Sharing Culture and Management of Sex Work Information on Mobile Phones by Female Sex Workers in Nepal: Implications for mHealth Practice and Research.

Female sex workers (FSWs) in Nepal continue to be disproportionately at risk for Sexually Transmitted Infections (STIs), including HIV. Due to stigma related to sex work and HIV, FSWs keep their sex work information hidden, which poses a barrier to seeking health services. Emerging research indicates a high uptake of mobile phones among FSWs in Nepal. Mobile health (mHealth) interventions can provide health information and linkage to care. However, largely missing from the literature is FSWs' experience of managing the information about their involvement in sex work in a culture where sharing personal information and belongings is a part of the social norm, and maintaining privacy could have negative social repercussions. The current study aims to understand how FSWs perceive and manage privacy when they share their mobile phones. Using the Communication Privacy Management theory, we explore FSWs' perception of the threat to their privacy posed by mobile phones. We conducted 30 in-depth interviews among FSWs in Kathmandu, Nepal. Results showed that all participants owned mobile phones, and sharing devices was common. Mobile phones pose a considerable challenge in keeping sex work information private, and FSWs use various communication strategies to circumvent privacy threats. The findings highlight the mental and emotional burden FSWs face trying to conceal their private information in a sharing culture. The study discusses the importance of theorizing privacy in the cultural context of the Global South and the practical implications for developing mHealth interventions for this population.

Damage to medical complexes in the Israel-Hamas war: a geospatial analysis.

INTRODUCTION: Medical facilities are civilian objects specially protected during armed conflict by international humanitarian law (IHL). These protections are customarily applied regardless of the conflict, parties or contexts involved. Attacks on medical care have characterised the bombardment campaign of the Gaza Strip beginning 7 October 2023. This study presents evidence regarding patterns of damage to medical complexes relative to all other buildings in the first month of this conflict. METHODS: This is an observational pre/post-study of damage to buildings during the first month of the Israel Defence Force bombardment of Gaza from 7 October to 7 November 2023. Open-source polygons for the Gaza Strip were spatially joined with building damage assessments from satellite imagery analysis. Medical facilities were included in the analysis if they were cross-referenced by a minimum of two datasets. Welch's t-test was used to test for statistically significant differences in the proportions of damaged medical complexes and other buildings. RESULTS: A total of 167 292 unique buildings were identified, including 106 cross-referenced medical complexes. Approximately 9% of non-medical buildings and medical complexes alike sustained damage during the first month of the bombardment (p>0.7292). CONCLUSION: During the first month of the bombing campaign, evidence suggests medical complexes have not received special protection as required by IHL. This finding raises concerns about combatants' application of the principles of distinction, proportionality and precaution, suggesting the importance of further investigation.

Social support as a mediator between mental health and stigma among newly HIV-positive men who have sex with men.

OBJECTIVES: The sociocultural context of China gives rise to unique experiences of HIV-related stigma and adverse impacts on mental health among men who have sex with men (MSM) living with HIV. However, few studies have explored the stigma among families in the cultural context of China and the role of social support as a mediator to explain how HIV-related stigma results in poor psychological well-being. This study aims to test the mediating effect of social support between HIV-related stigma and family stigma on the mental health of MSM. METHODS: This cross-sectional study recruited newly MSM with HIV in two cities (Beijing and Wuhan) in China as participants from February 2021 to August 2022. A total of 257 MSM with HIV were recruited for the study. The mediating effects were examined using mediation models (SAS PROC CAUSALMED). RESULTS: The overall total effect of HIV-related stigma on mental health was ß = -1.483 (bootstrap 95% CI = -1.881, -1.104 p < 0.001), and the mediating effect of social support was ß = -0.321 (bootstrap 95% CI = -0.571, -0.167 p = .001). A higher level of stigma from family predicts lower mental health with an overall total effect of ß = -1.487 (bootstrap 95% CI = -1.823, -1.101 p < 0.001), while the indirect effect (mediation effect) of social support on mental health is ß = -0.281 (bootstrap 95% CI = -0.477, -0.142 p = .003). CONCLUSIONS: Given the mediating effect of social support on mental health, programs enhancing social support and decreasing stigmatization should be designed to improve the mental health of MSM with HIV, the interventions are needed at both the family and community levels. Public health campaigns in China that frame HIV and same-sex behavior as chronic issues and normal phenomena can correct misinformation related to HIV and MSM that leads to stigma and negative emotional reactions.

