Aprendizagem baseada em projeto e a formação médica: relato de experiência introduzindo questões para o debate interprofissional / Project-based learning and medical education: experience report introducing issues for interprofessional debate / El aprendizaje basado en proyecto y la formación médica: informe de experiencia que introduce cuestiones para el debate interprofesional

A aprendizagem baseada em projeto orientada pelos fundamentos da educação interprofissional é um modelo que pode contribuir para a formação de relacionamentos interpessoais, criatividade, empatia e colaboração na educação médica, por meio de uma colaboração mútua com profissionais de saúde da rede. Muito se fala da efetividade desse método no campo do ensino e aprendizagem médica, mas há a necessidade de incluir a importância do desenvolvimento de habilidades interprofissionais, com equipes colaborativas, em ações extensionistas, diante das necessidades locais no contexto da atenção primária, pensando na melhoria dos resultados de saúde. O objetivo deste trabalho é apresentar um relato de experiência de aprendizagem baseada em projeto de estudantes de Medicina no contexto da Estratégia Saúde da Família. Participaram deste trabalho estudantes do Módulo Integração Ensino, Serviço e Comunidade da Faculdade de Medicina da Universidade Federal dos Vales do Jequitinhonha e Mucuri que executaram, em colaboração com uma equipe interprofissional o projeto sobre a saúde do homem. Como resultado da análise qualitativa do feedback entre os integrantes, observaram-se mudanças no comportamento dos estudantes, com melhorias na comunicação, empatia e nas relações interpessoais, por meio do trabalho colaborativo com a equipe interprofissional. Esta experiência poderá ser adaptada para implementar o ensino e aprendizagem no projeto pedagógico orientado pela educação interprofissional na atenção primária.

Project-based learning guided by the fundamentals of interprofessional education is a model that can contribute to the formation of interpersonal relationships, creativity, empathy and collaboration within medical education, through mutual collaboration with health professionals in the health network. Much has been said about the effectiveness of this method in medical teaching and learning, but there is a need to include the importance of developing interprofessional skills, with collaborative teams, within extension actions, in view of local needs in the context of primary care, thinking about the improved health outcomes. The objective of this work was to present a report of a project-based learning experience of medical students in Family Health Strategy. Students from the Teaching, Service and Community Integration Module of the Faculty of Medicine of Universidade Federal dos Vales do Jequitinhonha e Mucuri participated in this work, executing in collaboration with an interprofessional team a project about men's health. As a result of the qualitative analysis of the feedback among the members, changes in student behavior were observed with improvements in communication, empathy and interpersonal relationships through collaborative work with the interprofessional team. This experience can be adapted to implement teaching and learning in the pedagogical project guided by interprofessional education in primary care.

El aprendizaje basado en proyectos y guiado por los fundamentos de la educación interprofesional es un modelo que puede contribuir a la formación de relaciones interpersonales, creatividad, empatía y colaboración dentro de la educación médica, a través de la colaboración mutua con los profesionales de la salud en la red de salud. Mucho se habla de la efectividad de este método dentro de la enseñanza y el aprendizaje médico, pero es necesario incluir la importancia del desarrollo de habilidades interprofesionales, con equipos colaborativos, dentro de las acciones de extensión, frente a las necesidades locales en el contexto de la atención primaria, pensando sobre los mejores resultados de salud. El objetivo de este trabajo es presentar un informe de experiencia de aprendizaje basado en proyectos de estudiantes de medicina en la Estrategia de Salud Familiar. Participaron en este trabajo estudiantes del Módulo Integración Enseñanza, Servicio y Comunidad de la Facultad de Medicina de la Universidade Federal dos Vales do Jequitinhonha e Mucuri que ejecutaron en colaboración con un equipo interprofesional el proyecto sobre la salud del hombre. Como resultado del análisis cualitativo de la retroalimentación entre los integrantes, se observaron cambios en el comportamiento de los estudiantes con mejoras en la comunicación, la empatía y las relaciones interpersonales a través del trabajo colaborativo con el equipo interprofesional. Esta experiencia puede adaptarse para implementar la enseñanza y el aprendizaje en el proyecto pedagógico guiado por la educación interprofesional en atención primaria.

