Archives of Public Health

Vaccine hesitancy has emerged as a significant global challenge impacting healthcare institutions, workplaces and governments alike. Despite concerted efforts by the government and numerous other institutions in South Africa, low vaccination rates persist (33% as of November 13, 2023), reflecting the persistence of this global challenge. This challenge is particularly pronounced in educational institutions such as institutions of higher learning in South Africa, where many people converge, increasing the risk of viral exposure. This study aims to assess the knowledge, attitudes, and perceptions of healthcare workers (HCWs) at a Nursing College regarding voluntary and mandatory COVID-19 vaccination. Employing a quantitative approach, a survey with closed-ended Likert-type questions was administered to 504 individuals at the College. The sample size of 218 respondents was calculated based on a margin of error of 5%, a confidence level of 95%, and an additional 25% contingency for potential incomplete data, resulting in a final representative sample of 270 respondents. The Statistical Package for Social Sciences (SPSS) was used for the analysis. Findings indicate a high uptake of voluntary COVID-19 vaccinations among HCWs, with some being mandated. Most HCWs demonstrated a strong commitment to safeguarding themselves and others. Despite concerns, HCWs thought the COVID-19 vaccines were effective, and their views were supported by a low level of infection among the participants, underscoring its efficacy in preventing transmission. Effective communication emerged as a critical factor in addressing post-vaccination behaviours and enhancing vaccine acceptance. However, the findings also highlighted the need for tailored outreach strategies to specific audiences, such as pregnant women, and the importance of addressing concerns about adverse effects through clear and open communication. Several factors influencing the choice between mandatory and voluntary vaccination were identified, including eligibility concerns, religious convictions, and financial considerations. Notably, concerns about safety and knowledge gaps outweighed these factors, suggesting the need for targeted educational initiatives to bolster vaccine acceptance. In conclusion, this study provides valuable insights into the dynamics of vaccination acceptance among an influential occupational group, with implications for the acceptance of other vaccines. Vaccination efforts can be strengthened by addressing concerns, enhancing communication strategies, and tailoring outreach efforts to promote public health in light of future outbreaks. Author summaryConception and design of the study: LM, TS Data acquisition: LM Data analysis: LM Interpretation of the data: LM, TS Drafting of the paper: LM Critical revision of the paper: TS Both authors approved the final manuscript

ObjectiveHealthcare workers (HCWs) are at increased risk of COVID-19 infection and play a critical role in influencing public vaccine acceptance. This study aimed to assess vaccination coverage and identify the determinants of vaccine uptake among healthcare workers in Cameroon, in order to inform targeted strategies to strengthen immunization programs and improve epidemic preparedness. ResultsAmong 406 participants (75.6% female, 65.5% aged 30-44 years, 61.3% nurses), 42.4% were fully vaccinated against COVID-19, while only 4.7% had completed the cholera vaccine series. Coverage varied across districts, with Biyem-Assi (53.0%) and Odza (46.0%) recording the highest COVID-19 uptake, and Nkolndongo (11.5%) leading for cholera vaccination. Independent predictors of COVID-19 uptake included being a nurse (aOR = 3.96; 95% CI: 2.07-7.81; p = 0.001) and laboratory technician professions (aOR = 8.00; 95% CI: 1.38-69.8; p =0.032). For cholera vaccination, working in internal medicine wards (aOR=11.2; 95% CI: 1.04-120; p = 0.046) and being a nurse (aOR = 1.54; p = 0.001) emerged as significant predictors. Although 62.8% of HCWs perceived their work environment as high-risk, knowledge of recommended vaccines was limited, with only 18.7% aware of cholera vaccination recommendations. Strengthening vaccine education, improving accessibility, and reducing financial barriers could enhance vaccine acceptance among HCWs. These findings provide important insights for designing targeted immunization strategies in Cameroon and similar contexts.

