'We thought supporting was strengthening': re-examining the role of external assistance for health systems strengthening in Zimbabwe post-COVID-19.

Zimbabwe has received substantial external assistance for health since the early 2000s, including funding earmarked for, or framed as, health systems strengthening (HSS). This study sought to examine whether external assistance has strengthened the health system (i.e. enabled comprehensive changes to health system performance drivers) or has just supported the health system (by increasing inputs and improving service coverage in the short term). Between August and October 2022, we conducted in-depth key informant interviews with 18 individuals and reviewed documents to understand: (1) whether external funding has supported or strengthened Zimbabwe's health system since the 2000s; (2) whether the experience of COVID-19 fosters a re-examination of what had been considered as HSS during the pre-pandemic era; and (3) areas to be reconsidered for HSS post COVID-19. Our findings suggest that external funders have supported Zimbabwe to control major epidemics and avert health system collapse. However, the COVID-19 pandemic showed that supporting the health system is not the same as strengthening it, as it became apparent at that time that the health sector is plagued with several system-wide bottlenecks. External funding is fragile and highly unsustainable, which reinforces the oft-ignored reality that HSS is a sovereign mandate of country-level authorities, and one that falls outside the core interests of external funders. The key positive lesson from the pandemic is that Zimbabwe is capable of raising domestic resources to fund HSS. However, there is no guarantee that such funding will be maintained. There is a need, then, to reconsider government's stewardship for HSS. External funders need to re-examine whether their funding really strengthens the national health system or just supports the country to provide basic services in their areas of interest.

Cross-sectional study: mindset towards Coronavirus in developing countries and lessons learned: the case of Sudan.

Introduction: People's mindset towards COVID-19 in developing countries has an impact on how they perceive and react to the preventative measures taken by the governments to contain the virus. Understanding the factors influencing the mindset and identifying lessons learned amidst COVID-19 are critical to inform any future intervention strategy. Methods: This was a cross-sectional, community-based study conducted to assess the mindset changes and lessons learned post-COVID-19 in developing countries, focusing on Sudan. The study adopted a sequential mixed approach (SMA), combining qualitative and quantitative methods. The study used a structured questionnaire with 300 respondents and in-depth interviews with two experts. To identify the factors influencing the mindset of the people towards COVID-19, the study employed logistic regression. The data was analyzed using SPSS software. Results: Of the total (N = 300) respondents, 59.0% are female, 59.3% are between the ages of 20 and 39, 79.7% have a university education, 25.3% have the Coronavirus, and 42.3% has their family or relative contracted the virus. Further, only 22.7% had taken the vaccine. Reasons for vaccine hesitancy include lack of trust (29.5%), fear of side effects (24.1%), and absence of the need to travel outside the country (25.5%). When the virus first appeared, 77.3% thought it posed a health risk, while 22.7% perceived it as a hoax or conspiracy. After 3 years, 73% still regarded it as a health threat, while 27% believed it was a hoax or conspiracy. The mindset was found to be influenced by age, history of the disease, the extent of trust in foreign media coverage, and the belief in the effectiveness of the vaccination. Conclusion: Assessing the mindset towards the virus and identifying the lessons learned from the pandemic could be of vital importance to control the spread of the virus in developing countries. Making use of such lessons and influencing the mindset of the people towards positive attitudes and behaviours are required to enhance the effectiveness of the health precaution measures adopted. Further research is required on the public's mistrust of foreign media coverage and the contribution of local media to educate the public about the virus, particularly among the elderly.

Conducting Community-Based Research in An African Immigrant Population: Lessons Learned.

