Search

Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has long recognized and championed increasing diversity within the surgical workplace. SAGES initiated the Fundamentals of Leadership Development (FLD) Curriculum to address these needs and to provide surgeon leaders with the necessary tools and skills to promote diversity, equity, and inclusion (DEI) in surgical practice. In 2019, the American College of Surgeons issued a request for anti-racism initiatives which lead to the partnering of the two societies. The primary goal of FLD was to create the first surgeon-focused leadership curriculum dedicated to DEI. The rationale/development of this curriculum and its evaluation/feedback methods are detailed in this White Paper. Methods: The FLD curriculum was developed by a multidisciplinary task force that included surgeons, education experts, and diversity consultants. The curriculum development followed the Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional design model and utilized a problem-based learning approach. Competencies were identified, and specific learning objectives and assessments were developed. The implementation of the curriculum was designed to be completed in short intervals (virtual and in-person). Post-course surveys used the Kirkpatrick's model to evaluate the curriculum and provide valuable feedback. Results: The curriculum consisted of interactive online modules, an online discussion forum, and small group interactive sessions focused in three key areas: (1) increasing pipeline of underrepresented individuals in surgical leadership, (2) healthcare equity, and (3) conflict negotiation. By focusing on positive action items and utilizing a problem-solving approach, the curriculum aimed to provide a framework for surgical leaders to make meaningful changes in their institutions and organizations. Conclusion: The FLD curriculum is a novel leadership curriculum that provided surgeon leaders with the knowledge and tools to improve diversity in three areas: pipeline improvement, healthcare equity, and conflict negotiation. Future directions include using pilot course feedback to enhance curricular effectiveness and delivery. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment associated with schizophrenia (CIAS) represents a distinct, persistent, and core group of schizophrenia symptoms. Cognitive symptoms have been shown to have an impact on quality of life. There are several published CIAS measures, but none based on direct patient self-report. It is important to capture the patient's perspective to supplement performancebased outcome measures of cognition to provide a complete picture of the patient's experience. This paper describes additional validation work on the Patient-Reported Experience of Cognitive Impairment in Schizophrenia (PRECIS) instrument. Methods: Data from two large, international, pharmaceutical clinical trials in medically and psychiatrically stable English-speaking patients with schizophrenia and 88 healthy controls were analyzed. An exploratory factor analysis (EFA) was conducted in one trial (n = 215), using the original 35-item PRECIS. The factor structure suggested by EFA was further evaluated using item response theory (IRT; Samejima's graded response model), and tested using confirmatory factor analysis (CFA). Both EFA and CFA results were tested in a second trial with similar inclusion/exclusion characteristics (n = 410). Additional statistical properties were evaluated in healthy controls. Results: EFA suggested that the best solution after item reduction suggested a factor structure of 6 factors based on 26 items (memory, communication, self-control, executive function, attention, sharpness of thought), supporting a total score, with an additional 2-item bother score (28 items in all). IRT analysis indicated the items were well-ordered within each domain. The CFA demonstrated excellent model fit, accounting for 69% of the variance. The statistical properties of the 28-item version of the PRECIS were confirmed in the second trial. Evidence for internal consistency and test-retest reliability was robust. Known-groups validity was supported by comparison of healthy controls with patients with schizophrenia. Correlations indicated moderate associations between PRECIS and functioning instruments like the Schizophrenia Cognition Rating Scale (SCoRS), but weak correlations with performance-based outcomes like MATRICS Consensus Cognitive Battery (MCCB). Discussion: Using two clinical trial samples, we identified a robust factor structure for the PRECIS and were able to replicate it in the second sample. Evaluation of the meaningful score difference (MSD) should be repeated in future studies, as these samples did not show enough change for it to be evaluated. Conclusions: This analysis provides strong evidence for the reliability and validity of the PRECIS, a 28-item, patient-reported instrument to assess cognitive impairment associated with schizophrenia. The correlation with functioning and the weak correlation with performance on cognitive tasks suggests that patient reports of cognitive impairment measure a unique aspect of patient experience. [ABSTRACT FROM AUTHOR]

