This study aimed to investigate the relationship between death anxiety levels at pre-exposure to human donor remains, post-exposure self-worth, and post-exposure death anxiety levels, among a sample of Irish medical students. A multi-wave prospective study was conducted, using questionnaires administered at six time-points. Path analysis was used to investigate the effect of pre-exposure death anxiety levels and post-exposure self-worth on post-exposure death anxiety levels. Baseline death anxiety was found to predict post-exposure death anxiety. Furthermore, self-worth at one month of exposure was found to mediate the relationship between pre-exposure death anxiety levels and death anxiety levels at six months.

• MeSH
• lidé MeSH
• longitudinální studie MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• studenti lékařství * MeSH
• úzkost MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Seafarers are an occupational group amongst those at highest risk for stress, which may adversely affect their mental health. The primary aim of this study was to assess the effects of a psychosocial programme on perceived stress, resilience, and job satisfaction among a sample of merchant seafarers. MATERIALS AND METHODS: Secondary data analysis was conducted using a work questionnaire administered by a large shipping company. The matched subjects technique and multivariate analysis of covariance were conducted using a theoretical model of the programme's effects on job satisfaction, resilience, and perceived stress. RESULTS: A significant interaction between programme participation and weeks on board indicated that the effects of weeks on board on perceived stress differed significantly for the intervention group and matched control group. Weeks on board had a significant effect for perceived stress for the control group (p = 0.02), but not for the intervention group (p = 0.857). CONCLUSIONS: These findings indicate that participation in the programme moderated the effects of weeks on board on perceived stress, suggesting that the programme may have safeguarded participants against the effects of weeks on board on perceived stress. Importantly, however, a work environment that is experienced as supportive, inclusive and just is necessary as a cornerstone for individually-focused psychosocial interventions to be optimally applied.

• Klíčová slova
• MANCOVA, duration on board, job satisfaction, merchant seafarers, psychosocial intervention, resilience, stress,
• MeSH
• duševní zdraví MeSH
• lidé MeSH
• lodě MeSH
• pracoviště MeSH
• pracovní uspokojení * MeSH
• průzkumy a dotazníky MeSH
• psychický stres * psychologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Despite numerous efforts to improve maternal and child health in Malawi, maternal and newborn mortality rates remain very high, with the country having one of the highest maternal mortality ratios globally. The aim of this study was to identify which individual factors best predict utilisation of skilled maternal healthcare in a sample of women residing in Lilongwe district of Malawi. Identifying which of these factors play a significant role in determining utilisation of skilled maternal healthcare is required to inform policies and programming in the interest of achieving increased utilisation of skilled maternal healthcare in Malawi. METHODS: This study used secondary data from the Woman's Questionnaire of the 2010 Malawi Demographic and Health Survey (MDHS). Data was analysed from 1126 women aged between 15 and 49 living in Lilongwe. Multivariate logistic regression was conducted to determine significant predictors of maternal healthcare utilisation. RESULTS: Women's residence (P=.006), education (P=.004), and wealth (P=.018) were significant predictors of utilisation of maternal healthcare provided by a skilled attendant. Urban women were less likely (odds ratio [OR] = 0.47, P=.006, 95% CI = 0.28-0.81) to utilise a continuum of maternal healthcare from a skilled health attendant compared to rural women. Similarly, women with less education (OR = 0.32, P=.001, 95% CI = 0.16-0.64), and poor women (OR = 0.50, P=.04, 95% CI = 0.26-0.97) were less likely to use a continuum of maternal healthcare from a skilled health attendant. CONCLUSION: Policies and programmes should aim to increase utilisation of skilled maternal healthcare for women with less education and low-income status. Specifically, emphasis should be placed on promoting education and economic empowerment initiatives, and creating awareness about use of maternal healthcare services among girls, women and their respective communities.