IntroductionAccidental exposure to body fluids (AEBs) increases the risk of blood-borne infections among susceptible HCWs. While 90% of the AEB reported occur in developed nations, developing countries bear 90% of the burden of healthcare associated infections, especially those of sub-Saharan Africa. Social insecurity may contribute further to the vulnerability of HCWs. Our study sought to determine the prevalence, reporting and management of AEBs among HCWs in the security-challenged Region of South-West Cameroon. MethodsA cross-sectional study was carried out from February 2023 to April 2023, at the Buea Regional Hospital. Following informed consent, a 28-item interviewer-administered questionnaire to HCW was used. Data was entered and analyzed using R Statistics version 4.3.1. ResultsOut of the 230 HCWs that were approached, 200 were responded for a participation rate of >85%. The prevalence of AEB was high (93%). Exposures occurred while administering injections (37%), during blood sample collection (16%), delivery (11%), surgery (10.2%) and washing. The main risk factors for AEB included female gender (aOR=2.86) and those exercising in the medical (aOR=5.95), pediatrics (aOR=10.5), obstetrical (aOR=22.6), dental (aOR=26.3) units. Only 46.8% of AEBs were reported. Post-exposure management was carried out for 67.2% of the reported cases. Most HCW were unaware of the existence of an Infection Control Committee within the study setting, corroborating gaps in the observance of Standard Precautions. ConclusionsMost HCWs experienced AEBs over the last year. There is a need to sensitize and enforce the observance of universal precautions among HCW of the Buea Regional Hospital. Such measures should be extended to other health facilities in related settings.

Background: Polypharmacy is common in people living with dementia (PLwD) and associated with adverse outcomes. Although Structured Medication Reviews (SMRs) are recommended to optimise medication regimens, their delivery is often constrained by limited healthcare resources. Artificial intelligence (AI) may support SMRs, yet little is known about how it is perceived by PLwD and their carers. This study explored their experiences of polypharmacy, views on SMRs, and attitudes towards use of AI tools in SMRs. Methods: Semi-structured interviews with 12 PLwD experiencing polypharmacy and two focus groups with 14 carers were conducted via Microsoft Teams or telephone and analysed using Reflexive Thematic Analysis. Results: Two themes were constructed: experiences of SMRs, and attitudes towards AI in SMRs. Participants described challenges in managing polypharmacy, with carers often playing a central role in supporting adherence and monitoring side effects. Experiences of SMRs varied widely. SMRs were most valued when clinicians were empathetic and able to offer personalised guidance. Participants viewed AI use in SMRs positively, provided that such tools were well validated and used to assist rather than replace healthcare professionals. AI was viewed as having the potential to reduce administrative burden and support more person-centred care. However, some had concerns regarding patient safety and data security, highlighting the need for appropriate regulation and human oversight. Conclusion: Participants were supportive of AI use in SMRs, despite concerns about safety, data security and disclosure of AI use, and emphasised the importance of patient-clinician interactions and lived experience involvement in AI tool development.

ObjectiveThis scoping review protocol outlines the steps to conduct a scoping review to assess the health experiences of female head porters and their unique health challenges and needs. The review aims to broaden our understanding of the occupational health challenges facing head porters in sub-Saharan Africa and identify any gaps in the health literature related to this population. IntroductionHead portering is an informal occupation predominantly undertaken by women and girls in sub-Saharan Africa. Female head porters often lack education and skills, which makes head portering an appealing yet laborious occupation to improve income and associated social conditions and support families left behind. Inclusion criteriaStudies were included in the review if they included females of all ages engaging in head-portering activities as a livelihood in sub-Saharan Africa. Methods and AnalysisThe six stages of the Arksey and OMalley (2005) framework guided the design and reporting of this scoping review. The methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for scoping reviews. Relevant articles and grey literature were identified through searches of health-related databases. The extracted data will be presented using a narrative summary to complement a data table. Ethics and disseminationThe ethical approval submission for this scoping review protocol was not completed as it is not required. Formal knowledge translation and dissemination activities will include publishing findings in African-based high-impact journals and conference presentations to reach relevant audiences. The final recommendations for practice, policy, and research will be shared and distributed through toolkits for healthcare professionals and stakeholder information leaflets. RegistrationThe review has been registered with Open Science Framework Registries: https://osf.io/c3q7as Strengths and LimitationsThis scoping review explores the literature on the health implications of head portering among female head porters, encompassing a broad range of studies and evidence. It aims to identify research gaps, highlight key health concerns requiring further investigation, and serve as a foundation for future reviews and primary studies. However, this review does not include a formal quality assessment of the included studies, which may impact the reliability of the findings. Due to its broad scope, detailed analyses of specific health issues may be limited. Additionally, the risk of selection and interpretation bias may constrain the depth of analytic synthesis, reducing its applicability for precise policy and practice recommendations.

