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Background: Festivals play an important role in improving death and grief literacy, enabling members of the public to engage with these often-sensitive topics. Good Grief Weston festival was co-designed and delivered with the community in Weston-super-Mare, a coastal town in South-West England with high levels of socioeconomic disadvantage but rich community assets. It was held in person over 8 days in May 2023. Objectives: To evaluate the reach and impact of Good Grief Weston festival and gather data to inform future festivals. Design: Mixed methods evaluation (survey and focus groups). Methods: Online and paper surveys assessing participants' characteristics and experiences were administrated during and after the festival. Survey participants who indicated their willingness to participate were invited to attend a focus group. Focus groups were recorded, transcribed and analysed using thematic analysis. Data were collected by trained community co-researchers. Results: Approximately 3000 people attended the festival. Of 204 completed surveys, 64.5% were from women, age range ⩽15 to ⩾75 years; 88.2% identified as White; 14.9% deaf, disabled/with a chronic condition; 18.9% neurodivergent; 9.0% gay, bisexual or queer. Festival participants were entertained (70.9%), inspired (68.5%), felt part of a like-minded community (54.3%), talked to someone new (49.2%), learnt about grief/bereavement (34.3%), shared or expressed experiences (30.3%) and found out about local support (19.7%). 71.3% reported that they felt more confident talking about grief after attending. Median experience rating was 5 (IQR 0; possible range 1 = poor to 5 = excellent). In free-text comments, participants expressed appreciation for the festival and described benefits in attending. Two focus groups were conducted (n = 8 participants, all women), lasting c.1.5 h. Focus groups added rich descriptions of the festival's value, and data to inform the next festival. Conclusion: Findings suggest festivals of this nature can play a central role in a public health approach. Plain language summary: What was the impact of Good Grief Weston festival? Why was the study done? Previous studies have shown that many people feel unsupported by their community after the death of a loved one. We designed a festival to improve knowledge and support for bereaved people. We did this study to assess how the festival affected the people who attended. What did the researchers do? The team included researchers and people and organisations from the local community. Together, we designed and ran a festival on the topic of death, grief and bereavement in Weston-super-Mare, a coastal town with areas of high deprivation. The festival took place over an eight-day period in May 2023 and included creative, interactive and educational events. The team collected feedback on attendees' experiences of the festival. We did this using online and paper feedback forms, postcards, and focus groups to collect as many opinions as possible. What did the researchers find? We found that a wide range of people attended the festival. Most people who took part in the research rated the festival as 'excellent'. They told us they learnt about grief and bereavement and found out about local support services. Attendees met new people, shared their experiences, and felt that the festival built community spirit. They also made suggestions to improve any future festivals. What do the findings mean? The findings show that in-person festivals can effectively engage the public on the topic of death, grief and bereavement. They can also help develop connections between people and organisations in communities. These connections and learning opportunities may help communities to support their members through bereavement. [ABSTRACT FROM AUTHOR]

The purpose of this study is to provide an overview of patients' experiences using a precision medicine (PM) clinic that conducts pharmacogenomics-based (PGx) testing for adverse drug reactions. The study aimed to identify the features of the clinic valued most by patients and areas for improvement. A paper survey was used to collect data. Survey questions focused on patients' perceptions of the PM testing and the overall clinic experience. Sixty-seven patients completed the survey. Quantitative data were analyzed using SPSS and frequencies were reported. Open-ended responses were coded and organized thematically. Patients reported that the clinic services increased confidence in their medication usage. Feeling respected by staff, receiving education, and quick appointments were highly valued by patients. Suggested areas for improvement included better communication from the clinic to patients, expansion of clinic services, and education for other healthcare providers. The findings demonstrate that patient experience goes beyond the clinical care provided. Current and potential future providers of PM should invest the time and energy to configure their care delivery system to enhance the patient experience. [ABSTRACT FROM AUTHOR]

Introduction: Globally, healthcare organizations have transitioned from paper-based documentation to electronic health records (EHR), including in Saudi Arabia. However, the adoption of EHR at the national level in Saudi Arabia needs more attention. Thus, this study aimed to determine the workflow integration of EHR and associated factors. Objectives: The specific aims were to examine the level of EHR use and workflow integration among nurses, to determine the differences in EHR use and workflow integration based on nurses' demographic characteristics, and to determine the association between the predictive factors and EHR workflow integration. Methods: This is a cross-sectional, correlational descriptive study. The data were collected from 293 nurses using the convenience sampling method. The participating nurses completed a questionnaire that included two measures: the Information System Use Survey and the Workflow Integration Survey (WIS). The data were analyzed using descriptive and multivariate statistics with SPSS software. Results: The nurses had a positive perception of EHR use and workflow. The EHR use scores differed based on workplace (P <.01), education level (P <.05), and area of practice (P <.001). Similarly, the EHR workflow integration scores varied according to workplace (P <.05), education level (P <.05), and area of practice (P <.001). Education level and workplace significantly predicted information system use. Furthermore, education level and information system use significantly predicted the EHR integration into nurses' workflow. Conclusion: The nurses expressed a greater perceived use of EHR regarding the integrated health information system, which was a predictor of EHR integration into nurses' workflow. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Social determinants of health (SDoH) screening and intervention in pediatric primary care depends upon caregiver disclosure of adverse household or social conditions and thus may be influenced by perceived bias or stigma. This paper examines to what extent parents' experience of their child's medical home is associated with their perceptions of a practice-based social needs intervention. Methods: We conducted a cohort study of data reported by 73 parents of children obtaining care in a medical home with an embedded SDoH navigation program. Using survey data collected in October 2021 and October 2022, we calculated descriptive statistics and non-parametric bivariate analyses of the association between engagement with the SDoH navigation program and parent-reported social needs, stress, and perception of care quality as measured by the Person-Centered Primary Care Measure (PCPCM). Results: Initial ratings of care quality were high (mean baseline PCPCM score = 3.63) and remained high on second interview (mean change in PCPCM score = −0.04, 95%CI −0.16, 0.09, P =.58) despite significant reductions in parents' ratings of access to care over time. Parents reported substantial stress, unmet social needs, and unmet healthcare needs, with 41 families (56%) ever using the practice-based SDoH program, including 16 (22%) who were new users in 2022. There was no association observed between PCPCM score and parent stress, unmet social needs, or use of SDoH services. Conclusions: Parents' perceptions of care delivered in their child's medical home appears to be stable on repeat measurement, and independent of family context or interactions with social needs navigation services offered in the practice. [ABSTRACT FROM AUTHOR]

Background: Working in pediatric palliative care (PPC) impacts healthcare and allied professionals' work-related quality of life (QoL). Professionals who lack specific PPC training but who regularly provide services to the affected children have articulated their need for support from specialized PPC (SPPC) teams. Objectives: This study had two objectives: (1) to evaluate whether the availability of a SPPC team impacted the work-related QoL of professionals not specialized in PPC; and (2) to explore the work-related QoL of professionals working in PPC without specialized training. Design: Repeated cross-sectional comparative effectiveness design. Methods: One hospital with an established SPPC program and affiliated institutions provided the intervention group (IG). Three hospitals and affiliated institutions where generalist PPC was offered provided the comparison group (CG). Data were collected by paper-pencil questionnaire in 2021 and 2022. The Professional Quality of Life (ProQOL 5) questionnaire was used to assess work-related QoL, yielding separate scores for burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS). A descriptive statistical analysis was performed and general estimation equations were modelled. To increase the comparability of the IG and CG, participants were matched by propensity scores. Results: The 301 participating non-PPC-specialized professionals had overall low to moderate levels of BO and STS and moderate to high levels of CS. However, none of these scores (BO: p = 0.36; STS: p = 0.20; CS: p = 0.65) correlated significantly with support from an SPPC team. Compared to nurses, physicians showed higher levels of BO (1.70; p = 0.02) and STS (2.69; p ⩽ 0.001). Conclusion: Although the study sample's overall work-related QoL was satisfactory, it showed a considerable proportion of moderate BO and STS, as well as moderate CS. To provide tailored support to professionals working in PPC, evidence regarding key SPPC support elements and their effectiveness is needed. Trial registration: ClinicalTrials.gov ID, NCT04236180. Plain language summary: Work-related quality of life in professionals involved in pediatric palliative care - Why was this study done? Caring for children suffering from life-limiting conditions and their families impacts professionals' work-related Quality of Life (QoL). Professionals without specific training often provide pediatric palliative care (PPC) to children and their families. - What did the researchers do? We aimed to determine whether the work-related the QoL of professionals without specialised PPC training would be positively influenced when they were supported by PPC specialists. We also wanted to explore what person-specific factors might correspond with higher or lower work-related QoL. Work-related QoL was analysed in relation to burnout (BO), secondary traumatic stress (STS), and compassion satisfaction (CS). These variables' levels were assessed with a questionnaire survey in 2021 and 2022. - What did the researchers find? The 301 participating professionals had overall low to moderate levels of BO and STS and moderate to high levels of CS. There was no substantial difference in work-related QoL in the professionals supported by PPC specialists compared to those who did not receive specialist support. Physicians showed higher levels of BO and STS than nurses. - What do the findings mean? Although the studied professionals' overall work-related QoL was satisfactory, there is a considerable proportion of moderate BO and STS scores in professionals working with children suffering from life-limiting conditions. Further research should explore the specific needs of professionals not specialised in PPC. [ABSTRACT FROM AUTHOR]

