BACKGROUND: Although healthcare personnel (HCP) are targeted for influenza vaccination they typically underutilize vaccines especially in low- and middle-income countries. We explored knowledge, attitudes, and practices of HCP about seasonal influenza vaccines (SIV) to identify factors associated with and modifiable barriers to SIV uptake.
METHODS: We pooled individual-level data from cross-sectional surveys about SIV conducted among health workers in 12 low- and middle- income countries during 2018-2020 (i.e., Albania, Armenia, Cote d\'Ivoire, Kenya, Kyrgyzstan, Lao PDR, Lebanon, Morocco, North Macedonia, Tunisia, Tajikistan, and Uganda). Eleven countries used a standard protocol and questionnaire based on the Health Belief Model to measure perceptions of susceptibility and severity of influenza disease, benefits of, barriers to, and motivators for vaccination. We analyzed attitudes and perceptions among HCP, including acceptance of vaccine for themselves and willingness to recommend vaccines to patients, grouped by the presence/absence of a national influenza vaccination program. Models were adjusted for geographic region.
RESULTS: Our analysis included 10,281 HCP from 12 countries representing four of the six World Health Organization regions: African, Eastern Mediterranean, European, and Western Pacific. The sample was distributed across low income (LIC) (3,183, 31 %), lower-middle (LMIC) (4,744, 46 %), and upper-middle income (UMIC) (2,354, 23 %) countries. Half (50 %) of the countries included in the analysis reported SIV use among HCP in both the year of and the year preceding data collection while the remainder had no influenza vaccination program for HCP. Seventy-four percent (6,341) of HCP reported that they would be willing to be vaccinated if the vaccine was provided free of charge. HCP in LICs were willing to pay prices for SIV representing a higher percentage of their country\'s annual health expenditure per capita (6.26 % [interquartile range, IQR: 3.13-12.52]) compared to HCP in LMICs and UMICs. HCP in countries with no SIV program were also willing to pay a higher percentage for SIV (5.01 % [IQR: 2.24-8.34]) compared to HCP in countries with SIV programs.. Most (85 %) HCP in our analysis would recommend vaccines to their patients, and those who would accept vaccines for themselves were 3 times more likely to recommend vaccines to their patients (OR 3.1 [95 % CI 1·8, 5·2]).
CONCLUSIONS: Increasing uptake of SIV among HCP can amplify positive impacts of vaccination by increasing the likelihood that HCP recommend vaccines to their patients. Successful strategies to achieve increased uptake of vaccines include clear guidance from health authorities, interventions based on behavior change models, and access to vaccine free-of-charge.

