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Background: A total of 68% of pre‐school children with cleft palate have speech problems requiring speech therapy. There is a lack of access to regular targeted therapy. Parent training leads to positive outcomes in early communication skills in cleft palate and non‐cleft speech disorders. Connected health has been used to address inadequate access to therapy, providing intervention to those who would not otherwise receive therapy. Aims: To evaluate the speech, activity and participation outcomes of Parent Led, Therapist Supervised, Articulation Therapy (PLAT) compared with routine speech therapy intervention in parent–child dyads. Methods & Procedures: A total of 44 children, aged 2.9–7.5 years, were included in a two‐centre, two‐phase randomized controlled trial. Informed consent and assent were obtained. Participants and speech and language therapists (SLTs) were unblinded to the groups. Parents, in the parent‐trained group (n = 23), attended 2 days' training, received a detailed speech therapy programme, and undertook intervention over 12 weeks supported by the cleft specialist SLT using FaceTime and one face‐to‐face session. In the control arm (n = 21), parent–child dyads received six therapy sessions over 12 weeks with a research SLT, comparable with usual care. Speech recordings were undertaken pre‐ and post‐intervention. Percent consonant correct (PCC) was analysed by external SLTs blinded to the time and group. Activity and participation were measured using the Intelligibility in Context Scale (ICS) and Focus on Outcomes for Children Under Six (FOCUS) questionnaire. Outcomes & Results: There was no evidence of an interaction between Time and Group or an overall statistical difference between groups for PCC scores. There was a statistically significant difference over time for both groups (words: p < 0.002; confidence interval (CI) = 9.38–16.27; d = 0.57; sentences: p < 0.002; CI = 16.04–25.97; d = 0.23). Effect sizes were medium for words and small for sentences. For intelligibility and participation, there was no evidence of an interaction between Time and Group or an overall statistical difference between groups. A statistically significant difference over time was found for intelligibility (F = 29.97, d.f. = 1, 42, p < 0.001, 95 % CI = 1.45–3.15 d = 0.46) and for participation (F = 14.19, d.f. = 1, 41, p < 0.001 95% CI = 7.63–25.03; d = 0.36) with FOCUS results indicating clinically meaningful (parent‐led group) and significant (control group) change in participation. Conclusions & Implications: PLAT can be as effective as routine care in changing speech, activity and participation outcomes for children with cleft palate, when supported by a specialist cleft SLT using connected health. What this paper addsWhat is already known on this subjectOver 50% of children with cleft palate require speech therapy. However, there is a lack of timely, accessible speech therapy services in the UK and Ireland. Previous studies have shown that parents can deliver therapy effectively, and that connected health can support the delivery of speech therapy. This study aims to provide evidence that parent‐led therapy with the supervision of a specialist cleft therapist using FaceTime is effective.What this paper adds to existing knowledgeThis randomized controlled trial indicates that parents can be trained to deliver therapy for children with cleft palate speech disorders, under the supervision of an SLT. This approach results in improved speech, activity and participation outcomes similar to routine care.What are the potential or actual clinical implications of this work?This study indicates that both parent‐led articulation therapy and routine care showed meaningful gains in speech, activity and participation, and that parent‐led articulation therapy when supported by a cleft SLT using connected health could be an additional service delivery model for children with cleft palate speech disorders. [ABSTRACT FROM AUTHOR]

Given the widespread use of touch screen devices, the effect of the users' fingers on information processing and learning is of growing interest. The present study drew on cognitive load theory and embodied cognition perspectives to investigate the effects of pointing and tracing gestures on the surface of a multimedia learning instruction. Learning performance, cognitive load and visual attention were examined in a one‐factorial experimental design with the between‐subject factor pointing and tracing gestures. The pointing and tracing group were instructed to use their fingers during the learning phase to make connections between corresponding text and picture information, whereas the control group was instructed not to use their hands for learning. The results showed a beneficial effect of pointing and tracing gestures on learning performance, a significant shift in visual attention and deeper processing of information by the pointing and tracing group, but no effect on subjective ratings of cognitive load. Implications for future research and practice are discussed. Lay Description: What is currently known about the subject matter? Pointing and tracing gestures enhance learning with multimediaThe effect is true for paper based and digital learning instructionsLess is known about the cause of this effect with regard to complex learningDifferent theoretical explanations are currently discussed What our paper adds to this A detailed analysis of the effect using eye‐tracking and touch screen dataEvidence that the effect of pointing and tracing is mediated by eye‐movementsRelevant information concerning the discussion about theoretical explanations The implications of study findings for practitioners Pointing and tracing gestures can guide the learners' visual focus of attentionPointing and tracing gestures can increase the learners' visual attentionPointing and tracing gestures foster information processing when learning with multimediaLearners can or even should use pointing and tracing gestures to support learning [ABSTRACT FROM AUTHOR]

Aim: To test the psychometric properties of the Finnish version of the Dempster Practice Behaviour Scale and explore nurses' professional autonomy along with which characteristics are related to it. Design: An instrument validation and a descriptive cross‐sectional study. Methods: The web‐based survey was conducted in September 2021 at two university hospitals in Finland. Exploratory factor analysis (EFA) was used to explore the factor structure of the modified instrument, while Cronbach's α coefficients were calculated to determine the reliability of the scale. Descriptive univariate and multivariate analyses were conducted to examine Registered Nurses' professional autonomy. The study followed STROBE guidelines. Results: During the validation process, the 30 items of the Dempster Practice Behaviour Scale were reduced to 25 items. The S‐CVI/Ave for the translated scale was 0.94. When one additional item was omitted from the EFA, the results supported five factors, which explained 45.9% of the total variance. The mean overall autonomy score was 3.63 out of 5, with readiness and empowerment the subscales with the highest and lowest, respectively, mean values. The linear regression models showed that age, nursing experience, unit type, education, shift, and perceptions of the importance of professional autonomy were related to the subscales describing professional autonomy. Conclusion: The psychometric testing provided evidence that the translated instrument was reliable. Nurses assessed that they are skilled professionals who are accountable for their actions. However, they experienced rather low levels of professional autonomy in empowerment and valuation. Health care organizations should consider this through authentic leadership and, thus, possibly strengthen professional autonomy. [ABSTRACT FROM AUTHOR]

Previous research has focused on the importance of leaders being seen to be of the group (i.e. to be prototypical of a group) but less on the impact of leaders' own degree of identification with the group. Also, little is known about the combined impact of leader prototypicality and leader identification on followers' responses. This paper reports two studies that address these lacunae. Study 1 shows experimentally that perceived leader identification and prototypicality interact to determine followers' personal identification with leaders and their perceptions of leader charisma. Findings indicate that high identification can compensate for low prototypicality such that high-identified leaders are able to inspire followership when leaders are low prototypical. Study 2 replicates these findings in the field by examining followers' responses to workgroup leaders. In addition, results demonstrate that the aforementioned responses are more pronounced for highly identified followers. The present research extends social identity theorizing by demonstrating that leaders' inability to inspire followership derives as much from their failure to project a sense of 'we' and 'us' as part of their self-concept as from a failure to exemplify group-typical attributes. [ABSTRACT FROM AUTHOR]

