Neuropathology consultations are an essential part of medico-legal cause-of-death investigations. However, there are little data on the rates of neuropathological examinations in medico-legal autopsies. The present nationwide, retrospective, register-based study aimed to report and compare neuropathology consultation rates (i.e. the percentages of medico-legal autopsies with a neuropathology consultation) in five Finnish regions from 2016 to 2021. The dataset comprised 50 457 medico-legal autopsies with 1 274 neuropathology consultations. Overall, ~1 in 40 autopsies (2.5%) involved a neuropathology consultation. Consultation rates were lowest in the Southern Finland region (1.4%) and highest in the Southwestern Finland and Åland region (6.5%). Throughout the study period, the consultation rates of Southwestern Finland and Åland were 1.5 to 9.4 times those of other regions (P < 0.001). In conclusion, this nationwide Finnish study identified substantial differences in neuropathology consultation rates between regions, which may indicate regional differences in conventions and policies. However, the \"optimal\" consultation rate remains unknown. Future studies are required to further understand the differences in autopsy practices within the Finnish context as well as in medico-legal institutions elsewhere.
UNASSIGNED: There are little data on the rates of neuropathology consultations in medico-legal autopsies.This Finnish study characterized regional differences in neuropathology consultation rates between 2016 and 2021.Overall, 1 in 40 autopsies (2.5%) involved a neuropathology consultation.The consultation rates of Southwestern Finland and Åland were 1.5 to 9.4 times those of other regions.Our findings may reflect regional differences in conventions and policies.

Research on coparenting is virtually absent from the refugee literature, despite its importance for family systems, children\'s bio-behavioural and emotional development, and intergenerational responses to social change. In 2022, we conducted 30 semi-structured interviews with Syrian refugees in Jordan and used thematic analysis to examine how fathers and mothers (n = 15 dyads) enacted parenting together. We identified four approaches characterising how couples navigated coparenting interactions, family cohesion, and intergenerational change. These were negotiation, mirroring, anchoring, and transformation. Specifically, Syrian couples negotiated how to balance responsibilities, sought emotions and behaviours that reflected calm and respect, prioritised family togetherness over education or resettlement opportunities, and, strikingly, adopted gentler parenting approaches to transform intergenerational experiences. Underpinning these four themes were efforts to uphold family dignity. Syrians described themselves as ordinary parents, eschewing the label of refugee parents and building a normal life for their families after war and displacement. Our thematic analysis offers methodological and conceptual advances in exemplifying how to capture a dyadic understanding of coparenting and why refugees strive to parent in ways that sustain mental health and dignity. This systems-level analysis of coparenting in dignity is specifically relevant to strengthening the processes of family-level communication and to designing integrated programs that support caregiving, wellness, and family unity. Our findings lay the groundwork for developing a relational, agentic model of family caregiving systems in the context of precarity and forced displacement.

Diversification of the midwifery workforce is key to addressing disparities in maternal health in the United States. Midwives who feel supported in their practice environments report less burnout and turnover; therefore, creating positive practice environments for midwives of color is an essential component of growing and retaining midwives of color in the workforce. The Midwifery Practice Climate Scale (MPCS) is a 10-item instrument developed through multiphase empirical analysis to measure midwives\' practice environments, yet the MPCS had not been independently tested with midwives of color. We conducted invariance analyses to test whether latent means can be compared between midwives of color and non-Hispanic White samples. A step-up approach applied a series of increasingly stringent constraints to model estimations with multiple group confirmatory factor analyses with two pooled samples. A configural model was estimated as the basis of multiple group comparisons where all parameters were allowed to freely vary. Metric invariance was estimated by constraining item factor loadings to be equal. Scalar invariance was estimated by constraining intercepts of indicators to be equal. Each model was compared to the baseline model. The findings supported scalar invariance of MPCS across midwives of color and non-Hispanic White midwives, indicating that the MPCS is measuring the same intended construct across groups, and that differences in scores between these two groups reflect true group differences and are not related to measurement error. Additionally, in this sample, there was no statistically significant difference in perceptions of the practice environments across midwives of color and non-Hispanic White midwives (p > 0.05).

The COVID-19 pandemic created novel patient care circumstances that may have increased nurses\' moral distress, including COVID-19 transmission risk and end-of-life care without family present. Well-established moral distress instruments do not capture these novel aspects of pandemic nursing care. The purpose of this study was to develop and evaluate the psychometric properties of the COVID-19 Moral Distress Scale (COVID-MDS), which was designed to provide a short MDS that includes both general and COVID-19-specific content. Researcher-developed COVID-19 items were evaluated for content validity by six nurse ethicist experts. This study comprised a pilot phase and a validation phase. The pilot sample comprised 329 respondents from inpatient practice settings and the emergency department in two academic medical centers. Exploratory factor analysis (EFA) was conducted with the pilot data. The EFA results were tested in a confirmatory factor analysis (CFA) using the validation data. The validation sample comprised 5042 nurses in 107 hospitals throughout the United States. Construct validity was evaluated through CFA and known groups comparisons. Reliability was assessed by the omega coefficient from the CFA and Cronbach\'s alpha. A two-factor CFA model had good model fit and strong loadings, providing evidence of a COVID-19-specific dimension of moral distress. Reliability for both the general and COVID-19-specific moral distress subscales was satisfactory. Known groups comparisons identified statistically significant correlations as theorized. The COVID-MDS is a valid and reliable short tool for measuring moral distress in nurses including both broad systemic sources and COVID-19 specific sources.

