Background As the COVID-19 pandemic evolves, challenges in frontline work continue to impose a significant psychological impact on nurses. However, there is a lack of data on how nurses fared compared to other health care workers in the Asia-Pacific region. Objective This study aims to investigate (1) the psychological outcome characteristics of nurses in different Asia-Pacific countries and (2) psychological differences between nurses, doctors, and nonmedical health care workers. Methods Exploratory data analysis and visualization were conducted on the data collected through surveys. A machine learning modeling approach was adopted to further discern the key psychological characteristics differentiating nurses from other health care workers. Decision tree–based machine learning models (Light Gradient Boosting Machine, GradientBoost, and RandomForest) were built to predict whether a set of psychological distress characteristics (ie, depression, anxiety, stress, intrusion, avoidance, and hyperarousal) belong to a nurse. Shapley Additive Explanation (SHAP) values were extracted to identify the prominent characteristics of each of these models. The common prominent characteristic among these models is akin to the most distinctive psychological characteristic that differentiates nurses from other health care workers. Results Nurses had relatively higher percentages of having normal or unchanged psychological distress symptoms relative to other health care workers (n=233-260 [86.0%-95.9%] vs n=187-199 [74.8%-91.7%]). Among those without psychological symptoms, nurses constituted a higher proportion than doctors and nonmedical health care workers (n=194 [40.2%], n=142 [29.5%], and n=146 [30.3%], respectively). Nurses in Vietnam showed the highest level of depression, stress, intrusion, avoidance, and hyperarousal symptoms compared to those in Singapore, Malaysia, and Indonesia. Nurses in Singapore had the highest level of anxiety. In addition, nurses had the lowest level of stress, which is the most distinctive psychological outcome characteristic derived from machine learning models, compared to other health care workers. Data for India were excluded from the analysis due to the differing psychological response pattern observed in nurses in India. A large number of female nurses emigrating from South India could not have psychologically coped well without the support from family members while living alone in other states. Conclusions Nurses were least psychologically affected compared to doctors and other health care workers. Different contexts, cultures, and points in the pandemic curve may have contributed to differing patterns of psychological outcomes amongst nurses in various Asia-Pacific countries. It is important that all health care workers practice self-care and render peer support to bolster psychological resilience for effective coping. In addition, this study also demonstrated the potential use of decision tree–based machine learning models and SHAP value plots in identifying contributing factors of sophisticated problems in the health care industry.
Background A poor diet contributes substantially to the development of noncommunicable diseases. In Singapore, it is recommended to consume at least 2 servings of fruits and vegetables daily to reduce the risk of developing noncommunicable diseases. However, the adherence rate among young adults is low. The COVID-19 pandemic has led to frequent users of mobile food delivery apps (MFDAs) adopting unhealthy eating habits, including high consumption of sugar-sweetened beverages, making it crucial to gain a deeper understanding of the underlying factors driving their use patterns. Objective We aimed to examine the use patterns of MFDAs among young adults during the COVID-19 pandemic; investigate the association between MFDA use and sociodemographic factors, dietary factors, and BMI; identify the underlying reasons for the observed use patterns of MFDAs among users; and compare the influences of MFDA use between frequent and infrequent users. Methods A sequential mixed methods design was used involving a web-based survey and in-depth interviews with a subset of respondents. Poisson regression and thematic analysis were used to analyze the quantitative and qualitative data, respectively. Results The quantitative results revealed that 41.7% (150/360) of participants reported using MFDAs frequently, defined as at least once a week. Although not substantial, the study found that frequent users were less likely to consume 2 servings of vegetables per day and more likely to drink sugar-sweetened beverages. Nineteen individuals who had participated in the quantitative component were selected for and completed the interviews. Qualitative analysis identified 4 primary themes: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. Before making any purchase, MFDA users consider all these themes at the same time, with cost being the most important influential factor. A conceptual framework based on these themes was presented. Lack of culinary skills and COVID-19 restrictions were also found to influence frequent use. Conclusions This study suggests that interventions should focus on promoting healthy dietary patterns in young adults who frequently use MFDAs. Teaching cooking skills, especially among young male individuals, and time management skills could be useful to reduce reliance on MFDAs. This study highlights the need for public health policies that make healthy food options more affordable and accessible. Given the unintended changes in behavior during the pandemic, such as reduced physical activity, sedentary behavior, and altered eating patterns, it is essential to consider behavior change in interventions aimed at promoting healthy lifestyles among young adults who frequently use MFDAs. Further research is needed to evaluate the effectiveness of interventions during COVID-19 restrictions and assess the impact of the post–COVID-19 new normal on dietary patterns and physical activity levels.
Bulimia nervosa is a crippling and chronic disorder, with individuals experiencing repeated binge-purge episodes. It is not widely understood by society. The use of the Roy adaptation model for the management of bulimia nervosa is examined in this article. Nursing models are utilized to provide a structure for planning and implementation of patient management. The Roy adaptation model focuses on the importance of individuals as able to adapt well to their changing surrounding environments. This model can be useful in managing patients with bulimia nervosa.
BACKGROUND Young adults tend to order unhealthy diets via mobile food delivery applications (MFDAs). However, it is not known why these young adults order food via MFDAs, and why young adults tend to order unhealthy food via MFDAs especially during this period of COVID-19. OBJECTIVE To investigate MFDA usage patterns of young adults and their associations with the healthfulness of users’ diets. METHODS Cross-sectional, sequential mixed-methods (QUAN) – (QUAL) was adopted. Students in a Singapore university aged 18 to 35 years were invited to complete online questionnaire via convenience sampling. Interviewees were then selected via purposeful stratified sampling. Chi-square and Poisson regression analyses were used to investigate any associations between the variables. Qualitative data were analysed using thematic analysis, guided by Braun and Clarke’s Six-Phase approach. RESULTS Among the survey participants (n=360), 41.7% used MFDAs at least once-a-week and 22.2% used at least twice-per-week. 81.4% used MFDAs more often compared to pre-COVID period. No statistical significance was observed for associations of MFDA usage frequency with and socio-demographic variables. A trend towards association was observed in vegetables and sugar-sweetened beverages (SSBs) intake. Nineteen interviewees were recruited. Four themes emerged from qualitative analysis: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. A narrative-weaving approach was utilised to integrate QUAN-QUAL findings. CONCLUSIONS Less regular use of MFDAs points towards higher consumption of vegetables and lower consumption of SSBs. Four meta-inferences explained the MFDA usage patterns among young adults: (i) Staying at home is a double-edged sword since it is convenient but can lead to unhealthy behaviours; (ii) Cooking is valued by females; (iii) Cost of food delivery is trivial if time is scarce; (iv) Young adults’ general indifference towards healthfulness of diets. Since MFDA use is frequent amongst young adults, interventions can consider these issues when promoting healthy eating amongst young adult populations.
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