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Based on our findings, 15-mg zinc supplementation daily from 16 weeks of pregnancy until delivery cannot improve pregnancy outcomes.

Background Although the availability of fully funded direct‐acting antivirals (DAAs) and the eligibility of primary care providers (PCPs) to provide hepatitis C virus (HCV) have removed barriers related to access to hospital‐based HCV treatment in Australia, there are still many barriers to the provision of HCV treatment in community settings. There is a lack of knowledge regarding the barriers to, and enablers of HCV treatment in community settings in Australia. This study aimed to identify barriers and enablers for the provision of community‐based HCV treatment. Methods This study was a part of a mixed‐method case study of the Cure‐It programme. The programme was studied to better understand barriers and enablers experienced by stakeholders of such programmes. The programme is delivered through the Prince Charles Hospital in Brisbane, Australia, and aimed to improve access to HCV treatment in community settings. Data were collected using semi‐structured interviews with 12 healthcare providers and nine patients between July and December 2018. Purposive sampling was used to ensure diverse views were captured. The interview transcripts were analysed using inductive thematic analysis. Results Ease of access to specialist support, easy and high value treatment, co‐location with or providing other services and motivated patients enabled PCPs to be engaged with the Cure‐It programme. Several interconnected factors related to patients’ characteristics and health system acted synergistically to enable patients to initiate and complete treatment. These included a desire to remove HCV as a source of shame, having children, awareness of HCV consequences, access to DAAs for free, ease of access to general practices and drug and alcohol services, and access to a safe and enabling environment. The identified barriers were interconnected at the levels of patients, PCPs and primary care systems and acted synergistically to prevent patients and PCPs from becoming engaged with HCV treatment. PCPs’ related barriers included a lack of knowledge, their perception of HCV as a specialist area and of patients with HCV as ‘hard to manage’ patients along with the practice preferences and priorities. Patients’ related barriers included their socioeconomic characteristics, internalized stigma, perception of not being sick and lack of knowledge. Additionally, the unavailability of support for patients and existence of stigma in primary health care, along with poor communication between the hospital and primary care system, and the unavailability of FibroScan® in primary care discouraged PCPs and patients engagement specifically with the provision of community‐based HCV treatment. Conclusion Various strategies are needed to improve PCPs and patients’ knowledge and awareness of HCV treatment. Training and support for PCPs need to be easy to access and should cover both clinical and social aspect of HCV. Connecting PCPs to other related services may improve PCPs’ and patients’ engagement with HCV treatment.

Summary Several community‐based models for treating hepatitis C virus (HCV) infection have been implemented to improve treatment accessibility and health outcomes. However, there is a lack of knowledge regarding how well these models achieve the desired goals. We conducted a mixed‐method systematic review of quantitative and qualitative evidence about clinical effectiveness, cost effectiveness and acceptability of community‐based HCV treatment models. Seventeen databases were researched for published and unpublished studies. Methodological quality was assessed using The Joanna Briggs Institute Critical Appraisal tools. Quantitative findings were synthesized in narrative form and qualitative findings were synthesized using meta‐synthesis. Forty‐two quantitative and six qualitative studies were included. No relevant cost effectiveness studies were found. Five categories of community‐based models were identified: telehealth, integration of HCV and addiction services, integration of HCV and HIV services, integration of HCV and primary care, and implementation by a home care and health care management company. The range of reported outcomes included; end of treatment response: 48.7% to 96%, serious side effects: 3.3% to 27.8%, sustained virological response: 22.3% to 95.5%, relapse: 2.2% to 16.7%, and treatment completion: 33.4% to 100%. Inconsistent measures of uptake and adherence were used; uptake ranged from 8.3% to 92%, and 68.4% to 100% of patients received ≥80% of prescribed doses. Patient reported experiences included trusted and supportive care providers, safe and trusted services, easily accessible care, and positive psychological and behavioural changes. The clinical effectiveness and acceptability reported from the included studies are similar to or better than reported outcomes from systematic reviews of studies in tertiary settings. Studies of the cost effectiveness of community‐based models for treating HCV are needed.