Caregiving During COVID and Beyond: The Experience of Workplace Stress and Chaplain Care Among Healthcare Workers.

Healthcare workers (HCWs) experience occupational stressors that negatively impact emotional well-being and exacerbate turnover intentions. In the wake of the COVID-19 pandemic, the resultant acute care turnover rates have reached an all-time high. In addition, occupational stressors lead to psychological stress, including moral distress, defined as the dissonance between perceiving what the right course of action is and encountering an obstacle to acting accordingly. This qualitative descriptive study explored the perceptions of patient-facing HCWs in acute care hospital settings regarding the workplace stressors they encountered and the role of hospital-based chaplains in addressing emotional well-being and stress with 33 interviews. Findings suggest that HCW frequently experience work-related moral distress and seek relief by interacting with hospital chaplains. Chaplain care, common in American healthcare facilities for the spiritual care of patients, is an easily accessible resource to HCWs. Facilitating chaplain-HCW interactions may be an effective strategy for responding to moral distress and improving healthcare workers' well-being.

The Interplay Between Problematic Internet Use, Anxiety, Depression and Functional Impairment in Front-Line Healthcare Workers During the COVID-19 Pandemic.

OBJECTIVE: We aimed to assess the interplay between functional impairment and anxiety, depression, and problematic Internet use levels in front-line healthcare workers who work in inpatient clinics of coronavirus disease-2019 (COVID-19) during the COVID-19 pandemic. METHODS: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Internet Addiction Test (IAT), and Sheehan Disability Scale (SDS) were administered to assess the depression, anxiety, problematic Internet use, and functional impairment levels of the participants. RESULTS: Two hundred thirteen participants were enrolled in the present study. Medical doctors showed significantly higher scores of IAT than the nurses and other medical staff (Kruskal-Wallis=6.519, p=0.038). Levels of SDS total are significantly correlated with scores of IAT (r=0.257, p<0.001), BDI (r=0.383, p<0.001), and BAI (r=0.308, p<0.001). All subdomain scores of SDS (social, family, work) and total scores of SDS were significantly and positively correlated with BAI, BDI, and IAT scores (p<0.05). In the separation mediation analysis, problematic Internet use partially mediated the relationship between anxiety-depression and global functional impairment. CONCLUSION: Health politicians should produce policies to develop strategies for coping with consequences of anxiety and depression in healthcare professionals during any health crisis. In addition, we should raise healthcare professionals' awareness that problematic Internet use is not suitable for dealing with anxiety and depression and may even lead to increase of functional loss.

Health and social care staff's recognition of elder abuse perpetrated by family members of persons with dementia: a mixed-method study.

BACKGROUND: Health and social care staff play a significant role in detecting and reporting abuse among persons with dementia. However, they are often left to their own judgements which can lead to elder abuse not being detected or acted on. The aim was to explore what healthcare and social care staff consider elder abuse, and their experience of elder abuse perpetrated by family members of persons with dementia. METHODS: This mixed-method vignette study was conducted in Sweden during the year 2021. In total 39 staff working in dementia care were included. They first answered the Caregiver Scenario Questionnaire and then participated in a group interview. RESULTS: An inconsistency was revealed regarding whether a management strategy for behavioural difficulties included in the Caregiver Scenario Questionnaire should be considered an abusive act or not. No participants were able to identify all five abusive behaviour management strategies. Participants described witnessing 101 abusive acts including different types of abuse of a person with dementia, with emotional/psychological abuse and neglect being most common. CONCLUSIONS: Health and social care staff who work close to older persons are able to detect abuse perpetrated by family members. However, inconsistency in defining abusive acts demonstrates the uncertainty in identifying abuse. This may lead to abuse not being identified, but it also creates feelings of inadequacy among staff.

"It's normal to be afraid": attacks on healthcare in Ouaka, Haute-Kotto, and Vakaga prefectures of the Central African Republic, 2016-2020.