Background and Objectives: Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. Methods: Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. Results: Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. Conclusions: This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD. [ABSTRACT FROM AUTHOR]

This paper explores Facebook's role in shaping the political perception of youth during the 2018 general elections in Pakistan. It also gauges the ideological standpoint of youth in Pakistan that influences their voting decisions. An online campaign has become an indispensable source for politicians to influence the masses without the constraints of distance and time. It is a quantitative study based on a questionnaire survey of young Pakistani voters. Findings show that Facebook has presumed the role of an instigator in shaping the voting behavior of educated youth. Respondents perceived Facebook as biased while expressing views and assisted political entities in manipulating the data to increase their vote bank. Though the majority of them haven't experienced fake news so either they are not conscious or they trust blindly the information. Furthermore, respondents' cognitive abilities are not obstructed by politicians using Facebook, instead, friends and family network seems more persuasive in determining voters' choice. Results manifest that ideological standpoint impacts voters' decisions substantially. There is no statistical difference in the voting behavior of respondents based on gender and/or age. The individuality of this study is that it focuses on the medium of communication between politicians and youth instead of emphasizing the social cleavages and their impact on voters' decisions, which Pakistani scholars largely study. This study will prompt the field of psephology in Pakistan, which is largely ignored, and help scholars to move out of the domain of identity politics. [ABSTRACT FROM AUTHOR]

Introduction: Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients' experiences. Objectives: The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation. Methods: An explorative cross-sectional study using a self-completed questionnaire to assess patients' radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated. Results: The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not. Conclusion: Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care. [ABSTRACT FROM AUTHOR]

BACKGROUND: A greater understanding of Over the Counter (OTC) and Prescription Only Medication (POM) misuse amongst adults accessing substance misuse services (SMS) during COVID-19 is required to identify how SMS can better meet the needs of the people who require treatment. AIM: To use a questionnaire to explore OTC/POM misuse during COVID-19 in adults accessing community SMS in England. METHODS: In 2020 to 2021 anonymous self-administered online/paper questionnaires which collated quantitative and qualitative data were completed. They were piloted for suitability and ethical approval was obtained. Thematic analysis was conducted for qualitative data and chi-square tests used to assess the relationship between quantitative variables. RESULTS: Participants were Caucasian (94.6% British), majority male (58.9%), aged 18 to 61 years. Most were prescribed medication for problematic substance use, with a 92.5% self-reported adherence rate. The misuse of benzodiazepines (22.2%) codeine products (30.8%) and pregabalin (14.5%) predominated and 37.5% misused 2 or more medicines. Administration was usually oral and concomitant use of other substances was common: alcohol 44.6% (52% daily), tobacco/vaping 73.2% and illicit substances 58.9%. There were statistically significant associations identified, including between changes during COVID-19 to OTC/POM misuse and illicit use. Only 56 questionnaires were included in the analysis: we believe this low number was because of infection control measures, limited footfall in services, pressures on staff limiting their capacity to distribute the paper questionnaires and reliance upon telephone consultations limiting online distribution. Increasing OTC/POM misuse and obtaining illicit supplies were reported when access to usual supplies were restricted; however, changes to doses/dispensing arrangement liberalisation in response to COVID-19 were positively viewed. CONCLUSION: OTC/POM misuse, including polypharmacy and concomitant use of other substances occurred during COVID-19: SMS need to be vigilant for these issues and mitigate the associated risks for example with harm reduction interventions. Further qualitative research is required to explore the issues identified. [ABSTRACT FROM AUTHOR]

A key challenge for self-administered questionnaires (SaQ) is ensuring quality responses in the absence of a marketing professional providing direct guidance on issues as they arise for respondents. While numerous approaches to improving SaQ response quality have been investigated including validity checks, interactive design, and instructional manipulation checks, these are primarily targeted at situations where expected responses are of a factual nature or stated preferences. These interventions have not been evaluated in scenarios that require higher levels of engagement and judgment from respondents. While professional marketers are guided by codes of conduct, there is no equivalent code of conduct for SaQ respondents. This is particularly salient for SaQ that require higher levels of reflection and judgment, since in the absence of professional guidance, respondents rely more on their individual ethical ideologies and experience, leaving SaQ responses potentially devoid of the standards that normally set the expectations around data quality for marketing professionals. As marketing professionals are unable to provide guidance directly in a SaQ context, the approach used in this study is to offer varying levels of professional marketing guidance indirectly through specific codes of conduct reminders that are easily consumable by SaQ participants. We demonstrate that reminders and ethical ideologies moderate the relationship between the participant's experience with SaQ and compliance with a code of conduct. Specifically, SaQ respondents produce fewer code of conduct infractions when receiving reminders than the control group, and this improves even more when the reminders coincide with the SaQ task. The paper concludes with implications for theory and practice. [ABSTRACT FROM AUTHOR]

Purpose: Self-rated physical health (SRPH) and self-rated mental health (SRMH) are both linked to excess morbidity and premature mortality and can vary across rural and urban contexts. This can be particularly problematic for rural residents who have less access to important health care infrastructure. In this paper, we assess the prevalence of and rural-urban disparities at the intersection of SRPH and SRMH, specifically self-rated physical/mental multimorbidity (SRPMM) overall and across rural-urban contexts. Methods: Using a cross-sectional demographically representative national dataset of over 4000 working age adults in the U.S., we expose rural-urban differences in the prevalence of SRPMM and explore individual-level factors that may explain this disparity. Results: Approximately 15 percent of working age adults reported SRPMM, but rural adults were at higher risk than their urban counterparts. However, this disadvantage disappeared for remote rural working-age adults and was attenuated for metro-adjacent rural working-age adults when we controlled for the fact that rural adults had lower household incomes. Conclusion: Findings reveal a higher risk of SRPMM among rural adults, in part because of lower incomes among this group. This work acts as the foundation for facilitating research on and addressing rural-urban disparities in SRPMM. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to provide a preliminary evaluation of treatment outcomes, retention and client satisfaction following a 12-week combined cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) group treatment for cannabis use disorder (CUD) delivered in an outpatient setting. Implementation of the program is also described. Methods: A retrospective observational cohort study was conducted using data collected from medical records and self-report assessments. Participants were treatment-seeking cannabis users at the Centre for Addiction and Mental Health, Toronto. Cannabis use, cannabis-related problems, craving, withdrawal symptoms, self-efficacy for remaining abstinent, depression and anxiety were assessed pre- and post-treatment. Treatment retention was calculated by inspecting clinic attendance records, and client satisfaction was evaluated using an anonymous feedback survey. Potential predictors of treatment outcomes and retention were investigated in exploratory analyses. Results: Cannabis use was lower and days of abstinence higher post-treatment (vs pre-treatment). Post-treatment improvements in cannabis-related problems, craving, withdrawal symptoms, self-efficacy and mood were also observed. Completion of group treatment (⩾75% of sessions attended) was 57% and moderate levels of treatment satisfaction were reported. Conclusions: This study provides preliminary evidence that a 12-week combined CBT and MET treatment for cannabis use disorder delivered in a novel group setting improves cannabis use outcomes. Potential predictors of reduced cannabis use and retention were identified. Future controlled studies are warranted, and strategies for increasing retention should be explored. [ABSTRACT FROM AUTHOR]

Background and aims: Having a conversation with someone or even more within a group of people is complex. We are never taught at school how to do it, which implies we consider having a conversation as something simple and straightforward. Instead, we just learn from observing others. Some people are great conversationalists – it comes naturally to them – while others struggle. Some people may not fully understand how the process works, how turn-taking happens, don't understand visual cues such as body language and facial expressions, and fail to comprehend that some topics may be appropriate or inappropriate. This can be the case for both neurotypical and neurodivergent people. The Conversation skills Assessment Tool has been developed in this first instance to help in assessing and examining conversation skills in an intervention with young autistic adults on a virtual platform (a virtual world). This paper will present the evolution of the new measure through the exploratory phase, the development phase and finally a detailed account of the inter-rater reliability process. Methods: The intervention associated with this study was carried out though a multiple baseline design with 3 autistic participants (in their early 20 s) and took place over 4 phases (15–17 sessions). The sessions involved semi-structured conversations in face-to-face (phases 1 and 4) and virtual (phases 2 and 3) settings and were videotaped with the participants' consent. Twelve of those were used by this study in the development process through iterative inter-rater reliability stages between two coding teams. Results: Evaluation of the Conversation skills Assessment Tool tool revealed the potential benefit of implementing interventions with measures that more objectively and concretely (e.g., by noting frequencies) assess observable behaviours that are associated with having positive conversations with others. Beyond this, it is anticipated that Conversation skills Assessment Tool can emerge as a tool capable of not only accounting for the environment an interaction takes place in (e.g., professional, casual), but also offers beneficial feedback for both autistic students and other populations (e.g., young children, English language learners). Conclusions: This measure has the potential to offer quantifiable and trackable guidance to people who have difficulties conversing. The authors do not wish to perpetuate an ableist social construct of what is a 'good' conversation, nor do they suggest that conversation skills training is useful solely for people with communication and/or socialization difficulties. Rather, they hope that Conversation skills Assessment Tool can be adopted more broadly to give both neurotypical and neurodivergent people a better understanding of how to communicate more effectively with others, while also becoming more aware and accepting of differing conversational styles. Implications: Because of its ability to track (or self-monitor) one's development of conversational skills over time, Conversation skills Assessment Tool could serve as an educative tool in early childhood education. It can be used by occupational/speech therapists and other professionals and also used to self-monitor one's development of conversational skills. Conversation skills Assessment Tool was developed to assess conversation skills on a one-to-one basis; therefore, another iteration of Conversation skills Assessment Tool would have to look at group conversations. [ABSTRACT FROM AUTHOR]

Introduction: Effective communication is an essential skill for the professional nurse. Previous research demonstrates that nursing students lack skills in written communication, and there is limited time in the nursing curriculum to provide needed instruction. To address this issue, a writing workshop was provided for students at a regional state university. Methods: Nursing faculty developed and led four identical in-person sessions of the workshop over the course of one semester. Before and after each workshop, students completed the same quantitative survey. Results: Data indicate that students' knowledge and confidence of American Psychological Association (APA) format increased significantly as a result of the workshop. Conclusion: A workshop approach is a useful strategy to address the writing needs of nursing students. [ABSTRACT FROM AUTHOR]

Introduction: The creation of digestive stomata is associated with a change in people's lives. Causing a strong impact that influences all dimensions of life. This paper reports on the effects of socio-educational interventions on the quality of life (QOL) of people with a digestive ostomy. Objective: To describe the effect of a nursing intervention on the QOL of people with a digestive ostomy. Methods: A quasiexperimental study was conducted whose sample consisted of 12 people who were ostomized in a public hospital in Colombia. Participants were selected through convenience sampling and randomly assigned to the intervention group and the control group. For the control group, an educational process was carried out through a theoretical session with virtual mediation (educational video). The QOL was evaluated before and after the interventions through the Montreux questionnaire. Results: The average age was 57(+7) years. No statistical differences were found between the groups in the QOL index or for any of the dimensions that make up QOL. Pretest and post-test analysis for each intervention separately showed improvement in two dimensions of QOL for each group; in the intervention group body image dimension (p =.017) and the positive coping dimension (p =.027). In the control group, the physical well-being dimension (p =.037) and social concerns dimension (p =.034). Conclusions: The personalized educational intervention or carried out through virtual pedagogical mediation, generated a clinically significant increase in the dimensions of QOL, without statistical differences. The study adds knowledge about the impact that digestive stomata have on the QOL, which is why it is necessary to establish specialized interdisciplinary teams to care for the person's new condition at home during the following months. [ABSTRACT FROM AUTHOR]

Background: Although recommended for all member states of World Health Organization, there is no national human papillomavirus vaccination program in Kazakhstan. Furthermore, there are no studies in Kazakhstan that evaluate the mothers' perception of human papillomavirus vaccines. Objectives: This study aims to assess the knowledge and attitudes toward human papillomavirus vaccination among mothers in Kazakhstan and the factors associated with their attitudes. Design: A cross-sectional study was performed during the period of December 2021—February 2022. The STROBE guideline for cross-sectional studies was applied. Methods: Paper-based structured questionnaires were filled out by 191 mothers, 141 of whom had daughters. The attitude score was assessed as per the Likert-type scale. The Chi-square and Fisher's exact tests, with a significance value of < 0.05 were used to analyze the relationships between the characteristics of mothers and their attitude scores. Results: The following factors were significantly associated with mothers' attitudes toward human papillomavirus vaccination: a place of residence, family income, number of children, and refusal of vaccination for themselves (p < 0.005). Of all participants, only 45% of all mothers, 41% of mothers with a female, and 46% of mothers with male children had positive attitudes toward human papillomavirus vaccination. The child's gender was not a significant determinant. Overall, the level of knowledge about human papillomavirus vaccination was found to be low. The median total score is 0 out of 12 for women who have negative and neutral attitudes toward human papillomavirus vaccines. Among women who have positive attitudes toward HPV vaccines, the median score is around 3 points. Conclusion: Before the implementation of the human papillomavirus vaccination program into the Kazakhstani national vaccination calendar, comprehensive and adequate information and education campaigns are required on the national level for parents and the population in general. [ABSTRACT FROM AUTHOR]

Objective: During the COVID-19 pandemic in the United States, mitigation measures were implemented on a state-by-state basis. Governors were responsible for establishing interventions appropriate for their states and the timing of implementation. This paper evaluated the association between the presence and timing of a mask mandate and the severity of the COVID-19 epidemic by state. Methods: The states were divided into 3 categories based on when the governors of each state implemented a mask mandate: Early (mask mandate implemented between March 2020 and June 2020), Late (July 2020-December 2020), and Never (no mask mandate implemented). The rates of hospitalizations and mortality (per 100 000) were assessed at the different time points during the pandemic across these categories from March to December 2020. Results: The mortality rates across all 3 groups were observed to be highest in the beginning and toward the end of the pandemic in 2020 with the peak observed in the Early group between April and May 2020. Also, the rates of hospitalization increased steadily across all groups. The Early mask group was comprised of 86.7% and 13.3% states with Democratic and Republican governors respectively, and no states in the Never category had Democratic governors. Conclusion: These results support the benefit of implementing a mask mandate to minimize the impact of the COVID-19 pandemic and the role of political affiliation of governors on that impact. [ABSTRACT FROM AUTHOR]

The hospitalization and the unfamiliar experiences of patients in interventional radiology procedures cause a moderate to high levels of anxiety. This study was aimed to evaluate the anxiolytic effect of Cananga odorata essential oil (COE) aromatherapy in unexperienced patients hospitalized for interventional neuroradiology (INR) procedures. Forty-four patients admitted for their first INR procedure were randomly divided into COE and placebo control groups. COE or distilled water was dropped onto 2 pieces of mulberry paper and attached to the participant's gown at the shoulder level overnight. The main outcomes were observed from the morning salivary cortisol levels and salivary alpha-amylase activity after intervention. The Thai version of Spielberger State-Trait Anxiety Inventory (STAI) and the vital signs (blood pressure and heart rate) were also assessed before and after COE intervention as the secondary outcome. The demographic and baseline data of both groups did not show any significant difference. After intervention, COE group had a significantly lower salivary alpha-amylase activity than placebo control group. The post-intervention scores of Trait (STAI-T) and State (STAI-S) anxiety were significantly less than those of baseline in both groups. Interestingly, the COE group had a greater percentage reduction on STAI-T after intervention than placebo control group. No significant difference was observed in other outcomes. In addition, the salivary alpha-amylase activity was weak but showed significant correlation with STAI anxiety scores. This study indicates that COE aromatherapy reduces the saliva alpha amylase activity and STAI-T anxiety in unexperienced patients hospitalized for INR procedures. [ABSTRACT FROM AUTHOR]

Oppression refers to systemic discrimination where the injustice targets or disproportionately impacts specific groups of people. The Trauma Symptoms of Discrimination Scale (TSDS) is a self-report measure designed to assess the traumatizing impact of discrimination broadly by measuring anxiety-related symptoms of trauma due to discriminatory experiences. This may include symptoms arising from racism, homophobia, sexism, poverty, or other forms of marginalization. Almost all studies of the TSDS have examined its use in marginalized ethnoracial groups, primarily African Americans. This paper will extend prior work to help us better understand racial trauma across groups by reporting and comparing TSDS mean scores across ethnoracial identities in a diverse national sample (n = 923). It also explores trauma with other marginalized identities and demographic dimensions, including gender, sexual minority/LGBQ status, education, and income. The relationship of TSDS scores to clinical psychopathologies are examined, including stress, depression, anxiety, and PTSD. We also examine the unique risks associated with intersectionality, and how having multiple marginalized identities may increase traumatization. Clinical implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

