scholarly journals A systematic review and meta-analysis of HIV associated neurocognitive disorders (HAND) among people with HIV in Ethiopia

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Yosef Zenebe ◽  
Baye Akele ◽  
Mulugeta W/Selassie ◽  
Mogesie Necho
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Addis Ababa ◽  
Meta Analysis ◽  
Final Analysis ◽  
Cochrane Library ◽  
Early Screening ◽  
Cross Sectional ◽  
Pooled Prevalence ◽  
Size Heterogeneity

Abstract Background Ethiopia, being in the Sub Saharan region of Africa, is one of the countries with a substantial burden of HIV infection. Because of the high burden of HIV and poor health care settings, HAND is prevalent as demonstrated in various cross-sectional studies. However, no review has been conducted to report the consolidated magnitude of HAND among people with HIV in Ethiopia. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of HAND in Ethiopia. Methods Following the PRISMA guidelines, we systematically reviewed and meta-analyzed studies that investigated the prevalence of HAND in Ethiopia from PubMed, Google Scholar, Science Direct, HINARI, EMBASE, and Cochrane library databases. We also looked at the reference lists of the included studies to include other relevant studies. Subgroup analysis was performed based on publication year, study location, and sample size. Heterogeneity across studies was evaluated using the I2 test. Potential publication bias was assessed using Egger’s test and visual inspection of symmetry in the funnel plots. Results In the present meta-analysis, 627 articles were initially identified and evaluated. Of these, 8 studies that met the inclusion criteria were included in the final analysis. The pooled prevalence of HAND in people with HIV in Ethiopia was 39.15% (95% CI 29.36, 48.94). The highest prevalence observed in the Southern Nations, Nationalities, and Peoples’ Region (SNNPR) with 53.20% (95% CI 25.96, 80.44) followed by others 34.87% (Tigray, Addis Ababa, and Oromia) (95% CI 33.49, 36.24) and Amhara 34.07% (95% CI 25.39, 42.74).The funnel plot was asymmetrical. However, Egger’s regression tests provided no evidence of publication bias in the prevalence of HAND. Conclusion In this meta-analysis, the pooled prevalence of HAND, in Ethiopia, was high. Older age, substance use, advanced stages of the disease, and lack of education were the main determinants of HAND in Ethiopia. Health education, early screening of people with HIV, and training of health professionals working in hospitals on HAND are highly recommended.

scholarly journals Prevalence of Exclusive Breastfeeding Practice and its Association with Maternal Employment in Ethiopia: A Systematic Review and Meta-Analysis, 2020

2020 ◽  
Author(s):  
GETU ENGIDA WAKE ◽  
YOHANNES MOGES MITTIKU
Keyword(s):  
Systematic Review ◽  
Exclusive Breastfeeding ◽  
Maternal Employment ◽  
Maternity Leave ◽  
Meta Analysis ◽  
Final Analysis ◽  
Cochrane Library ◽  
Pooled Prevalence ◽  
Ethiopian Government ◽  
Meta Analyses

Abstract Background: Exclusive breastfeeding is defined as the practice of providing only breast-milk for an infant for the first 6 months of life without addition of any other food or water, which recommends initiation of breastfeeding within one hour of life and continued breastfeeding for up to 2 years of age or more. There are highly variable findings regarding the prevalence of exclusive breastfeeding in Ethiopia. Maternal employment is the most important factor contributing to the low practice of exclusive breastfeeding. The purpose of this review was to estimate the pooled prevalence of exclusive breastfeeding and its association with maternal employment in the context of Ethiopia.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in this systematic review and meta-analysis. The databases such as; PubMed, Google Scholar, Science Direct, Cochrane library, Scopus, CINAHL, and Web of Science were systematically searched. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal. Results: Forty-five studies were included in the final analysis after reviewing 751 studies in this meta-analysis yielding the pooled prevalence of EBF 60.42% (95% CI: 55.81-65.02%) in Ethiopia. The subgroup analysis showed the highest prevalence reported in a study conducted in SNNP and Tigray( 87.84%), a study published during (2015-2016) (64.60 %), and among studies with a sample size of less than 500 (64.15%). Those employed mothers were 57% less likely to practice exclusive breastfeeding in comparison to unemployed mothers in Ethiopia [OR] 0.43; 95% CI (0.31, 0.61).Conclusions: Maternal employment was significantly associated with the practice of exclusive breastfeeding in comparison to their counterparts. The prevalence of exclusive breastfeeding in Ethiopia is low in comparison to the global recommendation. Based On our findings, we recommended that the Ethiopian government should increase legislated paid maternity leave after delivery beyond current paid maternity leave and implement policies that empower women and create a conducive environment for mothers to practice exclusive breastfeeding in the workplace.

