Search results for: health triangle

Authors: Saiakhil Chilaka

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Understanding the demographic factors that influence mortality from respiratory diseases like COVID-19, pneumonia, and influenza is crucial for informing public health policy. This study utilizes multivariable regression models to assess the relationship between state, sex, and age group on deaths from these diseases using U.S. data from 2020 to 2023. The analysis reveals that age and sex play significant roles in mortality, while state-level variations are minimal. Although the model’s low R-squared values indicate that additional factors are at play, this paper discusses how these findings, in light of recent research, can inform future public health policy, resource allocation, and intervention strategies.

Keywords: COVID-19, multivariable regression, public policy, data science

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Authors: Funmilayo Abiola Opadoja, Samuel Olukayode Awotona

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Nursing services costing has been a major interest to nurses for a long period of time. Determination of nursing costing is germane in order to show the effectiveness of nursing practice in an improved and affordable health care delivery system. This has been a major concern of managers that have the mind of quality and affordable health services. The treatment or intervention should be considered as ‘product’ of nursing care and should provide an explainable term for billing. The study was non-experimental, descriptive and went about eliciting the views of nurses on costing nursing care at two public hospitals namely: University College Hospital and Adeoyo Maternity Teaching Hospital. The questionnaire was the instrument used in eliciting nurse’s response. It was administered randomly on 300 selected respondents across various wards within the hospitals. The data was collected and analysed using SPSS20.0 to generate frequency, and cross-tabulations to explore the statistical relationship between variables. The result shows that 89.2% of the respondents viewed costing of nursing care as an important issued to be looked into. The study concluded that nursing care costing is germane to enhancing the status and imagery of the nurses, it is essential because it would enhance the performance of nurses in discharging their duties. There is need to have a procedural manual agreed on by nursing practitioner on costing of each care given.

Keywords: costing, health care delivery system, intervention, nursing care, practitioner

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Authors: Stanis Koko Nyalongomo, Benjamin Mputela Bankanza, Moise Kisempa Mahungudi

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Several areas in the Democratic Republic of Congo (DRC) experience serious problems of streaming and soil erosion. Erosion leads to degradation of soil health, and the three main causative factors of similar importance are deforestation, overgrazing, and land agricultural mismanagement. Degradation of soil health leads to a decrease in agricultural productivity and carbon dioxide (CO₂), and other greenhouse gas emissions. Agricultural productivity low, and sanitation-related diseases are a concern of a majority of DRC rural people -whose main livelihoods are conventional smallholder agriculture- due to degradation of agricultural soil health and prevalence of inappropriate sanitation in rural areas. Land management practices that increase soil carbon stocks on agricultural lands with practices including conservation agriculture and agroforestry do not only limit CO₂ emissions but also help prevent erosion while enhancing soil health and productivity. Promotion to adopt sustainable land management practices, especially conversion to well-managed agroforestry practices, is a necessity. This needs to be accompanied by incentives. Methods that incite smallholders to adopt practices that increase carbon stocks in agricultural lands and enhance soil health and productivity for social, economic, and environmental benefits, and give them the ability to get and use household dry toilets -included activities to inform and raise smallholder households awareness on the conversion of croplands to well-managed agroforestry systems through planting at least 20 fruit trees and/or acacias, soil carbon and practices that sequester it in soil and ecological sanitation; and offer smallholders technique and material supports and incentives under the form of dry toilets constructed for free for well-managed agroforestry implementation- were carried out to address problems of soil erosion as well as agricultural productivity and sanitation-related diseases. In 2018 and 2019, 19 of 23 targeted smallholder households expressed their satisfaction and converted their croplands to agroforestry through planting 374 trees, and each gotten 1 dry toilet constructed for free. Their neighbors expressed a willingness to participate in the project. Conversion to well-managed agroforestry practices offers many advantages to both farmers and the environment. The strategy of offering smallholders incentives for soil-friendly agricultural practices, especially well-managed agroforestry, is one of the solutions to prevent soil erosion. DRC rural people whose majority are smallholder households, need to be able to get and use dry toilets. So, dry toilets could be offered like incentives for well-managed agroforestry practices. Given the many advantages agroforestry and dry toilet can offer, recommendations are made for funding organizations to support such projects that promote the adoption of soil health practices.

Keywords: agroforestry, croplands, soil carbon, soil health

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Authors: Ye Sun, Han-Youl Lee, Kathy Musa-Veloso, Nabil Bosco

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Japan has been experiencing global ageing of population with the World’s leading life expectancy (80.8 y for men and 86.9 y for women) and among the lowest birth rate. Preventive nutrition-based approaches have been identified by the health authorities as one of the strategies to increase the healthy life expectancy and reduce the healthcare costs. However, the nutritional needs and status of the senior population have not been well characterized to provide targeted solutions. This study aims to describe the age- and gender-specific prevalence of inadequacy of macro- and micronutrients intake based on the latest Japan National Health and Nutrition Survey (JNHNS) 2014. JNHNS collected data on the consumption of foods and beverages using 1-day semi-weight household dietary record. Nutrient intake levels were then calculated using the Japanese standard tables of food composition. Where applicable, Japanese population-specific estimated average requirements (EAR) were used as a benchmark to determine the prevalence of potential nutrient intake inadequacy, and adequate intake (AI) were used for nutrients with no available EARs. In all, 3403 senior adults aged 60 y and above and 3324 young adults aged 19 to 59 y were included in the 2014 JNHNS. Age- and gender-specific differences were observed in the mean nutrient intakes as well as the prevalence of inadequacy. Among the 22 nutrients examined, the prevalence of inadequacy for iron, vitamin C, magnesium, potassium, and folic acid in the senior adults was significantly lower than young adults, suggesting potentially healthier dietary choices by the seniors. However, there was still a considerable proportion of seniors who did not meet the requirement for key nutrients like vitamin B1 (67%), calcium (57%), vitamin A (48%), magnesium (47%), vitamin E (44%), and vitamin B6 (41%). Inadequate nutrient intake is generally more prevalent among elderly males than females for many nutrients, with the exception of iron (prevalence of inadequacy: 21% versus 42%) which could partly be explained by the higher intake recommendations for the females. In conclusion, high prevalence of nutrient inadequacy exists in older adults, with a potentially worsened picture for men. Such inadequacies could have multiple health implications including physical frailty and mental health. Further study is warranted to investigate the food consumption patterns that could explain the observed nutrient inadequacies, and to eventually develop nutrition-based solutions tailored to the needs of specific subgroups of the population.