The hospitalization and the unfamiliar experiences of patients in interventional radiology procedures cause a moderate to high levels of anxiety. This study was aimed to evaluate the anxiolytic effect of Cananga odorata essential oil (COE) aromatherapy in unexperienced patients hospitalized for interventional neuroradiology (INR) procedures. Forty-four patients admitted for their first INR procedure were randomly divided into COE and placebo control groups. COE or distilled water was dropped onto 2 pieces of mulberry paper and attached to the participant's gown at the shoulder level overnight. The main outcomes were observed from the morning salivary cortisol levels and salivary alpha-amylase activity after intervention. The Thai version of Spielberger State-Trait Anxiety Inventory (STAI) and the vital signs (blood pressure and heart rate) were also assessed before and after COE intervention as the secondary outcome. The demographic and baseline data of both groups did not show any significant difference. After intervention, COE group had a significantly lower salivary alpha-amylase activity than placebo control group. The post-intervention scores of Trait (STAI-T) and State (STAI-S) anxiety were significantly less than those of baseline in both groups. Interestingly, the COE group had a greater percentage reduction on STAI-T after intervention than placebo control group. No significant difference was observed in other outcomes. In addition, the salivary alpha-amylase activity was weak but showed significant correlation with STAI anxiety scores. This study indicates that COE aromatherapy reduces the saliva alpha amylase activity and STAI-T anxiety in unexperienced patients hospitalized for INR procedures. [ABSTRACT FROM AUTHOR]

The term racial trauma is used to describe the cumulative distressing and traumatizing effects of racism in all of its forms, and it closely resembles the construct of posttraumatic stress disorder (PTSD). This investigation aims to increase our understanding of racial trauma by comparing the characteristics of those with a clinically-relevant diagnosis of racial trauma to those without, based on the findings of a clinical semi-structured interview and symptom checklist for assessing racial trauma, the University of Connecticut Racial Ethnic Stress and Trauma Survey (UnRESTS), administered to a diverse group of adults (N = 97). This paper extends prior work on racial trauma by examining the correlations between racial trauma and validated self-report measures of discriminatory distress, controlling for racialization. We examine the correlation between a clinically-relevant diagnosis of racial trauma and racial/ethnic identity. We also compare racism-related PTSD symptoms in those with and without racial trauma to inform clinical assessment. Finally, we examine the factor structure of racial trauma symptoms using the 24 items from the UnRESTS PTSD symptom checklist and compare these to current DSM-5 models. The structure of racial trauma symptoms differed from the DSM-5 4-factor model, as do other PTSD models in the research literature. Clinical and research implications are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Quality of life, mental wellbeing, and physical function deteriorate among women with breast cancer. Tai Chi is a moderate form of exercise that may be effective in improving the mental and physical wellbeing, therefore, the quality of life of women with breast cancer. This protocol paper outlines a trial to determine the therapeutic effects of a Tai Chi programme on breast cancer management. Methods: The study will be an interventional, single-blind, double-armed, randomized, and controlled trial involving a 12-week Tai Chi programme for women with breast cancer. Forty participants aged 18 years and above who are diagnosed with breast cancer from the general community will be recruited. All participants will be randomized to either a Tai Chi programme or a waiting list control group. The Tai Chi programme will involve 12 weeks of group Tai Chi sessions, with 45 min per session, twice a week. The primary outcome will be potential improvements to the quality of life, and secondary outcomes will be potential improvements in mental wellbeing (anxiety and depression), and physical function (pain, flexibility, obesity, and vital signs). These outcomes will be assessed via self-administered online assessments and physical examinations pre-and post-intervention. Linear mixed modelling will be used to assess changes in outcomes. Discussion and dissemination: Tai Chi is a safe, easy to learn, inexpensive, and low-intensity exercise with increasing popularity worldwide. If the intervention improves the quality of life in women with breast cancer, this study will build research capacity and increase awareness of the potential for Tai Chi to empower patients and engage them in self-management of breast cancer symptoms. Research findings will be disseminated to the public, health professionals, researchers, and healthcare providers through conference presentations, lay summaries, and peer-reviewed publications. [ABSTRACT FROM AUTHOR]

Objectives: This study examines the implementation and short-term effects of a Learning Partner Model (LPM)-based educational program on cancer prevention and control information for community health volunteers in Japan. Methods: The program was undertaken by 3 local governments in collaboration with a government initiative and offered a 90-min group workshop to community health volunteers. Community health volunteers (primary participants) recruited in turn friend or family members (secondary participants) with whom they were prepared to share the content of the workshop with the help of printed materials received in the workshop. We conducted self-administered paper and pencil questionnaire surveys before, immediately after, and 3 months after the workshop. The t-test, Fisher's exact test, paired t-test, and McNemar test were used to compare the 2 groups' demographic characteristics and healthy habits at pretest. Repeated measures ANOVA was used to compare cancer prevention knowledge between groups and over time. Results: Of 142 participants, 107 pairs of learning partners (primary and corresponding secondary participant) completed all questionnaires. All primary participants and 37.4% of the secondary participants were women, and 57.9% of the learning partners were spouses. The results showed significantly higher correct answers on the cancer-prevention knowledge questions in the post-workshop and follow-up surveys compared to the pre-workshop survey (P <.001). The increase in knowledge was observed in all learning-partner groups in all 3 sites. Conclusion: The study demonstrates a promising strategy that can be adapted to the health needs of the community beyond cancer prevention and control, building on the efforts of local governments and government health initiatives. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUD) pose emotional, mental, and physical threats to persons worldwide. There is a paucity of research focused on capturing individual perspectives on supports and barriers to recovery from a SUD. This need has been identified in areas of Minnesota where a gap in evidence-based substance use support exists. A team of interdisciplinary professionals distributed a qualitative survey assessing supports and barriers to SUD recovery within recovery circles in order to inform the efforts of local organizations. This paper and online access survey was adapted from an existing survey created by Faces and Voices of Recovery. The online survey was accessed by a link and distributed to persons in recovery across Minnesota over 7 months. Data from this survey were analyzed through a consensual qualitative research (CQR) coding method. Notable themes emerged in the following domains: healthcare, environment, individual, and community. Community-wide stigma was an overarching concern, and the study yielded unique insights into stigma within healthcare and the community at-large. Barriers and support to recovery were reported. Barriers included experiencing high levels of stigma and identifying a need for community education on SUDs and recovery. Support included local recovery groups, peer recovery support, and access to healthcare and medication. Our findings illuminate the needs of the recovery community from the perspective of individuals with lived experience and will inform local organizations in specifying resources to help meet the identified needs. This survey may also be adapted and used around the world to inform substance use prevention, treatment, and recovery programing. [ABSTRACT FROM AUTHOR]

Introduction: Secondary traumatic stress is highly prevalent among nurses, especially among nurses working within the emergency department (ED). Reducing healthcare worker secondary traumatic stress is important for ensuring the delivery of high quality, safe patient care. This paper reports on the development and implementation of a secondary traumatic stress reduction program. Methods: We used an adaption of a 5-week intervention based on the Accelerated Recovery Program to test whether there would be a reduction in secondary traumatic stress in a pilot sample of nine ED nurses. Outcomes were assessed using the Secondary Traumatic Stress Scale (STSS), Somatic Symptoms Scale (SSS), and Compassion Satisfaction subscale (CSS) measures. Results: Eight of nine nurses were able to complete at least three of the five sessions. Results indicate significant change in STSS (F[5,23] = 4.22, p =.007) and SSS (F[3,15] = 4.42, p =.02) scores, but not CSS (F[5,23] = 0.83, p =.54) scores. Pairwise comparisons revealed that the beneficial effects of the program happened early. For both STSS and SSS, scores at sessions 1 and 2 were generally higher than subsequent sessions. We also found a trend for continued effects on STSS at a four-month follow-up (t23 = 1.95, p =.064). Conclusion: Overall, results indicate the 5-week program was associated with a significant reduction in secondary traumatic stress and related somatic symptoms in healthcare workers. [ABSTRACT FROM AUTHOR]

Introduction: Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community--primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. Methods: Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. Results: Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community--primary care partnership. Lack of previous collaborations with the formal health system was common to both. Conclusion: The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability. [ABSTRACT FROM AUTHOR]