Curricula and resources related to social entrepreneurship and public health innovation within schools of public health in the United States.

This paper examines the current state of social innovation and entrepreneurship programming, courses, and centers within schools of public health through a survey data analysis. This report presents a cross-sectional survey conducted among faculty members of public health schools in the United States. The survey aims to determine the availability and current state of student-centered programs and courses centered around social innovation and entrepreneurship within schools of public health. Insights were drawn from 19 professionals across 15 schools of public health. Uncertainties surround the sustainability of current programs, with insufficient funding, human resources, and the need to teach more pressing topics identified as the most significant obstacles. Key areas identified as opportunities for growth were faculty engagement, expertise, and funding to expand more structured programming.

A survey of ethical sensitivity among nursing students and its influencing factors.

BACKGROUND: Nurses frequently experience ethical issues in their area of practice. In the challenging reality of today's healthcare environment, nursing students need to be prepared to deal with ethical issues in their future roles. Nevertheless, Chinese nursing students' ethical sensitivity status and the factors influencing it have not been described. OBJECTIVE: This study aims to explore the level of ethical sensitivity and its influencing factors among Chinese nursing students. RESEARCH DESIGN: This was a cross-sectional study. We firstly cross-culturally adapted the Japanese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) into a Chinese version. Then, we administered the Chinese version of ESQ-NS, the Caring Ability Inventory (CAI), and general information questionnaire to nursing undergraduates. PARTICIPANTS AND RESEARCH CONTEXT: The invitations were sent to 600 nursing undergraduates from four universities in Hunan, China. ETHICAL CONSIDERATIONS: The study was supported by the Institutional Review Board (IRB) of the lead university. The Approval No. was E202092. RESULTS: A total of 489 undergraduate nursing students participated in the study. The mean score for ethical sensitivity of the samples was 36.34 ± 4.90, and 187.99 ± 22.64 for their humanistic care ability. Pearson's correlation coefficient test indicated a meaningful and positive relationship between the ethical sensitivity and humanistic care ability (r = 0.576 and p < .01). And regression analysis showed that age, school year, experience in studying nursing ethics, how much you like nursing major, and humanistic care ability were of relevance to nursing students' ethical sensitivity. DISCUSSION: Our findings suggest that the mean ethical sensitivity score of Chinese nursing students is 36.34 (13-52). The humanistic caring ability of Chinese nursing students is still at a low level. CONCLUSION: Future interventions for improving the ethical sensitivity of the nursing students should consider general information of participants and their humanistic care ability.

Gender inequality and burden of orofacial clefts in the Eastern Mediterranean region: findings from global burden of disease study 1990-2019.

BACKGROUND: Gender inequality may be associated with the burden of orofacial clefts (OFCs), particularly in low-and middle-income countries (LMICs). To investigate the OFCs' burden and its association with gender inequality in the Eastern Mediterranean region (EMR). METHODS: Country-specific data on the OFCs' prevalence and Disability-Adjusted Life Years (DALYs) from 1990 to 2019 were gathered from the Global Burden of Disease database by age and gender. Estimated annual percentage change (EAPCs) was used to investigate the OFCs' trends. The association of the Gender Inequality Index (GII) with prevalence and DALY rates was determined using multiple linear regression. Human Development Index (HDI), Socio-Demographic Index (SDI), and Gross Domestic Product (GDP) were also considered as potential confounders. RESULTS: In 2019, the overall regional OFCs' prevalence and DALYs (per 100,000 person-years) were 93.84 and 9.68, respectively. During the 1990-2019 period, there was a decrease in prevalence (EAPC = -0.05%), demonstrating a consistent trend across genders. Moreover, within the same timeframe, DALYs also declined (EAPC = -2.10%), with a more pronounced reduction observed among females. Gender differences were observed in age-specific prevalence rates (p-value = 0.015). GII was associated with DALYs (ßmale= -0.42, p-value = 0.1; ßfemale = 0.48, p-value = 0.036) and prevalence (ßmale= -1.86, p-value < 0.001, ßfemale= -2.07, p-value < 0.001). CONCLUSIONS: Despite a declining prevalence, the burden of OFCs remained notably significant in the EMR. Gender inequality is associated with the burden of OFCs in the Eastern Mediterranean region. Countries in the region should establish comprehensive public policies to mitigate gender inequalities in healthcare services available for OFCs.