Keywords: ageing, national health and nutrition survey, nutrients, nutrition

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Authors: Zakari Mustapha, Clinto Aigbavboa, Wellinton Didi Thwala

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Occupational Health and Safety (OHS) issues has been a major challenge to the Ghanaian government. The purpose of the study was to examine OHS practices in Ghana. The study looked at various views from different scholars about OHS practices in order to achieve the objective of the study. Literature review was conducted on OHS in Ghana. Findings from the study shows Ministry of Roads and Transport (MRT) and Ministry of Water Resources, Works and Housing (MWRWH) are two government ministries in charge of construction and implementation of the construction sector policy. The Factories, Offices and Shops Act 1970, Act 328 and the Mining Regulations 1970 LI 665 are the two major edicts. The study presents a strong background on OHS practices in Ghana and contribute to the body of knowledge on the solution to the current trends and challenges of OHS in the construction sector.

Keywords: ILO convention, OHS challenges, OHS practices, OHS improvement

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Authors: Namekong Fokeng Armand

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Background: Zoonoses are nowadays a serious public health problem in both developing and developed countries. They contribute to increase the economic burden. In case of emergence, rural populations are the most affected, hence the need to investigate risk practices in rural households of Penka-Michel (West Cameroon). Methods: This cross-sectional study was conducted from October to November 2021 among 200 heads of households living in the Penka-Michel health district (West Cameroon). It was done using a pre-tested and validated questionnaire, allowing to obtain socio-demographic, economic data, and data on zoonotic risk practices. Results: The participants [women (56%), men (44%)] worked mainly in the informal private sector (53%) and practiced agriculture secondarily (90%). Their highest level of education, for the most part, was a secondary school (50%); the average household size was 06 persons with a monthly income > 36270 FCFA (72%). 74% of household heads thought that animals can transmit diseases, and 17% had heard about zoonotic diseases through the media (65%). Rats caught in households (60%) were consumed there (74%), as was bush meat (61%) or dog meat (18%). For family food (90%), animals were slaughtered within the household (97%), rarely preceded by a veterinary inspection (6%). 87% of households practiced traditional rites with animal blood, 65% shared the same habitat as their animals, 41% did not systematically wash their hands after handling animals. More than 50% of households owned one or more dogs, usually strays (41%) and 48% of which were vaccinated (rabies). Many households had at least one: poultry (98%); pig (50%); dog (57%), cat (52%). 25% of households slaughtered sick animals for consumption, and 27% ate dead animals. Conclusion: This study identified numerous zoonotic risk practices in households in the Penka-Michel health district (West Cameroon). Concerted, multisectoral communication / awareness-raising actions are needed to break with these practices.

Keywords: zoonoses, risky practices, rural households, penka-michel, cameroon

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Authors: Layla Haidar, Shari Esquenazi-Karonika

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Introduction: Mental health includes one’s emotional, psychological, and interpersonal well-being; it ranges from “good” to “poor” on a continuum. At the individual-level, it affects how a person thinks, feels, and acts. Moreover, it determines how they cope with stress, relate to others, and interface with their surroundings. Research has yielded that mental health is directly related with short- and long-term physical health (including chronic disease), health risk behaviors, education-level, employment, and social relationships. As is the case with physical conditions like diabetes, heart disease, and cancer, mitigating the behavioral and genetic risks of debilitating mental health conditions like anxiety and depression can nurture a healthier quality of mental health throughout one’s life. In order to maximize the benefits of prevention, it is important to identify modifiable risks and develop protective habits earlier in life. Methods: The Adolescent Behaviors and Experiences Survey (ABES) dataset was used for this study. The ABES survey was administered to high school students (9th-12th grade) during January 2021- June 2021 by the Centers for Disease Control and Prevention (CDC). The data was analyzed to identify any associations between feelings of sadness, hopelessness, or increased suicidality among high school students with relation to their participation on one or more sports teams and their average daily consumed screen time. Data was analyzed using descriptive and multivariable analytic techniques. A multinomial logistic regression of each variable was conducted to examine if there was an association, while controlling for grade-level, sex, and race. Results: The findings from this study are insightful for administrators and policymakers who wish to address mounting concerns related to student mental health. The study revealed that compared to a student who participated on zero sports teams, students who participated in 1 or more sports teams showed a significantly increased risk of depression (p<0.05). Conversely, the rate of depression in students was significantly less in those who consumed 5 or more hours of screen time per day, compared to those who consumed less than 1 hour per day of screen time (p<0.05). Conclusion: These findings are informative and highlight the importance of understanding the nuances of student participation on sports teams (e.g., physical exertion, social dynamics of team, and the level of competitiveness within the sport). Likewise, the context of an individual’s screen time (e.g., social media, engaging in team-based video games, or watching television) can inform parental or school-based policies about screen time activity. Although physical activity has been proven to be important for emotional and physical well-being of youth, playing on multiple teams could have negative consequences on the emotional state of high school students potentially due to fatigue, overtraining, and injuries. Existing literature has highlighted the negative effects of screen time; however, further research needs to consider the type of screen-based consumption to better understand its effects on mental health.

Keywords: behavioral science, mental health, adolescents, prevention

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Authors: Inna Vinokurova, N. Savvina

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The goal of research: to study the organization of multi-field hospital’s work environment in the Republic of Sakha (Yakutia), Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine. Results: Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine is a multidisciplinary, specialized hospital complex that provides specialized and high-tech medical care to children and adults in the Republic of Sakha (Yakutia) of the Russian Federation. There are 5 diagnostic and treatment centers (advisory and diagnostic, clinical, pediatric, perinatal, Republican cardiologic dispensary) with 45 clinical specialized departments with 727 cots, 5 resuscitation departments, 20 operating rooms and out-patient department with 905 visits in alternation in the National Center of Medicine. Annually more than 20,000 patients receive treatment in the hospital of the Republican Hospital of the Republic of Sakha (Yakutia), more than 70,000 patients visit out-patient sections, more than 2 million researches are done, more than 12,000 surgeries are performed, more than 2 thousand babies are delivered. National Center of Medicine has a great influence with such population’s health indicators as total mortality, birth rate, maternal, infant and perinatal mortality, circulatory system incidence. The work environment of the Republican Hospital of the Republic of Sakha (Yakutia) is represented by the following structural departments: pharmacy, blood transfusion department, sterilization department, laundry, dietetic department, infant-feeding centre, material and technical supply. More than 200 employees work in this service. The main function of these services is to provide on-time and fail-safe supply with all necessary: wear parts, medical supplies, donated blood and its components, foodstuffs, hospital linen , sterile instruments, etc. Thus, the activity of medical organization depends on the work environment, including quality health care, so it is a main part of multi-field hospital activity.