Introduction: While evidence has been established on the impact of medical appointment non-attendance on the healthcare system and patient health, previous research has not focused on how poverty and rurality may influence patient experiences with non-attendance. This paper explores patient perceptions of non-attendance among those experiencing poverty in a rural U.S county to better inform providers to the context in which their patients make attendance-related decisions. Methods: Using a grounded theory approach, we conducted semi-structured interviews with 32 U.S. low-income adults in the rural Western U.S. who recurrently missed primary care appointments. We also used a questionnaire to assess individual characteristics related to health, resiliency, personal mastery, medical mistrust, life chaos, and adverse childhood experiences. Results: Participants identified 3 barriers to attending appointments: appointment disinterest, competing demands, and insufficient systems. Appointment disinterest stemmed from physical and mental health issues, misalignment between needs and treatment, and comfort with the provider. Competing demands included family responsibilities, employment, and relationships. Finally, participants reported that current scheduling and transportation systems were helpful but insufficient. To provide further context, participants also reported low overall health, moderate levels of medical mistrust, life chaos, and mastery, moderate to low resilience, and very a high number of adverse childhood experiences. Conclusions: Results point to the need for modified structures that allow low-income patients more control over their personal health and highlight opportunities for clinics to address patients' lack of interest and fear in the medical encounter. [ABSTRACT FROM AUTHOR]

Background: Caring for a family member can be demanding, particularly when caregivers experience profound distress. Supportive interventions may help prevent mental and physical illness in the caregiver. General practice plays a key role by regularly engaging with patients and caregivers, thereby being able to identify their support needs, offer talk therapy and refer to care initiatives. Objective: This study aimed to develop and pilot-test the Caregiver Care Model to mitigate grief reactions among caregivers in general practice. Design: A participatory intervention development study. Methods: A prototype was developed in a workshop with healthcare professionals. The prototype was refined based on a pilot-test among 40 caregivers from 5 general practice clinics and a workshop with general practitioners. The data were obtained from workshops, feedback questionnaires completed by healthcare professionals, and interviews with caregivers and general practitioners. The analysis focused on model development and mechanisms of impact. Results: The prototype was refined by focusing the dialogue questionnaire, minimising the grief facilitation tools and expanding the target group. The prototype seemed to accommodate the needs among caregivers by acknowledging their situation. The final model includes up to seven caregiver consultations in general practice. A dialogue questionnaire filled in by the caregiver serves as a fixed starting point and preparation for the first consultation. If needed, talk therapy in general practice or referrals to other services are used. Conclusion: The model offers promising support for caregivers. Its flexible structure allows for customisation. The viability of the model should be further tested. [ABSTRACT FROM AUTHOR]

Introduction/Objective: The objective of the study was to develop an understanding of the perceptions of people with Parkinson's disease and clinical academics on the implementation of a regional interdisciplinary model of care. Methods: A qualitative descriptive study was undertaken. A PD interdisciplinary clinic was conducted in an Australian regional location. As a novel variation, in this clinic, 4 clinical academics consulted simultaneously offering a long, 3-h appointment. Following the clinic, we conducted 2 focus groups with all clinical academics and 6 semi-structured interviews with people with PD and carers. Data were analyzed using Elo & Kyngäs' inductive content analysis approach. Results: An overarching main category namely, "interdisciplinary care proved valuable to regional people with PD and clinical academics," and 3 generic-categories including "identifying interdisciplinary care as a viable option in regional locations," "current care provision is disempowering and burdensome," and "regional residing people with PD and their carers seek locally accessible healthcare with PD skilled clinicians" were identified. Conclusion: Our findings suggest the implementation of interdisciplinary care to regional healthcare systems is valued by clinical academics and people with PD and carers. Further research is required to establish how interdisciplinary care can be implemented in regional Australia and its effects on practice changes, patient outcomes, and quality of life. [ABSTRACT FROM AUTHOR]

Introduction: The Diabetes Prevention Program (DPP) is effective; enrollment is low. Little research has examined factors driving individuals' enrollment decisions. Methods: In our final survey of a randomized trial comparing methods to increase enrollment in the DPP, we asked participants about factors impacting enrollment. We conducted interviews with a subgroup. Results: Participants who completed the survey (n = 299) were primarily female (96 male); middle-aged (mean 52.9, SD = 14.7); white (86%); non-Hispanic (85%). Only 19% reported awareness of the DPP prior to the study. Cost, online availability, and behavior-change motivation were the most highly rated factors influencing enrollment. The median amount participants were willing to pay for the program was $66.50. Phone interviews included 17 individuals who were/were not interested in receiving a referral to the DPP. Those interested described risk awareness, family history, social support, and healthcare-provider influence as facilitating enrollment. Cost, time, travel, unsupportive family, incomplete knowledge about the program's impact and low self-efficacy were barriers. Among those uninterested, some were already engaging in lifestyle change, and some didn't see a benefit. Conclusions: Results suggest that, even among high-risk individuals, efforts to increase awareness and benefits of the DPP are needed, as are efforts to address cost of enrollment and low motivation. Trial Registration: ClinicalTrials.gov protocol ID: 00132307. The Effect of 360 Video and MAPS on Enrollment in the DPP. URL: https://www.clinicaltrials.gov/study/NCT04746781?id=00132307&rank=1. [ABSTRACT FROM AUTHOR]

This study explored the experiences of public health nurses (PHN) in preventing obesity in preschool children and following national guidelines. We used a descriptive qualitative design with an online open-ended questionnaire based on vignettes describing fictitious practical situations during the follow-up of children presenting with overweight issues in child health clinics. Following qualitative content analysis, we identified one main theme: Strong but complex feelings of responsibility toward supporting parents in preventing obesity in preschool children and adhering to the guidelines. We also identified four subthemes: (a) Difficulties in deciding if the child's weight is a concern. (b) Challenges with meeting children's healthcare needs when weight is a concern. (c) Approaches for engagement and caring weight talks with parents. (d) The need for resources and interdisciplinary collaboration. PHNs suggested improvements for preventing childhood obesity and called for municipal prioritizing of organizational and personnel-related resources to ensure PHNs can efficiently follow national guidelines. [ABSTRACT FROM AUTHOR]

Background: Physiological and psychosocial changes experienced by women during the perinatal period may put them at risk for postpartum mental health disturbances. Accumulating evidence suggests that dietary patterns may influence mental health through the modulation of the gut microbiota and its effects on host immune activity. Thus, targeting the gut microbiota via dietary intake could serve as both a preventative and therapeutic strategy in improving perinatal mental health. Objectives: Here, we present a protocol for a prospective cohort study that primarily aims to determine if diet quality during pregnancy is protective against postpartum depression severity. Secondary objectives will examine if microbiota- and blood-based inflammatory markers may be associated with the relationship between prenatal diet quality and postpartum depression severity, as well as with associations between additional dietary and mental health outcomes. Methods and Analysis: Dietary patterns and mental health symptoms will be documented in 100 pregnant women at 4 time points during pregnancy and postpartum. Participants will also provide stool and blood samples at the same time points to determine microbiota composition and predicted function and inflammatory factors, respectively. Stool microbiota will be analyzed using 16S ribosomal RNA gene sequencing and bioinformatics tools (QIIME 2/PICRUSt2). Inflammatory factors will be determined using high-sensitivity antibody-based immunoassays. Statistical analyses will include linear mixed models and hierarchical linear mixed effect models. Ethics: The study was approved by the Research Ethics Boards of the Royal Ottawa Health Care Group (#2022002) and of the University of Ottawa (#H-06-22-8013). Informed consent will be obtained from all participants before their enrollment. Discussion: Findings from this study will help develop evidence-based dietary recommendations and potential interventions for women susceptible to or suffering from postpartum mental health issues that are accessible, noninvasive, and have potential to play a role in prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: Preliminary evidence suggests that Qigong (QG), a mind-body therapy, may help address symptoms of multiple sclerosis (MS), but the heterogeneity of QG content and delivery may affect its feasibility, acceptability, and efficacy. Objective: To survey researchers, clinicians, and QG instructors with experience working with people with MS to identify key components of MS-specific QG guidelines and protocols. Methods: We conducted an online survey to identify QG forms and movements considered helpful for MS, reasons for selection, characteristics of effective learning environments, and recommended dosage and frequency of practice. Quantitative data were analyzed using summary statistics. Qualitative data were analyzed using reflexive thematic analysis. Results: Forty-seven experts, including QG instructors, clinicians, and QG and MS researchers, completed the survey. Respondents had a mean (SD) of 20 (11) years of QG teaching experience, 26 (12) years of clinical practice, 24 (9) years of QG research experience, 13 (5) years of MS research experience, and worked with at least 3 (2) people with MS. Approximately 125 QG forms/movements were recommended. Some forms were specifically recommended to address MS symptoms (e.g., emotional regulation, balance and coordination, muscle strength and flexibility, immune regulation, and circulation). Some respondents felt that any QG form could be beneficial if basic principles were met (e.g., intentional movement, posture, focused awareness, rhythmic breathing/movement, and a relaxed mind and body). Instructor qualities included the ability to convey information clearly, being caring and compassionate, proficient in QG, and having basic knowledge of MS. To promote confidence in learning QG, recommendations included having simple, easy-to-learn movements with modifications based on physical ability. We provide a sample protocol based on these recommendations. Conclusions: This study provides expert guidance for developing a QG protocol for an MS population, including content and delivery recommendations. [ABSTRACT FROM AUTHOR]