WHAT IS KNOWN ON THE SUBJECT?: In the past 2 years, the COVID-19 pandemic had a robust negative impact on the mental health of healthcare providers, with increasing rates of depression, anxiety, acute stress and burnout. Healthcare workers experiencing poor mental health are reluctant to seek help and treatment because they are afraid of being stigmatized and excluded by their colleagues and employers. During the pandemic positive emotions, resilience and psychological well-being buffered distress and burnout in healthcare workers. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper describes positive mental health, depression, anxiety and burnout in healthcare workers during the second wave of the pandemic. Forty-eight per cent of healthcare workers were flourishing (high levels of positive emotions and well-being), 10% languishing (absence of well-being and positivity). Flourishing individuals reported lower levels of depression, anxiety and burnout. These findings documented a relevant number of resilient healthcare workers, who restored/maintained their well-being also under stressful conditions. Vulnerable healthcare workers were less than 20%, and they reported severe anxiety, depression and burnout. No differences emerged between languishing and moderate mental health groups in their levels of anxiety, depression and burnout. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The condition of flourishing is the only one that provides protection from depression and anxiety and burnout, while moderate mental health does not differ substantially from the languishing state. The study confirms the importance of maintaining and/or promoting the well-being of healthcare workers. Interventions for promoting positive mental health of vulnerable workers are needed. Mental health nurses can have the skills and expertise for evaluating early symptoms of psychological distress and for implementing interventions for promoting and restoring well-being. These interventions may include informational campaign (i.e. preparing and distributing pamphlets and guidelines) and emotional support programmes (psychoeducation and training, mental health support team, peer support and counselling) that can be delivered also via digital platforms.
UNASSIGNED: INTRODUCTION: Few studies focused on healthcare workers\' positive mental health (i.e. high levels of psychological well-being) and its association with anxiety, depression and burnout in the second wave of the pandemic.
OBJECTIVE: To evaluate the protective role of well-being in buffering burnout and psychological distress.
METHODS: We evaluated 173 Italian healthcare workers with indicators of psychological distress (Depression Anxiety Stress Scales [DASS]-21), burnout (Copenhagen Burnout Inventory [CBI]) and positive mental health (Mental Health Continuum) and we cross-classified them according to their levels of mental health (flourishing, languishing and moderate mental health) and their levels of anxiety, depression and burnout.
RESULTS: Forty-eight per cent of health workers were classified as flourishing, 10% as languishing and 42% as moderate mental health. Flourishing individuals presented lower scores on DASS and CBI scales, whereas no differences emerged between languishing and moderate mental health groups. More than 80% of health workers with clinically significant symptoms of anxiety, depression and risk of burnout were classified as not flourishing.
CONCLUSIONS: This investigation documented the presence of flourishing mental health in almost half of the sample of Italian healthcare workers. However, those with moderate or languishing mental health manifested higher levels of anxiety, depression and higher risks of burnout.
CONCLUSIONS: The study confirms the importance of maintaining and/or promoting the well-being of this population, with a crucial role of mental health nurses who can easily approach other healthcare workers and provide them informational (training, guidelines) and emotional support programmes (psychoeducation, mental health support team, peer support and counselling) when facing adverse working conditions.

OBJECTIVE: To identify the relationship between the violence-prevention climate and workplace happiness in hospitals. The secondary objective is to adapt a valid and reliable scale to a different culture in healthcare settings.
BACKGROUND: Healthcare settings are not immune to the harmful effects of violence, which can exacerbate existing challenges such as staff shortages. In the midst of these challenges, organizational efforts to ensure the safety of health workers are critical. These efforts can contribute positively to workers\' happiness or well-being.
METHODS: Using a cross-sectional design with 400 healthcare professionals from five hospitals in Trabzon, Turkey, data collection involved the Violence-Prevention Climate Scale and Workplace Happiness Scale. Confirmatory factor analysis was conducted to test the Turkish validity and reliability of the scale, and the consistency coefficient was calculated.
RESULTS: The findings revealed that, on average, employees exhibited high levels of violence-prevention climate ( x ¯ ${{\\bar{\\rm x}}}$  = 4.22) and moderate levels of workplace happiness ( x ¯ ${{\\bar{\\rm x}}}$  = 3.70). Subsequently, correlation analysis unveiled a statistically significant association between the dimensions of violence-prevention climate and workplace happiness (p < 0.05, r = 0.392). It was observed that those who experienced violence and did not feel safe in the workplace had lower levels of happiness.
CONCLUSIONS: The instances of healthcare workers being exposed to violence identified in the study largely align with previous theories related to both individual and organizational effects.
CONCLUSIONS: Violence-prevention climate affects the safety and workplace happiness of workers.
CONCLUSIONS: Employees expect their managers to seriously consider all reports of violence. In this context, creating a violence-prevention climate would be a good start. According to WHO 2030 targets, in an environment where there is a significant shortage of healthcare personnel, especially nurses, ensuring that existing employees work in a safer and happier environment will make a positive contribution to healthcare systems.

