Job morale is a complex phenomenon and currently has no universally agreed-on definition.^1,2 In a broad sense, it is undecided whether it is a group^3,4 or individual^2,5,6 concept or whether it is generalizable or context dependent.^3,7-10 There is also little agreement about how job morale should be measured.^1,2 Despite this ongoing debate, much of the literature refers to the importance of job satisfaction, job motivation, and job burnout in the assessment of job morale. Therefore, these 3 factors can be seen as indicators of job morale¹¹ and are often measured using standardized methods. By measuring these indicators, positive job morale of health care professionals has been found to be an important factor for the provision of high-quality health care. It has been associated with better recruitment and retention of medical staff¹² as well as better quality of care.^13-16 A number of studies have found that better job-related well-being among health care staff is associated with higher patient satisfaction and better patient experiences of care.^13,16,17 The World Health Organization suggests that higher job morale can contribute positively to 3 domains, ie, the accessibility, safety, and acceptability of care.¹⁸ In low- and middle-income counties (LMICs), significant shortages, maldistribution, and absenteeism of health care staff have a negative impact on services and could potentially lower the morale of staff working within services.^19-21 If interventions were targeted to improve job morale, it could be possible to reduce spending on staff turnover and absences from illness.²⁰ Improved job morale could also address issues of inadequate job performance in settings with scarce resources.²² Finally, qualified physicians and dentists have received the most extensive and expensive training of health care professionals and are at the center of health care provision. However, data suggest that many qualified physicians are moving away from LMICs to work in high-income countries (HICs).²³ Job morale may be a factor in this move and therefore must be explored to enable LMICs to retain qualified physicians and dentists.

Background: The COVID-19 pandemic has had a multifaceted impact on maternal and child services and adversely influenced pregnancy outcomes. This systematic review aims to determine the impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low- and middle-income countries.Methods: The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A primary search of electronic databases was performed using a combination of search terms related to the following areas of interest: “impact’ AND ‘COVID-19’ AND ‘maternal and child health services’ AND ‘low- and middle-income countries. A narrative synthesis approach was used to analyse and integrate the results.Results: Overall, 45 unique studies conducted across 28 low- and middle-income countries met the inclusion criteria for the review. The findings suggest the number of family planning visits, antenatal and postnatal care visits, consultations for sick children, paediatric emergency visits and child immunisation levels decreased compared to the pre-pandemic levels in the majority of included studies. An analytical framework including four main categories was developed based on the concepts that emerged from included studies: the anxiety of not knowing (1), overwhelmed healthcare systems (2), challenges perceived by healthcare professionals (3) and difficulties perceived by service users (4).Conclusion: The COVID-19 pandemic disrupted family planning services, antenatal and postnatal care coverage, and emergency and routine child services. Generalised conclusions are tentative due to the heterogeneity and inconsistent quality of the included studies. Future research is recommended to define the pandemic’s impact on women and children worldwide and prepare healthcare systems for future resurgences of COVID-19 and potential challenges beyond.Systematic review registration: PROSPERO (CRD42021285178).

Background: The job morale of healthcare staff is widely seen as an important factor for the quality of care. Yet, there are different understandings of what constitutes job morale, which hinders systematic research and comparisons. We therefore conducted a scoping review of how the concept of job morale has developed over time and how it is used in healthcare research.Methods: A scoping review was conducted to identify relevant literature. Data were gathered on study design and context, objectives, definitions of morale, outcome measures and key findings. Data was synthesised using a descriptive analytical framework.Results: Ninety-three unique studies met eligibility criteria for the present review. The literature outlines four main periods of the evolution of the concept of job morale: The First World War and the interwar years; Second World War; Aftermath of the Second World War; and Contemporary period. The concept of job morale originated in a military context and was later applied to and specified in the healthcare literature. The concept has been applied to individuals and groups. The understandings used in healthcare vary, but overlap. Methods for assessing job morale in healthcare include quantitative scales, indirect measurements of consequences and predictors of morale, and qualitative approaches. Existing studies have mainly focused on the job morale of general practitioners, nurses and mental health professionals in high-income countries.Conclusions: Although the understandings of job morale in healthcare are heterogeneous and inconsistent, the concept appears to have been useful over longer periods of time and in different contexts. Which precise understanding of job morale is useful, depends on the given research purpose, and studies should make explicit which exact understanding they apply. Systematic research on job morale is required to facilitate measures to improve and maintain high levels of morale across different professional groups, including professionals in low- and middle-income countries.