BackgroundNeonicotinoid pesticides are systemic insecticides with neurotoxic potential and environmental persistence, raising concerns about chronic low-dose exposure in humans and impacts on ecosystems. In Japan, regulatory restrictions are generally less stringent than in the European Union, yet risk perception among young adults remains underexplored. ObjectiveTo examine factors associated with university students interest in pesticide-related issues, focusing on family discussions about environmental topics, household preference for organic vegetables, agricultural experience, and depressive symptoms. MethodsWe conducted a cross-sectional questionnaire survey among 690 undergraduate students at a private university in the Tokyo metropolitan area (academic year 2024). Interest in pesticide issues was assessed on a 4-point scale and dichotomized as high (very/somewhat) vs low (not very/not at all). Explanatory variables included frequency of family discussions about environmental issues, household preference for organic vegetables, agricultural experience, the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR-J), age, and sex. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). ResultsParticipants mean age was 20.6 (SD 4.9) years and mean QIDS-SR-J score was 6.0 (SD 4.2). Overall, 74.6% reported high interest in pesticide issues. High interest was associated with more frequent family discussions about environmental issues (aOR 2.22, 95% CI 1.50-3.30; p<0.001) and household preference for organic vegetables (aOR 1.73, 95% CI 1.14-2.62; p=0.009). Agricultural experience, depressive symptoms, age, and sex were not significantly associated. Notably, while 53.2% supported pesticide-free/organic farming, 85.5% avoided blemished (insect-damaged) vegetables and 77.1% considered pesticides necessary, suggesting an attitude-behavior gap. O_TBL View this table: org.highwire.dtl.DTLVardef@18a3257org.highwire.dtl.DTLVardef@1ef0b44org.highwire.dtl.DTLVardef@ccadbdorg.highwire.dtl.DTLVardef@1a256c7org.highwire.dtl.DTLVardef@ef57f8_HPS_FORMAT_FIGEXP M_TBL O_FLOATNOTable 1.C_FLOATNO O_TABLECAPTIONParticipant characteristics and related factors (N = 690) C_TABLECAPTION C_TBL ConclusionsAmong Japanese university students, interest in pesticide issues was linked to family-level environmental discourse and household organic orientation, rather than depressive symptoms. The observed gap between pro-organic attitudes and consumer preferences underscores the need for risk communication and environmental health education that connect values to feasible purchasing behaviors.

Background: Healthcare workers (HCWs) are at increased risk of exposure to vaccine-preventable diseases, including hepatitis B, tuberculosis (TB), and tetanus, due to their occupational environment. Despite the availability of safe and effective vaccines, vaccination coverage among HCWs remains suboptimal in many low- and middle-income countries. This study aimed to determine the vaccination coverage for hepatitis B, tuberculosis, and tetanus among HCWs in district hospitals in Yaounde, Cameroon, and to identify factors associated with incomplete vaccination. Methods: A cross-sectional analytical study was conducted from January to June 2024 across all seven district hospitals in Yaounde. A total of 406 HCWs were enrolled using a structured, self-administered questionnaire. Incomplete vaccination status was defined as nit having received three doses for hepatitis B, at least two doses for TB, and at least three doses for tetanus. Data were analyzed using R Statistics version 4.3.3. Bivariate and multivariate logistic regression models were used to identify predictors of incomplete vaccination, with statistical significance set at p < 0.05. Results: Most of participants were female (75.6%) and aged 30-44 years (65.5%). Full vaccination coverage was 36.2% for hepatitis B, 15.8% for tuberculosis, and 53.4% for tetanus. Unvaccinated proportions were 43.1% for hepatitis B, 0.5% for tuberculosis, and 17.2% for tetanus. Multivariate analysis revealed that HCWs aged 55-66 years were significantly less likely to be incompletely vaccinated against hepatitis B compared to those aged 19-29 years (aOR = 0.07; 95% CI: 0.01-0.39; p = 0.004). Nurses and laboratory technicians were more likely to be incompletely vaccinated than doctors (aOR = 7.06; 95% CI: 3.82-13.6; p < 0.001 and aOR = 3.78; 95% CI: 1.73-8.52; p = 0.001, respectively). Longer professional experience was protective against incomplete vaccination for all three vaccines (p < 0.05). The main barriers to vaccination included high cost, doubts about the need for vaccination, and concerns about side effects. Conclusions: Vaccination coverage for hepatitis B, tuberculosis, and tetanus among HCWs in Yaounde remains suboptimal, particularly for hepatitis B. Addressing financial barriers, improving access to vaccines, and implementing targeted educational interventions are essential to enhance vaccine uptake and protect both HCWs and their patients from preventable occupational infections.