INTRODUCTION: Attacks on healthcare have further weakened the already fragile health system in the Central African Republic. We investigated attacks on healthcare in three conflict-affected prefectures-Ouaka, Haute-Kotto, and Vakaga-from 2016 to 2020. The study aim was to gain an in-depth understanding of the immediate and long-term effects of attacks on healthcare workers, facilities, supply chain, quality of care, and other components of the health system. We provide a qualitative description of the incidents, assess their impacts, identify mitigation efforts, and discuss challenges to recovery. METHODS: We used purposive and snowball sampling to identify participants in the study. Semi-structured key informant interviews were conducted with administrative and health authorities, front-line personnel, and staff of non-governmental organizations. Interviews were done in Sango, French, or English. Recorded interviews were transcribed and notes taken for non-recorded interviews. Transcripts and notes were analyzed using inductive coding, allowing participant responses to guide findings. RESULTS: Of 126 attacks identified over the study period, 36 key informants discussed 39 attacks. Attacks included killings, physical and sexual assault, abductions, arson, shelling with grenades, pillage, occupations, and verbal threats. The violence led to extended closures and debilitating shortages in healthcare services, disproportionately affecting vulnerable populations, such as children under five, or people who are elderly, chronically ill, or displaced. Healthcare workers faced psychological trauma and moral injury from repeated attacks and the inability to provide adequate care. Personnel and communities made enormous efforts to mitigate impacts, and advocate for assistance. They were limited by failed reporting mechanisms, ongoing insecurity, persistent lack of resources and external support. CONCLUSION: Effective strategies to safeguard healthcare from violence exist but better support for communities and health workers is essential, including measures to assess needs, enhance security, and facilitate recovery by quickly rebuilding, resupplying, and re-staffing facilities. CAR's government, international organizations, and donors should make concerted efforts to improve reporting mechanisms and end impunity for perpetrators. Their investment in community organizations and long-term health system support, especially for health worker training, salaries, and psychosocial care, are vital steps towards building resilience against and mitigating the impacts of attacks on healthcare.

Evaluation of the psychometric properties of the health care providers' pain and impairment relationship scale (HC-PAIRS) in health professionals and university students from Chile and Colombia.

Background: Chronic back pain is a frequent and disabling health problem. There is evidence that ignorance and erroneous beliefs about chronic low back pain among health professionals interfere in the treatment of people who suffer from it. The Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) has been one of the most used scale to assess these misbeliefs, but no studies have been reported in Latin America. Method: We studied the factorial structure of the HC-PAIRS in health personnel and health sciences university students in two Latin American countries: Colombia (n = 930) and Chile (n = 190). Spain's data was taken of the original study of the Spanish version of the HC-PAIRS (171 Physiotherapy students). Additionally, the measurement invariance of this scale among Chile, Colombia and Spain was evaluated by calculating three nested models: configural, metric and scalar. We used a Confirmatory Factor Analysis (CFA) in both Latin American samples, with Maximum Likelihood Robust (MLR) estimation to estimate the parameters. For the final model in each sample, reliability was assessed with the Composite Reliability (CR) index, and to obtain the proportion of variance explained by the scale the Average Variance Extracted (AVE) was calculated. Results: The one-factor solution shows an acceptable fit in both countries after deleting items 1, 6, and 14. For the resulting scale, the CR value is adequate, but the AVE is low. There is scalar invariance between Chile and Colombia, but not between these two countries and Spain. Conclusions: HC-PAIRS is useful for detecting misconceptions about the relationship between chronic low back pain that would cause health personnel to give wrong recommendations to patients. However, it has psychometric weaknesses, and it is advisable to obtain other evidence of validity.

Patient safety and the COVID-19 pandemic: a qualitative study of perspectives of front-line clinicians.