Rationale: There is a need for medicine to deliver more whole-person care. This is a narrative review of several models of whole-person care and studies that illustrate the business case for whole-person models in primary care. Objectives: To provide an overview of what whole-person care models exist and explore evidence to support these models. Study Selection: Representative whole-person care models widely used in the United States are summarized and evaluated. Selected studies focused on outpatient primary care with examples from programs that integrate the delivery of conventional medical care, complementary and alternative medicine, and self-care within the context of social and cultural environments. Methods: Pubmed search conducted December 2020-February 2021. Two iterative searches using terms for \"Whole Health Veterans Administration,\" \"integrative medicine,\" \"integrative health,\" \"complementary and alternative medicine,\" and, as they related to the outcomes, of \"health outcomes,\" \"cost-effectiveness,\" \"cost reduction,\" \"patient satisfaction,\" and \"physician satisfaction.\" Additional studies were identified from an initial search and the authors\' experience of over 50 years. We looked for studies of whole-person care used in general primary care, those not using a single modality and only from United States practices. Results: A total of 125 (out of 1746) studies were found and met our inclusion criteria. We found that whole-person models of primary care exist, are quite heterogeneous in their approaches, and routinely report substantial benefits for improving the patient experience, clinical outcomes and in reducing costs. Conclusions: Evidence for the benefit of whole-person care models exist but definitions are quite heterogenous and unfocused. There is a need for more standardization of whole-person models and more research using whole systems approaches rather than reductionistic attempts using isolated components.

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OBJECTIVE: To measure the association between the nurse work environment (NWE) and missed nursing care on labour and delivery (L&D) units.
BACKGROUND: L&D units provide a sizable fraction of acute hospital services to a unique population that is a national and global priority. L&D nurses are the frontline providers during labour. Maternal morbidity and mortality may be influenced by the NWE and missed care.
METHODS: This cross-sectional study utilized secondary data from 1,313 L&D staff nurses in 247 hospitals from a four-state nurse survey collected in 2005-2008.
RESULTS: Half of nurses missed care (range: zero to 100% across hospitals). Nurses on average missed 1.25 of 10 activities. The most commonly missed activities were comforting/talking with patients and teaching/counselling. In better as compared to poor NWEs, the odds and frequency of missed care were significantly lower.
CONCLUSIONS: L&D nurses routinely miss necessary nursing activities. Labouring women\'s psychosocial, comfort and educational needs are compromised most often, likely impacting quality and outcomes. Nurse communication with colleagues and managers about missed care is warranted.
CONCLUSIONS: The L&D NWE is modifiable and appears to influence missed care. Managers should discuss missed care with staff and measure their NWE to identify actionable weaknesses.

UNASSIGNED: Estimates suggest that one in two deaths go unrecorded globally every year in terms of medical causes, with the majority occurring in low and middle-income countries (LMICs). This can be related to low investment in civil registration and vital statistics (CRVS) systems. Verbal autopsy (VA) is a method that enables identification of cause of death where no other routine systems are in place and where many people die at home. Considering the utility of VA as a pragmatic, interim solution to the lack of functional CRVS, this review aimed to examine the use of VA to inform health policy and systems improvements.
UNASSIGNED: A literature review was conducted including papers published between 2010 and 2017 according to a systematic search strategy. Inclusion of papers and data extraction were assessed by three reviewers. Thereafter, thematic analysis and narrative synthesis were conducted in which evidence was critically examined and key themes were identified.
UNASSIGNED: Twenty-six papers applying VA to inform health policy and systems developments were selected, including studies in 15 LMICs in Africa, Asia, the Middle East and South America. The majority of studies applied VA in surveillance sites or programmes actively engaging with decision makers and governments in different ways and to different degrees. In the papers reviewed, the value of continuous collection of cause of death data, supplemented by social and community-based investigations and underpinned by electronic data innovations, to establish a robust and reliable evidence base for health policies and programmes was clearly recognised.
UNASSIGNED: VA has considerable potential to inform policy, planning and measurement of progress towards goals and targets. Working collaboratively at sub-national, national and international levels facilitates data collection, aggregation and dissemination linked to routine information systems. When used in partnerships between researchers and authorities, VA can help to close critical information gaps and guide policy development, implementation, evaluation and investment in health systems.

BACKGROUND: The 2004 Mexico Declaration, and subsequent World Health Assembly resolutions, proposed a concerted support for the global development of health policy and systems research (HPSR). This included coordination across partners and advocates for the field of HPSR to monitor the development of the field, while promoting decision-making power and implementing responsibilities in low- and middle-income countries (LMICs).
METHODS: We used a network science approach to examine the structural properties of the HPSR co-authorship network across country economic groups in the PubMed citation database from 1990 to 2015. This analysis summarises the evolution of the publication, co-authorship and citation networks within HPSR.
RESULTS: This method allows identification of several features otherwise not apparent. The co-authorship network has evolved steadily from 1990 to 2015 in terms of number of publications, but more importantly, in terms of co-authorship network connectedness. Our analysis suggests that, despite growth in the contribution from low-income countries to HPSR literature, co-authorship remains highly localised. Lower middle-income countries have made progress toward global connectivity through diversified collaboration with various institutions and regions. Global connectivity of the upper middle-income countries (UpperMICs) are almost on par with high-income countries (HICs), indicating the transition of this group of countries toward becoming major contributors to the field.
CONCLUSIONS: Network analysis allows examination of the connectedness among the HSPR community. Initially (early 1990s), research groups operated almost exclusively independently and, despite the topic being specifically on health policy in LMICs, HICs provided lead authorship. Since the early 1990s, the network has evolved significantly. In the full set analysis (1990-2015), for the first time in HPSR history, more than half of the authors are connected and lead authorship from UpperMICs is on par with that of HICs. This demonstrates the shift in participation and influence toward regions which HPSR primarily serves. Understanding these interactions can highlight the current strengths and future opportunities for identifying new strategies to enhance collaboration and support capacity-building efforts for HPSR.