IntroductionDementia is becoming increasingly prevalent in the UK. Older adults from black and south Asian communities have a higher risk for dementia due to an increased prevalence of dementia specific risk factors such as hypertension, diabetes, and heart disease. Deprivation has also been linked to an increased risk of dementia. Ethnic minority and lower socioeconomic groups are underrepresented in dementia research. The aim of this study was to explore factors influencing diversity in dementia and rehabilitation research within the context of the Promoting Activity, Independence, and Stability in Early Dementia (PrAISED) randomised controlled trial (RCT). MethodsWe conducted an exploratory sequential mixed methods study to explore disparities in socioeconomic and ethnic diversity between the PrAISED RCT population and recruitment pathways used in one study site (Nottinghamshire) and compared these with regional and national data. We aimed to collate and summarise data available on ethnicity and deprivation for recruitment/referral pathways (Nottinghamshire site) and the PrAISED cohort (all sites). Additionally, we interviewed healthcare professionals (n=2), researchers (n=2) and members of black and south Asian communities (n=4) to explore barriers to participating in research for people with dementia. ResultsUnder 2% of the overall PrAISED RCT sample (across all sites) were from a non-white ethnic minority background and a third of participants lived in areas with the least deprivation. Referrals to memory assessment services in Nottinghamshire included people from diverse socioeconomic backgrounds, with 7.3% being from non-white ethnic minority communities. Through interviews, several barriers to healthcare, research and rehabilitation were identified. Healthcare barriers included lack of awareness of dementia, mistrust, stigma, fear, and lack of culturally appropriate services. Research barriers included recruitment routes, awareness of research, language, and recruiter beliefs. Barriers to rehabilitation research included a lack of use of culturally appropriate language, more culturally specific barriers, and lack of representation. ConclusionParticipants recruited to the PrAISED RCT were mainly white and socioeconomically privileged. Data recording and access around ethnicity is still inconsistent, making it difficult to ascertain at which point services and research become inaccessible for people from underserved communities. Future research needs to work with these communities to develop innovative solutions to overcome the barriers identified in this study and to put recommendations made into practice.

BackgroundThe risk of infection among healthcare workers (HCW) is a looming public health problem worldwide. Developing countries are most affected. The present study aimed to identify knowledge gaps, risk perceptions, reporting patterns, and post-exposure management, following needle stick and sharp injuries and contact with other body fluids HCW. MethodsA cross sectional descriptive study was carried out from January to April 2022 in six District Hospitals in Yaounde. An auto-administered questionnaire was addressed to consenting HCW. Data were analyzed using R statistic version 4.2.3 and p-value<5% was considered significant. ResultsOut of the 217 HCWs that were enrolled, some 10% were unaware of sources of exposure to blood and other body fluids (BBF). Respondents displayed insufficient awareness (74-94%) of the main infectious agents that are likely to be transmitted during an accidental exposure to body fluids (AEB). Some HCWs (6,9%) reported a lack of knowledge of the vaccine against Viral Hepatitis B (VHB). Almost half of participants did not know the appropriate recommended action for post-exposure case management (42.9%). Most HCW who had experienced exposure (53.7 %) reported that they did not receive any post-exposure care. Such exposure was often (56.4%) not reported. There was a horizontal variation in underreporting for the same level of healthcare facilities, as it was higher in the Efoulan (OR=3.33) and Nkolndongo (OR=5) District Hospitals. Reasons explaining AEB underreporting were underestimation of vulnerability (51 %) and lack of unawareness of existing post-exposure prophylaxis procedures (42%). ConclusionWhile most HCW are aware of the risk of infection associated with exposure to blood and body fluids, reporting was low. Continued educational activities on the risk of infections associated to AEB is warranted. There is a need to implement and scale up structural facilities to enforce measures to prevent exposure, report cases of accidental exposure, ensure post-exposure prophylaxis and counselling.