IFamily members of individuals with colorectal cancer (CRC) may be at increased risk of developing the disease. However, the majority of CRC can be prevented through colonoscopy screening and family members may not be aware if they are recommended to pursue earlier screening because of their family history of CRC. As such, tools must be developed to effectively communicate potential changes to the recommended age for colonoscopy screening and other important CRC-related information to family members. We modified and adapted a successful intervention for families with melanoma to be appropriate for families with CRC to increase communication and screening in family members. The multistep process included the following: (1) developing a paper version of the intervention, (2) piloting the paper version among families with CRC, (3) developing the web-based version, and (4) testing the intervention for usability. Qualitative data was collected and analyzed for pilot testing. Usability testing utilized both qualitative and quantitative data. Patients with CRC liked the paper version and had multiple suggestions, including adding a better introduction, sections on genetics and family history, and clearer communication assistance. The web-based tool was well received and improved upon the linear book format with links, better section instructions, and more proactive communication tools for families. These processes produced materials that satisfied individuals from various families with assistance and support for communicating about CRC. Evaluating the effects of the tools in rigorous research projects is the next step. [ABSTRACT FROM AUTHOR]

Aim: In response to the SARS-CoV-2 emergency, the Competence Centre on digital health 'TrentinoSalute4.0' has developed TreC_Televisita, a tele visit solution that meets the needs of the Trentino healthcare system and maintains high-quality patient–doctor interactions while respecting social distancing. This paper highlights how 'TreC_Televisita' was integrated into the Trentino healthcare system and its potential to become a structural and durable solution for the future local healthcare service provisioning. Subject and methods: This paper presents the multifactorial context that TreC_Televisita has faced for its implementation and the strategies adopted for its structural integration into the healthcare system. The analysis focuses on the main issues faced for the integration of the tele visits (e.g. privacy, payments) and how the context of TrentinoSalute4.0 permitted responding quickly to its implementation during the pandemic. It also describes how TreC_Televisita fits into the healthcare continuum from the organisational and technological standpoint, the end-user perspective and the barriers that could hamper the solution scalability. Results: TreC_Televisita has demonstrated to be a technological solution that can be contextualised for different clinical domains beyond SARS-CoV-2. Moreover, it has shown its potential to scale up the solution beyond the COVID-19 emergency to the whole healthcare provisioning system in the long term. Conclusion: Being a positive experience in the first months of its implementation, the long-term goal is to transform TreC_Televisita into a structural pillar of the Trentino healthcare system, setting the bases for a sustainable, win–win situation for all the stakeholders involved in healthcare service provisioning. [ABSTRACT FROM AUTHOR]

Copyright of HeilberufeSCIENCE is the property of Springer Nature 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.)

The paper aims to identify and describe the European evidence on opportunities and barriers to access and utilization of palliative care among non- western migrants. A systematic review in accordance with PRISMA guidelines was conducted in June 2020, searching Medline, CINAHL, PsychINFO and EMBASE databases. PROSPERO# CRD42020193651. Studies included empirical research published between 2011 and 2020. Search words were, for example, ethnic groups and palliative care. Thematic analysis was used to analyze data. Twenty nine qualitative and six quantitative studies were included. Four main themes were identified: communication and language; knowledge and awareness; patient preferences, cultural and religious issues; and lack of resources at different levels of palliative care service provision. Migrants' access to palliative care is impeded at system, community and individual levels, yet, recommendations are mostly at the individual level. Closer attention is required to these different levels when designing future palliative interventions for migrants. [ABSTRACT FROM AUTHOR]

