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Objective: This study investigated Pakistani physicians' decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. Methods: This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as 'stayers', 'leavers' and 'resettlers' were interviewed via telephone to explore their lived experience in 2008-2009. Results: Results show a dynamic nature of the physicians' career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians' can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. Conclusions: The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals.

Introduction. The United States has always been one of the five permanent members of the United Nations Security Council and the largest financial donor to the UN System and peacekeeping operations. American policy towards the organization and peacekeeping operations has varied from harsh critique to active support. While in the office, President Trump criticized UN PKO missions for their inefficiency and pointed out the need for reforms both in the field of peacekeeping and the entire UN system. This led some American scholars to conclude that the Trump administration was an entirely special phenomenon in American policy towards the United Nations. This article analyzes United States policy towards UN peacekeeping under the Trump administration and attempts to respond to the question: does President Trump's policy regarding UN peacekeeping operations represent a fundamentally new phenomenon, or is it a continuation of trends that emerged during previous administrations? Methods and materials. The article analyses U.S. State Budgets, State Department Congressional Budget Justifications, official speeches by President Trump, Trump Administration foreign policy doctrine 'America First', official UN documents related to funding issues and troop contributions. The authors also conducted expert interviews. Analysis. President Trump administration policy towards UN peacekeeping is analyzed to identify its main trends and determine their similarities with the policies of previous presidents towards UN peace operations. Results. The article concludes that, although President Trump's policy on UN peacekeeping operations was more critical than that of many of his predecessors, it is essentially a continuation of long-standing trends in U.S. politics. Authors' contributions. D. Pushkina defined research focus of the article, examined academic literature on USA administrations' policies towards the United Nations, selected research methods, defined the main vectors of the research, organized interviews with experts and made general conclusions. A. Khazanova researched and analyzed official U.S. documents with special focus on U.S. policy towards United Nations and UN peacekeeping, examined relevant UN documents, gathered budgetary data, conducted interviews with experts, made conclusions.

Background: Mobile mental health apps have become ubiquitous tools to assist people in managing symptoms of anxiety and depression. However, due to the lack of research and expert input that has accompanied the development of most apps, concerns have been raised by clinicians, researchers, and government authorities about their efficacy.Objective: This review aimed to estimate the proportion of mental health apps offering comprehensive therapeutic treatments for anxiety and/or depression available in the app stores that have been developed using evidence-based frameworks. It also aimed to estimate the proportions of specific frameworks being used in an effort to understand which frameworks are having the most influence on app developers in this area.Methods: A systematic review of the Apple App Store and Google Play store was performed to identify apps offering comprehensive therapeutic interventions that targeted anxiety and/or depression. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was adapted to guide this approach.Results: Of the 293 apps shortlisted as offering a therapeutic treatment for anxiety and/or depression, 162 (55.3%) mentioned an evidence-based framework in their app store descriptions. Of the 293 apps, 88 (30.0%) claimed to use cognitive behavioral therapy techniques, 46 (15.7%) claimed to use mindfulness, 27 (9.2%) claimed to use positive psychology, 10 (3.4%) claimed to use dialectical behavior therapy, 5 (1.7%) claimed to use acceptance and commitment therapy, and 20 (6.8%) claimed to use other techniques. Of the 162 apps that claimed to use a theoretical framework, only 10 (6.2%) had published evidence for their efficacy.Conclusions: The current proportion of apps developed using evidence-based frameworks is unacceptably low, and those without tested frameworks may be ineffective, or worse, pose a risk of harm to users. Future research should establish what other factors work in conjunction with evidence-based frameworks to produce efficacious ...

