and (5) being guided and cared for.
This study highlights that older adults with depression perceive spirituality as essential for their well-being. Personal practices, such as meditation and chanting, played a key role in strengthening spirituality and reducing the risk of relapse in depressive symptoms, which are distinct for each older adult. Understanding spirituality's role in mental health guides nurses to develop strategies for providing more empathetic spiritual care.
Nurses must address depression in older adults through individualized practices to effectively empower their inner strength and coping mechanisms. Understanding each individual's spiritual practices is essential to help them harness their inner strength when coping with depression.
by Sudim Sharma, Anjali Neupane, Dikshya Kandel, Pratibha Chalisay, Sabina Marasini, Budhi Setiawan, Deepak Chandra Bajracharya, Shyam Raj Upreti, Leela Khanal, Haruko Yokote, Chahana Singh, Kshitij Karki
BackgroundHome-Based Records (HBRs) are personal health documents intended to improve continuity of care and caregiver engagement across reproductive, maternal, newborn, and child health (RMNCH) services. In Nepal, both standalone (sHBR) and integrated (iHBR) models are implemented, yet comparative evidence on their utilization and implementation challenges is limited. This study examined utilization patterns and system-level barriers associated with sHBR in Madhesh Province and iHBR in Koshi Province.
MethodsWe conducted a comparative qualitative study with descriptive quantitative profiling between May 17 and August 27, 2024. A total of 100 semi-structured in-depth interviews were completed with caregivers, health workers, Female Community Health Volunteers, and program managers across two provinces. The study applied “kuragraphy,” an ethnographic approach integrating interviews and field observations to construct contextual case narratives. Socio-demographic data were analyzed descriptively using the statistical package for the social Sciences (SPSS). Informed by the Human Centered Design (HCD) approach, the qualitative data were thematically analyzed in Excel using the Journey to Health and Immunization (JTHI) framework.
ResultsCaregivers widely perceived HBRs as essential documents, primarily for immunization tracking and future service access. The iHBR was viewed as more comprehensive and user-friendly, particularly due to its illustrations, which improved comprehension among low-literacy users. However, understanding remained limited among illiterate and marginalized populations. Family involvement in record management was minimal and largely confined to mothers. Implementation barriers included inadequate training – particularly for iHBR use, limited decision-making authority among frontline health workers, incomplete documentation of non-immunization components, poor material quality of sHBR, and concerns regarding the sustainability of donor-supported iHBR initiatives.
ConclusionHBR utilization in Nepal is shaped by caregiver literacy, gender dynamics, and health-system readiness. Strengthening training, supportive supervision, user-centered design, and sustainable supply mechanisms will be essential to optimize HBR effectiveness and support equitable RMNCH service delivery.
by Gift Treighcy Banda-Mtaula, Ibrahim Simiyu, Sangwani Nkhana Salimu, Stephen A. Spencer, Nateiya M. Yongolo, Marlen Chawani, Hendry Sawe, Jamie Rylance, Ben Morton, Adamson S. Muula, Eve Worall, Felix Limbani, Miriam Taegtmeyer, Rhona Mijumbi, on behalf of the Multilink consortium
Multimorbidity, the presence of multiple chronic health conditions, is a leading cause of death globally. In Malawi, chronic noncommunicable and communicable diseases such as HIV frequently co-exist, putting pressure on an under-resourced system. However, the health system is primarily structured around disease-specific [vertical] programs, which hinders person-centred care approaches to multimorbidity. Our study focuses on multimorbidity care and explores the perceptions of healthcare workers on the patient pathways and service organisation throughout the patient’s interaction with the health facilities. This cross-sectional qualitative study took an interpretivist approach. We conducted 13 days of clinical observations at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. We also conducted 13 days of clinical observations and semi-structured in-depth interviews with different cadres of purposively sampled healthcare workers (n = 22) at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. Through thematic analysis, we identified an understanding of the organisation of care and healthcare workers’ perspectives on the delivery of services. Findings showed both hospitals provided services for inpatients and outpatients with multimorbidity, including screening, management, prevention of secondary conditions and rehabilitation. Patient diagnosis and management for multimorbidity were often delayed due to frequent stockouts of medication and consumables necessary for diagnostic testing for NCDs at the hospital level. Some healthcare workers were not equipped with the knowledge, skills, or guidelines to manage multimorbidity. As HIV care is currently better resourced than other chronic conditions, healthcare facilities may strengthen the supply chain, healthcare workers’ training sessions and monitoring and evaluation tools to ensure NCDs are well managed, learning from HIV programmes.by Tanaporn Anosri, Soraya Kaewngam, Ram Prajit, Kornrawee Suwannakot, Nataya Sritawan, Anusara Aranarochana, Wanassanan Pannangrong, Jariya Umka Welbat, Peter Wigmore, Apiwat Sirichoat