UNASSIGNED: The aim of this study was to investigate the significance of associations between knowledge, professional ethics, institutional support, perceptions regarding HIV/AIDS, and HIV/AIDS-related stigma among health workers in West Sumatra, Indonesia.
UNASSIGNED: We conducted a cross-sectional study involving health workers at public hospitals and health centers in West Sumatra in June 2022. The Health Care Provider HIV/AIDS Stigma Scale (HPASS) was employed to assess the stigma associated with HIV/AIDS. To estimate and evaluate the model\'s ability to explain the proposed constructs, we utilized the standardized partial least squares structural equation model (PLS-SEM).
UNASSIGNED: In total, 283 individuals participated in this study (average age, 39 years). The majority were female (91.2%), nearly half were nurses (49.5%), and 59.4% had been working for more than 10 years. The study revealed that HIV/AIDS-related stigma persisted among health workers. The PLS-SEM results indicated that all latent variables had variance inflation factors below 5, confirming that they could be retained in the model. Knowledge and professional ethics significantly contributed to HIV-related stigma, with an effect size (f²) of 0.15 or greater. In contrast, perceived and institutional support had a smaller impact on HIV-related stigma, with an effect size (f²) of at least 0.02. The R2 value for health worker stigma was 0.408, suggesting that knowledge, professional ethics, institutional support, and perceived support collectively explain 40.8% of the variance in stigma.
UNASSIGNED: Improving health workers\' understanding of HIV, fostering professional ethics, and strengthening institutional support are essential for reducing HIV-related stigma in this population.

BACKGROUND: Developmental outcomes for children and young people with fetal alcohol spectrum disorder (FASD) are optimised if their needs are identified early. Yet, health workers miss vital opportunities to identify and respond to FASD due to a lack of support, knowledge and skills.
METHODS: Through surveys and interviews, our study investigated what child and family health workers in an Australian metropolitan local health district understand, already do and want to learn about FASD.
RESULTS: The study provided evidence of low FASD knowledge and confidence and a lack of referral options with some workers \'patching together\' care planning in a \'referral black hole\'. Qualitative data provided insight into how skilled clinicians engage families in FASD assessment and negotiate gaps in clinical knowledge.
CONCLUSIONS: Health workers in this study requested high-quality training and the development of FASD practice guidelines to improve role clarity and clinical impact when working with FASD populations.

The use of jewelry among healthcare professionals poses a risk of cross contamination due to potential bacterial accumulation and spread. Through a mixed-method design, this study first analyzed the implications of healthcare professionals wearing jewelry on patient care biosafety as well as on the residual bacterial load of hands and rings after hand hygiene. Firstly, an observational prevalence study to verify whether nursing professionals wear personal accessories during healthcare assistance was carried out. Second, an experimental design involving intentional contamination and hygiene of the hands, with and without a ring, was conducted. The bacterial load of both hands and rings was measured by counting colony forming units. The observational study showed that nursing workers frequently wear jewelry during healthcare assistance. Nonetheless, the experimental study did not indicate differences in bacterial contamination between hands with and without a ring, despite the hand hygiene procedure applied. In conclusion, many nursing workers wear jewelry in the workplace. Although hands with and without a ring exhibited similar microbial load, rings appeared as a potential source of bacterial contamination, reinforcing the need to remove jewelry during working hours. Hand hygiene using alcohol, or soap and water significantly decreased the bacterial load on the participants\' hands, with handwashing proving to be the most efficient method for removing intentional contamination.

UNASSIGNED: Research indicates that a significant number of healthcare workers accounted for all confirmed Coronavirus disease 2019 (COVID-19) cases, and many of the infected healthcare workers were asymptomatic. During the COVID-19 outbreak, a considerable number of people in Taiwan contracted the disease. Therefore, health workers in Taiwan often experienced lack of medical resources, and this problem is worse for outer island areas. In terms of stress and mental health, this study investigated the effect of poor healthcare capacity and high workload on health workers during the COVID-19 pandemic. This study also explored mindfulness-based stress reduction and resilience in health workers.
UNASSIGNED: This study conducted an in-depth interview to investigate stress perceived by health workers in a hospital located on an outer island of Taiwan as well as their mental health and stress relieving strategies.
UNASSIGNED: It was found that during the COVID-19 outbreak, some common sources of stress for health workers included exposure to infectious diseases, heavy workloads, facing ethical dilemma in clinical decision-making, and unfamiliar problems from the pandemic. These types of stress cause worries, anxiety, and depression in health workers, which affects their mental and physical health as well as their patient-care performance.
UNASSIGNED: This study proposed that mindfulness-based stress reduction and protecting mental health are important for health workers.