One of the biggest growth areas in e-mental health resources has been the development and use of mobile mental health apps for smartphones and tablet devices. Such apps are being downloaded at increasing rates, but there have been questions about their efficacy and the research methodologies used to examine this. A review of the major app marketplaces, the Apple App Store and Google Play store, was conducted to locate apps claiming to offer a therapeutic treatment for depression and/or anxiety, and have research evidence for their effectiveness, according to their app store descriptions. App store descriptions were also analyzed to determine whether the app had been developed with mental health expert input; whether they had been developed in association with a government body, academic institution, or medical facility; and, whether or not they were free to download. Overall, 3.41% of apps had research to justify their claims of effectiveness, with the majority of that research undertaken by those involved in the development of the app. Other results indicated that 30.38% of shortlisted apps claimed to have expert development input; 20.48% had an affiliation with a government body, academic institution, or medical facility; and, 74.06% were free to download. Future research must consider other methodologies that may facilitate more research being completed on a greater number of apps, and future development needs to incorporate greater levels of input by mental health experts. Ways in which app stores could play a key role in encouraging more scientific research into the effectiveness of the mental health apps they sell are discussed.

Military personnel can be exposed to events such as killing or human suffering that can breach or violate their core moral frameworks. The breaching or violation of one's core moral framework can create moral trauma-often termed "moral injury." Moral injury has gained increased attention during the last decade due to its links to military suicide. The core characteristics of moral injury have not yet reached a universal consensus but can include deep feelings of shame, guilt, distrust, anger, and self-condemnation. Few studies have focused on moral injury in Australia. This paper is one of several published from a larger PhD study. The purpose of this paper is to understand participants' experiences of moral injury. Analysis of the data revealed the overarching theme-walking forwards with moral injury-describing participants' experiences of living with a moral injury and how they navigated and made meaning of their experience. From this overarching theme, three sub-themes emerged: (a) meaning-making and moral injury, (b) narratives of transformation, and (c) leading the charge. The study found that to continue "walking forwards" a transformation of identity was needed. The transformation happened when an understanding of the meaning underpinning identity occurred, and when validation and reconciliation of the experience were achieved. These findings enhance knowledge of the mechanisms needed to better support veterans living with moral injury in Australia. Outcomes from this work may assist clinicians or those working with military veterans in providing more appropriate care to those experiencing moral injury.

Despite high rates of critical incidents (CIs) in working class occupations, there is a significant gap in our understanding of responses to these events. In this study, we aimed to inform a response training module by synthesising the key elements of pre-, during- and post-incident responses to CIs and suicide in the workplace. A rapid review identified studies on responses to CIs or suicide deaths in the workplace published between January 2015 and June 2020. A systematic search of six databases (Medline, CINAHL, PsycINFO, Sociology Collection, Academic Search and Business Search Complete) and grey literature was performed. Studies were excluded if the focus was on non-colleagues. Two reviewers independently conducted record screening, a review of the full text and assessed study quality. The existing evidence was synthesised and interventions were categorised using Haddon's Matrix. Five studies were included, reporting on CIs across a range of workplace settings, including railways, factories, police and military, along with external critical response units. Overall, study quality was assessed as being poor. Most of the evidence focused on the pre-incident and post-incident stage. There is little evidence on responses to CIs in the workplace. Evidence-based education and training is necessary to establish organisational responses to assist with supporting workers exposed to workplace CIs.

This study aims to identify the ongoing physical and psychological health vulnerabilities of the readymade garment (RMG) factory workers involved in the Rana Plaza building collapse in 2013, along with their experiences within the current socioeconomic and political contexts of Bangladesh. Seventeen Rana Plaza survivors participated in unstructured, face-to-face, in-depth interviews. Interviews were thematically analyzed using Haddon's matrix to examine pre-event, event, and post-event injury experiences. The collapse of the Rana Plaza building resulted in significant physical and emotional trauma for those who survived the event. The majority of the participants were forced to attend work on the day of the collapse. Participants reported physical health complaints related to bone injuries/fractures and amputation, severe headache, kidney problems, and functional difficulties. In addition to the reported physical health issues, the participants revealed psychological health issues including trauma, depression and suicidal ideation, sleep disorders, anxiety, and sudden anger. Participants described barriers to their potential for re-employment in the RMG sector and outlined their limited access to free healthcare for follow-up treatment. Those who survived the collapse of the Rana Plaza building continue to experience significant adverse physical and emotional outcomes related to the disaster. Yet, they have little recourse to ensure the availability of adequate health care and rehabilitation. Given the international reliance on the Bangladeshi RMG industry, continued pressure to ensure care is provided for these survivors, and to reduce the risk of future disasters, is necessary.