Methotrexate (MTX) is used in treating several malignancies. However, MTX neurotoxicity remains a significant clinical side effect, leading to cell division malformation, and neurogenesis impairment. Chrysin, a flavonoid compound found in natural products, demonstrates various biological characteristics, including neuroprotective and antioxidant properties. The purpose of this study was to investigate the ameliorative effect of chrysin on oxidative damage and neurogenesis impairment caused by MTX. Male Sprague-Dawley rats were randomly divided into four groups, including the vehicle, MTX (75 mg/kg), chrysin (10 mg/kg), and chrysin+MTX groups. Chrysin was orally administered for 15 days. MTX was administered intravenously on days 8 and 15. The hippocampal neural stem cells were evaluated using sex determining region Y-box 2 (sox2) and nestin immunofluorescence staining. Antioxidant enzyme expression and the levels of oxidative stress marker were assessed. Additionally, the expressions of nuclear factor erythroid 2-related factor 2 (Nrf2), brain-derived neurotrophic factor (BDNF), cAMP-response element binding (CREB), and phosphorylated CREB (pCREB) were evaluated using Western blotting. Results showed that MTX significantly decreased the activity of antioxidant enzymes and produced oxidative stress. MTX also impaired neurogenesis, evidenced by decreased sox2 and nestin-positive cells and decreased expression of Nrf2, BDNF, CREB, and pCREB in the hippocampus and prefrontal cortex. However, chrysin significantly reversed the effects of MTX on these parameters. In conclusion, chrysin exhibits neuroprotective effects against MTX-induced neurogenesis impairment by upregulating antioxidant enzyme activity, reducing oxidative stress, and improving protein expression related to neurogenesis.In this paper, the development of an evidence-informed, data-driven strategy for implementation of the HIRAID emergency nursing framework in Thailand is reported. HIRAID stands for H istory including I nfection risk, R ed flags, A ssessment, I nterventions, D iagnostics, reassessment and communication.
This exploratory descriptive study was underpinned by the Knowledge-to-Action framework.
The study was conducted in Chiangrai Prachanukroh Hospital (CRH) in Northern Thailand. The identified problem was no standardised approach to patient assessment and management. Adaptation of knowledge to local context occurred by feasibility assessments and experience-based co-design. Surveys designed and analysed using the Behaviour Change Wheel and Theoretical Domains Framework were used to understand the barriers to knowledge use. Selecting, tailoring and implementing the intervention was guided by the Behaviour Change Wheel.
Practice environment and behavioural diagnostics surveys were completed by 49 nurses (response rate 100%) who identified 19 enablers and 33 barriers to HIRAID implementation at CRH. Enablers and barriers were mapped to seven intervention functions (education, modelling, persuasion, enablement, training, environment restructuring, incentivisation) and 19 behaviour change techniques most likely to be effective. The study methods and results culminated in an evidence-informed, data-driven HIRAID Thailand Implementation Strategy.
In-depth understanding of context-specific enablers and barriers, active engagement of end-users was critical to maximising likelihood of successful implementation. Development of an evidence-informed implementation strategy for a limited resource setting was achievable with robust application of theory, key stakeholder and end-user engagement and multi-agency collaboration.
Implementation of clinical interventions in emergency care settings is challenging, even in well-resourced settings. For end-users, knowledge that an intervention would improve patient care was a powerful enabler coupled with meaningful organisational support is critical to sustained implementation in complex nursing environments.
This study addresses the lack of standardised approach to patient assessment and management in the emergency department in a resource-limited setting. Application of robust theory is possible in middle-resource settings, and this study identified 19 behaviour change techniques that were distilled to develop a sustainable, context specific implementation strategy. Development of an evidence-informed implementation strategy for a limited resource setting with robust application of theory is possible with key stakeholder and end-user engagement and multi-agency collaboration.
There is no EQUATOR guideline available for this study.
This study did not include patient or public involvement in its design, conduct or reporting.
by Nitchawan Jongrakthanakij, Thanavadee Prachason, Nida Limsuwan, Komsan Kiatrungrit, Masatha Thongpan, Passaporn Lorterapong, Pattarabhorn Wisajun, Sudawan Jullagate
BackgroundRaising a child with Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with significant parental stress. However, the complex relationships between factors in the child and family in shaping this stress are not well understood. This study aimed to elucidate these interrelationships and identify the key determinants of parental stress.
MethodsA cross-sectional study included 127 children and adolescents with ADHD (70.9% males; mean age 9.6 ± 3.3 years) and their caregivers, recruited from the ADHD Registry at Ramathibodi Hospital, Bangkok (2019–2023). Caregivers completed standardized measures of parental stress, child ADHD symptoms, child functional impairment, family functioning, and parental ADHD symptoms. Structural equation modeling was used to examine pathways from child and parental ADHD symptoms to parental stress, with functional impairment and family functioning specified as mediators.