• Klíčová slova
• Health System, Malawi, Maternal Healthcare,
• MeSH
• dítě MeSH
• dospělí MeSH
• dostupnost zdravotnických služeb statistika a číselné údaje   MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• matky psychologie   statistika a číselné údaje   MeSH
• novorozenec MeSH
• odds ratio MeSH
• pacientův souhlas se zdravotní péčí psychologie   statistika a číselné údaje   MeSH
• předpověď MeSH
• předškolní dítě MeSH
• průzkumy a dotazníky MeSH
• služby zdravotní péče o dítě statistika a číselné údaje   MeSH
• služby zdravotní péče o matku statistika a číselné údaje   trendy   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Malawi MeSH

Background: Seafarers are amongst occupational groups with the highest risk for stress, a factor known to impact on mental health. Psychological issues such as depression, anxiety, suicide, and alcohol or drug dependence are recognized health problems within the maritime sector. The primary aim of this study was to identify which individual and occupational factors, known to impact on psychological functioning across the maritime industry and other sectors, best predict perceived stress and job satisfaction among a sample of merchant seafarers. Methods: Secondary data analysis was conducted using a work experiences and attitudes questionnaire administered by a large shipping company to seafarers within their organization. Structural equation modeling was conducted using a proposed theoretical model of perceived stress and job satisfaction in a sample of merchant seafarers. Results: While the structural equation model produced acceptable fit to the sample data according to numerous goodness-of-fit statistics, the comparative fit index and Tucker-Lewis index results indicated less than satisfactory model fit. The model explained 23.8% of variance in the criterion variable of perceived stress, and the strongest predictive effect was for dispositional resilience. The model explained 70.6% of variance in the criterion variable of job satisfaction, and the strongest predictive effect was for instrumental work support. Conclusion: When addressing the psychosocial well-being of merchant seafarers, findings of this study suggest that dispositional resilience may be a particularly important factor with regards to perceived stress, while instrumental work support appears to be a critical factor in relation to job satisfaction. Importantly, however, an overall work environment that is perceived by employees as supportive, equal and just is a cornerstone for the psychosocial well-being of seafarers.

• Klíčová slova
• job satisfaction, maritime, merchant seafarers, perceived stress, psychosocial well-being, structural equation modeling,
• Publikační typ
• časopisecké články MeSH

The Sustainable Development Goals (SDGs) aspire to "leave no-one behind". Universal access to assistive products is a critical link between the realization of the SDGs and those most likely to be left behind. However, assistive technology provision in many countries, particularly low- and middle-income countries, has traditionally been conducted through small-scale local providers, manufacturing products of varying degrees of quality at a limited price range. An effective way to scale these production and provision enterprises to the required level is needed to close the gap between available and required assistive technology. We argue that better access to assistive technology will only be realized through the adoption of a far stronger systems thinking and market shaping approach. We undertook a rapid literature review to explore the relationship between market shaping and assistive technology. Based on our review, we present an emergent framework for conceptualizing intersections between systems thinking and market shaping for assistive technology-the SMART (Systems-Market for Assistive and Related Technologies) Thinking Matrix.

• Klíčová slova
• assistive products, assistive technology, low- and middle-income countries, market shaping, resource poor settings, systems thinking,
• MeSH
• lidé MeSH
• marketing zdravotnických služeb * MeSH
• pomůcky pro sebeobsluhu * MeSH
• systémová analýza * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Equity and social inclusion for vulnerable groups in policy development processes and resulting documents remain a challenge globally. Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery. Such marginalization may occur because authorities deem the targeting of those who already have better access to healthcare a cheaper and easier way to achieve short-term health gains. The Government of Malawi wishes to achieve an equitable and inclusive HIV and AIDS Policy. The aim of this study is to assess the extent to which the Malawi Policy review process addressed regional and international health priorities of equity and social inclusion for vulnerable groups in the policy content and policy revision process. METHODS: This research design comprised two phases. First, the content of the Malawi HIV and AIDS Policy was assessed using EquiFrame regarding its coverage of 21 Core Concepts of human rights and inclusion of 12 Vulnerable Groups. Second, the engagement of vulnerable groups in the policy process was assessed using the EquIPP matrix. For the latter, 10 interviews were conducted with a purposive sample of representatives of public sector, civil society organizations and development partners who participated in the policy revision process. Data was also collected from documented information of the policy processes. RESULTS: Our analyses indicated that the Malawi HIV and AIDS Policy had a relatively high coverage of Core Concepts of human rights and Vulnerable Groups; although with some notable omissions. The analyses also found that reasonable steps were taken to engage and promote participation of vulnerable groups in the planning, development, implementation, monitoring and evaluation processes of the HIV and AIDS Policy, although again, with some notable exceptions. This is the first study to use both EquiFrame and EquIPP as complimentary tools to assess the content and process of policy. CONCLUSION: While the findings indicate inclusive processes, commitment to Core Concepts of human rights and inclusion of Vulnerable Groups in relation to the Malawi HIV and AIDS Policy, the results also point to areas in which social inclusion and equity could be further strengthened.