Background: Although small, the African immigrant population is one of the fastest growing immigrant populations in the United States. Emerging research indicates a high prevalence of noncommunicable preventable chronic conditions in this population. Like other African Americans, African immigrants are mistrustful of the health care system, hampering efforts for prevention and intervention research. Purpose: To describe our experiences conducting 2 studies in an African immigrant community, discuss the lessons learned, and provide advice to researchers interested in conducting research in similar populations. Design: The 2 published studies for which we derive lessons learned for this paper were a cross-sectional study and a qualitative study using focus group interviews. Participants included Zimbabwean immigrants in the Eastern United States recruited at religious festivals and community events. The 2 studies enrolled a total of 135 participants. Results: Of our recruitment goal of 120 in the first study, we enrolled only 98 despite numerous efforts. However, after strategically partnering with a community advisory board (CAB), in the second study, we met our recruitment goal within 4 months. With the CAB, we recruited a larger proportion of men (38% versus 24%). Without the CAB, 350 individuals agreed to participate, but only 98 (28%) returned the questionnaire, whereas with the CAB, 40 agreed to participate, and 37 (93%) successfully completed the study. Conclusion: Conducting health-related research in immigrants requires strategic partnerships with the community to build strong relationships between the research team and the target community. By nurturing these relationships, research teams can effectively access this hard-to-reach population and achieve high participation.

Lessons learned: avoiding bias via multi-state analysis of patients' trajectories in real-time.

Objectives: Many studies have attempted to determine the disease severity and patterns of COVID-19. However, at the beginning of the pandemic, the complex patients' trajectories were only descriptively reported, and many analyses were worryingly prone to time-dependent-, selection-, and competing risk biases. Multi-state models avoid these biases by jointly analysing multiple clinical outcomes while taking into account their time dependency, including current cases, and modelling competing events. This paper uses a publicly available data set from the first wave in Israel as an example to demonstrate the benefits of analysing hospital data via multi-state methodology. Methods: We compared the outcome of the data analysis using multi-state models with the outcome obtained when various forms of bias are ignored. Furthermore, we used Cox regression to model the transitions among the states in a multi-state model. This allowed for the comparison of the covariates' influence on transition rates between the two states. Lastly, we calculated expected lengths of stay and state probabilities based on the multi-state model and visualised it using stacked probability plots. Results: Compared to standard methods, multi-state models avoid many biases in the analysis of real-time disease developments. The utility of multi-state models is further highlighted through the use of stacked probability plots, which visualise the results. In addition, by stratification of disease patterns by subgroups and visualisation of the distribution of possible outcomes, these models bring the data into an interpretable form. Conclusion: To accurately guide the provision of medical resources, this paper recommends the real-time collection of hospital data and its analysis using multi-state models, as this method eliminates many potential biases. By applying multi-state models to real-time data, the gained knowledge allows rapid detection of altered disease courses when new variants arise, which is essential when informing medical and political decision-makers as well as the general population.

Examining the performance of responding to the Khoy earthquake 2022, challenges, strengths, and lessons learned: thematic analysis.

OBJECTIVE: Disasters in developing countries result in higher human and financial losses compared to global standards, with the death rate being 12 times higher than that of developed countries. Many experts attribute the failures in disaster management to the lack of a system for documenting and analyzing disaster management functions and not leveraging the experiences and lessons learned. This study employed a qualitative data collection approach, utilizing semi-structured interviews with managers, deputies, members of operational teams, and individuals affected by the disaster in the area. This research aims to explore the challenges, strengths, and lessons learned from the response to the Khoy earthquake in Iran. RESULTS: After conducting 40 interviews and achieving data saturation, we extracted experiences and lessons learned to investigate the performance of responsible organizations in the 2022 Khoy earthquake. The obtained data were categorized into 8 categories and 39 sub-categories. These categories encompassed warning and calling forces, disaster assessment, disaster commanding, emergency housing, supply and distribution of items, organization, and guidance of public participation and charities, psychological support, logistics operations, monitoring, evaluation, documentation, information dissemination, and media management. Planners and operational managers can use the findings to review and revise their action and prevention plans.

[Success factors and obstacles in the implementation of competence-oriented teaching in surgery]. / Erfolgsfaktoren und Hindernisse bei der Implementierung kompetenzorientierter Lehre in der Chirurgie.