scholarly journals Prevalence of exclusive breastfeeding practice in Ethiopia and its association with maternal employment: a systematic review and meta-analysis, 2019.

2020 ◽  
Author(s):  
Getu Engida Wake ◽  
Yohannes Moges Mittiku
Keyword(s):  
Systematic Review ◽  
Exclusive Breastfeeding ◽  
Maternal Employment ◽  
Maternity Leave ◽  
Meta Analysis ◽  
Final Analysis ◽  
Cochrane Library ◽  
Pooled Prevalence ◽  
Ethiopian Government ◽  
Meta Analyses

Abstract Background: Exclusive breastfeeding defined as the practice of providing only breast-milk for an infant for the first 6 months of life without the addition of any other food or water, which recommends initiation of breastfeeding within one hour of life and continued breastfeeding for up to 2 years of age or more. Maternal employment is the most important factor contributing to the low practice of exclusive breastfeeding. However; the effect of maternal employment on exclusive breastfeeding is not investigated in Ethiopia. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in this systematic review and meta-analysis. The databases used were; PubMed, Google Scholar, Science Direct, and Cochrane library were systematically searched. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. Results: thirty-six studies were included in the final analysis after reviewing 541 studies in this meta-analysis yielding the pooled prevalence of EBF 59.76% (95% CI: 54.84, 64.68) in Ethiopia.Those employed mothers were 57% less likely to practice exclusive breastfeeding in comparison to unemployed mothers in Ethiopia [OR] 0.43; 95% CI (0.3, 0.62).Conclusions: The overall prevalence of exclusive breastfeeding in this meta-analysis is low in comparison to the global recommendation of the practice of exclusive breastfeeding. Maternal employment was significantly associated with the practice of exclusive breastfeeding in comparison to their counterparts. Based On our review findings, we recommended that the Ethiopian government should increase legislated paid maternity leave after delivery beyond current paid maternity leave and implement policies that empower women and create a conducive environment for mothers to practice exclusive breastfeeding at the workplace.

scholarly journals The Prevalence of Depression among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis, 2018

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Henok Mulugeta Teshome ◽  
Getenet Dessie Ayalew ◽  
Fasil Wagnew Shiferaw ◽  
Cheru Tesema Leshargie ◽  
Dube Jara Boneya
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Addis Ababa ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Diabetic Patients ◽  
Comorbid Depression ◽  
Pooled Prevalence ◽  
Prevalence Of Depression

Background. Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. Depression is one of the major important public health problems that is often comorbid with diabetes. Despite the huge effect of comorbid depression and diabetes, the overall pooled prevalence of depression among diabetic patients in the country level remains unknown. Therefore, the objective of this systematic review and meta-analysis is to estimate the pooled prevalence of depression among patients with diabetes mellitus in Ethiopia.Method. Data extraction was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, Embase, and PsycINFO. All statistical analyses were done using STATA version 11 software using random effects model. The pooled prevalence was presented in forest plots.Results. A total of 9 studies with 2944 participants were included in this meta-analysis and the overall pooled estimated prevalence of depression among diabetic patients in Ethiopia was 39.73% (95% CI (28.02%, 51.45%)). According to subgroup analysis the estimated prevalence of depression in Addis Ababa was 52.9% (95% CI: 36.93%, 68.88%) and in Oromia region was 45.49% (95% CI: 41.94, 49.03%).Conclusion. The analysis revealed that the overall prevalence of comorbid depression among diabetic patients in Ethiopia was high. Therefore, Ministry of Health should design multisectorial approach and context specific interventions that address this comorbid depression in this specific group as well as general population.

scholarly journals Prevalence of depression among school going adolescents in India: a systematic review and meta-analysis of cross-sectional studies

2021 ◽  
Vol 8 (2) ◽  
pp. 833
Author(s):  
Prashanthi Kamath ◽  
Sushma Marita Dsouza ◽  
Subhransu Mahapatra ◽  
Sruthi Jayakumar
Keyword(s):  
Mental Health ◽  
High School ◽  
Systematic Review ◽  
Meta Analysis ◽  
Random Effect ◽  
Cochrane Library ◽  
Cross Sectional ◽  
School Based ◽  
Pooled Prevalence ◽  
Prevalence Of Depression

The objective of this systematic review was to estimate the pooled prevalence of depression among schoolgoing adolescents in India by using Beck’s Depression Inventory (BDI 1 or BDI 2). A systematic literature search was conducted in PubMed, Ovid MEDLINE, Ovid EMBASE, CINAHL, Cochrane Library, PsycINFO and Google Scholar to identify cross-sectional school-based studies published during 1990-2020. Studies with pre-identified mental illness were excluded. Heterogeneity between studies were examined and estimates were pooled using a random-effects model. Subgroup and sensitivity analysis were performed. Publication bias was evaluated using funnel plot and Egger’s test. We included 13 studies in the meta-analysis. The random effect meta-analysis revealed that the pooled prevalence of depression among school going adolescents was 53% (95% CI: 41% - 65%). By gender, the prevalence was 50% (95 % CI: 38%–62%) in males and 57% (95% CI: 46% - 69%) in females. The subgroup analysis revealed that the pooled prevalence increased with the education levels (High school: 42%; High school and pre-university: 55%; and Pre-university: 67%). In this review we found that more than half of the school going adolescents in India suffered from depression that ranged from mild to severe. These results draw attention to re-look at the mental health policy and newer public health approaches to address depression. Further, strengthening school-based mental health services, along with the community and center-based care is crucial to prevent and effective management of depression among adolescents.

Noncurative microsurgery for cerebral aneurysms: a systematic review and meta-analysis of wrapping, residual, and recurrence rates

2021 ◽  
pp. 1-11
Author(s):  
Derrek Schartz ◽  
Thomas K. Mattingly ◽  
Redi Rahmani ◽  
Nathaniel Ellens ◽  
Sajal Medha K. Akkipeddi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Cerebral Aneurysms ◽  
Final Analysis ◽  
Treatment Modalities ◽  
Cochrane Library ◽  
Recurrence Rates ◽  
Total Occlusion ◽  
Statistical Heterogeneity