Since the outbreak of COVID-19, Asians in the US have experienced a spike of racism. The goal of this paper is to examine the association between racial discrimination amid COVID-19 pandemic and depressive symptoms among Asian subgroups and to test whether communications about the incident with various sources moderate this relationship. Data come from an online survey conducted among 245 Asian Americans. Multiple linear regression analyses were conducted. COVID-19 racial discrimination was positively associated with depressive symptoms, and this association did not vary between Chinese Americans and other Asian subgroups. Communications with a spouse/partner buffered the mental burden of racial discrimination. Those who shared their experience in online ethnic communities displayed stronger depressive symptoms than who did not. These results suggest the potential benefit of communication with a spouse/partner in mitigating the mental burden of discrimination and call for more online mental health support for Asians. [ABSTRACT FROM AUTHOR]

It is important to understand genetics within the context of health. This paper assesses (a) genetic knowledge among Mexican-born farmworker and non-farmworker adults; (b) their interpersonal and device sources of genetic knowledge; and (c) the association between their genetic knowledge and the sources of this genetic knowledge. Interviews were conducted with Mexican-born farmworkers (100) and non-farmworkers (100) in North Carolina. Participants answered 15 questions to assess genetic knowledge, and sources from which they had seen or heard about genes and genetics. Results show limited knowledge of genetics, with farmworkers and non-farmworkers providing a similar level of correct responses (6.6 versus 7.3), but with farmworkers providing more incorrect responses (4.0 versus 2.7). Important sources of genetic information for farmworkers were promotoras (47%), compared to teachers (49%) for non-farmworkers. This study demonstrates a need for increased dissemination of genetic information to Mexican-origin farmworkers and non-farmworkers. [ABSTRACT FROM AUTHOR]

Background To reduce the burden of low back pain (LBP) in the Netherlands, a multidisciplinary guideline for LBP has been implemented in Dutch primary care using a multifaceted implementation strategy targeted at health care professionals (HCPs) and patients. The current paper describes the process evaluation of the implementation among HCPs. Methods The strategy aimed to improve multidisciplinary collaboration and communication, and consisted of 7 components. This process evaluation was performed using the Linnan and Steckler framework. Data were collected using a mixed methods approach of quantitative and qualitative data. Results 128 HCPs participated in the implementation study, of which 96 participated in quantitative and 21 participated in qualitative evaluation. Overall dose delivered for this study was 89 %, and the participants were satisfied with the strategy, mostly with the multidisciplinary approach, which contributed to the mutual understanding of each other's disciplines and perspectives. While the training sessions did not yield any new information, the strategy created awareness of the guideline and its recommendations, contributing to positively changing attitudes and aiding in improving guideline adherent behaviour. However, many barriers to implementation still exist, including personal and practical factors, confidence, dependence and distrust issues among the HCPs, as well as policy factors (e.g. reimbursement systems). Conclusions The data presented in this paper have shown that the strategy that was used to implement the guideline in a Dutch primary care setting was feasible, especially when using a multidisciplinary approach. However, identified barriers for implementation have been identified and should be addressed in future implementation. [ABSTRACT FROM AUTHOR]

Background: The value of using real-time patient-reported outcome (PRO) measures in cancer communication has gained attention both in the clinic and in research. Despite this, no internationally accepted guidelines or training programs for clinicians on how to engage in patient-centred communication based on PROs exist. Lack of training may complicate implementation and systematic use of PROs in the clinic. We aimed to develop a short and feasible manual and training session in PRO-based dialogue rooted in patient-centred communication, coined PROmunication. Methods: PROmunication was implemented in two studies using PROs in different clinical cancer settings. We interviewed clinicians twice during the development phase. First, adopting a clinical perspective, they provided ideas for content, length and structure of the training session and the manual. Second, they approved the draft of the manual with minor adjustments on how to document clinician-patient communication. The final version of the PROmunication tool was built on clinicians' input, theory on patient-centred communication, a literature review, and didactic considerations. Results: The one-page manual gave clinicians a brief and clear overview of how to prepare for, undergo and document a PRO-based consultation. Illustrations and verbal phrases were offered to operationalize and facilitate patient-centred communication. The training session included elements like evidence-based knowledge about the rationale, benefits and challenges of using PROs and comprised theory, experimental training and instructions for the use of the manual in clinical practice. Ad hoc training and feedback in the clinic followed the training session. Conclusions: This paper presents the development of a short, theory-driven manual and training session intended to support and engage clinicians in PRO-based dialogue leading to patient-centred communication. Further testing of the tool is necessary and adjustments may be required if the PROmunication tool should be applied in other clinical settings were patients are seen regularly. An evaluation of the tool is planned to be performed in future studies. Training in PROmunication may further systematic and consistent use of PRO data in the consultation, leading to patient-centred consultations and increased patient involvement. [ABSTRACT FROM AUTHOR]