Keywords: organization of multi-field hospital’s, work environment, quality health care, pharmacy, blood transfusion department, sterilization department

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Authors: Afrin Jaman Bonny, Mehrin Jahan, Zannatul Ferdhoush, Mumenunnessa Keya, Md. Shihab Mahmud, Sharun Akter Khushbu, Sheak Rashed Haider Noori, Sheikh Abujar

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In 2020, the SARS-CoV-2 pandemic had led all the educational institutions to move to online learning platforms to ensure safety as well as the continuation of learning without any disruption to students’ academic life. But after the reopening of those educational institutions suddenly in Bangladesh, it became a vital demand to observe students take on this decision and how much they are comfortable with the new habits. When all educational institutions were ordered to re-open after more than a year, data was collected from students of all educational levels. A Google Form was used to conduct this online survey, and a total of 565 students participated without being pressured. The survey reveals the students' preferences for online and offline education systems, as well as their mental health at the time including their behavior to get back to offline classes depending on getting vaccinated or not. After evaluating the findings, it is clear that respondents' choices vary depending on gender and educational level, with female and male participants experiencing various mental health difficulties and attitudes toward returning to offline classes. As a result of this study, the student’s overall perspective on the sudden reopening of their educational institutions has been analyzed.

Keywords: covid-19 epidemic, educational proceeding, university students, school/college students, physical activity, online platforms, mental health, psychological distress

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Authors: A. Sathiya Susuman, N. Wilson

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Background: The sexual behaviour of youths is believed to play an important role in the spread of sexually transmitted infections (STIs). Method: The data from the Malawi Demographic and Health Survey 2010 and a sample of 16,217 youth’s age 15 to 24 years (with each household 27.2% female and 72.8% male) was the basis for analysis. Bivariate and logistic regression analysis was performed. Results: The result shows married youth were not interested in condom use (94.2%, p<0.05). Those who were living together were 69 times (OR=1.69, 95% CI, 1.26–2.26) more likely to be involved in early sexual activity compared to those who were not living together. Conclusion: This scientific paper will help other researchers, policy makers, and planners to create strategies to encourage these youths to make use of contraception.

Keywords: sexually transmitted infections (STIs), reproductive tract infections (RTIs), condom use, sexual partners, early sexual debut, youths

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Authors: Daniel C. S. Lim

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There are numerous nutritional supplements, such as multivitamins and nutrition drinks, in the market today. Many of these supplements are expensive and tend to be driven commercially by business decisions and big marketing budgets. Many of the costs are ultimately borne by the end user in the quest for keeping to a healthy lifestyle. This paper proposes a system with a list of ten determinants to gauge how to decide the value of various supplements. It suggests variables such as composition, safety, efficacy and bioavailability, as well as several other considerations. These guidelines can help to tackle many of the issues that people of all ages face in the way that they receive essential nutrients. The system also aims to promote and improve the safety and choice of foods and supplements. In so doing, the system aims to promote the individual’s or population’s control over their own health and reduce the growing health care burden on the society.

Keywords: choice of foods and supplements, essential nutrients, nutritional supplements, system safety

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Authors: Piedad Lucia Bolivar Goez, Daniel Ignacio Garzon Luna, Maria Camila Balcero Angel, Sara Carolina Martinez Roman, Daniela Natalia Polo Rivas, Sandra Liliana Rocha Guitierrez

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This article provides a critical analysis on the conception of disorders of sexual development (DSDs) within the bioethics framework. By means of analytical thought, the objective is to approach topics such as the rediscovery of the body, the reinvention of sexuality and link them to the liability that health personnel have to inform people about the options they have to decide over their health and body. The medicalization of sexed bodies in both psychosocial and anatomo-morpho-physiological dimensions from a legal standpoint were analyzed. Its also explored the gender stereotypes established by society and the role of laws in guaranteeing the right of autonomy that takes on greater relevance in DSD. Through this analysis, it was concluded that despite intersexuality having been analyzed by Colombia’s Constitutional Court, that it is stated as a fair entity, the stigmatization by society has not allowed these individuals to belong to an egalitarian context in which everyone has the same opportunities of access to the goods and services that they need. This leads individuals to hide their identity and expression of genre in order to be accepted in a set of contexts. Thus creating a vulnerability that the health system must be able to identify and in which it is necessary to intervene at a biopsychosocial level, in order to guarantee the protection of the individual within an unquestionable frame of equality and solidarity.

Keywords: disorders of sex development, gender identity, sexuality, transgender persons

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Authors: Laura Struik, Sarah Dow-Fleisner, Robert Janke

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Introduction: The use of e-cigarettes, also known as vaping, has risen exponentially among North American youth and young adults (YYA) in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among YYA, with video advertisements on TV and other electronic platforms being the most pervasive strategy. It is unknown if or how these advertisements capitalize on the recently documented multi-faceted influences that contribute to the initiation of vaping among this demographic (e.g., stress, anxiety, gender, peers, etc.), which is examined in this study. Methods: This content analysis is phase one of a two-phased research project that aims to inform meaningful approaches to anti-vaping messaging and campaigns. As part of this first phase, a scoping review has been conducted to identify various influences (environmental, cognitive, contextual, social, and emotional) on e-cigarette uptake among YYA. The results of this scoping review will inform the development of a coding framework to analyze the multiple influences present in vaping advertisements, as seen on two popular television channels (Discovery and AMC). In addition, advertisement characteristics will be incorporated into the coding framework (e.g., the number of people present, demographic details, context, and setting, etc.), and analyzed. Findings: Findings will reveal the types of influences being leveraged in vaping advertisements, and identify the underlying messages that may be particularly attractive to YYA. This will contribute to a more nuanced understanding of how e-cigarette companies market their products and to whom. The results will also inform the next phase of this research project, which will encompass an analysis of anti-vaping advertisements and how the underpinning strategies align with those of the pro-vaping advertisements. Conclusions: Findings of this will study bring forward important implications for developing effective anti-vaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. Understanding which marketing strategies e-cigarette companies use is vital to our understanding of how to combat them. Findings will inform recommendations for public health efforts aimed at curbing e-cigarette use among YYA, and ultimately contribute to the health and well-being of YYA.