OBJECTIVE Microsurgery for cerebral aneurysms is called definitive, yet some patients undergo a craniotomy that results in noncurative treatment. Furthermore, the overall rate of noncurative microsurgery for cerebral aneurysms is unclear. The objective of this study was to complete a systematic review and meta-analysis to quantify three scenarios of noncurative treatment: aneurysm wrapping, postclipping remnants, and late regrowth of completely obliterated aneurysms. METHODS A PRISMA-guided systematic literature review of the MEDLINE and Cochrane Library databases and meta-analysis was completed. Studies were included that detailed rates of aneurysm wrapping, residua confirmed with imaging, and regrowth after confirmed total occlusion. Pooled rates were subsequently calculated using a random-effects model. An assessment of statistical heterogeneity and publication bias among the included studies was also completed for each analysis, with resultant I2 values and p values determined with Egger’s test. RESULTS Sixty-four studies met the inclusion criteria for final analysis. In 41 studies, 573/15,715 aneurysms were wrapped, for a rate of 3.5% (95% CI 2.7%–4.2%, I2 = 88%). In 43 studies, 906/13,902 aneurysms had residual neck or dome filling, for a rate of 6.4% (95% CI 5.2%–7.6%, I2 = 93%). In 15 studies, 71/2568 originally fully occluded aneurysms showed regrowth, for a rate of 2.1% (95% CI 1.2%–3.1%, I2 = 58%). Together, there was a total rate of noncurative surgery of 12.0% (95% CI 11.5%–12.5%). Egger’s test suggested no significant publication bias among the studies. Meta-regression analysis revealed that the reported rate of aneurysm wrapping has significantly declined over time, whereas the rates of aneurysm residua and recurrence have not significantly changed. CONCLUSIONS Open microsurgery for cerebral aneurysm results in noncurative treatment approximately 12% of the time. This metric may be used to counsel patients and as a benchmark for other treatment modalities. This investigation is limited by the high degree of heterogeneity among the included studies.

scholarly journals Burden of Uterine Rupture and Its Determinant Factors in Ethiopia: A Systematic Review and Meta-analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Dagne Addisu ◽  
Maru Mekie ◽  
Abenezer Melkie ◽  
Worku Necho
Keyword(s):  
Systematic Review ◽  
Antenatal Care ◽  
Uterine Rupture ◽  
Addis Ababa ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Obstructed Labor ◽  
Pooled Prevalence ◽  
Rural Residency

Background. Uterine rupture is a life-threatening obstetrical emergency, which results in serious undesired maternal and perinatal complications in resource-limited countries, mainly in Ethiopia. The prevalence, determinants, and outcomes of uterine rupture described by different studies were highly inconsistent in Ethiopia. Therefore, this systematic review and meta-analysis is aimed at estimating the pooled prevalence, determinants, and adverse outcomes of uterine rupture in Ethiopia. Methods. Studies were searched from international databases (PubMed/MEDLINE, HINARI, Cochrane library, Google Scholar, and web of science) and Ethiopian universities’ digital libraries (Addis Ababa University, University of Gondar, and Harameya University). All observational studies were included. A total of 15 studies that fulfill the inclusion criteria were included in this meta-analysis. Data were extracted by two reviewers and exported to STATA version 11 for analysis. The I 2 statistics were used to assess heterogeneity across the studies. Publication bias was examined by using Egger’s test and funnel plot. The pooled prevalence of uterine rupture and its outcomes were estimated by using a random effects model. The associations between determinants and uterine rupture were evaluated by using both random and fixed-effect models. Results. In this meta-analysis, a total of 15 studies with 92,394 study participants were involved. The pooled prevalence of uterine rupture was 2.37% in Ethiopia. Obstructed labor ( OR = 3.03 ; 95 % CI = 2.52 , 3.63 ), lack of antenatal care follow-up ( OR = 5.79 ; 95 % CI = 2.47 , 13.61 ), duration of labor > 24 hours ( OR = 3.75 ; 95 % CI = 2.24 , 6.29 ), grand multipara ( OR = 10.79 ; 95 % CI = 4.77 , 24.40 ), and being rural residency ( OR = 7.17 ; 95 % CI = 3.90 , 13.16 ) were significantly associated with uterine rupture. Conclusion. The overall prevalence of uterine rupture was high in Ethiopia. Obstructed labor, lack of antenatal care follow-up, duration of labor > 24 hours, grand multipara, and rural residency were determinants of uterine rupture. This study implies the need to develop plans and policies to improve antenatal care follow-up and labor and delivery management at each level of the health system.

scholarly journals Prevalence of Exclusive Breastfeeding Practice in Ethiopia and Its Association with Maternal Employment: A Systematic Review and Meta-analysis, 2019