BACKGROUND AND OBJECTIVES: For successful competence-oriented teaching at the medical faculties it is important to identify the factors that influence its implementation in order to benefit from the strengths and balance out weaknesses. The present study examined the success factors and obstacles of the implementation of competence-oriented teaching in the surgical discipline from the point of view of students and lecturers. METHODS: After implementation of competence-oriented teaching based on the teaching goals of the NKLM, in clinical examination courses (bedside teaching and block internship, BP) at two hospitals, a qualitative content analysis and quantification of the answers were performed using focus group interviews and questionnaires with students (S) and lecturers (D). RESULTS: During the summer semester 2022 a total of 31 students and 14 lecturers were interviewed in focus groups and 143 questionnaires (123 S, 20 D) were analyzed. For the students the presence of concrete competences/teaching goals, guidelines for the lesson, transparent goals and ability to demand teaching goals as well as structured lessons and mentoring were the main success factors. Lecturers on the other hand reported the presence of concrete goals, assistance for the lesson preparation and the activity of the students as success factors. The results of the questionnaires showed that the majority (88% S, 75% D) were informed about the teaching goals and considered them to be followed (84%S, 95% D). Obstacles were the factors "time", "mentoring" and "information". Factors that were between negative and positive (indifferent factors) were "uncertainty about competence-orientation" and "uncertainty how to examine the teaching success". DISCUSSION: Transparent structure and teaching goals as well as a mentoring system are the success factors for the implementation of competence-oriented lessons and should be used as strengths. Indifferent factors represent weaknesses and need to be addressed by training and instruction. Restricted time and personnel resources are the immanent problems that hamper the implementation and require fulminant structural changes.

Implementation of Complex Suicide Prevention Interventions: Insights into Barriers, Facilitators and Lessons Learned.

INTRODUCTION: Effective suicide prevention interventions are infrequently translated into practice and policy. One way to bridge this gap is to understand the influence of theoretical determinants on intervention delivery, adoption, and sustainment and lessons learned. This study aimed to examine barriers, facilitators and lessons learned from implementing complex suicide prevention interventions across the world. METHODS AND MATERIALS: This study was a secondary analysis of a systematic review of complex suicide prevention interventions, following updated PRISMA guidelines. English published records and grey literature between 1990 and 2022 were searched on PubMed, CINAHL, PsycINFO, ProQuest, SCOPUS and CENTRAL. Related reports were organized into clusters. Data was extracted from clusters of reports on interventions and were mapped using the updated Consolidated Framework for Implementation Research. RESULTS: The most frequently-reported barriers were reported within the intervention setting and were related to the perceived appropriateness of interventions within settings; shared norms, beliefs; and maintaining formal and informal networks and connections. The most frequently reported facilitators concerned individuals' motivation, capability/capacity, and felt need. Lessons learned focused on the importance of tailoring the intervention, responding to contextual needs and the importance of community engagement throughout the process. CONCLUSION: This study emphasizes the importance of documenting and analyzing important influences on implementation. The complex interplay between the contextual determinants and implementation is discussed. These findings contribute to a better understanding of barriers and facilitators salient for implementation of complex suicide prevention interventions.

How to Overcome the Barriers Behind Writing Case Reports for Beginners and Young General Physicians.

Background: Case reports are fundamental to clinical medicine that trace back to ancient Egypt preceding Hippocrates in the history of medicine. Case reports contribute to academic development and new clinical research. However, among cases presented at an annual academic conference for Japanese generalists, only a few cases were later published in peer-reviewed journals, highlighting potential barriers regarding the writing of case reports, such as mentorship absence. This paper aimed to offer guidance and strategies to novice and young general physicians in overcoming barriers and effectively composing case reports for international peer-reviewed journals. Methods: This paper focuses on case reports for general physicians with extensive experience in writing case reports for international peer-reviewed journals. We conducted a narrative review to help beginners and young general physicians in writing case reports and discussed strategies for overcoming these barriers. Results: We propose the following three tips as important processes for writing case reports: recognize the types of suitable cases for case reports; select a journal for submission using a list of candidate journals for general physicians; and organize the discussion section with one theme per paragraph. In addition, we provide a list of journals that specifically focus on case reports, along with important pointers for beginners and young general physicians that will assist authors in the field of general medicine in choosing appropriate journals for submission. Conclusion: We hope that understanding and applying these tips will aid beginners and young general physicians in writing case reports.