Epidemiology of substance use and mental health disorders among forced migrants displaced from the MENAT region: A systematic review and meta-analysis protocol.

BACKGROUND: Understanding the epidemiology of substance use disorders (SUDs) and mental health disorders (MHDs) among forced migrants from the Middle East and North Africa and Türkiye (MENAT) region is of utmost importance given their distinct challenges and vulnerabilities. Existing research on the topic is substantial; however, comprehensive systematic reviews are limited. We aim to conduct a systematic literature review to bridge this gap, providing a thorough understanding of SUDs and MHDs epidemiology among this population. METHODS: The systematic review will include original, peer-reviewed research articles published in English or Arabic between 2013 and 2023. It will encompass qualitative, quantitative, and mixed-methods studies focusing on SUDs and/or MHDs among forced migrants from the MENAT region. A Medline (via Ovid) search strategy was developed and will be translated into databases of EMBASE (via Ovid), Web of Science Core Collection (as licensed at Yale), and CINAHL. Risk of Bias in the included studies will be assessed using the Joanna Briggs Institute (JBI) checklist for observational studies and the Cochrane Risk of Bias (ROB) 2 tool for intervention studies. Meta-analysis using random-effects models will be conducted and subgroup analyses based on studies' data will be performed. The systematic review will be conducted based on the framework introduced by the Joanna Briggs Institute. Additionally, the PRISMA-P extension for systematic reviews was used to report the present protocol. The present systematic review protocol has been registered with PROSPERO, an international prospective register of systematic reviews. The review's registration ID is CRD42021286882. DISCUSSION: The systematic review aims to explore, identify and synthesize the evidence to reveal the epidemiology of SU and/or MH of forced migrants of the MENAT region as described in this protocol. In sum, the review will provide evidence to fill the gap in the literature and help the stakeholders, policymakers, and health providers to expand current knowledge of the prevalence and risk factors of SU and/or MH in humanitarian settings.

Experiences of stigma, mental health, and coping strategies in Lebanon among Lebanese and displaced Syrian men who have sex with men: A qualitative study.

BACKGROUND: In Lebanon, men who have sex with men (MSM) face high rates of stigma, discrimination, and violence. Minority stress, or the unique stressors related to anti-MSM stigma and discrimination, negatively impacts the mental health of MSM. These stressors are heightened for those with intersectional minority identities such as displaced Syrian MSM in Lebanon. METHODS: In this qualitative study conducted in 2020-21, part of a larger study focused on the mental and sexual health risks among MSM, we collected qualitative data from Lebanese and displaced Syrian MSM living in Lebanon and analyzed reports of their experiences with stigma, mental health, and coping strategies. We conducted semi-structured, in-depth interviews with 12 displaced Syrian MSM and 13 Lebanese MSM. RESULTS: Our findings highlight how MSM in Lebanon navigate stigma and the mental health risks that result. Common stressors among Lebanese and displaced Syrian MSM were related to finances, sexual orientation discrimination, and social isolation. Comparing the two groups, we found that stressors specific to displaced Syrian MSM were related to adverse childhood experiences, recent exposure to the Syrian war, displacement, and discrimination in Lebanon based on their intersectional identities as MSM and Syrians. For Lebanese participants, the most common stigma coping strategies were avoidance, drinking alcohol, using drugs, or having sex. As for displaced Syrian MSM, the most common stigma coping strategy was seeking the freely available mental health services offered to them through non-governmental organizations. CONCLUSION: Our findings suggest that increased targeted mental health and social support interventions, informed by the unique experiences of Lebanese and displaced Syrian MSM, are highly needed to improve the coping and mental health resources of all MSM in Lebanon.

Informed consent in cancer clinical drug trials in China: a narrative literature review of the past 20 years.