Background and aims: Peer interaction difficulties are often elevated amongst children with language disorders, yet the mechanisms underlying these difficulties are unclear. Previous research indicates that poor conflict management, social withdrawal, emotion regulation difficulties, and reduced prosocial behavior may contribute to peer interaction difficulties. However, this research often uses adult perspectives, failing to acknowledge child perceptions of these experiences. The present study aimed to qualitatively investigate perceptions of peer interactions from the perspective of children with language disorders. Methods: Seven participants aged between 7- and 10-years-old took part. All participants were diagnosed with a language disorder and had language as their primary area of difficulty. Participants were recruited from a specialist language school and via an online database. Semi-structured interviews were conducted, with participants given the choice to answer questions verbally or creatively, using toys or drawing materials. Interview transcripts were analyzed using interpretative phenomenological analysis. Results: Participants valued play, conversation, and helping others. They felt that spending time with peers could alleviate loneliness. However, sometimes solitude was needed as social interaction could be overwhelming. Participants found conflict challenging and exhibited difficulties with regulating emotions. Participants relied on running away, retaliation, or asking an adult for help, to resolve conflict. Conclusions and implications: The findings suggest that children with language disorders are socially motivated and have relative strengths in displaying prosocial behavior. However, children with language disorders require support to promote positive relationships. This support includes help with making deeper connections with peers, opportunities to spend time alone when needed, and providing adept conflict resolution and emotion regulation strategies. [ABSTRACT FROM AUTHOR]

Patient satisfaction is important in healthcare as it affects the quality of care and can lower costs in hospitals. This study aimed to measure immigrant satisfaction with outpatient services at Firoozabadi Hospital's pediatric clinic. Data were collected from immigrant patients from January to July 2023. The Patient Satisfaction Questionnaire 18 and the personal information checklist were used in oral interviews with caregivers. The overall satisfaction score was 72.95 out of 90, with a standard deviation of 12.57. Financial issues received the lowest satisfaction scores, while interpersonal manner received the highest ratings. Out of the 241 respondents, 48.6% were completely satisfied, 32.7% were satisfied, 10.6% had no opinion, and 4.4% expressed dissatisfaction. Satisfaction levels were not correlated with income, education, possession of identification documents or health insurance, and length of stay in Iran. Overall, most participants were happy with the outpatient services, but many lacked health insurance. Providing easier access to health insurance for immigrants could help reduce dissatisfaction with expensive medical bills. [ABSTRACT FROM AUTHOR]

Background/Objective: Pain is one of the most common chronic conditions in the US, estimated to affect 20.9% of the population (51.6 million people). We evaluated the Partners Aligned in Transformative Healing (PATH) program at University Medical Center's Comprehensive Pain Program clinic. Feasibility, initial clinical and financial results were assessed to inform payers' support for PATH, an integrative transdisciplinary program within a bundled payment format. Methods: Participants completed a multi-week program including integrative therapies, with empirically validated assessment surveys administered at the beginning and end of the program. Insurance claims data were analyzed 12 months pre- and post-program. Statistical significance of pre-post differences was assessed by paired T-tests with P < 0.05. Results: Between June 2019 and August 2022, 170 individuals enrolled in PATH, 151 (88.8%) completed the program, and 121 participants completed outcome surveys. Participants were predominately White, non-Hispanic (98%), female (76%), with an average age of 49.8. All participant-reported clinical outcomes (PROs) showed statistically significant improvement from baseline to final assessment, and some but not all were clinically significant. PEG subscale of average pain interference, enjoyment of life, and interference with general activity each decreased. The T-scores for the following domains of PROMIS-29 decreased: Pain interference; fatigue; sleep disturbance; anxiety, and depression. The PROMIS-29 domains of overall physical function and social roles and activities mean T-scores increased. Per Member Per Month (PMPM) total cost of care decreased by $462 (18%). Emergency room utilization for all diagnoses decreased by 457 visits/1000 patients (65%), and for pain-related diagnoses by 194 visits/1000 patients (67%) during the observation period. Conclusions: Results suggest that the PATH Program is a feasible and acceptable model that shows initial effectiveness relative to short-term patient-reported clinical outcomes and shows signs of durability in both utilization and financial outcomes at 1 year. The results support continued study including a multi-site RCT. [ABSTRACT FROM AUTHOR]

Introduction: While each of the 44 National Health Service commissioned artificial limb clinics in the United Kingdom record information about their own prosthetic limb users, these are not collated to give a national picture of amputee epidemiology. The requirement to respond to Freedom of Information (FoI) requests within 20 working days offers another way of extracting data from all centres, and this study describes a first attempt to use this method to update national epidemiological data. Methods: Questions were sent to the FoI email addresses of all 44 centres, requesting numbers of adult unilateral below-knee amputees, adult unilateral above or through-knee amputees and child unilateral above or through-knee amputees (all of K2 level mobility), numbers of people consistently using a prosthesis with a single axis myoelectric hand, and access to an occupational therapist with skills to teach someone to use a myoelectric hand. A FoI request was sent to NHS England seeking release of data that they collect every month from all the prosthetic services which they commission in England. Results: All but one of the UK centres responded, the great majority within 31 days. Incomplete results were generally due to centres finding the questions ambiguous and many did not record mobility levels consistently. While 33 centres had access to skilled occupational therapy, only 4 reported more than 10 patients who constantly used a single axis myoelectric hand. Eighteen centres were unable to provide complete data, and the remainder reported a ranges of 5 to 992 below-knee amputees, 7 to 574 adult above-knee amputees and 0 to 137 child above-knee amputees, suggesting different approaches to managing missing mobility level data. Conclusions: Freedom of Information requests are an inexpensive way of gathering data from NHS prosthetic clinics, which can identify age, sex, level of amputation but not activity levels or use of a prosthesis and hence only gives limited demographic information of the amputee cohort. [ABSTRACT FROM AUTHOR]

Introduction: An increasing population and a shortage of identified potential organ donors are causing the waiting list for organ transplants to grow continuously. Donation after circulatory death (DCD) is a method aimed at meeting the demand for transplantable organs. However, it presents new challenges in nursing care, and there is a lack of studies investigating nurses' attitudes and knowledge of DCD. Objective: The objective of this study was to determine and describe intensive care nurses' (ICNs') knowledge, attitudes, and views on DCD before a national implementation in Sweden. Method: This study utilized a cross-sectional mixed-method design. A convenience sampling method was employed, targeting ICNs working in four intensive care units in Sweden. A study-specific tool comprising fixed and free-text questions was developed. Fifty-one ICNs participated. Data were analyzed descriptively, and correlation analysis was performed using Spearman's correlation. Free-text answers were qualitatively assessed and analyzed. An integrated analysis was conducted to synthesize the quantitative and qualitative findings. Results: Fifty-three percent reported limited knowledge about DCD. Nurses with previous education on DCD had significantly higher knowledge (r =.380, p =.006), were more engaged with the public debate on organ donation (r =.423, p =.002), and considered the ethical aspects of DCD more thoroughly (r =.386, p =.022). The qualitative analysis identified four key categories: The importance of the team, the need for ethical discussions, increased knowledge of DCD, and unanswered questions and unmet needs. The integrated analysis underscored the need for targeted education, clear guidelines, and ongoing ethical discussions to prepare ICU nurses for DCD. Conclusion: Nurses educated in organ donor care had better knowledge and a more positive attitude toward DCD implementation. The study also highlights the importance of interprofessional teamwork in DCD implementation. The findings suggest that education on DCD could improve the identification and implementation of DCD donors, addressing the global shortage of transplantable organs. [ABSTRACT FROM AUTHOR]

Background and aims: Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD. Methods: Participants were five children with DLD aged 9–12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories. Results: For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions. Conclusions: By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD. Implications: The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM. [ABSTRACT FROM AUTHOR]