From Crisis to Opportunity: A Qualitative Study on Rehabilitation Therapists' Experiences and Post-Pandemic Perspectives.

Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care.

The mental health of high school students returning to in-class lessons.

OBJECTIVES: It is known that lockdown alters the mental health of children in general and adolescents in particular. Here, we surveyed the mental health of high school students returning to in-class lessons after the pandemic. We compared an "anxious-depressed" group with a "neither anxious nor depressed" group with regard to perceived self-efficacy. METHODS: Students from a high school in the Rhône-Alpes region of France participated in a mental health survey. After the students had been given a study information sheet and had agreed to participate, they filled out three paper-based questionnaires the State-Trait Anxiety Inventory for Children (STAI-C), the Center for Epidemiological Studies-Depression (CES-D) self-questionnaire, and the Self-Efficacy Questionnaire for Children (SEQ-C) on an anonymous basis. RESULTS: A total of 709 datasets were analyzed. The participants' mean±standard deviation age was 15.89±0.93. The group comprised 438 girls, 251 boys, and 20 participants who did not state their sex. Compared with the boys, the girls had significantly higher scores in the STAI-C and CES-D questionnaires. According to the SEQ-C, the boys felt significantly more effective than the girls overall and for social efficacy and emotional efficacy. In contrast, the boys and girls did not differ regarding the academic efficacy score. Our main findings were that 53% (n=379) of the high school students were reportedly free of anxiety or depression, 28% (n=198) showed symptoms of subclinical anxiety and depression, and 19% (n=131) showed symptoms of clinical anxiety or depression. We compared the "anxious-depressed" group with the "neither anxious nor depressed" group: the former group was mainly composed of girls, whereas there were nearly as many boys as girls in the latter group. After adjustment for sex, the overall self-efficacy and the academic, social and emotional efficacy scores were found to be lower in the "anxious-depressed" group. The sex difference was null for social efficacy, small for overall efficacy and academic efficacy, and moderate for emotional efficacy. CONCLUSIONS: Overall, 47% of the study participants reported subclinical anxiety and/or a depression. It appears that anxiety and depression are linked to self-efficacy: the self-efficacy score was lower in the "anxious-depressed" group than in the "neither anxious nor depressed" group.

Lessons Learned from COVID-19 Response in Correctional and Detention Facilities.

The COVID-19 pandemic disproportionately affected persons held in and working in correctional and detention facilities, causing facilities' traditional priorities to shift when healthcare and public health needs temporarily drove many aspects of operations. During July-August 2022, we interviewed members of health departments and criminal justice organizations to document lessons learned from the COVID-19 response in correctional settings. Participants valued enhanced partnerships, flexibility, and innovation, as well as real-time data and corrections-specific public health guidance. Challenges included cross-sector collaborations, population density, scarcity of equipment and supplies, and mental health. Most participants reported improved relationships between criminal justice and public health organizations during the pandemic. Lessons from COVID-19 can be applied to everyday public health preparedness and emergency response in correctional facilities by ensuring representation of correctional health in public health strategy and practice and providing timely, data-driven, and partner-informed guidance tailored to correctional environments when public health needs arise.

Digital storytelling online: a case report exploring virtual design, implementation opportunities and challenges.

BACKGROUND: Digital storytelling is an arts-informed approach that engages short, first-person videos, typically three to five minutes in length, to communicate a personal narrative. Prior to the pandemic, digital storytelling initiatives in health services research were often conducted during face-to-face workshops scheduled over multiple days. However, throughout the COVID-19 lockdowns where social distancing requirements needed to be maintained, many digital storytelling projects were adapted to online platforms. METHODS: As part of a research project aiming to explore the day surgery treatment and recovery experiences of women with breast cancer in Peel region, we decided to pivot our digital storytelling process to an online format. During the process, we observed that the online digital storytelling format had multiple opportunities and challenges to implementation. RESULTS: This paper outlines our promising practices and lessons learned when designing and implementing an online digital storytelling project including pre-production, production and post-production considerations. CONCLUSIONS: We provide lessons learned for future teams intending to conduct an online digital storytelling project.