Patient medication safety is an important issue in patient medication systems. In order to prevent medication errors, integrating Radio Frequency Identification (RFID) technology into automated patient medication systems is required in hospitals. Based on RFID technology, such systems can provide medical evidence for patients' prescriptions and medicine doses, etc. Due to the mutual authentication between the medication server and the tag, RFID authentication scheme is the best choice for automated patient medication systems. In this paper, we present a RFID mutual authentication scheme based on elliptic curve cryptography (ECC) to enhance patient medication safety. Our scheme can achieve security requirements and overcome various attacks existing in other schemes. In addition, our scheme has better performance in terms of computational cost and communication overhead. Therefore, the proposed scheme is well suitable for patient medication systems. [ABSTRACT FROM AUTHOR]

Despite increasing need to boost the recruitment of underrepresented populations into cancer trials and biobanking research, few tools exist for facilitating dialogue between researchers and potential research participants during the recruitment process. In this paper, we describe the initial processes of a user-centered design cycle to develop a standardized research communication tool prototype for enhancing research literacy among individuals from underrepresented populations considering enrollment in cancer research and biobanking studies. We present qualitative feedback and recommendations on the prototype's design and content from potential end users: five clinical trial recruiters and ten potential research participants recruited from an academic medical center. Participants were given the prototype (a set of laminated cards) and were asked to provide feedback about the tool's content, design elements, and word choices during semi-structured, in-person interviews. Results suggest that the prototype was well received by recruiters and patients alike. They favored the simplicity, lay language, and layout of the cards. They also noted areas for improvement, leading to card refinements that included the following: addressing additional topic areas, clarifying research processes, increasing the number of diverse images, and using alternative word choices. Our process for refining user interfaces and iterating content in early phases of design may inform future efforts to develop tools for use in clinical research or biobanking studies to increase research literacy. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) confers increased risks of premature mortality, non-fatal morbidity, and significant impairment in functional status and health-related quality of life. Routine administration of electronic patient-reported outcome measures (PROMs) and its real time delivery to care providers is known to have the potential to inform routine cardiac care and to improve quality of care and patient outcomes. This study describes a user-centered development and evaluation of the Alberta Provincial Project for Outcomes Assessment (APPROACH) electronic Patient Reported Outcomes Measurement (e-PROM) system. This e-PROM system is an electronic system for the administration of PROMs to patients with CAD and the delivery of the summarized information to their care providers to facilitate patient-physician communication and shared decision-making. This electronic platform was designed to be accessible via web-based and hand-held devices. Heuristic and user acceptance evaluation were conducted with patients and attending care providers. Results: The APPROACH e-PROM system was co-developed with patients and care providers, research investigators, informaticians and information technology experts. Five PROMs were selected for inclusion in the online platform after consultations with patient partners, care providers, and PROMs experts: the Seattle Angina Questionnaire, Patient Health Questionnaire, EuroQOL, and Medical Outcomes Study Social Support Survey, and Self-Care of Coronary Heart Disease Inventory. The heuristic evaluation was completed by four design experts who examined the usability of the prototype interfaces. User acceptance testing was completed with 13 patients and 10 cardiologists who evaluated prototype user interfaces of the e-PROM system. Conclusion: Both patients and physicians found the APPROACH e-PROM system to be easy to use, understandable, and acceptable. The APPROACH e-PROM system provides a user-informed electronic platform designed to incorporate PROMs into the delivery of individualized cardiac care for persons with CAD. [ABSTRACT FROM AUTHOR]