INTRODUCTION: Studies on the impacts of COVID-19 on patient safety are emerging. However, few studies have elicited the perspectives of front-line clinicians. METHODS: We interviewed clinicians from 16 US hospitals who worked in the emergency department, intensive care unit or inpatient unit during the COVID-19 pandemic. We asked about their experiences with both clinician well-being and patient care throughout the pandemic. We used a rigorous thematic analysis to code the interview transcripts. This study was part of a larger randomised control trial of an intervention to improve healthcare worker well-being during the COVID-19 pandemic; the findings described here draw from clinicians who spontaneously raised issues related to patient safety. RESULTS: 11 physicians and 16 nurses in our sample raised issues related to patient safety. We identified two primary themes: (1) compromised access to healthcare and (2) impaired care delivery. First, clinicians discussed how changes in access to healthcare early in the pandemic-including a shift to telehealth and deferred care-led to delays in accurate diagnosis and patients presenting later in their disease course. Second, clinicians discussed the effects of COVID-19 on care delivery related to staffing, equipment shortages and space constraints and how they deviated from the standard of care to manage these constraints. Clinicians noted how these issues led to patient safety events such as central line infections, patient falls and serious medication administration errors. CONCLUSIONS: Several well-intentioned interventions implemented in the early weeks of the pandemic created a unique context that affected patient safety throughout the pandemic. Future pandemic preparedness should consider planning that incorporates a patient safety lens to mitigate further harm from occurring during a public health crisis.

Factors associated with work ability among primary health care professionals: an integrative review.

The self-perception of the individual in relation to their health, work, and lifestyle is considered as work ability, a concept of various dimensions, characterizing a multidimensional and versatile construct, because it encompasses physical, mental, and social prerequisites. This study aims to identify the factors associated with work capacity among primary health care professionals. An integrative review was conducted from March to June 2020, following this eligibility criteria: studies in Portuguese, Spanish, and English; from 1996, available on PubMed, SciELO, LILACS, and Cochrane databases; longitudinal studies, clinical trials, and crosssectional studies; among primary health care professionals; which used the Work Ability Index. Three articles were found, two in English and one in Portuguese. It was concluded that further studies should be conducted, with primary health care professionals, in order to propose measures that can reduce inadequate capacity rates and better understand the variables associated with work ability.

A autopercepção do indivíduo em relação à saúde, ao trabalho e ao estilo de vida é considerada como a capacidade para o trabalho, um conceito de várias dimensões, caracterizando um constructo multidimensional e versátil por englobar pré-condições físicas, mentais e sociais. Este trabalho teve como objetivo identificar os fatores associados à capacidade para o trabalho entre profissionais de saúde da atenção primária. Foi realizada uma revisão integrativa no período de março a junho de 2020, seguindo os critérios de elegibilidade: artigos em português, espanhol e inglês; trabalhos disponíveis a partir de 1996 nas bases PubMed, SciELO, LILACS e Cochrane; estudos longitudinais, ensaios clínicos e estudos transversais; artigos com profissionais da saúde da atenção primária; e trabalhos que usaram o índice de capacidade para o trabalho. Foram encontrados três artigos, sendo dois em inglês e um em português. Concluiu-se que novos estudos devem ser realizados, com profissionais da equipe da atenção primária, a fim de propor medidas que possam reduzir taxas de capacidade inadequadas e gerar mais conhecimento sobre as variáveis associadas à capacidade para o trabalho.

Analysis of the influence of occupational, sociodemographic and health factors on the demotivation of the intensivist.

Introduction: Understanding motivation, identifying motivational factors of health professionals, and recognizing how managers and leaders can successfully motivate healthcare professionals is a growing concern. Objectives: To assess the occupational, sociodemographic, and health factors that influence the occurrence of demotivation in the intensive care unit professionals. Methods: We performed a cross-sectional study with health professionals from nine intensive care units in João Pessoa, Paraíba state, Brazil. Data were collected using an adapted version of the Health Care Establishment Questionnaire. We built a Logistic Regression model to analyze the influence of variables on the motivational state, and variables were selected by the Backward method. We used 80% of the sample for parameter estimation and the remaining 20% for testing and validation. We used the R software for the analyses, with a significance level of α ≤ 0.05. Results: We identify that the variable with the greatest power over the intensivist's demotivation was shift work (odds ratio [OR] = 4.215, p = 0.006). The number of symptoms (OR = 1.206, p = 0.000) and working time (OR = 1.080, p = 0.031) were also significant risk variables. When the three variables were combined, the professional's chance of feeling unmotivated increased by 38 times (OR = 38.99, p = 0.000). Conclusions: Based on these results, it is possible to identify aspects that will require organizational adjustments so that intensivists remain satisfied and motivated.