Digital storytelling uses pictures, video clips and audio to create a short, first-person video, to share a person's story. Before the pandemic, digital storytelling workshops were often held in-person over multiple days to help members of the community create their own digital stories. However, throughout COVID-19, many digital storytelling workshops were held online instead. This paper outlines our lessons learned when hosting an online digital storytelling workshop series to capture women's experiences with breast cancer in our local community. We hope our lessons learned are helpful for other teams who are considering using online digital storytelling workshops for their own research projects.

Practical Considerations for Navigating Withdrawal from the Federal Select Agent Program.

Introduction: Clear guidance is provided by the Federal Select Agent Program (FSAP) to assist registered entities in nearly all facets of compliance with the Federal select agent regulations (7 CFR Part 331; 9 CFR Part 121; 42 CFR Part 73). If a registered entity chooses to discontinue its registration, detailed instructions for registration withdrawal are deeply embedded within a document entitled "eFSAP Form 1 Amendment Instructions," which is found on the FSAP website within the electronic Federal Select Agent Program (eFSAP) Resource Center. Methods: Using the information found within the eFSAP Form 1 Amendment Instructions, as well as extensive written and verbal guidance provided by the lead assigned entity point of contact at the FSAP, we completed the FSAP withdrawal process during a 12-month period between 2022 and 2023. Discussion: This commentary shares our recent professional experiences navigating the FSAP withdrawal process at the University of Texas Health Science Center at Houston (UTHealth Houston). Successes, challenges, and lessons learned are shared so that others planning or considering withdrawing may benefit from our experience. Conclusion: The resources provided for withdrawal within the eFSAP Form 1 Amendment Instructions are relatively basic, and additional details are not currently found in other FSAP guidance documents. Therefore, direct communication and support from the FSAP to the entity Responsible Officials are imperative to ensure a safe, secure, and compliant withdrawal.

Unmasking the Unrecognized: Exploring Registered Pharmacy Technicians' Stressors During COVID-19 Through a Demands-Resources Inquiry and Looking Ahead.

Canadian registered pharmacy technicians (RPTs) were vital in supporting pharmacy operations during the pandemic. However, they have received little attention during or pre-pandemic. This study aimed to identify and understand the stressors experienced by Canadian RPTs during the pandemic and gain insights on lessons learned to help improve the profession. Through a descriptive qualitative design, virtual semi-structured focus groups were conducted with RPTs who were recruited through various sampling methods across Canada. Data were inductively analyzed and then deductively; themes were categorized using the Job Demands-Resources (JD-R) model. We reached data saturation after 4 focus group sessions with a total of 16 participants. As per the JD-R model, job demands included: (1) increased work volume and hours to meet patient demand; (2) drug shortages and managing prescriptions increased due to influx of orders coinciding with restricted access to medications; (3) fear of the unknown nature of COVID-19 met with frequent change in practices due to protocol changes and ineffective communication; and, (4) the pandemic introduced several factors leading to increased staff shortages. Themes pertaining to resources included: (1) poor incentives and limited access to well-being resources; (2) limited personal protective equipment delaying work operations; (3) and a general lack of knowledge or appreciation of the profession impacting work morale. Lessons learned from the pandemic were also provided. Overall, our findings revealed an imbalance where RPTs experienced high job demands with limited resources. Improved leadership within pharmacies, including improved communication between team members, is required. Furthermore, efforts to highlight and recognize the work of RPTs to the public is important to help improve enrollment, especially with their recent scope of practice expansion.

The role of momentary emotions in promoting error learning orientation among lower secondary school students: An intervention study embedded in a short visual programming course.