Background/aim Engagement in desired occupations can promote health and wellbeing in older adults. Assessments of engagement often measure frequency, amount or importance of specific activities. This study aimed to develop a scale to measure older adults' evaluation of the extent to which their everyday activities are contributing to their health and wellness. Methods Eighteen items, each scored with a seven-point rating scale, were initially developed by content experts, covering perceptions of how daily activities contribute to physical and mental health, as well as satisfaction and activity participation in the last six months. Rasch analysis methods were used to refine the scale using the pencil and paper responses of 460 community-living older adults. Results Initial Rasch analysis indicated three unlabelled rating scale categories were seldom used, reducing measurement precision. Five items were conceptually different by misfit statistics and principal component analysis. Subsequently, those items were removed and the number of rating scale steps reduced to 4. The remaining 13-item, 4-step scale, termed the Activity Significance Personal Evaluation ( ASPEn), formed a unidimensional hierarchy with good fit statistics and targeting. Person separation reliability (2.7) and internal consistency (.91) indicated the tool is appropriate for individual person measurement. Relative validity indicated equivalence between Rasch measures and total raw scores. Conclusions ASPEn is a brief, easily administered assessment of older adults' perception of the contribution of everyday activities to personal health and wellness. ASPEn may facilitate occupational therapy practice by enabling clinicians to assess change in meaning of an older adult's activity over time. [ABSTRACT FROM AUTHOR]

Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this project, potential predictors of ITL were related to the individual RN worker, the workplace, the community context, and satisfaction related to both the workplace and the community(s) within which the RN lived and worked. A national cross-sectional mail survey of RNs in rural and remote Canada provided the data (n = 3,051) for the logistic regression analysis of predictors of ITL. We found that RNs were more likely to plan to leave their nursing position within the next 12 months if they: were male, reported higher perceived stress, did not have dependent children or relatives, had higher education, were employed by their primary agency for a shorter time, had lower community satisfaction, had greater dissatisfaction with job scheduling, had lower satisfaction with their autonomy in the workplace, were required to be on call, performed advanced decisions or practice, and worked in a remote setting. The statistical evidence for predictors of ITL supported our framework with determinants related to the individual, the workplace, the community, and satisfaction levels. The importance of community makes this framework uniquely relevant to the rural health context. Our findings should guide policy makers and employers in developing retention strategies. [ABSTRACT FROM AUTHOR]

In this study, we investigated the validity of a stealth assessment of physics understanding in an educational game, as well as the effectiveness of different game‐level delivery methods and various in‐game supports on learning. Using a game called Physics Playground, we randomly assigned 263 ninth‐ to eleventh‐grade students into four groups: adaptive, linear, free choice and no‐treatment control. Each condition had access to the same in‐game learning supports during gameplay. Results showed that: (a) the stealth assessment estimates of physics understanding were valid—significantly correlating with the external physics test scores; (b) there was no significant effect of game‐level delivery method on students' learning; and (c) physics animations were the most effective (among eight supports tested) in predicting both learning outcome and in‐game performance (e.g. number of game levels solved). We included student enjoyment, gender and ethnicity in our analyses as moderators to further investigate the research questions. [ABSTRACT FROM AUTHOR]

Objectives As the need for greater global health competency increases for health care professionals in South Korea, educational efforts for nursing students have begun. This study examined the effectiveness of two educational courses for freshmen and sophomores that were designed to improve students' global health competencies. Design and Sample A trend study was conducted for all undergraduate nursing students enrolled in a 4-year undergraduate nursing program in 2013 and 2014. Measures We assessed students' global health competencies (1-knowledge and interests in global health and health equity, 2-global health skills, and 3-learning needs) in 2013 and 2014 and analyzed variance between mean scores by year and by course exposure, using 95% confidence intervals. Results Students who took both global health courses (sophomores in both years) reported higher global health-related knowledge and interests than did freshmen ( p < .01); these scores were not sustained a year later. Conclusions The two courses may have improved students' global health competencies. Reinforcement of knowledge in later courses may be needed to build on the global competencies. [ABSTRACT FROM AUTHOR]

Objectives To investigate the relationship between polypharmacy and frailty. Design Longitudinal, observational cohort study. Setting Saarland, Germany. Participants 3,058 community-dwelling adults aged between 57 and 84 years. Measurements Frailty was assessed according to the frailty phenotype, described by Fried et al. Polypharmacy and hyperpolypharmacy were defined as the concomitant use of five or more and 10 or more drugs, respectively. We assessed associations between polypharmacy and prevalent and incident frailty within 3 years of follow-up by logistic regression models controlled for multiple potential confounders including comorbidity. Additionally, cubic splines were used to assess dose-response associations. Results Polypharmacy was reported in 39.1% (n = 1,194), and hyperpolypharmacy in 8.9% (n = 273) of participants. Prevalent frailty was present in 271 (8.9%) participants; 186 (9.3%) of 1,998 non-frail participants with follow-up data became frail within 3 years. After adjustment, polypharmacy and hyperpolypharmacy were associated with prevalent frailty with adjusted odds ratios (95% confidence interval) of 2.30 (1.60-3.31) and 4.97 (2.97-8.32), respectively. Polypharmacy (odds ratio ( OR) 1.51 (1.05-2.16)) and hyperpolypharmacy ( OR 1.90 (1.10-3.28)) were also independent predictors of incident frailty. Furthermore, there was a moderate exposure-response relationship between the number of medicines and prevalent as well as incident frailty. Conclusion Our study showed that polypharmacy is associated with frailty. Further research should address the potential benefit of reducing of inappropriate polypharmacy and better pharmacotherapeutic management for preventing medication-associated frailty. [ABSTRACT FROM AUTHOR]

We tested both Rogers's hypothesis that listening enables speakers to experience psychological safety and our hypothesis that the benefit of listening for psychological safety is attenuated by avoidance-attachment style. We tested these hypotheses in six laboratory experiments, a field correlational study, and a scenario experiment. We meta-analyzed the results of the laboratory experiments and found that listening increased psychological safety on average but that the variance between the experiments was also significant. The between experiment variance in the effect of listening manipulation on psychological safety exposes a methodological challenge in choosing a research paradigm of good-versus-normal listening, as opposed to normal-versus-poor listening. More importantly, we found, as expected and across all designs, that the higher the avoidance-attachment style was, the lower the effect of listening on psychological safety. This finding has implications both for practice and for placing a theoretical boundary on Rogers's theory. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The ability to understand and manage emotional experience is critical to children's health. This study confirmed the validity of the How I Feel ( HIF) Questionnaire, a measure of children's emotional arousal and regulation, exploring its associations with measures of emotional and social functioning. METHODS The sample was comprised of 1379 Italian students (aged 8 to 12 years) who attended schools interested in the study aims. Participants completed the 30-item HIF scale, and measures of emotional self-efficacy and social desirability (SD). Factor structures were assessed using confirmatory factor analysis. Invariance by age and gender, internal consistency, temporal stability, and concurrent validity were also tested. RESULTS A 3-factor model was identified: frequency and intensity of (1) positive emotion - PE (8 items, α = .82), (2) negative emotion - NE (12 items, α = .86), and (3) positive and negative emotion control - EC (10 items, α = .77). This factor structure was invariant across age and gender groups. The HIF displayed moderate longitudinal stability over a 15-month period and a low social desirability effect. Positive emotion was positively associated with social acceptance and visibility, and negatively with social withdrawal. CONCLUSIONS The HIF is a reliable and valid measure for research and school intervention promoting students' emotional and mental health. [ABSTRACT FROM AUTHOR]

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Self-interested behavior may have positive consequences for individual group-members, but also negatively affects the outcomes of the group when group-level and individual-level interests are misaligned. In two studies, we examined such self-interested, group-undermining behavior from the perspective of regulatory focus theory. We predicted that when individual and group interests are out of alignment, individuals under promotion focus would be more likely than individuals under prevention focus to pursue individual success at the expense of their group. Two studies provided support for this prediction. Promotion oriented individuals were more willing to act in their self-interest (at the expense of their group) than individuals under prevention focus when self-interested goals were not compatible with cooperation. No effect of regulatory focus on group loyalty was found when cooperation formed the only viable route to individual success. We discuss how these findings extend our understanding of the role of regulatory focus in social situations and of the practice of ensuring loyalty in contexts where individual and group goals are misaligned while cooperation is an important part of group success. [ABSTRACT FROM AUTHOR]

Objectives In order to assist mental health services in developing countries, a key issue is the availability of psychometrically sound, brief, and cost-effective measures that have been tested within the relevant context. The present study was designed to evaluate within a young Bangladeshi population, the psychometric properties of two widely used Western measures of internalizing distress in young people: the short form of the Spence Children's Anxiety Scale and the Short Moods and Feelings Questionnaire. Method The sample included 1,360 children and adolescents aged 9-17 years ( M = 12.3 years, SD = 2.12) recruited from six districts of Bangladesh, including both community and emotionally at-risk participants. A total of 179 children were re-tested on the measures within 3-4 weeks. Results Confirmatory factor analyses showed single-factor structures for both scales in the total sample and in both community and at-risk participants separately. Multiple group analyses across gender and age-group within the at-risk and community samples showed that the single-factor structure was suitable regardless of subgroup. Analyses also indicated acceptable internal consistency, test-retest reliability and construct validity for both scales. Conclusion The two measures show promise as brief, reliable, and valid instruments for the assessment of internalizing distress among young people from Bangla-speaking communities. Practitioner points Positive clinical implications These two measures of internalizing distress in young people showed solid psychometric properties within samples collected from various parts of Bangladesh. The measures can therefore be used to assess anxiety and depression in Bangla-speaking youth., These measures should be of value in both clinical settings and at a community level to assess the need for services., Cautions and limitations Resource limitations did not allow comparison against diagnostic criteria and therefore cut-off scores to indicate clinical status among Bangladeshi youth will require further research. [ABSTRACT FROM AUTHOR]

Context Dyad practice may be as effective as individual practice during clinical skills training, improve students' confidence, and reduce costs of training. However, there is little evidence that dyad training is non-inferior to single-student practice in terms of skills transfer. Objectives This study was conducted to compare the effectiveness of simulation-based ultrasound training in pairs (dyad practice) with that of training alone (single-student practice) on skills transfer. Methods In a non-inferiority trial, 30 ultrasound novices were randomised to dyad ( n = 16) or single-student ( n = 14) practice. All participants completed a 2-hour training programme on a transvaginal ultrasound simulator. Participants in the dyad group practised together and took turns as the active practitioner, whereas participants in the single group practised alone. Performance improvements were evaluated through pre-, post- and transfer tests. The transfer test involved the assessment of a transvaginal ultrasound scan by one of two clinicians using the Objective Structured Assessment of Ultrasound Skills ( OSAUS). Results Thirty participants completed the simulation-based training and 24 of these completed the transfer test. Dyad training was found to be non-inferior to single-student training: transfer test OSAUS scores were significantly higher than the pre-specified non-inferiority margin (delta score 7.8%, 95% confidence interval −3.8-19.6%; p = 0.04). More dyad (71.4%) than single (30.0%) trainees achieved OSAUS scores above a pre-established pass/fail level in the transfer test (p = 0.05). There were significant differences in performance scores before and after training in both groups (pre- versus post-test, p < 0.01) with large effect sizes (Cohen's d = 3.85) and no significant interactions between training type and performance (p = 0.59). The dyad group demonstrated higher training efficiency in terms of simulator score per number of attempts compared with the single-student group (p = 0.03). Conclusion Dyad practice improves the efficiency of simulation-based training and is non-inferior to individual practice in terms of skills transfer. [ABSTRACT FROM AUTHOR]

Members of conflicting groups often engage in 'competitive victimhood', that is, they are motivated to gain acknowledgment that their in group is the conflict's 'true' victim. The present study found that compared with a control group, Israeli Jews and Palestinians reassured that their in group had won the victim status showed increased willingness to reconcile with the outgroup and held less pessimistic, fatalistic views of the conflict. Moreover, for members of the stronger party--Israeli Jews--winning the victim status also led to increased group efficacy and consequent readiness to take action toward resolution. These findings extend previous theorizing about the positive effects of addressing group members' need for acknowledgement of their victimization. [ABSTRACT FROM AUTHOR]

Background and aim When a child is diagnosed with type 1 diabetes, it is a complex and challenging situation for the whole family. The management of the disease places substantial demands on the family and they need to change their daily life. The short- and long-term impact on the family has rarely been described; therefore, the aim of this study was to describe and compare the disease impact on parents and children in terms of health-related quality of life ( HRQOL) at diagnosis and 1 year subsequent to the child's diagnosis with type 1 diabetes. A further aim was to describe and compare the parents' satisfaction with the care received. Method Sixty-nine children and their parents were included. Parents independently filled in the Peds QL™ Family Impact Module and the Peds QL™ Health Care Satisfaction Generic Module. The Peds QL™ 3.0 Diabetes Module was filled in by parents and children over the age of 5. Results Mothers reported a lower HRQOL than fathers both at the time of diagnosis (p = 0.003) and 1 year later (p = 0.041). For diabetes-specific HRQOL, children aged 5-7 years and their parents reported more worry than children and parents in older age groups (p = 0.037). Children aged 8-12 and 13-18 years reported a higher treatment adherence than mothers (p = 0.011 and p = 0.039, respectively); no differences were found between children and fathers. Both parents expressed overall satisfaction with the child's health care. Conclusion The family is affected during the first year after their child is diagnosed with type 1 diabetes. Both parents and the youngest children estimated a high degree of worry. The diabetes team needs to be aware of this and to take it into consideration. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Eating behavior traits measured in early life predict eating behavior and weight trajectories later in development, and may be associated with certain parental feeding behaviors. Our goal was to investigate the relationship between a range of feeding behaviors, and preschoolers' appetitive traits. Method Four hundred thirty-nine parents of UK 3-5 year olds completed scales measuring authoritarian vs. authoritative forms of limiting (Restriction vs. Monitoring) and promoting (Pressuring vs. Prompting) intake, as well as Emotional and Instrumental Feeding. Parents also completed scales measuring child Food responsiveness and Satiety responsiveness. Child BMI z-scores were calculated based on measured heights and weights. Results Parental Restriction was significantly associated with greater child Food responsiveness ( p < .001), but parental Monitoring was not. Parental Pressuring was significantly associated with greater child Satiety responsiveness ( p < .001), while parental Prompting was not. Parental Instrumental and Emotional feeding were both associated with greater child Food responsiveness ( p < .001). All relationships were independent of child BMI z-score. Discussion Prospective data are needed to determine whether the parent-child feeding relationships identified here promote, or protect against, the development of eating pathology in children. However, our results suggest that cross-sectional associations depend on the style (e.g., authoritarian vs. authoritative), as well as the type of feeding behavior measured. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:705-709) [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to investigate the degree and influencing factors of musculoskeletal disease symptoms among care workers in long-term care facilities in South Korea. Methods Participants in this cross-sectional study were 265 care workers in 15 long-term care facilities. Data were collected between 1 and 27 August 2011, using the Korea Occupational Safety and Health Agency ( KOSHA) code H-30-2003 and analyzed using logistic regression with SPSS ver. 18.0. Results Of the care workers, 88.7% had pain in at least one of the six body parts. The highest prevalence of musculoskeletal disease symptoms was in the lower back and legs. Among the organizational factors, there were significant differences in neck pain by work shift and patient grade. Neck pain was more severe in the 8 h shift group than 12-24 h shift group. Care workers caring for patients who were classified in the first patient grade of long-term care insurance had 4.73 times more complaints of musculoskeletal symptoms in the neck, 9.54 times (95% confidence interval [ CI] = 3.37-27.02) in the hand and wrist, 4.37 times (95% CI = 1.59-12.03) in the lower back, and 2.96 times (95% CI: 1.17-7.51) in the leg and foot. Conclusion To prevent and manage musculoskeletal disease symptoms, activities and the intensity of work should be arranged systematically and planned, and the improvement of organizational factors such as appropriate assignment by patients' severity is considered. [ABSTRACT FROM AUTHOR]