• Klíčová slova
• EquIPP, EquiFrame, Equity, Human Rights Core Concepts, Social Inclusion, Vulnerable Groups,
• MeSH
• AIDS MeSH
• HIV infekce * MeSH
• lidé MeSH
• lidská práva MeSH
• psychologický odstup * MeSH
• rovnost ve zdraví * MeSH
• vytváření politiky * MeSH
• zdravotní politika * MeSH
• zranitelné populace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Malawi MeSH

We welcome Jesus et al.'s paper, which makes an important contribution to the under-researched area of the physical rehabilitation workforce. The authors present recommendations to "advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs" (p. 1). We argue that their perspective could however be strengthened by adopting a stronger global perspective, including consideration of the needs of low-resource settings. In particular, we highlight the integral role of more effective sector and inter-sectoral governance, the opportunity to support the development of community-based rehabilitation (CBR), the lessons that can be learnt from human resources for health (HRH) research and practice more generally, and the recent developments in the global provision of assistive technologies. Each of these issues has important implications and contributions to make to advance the policy and research agenda for the global rehabilitation workforce.

• Klíčová slova
• Rehabilitation, Workforce, “Global Health”,
• MeSH
• lidé MeSH
• postup * MeSH
• zdravotnické zdroje * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• komentáře MeSH
• úvodníky MeSH

BACKGROUND: It is estimated that over one billion persons worldwide have some form of disability. However, there is lack of knowledge and prioritisation of how to serve the needs and provide opportunities for people with disabilities. The community-based rehabilitation (CBR) guidelines, with sufficient and sustained support, can assist in providing access to rehabilitation services, especially in less resourced settings with low resources for rehabilitation. In line with strengthening the implementation of the health-related CBR guidelines, this study aimed to determine what workforce characteristics at the community level enable quality rehabilitation services, with a focus primarily on less resourced settings. METHODOLOGY: This was a two-phase review study using (1) a relevant literature review informed by realist synthesis methodology and (2) Delphi survey of the opinions of relevant stakeholders regarding the findings of the review. It focused on individuals (health professionals, lay health workers, community rehabilitation workers) providing services for persons with disabilities in less resourced settings. RESULTS: Thirty-three articles were included in this review. Three Delphi iterations with 19 participants were completed. Taken together, these produced 33 recommendations for developing health-related rehabilitation services. Several general principles for configuring the community rehabilitation workforce emerged: community-based initiatives can allow services to reach more vulnerable populations; the need for supportive and structured supervision at the facility level; core skills likely include case management, social protection, monitoring and record keeping, counselling skills and mechanisms for referral; community ownership; training in CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve persons with disabilities in the delivery and planning. CONCLUSION: This research can contribute to implementing the WHO guidelines on the interaction between the health sector and CBR, particularly in the context of the Framework for Action for Strengthening Health Systems, in which human resources is one of six components. Realist syntheses can provide policy makers with detailed and practical information regarding complex health interventions, which may be valuable when planning and implementing programmes.

• Klíčová slova
• Community-based rehabilitation, Delphi study, Human resources, Low resource settings, Realist synthesis, Rehabilitation,
• MeSH
• dostupnost zdravotnických služeb * MeSH
• kvalita zdravotní péče MeSH
• lidé MeSH
• postižení rehabilitace   MeSH
• pracovní síly MeSH
• rehabilitace MeSH
• veřejné zdravotnické služby * MeSH
• vládní programy MeSH
• zdravotní pomocníci v komunitě MeSH
• zdravotnické zdroje * MeSH
• zdravotnický personál * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH