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Social workers have long been active in social and political organizing to ensure a living wage. Yet recent social work research largely neglects efforts to raise wages and effective means for organizing to do so. This paper draws on in-depth interviews from a longitudinal study of low-wage hospital workers who formed a union and negotiated annual, incremental wage increases to achieve a $15 minimum wage floor to understand their perceptions of the effects of the initial wage increase. Results show workers have a wide spectrum of perceptions, with many feeling no effect or even a negative effect due to losses in public benefits. A visualization used to aid interpretation of results identifies race and family structure as salient factors, pointing to the role of structural discrimination in experiences and perceptions of wage increases. Given that this workplace, like many other employers and localities, has implemented a $15 minimum wage through incremental raises across time, it is important that social workers be aware of the experiences of workers at each stage of this process. This study examines the impact of the first raise, establishing a framework from which future research can examine how individuals' perceptions and experiences develop over time. [ABSTRACT FROM AUTHOR]

In 2023, the UK Government published its long-awaited reform strategy for England's children's social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular 'priority' was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England's child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media. [ABSTRACT FROM AUTHOR]

This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Rehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement. The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations. Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process. Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run. [ABSTRACT FROM AUTHOR]

Purpose:To explore the usefulness of conventional tests for assessing spatial neglect and contrast these tests with daily challenges encountered by patients after discharge from rehabilitation to home. Methods:A mixed method prospective study of 15 patients with neglect after a right hemisphere stroke, <1 month after discharge to home. Data were obtained from: (1) Catherine Bergego Scale (CBS), (2) star cancellation and figure copying and (3) observations and interviews. Qualitative data were analysed with content analysis and quantitative data with non-parametric statistics. The data were presented in a ‘mixing matrix’ and integrated by ‘following threads’. Finally, a synthesis was written into a vignette. Results:The CBS significantly underestimated fluctuations and did not capture important items of neglect. The star cancellation and figure copying did not identify neglect in mildly affected participants. Left starting point in the star cancellation and a characteristic process of drawing in figure copying were observed in all participants. Conclusion:Traditional numerical interpretations of paper-pencil tests inadequately confirmed mild neglect. Starting points of the star cancellation and observation of drawing should be incorporated into screening procedures. Assessment strategies need improvement to identify patients with subtle forms of neglect.Implications for RehabilitationFindings demonstrate that identification of spatial neglect and the way symptoms of neglect impact on daily life functioning of stroke patients must be carefully pursued by health-care professionals working in stroke rehabilitation.Areas that should receive professional attention in the rehabilitation process include: preparing patients and their family for fluctuations related to neglect in the patient’s own home, locating issues that might impact safety, and identifying unique factors that either enhance or diminish neglect within each patient’s daily life context.The results of this study could be used to develop more wide-ranging assessment strategies to assist health-care professionals in identifying neglect after hospital discharge, for instance by expanding existing ecological assessment tools and including qualitative evaluation of test performance in paper-pencil tests, such as the star cancellation and figure copying. [ABSTRACT FROM PUBLISHER]

A growing body of conceptual evidence over the last decade has increased our understanding of parents' experiences of having an infant with complex congenital heart disease. These concepts include parents' feelings of uncertainty, fear, excitement, and mastery. However, little is known about parents' experiences, confidence, and knowledge acquisition during transition from hospital to home with their infant after the first stage of complex cardiac surgery. A theoretical framework to assess, plan and implement child and family centered care would assist children's cardiac nurses responsible for parental education, discharge planning and coordination. To explore parents' experiences of the transition from hospital to home with their infant, following the first stage of cardiac surgery. A prospective mixed methods longitudinal design. Semi-structured interviews were undertaken, including administration of the Maternal Confidence Questionnaire at four timepoints: before discharge following stage one cardiac surgery (T0), 2 weeks' post discharge (T1), 8 weeks' post discharge (T2) and after stage two surgery (T3). Qualitative data were thematically analyzed. Descriptive statistics were used to characterize the sample and non-parametric repeated measures analysis of variance was used to analyze changes over time in maternal confidence scores. Sixteen parents of 12 infants participated. Four "patterns of transition experience" emerged, the fourth "Mastery", is discussed in this paper. Mastery can be contextualized in terms of the parents' journeys of knowledge construction, gaining confidence and reflection. Learning was dynamic and transformational, but successful learning and acquisition of knowledge was also dependent upon the parents' ability to absorb, integrate and adjust at any given time. Confidence at T0 was significantly lower than at T1 (p =.011), T2 (p =.018) and T3 (p =.012). There were no significant differences between scores at T1, T2 and T3. Liminality, as a concept, described the between and betwixt time that parents experienced as they were preparing for discharge from hospital; excitement to be going home balanced with the fear of being alone and confidence in looking after their fragile infant. Parents of infants with complex congenital heart disease obtain knowledge, confidence, and mastery dependent upon their transition experience and their personal journey through pre-liminal, liminal, and post-liminal phases of discharge from hospital to home. A conceptual framework "Parenting through Transitions – hospital to home" emerged that could assist in structuring assessment of parents' knowledge and support needs within a coordinated discharge process. Identifying individualized support would promote adaptation and adjustment during transition from the pre to post liminal phase, following their infant's first stage of complex cardiac surgery. Parents learning was dynamic and transformational, learning opportunities overlapped transitional phases of their infant's journey, but successful learning and acquisition of knowledge was also dependent upon the parents' ability to absorb, integrate and adjust at any given time. The transition from hospital to home and traversing the physical boundary of leaving the hospital for the first time with their infant (liminal phase), was loaded with emotionally traumatic experiences that could not be separated from the transition that was being explored within this study. Adjusting to the new situation, developing confidence over time, and becoming comfortable as they mastered new skills, demonstrated that some of these parents could pass through that liminal space to mastery of a new normal (post-liminal phase), which encompassed competence, integration, and comfort. [ABSTRACT FROM AUTHOR]

Leadership by health professionals is key in any health system, but health leadership training programmes are varied in their conceptualisation, learning objectives, and design. This paper describes an undergraduate leadership and management module for health students at the University of Sierra Leone and provides lessons from the design process. Our methods included an initial scoping review and qualitative study, followed by a co-design process of 10 workshops and 17 consultation meetings. The result was a curriculum with learning outcomes emphasising leadership identity, proactiveness, management of people and of change, and the formation of peer relationships. Learning methods included group teaching, team quality improvement projects, mentoring, and reflective practice. Lessons from the design process included the importance of support from university leadership and extensive consultation. Virtual workshops enabled broader participation but limited relationship building. Integrating doctoral research into the process facilitated inclusion of evidence and theory but risked reducing ownership by faculty. The importance of interprofessionalism and management skills in leadership training emerged during the process, illustrating the effectiveness of a co-design approach. Our programme is broadly aligned with other health leadership frameworks and is distinctive due to its undergraduate focus, offering insights for leadership training design in other settings. [ABSTRACT FROM AUTHOR]

Breast cancer rates among Asian American women are increasing. Despite this, there are limited studies on help-seeking among this population. Through a qualitative exploration, this paper examines the help-seeking experiences of Asian American breast cancer survivors. Asian American women (n = 52) with early-stage breast cancer were interviewed. Findings illustrate a continuum of experiences including: keeping diagnosis personal and not asking for help, keeping diagnosis personal but asking for limited help, and sharing diagnosis and seeking support. Results indicate that seeking support is a complex process for Asian Americans with breast cancer, with implications for survivorship and quality of life. [ABSTRACT FROM AUTHOR]

Purpose:The construct validity, test–retest reliability, and measurement error of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) were examined. Additionally, the influence of administration-method on reliability and measurement error was investigated. Method:112 Dutch adult MS-patients from an academic- and a residential care-facility participated. Questionnaires were administered on paper, online or as interview, and patients performed several performance tests. Construct validity was assessed by testing pre-defined hypotheses. Reliability was assessed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurements (SEMs) and Smallest Detectable Changes (SDCs). Results:For construct validity (N = 105) 9 of 13 hypotheses were confirmed (69%). As expected, the AMSQ showed moderate to strong relationships with the instruments measuring similar constructs. The test–retest reliability coefficient was 0.96 (95% Confidence Interval 0.94–0.97); SEM was 6.3 (6.3% of scale range); SDC was 17.5 (on a sale from 0 to 100). Different administration-methods showed good reliability (ICC 0.88–0.94) and small standard errors (SEM 5.6–7.2). Conclusion:The AMSQ shows satisfying results for validity and excellent reliability; allowing for proper use in research. Due to a large SDC value, caution is needed when using the AMSQ in individual patient care. Further research should determine whether the SDC is smaller than the minimal important change.Implications for RehabilitationThe Arm Function in Multiple Sclerosis Questionnaire (AMSQ) measures activity limitations due to hand and arm functioning in patients with Multiple Sclerosis (MS).Results of this study confirm adequate validity and reliability of the AMSQ in patient with MS.The equivalence of scores from online, paper or interview administration is supported.A change score of ≥18 points on the scale of the AMSQ (on a scale 0–100) needs to occur to be certain a change beyond measurement error has occurred in an individual patient. [ABSTRACT FROM AUTHOR]

As part of a larger prospective longitudinal research project to track parents as they navigate the family court system in Canada's two largest provinces, this paper reports on the mixed methodology results at Time 1 as parents came into contact with the family courts. Data was collected by using in-person surveys at seven family court sites in Ontario and five family court sites in Quebec. A total of n = 1,539 litigants in Ontario (n = 865) and Quebec (n = 674) were recruited for Time 1. Reflecting differences in eligibility for Legal Aid, significantly more Quebec (86%) litigants had a lawyer than in Ontario (37%). Only a minority of those who attended government supported mediation found it helpful. Those who were unrepresented generally expected a worse outcome and slower resolution because they did not have a lawyer. Implications for parents accessing family court services are considered. [ABSTRACT FROM AUTHOR]

While Electronic Medical Records (EMRs) are an important mechanism used to document patient information and service provision, most interfaces prioritize collection of information required for medical billing purposes, rather than complexities of behavioral and social service needs. An emphasis on encounter data renders it challenging for social workers (SWs) to communicate statistically compelling explanations of contributions to team-based care and overall value to the health system. This paper reports outcomes of feasibility, acceptability, and appropriateness of integrating a validated psychosocial acuity metric into standardized social work (SW) documentation at a large, pediatric quaternary hospital in the northeastern United States. Approximately 20% (N = 42) of departmental SWs participated in an open pilot trial wherein participants were first trained in scale administration, utilized it for a circumscribed period following training, and evaluated implementation outcomes. Across five unique practice settings, results showed that the metric was feasible, acceptable and appropriate for use; 78% of participants were in favor of integrating it into the EMR interface as a required component of SW documentation. Assessing psychosocial acuity in every documented patient encounter facilitates intermittent review of psychosocial acuity at individual, setting, and programmatic levels and opportunities to evaluate how SW interventions address psychosocial acuity. [ABSTRACT FROM AUTHOR]

Copyright of Australian Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Oto-Laryngologica is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Aging societies will bring an increase in the number of long-term care patients with mental-physical multimorbidity (MPM). This paper aimed to describe the natural course of neuropsychiatric symptoms (NPS) in patients with MPM in the first 8 months after admission to a geronto-psychiatric nursing home (GP-NH) unit. Methods: Longitudinal cohort study among 63 patients with MPM no dementia living in 17 GP-NH units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, and brief neuropsychological testing, among which our primary outcome measure the Neuropsychiatric Inventory (NPI). Descriptive and bivariate analyses were conducted. Results: Our study showed a significant increase of the NPI total score (from 25.3 to 29.3, p = 0.045), and the total scores of a NPI hyperactivity cluster (from 9.7 to 11.8, p = 0.039), and a NPI mood/apathy cluster (from 7.7 to 10.1, p = 0.008). Just over 95% had any clinically relevant symptom at baseline and/or six months later, of which irritability was the most prevalent and persistent symptom and the symptom with the highest incidence. Hyperactivity was the most prevalent and persistent symptom cluster. Also, depression had a high persistence. Conclusions: Our results indicate the omnipresence of NPS of which most were found to be persistent. Therefore, we recommend to explore opportunities to reduce NPS in NH patients with MPM, such as creating a therapeutic milieu, educating the staff, and evaluating patient's psychotropic drug use. [ABSTRACT FROM AUTHOR]

Children with a significant cognitive and motor developmental delay (SDD) are vulnerable for the development of (future) behavioral and mental health problems. To support children within this target group, knowledge on their social-emotional development is necessary. Therefore, in this paper, an explorative assessment of the changes in the social-emotional functioning of children with SDD over a two-year period was done. Yearly semi-structured interviews with one or more primary caregiver(s) of 25 children were conducted and analyzed on 13 domains of social-emotional functioning, according to an adapted version of the Scale for Emotional Development - Revised (SED-R). This study showed a lot of variation in individual and group patterns of change across the two-year period. Charting the social-emotional development in this target group is challenging and requires further in-depth analysis of individual trajectories as well as more fine-grained and long-term data collection. [ABSTRACT FROM AUTHOR]

Translation of findings from stroke trials into clinical practice remains low. Little is known about planned translation activities from the perspective of trialists who generate the evidence. This study aims to investigate perceptions of Australian stroke clinical trialists' about implementation of their findings into practice, and what translation activities they embedded into trial protocols. A descriptive cohort design and electronic survey was conducted. Three databases were searched to identify Australian stroke rehabilitation trials published between 2007 and 2017. Corresponding authors of the included trials were invited to complete an anonymous online survey about implementation of their trial intervention. Fifty-one trialists were invited to participate and 38 completed the survey (74% response rate). The majority (79%) considered their trial results to be clinically significant and 68% had pre-planned knowledge translation activities. The most common planned translation activities were publication (89%), conference presentation (87%), and feedback of results to target audiences (58%). Mixed opinions were evident regarding when and how to design knowledge translation activities for inclusion in trial protocols. Stroke rehabilitation trialists rely mostly on anecdotal reports about implementation of trial interventions, with few formally measuring uptake. The most common knowledge translation activities planned for by researchers are publication of findings in academic journals, and conference presentations. Mixed opinions exist regarding when and how to design for knowledge translation activities in trial protocols. Limited formal measurement of intervention uptake is completed. Further implementation research is required to support and measure effective translation efforts when embedded into trial protocols. [ABSTRACT FROM AUTHOR]

