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Enhanced Recovery After Surgery (ERAS) programs were developed as evidence-based, multi-disciplinary interventions in all the perioperative phases to minimise the surgical stress response, reduce complications, and enhance outcomes. The results across various surgical procedures have been positive, with a reduction in medical complications, a reduction in length of hospital stay, and a reduction in care costs without increased re-admission rates. However, implementation for many institutions has not been easy and suboptimal at best. The robust and pervasive adoption of these programs should be based on effective change management, dynamic and engaged clinical leadership, adherence to the principles of continuous quality improvement programs, and the adoption of evidence-based and data-driven changes in pathway development and implementation. Rapid cycle, randomised/quasi-randomised quality improvement projects must be the core foundation of an ERAS program. Finally, research methodologies should focus on controlling for adherence to the core elements of the pathways and testing for the effectiveness of an individual intervention in a randomised controlled trial. Keywords: Enhanced recovery after surgery, machine learning, perioperative medicine, perioperative research, surgical complications, Author(s): Vijaya Gottumukkala (corresponding author) [1]; Girish P. Joshi [2] INTRODUCTION Enhanced recovery after surgery (ERAS) programs were introduced into the surgical practice over two decades ago as evidence-based, multi-disciplinary [...]

This scoping review examines known associations between potential traumatic experiences and mental health outcomes among adolescent refugees. Little is known about the type and severity of traumatic experiences among adolescent refugees and whether the type and severity of these experiences are associated with poor mental health. Five electronic databases were searched to identify relevant peer-reviewed articles. Inclusion criteria were: 1) trauma was the predictor variable of the article, 2) at least one of two selected mental health conditions (depression and anxiety) was an outcome variable of the study, 3) the quantitative relationship between trauma and mental health was discussed; 4) participants of the study were adolescent refugees or asylum seekers; 5) the article was published between January 1, 2011 and August 30, 2020; 6) and written in English. Adolescents aged 12-18 of all genders were included in this review. Of 3319 potentially relevant articles identified, 11 articles were included. All the included studies employed a cross-sectional study design. Adolescent refugees experienced a variety of traumatic events, such as physical and sexual violence, war-related events, natural disasters, migration-related events, and verbal and emotional abuse. The review found a positive association between trauma exposure and poor mental health outcomes of depression and anxiety in all included studies across diverse adolescent refugee populations. The findings suggest that effective intervention strategies should be implemented to meet the needs of children and adolescent refugees as a vulnerable group in the host community as they adjust to the language, cultural, and school barriers and to support overall growth and development., Author(s): Solomon D. Danga [sup.1] , Babatope O. Adebiyi [sup.1] , Erica Koegler [sup.2] , Conran Joseph [sup.3] , Nicolette V. Roman [sup.1] Author Affiliations: (1) https://ror.org/00h2vm590, grid.8974.2, 0000 0001 [...]

This study investigated the unique impacts of emotional abuse and neglect on loneliness. Further, it explored the moderating effect of peer acceptance in these associations among Chinese rural left-behind adolescents with non-left-behind adolescents from the same rural areas as a comparison group. A total of 914 rural adolescents (M.sub.age = 13.71 years, SD = 0.90) participated in the study. Participants completed self-report measures of emotional abuse, emotional neglect, and loneliness. Classroom-based peer nominations were used to assess participants' peer acceptance. Hierarchical regression analyses were used to test the independent and interactive associations linking emotional abuse/neglect and peer acceptance with loneliness. The results showed that left-behind adolescents experienced higher levels of emotional neglect than non-left-behind adolescents. Emotional neglect was more strongly associated with adolescents' loneliness than emotional abuse. The associations between emotional neglect and loneliness were stronger for left-behind adolescents than non-left-behind adolescents. In addition, peer acceptance moderated the association between emotional abuse and loneliness among left-behind adolescents. Gender differences were found in the link between peer acceptance to loneliness among non-left-behind adolescents. Implications of these findings for future research and the development of interventions are discussed., Author(s): Qian Wang [sup.1] [sup.2] , Jingxin Zhao [sup.1] Author Affiliations: (1) grid.410585.d, 0000 0001 0495 1805, Department of Psychology, Shandong Normal University, , No. 88 East Wenhua Road, 250014, [...]

Early childhood traumas adversely impact both the developmental course and adulthood experiences of individuals. Previous literature showed that alexithymia- difficulties in recognizing, identifying, and expressing feelings increases as experienced childhood adversity increases. In this regard, the development and manifestation of early maladaptive schemas resemble the etiology and indications of alexithymia. Thereby, the current study aims to investigate the mediator role of different early maladaptive schema domains in the relationship between early childhood trauma and alexithymia levels. 435 participants, between the age of 18 and 74, were asked to fill out self-report questionnaires measuring traumatic childhood experiences (Childhood Trauma Questionnaire), alexithymia (Toronto Alexithymia Scale-20), and early maladaptive schemas (Young Schema Questionnaire- Short Form 3). Results indicated that participants with more childhood trauma experiences had a significantly higher score of alexithymia than participants with less childhood trauma experiences. Moreover, all early maladaptive schema domains- Disconnection and Rejection, Impaired Autonomy and Performance, Overvigilance and Inhibition, Impaired Limits and Other-Directedness, were found to be mediating the relationship between early childhood trauma and alexithymia levels. The current findings can contribute to the understanding of alexithymia and suggest a direction for schema therapy-based interventions that might reduce alexithymia levels effectively., Author(s): Aynur Feyzioglu [sup.1] , Aliye Canan Taslioglu Sayiner [sup.1] , Dila Özçelik [sup.1] , Feray Tarimtay Altun [sup.1] , Ezgi Nur Budak [sup.2] Author Affiliations: (1) grid.488643.5, 0000 0004 [...]

Although previous studies found the importance of community subjective social status for adolescent health, its relationship with mental health problems among refugee adolescents is unclear. To close this gap, we examined the nature of the relationship between subjective social status and externalizing problems in refugee adolescents. We carried out a cross-sectional study among three hundred and six 11-18-year-old Syrian refugee adolescents in Turkey. The measurements of the study were the MacArthur Scale of Subjective Social Status, Strengths and Difficulties Questionnaire (SDQ), the Depression Self Rating Scale for Children (DSRS-C), and the Spence Children's Anxiety Scale (SCAS). The results supported the idea that adolescent's community subjective social status may affect internalizing problems directly and externalizing problems indirectly via internalizing problems. The mediation effect of the internalizing problems on the relationship between subjective social status and externalizing problems were confirmed by three separate mediation models. The results were discussed in terms of previous literature., Author(s): Rahsan Düren [sup.1] [sup.2] , Özgen Yalçin [sup.3] Author Affiliations: (1) Dunya Doktorlari Dernegi, , Beyoglu, Istanbul, Turkey (2) grid.15876.3d, 0000000106887552, Koç University, , Istanbul, Turkey (3) grid.31730.36, 0000 [...]

Understanding associations between mothers' and children's physical activity and sedentary behavior on more fine-grained timescales can provide insights into real-time intervention opportunities. This study examined the extent to which mothers' and their children's device-measured moderate-to-vigorous physical activity (MVPA) and sedentary time (SDT) were associated at the day level during non-school time. Mother-child dyads (N = 193; baseline Mean ages = 40.69 ± 6.11 [mother] and 9.57 ± 0.89 [child] years) provided 3,135 paired days of accelerometry data from six bi-annual waves across three years. Controlling for covariates, multilevel models revealed that mothers' and their children's MVPA and SDT were positively associated at the day level during non-school time, both on weekdays and weekends. During weekdays, the day-level association for SDT was stronger for older than younger children, and the day-level association for MVPA was stronger for boys than girls. Designing family-based interventions targeting school-age children and their mothers during non-school time across the week may be useful for promoting active lifestyles., Author(s): Chih-Hsiang Yang [sup.1] , Shirlene Wang [sup.2] , Wei-Lin Wang [sup.2] , Britni R. Belcher [sup.2] , Genevieve F. Dunton [sup.2] [sup.3] Author Affiliations: (1) grid.254567.7, 0000 0000 9075 [...]

Introduction Maternal and child health (MCH) services are critical for vulnerable populations. Workforce shortages, poor retention, and gaps in necessary trainings impede the capacity of public health systems to address needs. This manuscript characterizes the current MCH workforce, MCH program applicants and graduates, and describe findings within a national context to devise elements of a recruitment and retention strategy. Methods Data were obtained for public health program applicants, first-destination employment outcomes, and worker perceptions and demographics. Data were stratified according to the MCH and total public health workforce and by local, state, and national totals. Data were characterized by degree type, discipline, demographics, and employment outcomes. Results MCH staff constitute 11% of the state and local governmental public health workforce. MCH staff are approximately as diverse, have higher educational attainment, and are more likely to hold nursing degrees than the rest of the public health workforce. Yet, just 14% of MCH staff hold any type of public health degree. The MCH pipeline from academia appears modestly sized, with approximately 5% of applicants between 2017 and 2021 applying to a MCH master's degree. Discussion The MCH workforce has a lower proportion of formal training or degrees in public health, though trends seem to indicate improvements. However, it is critical that a multi-faceted recruitment and retention strategy be coordinated by a broad range of stakeholders. These efforts will serve to improve the capability and capacity of the public health system to address critical needs of increasingly diverse MCH populations. Significance In order to modernize and reimagine the academic-public health pipeline, it is critical to better understand how many applicants and graduates exist within Maternal and Child Health programs across the US, and their characteristics. This manuscript connects that information with the most recently available public health workforce information on demographics, workplace perceptions, and intent to leave among staff at state and local health departments. Data presented in this paper allow the most comprehensive characterization of the MCH academia->practice pipeline to-date, identifies a fundamental disconnect in those career pathways, and offers options to repair that break., Author(s): Jonathon P. Leider [sup.1] , Jamie Stang [sup.1] , Zobeida E. Bonilla [sup.1] , Jason Orr [sup.1] , Christine M. Plepys [sup.2] , Moriah Gendelman [sup.3] , Ellen W. [...]