This research demonstrates social support from fellow group members as unique trigger of additional effort and performance in groups. Support-induced effort gains are shown both compared with groups without social support and individual work. Study 1 examined existing beliefs about motivating group work among employees with professional group work experience (n = 130). The results revealed social support as one of the most frequently reported sources of group-induced effort gains. Study 2 explored self-reported effort intentions in group training scenarios among athletes (n = 94). Finally, Study 3 examined performance as a manifest indicator of effort in an experimental persistence task among students (n = 88). The results of Study 2 and Study 3 showed significant gains due to social support in both self-reported effort and manifest performance, respectively. Together, the results demonstrate that receiving social support from fellow group members leads to higher effort in groups at the level of existing beliefs about motivating group work, at the level of effort intentions, and at the level of manifest performance behavior. The observed findings cannot be explained by established sources of motivation gains in groups such as social comparison or social indispensability. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims To describe and compare the perceived social provision for a group reporting never feeling lonely with that of a group reporting feeling lonely and to explore the meaning of loneliness. Subjects Participants (N = 101) were recruited from geriatric wards. Inclusion criteria were as follows: aged 65 years or more, the absence of dementia, one or more chronic physical disorders and plans to be discharged from the hospital to their home. The mean age was 81.3 years (range: 65-96 years), 68% were women, and 66% lived alone. Measures Assessments of social provisions and loneliness were collected by a subjective report using the Social Provision Scale ( SPS), and the Montgomery-Aasberg Depression Rating Scale ( MADRS) was used to assess depression. The participants were also asked whether they felt lonely and were then asked to describe the meaning of loneliness if they had indicated feeling lonely. Narratives were then condensed by the participants into short sentences. Results Seventy-five per cent of the participants reported feeling lonely, of these 54% were living alone, and 18% identified with depression. Three subscales of SPS scores were significantly lower in the lonely group: attachment (p < 0.001), a sense of reliable alliance (p = 0.001) and the obtaining of guidance (p = 0.01). The overall view of the experience of loneliness was dominated by emptiness and negative emotions. The following themes were identified: Emotions were dominated by sadness, anxiety and restlessness, anger and guilt. Relationships were dominated by being left alone, being confined and feeling useless. Existential dimensions were characterised by emptiness, endless boredom, isolation and the potential for change. Conclusion The study shows that loneliness is prevalent among older people suffering from chronic physical illness and confirms the complexity of the concept. A mixed-methods design contributed to nuanced and detailed information about the meaning of loneliness. [ABSTRACT FROM AUTHOR]

People's just world beliefs are related to how they feel and behave towards others: the stronger people hold beliefs that the world treats them fairly, the more they feel and act pro-socially towards others. It is conceivable, therefore, that pro-social feelings and behaviours towards others can strengthen people's personal belief in a just world, especially when people expect these positive feelings to be returned. Because mimicry enhances pro-social feelings towards others, we argue that mimicry may strengthen peoples' personal just world beliefs via positive feelings for the mimicked person and the expectation that these positive feelings are returned. Moreover, we expect these effects to be more pronounced for men because men have stronger reciprocity beliefs than women. The results of three studies supported this line of reasoning, showing that mimicry made men believe more strongly that the world is personally just to them. Further support for our line of reasoning was obtained by positive feelings for the (non)mimicked person (Study 2) and reciprocity beliefs (Study 3) mediating the effects. Taken together, the findings suggest that mimicry makes men view the world as more just. [ABSTRACT FROM AUTHOR]

In two studies, we test the prediction that perceived longevity increases system justification and the legitimacy of inequality. In Study 1, the foundations of the capitalist system were portrayed as younger or older on a timeline. Participants scored higher on economic system justification and perceived capitalism as more legitimate when they were led to believe that this economic system was older. In Study 2, we manipulated the longevity of the Indian caste system and recruited both Indians and Americans. Both groups judged the caste system as more justifiable and legitimate when it was described as more longstanding. In addition, Indians reported more system dependence and judged the caste system as more justifiable and legitimate than Americans. Feelings of system dependence explained the effects of nationality, but not the effects of longevity, on the justification and legitimacy of the caste system. Perceived longevity is a novel contributor to system justification. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The effectiveness of meditation as a tool to recover from stress has already been widely established. However, less is known about the potential psychological mediating and moderating mechanisms affecting its effectiveness. The present study aimed to advance insight in this respect by examining the mediating role of the recovery experiences 'relaxation', 'mastery', and 'detachment', and by studying the moderating role of intrinsic motivation. To this purpose, after completion of a stress-inducing speech preparation task, 100 participants were randomly assigned to either a 15-minute guided imagery meditation exercise or to a 15-minute radio interview on meditation. Subjectively experienced stress and serenity were included as measures of (recovery from) stress. These measures were completed after the speech preparation task and after the meditation exercise/radio interview. Results showed that participants who meditated reported a larger increase in serenity and decrease in subjectively experienced stress than those who listened to the radio fragment. Furthermore, it turned out that this superior effect of meditation could be partly explained by the mediating effects of 'relaxation' and 'mastery' (but not 'detachment'). The recovery effects of meditation were also stronger for participants who were highly intrinsically motivated for this activity. Altogether, results of this study provide insight into the underlying mediating and moderating mechanisms that explain the effectiveness of meditation as a recovery activity. [ABSTRACT FROM AUTHOR]