The 12-lead electrocardiogram (ECG) is an integral component to the diagnosis of a multitude of cardiovascular conditions. It is performed using a complex set of skin surface electrodes, limiting its use outside traditional clinical settings. We developed an artificial intelligence algorithm, trained over 600,000 clinically acquired ECGs, to explore whether fewer leads as input are sufficient to reconstruct a 12-lead ECG. Two limb leads (I and II) and one precordial lead (V3) were required to generate a reconstructed 12-lead ECG highly correlated with the original ECG. An automatic algorithm for detection of ECG features consistent with acute myocardial infarction (MI) performed similarly for original and reconstructed ECGs (AUC = 0.95). When interpreted by cardiologists, reconstructed ECGs achieved an accuracy of 81.4 ± 5.0% in identifying ECG features of ST-segment elevation MI, comparable with the original 12-lead ECGs (accuracy 84.6 ± 4.6%). These results will impact development efforts to innovate ECG acquisition methods with simplified tools in non-specialized settings. [ABSTRACT FROM AUTHOR]

Purpose: To explore the experiences of haematological cancer outpatients in obtaining information about their cancer and its treatment.Methods: A cross-sectional survey of adult haematological cancer outpatients was conducted. Participants completed two pen-and-paper questionnaires: the first examined demographics and disease characteristics; the second, completed four weeks later, asked about the cancer information received. Participants indicated whether they received the information they needed about medical procedures and self-management, experiences regarding doctor-patient communication, and self-efficacy in seeking information and support. Where possible, items were derived from Australian psychosocial cancer care guidelines.Results: Two hundred and ninety-three (84%) patients consented to participate, with 170 (58%) completing both questionnaires. Most participants reported receiving information in accordance with guidelines. Areas identified as requiring improvement included difficulty recalling information (28%); information overload (26%); insufficient opportunity to ask questions (23%); and insufficient information about managing anxiety related to medical procedures (20%).Conclusion: While many haematological cancer patients report receiving adequate information, there is room for improvement. Implementation of evidence-based strategies, such as decision aids or audiotapes of the consultation, may help to improve information experiences.Practice Implications: A patient-centred approach to information provision is essential for ensuring information addresses the needs and preferences of the patient. [ABSTRACT FROM AUTHOR]

Building on the Cognitive-Social Health Information-Processing model, this paper provides a theoretically guided review of monitoring (i.e., attend to and amplify) cancer-related threats. Specifically, the goals of the review are to examine whether individuals high on monitoring are characterized by specific cognitive, affective, and behavioral responses to cancer-related health threats than individuals low on monitoring and the implications of these cognitive-affective responses for patient-centered outcomes, including patient-physician communication, decision-making and the development of interventions to promote adherence and adjustment. A total of 74 reports were found, based on 63 studies, 13 of which were intervention studies. The results suggest that although individuals high on monitoring are more knowledgeable about health threats, they are less satisfied with the information provided. Further, they tend to be characterized by greater perceived risk, more negative beliefs, and greater value of health-related information and experience more negative affective outcomes. Finally, individuals high on monitoring tend to be more demanding of the health providers in terms of desire for more information and emotional support, are more assertive during decision-making discussions, and subsequently experience more decisional regret. Psychoeducational interventions improve outcomes when the level and type of information provided is consistent with the individual's monitoring style and the demands of the specific health threat. Implications for patient-centered outcomes, in terms of tailoring of interventions, patient-provider communication, and decision-making, are discussed. [ABSTRACT FROM AUTHOR]