Keywords: e-cigarettes, youth and young adults, advertisements, public health

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Authors: Farhana Karim, Abdullah N. S. Khan, Mohiuddin A. K. Chowdhury, Nabila Zaka, Alexander Manu, Shams El Arifeen, Sk Masum Billah

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Breastfeeding, an integral part of newborn care, can reduce 55-87% of all-cause neonatal mortality and morbidity. Early initiation of breastfeeding within 1 hour of birth can avert 22% of newborn mortality. Only 45% of world’s newborns and 42% of newborns in South-Asia are put to the breast within one hour of birth. In Bangladesh, only a half of the mothers practice early initiation of breastfeeding which is less likely to be practiced if the baby is born in a health facility. This study aims to generate strong evidence for early initiation of breastfeeding practices in the government health facilities and to explore the associated factors influencing the practice. The study was conducted in selected health facilities in three neighbouring districts of Northern Bangladesh. Total 249 normal vaginal delivery cases were observed for 24 hours since the time of birth. The outcome variable was initiation of breastfeeding within 1 hour while the explanatory variables included type of health facility, privacy, presence of support person, stage of labour at admission, need for augmentation of labour, complications during delivery, need for episiotomy, spontaneous cry of the newborn, skin-to-skin contact with mother, post-natal contact with the service provider, receiving a post-natal examination and counselling on breastfeeding during postnatal contact. The simple descriptive statistics were employed to see the distribution of samples according to socio-demographic characteristics. Kruskal-Wallis test was carried out for testing the equality of medians among two or more categories of each variable and P-value is reported. A series of simple logistic regressions were conducted with all the potential explanatory variables to identify the determining factors for breastfeeding within 1 hour in a health facility. Finally, multiple logistic regression was conducted including the variables found significant at bi-variate analyses. Almost 90% participants initiated breastfeeding at the health facility and median time to initiate breastfeeding was 38 minutes. However, delivering in a sub-district hospital significantly delayed the breastfeeding initiation in comparison to delivering in a district hospital. Maintenance of adequate privacy and presence of separate staff for taking care of newborn significantly reduced the time in early breastfeeding initiation. Initiation time was found longer if the mother had an augmented labour, obstetric complications, and the newborn needed resuscitation. However, the initiation time was significantly early if the baby was put skin-to-skin on mother’s abdomen and received a postnatal examination by a provider. After controlling for the potential confounders, the odds of initiating breastfeeding within one hour of birth is higher if mother gives birth in a district hospital (AOR 3.0: 95% CI 1.5, 6.2), privacy is well-maintained (AOR 2.3: 95% CI 1.1, 4.5), babies cry spontaneously (AOR 7.7: 95% CI 3.3, 17.8), babies are put to skin-to-skin contact with mother (AOR 4.6: 95% CI 1.9, 11.2) and if the baby is examined by a provider in the facility (AOR 4.4: 95% CI 1.4, 14.2). The evidence generated by this study will hopefully direct the policymakers to identify and prioritize the scopes for creating and supporting early initiation of breastfeeding in the health facilities.

Keywords: Bangladesh, early initiation of breastfeeding, health facility, normal vaginal delivery, skin to skin contact

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Authors: Julaine Allan, Katarzyna Olcon, Padmini Pai, Lynne Keevers, Mim Fox, Maria Mackay, Ruth Everingham

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Effective local responses to community needs are grounded in contextual knowledge and build on existing resources. The Stability, Encompassing, Endurance & Direction (SEED) Wellbeing Program was created in 2020 in response to cumulative disasters, bushfires, floods and COVID, experienced by healthcare staff in the Illawarra Shoalhaven Local Health District, NSW Australia. SEED used a participatory action methodology to bring healthcare staff teams together to engage in restorative activities in the workplace. Guided by Practice Theory, this study identified the practices that supported the recovery of healthcare staff.

Keywords: mental health and wellbeing, workplace wellness, healthcare providers, natural disasters, COVID-19, burnout, occupational trauma

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Authors: Karimeh Alnuaimi, Manal Kassab, Reem Ali, Khitam Mohammad, Kholoud Shattnawi

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Aim: To compare pregnancy outcomes of Syrian refugee women and Jordanian women. Background and introduction: The current conflict in Syria continues to displace thousands to neighboring countries, including Jordan. Pregnant refugee women are therefore facing many difficulties are known to increase the prevalence of poor reproductive health outcomes and antenatal complications. However, there is very little awareness of whether Syrian refugee women have different risks of pregnancy outcomes than Jordanian women. Methods: Using a retrospective cohort design, we examined pregnancy outcomes for Syrian refugee (N = 616) and Jordanian women (N = 644) giving birth at two governmental Hospitals in the north of Jordan, between January 1, 2014, and December 31, 2014. A checklist of 13 variables was utilized. The primary outcome measures were delivery by Caesarean section, maternal complications, low birth weight (< 2500 g), Apgar score and preterm delivery (< 37 weeks' gestational age). Results: Statistical analysis revealed that refugee mothers had a significant increase in the rate of cesarean section and the higher rate of anemia, a lower neonates’ weight, and Apgar scores when compared to their Jordanian counterparts. Discussion and Conclusion: Results were congruent with findings from other studies in the region and worldwide. Minimizing inequalities in pregnancy outcomes between Syrian refugees and Jordan women is a healthcare priority. Implications for nursing and health policy: The findings could guide the planning and development of health policies in Jordan that would help to alleviate the situation regarding refugee populations. The action is required by the policy makers, specifically targeting public and primary health care services, to address the problem of adequately meeting the need for antenatal care of this vulnerable population.