Work-related musculoskeletal disorders (WRMSDs) constitute the primary occupational health burden among healthcare professionals (HCPs) globally and directly threaten health workforce sustainability, a critical concern for Sustainable Development Goal 3 (Good Health and Well-being) and SDG 8 (Decent Work and Economic Growth). Despite high prevalence in Cameroon, downstream occupational effects and management strategies across hospital levels remain undocumented. A hospital-based, analytical cross-sectional study was conducted across five referral hospitals in Douala, Cameroon (2019-2022). A total of 561 HCPs were enrolled by stratified random sampling. The Modified Nordic Musculoskeletal Questionnaire and structured interviews assessed WRMSD occupational effects and management strategies. Data were analysed using IBM SPSS v26; chi-square tests and logistic regression assessed associations (p < 0.05). The 12-month WRMSD prevalence was 83.4% (468/561). WRMSDs caused absenteeism in 83.4% of affected HCPs ({chi}2 = 14.414; p < 0.001), reduced daily activity capacity in 55.6%, and job dissatisfaction in 60.4%; 38.9% were considering a career change. Management was predominantly reactive: fitness training (76.3%), rest (41.4%), and non-steroidal anti-inflammatory drugs (NSAIDs; 37.3%). Only 15.0% received physiotherapy referral, and no hospital had a formal WRMSD protocol. WRMSDs impose a substantial and measurable occupational burden on HCPs in Douala. Current management is reactive, non-standardised, and under-integrated with physiotherapy. Evidence-based, multicomponent prevention programmes, physiotherapy integration, and a national occupational health policy are urgently required to protect the healthcare workforce and advance SDG 3 and SDG 8 targets in Cameroon.

IntroductionAccidental exposure to blood and body fluids (AEB) in the workplace account for 40 % of contamination by hepatis B virus (HBV) and 2 - 3 % by HIV among healthcare workers (HCW). Developing countries are most affected. The present study sought to determine the prevalence of percutaneous injury and hepatitis B vaccination coverage among HCW. MethodsA cross-sectional study was carried out from January to April 2022 in six district hospitals in Yaounde using a self - administered questionnaire. Out of the 279 HCW who were solicited, 217 returned completed questionnaires. ResultsMore than half of HCW reported an AEB in the last 12 months (53,9 %). The prevalence of AEB varied among hospitals with the Nkolndongo DH reporting the highest prevalence (51.6 %). Healthcare workers were unvaccinated (53 %) or partially vaccinated against HBV (13,2 %); only one third were fully vaccinated (33,9 %). The lowest compliance with vaccination was observed among hygiene personnel (90 %). The high cost of the vaccine was the main reported reason for non - compliance (39 %). ConclusionThere is an urgent need to set up a monitoring system for the implementation of infection control and prevention in District Hospitals in Cameroon in order to raise awareness of AEB burden among healthcare workers and improve accessibility to HBV vaccine.

BackgroundDementia has no cure but interventions can stabilize the progression of cognitive, functional, and behavioral symptoms. Primary care providers (PCPs) are vital for the early detection, and long-term management of these diseases, given their gatekeeping role in the healthcare system. However, PCPs rarely implement evidence-based dementia care due to barriers such as limited dementia knowledge and time. Training PCPs and linking them to dementia care navigators may address these barriers. ObjectiveWe explored the preferences of PCPs about dementia care training programs and dementia care navigation services. MethodsWe conducted qualitative interviews with 24 PCPs recruited nationally via snowball sampling. We conducted all interviews via videocall and organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. ResultsPCP preferences varied regarding the topic, duration, materials, modality, and incentives of the dementia training. With regards to dementia care navigation services, preferences varied with respect to whether they benefited the PCP or the patient, and which were the optimal qualities of a dementia care navigator. ConclusionsDementia training and care navigation services would benefit from embedding cultural proficiency within their content, materials, and navigation abilities. EMR-based decision-support tools would facilitate PCPs implementation of evidence-based dementia care.

ObjectivesThis study aimed to evaluate the process of implementation of a peer coaching intervention program for occupational physicians (OPs) to improve the execution of preventive tasks. Specifically, the evaluation seeks to: (1) describe the reach and uptake of the intervention program; (2) determine the extent to which the program was implemented as intended; (3) provide insights into experiences of OPs, and (4) identify factors influencing the implementation. MethodsThis study employed a mixed-methods approach to assess seven main process indicators: acceptability, adoption, appropriateness, feasibility, fidelity, penetration and sustainability. Data were collected between March and June 2024 by means of an online questionnaire (N=98), and 17 semi-structured interviews with group coordinators and OPs. Results20 out of 21 groups allocated to the intervention program participated in the intervention and 98 out of 115 participants (85%) filled in the questionnaire. Three-quarters of the participants completed the entire program. 96% of the OPs successfully discussed barriers to the execution of preventive tasks, and 83% were able to formulate strategies for these barriers. Most participants managed to implement their formulated goals in practice. When they were unable to do so, time constraints and resistance from employers and their occupational health services often played a role. OPs valued the programs structure, interaction with colleagues, and the increased awareness it generated. Discussion and conclusionThe peer coaching group program was well-implemented and positively evaluated by OPs. The program can be improved by allocating more time to it, for instance by integrating it into the educational curriculum, and by paying more attention to the specific working conditions of OPs, such as the different sectors in which they are employed. Trial registration: ISRCTN registry; ISRCTN15394765. Registered on 27 June 2023.