One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients. [ABSTRACT FROM AUTHOR]

Internally displaced women are underserved by health schemes and policies, even as they may face greater risk of violence and unplanned pregnancies, among other burdens. There are an estimated 450,000 internally displaced persons in India, but they are not formally recognised as a group. Displacement has been a common feature in India's northeast region. This paper examines reproductive and maternal health (RMH) care-seeking among Bru displaced women in India. The study employed qualitative methodology: four focus group discussions (FGDs) were held with 49 displaced Bru women aged 18–45 between June and July 2018; three follow-up interviews with FGD participants and five in-depth interviews with community health workers (Accredited Social Health Activists – ASHAs) in camps for Bru displaced people in the Indian state of Tripura. All interviewees gave written or verbal informed consent; discussions were conducted in the local dialect, recorded, and transcribed. Data were indexed deductively from a dataset coded using grounded approaches. Most women were unaware of many of the RMH services provided by health facilities; very few accessed such care. ASHAs had helped increase institutional deliveries over the years. Women were aware of temporary contraceptive methods as well as medical abortion, but lacked awareness of the full range of contraceptive options. Challenges in accessing RMH services included distance of facilities from camps, and multiple costs (for transport, medicines, and informal payments to facility staff). The study highlighted a need for comprehensive intervention to improve RMH knowledge, attitudes, and practices among displaced women and to reduce access barriers. [ABSTRACT FROM AUTHOR]

This paper examines the preferred sexuality education sources of older Australian adults in later life. Drawing on findings from qualitative interviews with 30 men and 23 women aged 60 years and older, we consider the sources that participants currently use, or would like to use, in seeking information about sex. Where relevant, we examine participants’ experiences of learning about sex in later life using different sources, and the impact these had on their sexual expression, pleasure and well-being. Preferred sources of information include the Internet, the media, health care providers, books and workshops or discussion groups. A substantial number of participants did not actively seek information on sex. For those who had, these educational endeavours could profoundly shape their sexual practices. As such, learning about sex should be viewed as a lifelong endeavour. Our findings carry important implications for the development and delivery of sexuality education for older adults. [ABSTRACT FROM PUBLISHER]

Objectives:Subjective memory complaints (SMC) are common in older people and previous research has shown an association with mood problems, such as depression and anxiety. SMC form part of the criteria for many definitions of mild cognitive impairment (MCI), but there is controversy over whether they should be included as they may be related more strongly to mood than to objective cognitive impairment. This study aims to clarify the relationship between mood and SMC in people with MCI. Method:This paper reports an analysis of data from the Medical Research Council Cognitive Function and Ageing study. Structured interviews were conducted with community-dwelling older people to assess a range of aspects of cognitive functioning and mood. Data from two time points approximately 24 months apart were used in this analysis. At baseline, participants without dementia or severe cognitive impairment were categorised into three groups according to cognitive status. Mood was investigated by assessing symptoms of anxiety and depression which were defined using a diagnostic algorithm. Associations were tested using logistic regression and chi square analyses. Results:A clear association was shown between SMC and mood, both cross-sectionally and over time. The relationship between our two competing definitions of MCI suggested that mood problems were more strongly related to the presence of SMC than objective cognitive impairment. Conclusion:SMC may be a function of anxiety and depression rather than being related to objective cognitive function. This questions whether SMC should be included in definitions of MCI. [ABSTRACT FROM AUTHOR]

Evaluate accessibility, effectiveness, acceptability and efficiency of a student- assisted teleaudiology model of care in a regional hospital in Queensland, Australia. Prospective mixed method service evaluation study. Demographic, service and satisfaction data were collected from 233 patients (children aged ≥5 and adults) who received teleaudiology assessment. Satisfaction data was collected from 27 hospital clinic staff (medical, nursing and clinic assistants) and 28 university audiology clinical educator participants. Experience and satisfaction data were collected from 16 teleaudiology clinic university students. Quantitative data was analysed using SPSS software. Qualitative data were analysed using inductive content analysis. Following introduction of the teleaudiology service in 2017 and evaluation during the first 6 months, 95% of patients were able to access audiology assessments on the same day as their Ear, Nose and Throat appointments. New referrals to the service were seen within a month. The audiology assessment battery was completed 95% of the time within an average of 33 minutes by the end of the study period. Patients, hospital and university staff and students reported high satisfaction with their experiences of teleaudiology, including its convenience and efficiency. A student-assisted teleaudiology model of care can deliver accessible, effective, and efficient services with high levels of satisfaction by participants. [ABSTRACT FROM AUTHOR]

Problem: High-quality communication improves patient satisfaction and clinical outcomes, yet formal communication training in residency is often minimal. Many studies on empathic communication show mixed results and are often hindered and skewed by brief study lengths, insufficiently and ambiguously defined concepts, and limited methods for objective measurements. Intervention: The FAN Curriculum is a unique communication curriculum, based on the conceptual frameworks of patient-centered communication, reflective practice, mindfulness, and attunement using the Facilitating Attuned Interactions (FAN) model. The first part of the FAN Curriculum was delivered as a 3-hour interactive workshop involving didactics, group discussion, and role play with pediatric residents. Residents then completed weekly self-reflections, a follow-up one-hour training to reinforce concepts, and five monthly mentor sessions, all emphasizing reflective practice. Context: This longitudinal, mixed-methods study examined the effects of the FAN Curriculum on residents' empathy levels and ability to communicate with parents in the clinical setting. The study was conducted at two urban, academic, medium-sized pediatric residency programs in Chicago between October 2016 and November 2017. First- and second-year pediatric residents whose continuity clinic site was located at their home institution participated. Residents received training in the use of the FAN Communication Tool using a delayed-start crossover study design. Impact: At five time points, residents and parents completed instruments validated for measuring physician empathy and mindfulness. Post-study interviews were conducted for one institution's residents and mentors and were evaluated using open and focused coding. Participants (n = 23) demonstrated a high degree of use of the FAN Communication Tool six months post-training and a significant rise in self-reported comfort with four of five FAN core processes. One parent-completed survey (Consultation and Relational Empathy, CARE) showed a statistically significant rise of 3.26% in resident relational empathy and collaboration after training (p = 0.02). In qualitative analysis of interviews, residents and mentors found the FAN Communication Tool beneficial, making clinic visits more efficient and collaborative. Both groups noted improvement in the residents' relationship-building skills; residents were able to use enhanced communication skills to better approach challenging encounters and work through parent concerns. Lessons Learned: Family-centered communication training can improve physician-perceived empathy and mindfulness. Effective communication for pediatric residents incorporates an empathic approach, and introduction to this formal curriculum supported their growth in connecting and engaging with children and parents. The FAN Curriculum may provide a useful method for improving resident communication skills with a positive impact on pediatricians' collaboration with patients and families. [ABSTRACT FROM AUTHOR]

Cancer patients may seek a second opinion (SO) driven by reduced trust in their own providers. Their trust may be diminished or reinforced through the SO. This study aimed to assess (1) what proportion of patients seek SOs motivated by lacking trust and how trust changes over time; (2) whether patients' trust differs by the outcome of the SO (i.e. similar/different opinion); and (3) how communication during the SO affects trust. A longitudinal mixed methods study including self-report assessments before (T0), immediately following (T1), and two months after the SO (T2). SO consultations (N = 62) were audio recorded, and patient-oncologist communication about the referring oncologist was coded. Patient-reported motives and their trust in referring oncologists. Reduced trust motivated 21% of patients to seek a SO. Most patients criticised their referring oncologist. Consulting oncologists generally defended their colleagues, but such affirmation was unrelated to patients' subsequent trust. Over time, trust did not change substantially. Yet, it was restored in patients motivated by impaired trust, and remained low for patients receiving a different medical outcome. Patients need support to more constructively discuss their treatment relationship. Oncologists need support in providing independent SOs without harming trust relations. [ABSTRACT FROM AUTHOR]

Continuous monitoring of glucose (CGM) via subcutaneous patch is an accurate self-monitoring tool of blood glucose, but also introduces a range of additional benefits such as real-time feedback. While its value among pregnant women with gestational diabetes mellitus (GDM) is established in high-income countries, little is known about the feasibility and acceptability among pregnant women without GDM in low-resource settings in low- and middle-income countries. This study aims to assess the feasibility and acceptability of CGM with pregnant mothers in South Africa and to explore the value of a collected data set for GDM prevention. Ten women between 12 and 18 weeks pregnant were recruited from the antenatal clinic at Chris Hani Baragwanath Academic Hospital into a prospective mixed-methods pilot study. Demographic and anthropometric data, HbA1c and a lipid panel were collected. Women then wore two consecutive Freestyle Libre 2 patches for a total of 28 days. In-depth interviews were undertaken with all 10 women on study exit to explore themes of acceptability and the use of technology during pregnancy. Thematic analysis was performed on the qualitative data while exploratory data-analysis techniques were applied to the CGM data. Pregnant women (n = 10) had a mean (SD) age of 29.81 years (4.39), with most being unemployed (8), unmarried (8) and without a tertiary degree (7). Analysis suggests that fear of use was greater than the actual discomfort experienced during use of the CGM patch. The main barrier to use was the patch falling off and women being uncomfortable to reapply it. This was borne out by all 10 women wearing the first patch for at least 12 of the 14 days, but only 4 managing the same with patch two – primarily applied by themselves at home. Women expressed support for the use of technology during pregnancy, especially as it related to feeling that their pregnancy was being monitored and that they were being supported. In this pilot study, women overwhelmingly found the wearing of a CGM patch during pregnancy to be acceptable. Feasibility was reasonable with most data being successfully retrieved from the devices over a two-week period. Longer use was found to have additional challenges. The use of CGM patches appear to be a possible candidate for inclusion in GDM prevention or behavioural interventions during pregnancy in South Africa. [ABSTRACT FROM AUTHOR]

To ensure high qualification standards in medical institutions, a questionnaire has been developed to evaluate the postgraduate medical education in Switzerland. This article describes the development and longitudinal analysis of a questionnaire using eight scales to assess the quality of postgraduate medical education. The questionnaire has been administered to all residents every year since 2003. In 2020, 8,745 residents returned the questionnaire, resulting in a response rate of 70%. In addition, a survey is conducted annually among the directors of medical institutions. We present results of the directors' survey and the resident evaluation from 2020, as well as longitudinal data over 16 years. The mean values of the eight scales remained stable or increased slightly over the years. The decision-making culture scale is generally rated best by the residents, while the evidence-based medicine scale is rated as the least good. The most important drivers of residents' satisfaction with a training site are the work environment and leadership culture scales. The directors perceive the evaluation to be fair and useful. The questionnaire represents a reliable and useful tool for the quality control in postgraduate medical training. It provides yearly feedback to the directors regarding how the residents perceive their training giving insights for improvments. [ABSTRACT FROM AUTHOR]

Hearing loss can seriously impact children's daily life. This study aims to translate and validate the French versions of the hearing performance questionnaires, SSQ-Parent (for 5–18 years old children), and SSQ-Children (for 11–18 years old children). This controlled prospective trial was conducted between April and October 2020. The forward-backward translation method was used, and a test-retest procedure was carried out on a case and a control population. Cases had at least 30 dBHL hearing loss. 54 cases (mean age 10.4 years old) and 32 controls (mean age 12.5 years old) answered the SSQ-Parent. 35 cases (mean age 13.1 years old) and 35 controls (mean age 14.3 years old) answered the SSQ-Children. Spearman's correlation coefficients between global scores of the test and re-test were 0.91 (p < 0.001) for SSQ-Parent, and 0.89 (p < 0.001) for SSQ-Children. Both tests were discriminant (respectively, global score 57.8 vs 92 p < 0.001, 61.2 vs 92.6 p < 0.001), and internally consistent (Cronbach's alpha 0.94 and 0.97). Items-global score correlation was satisfactory. ROC curves showed high area under curve for the SSQ-Children (0.990), and SSQ-Parent (0.988). The SSQ-Parent and SSQ-Children revealed excellent statistical properties, and can be used for the evaluation of hearing performance of children. [ABSTRACT FROM AUTHOR]

Digital media initiated a paradigm shift of the doctor-patient relationship in which prospective patients "shop" for physicians as they do other goods and services: using search engines' results, aggregated review websites, and star ratings as cues. These are processed centrally or peripherally in accordance with the Elaboration Likelihood Model (ELM). Electronic word of mouth (EWOM) in conjunction with a pediatrician's digital brand management strategy impacts practice revenue through patient recruitment and retention. This exploratory study found that a pediatrician's placement on a review website and overall digital brand image leads to increased or decreased trust in expertise, competence, and likability. [ABSTRACT FROM AUTHOR]

The design of urban environments often influences neighborhood physical activity and is crucial to supporting the health and mobility of aging urban populations. However, changes to urban infrastructure take time to implement and are rarely evaluated over long periods. In this study, we examined the long-term outcomes of rapid urban change and rebuilding following a sequence of devastating earthquakes in Christchurch, New Zealand. The study drew on a novel mixed-methods approach, including on-site environmental audits, desktop spatial analyses, and subjective auditor observations, to track support for active aging over a decade of post-disaster rebuilding in 10 aging neighborhoods. [ABSTRACT FROM AUTHOR]

People with psychotic disorders have a significantly increased risk of physical diseases and excessive mortality rates. The aim of the study was to investigate relationships between changes in physical activity, levels of salutogenic health, and glycated hemoglobin among people with psychotic disorders after participation in an individualized lifestyle intervention. The results from analyses showed that self-reported increased physical activity was positively associated with the level of salutogenic health and negatively associated with the level of HbA1c on an individual level. The results indicate that coordinated, individualized, holistic and health-promoting nursing care is crucial to enabling enhanced lifestyle within this vulnerable target group. [ABSTRACT FROM AUTHOR]

To assess the benefits of the Ida Institute's Why improve my hearing? Telecare Tool used before the initial hearing assessment appointment. A prospective, single-blind randomised clinical trial with two arms: (i) Why improve my hearing? Telecare Tool intervention, and (ii) standard care control. Adults with hearing loss were recruited from two Audiology Services within the United Kingdom's publicly-funded National Health Service. Of 461 individuals assessed for eligibility, 57 were eligible to participate. Measure of Audiologic Rehabilitation Self-efficacy for Hearing Aids (primary outcome) scores did not differ between groups from baseline to post-assessment (Mean change [Δ]= −2.28; 95% confidence interval [CI]= −6.70, 2.15, p=.307) and 10-weeks follow-up (Mean Δ= −2.69; 95% CI= −9.52, 4.15, p =.434). However, Short Form Patient Activation Measure scores significantly improved in the intervention group compared to the control group from baseline to post-assessment (Mean Δ= −6.06, 95% CI= −11.31, −0.82, p =.024, ES=.61) and 10-weeks follow-up (Mean Δ= −9.87, 95% CI= −15.34, −4.40, p =.001, ES= −.97). This study demonstrates that while a patient-centred telecare intervention completed before management decisions may not improve an individual's self-efficacy to manage their hearing loss, it can lead to improvements in readiness. [ABSTRACT FROM AUTHOR]

Foster care placements for infants can be consequential. Research suggests that infants' path through and beyond the care system is different than the experience for children of other age groups. Studying infants is important because of their unique needs for developmentally-sensitive care; because of the underpinnings of attachment theory; and because the long-term impacts of quality care can be pronounced. Prior research examining infants in care has typically focused on their first episode and the outcomes of that episode. This study offers a longitudinal examination of a population-based cohort of infants (n = 5789) born in 2001 who entered care during the first year of life and who were followed through multiple care episodes until age 18. Findings suggest that using single, first episode data overstates the proportion of children who successfully reunify and understates the proportion of children who are adopted, return to care, or live with guardians. This research also suggests that the experience of infants who enter care as neonates is different from that of infants who enter care after the first four weeks of life. The long-term outcome for neonates is much more likely to be adoption. Long-term foster care for all infants is an especially unlikely outcome. [ABSTRACT FROM AUTHOR]

Patient satisfaction (PS) serves an important role in physiotherapy. Being able to measure PS is important for improving service delivery. The MedRisk has not been validated in the Singapore population. To validate the use of the MedRisk instrument for measuring PS in a local outpatient clinic, and to explore if PS was affected by continuity of care or individual items in the MedRisk. Three hundred and one participants who underwent physiotherapy in the clinic completed the MedRisk instrument. Factor analysis was adopted to group the individual items in the MedRisk questionnaire into components and multiple regression was conducted to explore items predicting the two global ratings. Factors affecting PS can be grouped into two distinct components, therapist-related attributes and organizational factors (47.7% and 11.8% of variance explained, respectively). All questionnaire items were retained. Giving patients a home exercise program (overall satisfaction [OS] r = 0.691 and willingness to return to the same clinic [WR] r = 0.578) and listening to the patients' concerns (OS r = 0.685, WR r = 0.569) correlated with both overall satisfaction and willingness to return. Continuity of care was not correlated to overall satisfaction (r = 0.001, p =.988) or willingness to return for treatment (r = 0.069, p =.234). The MedRisk instrument is applicable to the local population. Patient satisfaction with outpatient physiotherapy services was predominantly influenced by therapist-related attributes. [ABSTRACT FROM AUTHOR]

Consumer engagement is an important element for developing and maintaining value-based healthcare standards. Occupation-based practice in the context of a group has been adopted by inpatient rehabilitation clinicians, but little research has explored if these groups are valuable and useful to patients. To explore the experiences of patients participating in an occupation-based group intervention for instrumental activities of daily living to understand its value and usefulness in an inpatient rehabilitation setting. Interpretive description guided the development of the study. Semi-structured interviews were completed with 15 participants of an occupation-based group, the LifeSkills group. Comparative analysis was used to analyse the data and develop themes. Five themes were reported by participants: choice and control, confidence through doing, a real-world connection, the power of the therapeutic relationship and the impact of the shared experience. In line with current rehabilitation literature, patient experiences around client-centredness, occupational engagement in a 'real-world' environment, and valued relationships can be facilitated through an occupation-based group. This study supports the implementation of valued-based healthcare in understanding patient perceptions of occupation-based interventions into rehabilitation; ensuring that the right intervention is being used at the right time for the right patient. [ABSTRACT FROM AUTHOR]

To examine the validity of the Motor Functional Development Scale for Young Children (DF-mot) to predict motor developmental delays in preterm infants. This retrospective cohort study includes 67 preterm infants who were assessed at 3–5 months by the DF-mot and the Alberta Infant Motor Scale (AIMS); and at 22–25 months by the Bayley Scales of Infant-Toddler Development (Bayley-III). The properties of the DF-mot and the AIMS were examined based on their ability to predict motor delays on the Bayley-III. The DF-mot gross motor subscale −2 SD and the AIMS 10th centile showed best balance between sensitivity and specificity (respectively Se = 57.1%, Sp = 71.7% and Se = 50%, Sp = 73.5%). Overall, the DF-mot fine motor subscale fails to predict motor delays. The DF-mot shows a lack of sensitivity and of positive predictive value to accurately predict motor outcome at 2 years in preterm infants. CA, Corrected age; AIMS, Alberta Infant Motor Scale; DF-mot/PML, Motor Functional Development Scale for Young Children postural motor locomotor; DF-mot/EHGC, Motor Functional Development Scale for Young Children eye-hand grip coordination; Bayley-III/GM, Gross motor subscale of the Bayley Scales of Infant-Toddler Development Third Edition; Bayley-III/FM, Fine motor subscale of the Bayley Scales of Infant-Toddler Development Third Edition. [ABSTRACT FROM AUTHOR]