Keywords: pregnancy, Syrian refugee, Jordanian women, comparative study

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Authors: Delana Theiventhiran, Wally J. Bartfay

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Background and Significance: As the Internet is becoming the epitome of modern communications, there are many pragmatic reasons why the digital divide matters in terms of accessing and using E-health based technologies. With the rise of technology usage globally, those in the older adult generation may not be as familiar and comfortable with technology usage and are thus put at a disadvantage compared to other generations such as millennials when examining and using E-health based platforms and technology. Currently, little is known about how older adults and millennials access and use e-health based technologies. Methods: A systemic review of the literature was undertaken employing the following three databases: (i) PubMed, (ii) ERIC, and (iii) CINAHL; employing the search term 'digital divide and generations' to identify potential articles. To extract required data from the studies, a data abstraction tool was created to obtain the following information: (a) author, (b) year of publication, (c) sample size, (d) country of origin, (e) design/methods, (f) major findings/outcomes obtained. Inclusion criteria included publication dates between the years of Jan 2009 to Aug 2018, written in the English language, target populations of older adults aged 65 and above and millennials, and peer reviewed quantitative studies only. Major Findings: PubMed provided 505 potential articles, where 23 of those articles met the inclusion criteria. Specifically, ERIC provided 53 potential articles, where no articles met criteria following data extraction. CINAHL provided 14 potential articles, where eight articles met criteria following data extraction. Conclusion: Practically speaking, identifying how newer E-health based technologies can be integrated into society and identifying why there is a gap with digital technology will help reduce the impact on generations and individuals who are not as familiar with technology and Internet usage. The largest concern of all is how to prepare older adults for new and emerging E-health technologies. Currently, there is a dearth of literature in this area because it is a newer area of research and little is known about it. The benefits and consequences of technology being integrated into daily living are being investigated as a newer area of research. Several of the articles (N=11) indicated that age is one of the larger factors contributing to the digital divide. Similarly, many of the examined articles (N=5) identify that privacy concerns were one of the main deterrents of technology usage for elderly individuals aged 65 and above. The older adult generation feels that privacy is one of the major concerns, especially in regards to how data is collected, used and possibly sold to third party groups by various websites. Additionally, access to technology, the Internet, and infrastructure also plays a large part in the way that individuals are able to receive and use information. Lastly, a change in the way that healthcare is currently used, received and distributed would also help attribute to the change to ensure that no generation is left behind in a technologically advanced society.

Keywords: digital divide, e-health, millennials, older adults

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Authors: M. F. Abreu, A. I. Aguiar, R. Gaio, R. Duarte

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Background: Prison establishments constitute high-risk environments for the transmission and spread of tuberculosis (TB), given their epidemiological context and the difficulty of implementing preventive and control measures. Guidelines for control and prevention of tuberculosis in prisons have been described as incomplete and heterogeneous internationally, due to several identified obstacles, for example scarcity of human resources and funding of prisoner health services. In Portugal, a protocol was created in 2014 with the aim to define and standardize procedures of detection and prevention of tuberculosis within prisons. Objective: The main objective of this study was to identify and describe barriers to tuberculosis detection in prisons of Porto and Lisbon districts in Portugal. Methods: A cross-sectional study was conducted from 2ⁿᵈ January 2018 till 30ᵗʰ June 2018. Semi-structured questionnaires were applied to health care professionals working in the prisons of the districts of Porto (n=6) and Lisbon (n=8). As inclusion criteria we considered having work experience in the area of tuberculosis (either in diagnosis, treatment, or follow up). The questionnaires were self-administered, in paper format. Descriptive analyses of the questionnaire variables were made using frequencies and median. Afterwards, a hierarchical agglomerative clusters analysis was performed. After obtaining the clusters, the chi-square test was applied to study the association between the variables collected and the clusters. The level of significance considered was 0.05. Results: From the total of 186 health professionals, 139 met the criteria of inclusion and 82 health professionals were interviewed (62,2% of participation). Most were female, nurses, with a median age of 34 years, with term employment contract. From the cluster analysis, two groups were identified with different characteristics and behaviors for the procedures of this protocol. Statistically significant results were found in: elements of cluster 1 (78% of the total participants) work in prisons for a longer time (p=0.003), 45,3% work > 4 years while 50% of the elements of cluster 2 work for less than a year, and more frequently answered they know and apply the procedures of the protocol (p=0.000). Both clusters answered frequently the need of having theoretical-practical training for TB (p=0.000), especially in the areas of diagnosis, treatment and prevention and that there is scarcity of funding to prisoner health services (p=0.000). Regarding procedures for TB screening (periodic and contact screening) and procedures for transferring a prisoner with this disease, cluster 1 also answered more frequently to perform them (p=0.000). They also referred that the material/equipment for TB screening is accessible and available (p=0.000). From this clusters we identified as barriers scarcity of human resources, the need to theoretical-practical training for tuberculosis, inexperience in working in health services prisons and limited knowledge of protocol procedures. Conclusions: The barriers found in this study are the same described internationally. This protocol is mostly being applied in portuguese prisons. The study also showed the need to invest in human and material resources. This investigation bridged gaps in knowledge that could help prison health services optimize the care provided for early detection and adherence of prisoners to treatment of tuberculosis.

Keywords: barriers, health care professionals, prisons, protocol, tuberculosis

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Authors: Perpetual Onyejelem, Kenichi Matsui

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Solid waste management has recently posed urgent challenges to environmental sustainability and public health in emerging Sub-Saharan urban centers. This paper examines solid waste management in Port Harcourt, the rapidly growing city in Nigeria, with a focus on current solid waste management practices and its health implications. To do so we analyzed past academic papers and official documents. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and its four-stage inclusion/exclusion criteria were utilized as part of a systematic literature review technique to identify papers related to solid waste management practices (Scopus and Google Scholar). In terms of policy documents, we focused on information about the implementation between 2014 and 2023. We found that the Rivers State Waste Management Policy and the National Policy on Solid Waste Management were the two most important documents to understand Port Harcourt’s practices. Past studies, however, highlighted that residents continued to dump waste in drainages as they were largely unaware of the policies that encourage them to sort waste. The studies tend to blame the city of its lack of political commitment to monitoring waste sites. Another study highlighted inefficient waste collection practices, the absence of community participation and poor resident awareness of 3R practices. Government documents and past studies tend to agree that an increase in disorderly waste management practices and the emergence of vector-borne diseases (e.g., malaria, lassa fever, cholera) co-incided in Port Harcourt. This led to increased spending for healthcare for locals, particularly low-income households. This study concludes by making some remedial recommendations.