Since the start of the Coronavirus pandemic thousands of people have experienced teleworking and this practice is becoming increasingly commonplace. Systematic reviews can yield evidence and information to help inform the development of policies and regulations, the aim of this study was to highlight the differences in exposure to psychosocial risk factors for health between part-time and full-time teleworking from home. The protocol of the systematic review of the literature was registered on PROSPERO 2020 platform - International Prospective Register of Systematic Reviews (number CRD42020191455), according to the PRISMA statement guidelines. The key words "telework" and frequency ("part-time" or "full-time"), together with their synonyms and variations, were searched. Independent researchers conducted the systematic search of 7 databases: Scopus, SciELO, PePSIC; PsycInfo, PubMed, Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science. Of the 638 articles identified from 2010 to June 2021, 32 were selected for data extraction. The authors evaluated the risk of bias and quality of evidence of the studies included using the Mixed Methods Appraisal Tool. The results were categorized into 7 dimensions of psychosocial risk factors: work intensity and working hours; emotional demands; autonomy; social relationships at work; conflict of values, work insecurity and home/work interface. The results revealed scant practice of full-time teleworking prior to the pandemic. Regarding the psychosocial risk factors found, differences were evident before and during the COVID-19 pandemic. For part-time and full-time telework prior to the pandemic, the dimensions of intensification of work and working hours, social relationships at work, and the home-work interface were the most prominent factors. However, in studies performed during the COVID-19 pandemic where teleworking was mostly performed full-time, there was an increase in focus on emotional demands and the home-work interface, and a reduction in the other dimensions.

BackgroundFarmer using commercially available chemical pesticides are at high risk to develop various pesticide-related-illnesses. To mitigate the adverse effect of pesticides, it is crucial for famers to wear Personal Protective Equipment (PPE). This study aimed to assess the factors influencing knowledge, attitude, and practice (KAP) of PPE use among farmers using pesticides in mid-hills of Nepal. MethodsWe conducted a cross-sectional study among 256 farmers in Kirtipur Municipality. We collected data using structured questionnaire via telephone. Bi-variate and multivariate logistic regression was done to identify the association between individual, household and farming related characteristic with knowledge, attitude, and practice of PPE use. ResultsThe study found that the knowledge, attitude, and practice of PPE use was 53.75%, 55.11%, and 47.16%, respectively. The farmers with primary level schooling (AOR= 2.63; 95% CI 1.00-6.88) and secondary level schooling or higher (AOR= 4.19; 95% CI 1.64-0.68) had higher odds of having knowledge on PPE use rather than the farmers with no formal schooling. Farmers of upper lower socioeconomic status had higher odds (AOR=6.40; 95% CI 1.68-24.45) of having positive attitude towards PPE use compared to farmers of upper middle and upper socio-economic status. On the contrary, farmers with good knowledge (AOR=0.20; CI 0.09-0.48) and experience of pesticide-related-illness (AOR=0.29; 95% CI 0.13-0.65) had lower odds of having positive attitude towards PPE use. Married farmers (AOR=10.63; 95% CI 1.11-101.95), farmers using pesticides for more than 10 years (AOR=5.22; 95% CI 1.27-21.43), and farmers using pesticides for 10 hours or more in their lifetime (AOR=4.86; 95% CI 1.63-14.50) had higher odds of wearing basic set of PPE while handling pesticides. However, farmers who were involved in farming for more than 10 years (AOR=0.26; 95% CI 0.07-1.03), farmers who were using pesticide applying methods other than knapsack sprayer (AOR=0.03; 95% CI 0.00-0.34), and farmers having positive attitude towards PPE use (AOR=0.28; 95% CI 0.11-0.70) had lower odds of wearing basic set of PPE while handling pesticides. ConclusionFarmers in Nepal have a positive outlook on PPE use but multitude of factors including knowledge, farming related factors and socio-economic condition have acted as barrier to its use. Tailored educational programs that not only encompasses knowledge dissemination but also cultivation of positive safety attitudes towards PPE can help increase PPE use.