UNASSIGNED: The issue of restraint has long been considered a difficult political and social situation, affecting both healthcare wor-kers and facilities. The practice of restraint is still widespread in many public and private care settings, but there is a lack of systemic studies capable of monitoring the phenomenon. The framing of the question essentially concerns the right to personal freedom, guaranteed by the Italian Constitution.
UNASSIGNED: An anonymous questionnaire was developed containing questions on knowledge of the regulations on restraints, how, ways, and when they are implemented, and general information such as age, gender, educational qualification, qualification, O.Us. to which they belong. The collected data were statistically processed (Chi-square test) with the Epi Info 7.1.5 program (CDC-Atlanta- USA). A total of 1002 questionnaires were completed. The stratification of the sample by structure shows that 73.9% were public facilities. The indicative figure is represented by the 23.8% of respondents who say that \"the restraint is not noted in the medical record\".
UNASSIGNED: Restraint could be a real risk for the healthcare worker, encroaching on the issue of health liability. It is therefore important to raise awareness among healthcare professionals and top management of the need to structure, at company level, procedures that comply with the \"Recommendations on physical restraint\" to overcome the use of restraint through the improvement of care pathways in compliance with organizational and risk management standards.

The Maternal Death Surveillance and Response (MDSR) system is designed to continuously identify and review all maternal deaths. It aims to assist countries in understanding the scale and distribution of maternal deaths, identifying their causes, and informing corrective measures to address the challenge. Despite the growing adoption of the MDSR by numerous low- or middle-income countries, its implementation faces various challenges, including legal ones. This scoping review was conducted to map legal issues and challenges that arise during the implementation of the MDSR. It adapted the Bain and Kongnyuy framework, categorising legal issues into data, people, use of findings, and legal regulation. Literature was retrieved from seven databases, complemented by additional online searches. We included studies published in English between 2010 and November 2022 that report on legal issues arising during the implementation of MDSR. Out of 1,174 studies screened, 31 were selected for review. The review highlighted the limited attention given to the legal dimension of the MDSR by the research community. It also documented the lack of adequate legal framework essential for the system\'s effective implementation. Inadequate safeguards for informational privacy and the lack of confidentiality reinforce a prevalent sense of being blamed, mainly among health workers. Consequently, widespread underreporting and intentional misattribution of causes of maternal death, defensive referrals, and disengagement from the MDSR process were reported. We recommend that implementing countries regulate the gathering and use of MDSR data through suitable laws and legally ensure that the MDSR data are only used for the intended purpose. Appropriate complaint-handling mechanisms are needed in health systems to prevent the misuse of the MDSR. Future studies on MDSR implementation would benefit from involving legal experts, considering the multifaceted legal dimensions of the MDSR.

The migration of health workers remains one of the most pressing challenges facing many countries in the global South. This short communication seeks to reignite debate on the effectiveness of the World Health Organisation (WHO) Code as a tool for managing the migration of health workers from the South. While the WHO Code was somewhat effective in reducing the migration of health workers from countries such as Zimbabwe during the first five years of its implementation, demand for health workers in the UK after Brexit and the COVID-19 pandemic has accelerated the rate of migration of health workers from countries facing critical shortages. Clearly, new solutions are needed that strike a balance between the right of health workers in the South to migrate and the right of citizens in the region to a stable supply of health workers.