Keywords: health effects, solid waste management practices, environmental pollution, Port Harcourt

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Authors: Teo Hao Jing, Shane Ho Ken Wae, Lee Jin Yu, Burra Venkata Durga Kumar

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Current distributed healthcare systems face the challenge of interoperability of health data. Storing electronic health records (EHR) in local databases causes them to be fragmented. This problem is aggravated as patients visit multiple healthcare providers in their lifetime. Existing solutions are unable to solve this issue and have caused burdens to healthcare specialists and patients alike. Blockchain technology was found to be able to increase the interoperability of health data by implementing digital access rules, enabling uniformed patient identity, and providing data aggregation. Consortium blockchain was found to have high read throughputs, is more trustworthy, more secure against external disruptions and accommodates transactions without fees. Therefore, this paper proposes a blockchain-based model for data management applications. In this model, a consortium blockchain is implemented by using a delegated proof of stake (DPoS) as its consensus mechanism. This blockchain allows collaboration between users from different organizations such as hospitals and medical bureaus. Patients serve as the owner of their information, where users from other parties require authorization from the patient to view their information. Hospitals upload the hash value of patients’ generated data to the blockchain, whereas the encrypted information is stored in a distributed cloud storage.

Keywords: blockchain technology, data management applications, healthcare, interoperability, delegated proof of stake

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Authors: Eeva Wallenius-Nareneva, Tuula Toivanen-Labiad

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Background: Oral health promotion event was organised for forty Afghanistan, Iraqi and Bangladeshi underage asylum seekers in Finland. The invitation to arrange this coaching occasion was accepted in the Degree Programme in Oral Hygiene in Metropolia. The personnel in the reception center found the need to improve oral health among the youngsters. The purpose was to strengthen the health literacy of the boys in their oral self-care and to reduce dental fears. The Finnish studies, especially the terminology of oral health was integrated to coaching with the help of interpreters. Cooperative learning was applied. Methods: Oral health was interactively discussed in four study group sessions: 1. The importance of healthy eating habits; - Good and bad diets, - Regular meals, - Acid attack o Xylitol. 2. Oral diseases − connection to general health; - Aetiology of gingivitis, periodontitis and caries, - Harmfulness of smoking 3. Tools and techniques for oral self-care; - Brushing and inter dental cleaning. 4. Sharing earlier dental care experiences; - Cultural differences, - Dental fear, - Regular check-ups. Results: During coaching deficiencies appeared in brushing and inter dental cleaning techniques. Some boys were used to wash their mouth with salt justifying it by salt’s antiseptic properties. Many brushed their teeth by vertical movements. The boys took feedback positively when a demonstration with model jaws revealed the inefficiency of the technique. The advantages of fluoride tooth paste were advised. Dental care procedures were new and frightening for many boys. Finnish dental care system was clarified. The safety and indolence of the treatments and informed consent were highlighted. Video presentations and the dialog lowered substantially the threshold to visit dental clinic. The occasion gave the students means for meeting patients from different cultural and language backgrounds. The information hidden behind the oral health problems of the asylum seekers was valuable. Conclusions: Learning dental care practices used in different cultures is essential for dental professionals. The project was a good start towards multicultural oral health care. More experiences are needed before graduation. Health education themes should be held simple regardless of the target group. The heterogeneity of the group does not pose a problem. Open discussion with questions leading to the theme works well in clarifying the target group’s knowledge level. Sharing own experiences strengthens the sense of equality among the participants and encourages them to express own opinions. Motivational interview method turned out to be successful. In the future coaching occasions must confirm active participation of everyone. This could be realized by dividing the participants to even smaller groups. The different languages impose challenges but they can be solved by using more interpreters. Their presence ensures that everyone understands the issues properly although the use of plain and sign languages are helpful. In further development, it would be crucial to arrange a rehearsal occasion to the same participants in two/three months’ time. This would strengthen the adaption of self-care practices and give the youngsters opportunity to pose more open questions. The students would gain valuable feedback regarding the effectiveness of their work.

Keywords: cooperative learning, interactive methods, motivational interviewing, oral health promotion, underage asylum seekers

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Authors: A. Calabrese, V. F. Uricchio, D. di Noia, S. Favale, C. Caiati, G. P. Maggi, G. Donvito, D. Diacono, S. Tangaro, A. Italiano, E. Riezzo, M. Zippitelli, M. Toriello, E. Celiberti, D. Festa, A. Colaianni

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Climate change has a severe impact on human health. There is a vast literature demonstrating temperature increase is causally related to cardiovascular problem and represents a high risk for human health, but there are not study that improve a solution. In this work, it is studied how the clime influenced the human parameter through the analysis of climatic conditions in an area of the Apulia Region: Capurso Municipality. At the same time, medical personnel involved identified a set of variables useful to define an index describing health condition. These scientific studies are the base of an innovative alert system, IPPOCRATE, whose aim is to asses climate risk and share information to population at risk to support prevention and mitigation actions. IPPOCRATE is an e-health system, it is designed to provide technological support to analysis of health risk related to climate and provide tools for prevention and management of critical events. It is the first integrated system of prevention of human risk caused by climate change. IPPOCRATE calculates risk weighting meteorological data with the vulnerability of monitored subjects and uses mobile and cloud technologies to acquire and share information on different data channels. It is composed of four components: Multichannel Hub. Multichannel Hub is the ICT infrastructure used to feed IPPOCRATE cloud with a different type of data coming from remote monitoring devices, or imported from meteorological databases. Such data are ingested, transformed and elaborated in order to be dispatched towards mobile app and VoIP phone systems. IPPOCRATE Multichannel Hub uses open communication protocols to create a set of APIs useful to interface IPPOCRATE with 3rd party applications. Internally, it uses non-relational paradigm to create flexible and highly scalable database. WeHeart and Smart Application The wearable device WeHeart is equipped with sensors designed to measure following biometric variables: heart rate, systolic blood pressure and diastolic blood pressure, blood oxygen saturation, body temperature and blood glucose for diabetic subjects. WeHeart is designed to be easy of use and non-invasive. For data acquisition, users need only to wear it and connect it to Smart Application by Bluetooth protocol. Easy Box was designed to take advantage from new technologies related to e-health care. EasyBox allows user to fully exploit all IPPOCRATE features. Its name, Easy Box, reveals its purpose of container for various devices that may be included depending on user needs. Territorial Registry is the IPPOCRATE web module reserved to medical personnel for monitoring, research and analysis activities. Territorial Registry allows to access to all information gathered by IPPOCRATE using GIS system in order to execute spatial analysis combining geographical data (climatological information and monitored data) with information regarding the clinical history of users and their personal details. Territorial Registry was designed for different type of users: control rooms managed by wide area health facilities, single health care center or single doctor. Territorial registry manages such hierarchy diversifying the access to system functionalities. IPPOCRATE is the first e-Health system focused on climate risk prevention.