Introdução: Há uma crescente preocupação em relação a entender os fenômenos da motivação, identificar os fatores motivadores dos profissionais de saúde e reconhecer como o gestor e os líderes conseguem motivar a equipe com sucesso. Objetivo: Avaliar os fatores ocupacionais, sociodemográficos e de saúde que influenciam na ocorrência de desmotivação no profissional de saúde intensivista. Métodos: Tratou-se de um estudo transversal, realizado com profissionais de saúde de nove unidades de terapia intensiva localizadas em João Pessoa, no estado da Paraíba, Brasil. Os dados foram coletados por meio de uma versão adaptada do Health Care Establishment Questionnaire. Para análise da influência das variáveis sobre o estado motivacional, construiu-se um modelo de regressão logística, com seleção de variáveis pelo método backward. Utilizou-se 80% do total da amostra para estimação dos parâmetros, e os 20% restantes foram usados para o teste e a validação dos resultados. As análises foram realizadas no software R, com nível de significância de α ≤ 0,05. Resultados: Identificou-se que a variável com maior poder sobre a desmotivação do intensivista foi o trabalho em turnos (razão de chances [OR] = 4,215, p = 0,006). O quantitativo de queixas sintomatológicas (OR = 1,206, p = 0,000) e o tempo de trabalho (OR = 1,080, p = 0,031) também foram variáveis significativas sobre o risco. Quando as três variáveis estiveram combinadas, aumentou-se em 38 vezes a chance de o profissional se sentir desmotivado (OR = 38,99, p = 0,000). Conclusões: Com base nesses resultados, é possível identificar aspectos do trabalho que exigem ajustes organizacionais para que os intensivistas mantenham-se satisfeitos e motivados.

Kinesiophobia among health professionals' interventions: a scoping review.

Health professionals are regularly confronted with patients suffering from a fear of movement-related pain (unknown as kinesiophobia). The fear-avoidance attitudes and beliefs of healthcare professionals are likely to play a key role in their patients' therapeutic approach. However, kinesiophobia among health professionals is a relatively young topic. This scoping review aims to explore and catalogue the extent of scientific research that identifies the causes and consequences of kinesiophobia among health professionals while they perform their interventions. The review was based on the Joanna Briggs Institute manual and the PRISMA method for a scoping review. The research was conducted in May 2024 using CINHAL, Medline and Sportdiscus databases with the search terms "fear-avoidance", "kinesiophobia", "pain-related" and "physical therapist". Out of 2,162 potential studies, thirteen articles were included. No study directly mentioned kinesiophobia among health professionals, but it was studied through fear-avoidance beliefs. Two-thirds of the articles indicate that professionals with fear-avoidance beliefs tend to refer their patients to other specialists less frequently and limit their patients' activity, despite treatment guidelines. Most of the studies found were physiotherapists' interventions for chronic back pain patients. The current review emphasizes the need for additional studies involving more healthcare professionals and diverse health conditions.

What attributes of digital devices are important to clinicians in rehabilitation? A cross-cultural best-worst scaling study.

BACKGROUND: Digital interventions are becoming increasingly popular in rehabilitation. Understanding of device features which impact clinician adoption and satisfaction is limited. Research in the field should be conducted across diverse settings to ensure digital interventions do not exacerbate healthcare inequities. OBJECTIVE: This study aimed to understand rehabilitation clinicians' preferences regarding device attributes and included a cross-cultural comparison. MATERIALS AND METHODS: Choice experiment methodology (best-worst scaling) was used to survey rehabilitation clinicians across Australia and Brazil. Participants completed 10 best-worst questions, choosing the most and least important device attributes from subsets of 31 attributes in a partially balanced block design. Results were analysed using multinomial models by country and latent class. Attribute preference scores (PS) were scaled to 0-100 (least to most important). RESULTS: A total of 122 clinicians from Brazil and 104 clinicians from Australia completed the survey. Most respondents were physiotherapists (83%) working with neurological populations (51%) in the private/self-employed sector (51%) who had experience using rehabilitation devices (87%). Despite preference heterogeneity across country and work sector (public/not-for-profit versus private/self-employed/other), clinicians consistently prioritised patient outcomes (PS 100.0, 95%CI: 86.2-100.0), patient engagement (PS 93.9, 95%CI: 80.6-94.2), usability (PS 81.3, 95%CI: 68.8-82.5), research evidence (PS 80.4, 95%CI: 68.1-81.7) and risk (PS 75.7, 95%CI: 63.8-77.3). In Australia, clinicians favoured device attributes which facilitate increased therapy dosage (PS 79.2, 95%CI: 62.6-81.1) and encourage patient independent practice (PS 66.8, 95%CI: 52.0-69.2). In Brazil, clinicians preferred attributes enabling device use for providing clinical data (PS 67.6, 95%CI: 51.8-70.9) and conducting clinical assessments (PS 65.6, 95%CI: 50.2-68.8). CONCLUSION: Clinicians prioritise patients' needs and practical application over technical aspects of digital rehabilitation devices. Contextual factors shape clinician preferences rather than individual clinician characteristics. Future device design and research should consider preferences and influences, involving diverse stakeholders to account for context-driven variations across cultures and healthcare settings.