BACKGROUND: Although the number of cancer clinical drug trials is increasing rapidly in China, issues concerning informed consent in this research context are understudied. By performing a narrative literature review, we aim to describe the current situation and identify the most salient challenges affecting informed consent in cancer clinical drug trials among adult patients in China since 2000. METHODS: We searched Web of Science (WOS), PubMed, Scopus, EMBASE, the Cochrane Library databases, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database on Disc (CBMdisc), Chinese Scientific Journals Fulltext Database (CQVIP), and WANFANG Data to identify relevant publications since 2000. Data were extracted by three reviewers on six items pertaining to study type, theme, and challenges. RESULTS: We identified 37 unique manuscripts, from which 19 full texts were obtained and six were included in the review. All six studies were published in Chinese journals, and the publication years of the majority (five out of six) of the studies were 2015 or later. The authors of the six studies were all from clinical departments or ethical review committees at five hospitals in China. All of the included publications were descriptive studies. Publications reported challenges related to the following aspects of informed consent: information disclosure, patient understanding, voluntariness, authorization, and procedural steps. CONCLUSION: Based on our analysis of publications over the past two decades, there are currently frequent challenges related to various aspects of informed consent in cancer clinical drug trials in China. Furthermore, only a limited number of high-quality research studies on informed consent in cancer clinical drug trials in China are available to date. Efforts toward improvement of informed consent practice, in the form of guidelines or further regulations in China, should draw on both experience from other countries and high-quality local evidence.

Knowledge and attitudes of Chinese medical postgraduates toward research ethics and research ethics committees: a cross-sectional study.

BACKGROUND: Research ethics provides the ethical standards for conducting sound and safe research. The field of medical research in China is rapidly growing and facing various ethical challenges. However, in China, little empirical research has been conducted on the knowledge and attitudes of medical postgraduates toward research ethics and RECs. It is critical for medical postgraduates to develop a proper knowledge of research ethics at the beginning of their careers. The purpose of this study was to assess the knowledge and attitudes of medical postgraduates toward research ethics and RECs. METHODS: This cross-sectional study was conducted from May to July 2021 at a medical school and two affiliated hospitals in south-central China. The instrument of the study was an online survey that was distributed via WeChat. RESULTS: We found that only 46.7% were familiar with the ethical guidelines for research with human subjects. In addition, 63.2% of participants were familiar with the RECs that reviewed their research, and 90.7% perceived RECs as helpful. However, only 36.8% were fully aware of the functions of RECs. In the meantime, 30.7% believed that review by an REC would delay research and make it more difficult for researchers. Furthermore, most participants (94.9%) believed that a course on research ethics should be mandatory for medical postgraduates. Finally, 27.4% of the respondents considered the fabrication of some data or results to be acceptable. CONCLUSION: This paper serves to suggest that research ethics education should be prioritized in medical ethics curriculum, and course syllabi or teaching methods should be revised to provide medical postgraduates with a deeper understanding of the principles, regulations, and specifics of research ethics. We also recommend that RECs provide diverse approaches in their review procedure to facilitate the understanding of medical postgraduates of the functions and processes of RECs and to enhance their awareness of research integrity.

COVID-19 Vaccine Acceptance and Hesitancy Among Health Care Workers in Lebanon.

BACKGROUND: Lebanon endured its worst economic and financial crisis in 2020-2021. To minimize the impact of COVID-19 pandemic, it is important to improve the overall COVID-19 vaccination rate. Given that vaccine hesitancy among health care workers (HCWs) affects the general population's decision to be vaccinated, our study assessed COVID-19 vaccine acceptance among Lebanon HCWs and identified barriers, demographic differences, and the most trusted sources of COVID-19 information. METHODS: A cross-sectional study was conducted between January and May 2021 among HCWs across nine hospitals, the Orders of Physicians, Nurses, and Pharmacists in Lebanon. Descriptive statistics were performed to evaluate the COVID-19 vaccine acceptance, and univariate and multivariable to identify their predictors. RESULTS: Among 879 participants, 762 (86.8%) were willing to receive the COVID-19 vaccine, 52 (5.9%) refused, and 64 (7.3%) were undecided. Males (226/254; 88.9%) and those ≥ 55 years (95/100; 95%) had the highest rates of acceptance. Of the 113 who were not willing to receive the vaccine, 54.9% reported that the vaccine was not studied well enough. Participants with a previous SARS-CoV-2 infection and those who did not know if they had a previous infection (p = 0.002) were less likely to accept the vaccine compared to those with no previous infection. The most trusted COVID-19 sources of information were WHO (69.3%) and healthcare providers (68%). CONCLUSION: Lebanese HCWs had a relatively high acceptance rate for COVID-19 vaccination compared to other countries. Our findings are important in informing the Lebanese health care authorities to establish programs and interventions to improve vaccine uptake among HCWs and the general population.