Threats to group status can elicit different responses, ranging from those that motivate striving for improvement to those that motivate defending the threatened social identity. We examine why moral threats to group status may inhibit individuals' striving to improve. Specifically, we predicted that a threat to the group's moral status evokes a defensive emotional focus on the out-group that impedes individuals' striving to improve. Two studies (N = 76 and N = 90) showed that moral (as opposed to nonmoral) threats elicited more outrage directed at the out-group and, by trend, less outrage directed at the in-group. The follow-up study further demonstrated that moral threat impeded striving for improvement because of the relative focus of outrage on in-group versus out-group. Moreover, and consistent with our group-based analysis, this pattern was most pronounced among strongly identified group members. We discuss theoretical and practical implications of framing groups' shortcomings in moral versus nonmoral terms. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We apply latent class analysis (LCA) to build typologies of response profiles underlying variation in attitudes. LCA is directly suited for identifying categories of people who have distinct representational profiles, that is, discretely measureable patterns of attitudes that are bound together by a common system of interpretation used by the group to make sense of and communicate about a social object within a social context. This novel application extends social representations theory and provides a way to simultaneously examine the relevant content of important representations and their prevalence across a priori social categories and demographics within a given society. We identify four distinct representational profiles underlying bicultural policy attitudes in a nationally representative New Zealand sample (N = 6150). We map the prevalence of these four profiles across the population, show how they vary demographically across indicators of social class, immigration status, and ethnicity, and predict distinct patterns of voting behavior, political party support, social identification, and in-group and out-group attitudes. Guidelines for the use of LCA in the study of social representations are discussed, including a three-step model of the following: (i) profile prediction and derivation; (ii) profile validation; and (iii) prevalence mapping of profile distributions across strata within the population. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives To describe perceptions of medical students and emergency doctors towards careers in emergency medicine ( EM), and to identify influences on career choice. Methods A prospective, cross-sectional questionnaire study was performed in three EDs. The instrument used Likert-type items addressing: factors important in the choice of a career, factors offered by a career in EM, and opinions of EM. EM consultants and registrars and a cohort of final-year medical students participated. Results Overall, 22 consultants, 30 registrars and 164 students completed the questionnaire (77.1% overall response). Student interest in an EM career increased from 10/161 (6.2% [95% CI 3.0-11.1%]) before, to 26/137 (19.0% [95% CI 12.8-26.6%]) after an EM attachment ( P = 0.0014). The highest proportion of students chose work-life balance as being an important factor for career choice (143/163 students, 87.7% [95% CI 81.2-92.6%]). Compared with consultants and registrars, students had negative perceptions about lifestyle factors that EM offered, as well as about the future of the specialty, job security and workplace stress. Some students also preferred careers with opportunities for research, subspecialty practice, and better pay and conditions, yet perceived EM as not offering these factors. Students considered EM as an acute, procedural, public hospital specialty, with diverse patient problems and minimal continuity of care. Smaller proportions of students considered these factors important for career choice. Conclusion Increasing the attractiveness of a career in EM requires changing student perceptions of lifestyle and satisfaction benefits, access to EM subspecialties, increasing ED research, information about job security, and improved work conditions. [ABSTRACT FROM AUTHOR]

Background: Brief interventions have the potential to reduce heavy drinking in young adults who present to the emergency department (ED), but require time and resources rarely available. Text-messaging (TM) may provide an effective way to collect drinking data from young adults after ED discharge as well as to provide immediate feedback and ongoing support for behavior change. The feasibility of screening young adults in the ED, recruiting them for a TM-based interventional trial, collecting weekly drinking data through TM, and the variance in drinking outcomes remains unknown. Methods: Young adults in 3 urban EDs ( n = 45; aged 18 to 24 years, 54% women) identified as hazardous drinkers by the Alcohol Use Disorders Identification Test-Consumption score were randomly assigned to weekly TM-based feedback with goal setting (Intervention), weekly TM-based drinking assessments without feedback (Assessment), or control. Participants in the Intervention group who reported ≥5 (for men) and ≥4 (for women) maximum drinks during any one 24-hour period were asked whether they would set a goal to reduce their drinking the following week. We describe the interaction with TM and goal setting. We also describe the heavy drinking days (HDDs), drinks per drinking day (DPDD) using timeline follow-back procedure at baseline and 3 months. Results: We screened 109 young adults over 157 hours across 24 unique days and 52 (48%; 95% CI 38 to 50) screened positive for hazardous drinking. Of these, 45 (87%; 95% CI 74 to 94) met inclusion criteria, were enrolled and randomized, and 6 (13%; 95% CI 5 to 27) did not complete 3-month web-based follow-up; 88% (95% CI 84 to 91) of weekly TM-based drinking assessments were answered, with 77% (95% CI 58 to 90) of participants responding to all 12 weeks. Agreeing to set a goal was associated with a repeat HDD 36% (95% CI 17 to 55) of the time compared with 63% (95% CI 44 to 81) when not willing to set a goal. At 3 months, participants that were exposed to the TM-based intervention had 3.4 (SD 5.4) fewer HDDs in the last month and 2.1 (SD 1.5) fewer DPDD when compared to baseline. Conclusions: TM can be used to assess drinking in young adults and can deliver brief interventions to young adults discharged from the ED. TM-based interventions have the potential to reduce heavy drinking among young adults but larger studies are needed to establish efficacy. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Building a strong and positive safety culture in health care teams and organizations is essential for patient safety. Measuring individual perceptions of safety climate is an integral part of this process. Evidence of the successful application and potential usefulness of this approach is increasingly available for secondary care settings but little is known about the safety climate in UK primary care. We therefore aimed to measure perceptions of safety climate in primary care. Further aims were to determine whether perceptions varied significantly between practice teams and according to specific participant and practice characteristics. Method We undertook a cross-sectional, anonymous postal questionnaire survey of randomly selected west of Scotland primary care teams. Safety climate mean scores with standard deviations were calculated for respondents, practice teams and the region. Results A total of 563 (84%) team members from 49 practices (24.5%) returned questionnaires. The overall safety climate mean score was 5.48 (0.78). Significant differences in safety climate perceptions were found at the practice team level ( P < 0.001) and for specific characteristics: respondents' years of experience, whether they were community or practice based, their professional roles and practices' training status. Practice managers and general practitioners perceived the safety climate more positive than other respondents ( P < 0.001). Conclusion This was the first known attempt to measure perceptions of safety climate in UK primary care with a validated instrument specifically developed for that purpose. Reported perceptions of the prevailing safety climate were generally positive. This may reflect ongoing efforts to build a strong safety culture in primary care or alternatively point to an overestimation of the effectiveness of local safety systems. The significant variation in perception between certain staff groups has potential safety implications and may have to be aligned for a positive and strong safety culture to be built. While safety climate measurement has various benefits at the individual, practice team and regional level, further research of its association with specific safety outcomes is required. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Dual epidemics of human immunodeficiency virus (HIV) and alcohol use disorders, and a dearth of professional resources for behavioral treatment in sub-Saharan Africa, suggest the need for development of culturally relevant and feasible interventions. The purpose of this study was to test the preliminary efficacy of a culturally adapted six-session gender-stratified group cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use among HIV-infected out-patients in Eldoret, Kenya. Design Randomized clinical trial comparing CBT against a usual care assessment-only control. Setting A large HIV out-patient clinic in Eldoret, Kenya, part of the Academic Model for Providing Access to Healthcare collaboration. Participants Seventy-five HIV-infected out-patients who were antiretroviral (ARV)-initiated or ARV-eligible and who reported hazardous or binge drinking. Measurements Percentage of drinking days (PDD) and mean drinks per drinking days (DDD) measured continuously using the Time line Follow back method. Findings There were 299 ineligible and 102 eligible out-patients with 12 refusals. Effect sizes of the change in alcohol use since baseline between the two conditions at the 30-day follow-up were large [ d = 0.95, P = 0.0002, mean difference = 24.93, 95% confidence interval (CI): 12.43, 37.43 PDD; d = 0.76, P = 0.002, mean difference = 2.88, 95% CI: 1.05, 4.70 DDD]. Randomized participants attended 93% of the six CBT sessions offered. Reported alcohol abstinence at the 90-day follow-up was 69% (CBT) and 38% (usual care). Paraprofessional counselors achieved independent ratings of adherence and competence equivalent to college-educated therapists in the United States. Treatment effect sizes were comparable to alcohol intervention studies conducted in the United States. Conclusions Cognitive-behavioral therapy can be adapted successfully to group paraprofessional delivery in Kenya and may be effective in reducing alcohol use among HIV-infected Kenyan out-patients. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1209-1219 Context Globalisation initiatives in medical education are premised on a universal model of medical education. This study was conducted to challenge this premise by empirically examining the impact of culture on the practice of medical education in anaesthesia residency training programmes in Thailand and Canada. Methods Using a mixed-methods comparative case study research approach, one Thai and one Canadian anaesthesia residency training programme were examined with respect to curriculum, educational practices and teacher beliefs. Data sources included observations of academic and clinical teaching, programme document analysis, surveys and faculty interviews. Recruitment resulted in a 76% survey response rate and 13 interview participants at the Thai site and a 61% survey response rate and 16 interview participants at the Canadian site. Multiple linear regression analysis was used to compare survey responses between the two programmes. The qualitative analysis consisted of primary coding, clustering into pattern codes, and identifying themes and sub-themes. The integration of quantitative and qualitative data for each case was followed by a cross-case analysis. Results The two programmes were similarly organised and had similar curricular content. However, important differences emerged in curricular emphasis, educational practices, and teacher beliefs and values. Thai faculty staff emphasised knowledge and scholarship, described the faculty-resident relationship as 'familial' and focused on 'teaching methods'. Canadian faculty members emphasised clinical abilities, described the faculty-resident relationship as 'collegial' and focused on 'learning environments'. These findings were related to broader cultural differences that influenced how the curriculum was interpreted and enacted at each site. Conclusions This study shows that although the scientific and knowledge base of medical education is universal, its enactment may be influenced by culture and context. Globalisation initiatives in medical education must be tempered by recognition of these considerations. [ABSTRACT FROM AUTHOR]