Occupational Stress in Healthcare Professionals in Spain: A Multicenter Study.

Introduction: Occupational stress significantly impacts healthcare professionals in the Spanish public hospital system. This study, conducted from April to June 2022, focuses on analyzing stress levels using the Nursing Stress Scale through an online survey. Methods: A cross-sectional study was carried out using an online survey from April to June 2022 in four hospitals. The Nursing Stress Scale was used to comprehensively assess stress levels among healthcare professionals. Results: The findings revealed a substantial contrast in stress outcomes based on personal circumstances. Healthcare professionals in stable partnerships and with children exhibited lower stress levels, acting as protective factors during the pandemic. Conversely, those engaged in rotating shifts, especially those working over 60 h per week, showed a sevenfold increase in high-stress probability (p < 0.05). Temporary contract holders and those with heightened exposure to COVID-19 reported elevated stress levels, highlighting the complex dynamics impacting the mental well-being of healthcare workers. Conclusions: Findings emphasize the necessity for targeted interventions to safeguard healthcare professionals' well-being, focusing on the psychological consequences of factors like rotating shifts and extended working hours. Protective elements such as stable partnerships and parenthood could serve as a foundation for initiatives supporting work-life balance, potentially involving government policies and hospital management.

The Future Needs of External Beam Radiotherapy in Portugal Until 2040.

AIMS: External beam radiotherapy (EBRT) is essential to offer an effective cancer treatment, but it needs to be accessible, well-timed, and high-quality. There is a global lack of radiotherapy infrastructure and investment that compromises the cancer outcomes. The authors aim to quantify the future needs of EBRT until 2040 to cover the future demand. MATERIALS AND METHODS: Based on the Global Cancer Observatory estimate for new cancer cases in Portugal for 2040 it was calculated the optimal number of EBRT courses. The OUP is the proportion of new cancer cases that should receive EBRT at least once. In line with the International Atomic Energy Agency (IAEA) DIrectory of RAdiotherapy Centres and European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology guidelines, we estimated the number of EBRT machines / Megavoltage (MV) units needed. Also, the authors followed the IAEA staffing guidelines. RESULTS: The calculated median increase in the optimal number of EBRT courses for the year 2040 was found to be 18% when compared to the requirements in 2020. The projected number of optimal EBRT courses for 2040 was estimated to be approximately 34.000. Consequently, a range of 18 to 30 new EBRT machines/ MV units will need to be installed to adequately address the growing demand. To meet this demand, it is anticipated that a total of 28 to 46 radiation oncologists, 22 to 36 medical physicists, and 61 to 102 radiation therapists will be required. CONCLUSION: The deficit of EBRT machines / MV units in Portugal will require a change in the cancer related - policies and an investment to offer full access to EBRT treatments.

Prevalence of stigma towards mental illness among Portuguese healthcare professionals: a descriptive and comparative study.