There is a general lack of information about how insufficient physical activity impacts blood pressure and physical fitness in Latin-American ethnic minorities. To describe the interactions between insufficient physical activity, blood pressure, and physical fitness outcomes in Latin-American schoolchildren of different ethnicity. This was a prospective, international, multi-center, and cross-sectional study of three Latin-American countries involving schoolchildren from seven ethnic groups of Colombia (Tikuna, Nasa, Embera), Brazil (African, Mulato), and Chile (Mapuche), and also European schoolchildren from Brazil and Chile. Data were categorized based on whether participants were physically active (PA) or insufficient physical activity (iPA) using the WHO physical activity recommendations. The main outcomes were systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure, and scores for physical and cardiorespiratory fitness (CRF, by estimated V ˙ O2max), handgrip muscle strength (HGS), and standing long jump (SLJ). Secondary outcomes were anthropometric measures (weight, height, body mass index [BMI], waist circumference [WC], waist-to-height ratio), and body fat percentage (BF%, limited data by country). Primary and secondary outcomes were ranked. For both PA and iPA categories, significant interactions between ethnic groups were found concerning SBP/DBP (F(37.7), ES 0.08; F(51.5), ES 0.08), V ˙ O2max (F(37.7), ES 0.08; F(51.5), ES 0.08), HGS (F(33.8), ES 0.07; F(5.03), ES 0.04), and SLJ (F(64.3), ES 0.14; F(64.3), 0.14). In the iPA category, Mapuche schoolchildren were classified 1st (119.5; 81.5) with highest SBP/DBP and highest MAP (94.6 mmHg); Embera schoolchildren were classified 1st with lowest V ˙ O2max (33.7 mL/kg/min); and European schoolchildren were classified 1st (19.9 kg) with lowest HGS and SLJ (121.4 m) physical fitness. Under conditions of insufficient physical activity conditions, Mapuche schoolchildren had the most detrimental blood pressure, whereas Embera, Tikuna, and European schoolchildren had the lowest levels of physical fitness. These results serve to highlight the need for the early and appropriate promotion of physical activity based on ethnic differences in Latin-American schools. [ABSTRACT FROM AUTHOR]

Men are less vulnerable to HIV acquisition than women, but have poorer HIV-related health outcomes. They access HIV services less, and are more likely to die on antiretroviral therapy. The adolescent epidemic presents further challenges, and AIDS-related illness is the leading cause of death among adolescents in sub-Saharan Africa. We explored the health practices of adolescent boys and young men (aged 13–22) living with perinatally-acquired HIV and the processes through which these practices are formed and sustained. We engaged health-focused life history narratives (n = 35), semi-structured interviews (n = 32) and analysis of health facility files (n = 41), alongside semi-structured interviews with traditional and biomedical health practitioners (n = 14) in the Eastern Cape, South Africa. Participants did not access traditional products and services for HIV, a finding that deviates from much of the literature. Findings suggest that health practices are mediated not only by gender and culture, but also childhood experiences of growing up deeply embedded in the biomedical health system. [ABSTRACT FROM AUTHOR]

Identifying existing care pathways is the first step for understanding how services can be improved to enable early diagnosis and effective follow-up care for non-communicable diseases (NCDs); however, evidence on how care pathways can and should be identified in low- and middle-income countries (LMICs) is lacking. To describe generalisability and lessons learned from recruitment and data collection for the quantitative component of a mixed methods study designed to determine the care pathway for atrial fibrillation (AF) in Brazil, China and Sri Lanka. Adults (≥18 years) that spoke the local language and with an AF diagnosis were eligible. We excluded anyone with a hearing or cognitive impairment or ineligible address. Eligible participants were identified using electronic records in Brazil and China; in Sri Lanka, researchers attended the outpatient clinics to identify eligible participants. Data were collected using two quantitative questionnaires administered at least 2-months apart. A minimum sample size of 238 was required for each country. The required sample size was met in Brazil (n = 267) and China (n = 298), but a large proportion of AF patients could not be contacted (47% and 27%, respectively) or refused to participate (36% and 38%, respectively). In Sri Lanka, recruitment was challenging, resulting in a reduced sample (n = 151). Mean age of participants from Brazil, China and Sri Lanka was 69 (SD = 11.3), 65 (SD = 12.8) and 58 (SD = 11.7), respectively. Females accounted for 49% of the Brazil sample, 62% in China and 70% in Sri Lanka. Generalisability was an issue in Brazil and China, as was selection bias. Recruitment bias was highlighted in Sri Lanka. Additional or alternative recruitment methods may be required to ensure generalisability and reduce bias in future studies aimed at identifying NCD care pathways in LMICs. [ABSTRACT FROM AUTHOR]

Post-stroke emotionalism (PSE) is a common consequence of stroke characterised by episodes of crying or laughing. There is only one published qualitative study exploring the experience of emotionalism to date. This study aimed to explore individual's experience of PSE and develop a theoretical client-derived framework to shape future psychological interventions. A primary analysis of the qualitative pseudonymised pre-collected semi-structured interview data of the TEARS study was completed. Participants were recruited from nine acute stroke units in Scotland with participants commencing the study at baseline (two-weeks) and they either continued or dropped out. Interviews were completed at two-weeks, six-months and 12-months post-stroke. Data was analysed from 52 participants at two-weeks, 25 participants at six-months and 23 participants at 12-months. Three major themes were identified: "In the moment," describing characteristics and triggers, "Ways of coping," highlighted a variation of coping strategies including avoidance or acceptance and "Impact," outlining the longer-term effects of PSE such as individuals' beliefs. The results indicate specific psychological aspects of PSE which could be viable targets in psychological interventions such as increasing adaptive coping strategies and challenging negatively held beliefs. Emotionalism can cause emotional consequences such as distress, embarrassment and fear. Helping individuals to develop insight into triggers for emotionalism could be beneficial to help gain understanding and awareness whereby post-stroke emotionalism (PSE) has the potential to be anticipated and adapted to psychologically. Potential adaptive responses such as acceptance or control and better anticipation of episodes of emotionalism could help to reduce the emotional consequences of PSE. [ABSTRACT FROM AUTHOR]

Existing research on the effectiveness of career courses often lacks evidence on the comparative effects of different pedagogical formats. This study compared the effects of a flipped classroom approach to a traditional lecture-based approach for delivering a career course among Chinese undergraduate students. A longitudinal quasi-experimental field design was used to assess changes in the career outcomes between the flipped and non-flipped groups over three time points (pre-, post-, and two-month follow-up). Mixed-factorial ANOVAs showed the overall effects were stronger immediately post-course and at the two-month follow-up for the flipped approach, although both course designs decreased lack of career information and increased environmental exploration. The study suggests that the flipped classroom design has the potential to outperform traditional teaching approaches. [ABSTRACT FROM AUTHOR]