Family relations are essential for the bereaved in terms of healing and adjusting to life, especially after experiencing a traumatic death. Although 500 000 people die in drug-related deaths each year, few works focus on family interactions and the help needs of those bereaved by such losses. In this qualitative study, we interviewed 14 parents who had lost their child through a drug-related death. Through a reflexive thematic analysis, we generated three themes: (I) considerable needs in the family become our responsibility, capturing how parents try to mend the disrupted family system and provide adequate care for those who struggle after death, (II) conversations that are important for family connections are obstructed, encompassing how family members sometimes seem afraid of grief emotions and try to protect each other by not talking, and (III) as parents, we can strengthen family connections, encapsulating how parents create space to talk and listen to each other in the family and navigate relational challenges in maintaining relationships. The findings are discussed through the Dual Process Model of Coping with Bereavement as well as family resilience theory. Based on the results, we propose that professional family-oriented help efforts for drug death-bereaved families in two main domains should be considered. The first includes those related to the family's need and ability to adapt roles and relationships to the new reality, and the second involves those connected to creating a space and environment for emotional sharing and joint meaning-making processes in the family. [ABSTRACT FROM AUTHOR]

Growing use of mobiles phones (MP) and other wireless devices (WD) has raised concerns about their possible effects on children and adolescents' wellbeing. Understanding whether these technologies affect children and adolescents' mental health in positive or detrimental ways has become more urgent following further increase in use since the COVID-19 outbreak. To review the empirical evidence on associations between use of MP/WD and mental health in children and adolescents. A systematic review of literature was carried out on Medline, Embase and PsycINFO for studies published prior to July 15th 2019, PROSPERO ID: CRD42019146750. 25 observational studies published between January 1st 2011 and 2019 were reviewed (ten were cohort studies, 15 were cross-sectional). Overall estimated participant mean age and proportion female were 14.6 years and 47%, respectively. Substantial between-study heterogeneity in design and measurement of MP/WD usage and mental health outcomes limited our ability to infer general conclusions. Observed effects differed depending on time and type of MP/WD usage. We found suggestive but limited evidence that greater use of MP/WD may be associated with poorer mental health in children and adolescents. Risk of bias was rated as 'high' for 16 studies, 'moderate' for five studies and 'low' for four studies. More high-quality longitudinal studies and mechanistic research are needed to clarify the role of sleep and of type of MP/WD use (e.g. social media) on mental health trajectories in children and adolescents. [ABSTRACT FROM AUTHOR]

Screening for autism spectrum disorder (ASD) is an essential early step in the identification process and inaccurate screening may lead to significant delays in the onset of treatment. Past research has highlighted discrepancies in the performance of ASD screening tools such as the Social Communication Questionnaire (SCQ) among certain racial and ethnic groups. The current study explored the functioning of the SCQ among African American/Black and White respondents based on item level performance on the measure. Differential Item Functioning (DIF) analyses showed that 16 (41%) items of the SCQ functioned differently for African American/Black respondents when compared to White respondents. Implications, such as the potential for delayed diagnosis and treatment, and the influence on downstream outcomes, are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Children exposed to domestic violence are at risk of adverse short- and long-term psychosocial effects and of being abused themselves. However, mothers and children face systemic gaps when seeking safety from domestic violence services and police. Safety planning typically focuses on women, overlooking their multiple social identities and excluding their children. We explored safety strategies used by mothers and children coping together with severe domestic violence. Method: Interviews with 30 mothers who experienced severe or potentially life-threatening domestic violence and 5 adults who experienced domestic violence in childhood were qualitatively analyzed using thematic analysis, revealing five major themes: ongoing communication, appeasing the abuser, soothing activities, exposure reduction, and fostering independence. Results: Interpreting participants' experiences in terms of the mother-child dyad, we found that mothers and their children worked together to reassure each other, keep each other safe, and make plans to leave their abuser. Conclusions: Safety planning for the mother-child dyad could build on children's existing coping strategies and recognize and support children's desire to protect their mother and themselves effectively and safely according to their developmental stage. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis were utilised to explore the methodological quality, program fidelity, and efficacy of social skills group programs (SSGPs) aiming to support autistic adolescents in navigating their everyday social worlds. The study evaluated the methodological quality and theoretical fidelity of studies, with a random effect meta-analysis conducted to summarise the overall efficacy of SSGP and its effect on social communication and interaction, behavioural/emotional challenges, adaptive functioning, and autism characteristics. Although findings from the 18 identified studies indicated an adjusted medium overall effect with these programs successfully supporting autistic adolescents' socialisation needs (g = 0. 60, p < 0.001), most studies demonstrated medium to low program fidelity despite their good methodological quality. Given the significant heterogeneity of SSGPs and variations in the design and measurement frameworks of efficacy studies, understanding the generalisability of the findings of this research is unclear. [ABSTRACT FROM AUTHOR]