2020 ◽  
Author(s):  
Getu Engida Wake ◽  
Yohannes Moges Mittiku
Keyword(s):  
Systematic Review ◽  
Exclusive Breastfeeding ◽  
Maternal Employment ◽  
Maternity Leave ◽  
Meta Analysis ◽  
Final Analysis ◽  
Cochrane Library ◽  
Pooled Prevalence ◽  
Ethiopian Government ◽  
Meta Analyses

Abstract Background: Exclusive breastfeeding defined as the practice of providing only breast-milk for an infant for the first 6 months of life without the addition of any other food or water, which recommends initiation of breastfeeding within one hour of life and continued breastfeeding for up to 2 years of age or more. Maternal employment is the most important factor contributing to the low practice of exclusive breastfeeding. However; the effect of maternal employment on exclusive breastfeeding is not investigated in Ethiopia.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in this systematic review and meta-analysis. The databases used were; PubMed, Google Scholar, Science Direct, and Cochrane library were systematically searched. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies.Results: 36 studies were included in the final analysis after reviewing 541 studies in this meta-analysis yielding the pooled prevalence of EBF 59.79% (95% [CI] 54.58, 65.00) in Ethiopia.Those employed mothers were 57% less likely to practice exclusive breastfeeding in comparison to unemployed mothers in Ethiopia [OR] 0.43; 95% CI (0.3, 0.62).Conclusions: The overall prevalence of exclusive breastfeeding in this meta-analysis is low in comparison to the global recommendation of the practice of exclusive breastfeeding. Maternal employment was significantly associated with the practice of exclusive breastfeeding in comparison to their counterparts. Based On our review findings, we recommended that the Ethiopian government should increase legislated paid maternity leave after delivery beyond current paid maternity leave and implement policies that empower women and create a conducive environment for mothers to practice exclusive breastfeeding at workplace.

scholarly journals Prevalence of endocrine disorders in obese patients: systematic review and meta-analysis

2020 ◽  
Vol 182 (1) ◽  
pp. 11-21 ◽  
Author(s):  
L T van Hulsteijn ◽  
R Pasquali ◽  
F Casanueva ◽  
M Haluzik ◽  
S Ledoux ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Free Testosterone ◽  
Cochrane Library ◽  
Total Testosterone ◽  
Endocrine Disorders ◽  
Cross Sectional ◽  
Pooled Prevalence ◽  
Cross Sectional Design ◽  
Underlying Mechanisms

Objective The increasing prevalence of obesity is expected to promote the demand for endocrine testing. To facilitate evidence guided testing, we aimed to assess the prevalence of endocrine disorders in patients with obesity. The review was carried out as part of the Endocrine Work-up for the Obesity Guideline of the European Society of Endocrinology. Design Systematic review and meta-analysis of the literature. Methods A search was performed in MEDLINE, EMBASE, Web of Science and COCHRANE Library for original articles assessing the prevalence of hypothyroidism, hypercortisolism, hypogonadism (males) or hyperandrogenism (females) in patients with obesity. Data were pooled in a random-effects logistic regression model and reported with 95% confidence intervals (95% CI). Results Sixty-eight studies were included, concerning a total of 19.996 patients with obesity. The pooled prevalence of overt (newly diagnosed or already treated) and subclinical hypothyroidism was 14.0% (95% CI: 9.7–18.9) and 14.6% (95% CI: 9.2–20.9), respectively. Pooled prevalence of hypercortisolism was 0.9% (95% CI: 0.3–1.6). Pooled prevalence of hypogonadism when measuring total testosterone or free testosterone was 42.8% (95% CI: 37.6–48.0) and 32.7% (95% CI: 23.1–43.0), respectively. Heterogeneity was high for all analyses. Conclusions The prevalence of endocrine disorders in patients with obesity is considerable, although the underlying mechanisms are complex. Given the cross-sectional design of the studies included, no formal distinction between endocrine causes and consequences of obesity could be made.