Measuring the physical activity of adults with progressive muscle diseases is important to inform clinical practice, for activity recommendations and for outcomes meaningful to participants in clinical trials. Despite its wide use, the measurement properties of the International Physical Activity Questionnaire (IPAQ) have not been established in a muscle disease population. The sample of 103 adults with progressive muscle diseases included independently mobile participants and wheelchair users. Their home-based activity measured by the IPAQ was compared to simultaneous weeks of accelerometer activity data collected remotely in a longitudinal, measure evaluation study. Validity, reliability, and responsiveness were evaluated for the IPAQ alone, and for the IPAQ used in conjunction with a smart activity monitor. The IPAQ did not demonstrate satisfactory criterion validity, reliability or responsiveness and it systematically overestimated moderate and vigorous physical activity time by 161 minutes per week. Measurement properties of the IPAQ were improved when it was used in combination with a smart activity monitor. The IPAQ did not have satisfactory measurement properties compared to accelerometry in adults with progressive muscle disease. Combining self-report and objective activity measures might improve the accuracy of physical activity assessment in this and other comparable populations. Physical activity is a meaningful health outcome for adults with progressive muscle diseases, for whom precise activity quantification is important because of the potential for activity-related disease exacerbation. The International Physical Activity Questionnaire (IPAQ) had unsatisfactory measurement properties compared to accelerometry; however, these were improved by adjunctive smart activity monitoring. Objective or combined physical activity measurement is recommended over self-report alone for clinical assessment of physical activity as part of rehabilitation and self-management programmes. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the effectiveness of an Acceptance and Commitment Therapy-based group resilience intervention (The REsilience and Activities for every DaY program, READY) delivered to people with MS (PwMS) via frontline Italian services. This is a single-arm longitudinal study (with a nested qualitative study). READY is composed of seven weekly in-person sessions (2.5-h each) plus a booster session five weeks later. Data were collected immediately before the program, after the booster session, and at 3-months follow-up. Thirty-three READY groups (237 participants) were run by thirty-three trained psychologists. Participants improved in resilience (primary outcome), anxiety, depression, stress, health-related quality of life (HRQoL), and psychological flexibility and associated processes (acceptance, defusion, and values). Improvements on most outcomes occurred post-intervention and were maintained at a 3-month follow-up. No demographic or illness variables predicted these improvements. Psychological flexibility mediated improvements in resilience, anxiety, depression, stress, and HRQoL. Qualitative data confirmed READY feasibility and the positive psychological impacts on participants. Study findings support READY effectiveness with PwMS, its broad applicability in this population, and its delivery through frontline services. READY for MS is a highly structured, brief manualized group intervention. It is effective in improving participants' psychological functioning (resilience, anxiety, depression, stress, HRQoL, psychological flexibility, and related ACT processes). Psychological flexibility mediated the improvements in resilience, anxiety, depression, stress, HRQoL. READY can be effectively delivered through frontline services for PwMS without limitation in terms of participants' demographic and illness characteristics. [ABSTRACT FROM AUTHOR]

To describe the nutritional and functional changes that occurred in older patients with a femur fracture following a dietary intervention and oral nutritional support implemented at an orthogeriatric unit in Aragon, Spain. Open-label, prospective study. Patients were consecutively recruited and arranged into three groups based on their CONtrolling NUTritional (CONUT®) score and nutritional needs. Nutritional status was assessed while in hospital, and at 45-, 100- and 180-days post-hospital discharge. One hundred and sixty-nine patients [mean age: 86 years (SD ± 5.48)] were recruited (July 2017 to January 2020). At admission, 53.3% were at risk of malnutrition; 26.6% were malnourished; 20.1% were well-nourished. Variable proportions of malnourished patients at admission were well-nourished 45-, 100-, and 180-days post-discharge. CONUT® and Barthel index correlations showed that as nutritional status enhanced, patients gained functionality. Dietary interventions and nutritional support may help restoring the nutritional and functional status of older patients with a femur fracture. [ABSTRACT FROM AUTHOR]

To evaluate health literacy learning modules designed specifically for physiotherapists in private practice. Mixed-method design was used, evaluating pre-post physiotherapist health literacy knowledge and competencies using questionnaires and semi-structured interviews. One rural and one metropolitan private physiotherapy practice were recruited. Clients, physiotherapists, and other clinic staff. The OPHELIA (Optimizing Health Literacy and Access) process was applied to identify the health literacy needs of clients; co-design interventions; and implement and evaluate the interventions. The health literacy learning modules were co-designed with the physiotherapists and included one 3-h face-to-face workshop, followed by two 1-h videoconference workshops. Health literacy knowledge (rated 1–5 for 10 items, max score 50) and skills (rated 1–5 for 5 items, max score 25) were assessed before and after the workshops. Data were analyzed by paired t-test. Interviews were recorded, transcribed, and thematically analyzed. Health literacy knowledge of 19 health professionals improved after the workshop by 63% (pre 26.0 (7.5), post 41.0 (2.7), p <.001). Health literacy skills improved by 65% (pre 4.2 (3.3), post 21.8 (2.3), p <.001). We identified three themes from interview data: 1) 'the multi-faceted nature of health literacy requires multiple strategies'; 2) 'changing practice to promote understanding'; and 3) 'reflection on roles of multidisciplinary private practice.' Improvements in health literacy knowledge and skills are possible through post-graduate professional development. Workshops changed physiotherapists' understanding of their role in promoting health literacy. [ABSTRACT FROM AUTHOR]

The research presented is a qualitative, descriptive and cross-sectional study, with a multi-methodological structure. The sample is composed by 25 prospective adoptive parents couples (n = 50 subjects) who show an initial interest in adoption. The research results indicate that the representation by the prospective adoptive parents is a crucial one, in many cases characterized by a significant negativity or ambivalence as well as the child's and his pre-adoptive history representation. So, it is important to deepen not only the topic of family of origin, but also its associated topics like child history and child history representation during the assessment and training of prospective adoptive couples. [ABSTRACT FROM AUTHOR]

We aimed to find the association of inflammation and respiratory failure with delirium in COVID-19 patients. We compare the inflammatory and arterial blood gas markers between patients with COVID-19 delirium and delirium in other medical disorders. This cross-sectional study used the CHART-DEL, a validated research tool, to screen patients for delirium retrospectively from clinical notes. Inflammatory markers C-reactive protein (CRP) and white cell count (WBC), and the partial pressures of oxygen (PO2) and carbon dioxide (PCO2) were compared between patients with COVID-19 delirium and delirium in other medical disorders. In bivariate analysis, CRP (mg/L) was significantly higher in the COVID-19 group, (81.7 ± 80.0 vs. 58.8 ± 87.7, p = 0.04), and WBC (109/L) was significantly lower (7.44 ± 3.42 vs. 9.71 ± 5.45, p = 0.04). The geometric mean of CRP in the COVID-19 group was 140% higher in multiple linear regression (95% CI = 7–439%, p = 0.03) with age and sex as covariates. There were no significant differences in pO2 or pCO2 across groups. The association between higher CRP and COVID-19 in patients with delirium may suggest an inflammatory basis for delirium in COVID-19. Our findings may assist clinicians in establishing whether delirium is due to COVID-19, which may improve management and outcomes of infected patients. [ABSTRACT FROM AUTHOR]

Intolerance of uncertainty, generally measured through the Intolerance of Uncertainty Scale - Short form (IUS-12), is a significant trans-diagnostic characteristic determining anxiety disorders and depression. Nevertheless, there are fewer studies on the factor structure of intolerance of uncertainty in non-western countries. In the present study, using confirmatory factor analysis, we studied the factor structure, measurement invariance, and psychometrics of the IUS-12 (Hindi version) on a sample of 862 college students (age: M = 21.42, SD = 3.1) in India. Results show that whereas the different models (i.e. the single-factor, the correlated two-factor, the truncated bi-factor, and the full bi-factor models) were a good fit with the data, the full bi-factor model was the best fitting model. The general factor was a stable and reliable construct that explained most of the variance and, thereby, showed the unidimensionality of the scale. In addition, there was strong measurement invariance in the IUS-12 across gender. Thus, the present study supports the reliability and validity of the IUS-12 and indicates cross-cultural validity of the intolerance of uncertainty. We have also discussed the implications of higher intolerance of uncertainty in India. [ABSTRACT FROM AUTHOR]