Coronary artery calcium (CAC) is a powerful tool to refine atherosclerotic cardiovascular disease (ASCVD) risk assessment. Despite its growing interest, contemporary public attitudes around CAC are not well-described in literature and have important implications for shared decision-making around cardiovascular prevention. We used an artificial intelligence (AI) pipeline consisting of a semi-supervised natural language processing model and unsupervised machine learning techniques to analyze 5,606 CAC-related discussions on Reddit. A total of 91 discussion topics were identified and were classified into 14 overarching thematic groups. These included the strong impact of CAC on therapeutic decision-making, ongoing non-evidence-based use of CAC testing, and the patient perceived downsides of CAC testing (e.g., radiation risk). Sentiment analysis also revealed that most discussions had a neutral (49.5%) or negative (48.4%) sentiment. The results of this study demonstrate the potential of an AI-based approach to analyze large, publicly available social media data to generate insights into public perceptions about CAC, which may help guide strategies to improve shared decision-making around ASCVD management and public health interventions. [ABSTRACT FROM AUTHOR]

Background: In the rapid development in prehospital medicine the awareness of the many challenges in prehospital care is important as it highlights which areas need improvement and where special attention during education and training should be focused. The purpose of this study is to identify challenges that physicians face when working in the prehospital environment. The research question is thus; what challenges do physicians face when working in prehospital care? Method: This is a qualitative study with an inductive approach and is based on individual interviews. The interviews were analyzed using the Classic Grounded Theory (GT) method as an approach. The interviews were conducted as semi-structured interviews via the digital platform Zoom during winter / early spring 2022. Results: Challenges for prehospital physicians can be understood as a process that involves a balancing act between different factors linked to the extreme environment in which they operate. This environment creates unique challenges not usually encountered in routine hospital practice, which results in trade-offs that they would not otherwise be faced with. Their individual situation needs to be balanced against organizational conditions, which means, among other things, that their medical decisions must be made based on limited information as a result of the constraints that exist in the prehospital environment. They must, both as individuals and as part of a team, manoeuvre in time and space for decision-making and practical tasks. This theory of balancing different entities is based on four themes; thus the theory is the relation between the four themes: leadership, environment, emotion management and organization. Conclusions: With the help of previous studies and what we have found, it is reasonable to review what training is needed before starting to work prehospital as a physician. This should include components of the themes we have described: organization, environment, leadership and emotional management. [ABSTRACT FROM AUTHOR]

Background: Suicide, especially by firearm, remains a leading cause of death in military populations in the USA. Reducing access to firearms, especially during high risk times, may help prevent suicide and other forms of violence. The purpose of this study was to adapt a promising existing lethal means safety intervention (Project Safe Guard, PSG) for cross-cutting violence prevention and peer support in active-duty service communities using community engagement methods. Methods: A two-pronged community-engaged research approach was employed, including the Community Translation (CT) process that engaged 15 Service Members from one installation to help adapt PSG successfully. In addition, qualitative data was collected from 40 active-duty service members and military violence prevention specialists through in-depth interviews and focus group discussions. Results: Qualitative data and CT feedback led to site-specific PSG adaptations. Participants emphasized the importance of peer-to-peer discussions and highlighted resource allocation, leadership support, and stigma on firearm ownership as potential implementation challenges. Conclusions: Findings demonstrate the feasibility of community-engaged research to adapt lethal means safety interventions within military populations. PSG implementation should consider resource allocation, leadership support, and addressing stigma. This study has implications for future policies and standards for performing research on sensitive topics, particularly among military populations. [ABSTRACT FROM AUTHOR]