Knowledge of mental health diagnosis among patients and their family members: an inpatient survey in China.

BACKGROUND: Patient-oriented information disclosure has been advocated by the National Mental Health Law (NMHL) in China since 2012; however, reporting on diagnostic disclosure to patients with mental disorders after the NMHL is limited. AMIS: This study aims to investigate and compare the knowledge of mental health diagnosis among patients and their family members in China. METHODS: An inpatient survey was conducted among 205 patients with mental disorders and their family members. Group differences of the correctness of self-reported mental health diagnosis were compared, and logistic regression was performed to investigate correlates among both patients and their family members. RESULTS: Overall, 76.7% patients and 80.6% of their family members reported a correct diagnosis. Only 46.2% patients with psychotic disorders correctly knew their diagnosis, significantly lower than their family members and patients with non-psychotic disorders. Multivariate regression analysis found that the diagnosis of psychotic disorders was a risk factor of patients' diagnostic knowledge (AOR = 0.137; 95% CI = 0.044-0.429), while family members' diagnostic knowledge was associated with their employment (AOR = 6.125, 95% CI = 1.942-19.323) and parent-child relationship with patients (AOR = 3.719; 95% CI = 1.057-13.086). CONCLUSIONS: The majority of patients with non-psychotic disorders know their diagnosis correctly and informing family members of patients' diagnosis remains a common practice in psychiatric setting after the implementation of China's NMHL.

The COVID-19 Pandemic, Socioeconomic Effects, and Intimate Partner Violence Against Women: A Population-Based Cohort Study in 2020, Iran.

Objectives. To investigate the prevalence, pattern, and socioeconomic risk factors of intimate partner violence (IPV) before and 6 months after the pandemic onset among a cohort of Iranian women. Methods. We conducted a population-based IPV survey among 2502 partnered Iranian women aged 18 to 60 years before (n = 2502) and 6 months after (n=2116) the pandemic's onset. We estimated prevalence and incidence of psychological, physical, and sexual IPV, and the odds of different forms of IPV associated with main exposure variables, adjusted for participant relationship factors. Results. Pandemic prevalence of IPV (65.4%; 95% confidence interval [CI] = 63.4%, 67.4%) was higher than prepandemic prevalence (54.2%; 95% CI = 52.2%, 56.3%). At follow-up, the incidence of IPV was 25.5% (95% CI = 22.9%, 28.4%). The highest incidence was in cases of physical and sexual IPV. Women whose partners lost their employment were at significant risk of new exposure to IPV. Highest socioeconomic status (SES) was associated with less physical IPV (odds ratio = 0.03; 95% CI = 0.01, 0.14). Conclusions. IPV prevalence has risen since the COVID-19 epidemic began with many women who had never experienced IPV now facing it. Unemployment of women or their partners and prepandemic lower socioeconomic status are risk factors of IPV. Monitoring programs should target these populations. (Am J Public Health. 2023;113(2):228-237. https://doi.org/10.2105/AJPH.2022.306839).

Knowledge, attitudes and practices concerning breast cancer, cervical cancer and screening among healthcare professionals and students in Mogadishu, Somalia: a cross-sectional study.