Keywords: climate change, health risk, new technological system

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Authors: Getachew Belay, Getachew Kahsu, Brhane Berhe, Kebede Tesfay, Fitsum Mardu, Nigus Shishay, Hadush Negash, Aster Tsegaye

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Background: Malaria kills million people around the world, and it is still a serious public health problem in Ethiopia. Over the past years, the disease has been consistently reported as leading cause of outpatient visits, hospitalization and death in health facilities across the country. This study assessed malaria trend in Humera Town Kahsay Abera Hospital Tigrai region, Northern Ethiopia. Method: A Health facility retrospective cross sectional study was conducted in Kahsay Abera General Hospital from January 2011 to December 2019. Data of Malaria cases were reviewed from Health Management Information System with the help of experts in the office. The nine year data were extracted and analyzed using Excel by excluding those which lack demographic data. Result: A total of 36,604 smear positive malaria cases were confirmed in last nine years in the study area. Plasmodim falcifarum was the most prevalent reported species. Higher number of malaria cases were reported during October season.Males were more infected by the disese (63.1%) than females and males aged 15 years and above were the most iffected ones. The percentage proportion of P.falcifarum and P.vivax were 61.6% to 38.4%, respectively. There was a decreasing trend over the nine years following the peak in 2013. Conclusion: Malaria smear positivity, with highest cases being recorded in October, was declined over the nine years after peaking in 2013. Males aged 15 years and above were more affected, and P falciparum was the predominat species. Strengtheing the prevention and control activities is warranted in the study area.

Keywords: trend, malaria, kahsay abera general hospital, tigray, ethiopia

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Authors: Priyanka Patil, Logan Manikam

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Background: The first 1000 days of life are a critical window and can result in adverse health consequences due to inadequate nutrition. South-Asian (SA) communities face significant health disparities, particularly in maternal and child health. Community-based interventions, often employing Participatory-Learning and Action (PLA) approaches, have effectively addressed health inequalities in lower-income nations. The aim of this study was to assess the feasibility of implementing a PLA intervention to improve infant feeding and care practices in SA communities living in London. Methods: Comprehensive analyses were conducted to assess the feasibility/fidelity of this pilot randomized controlled trial. Summary statistics were computed to compare key metrics, including participant consent rates, attendance, retention, intervention support, and perceived effectiveness, against predefined progression rules guiding toward a definitive trial. Secondary outcomes were analyzed, drawing insights from multiple sources, such as The Children’s-Eating-Behaviour Questionnaire (CEBQ), Parental-Feeding-Style Questionnaires (PFSQ), Food-diary, and the Equality-Impact-Assessment (EIA) tool. A video analysis of children's mealtime behavior trends was conducted. Feedback interviews were collected from study participants. Results: Process-outcome measures met predefined progression rules for a definitive trial, which deemed the intervention as feasible and acceptable. The secondary outcomes analysis revealed no significant changes in children's BMI z-scores. This could be attributed to the abbreviated follow-up period of 6 months, reduced from 12 months, due to COVID-19-related delays. CEBQ analysis showed increased food responsiveness, along with decreased emotional over/undereating. A similar trend was observed in PFSQ. The EIA tool found no potential discrimination areas, and video analysis revealed a decrease in force-feeding practices. Participant feedback revealed improved awareness and knowledge sharing. Conclusion: This study demonstrates that a co-adapted PLA intervention is feasible and well-received in optimizing infant-care practices among South-Asian community members in a high-income country. These findings highlight the potential of community-based interventions to enhance health outcomes, promoting health equity.

Keywords: child health, childhood obesity, community-based, infant nutrition

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Authors: Hiranmoyee Das

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Aim. Due to late presentation and delayed diagnosis mortality rate of retinoblastoma is more than 50% in developing counties. So to facilitate the diagnosis, to decrease the disease and treatment burden and to increase the disease survival rate, an attempt was made for early diagnosis of Retinoblastoma by including fundus examination in routine immunization programs. Methods- A unique immunization card is followed in a tertiary health care center where examination of pupillary reflex is made mandatory in each visit of the child for routine immunization. In case of any abnormality, the child is referred to the ophthalmology department. Conclusion- Early detection is the key in the management of retinoblastoma. Every child is brought to the health care system at least five times before the age of 2 years for routine immunization. We should not miss this golden opportunity for early detection of retinoblastoma.

Keywords: retinoblastoma, immunization, unique, early

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Authors: P. Saee, Baiju Gopal

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YouTube has seen a surge in the recent years in the number of creators opening up about their mental illness on the video-sharing platform. In documenting their mental health, YouTubers perform an identity of their mental illness in the online world. Identity performance is a theory under identity research that has been readily applied to illness narratives and internet studies. Furthermore, in India, suffering from mental illnesses is regarded with stigma, making the act of taking mental health from a personal to a public space on YouTube a phenomenon worth exploring. Thus, the aim of this paper is to analyse the mental illness narratives of Indian YouTubers for understanding its performance in the virtual world. For this purpose, thematic narrative analysis on the interviews of four Indian YouTubers was conducted. This data was synthesized with analysis of the videos the YouTubers had uploaded on their channel sharing about their mental illness. The narratives of the participants shed light on two significant presentations that they engage in: (a) the identity of a survivor/fighter and (b) the identity of a silent sufferer. Further, the participants used metaphors to describe their illness, thereby co-constructing a corresponding identity based on their particular metaphors. Lastly, the process of bringing mental illness from back stage to front stage on YouTube involves a shift in the audience, from being rejecting and invalidating in real life to being supportive and encouraging in the virtual space. Limitations and implications for future research were outlined.