Introduction: One of the six guiding principles of the EMS Agenda 2050 is to foster a socially equitable care delivery system. A specific recommendation within this principle is that "local EMS leadership, educators and clinicians [should] reflect the diversity of their communities." Research has shown that women comprise a minority of emergency medicine services (EMS) field clinicians. In academic settings, women are represented at lower rates among experienced EMS faculty than within Emergency Medicine clinicians or faculty at large. The reasons for these differences are also unknown. Little data exist describing the number or experience of female physicians and professionals in EMS. Purpose: Our objective was to describe the composition and experiences of EMS physicians, researchers and professionals who participate in the Women in EMS group of the National Association of EMS Physicians (NAEMSP). Methods: We performed a cross-sectional, mixed-methods descriptive study of women belonging to the Women in EMS Committee of NAEMSP. A survey was sent to the 143 members of this group using a list-serve, and the data was collected in Redcap. Results: Seventy-four people completed the survey. Respondents were 96% female, 82% Caucasian, 11% underrepresented minorities (URM), and 7% LGBTQI. Of the 88% that are physicians, 78% are board certified in Emergency Medicine, compared to 55% in EMS. Forty-eight percent reported they received some form of mentorship. Among these respondents, a minority reported female mentorship, which was usually from a remote rather than local mentor (41% vs. 15%). Eighty-three percent of respondents had experienced some form of discrimination or harassment in their career, but only 68% reported their workplace culture discourages such behavior. Thirty-three percent of respondents report receiving unequal recognition because of gender. Thematic evaluation of the qualitative responses showed that respondents felt there were fewer barriers to mentorship and professional advancement opportunities in local work versus national engagement. Conclusions: In a survey evaluating representation of female professionals in EMS, participants reported on their career representations, and experiences of gender-based inequity within their EMS career settings. Several opportunities exist to improve diversity, equity, and inclusion for women in EMS based on our findings. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to test the diagnostic validity of the Primary Care PTSD screen (PC-PTSD) in a generalizable college sample and to examine potential differences in its predictive efficacy according to sex and racial/ethnic identity. An exploratory aim was to determine whether PC-PTSD symptom items differentially predicted PTSD diagnostic status. Participants: Data from 475 undergraduates were analyzed. Methods: Logistic regressions were conducted to examine the relationship between different PC-PTSD endorsement thresholds and probable PTSD among various subsamples. Follow-up tests of diagnostic accuracy were performed. Results: Results of this study indicated that the PC-PTSD identified PTSD among college students with poor accuracy. Furthermore, the PC-PTSD did not demonstrate equal predictive validity across neither sex nor racial/ethnic identity. Endorsement of reexperiencing symptoms appeared to be the strongest predictor of PTSD. Conclusions: Results highlight the clear need for a validated PTSD screener effective for a diverse college population. [ABSTRACT FROM AUTHOR]

to assess the effect of wearing a compressive short-sleeve jacket on shoulder stability and rotator muscles in adult patients with a hypermobile subtype of Ehlers–Danlos syndrome. a quasi-experimental study with "Pre/Post" design (4 weeks with versus 4 weeks without), open, conducted on a national cohort. Shoulder rotators were assessed with an isokinetic device at 180°/s and 90°/s; frequency of shoulder stability defects, pain (Visual Analogical Scale), and satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology) were reported. 36 patients (35 women), mean age 37.9 years, wore jackets for a meanly 7.8 h/day. >70% were satisfied with the effect on arthralgia, instability, or function. QUEST results were high (m = 4.1, SD = 0.7). After jacket wear, the power of external rotators at 180°/s was significantly increased (+1.29 W, CI95%: 0.31; 2.28; p = 0.0318). At 90°/s, no significant difference was found, either on power or strength. The on-off effect highlights a significant difference in external and internal rotators power, whatever the speed. The occurrence of subluxation (p = 0.0140) and dislocations (p = 0.0163) decreased. Pain decreased from 3.5/10 to 2.5/10, without significance (p = 0.0964). compressive CICATREX SED® jackets are well supported by patients, impact the power of external rotators at high speed (180°/s), and improve joint stability. Compressive garments made to measure are beneficial to patients with hypermobile Ehlers–Danlos syndrome. Compressive CICATREX SED® jackets clearly improve shoulder stability and help to promote muscle power in shoulder external rotators during high-speed movements. One month of jacket wearing seems to bring no lasting effect on shoulder-rotator power, so the jacket needs to be kept on for the benefits to be maintained. [ABSTRACT FROM AUTHOR]

Divorce is a life-changing event with financial implications for women. Although large-scale studies have examined the factors associated with financial coping after divorce, little attention has been paid to the lived experience of women over time. In this study, we used mixed methods to examine the financial well-being of divorced women over 20 years from 1996 to 2016. Using data from the Australian Longitudinal Study on Women's Health [ALSWH], we analyzed women's ratings of their ability to manage on available income, and their narrative comments about financial coping over eight waves, beginning in midlife (ages 46–51). The ratings improved over time, particularly as women reached peak career in their 50s or 60s or entered retirement. Despite this upward trajectory, financial strain persisted for ~40% of the cohort who faced poor health or diminishing job prospects. We conclude that, although financial hardship often eases over time, women's early ratings of financial coping predict levels of income security in older age. [ABSTRACT FROM AUTHOR]

Lower limb exoskeletons are a recent intervention promoted to improve gait disorders. Available research has focused on clinical outcomes; however, little is known about therapists' experiences using the device in practice. We explored the implementation of an exoskeleton at a tertiary rehabilitation center. In this longitudinal qualitative study we conducted semi-structured interviews with 10 therapists. One group of therapists was formally trained using the device, whereas the other group only had clinical exposure to the device. The interviews were transcribed, coded, and analyzed for themes. Three main themes emerged: (1) A steep learning curve described challenges in learning to use the exoskeleton. (2) One step at a time illustrated the complex process of incorporating the exoskeleton in daily work. (3) Not a magic bullet revealed the tensions using this emergent technology in practice. The exoskeleton represents one of the most complicated and labor-intensive interventions provided by therapists. Implementation requires substantial resources, raising questions regarding its efficacy and cost-effectiveness relative to other approaches. Until more evidence becomes available around the use and effectiveness of this rapidly evolving technology, therapists must contend with a high degree of uncertainty. Using a lower limb exoskeleton may reduce physical demands on therapists in high-intensity rehabilitation programs that involve repetitive, effortful movements. However, a number of potential barriers to implementing the exoskeleton into practice need to be taken into consideration, including calibration time, intensive training required to become qualified to administer the intervention, the cost of the device, and comfort and safety of the device affecting user acceptance and uptake. Therapists also need to manage patient expectations related to outcomes related to use of exoskeletons. [ABSTRACT FROM AUTHOR]