Background: Stigmatising attitudes among healthcare professionals can hinder access to healthcare, making it important to address this issue. This study aimed to investigate the prevalence of stigma related to mental illness among Portuguese healthcare professionals and to compare the results among mental health professionals, General Practitioners (GPs) and other health professionals. Methods: An online cross-sectional observational study was conducted in Portugal using Google Forms® to collect data. The data collection process lasted five months, from September 2023 to January 2024. Participants were recruited from various professional associations and Health Centre Groups, through a purposive sampling. The study used the Portuguese version of the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) to measure stigma which assesses three dimensions: attitudes towards disclosure and help-seeking, attitudes towards people with mental illness, and attitudes towards social distance. Results: A total of 292 healthcare professionals participated in the study. In Portugal, healthcare professionals displayed low to moderate levels of stigma towards mental illness (M = 22.17, SD = 5.41). Mental health professionals demonstrated significantly lower levels of stigma (M=20.37, SD=5.37) compared to other healthcare professionals (M=24.15, SD=4.71), including GPs (M=23.97, SD=5.03). Additionally, having a close friend or relative with mental illness seemed to be related with lower levels of stigma for the dimension attitudes towards social distance (M=6.93, SD=2.50), compared to not having one (M=7.60, SD=2.56). On the other hand, a personal history of mental illness indicated higher levels of stigma for the dimension disclosure and help-seeking (M=8.95, SD=3.07), compared to having no history of mental illness (M=8.16, SD=2.67). Conclusion: This study indicates that Portuguese healthcare professionals have stigmatising attitudes towards mental illness, although at low to moderate levels. Training and frequent interaction with people with mental illness seem to be associated with lower levels of stigma. Personal experience of mental illness seems to follow the opposite path regarding disclosure and seeking help. Thus, further research is necessary to evaluate the effectiveness of anti-stigma measures and deepen the study of the concept of self-stigma in healthcare professionals.

A Scoping Review on Staff Attitudes towards the Use of Coercion in Mental Healthcare.

Attitudes of mental health professionals towards the use of coercion are highly relevant concerning its use coercion in mental healthcare, as mental health professionals have to weigh ethical arguments and decide within a legal frame in which situations to use coercion or not. Therefore, assessment of those attitudes is relevant for research in this field. A vital instrument to measure those attitudes towards the use of coercion is the Staff Attitude to Coercion Scale. This scoping review aims to provide a structured overview of the advantages and limitations in the assessment of attitudes toward coercion. We conducted a scoping review in Medline, PsycINFO, CINAHL, and Web of Science, based on the PRISMA-ScR. Inclusion criteria were empirical studies on the attitudes of mental health professionals. We included 80 studies and systematically mapped data about the main results and limitations in assessing attitudes toward coercion. The main results highlighted the relevance and increased interest in staff attitudes towards coercion in mental healthcare. Still, the majority of the included studies relied on a variety of different concepts and definitions concerning attitudes. The data further indicated difficulties in developing new and adapting existing assessment instruments because of the equivocal definitions of underlying concepts. To improve the research and knowledge in this area, future studies should be based on solid theoretical foundations. We identified the need for methodological changes and standardized procedures that take into account existing evidence from attitude research in social psychology, nursing science, and other relevant research fields. This would include an update of the Staff Attitude to Coercion Scale based on the limitations identified in this review.

Pitfalls of Artificial Intelligence in Medicine.

Artificial Intelligence (AI) offers great promise for healthcare, but integrating it comes with challenges. Over-reliance on AI systems can lead to automation bias, necessitating human oversight. Ethical considerations, transparency, and collaboration between healthcare providers and AI developers are crucial. Pursuing ethical frameworks, bias mitigation techniques, and transparency measures is key to advancing AI's role in healthcare while upholding patient safety and quality care.

Knowledge, attitudes, and practices of healthcare providers among women oncofertility in Iran: a cross-sectional study.