BACKGROUND: Students make many errors in visual programming. In order to learn from these, it is important that students regulate their emotions and view errors as learning opportunities. AIMS: This study aimed to explore to what extent momentary emotions, specifically enjoyment, anxiety and boredom, as well as the error learning orientation of students, interacted during a 1-day course on visual programming in an out-of-school learning environment. SAMPLES: The sample consisted of 269 lower secondary school students (grades 7-9). METHODS: The data were collected in an intervention study, with questionnaires applied directly before and after the course, and with four measurements of state emotions during the course. RESULTS: The results showed that error learning orientation had an expected effect on the students' emotions at the beginning of the course. The emotions changed positively over the course of the workshop, while the error learning orientation remained stable. No differences in error learning orientation were found between the control and intervention groups. An expected, reciprocal effect of students' emotions on their error learning orientation at the end of the course day could not be found. CONCLUSION: Changes in error learning orientation are difficult to achieve during 1-day courses. Nevertheless, through targeted, pedagogical approaches, which aim to minimize the influence of unfavourable emotions that occur in problem-oriented learning situations, teachers could help students develop a positive error learning orientation in the long term, whereby errors are viewed as an opportunity for learning.

Ebola lessons: Did prior epidemic experience protect against the spread of COVID-19 in Sierra Leone?

The COVID-19 pandemic has prompted a re-examination of public health preparedness with an emphasis on lessons learned following the West African Ebola epidemic. However, much of this work focuses on technological solutions rather than social learning. Drawing upon anthropological work, this paper examines how Sierra Leoneans prepared for COVID-19 through a lens of "embodied epidemic memory." Findings reveal that while people felt more empowered to respond to COVID-19 due to their past experiences, traumatic memories from the Ebola outbreak also sparked logics of fear and avoidance, driven by mistrust toward the state and its healthcare system. As a result, people avoided healthcare facilities, and rumors concerning government corruption threatened mitigation efforts. While local populations should be better leveraged for their existing epidemic expertise, greater attention is needed to the "higher hanging fruit" of preparedness: restoring trust in the government's ability to respond to epidemics.

U.S. COVID-19 vaccine distribution strategies, systems, performance, and lessons learned, December 2020 - May 2023.

During December 2020 through May 2023, the Centers for Disease Control and Prevention's (CDC) Immunization Services Division supported and executed the largest vaccine distribution effort in U.S. history, delivering nearly one billion doses of COVID-19 vaccine to vaccine providers in all 50 states, District of Columbia, Puerto Rico, Virgin Islands, Guam, Federated States of Micronesia, American Samoa, Marshall Islands, Northern Mariana Islands, and Palau. While existing infrastructure, ordering, and distribution mechanisms were in place from the Vaccines for Children Program (VFC) and experience had been gained during the 2009 H1N1 pandemic and incorporated into influenza vaccination pandemic planning, the scale and complexity of the national mobilization against a novel coronavirus resulted in many previously unforeseen challenges, particularly related to transporting and storing the majority of the U.S. COVID-19 vaccine at frozen and ultra-cold temperatures. This article describes the infrastructure supporting the distribution of U.S. government-purchased COVID-19 vaccines that was in place pre-pandemic, and the infrastructure, processes, and communications efforts developed to support the heightened demands of the COVID-19 vaccination program, and describes lessons learned.

Policy Evolution and Lessons Learned from China's Efforts to Eliminate Leprosy.

The prevention and treatment of leprosy is a public health and social issue of global concern. China has become the first country in the world to put forward a proposal on the elimination of the harm caused by leprosy. This paper briefly introduces the status of the spread of leprosy in China, and systematically reviews the evolution of policies and measures at different stages of the disease in China, from the serious epidemic of leprosy to the control of the infection, to the basic elimination, and to the elimination of the hazards. On this basis, five main lessons learned from the control and elimination of leprosy in China were also summarized. These provide the basis for promoting the complete global elimination of leprosy and preventing its re-transmission, thereby benefiting all those who still suffer from the scourge of leprosy.