Keywords: cyber-psychology, internet, media, mental health, mental illness, technology

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Authors: Keith T. S. Tung, Frederick K. Ho, Rosa S. Wong, Camilla K. M. Lo, Wilfred H. S. Wong, C. B. Chow, Patrick Ip

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Objectives: Underage drinking is an important public health problem both locally and globally. Conventional prevention/intervention relies on unidirectional knowledge transfer such as mail leaflets or health talks which showed mixed results in changing the target behaviour. Previously, we conducted a school internet-based intervention which was found to be effective in reducing alcohol use among adolescents, yet the underlying mechanisms have not been properly investigated. This study, therefore, examined the mechanisms that explain how the intervention produced a change in alcohol drinking behaviours among Chinese adolescent as observed in our previous clustered randomised controlled trial (RCT) study. Methods: This is a cluster randomised controlled trial with parallel group design. Participating schools were randomised to the Internet intervention or the conventional health education group (control) with a 1:1 allocation ratio. Secondary 1–3 students of the participating schools were enrolled in this study. The Internet intervention was a web-based quiz game competition, in which participating students would answer 1,000 alcohol-related multiple-choice quiz questions. Conventional health education group received a promotional package on equivalent alcohol-related knowledge. The participants’ alcohol-related attitude, knowledge, and perceived behavioural control were self-reported before the intervention (baseline) and one month and three months after the intervention. Results: Our RCT results showed that participants in the Internet group were less likely to drink (risk ratio [RR] 0.79, p < 0.01) as well as in lesser amount (β -0.06, p < 0.05) compared to those in the control group at both post-intervention follow-ups. Within the intervention group, regression analyses showed that high quiz scorer had greater improvement in alcohol-related knowledge (β 0.28, p < 0.01) and attitude (β -0.26, p < 0.01) at 1 month after intervention, which in turn increased their perceived behavioural control against alcohol use (β 0.10 and -0.26, both p < 0.01). Attitude, compared to knowledge, was found to be a stronger contributor to the intervention effect on perceived behavioural control. Conclusions: Our internet-based intervention has demonstrated effectiveness in reducing the risk of underage drinking when compared with conventional health education. Our study results further showed an attitude to be a more important factor than knowledge in changing health-related behaviour. This has an important implication for future prevention/intervention on an underage drinking problem.

Keywords: adolescents, internet-based intervention, randomized controlled trial, underage drinking

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Authors: Swati Rajput

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Environmental psychology explains that the person is a social agent that seeks to extract meaning from their built and natural environment to behave in a particular manner. It also shows the attachment or detachment of people to their environment. Assessing environmental psychology of people is imperative for planners and policy makers for urban planning. The paper investigates the environmental psychology of people living in nine districts of Delhi by calculating and assessing their Environmental Emotional Quotient (EEQ). Emotional Quotient deals with the ability to sense, understand, attach and respond according to the power of emotions. An Environmental Emotional Quotient has been formulated based upon the inventory administered to them. The respondents were asked questions related to their view and emotions about the green spaces, water resource conservation, air and environmental quality. An effort has been made to assess the feeling of belongingness among the residents. Their views were assessed on green spaces, reuse, and recycling of resources and their participation level. They were also been assessed upon health awareness level by considering both preventive and curative segments of health care. It was found that only 12 percent of the people is emotionally attached to their surroundings in the city. The emotional attachment reduces as we move away from the house to housing complex to neighbouring areas and rest of the city. In fact, the emotional quotient goes lower to lowest from house to other ends of the city. It falls abruptly after the radius of 1 km from the residence. The result also shows that nearly 54% respondents accept that there is environment pollution in their area. Around 47.8% respondents in the survey consider that diseases occur because of green cover depiction in their area. Major diseases are to airborne diseases like asthma and bronchitis. Seasonal disease prevalent, which specially occurred from last 3-4 years are malaria, dengue and chikengunya. Survey also shows that only 31 % of respondents visit government hospitals while 69% respondents visit private hospitals or small clinics for healthcare services. The paper suggests the need for environmental sensitive policies and need for green insurance in mega cities like Delhi.

Keywords: environmental psychology, environmental emotional quotient, preventive health care and curative health care, sustainable living

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Authors: Himer Khalid, Alami Ilyass, Kharchoufa Loubna, Elachouri Mostafa

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It has been estimated by the World Health Organization that 80% of the world's population relies on traditional medicine to meet their daily health requirements. In Morocco reliance on such medicine is partly owing to the high cost of conventional medicine and the inaccessibility of modern health care facilities. There was high agreement in the use of plants as medicine in Oriental Morocco. Our objective is to evaluate the informant’s knowledge on medicinal plants by the local population and to document the uses of medicinal plants by this community, for the treatment of different illnesses. Using an ethnopharmacological approach, we collected information concerning the traditional medicinal knowledge and the medicinal plants used, by interviewing successfully 458 informants living in oriental Morocco (from Debdou, Taourirt, Guersif a,d Laayoune districts). The data were analyzed by statistical methods (Component Analysis “CA”, Factorial Analysis “FA”) and other methods such as through Informant’s Consensus Factor (ICF) and Use Value (UV). Our results indicate that, more than 60% of the population in these regions relies on medicinal plants for the treatment of different ailments with predominance of women consumers. 135 plant species belonging to 61 families were documented. These plants were used by the population for the treatment of a group of illness (about 14 principal ailments). We conclude that, in oriental Morocco, till now, the population has some traditional knowledge commonly used as medical tradition. These wealthy heritage needs conservation and evaluation.

Keywords: Morocco, medicinal plants, traditional knowledge, wealthy heritage

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Authors: Katerine Moraes dos Satons, Gisele Massante Peixoto Tracera, Regina Célia Gollner Zeitoune

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To analyze the psychosocial risks related to the organization of nursing work in outpatient clinics of university hospitals. Cross-sectional epidemiological study developed in 11 outpatient units linked to the three public universities of the city of Rio de Janeiro, Brazil. Participants were 388 nursing professionals who worked in patient care at the time of the research. Data were collected from July to December 2018, using a self-applicable instrument. A questionnaire was used for sociodemographic, occupational and health characterization, and the Work Organization Scale. The bivariate analyses were performed using the odds ratio (OR), with a confidence interval of 95%, significance level of 5%. The organization of nursing work received an assessment of medium psychosocial risk by the professionals participating in the research, demanding interventions in the short and medium term. There was no association between sociodemographic, occupational and health characteristics and the organization of outpatient work. Interventional measures should be performed in the psychosocial risk factors presented in this research, with a view to improving the work environment, so that the importance of maintaining satisfactory material conditions is considered, as well as the adequate quantity of human resources. In addition, it aims to expand the spaces of nursing participation in decision- making, strengthening its autonomy as a profession.

Keywords: occupational risks, nursing, nursing team, worker’s health, psychosocial risks

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