Given the chronic work-related stressors experienced by nursing staff in today's healthcare systems, international evidence suggests an elevated risk of developing stress-related mental symptoms. Therefore, identifying effective methods to foster resilience (i.e., maintenance or fast recovery of mental health despite stressor exposure) seems crucial. To date, little is known about the efficacy of these interventions in nurses.
This systematic review aimed at summarizing the evidence on the pre-pandemic efficacy of psychological interventions to foster resilience, to improve mental symptoms and well-being as well as to promote resilience factors in nurses. Based on training programs with evidence for positive effects on resilience and mental health in meta-analyses, we aimed at identifying important and helpful intervention techniques.
Systematic review and meta-analyses based on a Cochrane review on pre-pandemic resilience interventions in healthcare professionals.
MEDLINE, Embase, CENTRAL and 11 other databases were searched until June 2020 to identify eligible randomized controlled trials. Trial registers, reference lists and contact with authors were additional sources.
Two reviewers independently assessed study eligibility and extracted data. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias of included studies. We conducted random-effects pairwise meta-analyses for five primary outcomes, including resilience. The intervention contents and techniques were narratively synthesized.
Of 39,794 records retrieved, 24 studies were included in the review (N = 1879 randomized participants), 17 in meta-analyses (n = 1020 participants). At post-intervention, we found very-low certainty evidence of moderate effects in favor of resilience training for resilience (standardized mean difference [SMD] 0.39; 95% CI [confidence interval] 0.12-0.66) and well-being (SMD 0.44; 95% CI 0.15-0.72), while there was no evidence of effects on symptoms of anxiety, depression and stress. The improvement of well-being was sustained in the short-term (≤3 months), with additional delayed benefits for anxiety and stress. There was no evidence of effects at later follow-ups, with the caveat of only three available studies. Among nine programs with evidence of positive moderate effect sizes, intervention contents included mindfulness and relaxation, psychoeducation, emotion regulation, cognitive strategies, problem-solving and the strengthening of internal and external resources.
Given the chronic stressor exposure in nursing staff, our findings may guide both the design and implementation of nurse-directed resilience interventions. To improve the certainty of evidence, more rigorous high-quality research using improved study designs (e.g., larger sample sizes, longer follow-up periods) is urgently needed.
PROSPERO 2017 CRD42017082827.

Interventions to foster resilience in nursing staff: A systematic review and meta-analyses of pre-pandemic evidence.

Comment on Kunzler et al. (2022) 'Interventions to foster resilience in nursing staff: A systematic review and meta-analyses of pre-pandemic evidence'.

Women in Sub-Saharan African experience socioeconomic barriers in the use of reproductive health care services. This paper analyzes the evidence on socioeconomic inequalities in reproductive health care utilization in Sub-Saharan Africa and identifies the variance in the estimates of these inequalities.
We performed a systematic review and meta-analysis of studies on socioeconomic inequalities in the use of reproductive health care services published between January 2008 and June 2019. We used meta-regression to identify heterogeneity sources in reproductive care services use.
Twenty-two studies were included and they reported 305 estimates of the concentration index for different reproductive health care services. We grouped the services into ten categories of reproductive health care services. Socioeconomic status was associated with inequality in reproductive health care use and was on average high, with a pro-wealthy inequality magnitude of the concentration index of 0.202. The meta-analysis indicated that inequality was highest for skilled childbirth services with an average concentration index of 0.343. The average concentration index for family planning and components of antenatal care was 0.268 and 0.142 respectively. Random-effects meta-regression showed that the heterogeneity in reproductive health care use was explained by contextual differences between countries.
The magnitude of inequality in reproductive health care use varies with the type of service and the focus on skilled childbirth services through user fees removal appears to have fostered inequality. The one-size-fits-all approach to reproductive health care initiatives has ignored differences in reproductive health care needs and the ability to overcome use barriers.

Socioeconomic inequalities in reproductive health care services across Sub-Saharan Africa. A systematic review and meta-analysis.