Background Migrants have been disproportionally affected by COVID-19 in Australia. Vaccination against COVID-19 is a key pillar of Australia's public health response, but little is known about the willingness to receive booster vaccinations among migrants. This study aimed to assess the factors associated with a willingness to receive a COVID-19 booster vaccine among migrants living in Australia born in the World Health Organization’s Eastern Mediterranean Region (EMRO). Methods A cross-sectional survey was conducted from September to November 2021 (n = 300). Participants were questioned on booster vaccine willingness, sociodemographic characteristics, COVID-19 vaccine information needs and sources, and perceptions of COVID-19 vaccines. Univariate and multivariate logistic regression were used to assess factors associated with booster willingness. Results Most respondents (87%) had received two doses of COVID-19 vaccine, of which 81% were willing to receive a booster dose. About half of the participants reported high or very high needs for receiving information about “COVID-19 vaccines’ safety monitoring in Australia”, “COVID-19 vaccines protection against illness”, “Safety of COVID-19 vaccines used in Australia”, and “The Australian COVID-19 vaccination program”. People who were willing to receive a boost dose had significantly higher self-estimated knowledge of COVID-19 vaccines, confidence in COVID-19 vaccines and trust in the Australian government’s vaccine recommendations, and perceived COVID-19 as a greater risk compared to those who were unsure/hesitant. Both groups reported similar perceptions of their personal risks from COVID-19 but diverged on their views of COVID-19 as a broader health problem. There were no statistically significant differences between the two groups in terms of channels used to find information about COVID-19 vaccines. Factors associated with willingness to receive a COVID-19 booster vaccine in the multivariate logistic regression were age (aOR 1.07 95% CI 1.02–1.12), and no exposure to concerning news about COVID-19 vaccines (aOR 3.71 95% CI 1.51–9.09). Conclusion Vaccine acceptance and reported booster willingness was high. The results suggest the news and information seen may impact willingness to receive booster doses, even among those who have already received doses of COVID-19 vaccine. Addressing vaccine concerns and transparent communication about uncertainty should be a priority in the current and in future pandemics.

For determining relationship between quality of sleep and spiritual well-being/religious activities in Muslim women with breast cancer (WBC), we conducted a cross-sectional study on 80 WBC who presented at all chemotherapy clinics in Qom, Iran, in 2012. We used Pittsburgh Sleep Quality Index (PSQI), spiritual well-being scale (SWBS), and religious activities (RA) questionnaire. Global PSQI score and its seven components score were not significantly correlated with total score of SWBS and its two subscales. Global PSQI score was not significantly correlated with total score of RA questionnaire (P = 0.278), but its "sleep latency" (r = 0.235, P = 0.044) and "use of sleep medications" (r = 0.237, P = 0.040) components were significantly correlated with total score of RA. Global PSQI was significantly correlated with "I don't get much personal strength and support from my God," "I believe there is some real purpose for my life" questions in SWBS, and "Attendance in mosque or religious places" subscale of RA.

Summary Background A key to achieving the goal of hepatitis C virus (HCV) elimination is the provision of its treatment in community settings. This study aimed to identify the important organisational and operational elements of community‐based models for treating HCV and their feasibility in the Australian context. Methods A Delphi study was conducted with 33 experts from Australia. The questionnaire included 13 elements drawn from the literature. Participants rated each element on a five‐point Likert scale for importance and feasibility and suggested additional elements. Consensus was identified when the sum of categories 1 and 2 or 4 and 5 of the five‐point Likert scale reached greater than or equal to 70%. Results Eight elements reached consensus in regard to importance including “Safe and enabling environment,” “Training and support for healthcare providers,” “Open referral policy,” “Linkage with or providing outreach services,” “Person‐centred approach,” “On‐site screening and assessment,” “Linkage or co‐location with harm reduction services,” and “Linkage or co‐location with drug and alcohol services.” At least 65% of participants agreed implementing elements of open referral policy, Training and support for healthcare providers, and Person‐centred approach are usually or always/very feasible. For the other five elements, this was agreed to by a range of 15.2%‐57.6% of participants. Conclusion Successful community‐based models for treating HCV in Australia are dependent on the integration and coordination of care and the support provided for both patients and healthcare providers. Substantial work is required across policy and health service planning to integrate these highly rated elements into Australian primary health care.

Background: Nurses, on a daily basis, face ethical dilemmas that arise from situations involving conflicting values or beliefs. Overall, ethical decision making of nurses seems to be a challenging aspect of their duties. This study has examined the relationship between spiritual intelligence and ethical decision making in nurses working in hospitals in Iran. Proportional stratified sampling was used in this study. Data were collected from 376 nurses who completed the Spiritual Intelligence Self-Report Inventory (SISRI) and Nursing Dilemma Test. Statistical analyses were done using descriptive statistics and Pearson correlations. Findings: The mean spiritual intelligence score was 49.5 ± 14.6, and mean ± SD of the Nursing Principled Thinking was 52.8 ± 12.1 and Practical Consideration was 28.16 ± 7.6. The mean score in the postconventional level was higher than the two other levels. Significant negative correlations exist between the preconventional component of the Nursing Dilemma Test and Personal Meaning Production and the Critical Existential Thinking components of the SISRI ( p < .05). There were significant positive correlations between the postconventional (Nursing Principled) and Critical Existential Thinking, Personal Meaning Production, and total score of the SISRI. Conclusion: Hence, we have concluded that spiritual intelligence plays a positive role in the ethical decision making of nurses.