scholarly journals Overweight and Obesity Among Adult HIV Infected Peoples Receiving ART in Ethiopia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
pp. 215013272199364
Author(s):  
Robel Hussen Kabthymer ◽  
Solomon Nega Techane ◽  
Temesgen Muche ◽  
Helen Ali Ewune ◽  
Semagn Mekonnen Abate ◽  
...  
Keyword(s):  
Publication Bias ◽  
Addis Ababa ◽  
Data Extraction ◽  
Meta Analysis ◽  
Overweight And Obesity ◽  
Obesity And Overweight ◽  
Pooled Prevalence ◽  
Nutrition And Diet ◽  
Prevalence Of Obesity ◽  
Trim And Fill

Background: Over-nutrition and diet-linked non-communicable morbidities are showing increasing trend overtime. Even if there are different factors that affect the change in BMI other than ART, several authors have reported increases in BMI among PLHIV on treatment that are equal to or surpass the general population. This study is aimed to estimate the prevalence of obesity and overweight among adult HIV infected peoples taking ART in Ethiopia. Method: PubMed, CINAHL, Web of science, global health and Google scholar electronic databases were used to perform a systematic literature search. Two authors independently extracted all the necessary data using a structured data extraction format. Data analysis was done using STATA Version 14. The heterogeneity of the studies was assessed by using I2 test. A random-effects model was used to estimate the pooled prevalence. Publication bias was checked using Funnel plot and Egger’s test. Result: Two thousand seven hundred and fifty-one studies were reviewed and 13 studies fulfilling the inclusion criteria were included in the meta-analysis. The meta-analysis of 13 studies, comprising 4994 participants resulted in pooled prevalence of overweight to be 17.85% (95% CI: 12.22-23.47). Whereas, the pooled prevalence of overweight was found to be 3.90 (95% CI: 2.31-5.49) but after adjusting for publication bias using trim and fill analysis it has become 3.58 (95% CI: 2.04-5.13). Magnitude of both overweight and obesity was higher in studies conducted in Addis Ababa, studies done after 2016 and studies having sample size of less than 400, in subgroup analysis. Conclusion: The magnitude of overweight and obesity among HIV infected peoples taking ART in Ethiopia is high. There is a need to have a routine screening to PLWHA on the risk of over-nutrition in order to facilitate early detection.

scholarly journals Prevalence of Depression among Healthcare Workers during the COVID-19 Outbreak: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (15) ◽  
pp. 3406
Author(s):  
Beatriz Olaya ◽  
María Pérez-Moreno ◽  
Juan Bueno-Notivol ◽  
Patricia Gracia-García ◽  
Isabel Lasheras ◽  
...  
Keyword(s):  
Systematic Review ◽  
Healthcare Workers ◽  
Mental Health Problems ◽  
Meta Analysis ◽  
Medical Doctors ◽  
Cross Sectional ◽  
Random Effects Models ◽  
Pooled Prevalence ◽  
Prevalence Of Depression ◽  
Common Mental Health Problems

Background: There is evidence of a high psychological toll from the COVID-19 pandemic in healthcare workers. This paper was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among healthcare workers during the COVID-19 and estimating the pooled prevalence of depression. Methods: We searched for cross-sectional studies listed on PubMed from 1 December 2019 to 15 September 2020 that reported prevalence of depression in healthcare workers, nurses, medical doctors, and COVID-19 frontline professionals. The pooled proportions of depression were calculated with random effects models. Results: We identified 57 studies from seventeen countries. The pooled prevalence of depression in healthcare workers was 24% (95% CI: 20%−28%), 25% for nurses (95% CI: 18%−33%), 24% for medical doctors (95% CI: 16%−31%), and 43% for frontline professionals (95% CI: 28%−59%). Conclusions: The proportion of depression in nurses and medical doctors during the COVID-19 pandemic was similar to that found in the general population as previously reported in other meta-analyses conducted with smaller numbers of studies. Importantly, almost half of the frontline healthcare workers showed increased levels of depression. There is need for a comprehensive, international response to prevent and treat common mental health problems in healthcare workers.

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