Objectives: Research on mental health in agriculture has increased in recent years; however, it remains largely focused on farmers themselves and is predominantly male-oriented. The mental health of farm wives and partners, many of whom play integral roles in farm operations, business management, and family life, remains difficult to characterise. This study therefore aims to explore the prevalence and causes of mental health challenges among farm wives and partners, and to investigate their use of, and barriers to, mental health support services. Methods: Quantitative data was collected using over 450 structured questionnaire responses that assessed mental health prevalence, contributing stressors and support service utilisation. Results: Findings indicate that there is a high prevalence of mental ill health amongst farm wives, seemingly due to industry stressors and support role overwhelm. Interpersonal relationships played a significant role in the types of mental distress experienced and highlighted the toll that farm life can take on farm wives' social and emotional connections. Despite a range of formal and informal support services being available, and effective when used, significant barriers to accessing these services were identified, including both practical difficulties and self-stigmatisation due to cultural beliefs. Conclusions: Farm wives and partners experience substantial mental health burdens linked to their diverse and often underrecognized roles within agricultural systems. In future, targeted interventions are needed to reduce stigma, improve service accessibility, and recognize women's contributions within farm enterprises. Further research and dedicated investment are also essential to better understand and help improve the mental health of this overlooked population within agricultural industries.

BackgroundThere is a paucity of evidence relating to the implementation of interventions for dementia care. The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention is a 12-month, home-based, individually tailored rehabilitation programme, delivered by therapists and rehabilitation support workers, with a focus on strength, balance, physical activity and activities of daily living which has been tested in a randomised controlled trial (RCT). The aim of this study was to identify what is required to implement PrAISED, or similar interventions, in a real-world setting in routine practice. MethodsA 6-month version of PrAISED was delivered as a pilot service in one National Health Service organisation in England. Adaptations were made to intervention processes to facilitate the delivery of PrAISED as a service instead of as part of a research study. The number and duration of visits for each patient were recorded by intervention delivery staff and were summarised using descriptive statistics. Semi-structured interviews were conducted with seven members of staff delivering the PrAISED pilot service (two managers, five delivery staff) and eight members of staff from other sites involved in the PrAISED RCT (four managers, four delivery staff). The Consolidated Framework for Implementation Research was used to inform interview guides and conduct a codebook thematic analysis. ResultsBetween April and November 2022, 11 patients were referred to, and participated in, the service. Patients received on average 20.9 visits (mean duration 82.1 mins). Five themes were identified from interviews relating to the pilot service: operational processes; workforce capacity; referral; intervention delivery and patient impact. A further six themes were identified regarding the wider implementation of dementia therapy programmes: the need for support post-dementia diagnosis; acceptability; effective delivery; reach/referral; intervention design and adaptability; and intervention materials and training. ConclusionsInterventions like PrAISED are needed to fill a gap in support immediately post-dementia diagnosis. Future implementation in practice will require attention to the identification of intervention funding; leadership and management; time to establish operational processes; therapists with appropriate skills and experience; providing training and resources to support intervention delivery; defining patient eligibility, refining referral processes; and maintaining fidelity of the intervention.

BackgroundThe COVID-19 pandemic required South African public sector HIV viral load (VL) laboratories to scale up Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing while maintaining essential HIV services. This placed additional pressure on diagnostic services. This dual mandate introduced significant occupational and environmental challenges (OEC) for staff that remain underexplored. ObjectiveThis study aimed to investigate the OEC and effects that staff experienced during the implementation of COVID-19 testing at public sector VL laboratories in South Africa. MethodsA quantitative, cross-sectional study utilised a census approach among technical and support staff. Data were collected via a structured REDCap questionnaire using 5-point Likert scales. Pre- and post-implementation challenges were assessed across four domains: workload, environmental conditions (space, ventilation, waste), communication, and PPE availability. Statistical analyses included the Wilcoxon Signed-Rank and Spearmans correlation tests. ResultsPerceived occupational challenges increased significantly across all domains post-implementation. Staff workload saw the highest rise (mean score 3.02 to 3.53). Adverse health effects were pervasive; 80.2% of staff reported burnout/fatigue, and 76.5% reported increased anxiety/stress. A strong positive correlation was observed between post-COVID-19 challenges and adverse mental and physical health outcomes (rho = 0.449, p < 0.001). Furthermore, 35.8% of staff considered resigning due to increased job demands. ConclusionIntegrating COVID-19 testing exacerbated systemic weaknesses, causing measurable psychological injury and threatening workforce retention. Findings suggest that the diagnostic workforce requires formal crisis surge staffing models and institutionalised mental health support to safeguard personnel and maintain essential services during future health emergencies.