Introduction: Somali women face exceptionally high mortality and incidence rates from both breast cancer (BC) and cervical cancer (CC). They experience the highest age-standardised BC mortality rate in Africa and an age-standardised BC incidence rate of 41.7 per 100,000 women. Somalia's second-highest cancer-related mortality and incidence rates are due to CC, both behind BC. It is critical to identify the underlying factors that may influence healthcare workers' management of both cancers. At present, there is a lack of evidence regarding providers' knowledge of these two cancers and their screening in Somalia. Methods: A cross-sectional questionnaire was administered with a purposive sampling strategy to 469 healthcare professionals and students and was completed by 405 (86%). Healthcare workers were recruited from Mogadishu-based hospitals. Results: One hundred and ninety-seven healthcare professionals and 207 students completed the survey and were included in the analysis. 89% and 73% of respondents demonstrated good knowledge of BC and CC, respectively. Only 46% knew that a vaccine could prevent CC, and 89% of healthcare professionals disagreed that human papillomavirus (HPV) vaccines were available to their patients. Attitudes towards cancer screening, in addition to breast self-examination (BSE), were overwhelmingly positive. For both BC and CC, 24% reported having treated a patient and 30% reported having conducted a screen for either disease. Conclusion: Overall, while knowledge of both diseases and screening was good, there remain areas for clear educational targeting such as HPV vaccine availability and BC preventability. Attitudes to screening for both diseases were exceedingly positive but, with the exception of BSE, failed to translate into practice due to inadequate resources and patient refusal. Future investments into Somalia's chronic care management should prioritise technology necessary to conduct screenings for both diseases, expanding HPV vaccine access and understanding patients' potential motivations for refusing screening.

Hybrid warfare and public health: Conflicts in Ukraine and Nagorno-Karabakh raise the alarm.

Hybrid warfare strategies include weaponization of healthcare, the use of non-conventional weapons, and strategic displacement of civilian populations via direct targeting, sexual violence, disinformation campaigns, and disruption of essential services such as water, food, gas, and access to health services. All these actions harm public health. The current war in Ukraine and the 2020 Second Nagorno-Karabakh war between Azerbaijan and Armenia serve as vivid examples of the novel and devastating public health effects of hybrid warfare targeting civilians. The lessons learned from these conflicts should serve as a warning and a call to action. Politicians and public health officials should advocate for a comprehensive rethinking of previous measures to counteract the impacts of hybrid warfare. Concerted efforts and strategies to mitigate these impacts on public health at every phase are essential. De-escalation of conflicts should be facilitated, and civilian health should be prioritized by the global community by instituting a more punitive and comprehensive schema to both deter war and step-up penalties for the tactics of hybrid warfare. Failure to do so will undoubtedly result in this scenario being played out with greater frequency globally, erasing the public health wins of the previous century.

Ethical Decision-making of Health Professionals Caring for People Living with HIV/AIDS in Hunan, China: A Qualitative Study.

Numerous ethical issues surged the moment acquired immunodeficiency syndrome (AIDS) was discovered. As advocates of people living with HIV/AIDS (PLWHA), health professionals encounter many ethical dilemmas in clinical practice. However, it remains unclear how health professionals solve these issues. The descriptive qualitative research was conducted through semi-structured interviews with 22 health professionals from May to August 2018. Three themes emerged from data analyses of the interviews: (1) real ethical dilemma experienced by health professionals, (2) factors influencing ethical judgment, (3) ethical motivations. About two-thirds of participants failed to recall ethical dilemmas experienced in their clinical practice. Emotions, gender, occupation, and difficulty balancing different roles may influence the ethical judgments of health professionals. In the ethical decision-making (EDM) process, most participants took other people's interests into consideration and conformed to law and professional codes of conduct. However, the fear of medical disputes (conflicts with families and others) was experienced by many participants, influencing their ethical behaviors.

Performance of IRBs in China: a survey on IRB employees and researchers' experiences and perceptions.

BACKGROUND: Performance evaluation is vital for IRB operations. As the number of IRBs and their responsibilities in reviewing and supervising clinical research grow in China, there is a significant need to evaluate their performances. To date, little research has examined IRB performance within China. The aim of this study was to ascertain the perspectives and experiences of IRB employees and researchers to (1) understand the current status of IRBs; (2) compare collected results with those of other countries; and (3) identify shortcomings to improve IRB performance. METHODS: This study was conducted in China from October 2020 to September 2021, using an online survey with the IRB-researcher assessment tool-Chinese version. RESULTS: 757 respondents were included in the analysis and classified into IRB employees, researchers, or those who are both IRB employees and researchers. Overall, the score for an ideal IRB was significantly higher than that of an actual IRB. Compared to the US National Validation study, Chinese participants and American participants both agree and differ in their perspectives on the most and least important ideal items. CONCLUSION: This investigation provides a benchmark of the perceived performance of actual IRBs in China. IRBs in China can be precisely adjusted by targeting identified areas of weakness to improve their performances.