This study examined whether cultural values predict individuals' moral attitudes. The main objective was to shed light on the moral universalism and relativism debate by showing that the answer depends on the moral issues studied. Using items from the Morally Debatable Behaviours Scale (MDBS) fielded in the World Value Survey (WVS), we found that moral issues can be differentiated cross-culturally into attitudes towards (1) dishonest-illegal and (2) personal-sexual issues. Drawing upon evolutionary and cultural theories, we expected that the former moral domain is not related to cultural values, whereas the latter is influenced by cultural conceptions of the self (i.e. independent versus interdependent selves). We used multilevel modelling with Schwartz' cultural values as the independent variables and the two moral domains as assessed through the MDBS as dependent variables to test our hypothesis. After controlling for individual-level differences in moral attitudes as well as the socio-economic development of countries, our findings confirmed that attitudes towards dishonest-illegal issues were not related to cultural values whereas attitudes towards personal-sexual issues were predicted by the Autonomy-Embeddedness value dimension. We conclude that our study sheds not only light on the universalism and relativism debate, but also on the discriminant validity of cultural values. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

BSTRACT [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate pain severity and distribution in relation to sleep difficulty in older adults. DESIGN: Population-based cross-sectional study. SETTING: Community within a 5-mile radius of the study center at the Institute for Aging Research, Hebrew SeniorLife (HSL), Boston. PARTICIPANTS: Seven hundred sixty-five participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study aged 64 and older. MEASUREMENTS: Pain severity was measured using the Brief Pain Inventory (BPI) Pain Severity Subscale. Musculoskeletal pain distribution was grouped according to no pain, single site, two or more sites, and widespread pain (upper and lower extremities and back pain). Three aspects of sleep difficulty were measured using items from the Center for Epidemiologic Studies Depression Scale, Revised (trouble getting to sleep, sleep more than usual, and restless sleep). RESULTS: Prevalence of trouble getting to sleep according to BPI severity was 17.8%, 19.7%, 32.0%, and 37.0% for the lowest to highest pain severity quartiles, respectively. Similar relationships between pain and sleep were observed across sleep measures according to pain severity and distribution. Adjusted for sociodemographic characteristics, chronic conditions, and health behaviors, chronic pain was strongly associated with trouble sleeping (≥1 d/wk) (single-site pain, odds ratio (OR)=1.77, 95% confidence interval (CI)=1.10-2.87; multisite pain, OR=2.38, 95% CI=1.48-3.83; widespread pain, OR=2.55, 95% CI=1.43-4.54, each compared with no pain). Similar associations were observed for restless sleep and sleeping more than usual. For specific pain sites alone or in combination with other sites of pain, only modest associations were observed with sleep problems. CONCLUSION: Widespread or other multisite pain and moderate to severe pain are strongly associated with sleep difficulty in older adults. Further research is needed to better understand the burden and consequences of pain-related sleep problems in older adults. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the association between metabolic syndrome (MetS) and objective measures of physical performance. DESIGN: Cross-sectional analysis of the cohort study, the Osteoporotic Fractures in Men Study. SETTING: Six clinical sites in the United States. PARTICIPANTS: Five thousand four hundred fifty-seven ambulatory men (mean age 73.6 ± 5.9). MEASUREMENTS: Physical performance assessed according to grip strength, narrow walk speed, walking speed, and time to complete five repeated chair stands. Individual scores were converted to quintiles (worst=1 to best=5; unable to complete=0) and summed for an overall score (mean 11.6 ± 4.3, range, 1-20). MetS was defined according to World Health Organization criteria that include evidence of glucose dysregulation (insulin resistance, diabetes mellitus, or hyperinsulinemia) and at least two additional characteristics: high blood pressure, low high-density lipoprotein cholesterol, high triglycerides, obesity. RESULTS: More than one-quarter (26.3%) of participants met criteria for MetS. In separate linear regression models, four of five MetS components were related to performance ( P<.001); only high blood pressure was unrelated. Men with MetS had a 1.1-point lower performance score (mean 10.8, 95% confidence interval (CI)=10.6-11.0) than men without MetS (mean 11.9, 95% CI=11.8-12.0) ( P<.001), adjusting for age, race, education, and site. With further covariate adjustment, this difference was reduced but remained significant (β=−0.78, P<.001). A graded association was observed between number of MetS components (0, 1, 2, or ≥3) and performance ( P for trend <.001). Findings were similar excluding men with diabetes mellitus or obese men. CONCLUSION: Metabolic dysregulation is related to objectively assessed poorer physical performance in relatively healthy older men. [ABSTRACT FROM AUTHOR]

The aim of the current study was to address the intervening role of perceived control in the job insecurity-strain relationship. Two alternatives were investigated: (1) perceived control as a buffer of the relationship between job insecurity and outcome variables (i.e. job satisfaction, organizational commitment, psychological distress and turnover intentions); and (2) perceived control as a mediator of the relationship between job insecurity and the outcomes. Cross-sectional data of 211 employees were used to test the hypotheses. The results showed that perceived control did not buffer the relationship between job insecurity, and job satisfaction, organizational commitment, psychological distress and turnover intentions. However, perceived control was found to partially mediate the association between job insecurity and these outcomes. The results are explained using the cognitive theory of stress and coping of Lazarus and Folkman, and suggest that job insecurity is stressful because it decreases the experience of control. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We tested whether differential appraisals of inequality are a function of the injustice standards used by different groups. A confirmatory standard of injustice is defined as the amount of evidence needed to arrive at the conclusion that injustice has occurred. Consistent with a motivational shifting of standards view, we found that advantaged and disadvantaged group members set different standards of injustice when judging the magnitude of gender (Study 1) and racial (Study 2) wage inequality. In addition, because advantaged and disadvantaged group members formed - based on their differential standards - divergent appraisals of wage inequality, they experienced differential desire to restore inter-group justice. We discuss the implications of promoting low confirmatory standards for changing perceptions of social reality and for motivating justice-restorative behaviour. [ABSTRACT FROM AUTHOR]