Background: Adequate eHealth literacy and health promotion behavior (HPB) are important to achieve good health-related quality of life. There is limited information on the influence of eHealth literacy and HPB on body mass index (BMI) in our setting and among public service workers. Objectives: This study assessed the eHealth literacy, HPB, and BMI of public service workers and determined the influence of eHealth literacy and HPB on BMI. Design: A descriptive cross-sectional design was adopted. Methods: A simple random sampling technique was used to select 440 public service workers from civil service of redacted. A structured questionnaire was used to collect data on socio-demographics, eHealth literacy, and HPB. Weight and height were measured and BMI was calculated. Data were analyzed using frequency, percentage, mean, standard deviation, and logistic regression analysis. The significant level was set at 0.05. Results: More than one quarter (28.2%) of respondents had low eHealth literacy, and more than one third (42.5%) had inadequate (30.0% fair and 12.5% poor) HPB. An average (50.5%) had a level of obesity that ranged from preobesity to type 2 obesity. There was a significant association between eHealth literacy and HPB with the BMI of respondents at p <.05. Conclusion: There was inadequate eHealth literacy and HPB among public service workers. An average of the workers had a level of obesity that ranged from pre-obesity to type 2 obesity. There was a significant association between eHealth literacy and BMI and also between HPB and BMI of respondents. Community health professionals should assist public service workers to develop competencies and skills useful in evaluating health information on the Internet and applying such information to make informed decisions. [ABSTRACT FROM AUTHOR]

Introduction: Throughout their academic pursuits, students may encounter various sleep-related issues, including insomnia, sleep apnea, hypersomnia, or sleep terror disorder. These disorders can profoundly impact their well-being, emotional state, and academic achievements. Objective: This study, of significant relevance to the field of nursing and sleep disorders, aimed to investigate the prevalence of sleep disorders and their impact on academic performance among undergraduate nursing students in the United Arab Emirates. Methods: A cross-sectional research method was implemented among 177 undergraduate nursing students. Two tools were used: Too I consisted of two parts: sociodemographic and academic performance classifications, whereas Tool II comprised the SLEEP-50 questionnaire. Results: Our findings revealed that 30.6% of nursing students had one or more sleep disorders. Insomnia was the most prevalent among the nursing students (37.5%), followed by circadian rhythm (33.3%), narcolepsy (26.6%), sleep apnea and restless leg syndrome (25%), nightmares (22.2%), and sleepwalking (11.11%). There was a significant relation between restless leg syndrome and academic performance, while in linear regression analysis, it was found that the variable that most affects sleep is gender. Conclusion: The implications of this study's findings are clear-nursing schools must intensify their efforts to raise awareness about the detrimental effects of sleep problems on academic performance. Furthermore, subsequent research is crucial to evaluate the execution of interventions aimed at preventing such disorders. [ABSTRACT FROM AUTHOR]

Building on the premises of Positive Psychology, this undertaking conducted a pilot study of the designed 14-session Positive Psychology Intervention (PPI) program established based on the character strengths and virtues (CSV) of persons who use drugs (PWUDs) to assess its usefulness, delivery details, and impacts. Conducted in one of the biggest Drug Abuse Treatment and Rehabilitation Center in the Philippines, 24 PWUDs were randomly selected by the program staff to participate in its pilot run while securing all necessary ethical guidelines and requirements. Via within-subjects pretest-posttest experimental design, the especially adapted and developed tools were used to assess the PWUDs' progress as they were facilitated by the said program. Results yielded significant improvements in the PWUDs' mental wellbeing (M = 1.29, SD = 0.35; t (21) = 9.30, P <.00001), life satisfaction (M = 1.82, SD = 0.24; t (21) = 9.89, P <.00001), and psychological functioning (M = 1.65, SD = 0.19; t (21) = 8.58, P <.00001). Moreover, the PWUDs regarded the designed PPI program very highly and experienced it with positive outcomes, especially for their CSVs. Further improvement of the said program centers around proper time allotment, number of participants in the program sessions, appropriate activities per session, including specific ice breaker games, activity materials needed, and the proper sequencing of each session. These data are used to improve the PPI program structures and components. Pertinent conclusions about the gathered data were drawn, and relevant recommendations were also thereby provided. [ABSTRACT FROM AUTHOR]

Objective: The pandemic contributed to increased mental and cognitive health concerns as well as reduced utilization of preventive and treatment focused care. Deferred care can contribute to negative clinical outcomes, including increased acuity of mental and cognitive health concerns that benefit from early intervention. A new visit type was launched with the aim of reaching patients who may need care and supporting early identification of cognitive and mental health issues. Methods: We developed the Healthy Mind visit, a preventative visit administered by Primary Care Providers (PCPs) within outpatient clinics. The Healthy Mind visit included use of a pre-visit mental health screener as well as a brief computerized cognitive assessment. The clinical interaction focused on identifying mental and cognitive health concerns and developing a plan for wellness. Outcomes data collection occurred over nearly 2.5 years and focused on analyzing booking patterns, depression screening and follow-up, and clinical outcomes such as health confidence and post-visit motivation. Results: The visit was effective in supporting depression screening and follow-up with 29.6% of those participating in a Healthy Mind visit receiving a PHQ-9, and 82.5% of patients with elevated PHQ-9 scores attending a subsequent visit with their PCP. Improvements in health confidence and high patient reported motivation post-visit represent other notable clinical outcomes. The visit also promoted care utilization, with 73.5% of patients who attended a Healthy Mind visit being new to the practice or those who had not attended an appointment in the past 6 months. Conclusions: The Healthy Mind visit, with a focus on mental and cognitive health, was successful in reaching patients who may not have otherwise sought care and supported positive clinical outcomes including early identification and treatment of depression and increased health confidence. Recommendations: These findings reflect the importance of developing innovative programs to connect patients with care, especially those who may have deferred care due to a variety of factors. Focusing on mental and cognitive health with the use of innovative tools such as a computerized assessment, can drive patient interest in care offerings and support positive clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic has profoundly impacted global healthcare systems, necessitating substantial shifts in patient care strategies. The pandemic's onset led to drastic operational changes in hospitals, including reduced bed capacity and staffing levels, which could have further influenced the mortality outcomes for geriatric patients. The study aimed to assess the impact of the COVID-19 pandemic on 1-year mortality rates of surgically treated geriatric hip fractures. Methods: This retrospective, single-center cohort study included 346 participants aged 65 and above who underwent surgical treatment for hip fractures. We compared mortality rates between the pre-COVID and COVID eras. Data included demographics, treatment, complications, and COVID-19 status. The independent samples t test and Chi-square tests (or Fisher's exact test) were used for comparisons for era cohorts. Survival probabilities were assessed using Kaplan-Meier, while multivariate analysis identified mortality predictors. Results: 175 patients were included in the pre-COVID era, and 171 patients were included in the COVID era. During the COVID era, the 30-day mortality rate was 11.7% (compared to 13.7% in the pre-COVID era, p = 0.573), and the 1-year mortality rate was 43.9% (compared to 49.1% in the pre-COVID era, p = 0.325). The overall 1-year mortality rate was 46.5%. Patients who underwent surgery within 48 hours had a higher 1-year survival rate (60.5%) compared to those with delayed surgery (51.2%), p = 0.031. Additionally, patients not admitted to the ICU had a higher 1-year survival rate (74.7%) than those who were admitted (44.9%), p < 0.001. 70.1% of the total deaths occurred within the first 90 days. Conclusion: Elderly patients with hip fractures experienced high mortality rates before and during the pandemic. This study demonstrates that the 1-year mortality rates of geriatric hip fractures were not significantly affected by the pandemic. The findings emphasize the importance of pandemic preparedness and prompt surgeries and attentive ICU care in reducing mortality rates. [ABSTRACT FROM AUTHOR]

Introduction: Filipino Americans (FAs) are at high risk for developing type 2 diabetes despite other Asian phenotypes. Evidence suggests that pro-inflammatory interleukin-18 (IL-18) and anti-inflammatory adiponectin biomarkers associated with visceral adipose tissue (VAT) may explain this risk. Objectives: This study aimed to quantify the biomarkers in relation to standard ranges of VAT or typical circulating concentration ranges reported in the literature of IL-18 and adiponectin, examine relationships of these markers, and determine if they were different among those participants without diabetes, prediabetes, and diabetes. Methods: A cross-sectional study was used to enroll FAs without diabetes, prediabetes, or diabetes. VAT was measured using the InBody 570© Body Composition Analyzer. Blood samples were obtained to assess plasma concentrations of IL-18 and adiponectin using enzyme-linked immunosorbent assay. All analyses were conducted using a 5% type I error rate. Mean ±SD and percentages were used to describe the sample and data where appropriate. Pearson's correlations (R) were calculated to determine the relationships between VAT and IL-18 in each group. Analysis of variance was used to determine differences in VAT, IL-18, and adiponectin among groups. Further, nonparametric procedures examined the differences in adiponectin among those within groups. Results: Seventy-five participants were enrolled. Biomarkers above the typical concentration range were observed for VAT, IL-18, and adiponectin. Adiponectin significantly differed among groups with lower values in the diabetes group vs. the nondiabetes group. Conclusions: The findings indicate that while inflammation-related biomarkers, such as adiponectin, correlate with VAT and may serve as indicators of increased risk of type 2 diabetes in FAs, correlation alone does not establish causality. [ABSTRACT FROM AUTHOR]