BackgroundWomen in the fisher communities in coastal regions of Bangladesh are engaged in a wide range of fishery activities including fish sorting, grading, cutting, dry fish processing, transporting and selling. However, there is limited evidence available on the occupational hazards and risks experienced by them. MethodThe study was conducted among fishing colonies in Coxs Bazar and Chattogram districts in Bangladesh. This was a cross-sectional study comprised of both qualitative and quantitative approaches. Data were primarily collected through eight focus group discussions (FGD) and a quantitative survey of a sample of 207 women working in fisheries sector. FindingsThe study found a high occurrence of occupational hazards, health risks and disease conditions and limited availability of preventive measures among the women in the fisher communities in the coastal Bangladesh. Occupational hazards include physical safety hazards, like slippery surface, fish cutting instruments, fish sting or bite and contact with fishes; physical hazards, like prolonged sun exposure and noise; chemical hazards like pesticides, salt and salt water; ergonomic hazards, like prolonged sitting or standing in uncomfortable posture and heavy weight lifting; and biological hazards, like inadequate provision of sanitary latrine or hand washing soap at workplace. The study also found occupational risks resulting from the hazards including injuries (87.44%), musculoskeletal conditions (69.08%), skin diseases/conditions (56.52%), eye complaints (33.82%), severe respiratory distress (24.15%) and high incidence of self-reported communicable diseases. Majority of the women did not use personal protection equipment at their workplace (78.26%) and have a first aid kit at their workplace (93.72%). ConclusionThis study highlights the critical occupational health and safety challenges faced by the women in the fisheries sector. A comprehensive multisectoral strategy needs to be undertaken to mitigate the occupational hazards and prevent associated diseases among the women in fisher communities promoting their health and wellbeing.

IntroductionAlthough workplace violence impacts nearly all sectors, it is especially prevalent in healthcare settings, raising serious concerns for public health and occupational safety. Workers in healthcare and social services face the highest rates of violence-related injuries, being five times more likely to be injured compared to those in other industries. Furthermore, incidents of violence in the health sector are estimated to represent approximately 25% of all workplace violence occurrences ObjectiveThe main aim of this study is to examine the frequency of exposure of doctors to violence and aggression at work, and the contributing factors thereon, as well as the effects of violence on doctors. MethodThis study has been conducted in multiple hospitals in Pakistans five provinces (Punjab, Sindh, Khyber Pakhtunkhwa (KPK), Baluchistan, and Gilgit Baltistan), the Capital (Islamabad), and Azad Jammu and Kashmir (AJK). The questionnaire prepared by the researchers was filled in through face-to-face meetings by 1003 healthcare professionals who agreed to take part in the study. The resulting data has been assessed and evaluated using the SPSS V27 package program. Results77.6% of the respondents reported that they had been exposed to violence in the last 10 months. Among the reported events, the most common form was verbal violence at 70.7%. The most common perpetrators of these cases were attendants of the patients in 87% of the cases. As an impact of these cases, 87.7% of the respondents felt emotional distress due to violent incidents. In addition, 6.3% reported physical injury, and 6.0% considered leaving their jobs. A statistically significant difference in the frequency of exposure to violence has been detected between age, gender, seniority, and province. The major contributing factors towards violence included lack of communication and lack of facilities along with lack of patient care. ConclusionViolence and aggression are one of the major issues of healthcare workplaces in Pakistan. Therefore, there is a dire need to improve working conditions, build effective communication, and improve security standards to create safe workplaces for healthcare professionals What We Already Know Workplace violence in healthcare is a recognized global concern, with healthcare workers being at a higher risk compared to other professions. Verbal abuse is the most common form of workplace violence encountered by doctors and nurses, particularly in developing countries like Pakistan. Factor contributing to violence in hospitals include lack of communication, inadequate facilities, and unrealistic patient expectations. Previous studies in Pakistan have generally been limited in scope--focused on specific cities, hospitals, or types of healthcare professionals--resulting in incomplete national data. What This Article Adds This study is among the first to provide comprehensive nationwide data on workplace violence against doctors in both public and private healthcare settings in Pakistan, including previously underrepresented region like Baluchistan and Gilgit Baltistan. It identifies specific demographic risk factors (e.g., younger age, early career stage, region, and shift timing) associated with higher incidences of violence. The research uncovers that a majority of perpetrators are patient attendants, emphasizing the need for targeted awareness and security interventions. It highlights that 67.8% of doctors feel unsafe at work, with 87.7% of doctor reporting distress and 6% considering leaving job, offering critical evidence for policy changes and safety protocol implementation across healthcare institutions.