Objectives To systematically review the available literature on physicians’ and dentists’ experiences influencing job motivation, job satisfaction, burnout, well-being and symptoms of depression as indicators of job morale in low-income and middle-income countries. Design The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies evaluating outcomes of interest using qualitative methods. The framework method was used to analyse and integrate review findings. Data sources A primary search of electronic databases was performed by using a combination of search terms related to the following areas of interest: ‘morale’, ‘physicians and dentists’ and ‘low-income and middle-income countries’. A secondary search of the grey literature was conducted in addition to checking the reference list of included studies and review papers. Results Ten papers representing 10 different studies and involving 581 participants across seven low-income and middle-income countries met the inclusion criteria for the review. However, none of the studies focused on dentists’ experiences was included. An analytical framework including four main categories was developed: work environment (physical and social), rewards (financial, non-financial and social respect), work content (workload, nature of work, job security/stability and safety), managerial context (staffing levels, protocols and guidelines consistency and political interference). The job morale of physicians working in low-income and middle-income countries was mainly influenced by negative experiences. Increasing salaries, offering opportunities for career and professional development, improving the physical and social working environment, implementing clear professional guidelines and protocols and tackling healthcare staff shortage may influence physicians’ job morale positively. Conclusions There were a limited number of studies and a great degree of heterogeneity of evidence. Further research is recommended to assist in scrutinising context-specific issues and ways of addressing them to maximise their utility. PROSPERO registration number CRD42017082579.

To systematically review the available literature on the efficacy of erythropoietin for wound healing in human patients. The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A descriptive-analytical method was used to analyse and integrate review findings. A primary search of electronic databases was performed using a combination of search terms related to the following areas of interest: ‘efficacy’, ‘erythropoietin’ and ‘wound healing’. A secondary search of the grey literature was conducted in addition to checking the reference list of included studies and review papers. Seven distinct studies involving 150 patients met the inclusion criteria for the review. The included studies suggest that topical and subcutaneous application of erythropoietin improves the wound healing process via faster re-epithelialization and reducing wound area and depth. There were a limited number of studies and a great degree of heterogeneity of evidence due to differences in the course of concomitant illness, wound aetiology, and the time and dosing regimens adopted. Further research adopting validated and consistent outcome measures is recommended to determine the efficacy and safety of erythropoietin for wound healing.

Objective To systematically review the available literature on the efficacy of tibial nerve stimulation on faecal incontinence and quality of life in adult patients with low anterior resection syndrome following surgery for colorectal cancer.Methods A primary search of electronic databases was conducted adopting a combination of search terms related to the following areas of interest: “efficacy”, “tibial nerve stimulation” and “low anterior resection syndrome”. A secondary search of the grey literature was performed in addition to checking the reference list of included studies and review papers. The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A descriptive analysis was used to integrate the review findings.Results Five distinct studies involving 116 patients met the inclusion criteria for the review. The included studies suggest that tibial nerve stimulation may have a positive effect on faecal incontinence and quality of life in some patients with low anterior resection syndrome and might be considered as an additional treatment option.Conclusion There were a limited number of studies and a great degree of heterogeneity of evidence due to differences in participants’ baseline characteristics, dropout rates, and follow-up periods. Further research adopting validated, consistent, and complex outcome assessment methods is recommended to determine the efficacy of tibial nerve stimulation for treatment of patients with low anterior resection syndrome.