Cardiovascular diseases are patterned by race and socioeconomic status, and chronic low-grade inflammation is proposed as a key underlying mechanism. Theories for how racial and socioeconomic disadvantages foster inflammation emphasize a lifecourse approach: social disadvantages enable chronic or repeated exposure to stressors, unhealthy behaviors, and environmental risks that accumulate across the lifecourse to increase low-grade inflammation. However, single samples rarely include multiple racial and socioeconomic groups that each span a wide age range, precluding examination of this proposition. To address this issue, the current study combined seven studies that measured C-reactive protein and interleukin-6, producing a pooled sample of 1650 individuals aged 11-60 years. We examined (a) whether race and socioeconomic disparities in inflammatory biomarkers vary across the lifecourse, (b) whether adiposity operates as a pathway leading to these disparities, and (c) whether any indirect pathways through adiposity also vary across the lifecourse. Relative to White individuals, Black individuals exhibited higher, whereas Asian individuals exhibited lower, levels of inflammatory biomarkers, and adiposity accounted for these racial differences. Similarly, lower socioeconomic status was associated with higher inflammatory biomarkers via elevated adiposity. Importantly, both racial and socioeconomic disparities, as well as their pathways via adiposity, widened across the lifecourse. This pattern suggests that the impact of social disadvantages compound with age, leading to progressively larger disparities in low-grade inflammation. More broadly, these findings highlight the importance of considering age when examining health disparities and formulating conceptual models that specify how and why disparities may vary across the lifecourse.

Race, socioeconomic status, and low-grade inflammatory biomarkers across the lifecourse: A pooled analysis of seven studies.

Young women in West and Central Africa have been described by the United Nations as being especially vulnerable to HIV/AIDS. Despite a consensus that increased efforts are necessary to address the needs of this particular demographic, correlates of HIV seropositivity in young West and Central African women have not been systematically described. This study fills this gap using a rich set of publicly available survey data.
For this cross-sectional study, we combined HIV test results for young women (age 15-24 years) with information on demographic, cultural and socioeconomic correlates from 17 recent Demographic and Health Surveys (DHS) to estimate odds ratios (OR) from fixed effects logistic regression models accounting for potential individual, household-level and contextual risk factors of HIV seropositivity.
The prevalence of HIV seropositivity among young women is higher than for men of the same age in all included surveys, except for the Burkina Faso DHS. An important correlate of HIV seropositivity in young women is early sexual activity (OR = 1.510; 95% confidence interval (CI) = 1.100, 2.072), while higher education is associated with reduced odds of being HIV positive (OR = 0.215; 95% CI = 0.057, 0.820). No significant correlation has been found for individual HIV awareness, but HIV stigma is negatively associated with HIV seropositivity (OR = 0.495; 95% CI = 0.247, 0.990, in the fully adjusted model).
The results demonstrate the need to design effective policies addressing behavioral risks in young women. In particular, increasing HIV awareness alone is likely to be insufficient. Instead, information campaigns need to focus on transforming awareness into behavioral change. Moreover, fostering formal education may be an effective tool in the fight against HIV/AIDS.

Correlates of HIV seropositivity in young West and Central African women: A pooled analysis of 17 Demographic and Health Surveys.

Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system.
We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed.
Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €.
Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results.

Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE).

WHAT IS KNOWN ON THE SUBJECT?: Researchers have examined several interventions for psychological distress, mindfulness being a popular one. One intervention that fosters mindfulness is mantram repetition. Mantram repetition is an ancient traditional practice of repeating a sacred word/phrase at various times throughout the day and whenever needed. Psychologically, mantram repetition can mitigate immediate stressors. When used consistently, mantram repetition promotes resilience and deepens mindfulness, thereby promoting recovery from distress. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper examines the overall effect of mantram repetition on psychological distress symptoms (i.e., depression, anxiety and somatization). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The portable, cost-effective, mantram repetition intervention outperformed standard therapies. In people who are prone to psychological distress, practitioners might teach this technique, encouraging them to use it initially as they go through their day and then when they are experiencing distress. Mantram repetition can quiet the mind and pairs well with breathing exercises and routine activities such as walking or exercising, or during chores, thus, integrating the mantram into daily life.
INTRODUCTION: Researchers have examined several interventions for psychological distress, mindfulness being a popular one. One mindfulness intervention is mantram repetition. Mantram repetition is an ancient traditional practice of repeating a sacred word/phrase at various times throughout the day and whenever needed.
To examine the evidence of the effect of mantram repetition on psychological distress (i.e., depression, anxiety and somatization).
We searched 16 databases and retrieved 12 studies testing the effects of mantram repetition; only four of these measured aspects of psychological distress with comparison groups.
All studies showed positive effects ranging from very mild (.08) to very strong (.71). The summary effect across all studies was small (.23, p = .015). Importantly, this small effect was found when compared to treatment as usual and even psychotherapy.
The portable, cost-effective, mantram repetition intervention outperformed standard therapies.
In patients who are prone to psychological distress, practitioners might teach this technique, encouraging them to use it initially as they go through their day and then when they are experiencing distress. Mantram repetition could be practiced with breathing exercises, when walking or exercising, or during chores, integrating the mantram into daily life.

Papers