ResultsExamining child- and family-related factors separately, child ADHD symptoms indirectly influenced parental stress via functional impairment, whereas parental ADHD symptoms significantly influenced parental stress both directly and indirectly via family functioning. In the integrated model examining both child- and family-related factors concurrently, the direct and indirect pathways from parental ADHD symptoms to parental stress via family functioning remained significant, but not the pathway from child ADHD symptoms to parental stress via functional impairment.
ConclusionsFunctional impairment, parental ADHD, and family functioning, rather than child ADHD symptoms, are key determinants of parental stress in families of children with ADHD. These factors should be routinely assessed and targeted to alleviate parental stress more effectively than focusing on child ADHD symptoms alone.
To determine the proportion of postpartum depression (PPD), explore associated risk factors with PPD, and examine changes in PPD, social support and quality of life (QOL) among adolescent and adult mothers in the first 6 months postpartum during the COVID-19 pandemic.
A longitudinal comparative study was conducted using an online questionnaire from January to August 2021.
The study recruited 65 adolescent and 65 adult mothers who attended postpartum checkups at 6 weeks postpartum in primary hospitals across Ayutthaya, Chachoengsao and Phetchaburi provinces in Thailand. Data were collected by the Edinburgh Postnatal Depression Scale, Postpartum Support Questionnaire, and the World Health Organisation Quality of Life Brief at 6 weeks, 4 months and 6 months postpartum.
Finally, 60 adolescent and 60 adult mothers were included for analysis. Adolescent mothers experienced lower social support and QOL compared to adult mothers over the 6-month postpartum period. Notably, both adolescent and adult mothers had significantly increased PPD proportions from 6 weeks to 6 months postpartum (31.7%–48.3% and 23.3%–43.3%, respectively). However, there was no significant difference in the PPD proportions between groups. In adjusted models, significant risk factors for PPD during the first 6 months postpartum included educational level, unintended pregnancy, mode of delivery and social support.
Significant changes in PPD, social support and QOL were observed in both adolescent and adult mothers during the first 6 months postpartum. Adolescent mothers consistently demonstrated lower levels of social support and QOL at 6 weeks, 4 months and 6 months postpartum compared to adult mothers. Additionally, mothers with lower educational attainment, unintended pregnancies, caesarean deliveries and low social support were more likely to experience PPD.
Midwives/nurses should provide routine PPD screenings throughout the first six months postpartum for all mothers, particularly for at-risk mothers such as adolescent mothers or those with lower education, unintended pregnancies, caesarean deliveries and limited social support.
We have followed the STROBE guidelines.
No patient or public contribution.
by Pornpen Sangthawan, Thammasin Ingviya, Songyos Rajborirug, Jirayut Janma, Siribha Changsirikulchai
BackgroundThailand implemented a peritoneal dialysis (PD)-first policy under its universal health coverage (UHC) from 2008 to 2022. This study aims to describe patient survival during dialysis and after kidney transplantation (KT), and to identify factors associated with survival in these periods among UHC-covered patients undergoing PD, hemodialysis (HD), or transitioning between dialysis modalities.
MethodsThis retrospective study analyzed data from patients receiving PD, HD, or KT, recorded by the National Health Security Office (NHSO) between January 2013 and December 2021. Patients were categorized into four groups: PD, HD, PD-to-HD transition, and HD-to- PD transition. Survival factors were analyzed using Cox proportional hazards models.
ResultsAmong 81,572 patients receiving kidney replacement therapy, 38.9% were on PD, 35.3% were on HD, 10.2% transitioned from PD to HD, and 15.6% transitioned from HD to PD. Patients transitioning from PD to HD had superior 3- and 5-year survival rates compared to the other three groups. Survival outcomes were significantly influenced by age at dialysis initiation, diabetes, and comorbidities. Overall, 1,517 patients (1.9%) received KT: 70.4% had PD, 19.8% HD, and 9.8% had transitioned. Median follow-up time before KT was 94.5 months. Post-KT survival rates were comparable across dialysis groups. Factors associated with post-KT survival were age, cardiac disease, antibody-mediated rejection, and delayed graft function.
ConclusionsUnder Thailand’s PD-first policy, starting with PD and later switching to HD was linked to better survival than staying on a single modality or switching from HD to PD. A higher proportion of PD patients underwent KT compared to HD patients. Post-KT survival rates remained similar across all dialysis modalities. These findings underscore the importance of individualized dialysis modality selection and proactive transition planning to optimize patient outcomes.
FreshRSS 