Derdikman-Eiron, R., Indredavik, M. S., Bratberg, G. H., Taraldsen, G., Bakken, I. J. & Colton, M. (2011). Gender differences in subjective well-being, self-esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: Findings from the Nord-Trøndelag health study. Scandinavian Journal of Psychology 52, 261-267. Gender differences in the prevalence of symptoms of anxiety and depression during adolescence are well documented. However, little attention has been given to differences in subjective well-being, self-esteem and psychosocial functioning between boys and girls with symptoms of anxiety and depression. The aim of this study was to investigate gender differences in the associations between such symptoms and subjective well-being, self-esteem, school functioning and social relations in adolescents. Data were taken from a major population-based Norwegian study, the Nord-Trøndelag Health study (HUNT), in which 8984 (91% of all invited) adolescents, aged 13-19 years, completed an extensive self-report questionnaire. Although prevalence rates of symptoms of anxiety and depression were higher in girls than in boys, a significant interaction between gender and symptoms of anxiety and depression was found in respect of each of the following outcome variables: subjective well-being, self-esteem, academic problems, frequency of meeting friends and the feeling of not having enough friends. These interactions indicate that the associations between symptoms of anxiety and depression and lower subjective well-being and self-esteem, more academic problems in school and lower social functioning were stronger for boys than for girls. Our findings may contribute to an earlier assessment and more efficient treatment of male adolescent anxiety and depression. [ABSTRACT FROM AUTHOR]

School-based vaccination programs may provide an effective strategy to immunize adolescents against influenza. This study examined whether adolescent attitudes toward influenza vaccination mediated the relationship between receipt of a school-based influenza vaccination intervention and vaccine uptake. Participants were recruited from 2 counties participating in a school-based influenza vaccination intervention trial in rural Georgia (N = 337). Data were collected from surveys distributed to adolescents at pre- and post-intervention time points and from documents indicating vaccine uptake. Guided by the Health Belief Model and the Integrated Behavioral Model, surveys assessed demographic, behavioral, and psychosocial variables. A mediation analysis was used to test whether changes in psychosocial variables from baseline to follow-up mediated the relationship between study condition and influenza vaccine uptake. Controlling for background variables, step 1 of the mediation analysis revealed a significant relationship between study condition and vaccine uptake (odds ratio = 1.77, p = .038). Step 2 of the mediation analysis revealed a significant relationship between study condition and changes in psychosocial variables from baseline to follow-up. Steps 3 and 4 of the mediation analysis revealed that there was full mediation of the relationship between study condition and receipt of an influenza vaccination by intention to receive an influenza vaccination. Findings suggest that the success of our school-based influenza vaccination intervention in increasing vaccine uptake was mediated by adolescents' intention to receive an influenza vaccination. Future influenza vaccination efforts geared toward rural adolescents may benefit from addressing adolescent attitudes toward influenza vaccination, particularly increasing intention to receive a vaccine. [ABSTRACT FROM AUTHOR]

Experts estimate that the prevalence of antibiotics use exceeds the prevalence of bacterial acute respiratory infections (ARIs). To develop, adapt and validate DECISION+ and estimate its impact on the decision of family physicians (FPs) and their patients on whether to use antibiotics for ARIs. Two-arm parallel clustered pilot randomized controlled trial. Four family medicine groups were randomized to immediate DECISION+ participation (the experimental group) or delayed DECISION+ participation (the control group). Thirty-three FPs and 459 patients participated. DECISION+ is a multiple-component, continuing professional development program in shared decision making that addresses the use of antibiotics for ARIs. Throughout the pilot trial, DECISION+ was adapted in response to participant feedback. After the consultation, patients and FPs independently self-reported the decision (immediate use, delayed use, or no use of antibiotics) and its quality. Agreement between their decisional conflict was assessed. Two weeks later, patients assessed their decisional regret and health status. Compared to the control group, the experimental group reduced its immediate use of antibiotics (49 vs. 33% absolute difference = 16%; P = 0.08). Decisional conflict agreement was stronger in the experimental group (absolute difference of Pearson's r = 0.26; P = 0.06). Decisional regret and perceptions of the quality of the decision and of health status in the two groups were similar. DECISION+ was developed successfully and appears to reduce the use of antibiotics for ARIs without affecting patients' outcomes. A larger trial is needed to confirm this observation. [ABSTRACT FROM AUTHOR]

Objectives. Despite the well-replicated finding that neuroticism is associated with increased susceptibility for psychopathology, it remains unclear what 'vulnerability as indexed by neuroticism' represents in terms of everyday life emotional processes. This study examined the association between neuroticism and six phenotypes of daily life emotional responses: positive affect (PA), negative affect (NA), PA variability, NA variability, stress sensitivity, and reward experience, and investigated the contribution of genetic and environmental factors to these associations. Design. A prospective cohort study in a population-based sample of 416 adult female twins. Method. A momentary assessment approach (experience sampling method) was used to collect multiple assessments of affect in daily life. Neuroticism was assessed with the Eysenck Personality Scale. Multi-level regression analyses were carried out to examine the association between neuroticism and the phenotypes of daily life emotional responses. Cross-twin, cross-trait analyses, and bivariate structural equation modelling (SEM) were performed in order to investigate the nature of these associations. Results. A high neuroticism scorewas associated with lowermomentary PA levels and increased NA variability, independent of momentary NA, PA variability, stress sensitivity, and reward experience. Both the cross-twin, cross-trait analyses, and the bivariate SEM showed that unique, non-shared environmental factors drive the association between neuroticism and PA and that the association between neuroticism and increased NA variability is based on shared genetic factors as well as individual-specific environmental factors. Conclusions. Neuroticism as measured by Eysenck questionnaire may index an environmental risk for decreased daily life PA levels and a genetic as well as an environmental risk for increased NA variability. Decomposing the broad measure of neuroticism into measurable persons-context interactions increases its 'informative' value in explaining psychopathology. [ABSTRACT FROM AUTHOR]

Objectives: Acute gastroenteritis is a very common emergency department (ED) diagnosis accounting for greater than 1.5 million outpatient visits and 200,000 hospitalizations annually among children in the United States. Although guidelines exist to assist clinicians, they do not clearly address topics for which evidence is new or limited, including the use of antiemetic agents, probiotics, and intravenous (IV) fluid rehydration regimens. This study sought to describe the ED treatments administered to children with acute gastroenteritis and to compare management between Canadian and U.S. physicians practicing pediatric emergency medicine (PEM). Methods: Members of PEM research networks located in Canada and the United States were invited to participate in a cross-sectional, Internet-based survey. Participants were included if they are attending physicians and provide care to patients < 18 years of age in an ED. Results: In total, 235 of 339 (73%) eligible individuals responded. A total of 103 of 136 Canadian physicians (76%) report initiating oral rehydration therapy (ORT) in children with moderate dehydration, compared with 44 of 94 (47%) of their U.S. colleagues (p < 0.001). The latter more often administer antiemetic agents to children with vomiting (67% vs. 45%; p = 0.001). American physicians administer larger IV fluid bolus volumes (p < 0.001) and over shorter time periods (p = 0.001) and repeat the fluid boluses more frequently (p < 0.001). Probiotics are routinely recommended by only 35 of 230 respondents (15%). Conclusions: The treatment of pediatric gastroenteritis varies by geographic location and differs significantly between Canadian and American PEM physicians. Oral rehydration continues to be underused, particularly in the United States. Probiotic use remains uncommon, while ondansetron administration has become routine. Children frequently receive IV rehydration, with the rate and volume administered being greater in the United States. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the impact of the effort-reward imbalance (ERI) model on intent to leave the current organization (ITL organization) and intent to leave the nursing profession (ITL profession) in a prospective way. A total of 1,531 health care workers who remained in their job filled in a self-administered questionnaire at baseline and I year later. ERI was measured at baseline by a 23-item questionnaire. Multivariate logistic regression analyses were performed. Within a population with low intent to leave at baseline, we found that an imbalance between high efforts and low rewards (extrinsic hypothesis) increased the risk of high ITL organization (OR 4.98; 95% CI 2.07-11.97) and high ITL profession (OR 1.84; 95% CI I.O3-3.3O), I year later. A high level of overcommitment (OC; intrinsic hypothesis) was not predictive for both intent to leave outcome variables, neither was the interaction between high efforts/low rewards and a high level of OC (interaction hypothesis). Our results showed that a perceived effort-reward imbalance (ERI) at work is a significant predictor of intent to leave among health care workers. This contribution concludes with some directions aimed at boosting nurses' retention and recommendations for future research. [ABSTRACT FROM AUTHOR]