Background: Individuals experiencing socioeconomic inequity have worse health outcomes and face barriers to palliative and end-of-life care. There is a need to develop palliative care programs tailored to this underserved population. Objectives: To understand the characteristics and symptom profiles of a group of urban patients experiencing socioeconomic inequity and receiving palliative care. Design: Descriptive exploratory analysis of a patient dataset. The patient dataset was generated through a pilot research study with patients experiencing socioeconomic inequity and life-limiting illness who received a community-based palliative care intervention. Methods: The intervention took place over 1 year in the Palliative Care Outreach and Advocacy Team, a community-based urban palliative care clinic in Edmonton, Alberta, Canada, serving persons experiencing socioeconomic inequity. Participants had to be at least 18 years of age, be able to communicate in English, require palliative care for a life-limiting illness, and be able to consent to inclusion in the study. Results: Twenty-five participants were enrolled. Participants predominantly identified as male and Indigenous, experienced poverty and housing instability, and had metastatic cancer. Our participants rated their pain, shortness of breath, and anxiety as more severe than the broader community-based palliative care population in the same city. Most patients died in inpatient hospices (73%). Conclusion: Our analysis provides an in-depth picture of an understudied, underserved population requiring palliative care. Given the higher symptom severity experienced by participants, our analysis highlights the importance of person-centered palliative care. We suggest that socioeconomic inequity should be considered in patients with life-limiting illnesses. Further research is needed to explore palliative care delivery to those facing socioeconomic inequity. [ABSTRACT FROM AUTHOR]

Background: Health care workers (HCW) exposed to COVID-19 risk experiencing psychological distress. Little is known regarding longitudinal perspectives and evolutions of psychological distress within this population. The objective of this study is to extend the results of our previous study to the pandemic's second wave. Method: This prospective cohort study was conducted from May 8, 2020, to January 24, 2021, and includes 787 HCW. Symptoms of anxiety and depression were assessed using the Generalised Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics illustrated the evolution of psychological distress indicators, whereas latent class analysis helped identify trajectories. Results: The results showed that a lower proportion of HCW exceeded the clinical threshold during the second wave (36,5% vs. 31,1%). As in the first wave, most of our sample fell onto the resilient trajectory (67.22%). We adapted the name of the remaining trajectories to better suit their evolution: rapid recovery (15.76%), slow recovery (9.66%), and delayed (7.37%). Conclusion: Approximately two-thirds of the HCW did not manifest significant distress. For those who did, the distress was transient. We observed a trend of positive adaptability among HCW, considering that the proportion of HCW experiencing psychological distress exceeding clinical threshold remained lower than during the first wave. Our data highlight the dynamic nature of psychological distress. To be able to detect psychological distress as it arises, HCW should use self-monitoring as an essential tool. This vigilance would allow institutions to offer timely support and resources for those experiencing psychological distress. [ABSTRACT FROM AUTHOR]

Background: Caring for terminally ill patients with minor children can be very stressful. The perceived quality of life is significantly influenced by the Meaning in Life (MiL). No studies were found that focus on the prioritized special needs of this patient group. Objectives: The aim is to compare and contrast terminally ill parents with minor children and palliative care patients in Germany, in order to provide appropriate support beyond medical, nursing or therapeutic interventions. Methods: Terminally ill parents diagnosed were surveyed using a validated instrument 'Schedule for Meaning in Life Evaluation (SMiLE)'. The study listed various areas that contribute to the MiL, followed by an evaluation of their importance and satisfaction levels. The researchers then compared these findings with data collected from palliative care patients. Results: In Germany, 54 patients, mostly female and with a mean age of 43, were included in this study between February 2017 and September 2020. The median age of the 96 children during the survey phase was 7 years. The comparison group consists of 100 palliative care patients in Germany; mostly aged 50 years and older. For terminally ill patients most important areas were in decreasing order family (100%), social relations (80%), leisure time (61%), nature/animals (39%) and home/garden (30%). Although the overall indices are close between both groups, there are significant and highly correlated differences between them. Parents felt limited by their illness in being a mother or father, as they wanted to be. Conclusion: The involvement with SMiLE led patients to consider their coping resources. The areas relevant to terminally ill parents differed from those relevant to palliative care patients. All participants identified family as the most important factor for MiL. The results suggest that evaluating MiL can serve as a coping strategy and help terminally ill parents with minor children. Plain language summary: A comparison of answers to the meaning in life from seriously ill parents with young children with the answers of other seriously ill patients Background: Caring for seriously ill patients with young children can be very stressful. The quality of life depends on meaning in life. No studies were found that focus on the needs of this patients. Objectives: The aim was to explore similarities and differences between seriously ill parents with young children and palliative care patients in Germany to find the best way to support them. Methods: The Meaning in Life questions were used to find this out. Two researchers asked seriously ill parents about different things that make their lives meaningful. The researchers then compared the results with data from other seriously ill patients in need of palliative care. In Germany, 54 seriously ill parents with young children were interviewed between February 2017 and September 2020. The children were usually seven years old. The compared group consisted of 100 palliative care patients and was mostly older than 49 years. For seriously ill patients most important were family, social relations, leisure time, nature/animals, and home/garden. The values seemed similar, but there are clear differences between the groups. Parents felt their illness limited them in being a mother or a father. Conclusion: The questions helped patients helped to remember meaning in life and set goals. The things that mattered to seriously ill parents were different from those that mattered to palliative care patients. All participants said that family was the most important thing for meaning in life. The results show that thinking about meaning in life can help. [ABSTRACT FROM AUTHOR]

Background: Early detection of autism spectrum disorder (ASD) has the potential to significantly reduce the impact of the condition, however previous reviews have found little evidence to support screening programs for ASD in young children. Methods: We conducted a review with the aim of updating evidence on 3 aspects: (a) diagnostic stability of ASD in young children; (b) accuracy of ASD screening tools in young children; and (c) the benefits of early interventions in screen-detected young children with ASD. Results: A total of 33 studies were included in our review. Five studies looking at diagnostic stability reported estimates ranging from 71.9% to 100%, however the majority only included a follow-up of 24 months and all studies raised concerns regarding the risk of bias due particularly to lack of blinding, sample size, and patient flow. A total of 25 studies, reported in 26 articles, were identified that reported accuracy data on 11 screening tools. Most of the reports were concerned with versions of M-CHAT, reporting sensitivity estimates from 0.67 to 1.0; however, many of these were deemed to be of high risk of bias due to lack of blinding and follow-up. Four studies reported on early interventions in screen-detected children; however, the majority did not find significant improvements on the relevant outcomes. Conclusions: Overall, the evidence on screening for ASD in young children captured by this review is not conclusive regarding the 3 aspects of screening in this population. Future studies should attempt to ensure blinded diagnostic assessments, include longer follow-up periods and limit attrition. [ABSTRACT FROM AUTHOR]

The factors influencing caregivers' understanding of pediatric respiratory diseases, such as bronchiolitis, can guide patient care and the acceptability of treatment methods within the healthcare system. This study aims to identify illness perceptions and perform a needs assessment among caregivers of children diagnosed with respiratory diseases. This is a prospective, cross-sectional, questionnaire-driven study of a representative sample of caregivers whose children had an acute respiratory illness. The telephone-administered questionnaire was comprised of (1) demographic items; (2) illness perception questionnaire-revised (IPQ-R); and (3) items about personal barriers, the latter 2 of which employed a 5-point Likert response. Cronbach's alpha (α) was used to measure the internal consistency reliability for each item within the IPQ-R. The Pearson 2-tailed correlation coefficient was used to correlate questionnaire items. We included 75 caregivers whose children have been diagnosed with bronchiolitis (51%), reactive airway disease (RAD) (35%), asthma (33%), and wheezing (44%). We found no significance between the child's diagnosis and the site of recruitment. The most important components of the illness perception were illness coherence (α =0.849), psychological attributions (α =0.903), and barriers to diagnosis (α =0.633). Understanding caregivers' perceptions of respiratory diseases will lead to better treatment acceptance. We must clarify the terms used to define bronchiolitis from viral-induced wheezing, RAD, and the first asthma episode in older infants. Identifying caregivers' gaps in knowledge will help establish a cohesive approach to personalized treatment of respiratory diseases in children and their diagnosis. [ABSTRACT FROM AUTHOR]