BACKGROUND: In recent years, Iran has witnessed a remarkable increase in the incidence of cancer. This has led to an emerging challenge in the field of oncofertility, which seeks to address the impact of cancer treatments on fertility and endeavors to preserve reproduction. The study assessed healthcare providers' awareness, attitudes, and practices regarding fertility preservation (FP) in Iran. METHODS: A cross-sectional study was conducted to assess healthcare providers' knowledge, attitudes, and practices regarding oncofertility. An online self-made oncofertility survey of twenty-four items was administered to randomly selected participants from a list of healthcare providers registered with the Medical Council. The data were collected anonymously via Google Forms. Descriptive statistics, including number (n), prevalence (%), mean, and standard deviation, were calculated using SPSS 26.0. Additionally, chi-square tests were used to examine associations between categorical variables. Participants were categorized into oncology, obstetrics and gynecology (OB/GYN), and other specialties. RESULTS: A total of 423 responses were received and analyzed. Approximately 60% of the participants were obstetrics and gynecology subspecialists, while the remaining participants represented various disciplines such as surgery (9.7%), radiotherapy (6.4%), nuclear medicine (5.2%), and pediatrics (1.4%). More than 30% of the participants had not received any specific education about oncofertility, and more than 20% stated that FP strategies are not part of their routine treatment plan for young cancer patients. Oncologists had more education than those in the Obstetrics & Gynecology group. Half the participants were unaware of insurance coverage, and FP options were infrequently recommended. CONCLUSIONS: These findings highlight the urgent need to enhance healthcare workers' knowledge and attitudes toward FP in Iran and enable them to provide comprehensive support and guidance to cancer patients.

Paramedics' experiences and observations: work-related emotions and well-being resources during the initial months of the COVID-19 pandemic-a qualitative study.

BACKGROUND: As first responders, paramedics are an extremely important part of the care chain. COVID-19 significantly impacted their working circumstances. We examined, according to the experiences and observations of paramedics, (1) what kinds of emotions the Emergency Medical Service (EMS) personnel experienced in their new working circumstances, and (2) what work-related factors became resources for the well-being of EMS personnel during the initial months of the COVID-19 pandemic. METHODS: This qualitative study utilized reflective essay material written by experienced, advanced-level Finnish paramedics (n = 30). The essays used in this study were written during the fall of 2020 and reflected the period when Finland had declared a state of emergency (on 17.3.2020) and the Emergency Powers Act was implemented. The data was analyzed using an inductive thematic analysis. RESULTS: The emotions experienced by the EMS personnel in their new working circumstances formed three themes: (1) New concerns arose that were constantly present; (2) Surviving without proper guidance; and (3) Rapidly approaching breaking point. Three themes were formed from work-related factors that were identified as resources for the well-being of the EMS personnel. These were: (1) A high level of organizational efficiency was achieved; (2) Adaptable EMS operations; and (3) Encouraging atmosphere. CONCLUSIONS: Crisis management practices should be more attentive to personnel needs, ensuring that managerial and psychological support is readily available in crisis situations. Preparedness that ensures effective organizational adaptation also supports personnel well-being during sudden changes in working circumstances.

Exploring health equity integration among health service and delivery systems in Nova Scotia: perspectives of health system partners.

BACKGROUND: Achieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions. METHODS: Purposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration. RESULTS: Eleven individual interviews and one joint interview (n = 5 participants) were conducted, a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed. CONCLUSION: Our findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have implications for other jurisdictions seeking to advance health equity across health service and delivery systems.

Healthcare providers' communication experience in the pediatric intensive care unit: a phenomenological study.

BACKGROUND: Healthcare providers must effectively communicate with other professionals, multidisciplinary teams, and parents of patients in pediatric intensive care units (PICUs) to improve outcomes in children and satisfaction levels of parents. Few studies have focused on healthcare providers' communication experiences, which are crucial for identifying current problems and suggesting future directions. This phenomenological study was conducted to address this gap. METHODS: A qualitative study using online and face-to-face interviews was conducted from January to June 2021 by a trained researcher in PICUs of two tertiary hospitals. Participants were five physicians and four registered nurses who worked in the PICUs and had over five years of clinical experience. The interviews were audio recorded with the participant's consent and analyzed by the researchers using Colaizzi's seven-step method. RESULTS: Healthcare providers' communication experiences revealed four categories: facing communication difficulties in PICUs, communication relying on individual competencies without established communication methods, positive and negative experiences gained through the communication process, and finding the most effective communication approach. CONCLUSIONS: Without adequate support or a systematic training program, healthcare providers often have to overcome communication challenges on their own. Therefore, support and training programs should be developed to facilitate better communication in the future.