Problems of undernutrition are common in hospital in-patients. Multiple morbidity increases with age and may contribute to nutritional risks. This research aimed to determine whether increased burden of long-term conditions is associated with patients' difficulties gaining access to food in hospital. A survey was implemented in 29 wards at four hospitals using a questionnaire measure of patients' experiences of food access and the Cumulative Illness Rating Scale (CIRS) to evaluate the burden of long-term illness in each patient. Experiences of food access were evaluated in relation to CIRS score category using random effects logistic regression to adjust for age group, sex and clustering by ward. Data were analysed for 764/1154 (66%) eligible participants, including 384 women. The median age was 60 years (range 18-96 years). CIRS scores were analysed using the categories 0 (104 patients), 1-3 (197), 4-6 (285), 7-9 (144) and ≥10 (34). When the CIRS was zero, 10% of patients experienced physical problems with food access, whereas, when the CIRS was ≥10, 41% experienced physical barriers to food access, adjusted odds ratio 3.65 (1.14-11.7, P = 0.029). Problems with food quality were experienced by 13% with CIRS = 0 and 32% with CIRS ≥ 10 (adjusted odds ratio 3.97, 1.35-11.6, P = 0.012). Participants with greater morbidity were more likely to report that depression, breathing difficulties or chewing and swallowing difficulties affected the amount of food that they ate at mealtimes. Patients with multiple morbidities are more vulnerable to experiencing physical barriers to accessing food and increased concerns with food quality. Assessing barriers to food access is particularly important in multiple morbidity. [ABSTRACT FROM AUTHOR]

Background: The extent to which awareness of chronic disease (CD) diagnosis affects one’s healthy food knowledge, self-efficacy and intentions or healthy dietary and physical activity (PA) behaviours remains unexplored among Inuit in Canada. Methods: A food frequency questionnaire and an adult impact questionnaire were used in a cross-sectional study to collect self-reported data on daily energy and nutrient intake, PA and the diagnosis of hypertension, diabetes, heart disease and cancer amongst adult Inuit and their family members. Associations between awareness of personal and family CD status and healthy food knowledge, self-efficacy and intentions, percentage of energy consumed from non-nutrient-dense foods and PA were assessed via ordinal logistic regression. Results: Of the 266 participants, those who self-reported CD for both themselves and their relative(s) were more likely to have high healthy food knowledge [odds ratio (OR) = 2.45] than those who did not. Reporting hypertension and heart disease amongst only relatives increased the likelihood of high knowledge (OR = 5.20) and intentions (OR = 5.10) for healthy eating. Heart disease in both participants and their relatives was associated with high levels of PA (OR = 12.24). However, there were no associations when only participants (but not their relatives) reported having CD. A joint effect between a high level of education and awareness of CD was positively related to high food knowledge (OR = 38.93). An inverse association between awareness of CD and unhealthy eating was not observed. Conclusions: Awareness of a relative having a CD was a more important factor in increasing knowledge and, to a lesser degree, self-efficacy or intentions to eat healthy than participants’ awareness of personal CD. However, awareness was not associated with lower non-nutrient-dense food intake. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to evaluate safety of intravenous (IV) tissue plasminogen activator (tPA) delivered without dedicated thrombolytic stroke teams. Methods: This was a retrospective, observational study of patients treated between 1996 and 2005 at four southeastern Michigan hospital emergency departments (EDs) with a prospectively defined comparison to the National Institute of Neurological Disorders and Stroke (NINDS) tPA stroke study cohort. Main outcome measures were mortality, intracerebral hemorrhage (ICH), systemic hemorrhage, neurologic recovery, and guideline violations. Results: A total of 273 consecutive stroke patients were treated by 95 emergency physicians (EPs) using guidelines and local neurology resources. One-year mortality was 27.8%. Unadjusted Cox model relative risk (RR) of mortality compared to the NINDS tPA treatment and placebo groups was 1.20 (95% confidence interval [CI] = 0.87 to 1.64) and 1.04 (95% CI = 0.76 to 1.41), respectively. The rate of significant ICH by computed tomography (CT) criteria was 6.6% (odds ratio [OR] = 1.03, 95% CI = 0.56 to 1.90 compared to the NINDS tPA treatment group). The proportions of symptomatic ICH by two other prespecified sets of clinical criteria were 4.8 and 7.0%. The rate of any ICH within 36 hours of treatment was 9.9% (RR = 0.94, 95% CI = 0.58 to 1.51 compared to the NINDS tPA group). The occurrence of major systemic hemorrhage (requiring transfusion) was 1.1%. Functional recovery by the modified Rankin Scale score (mRS = 0 to 2) at discharge occurred in 38% of patients with a premorbid disability mRS < 2. Guideline deviations occurred in the ED in 26% of patients and in 25% of patients following admission. Conclusions: In these EDs there was no evidence of increased risk with respect to mortality, ICH, systemic hemorrhage, or worsened functional outcome when tPA was administered without dedicated thrombolytic stroke teams. Additional effort is needed to improve guideline compliance. ACADEMIC EMERGENCY MEDICINE 2010; 17:1062-1071 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]

ACADEMIC EMERGENCY MEDICINE 2010; 17:940–950 © 2010 by the Society for Academic Emergency Medicine Objectives: The objectives of this study were to determine concordance of emergency department (ED) management of acute myocardial infarction (AMI) with guideline recommendations and to identify ED and patient characteristics predictive of higher guideline concordance. Methods: The authors conducted a chart review study of ED AMI care as part of the National Emergency Department Safety Study (NEDSS). Using a primary hospital discharge diagnosis of AMI (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], codes 410.XX), a random sample of ED visits for AMI in 58 urban EDs across 20 U.S. states between 2003 and 2006 were identified. Concordance with American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations was evaluated using five individual quality measures and a composite concordance score. Concordance scores were calculated as the percentage of eligible patients who received guidelines-recommended care. These percentage scores were rescaled from 0 to 100, with 100 indicating perfect concordance. Results: The cohort consisted of 3,819 subjects; their median age was 65 years, and 62% were men. The mean (± standard deviation [SD]) ED composite concordance score was 61 ± 8), with a broad range of values (42 to 84). Except for aspirin use (mean concordance, 82), ED concordance scores were low (beta-blocker use, 56; timely electrocardiogram [ECG], 41; timely fibrinolytic therapy, 26; timely ED disposition for primary percutaneous coronary intervention [PCI] candidates, 43). In multivariable analyses, older age (beta-coefficient per 10-year increase, −1.5; 95% confidence interval [CI] = −2.4 to −0.5) and southern EDs (beta-coefficient, −5.2; 95% CI = −9.6 to −0.9) were associated with lower guideline concordance, whereas ST-segment elevation on initial ED ECG was associated with higher guideline concordance (beta-coefficient, 3.6; 95% CI = 1.5 to 5.7). Conclusions: Overall ED concordance with guideline-recommended processes of care was low to moderate. Emergency physicians should continue to work with other stakeholders in AMI care, such as emergency medical services (EMS) and cardiologists, to develop strategies to improve care processes. [ABSTRACT FROM AUTHOR]