Introduction: Social responsibility and, is an indicator that is important in the epidemic of diseases with high prevalence and death rates. The current study aims at determining the relationship between social responsibility and COVID-19 in the population covered by health centers in Iran. Methods: 500 people participated in this descriptive-analytical study. The data was collected using a researcher-made social responsibility questionnaire in the context of the Covid-19 pandemic in three areas general, individual, and social responsibility. The quantitative content validity method was used to measure the validity of the questionnaire and Cronbach's alpha calculation method was used to measure its reliability. The data were analyzed using SPSS21 software. Findings: Among the participants, 4.32% of them had a history of covid-19, and the history of complications was more in men (51.9%) and the mean social responsibility score of women was higher (P<0.001). The average responsibility score was higher in people without a history of Covid-19 than in people with a history of Covid-19 (P=0.006). Conclusion: Individuals with higher social responsibility observed more health protocols and had lower rates of covid-19 infection among them. Therefore, in the design of educational interventions, planning should be done to increase people's sense of social responsibility.

Background: Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement. Methods: The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed. Results: Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co design or co-evaluation stage. Conclusion: This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the flied of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed ...

Introduction Chronic conditions impact indigenous peoples of Australia at a much higher rate than non-indigenous Australians. Attendance at the Medicare Benefits Scheme (MBS) supported indigenous health checks are crucial to improve prevention and management of chronic health conditions. However, in conjunction with lifestyle and environmental factors, attendance rates at primary healthcare services for screening and treatment have fallen in Australia during the COVID-19 pandemic. This study aims to explore the influence of the COVID-19 pandemic on preventive health behaviours of indigenous Australians and the associated barriers to, and enablers of, engagement with health services to formulate a targeted intervention strategy. Methods and analysis A concurrent mixed-methods study (comprising quantitative and qualitative data collection methods) will be employed. Descriptive analysis of MBS data about the characteristics of indigenous peoples of Australia claiming health assessment services will be performed. Generalised estimating equation regression models will be used to examine the use of health assessment services over time. Qualitative interviews informed by indigenous research methods will be conducted. Interviews will investigate barriers to, and enablers of, engagement with health services. Thematic approach guided by the principles of indigenist praxis, storytelling and collaborative research will be used to analyse the interview data. The project commenced in July 2020 and will be completed by July 2022. Ethics and dissemination The project received ethics approval from the Aboriginal Health and Medical Research Council of New South Wales and the University of New England Human Research Ethics Committee. Findings will be disseminated via peer-reviewed journal articles, conferences, government and relevant stakeholder reports, and infographics.

Stepping is the strategy used in standing to prevent fall. Reactive stepping is made when perturbed to fall. Reactive stepping is less assessed in clinical setting, instead, proactive stepping is assessed to measure the risk of fall. Reactive stepping is commonly tested in research settings. This study was done to find relationship between proactive stepping and reactive stepping in healthy adults. We found that proactive stepping ability did not reflect reactive stepping ability. The study suggests that outcomes of proactive stepping measures must be used with caution to understand individual's ability to do reactive stepping and prevent falling.

"How people behave in an emergency depends on many social, cultural, and contextual factors. This study aimed to determine the COVID-19 risk perception in Iranian people. This study was descriptive. The study population was the assistant of patients who had come to Baqiyatallah Hospital in 2021. The number of participants was 500. The study tool was the COVID-19 risk assessment questionnaire. Data were analyzed using SPSS-22 software. The mean risk perception score was 2.78(±0.6) on a 7-point scale. The lowest and highest mean of the predictors of risk perception in COVID-19 was trust in government and personal efficacy, respectively. There was a significant difference between men and women in the mean of collective efficacy (P= 0.032). Social knowledge (p=0.007), trust in science (p=0.001), and trust in medical professionals (p=0.050) in positive direct experience people were significantly more than in people with negative direct experience of COVID-19. The most important predictors of risk perception in the COVID-19 epidemic were gender, education, social knowledge, and trust in science (P<0.05). People's perception of the risk of COVID-19 depends on several various factors, the most important factors were gender, level of education, social knowledge, and people's trust in science. "