Hoarding behaviour sometimes requires intervention from community agencies to reduce risks to residents and the nearby community. Human services professionals from a wide range of disciplines are called upon to address hoarding concerns, often in collaboration with each other. No guidelines currently exist to guide staff from those community agencies in a shared understanding of common health and safety risks that occur with severe hoarding behaviour. Using a modified Delphi method, we aimed to generate consensus among a panel of 34 service-provider experts from a range of disciplines on essential risks in the home that would require intervention for health or safety reasons. This process identified 31 environmental risk factors that experts agreed are critical to assess in cases of hoarding. Panelist comments outlined the debates that commonly occur in the field, the complexity of hoarding, and the difficulty with conceptualizing risks in the home. The multi-disciplinary consensus achieved on these risks will facilitate better collaboration between agencies by providing a minimum standard of what to evaluate in hoarded homes to ensure health and safety standards are being met. This can improve communication between agencies, specify the core hazards that should be incorporated into training for professionals who work with hoarding, and facilitate more standardized assessment of health and safety risks in hoarded homes. [ABSTRACT FROM AUTHOR]

Background: Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It describes critical elements of a proactive approach to achieving collaborative pediatric care under real-world circumstances using the patient-centered medical home neighborhood (PCMH-N) model. Objective: The current study evaluates the field test of the practitioner-informed model to facilitate interdisciplinary collaboration (PIM-FIC), a systematic approach to improving inter-professional collaboration by building relationships and enhancing communication between pediatric mental health and primary care practices. Methods: Thirty-nine providers at two mental health and two pediatric primary care practices participated in a pilot project and completed surveys prior to and following their participation. Key informant interviews were also conducted prior to the project. Results: Participating practitioners' survey and interview responses indicate that the quantity and quality of communication between pediatric mental and medical health care providers increased post-project, as did satisfaction with overall collaboration. Conclusions: Improving relationships and communication are first steps in building the infrastructure to support effective coordinated care. Project results highlight practical and easily implemented strategies that pediatric mental health and primary care practices can take to strengthen their collaboration. Findings also suggest a need for collaborative care policies and competencies for child mental health providers working in freestanding practices within the PCMH-N. [ABSTRACT FROM AUTHOR]

This paper describes Asian-American recruitment experiences using data from the cancer survivorship study involving Chinese- and Korean-American breast cancer survivors specifically. The article discusses challenges to the successful recruitment of Asian-American populations for cancer survivorship research and provides recommendations for future recruitment efforts. The study investigated the role of family communication in coping and quality of life for survivors from Chinese- and Korean-American groups diagnosed with breast cancer. Participants were primarily recruited through cancer registries and community outreach. A total of 157 breast cancer survivors (86 Chinese-Americans and 71 Korean-Americans) completed the final survey, yielding a final response rate of 62.8 % of the accessible samples. Chinese-Americans were more likely to agree to participate but less frequently completed the survey, and Korean-Americans were more likely to refuse to participate. Common reasons for refusal were "too busy or too painful to recall," followed by "not interested," "too old," "distrust of the research," or "health issue." Participants were more likely to be young and Korean-American compared to non-participants. Cultural and linguistic barriers, distrust, and lack of awareness about cancer research should be considered to recruit more Asian-American cancer survivors. Community participatory research is required to ensure participation by sufficient numbers of ethnic minorities in cancer survivorship research. [ABSTRACT FROM AUTHOR]

A Brain Computer Interface (BCI) allows communication for impaired people unable to express their intention with common channels. Electroencephalography (EEG) represents an effective tool to allow the implementation of a BCI. The present paper describes a modular framework for the implementation of the graphic interface for binary BCIs based on the selection of symbols in a table. The proposed system is also designed to reduce the time required for writing text. This is made by including a motivational tool, necessary to improve the quality of the collected signals, and by containing a predictive module based on the frequency of occurrence of letters in a language, and of words in a dictionary. The proposed framework is described in a top-down approach through its modules: signal acquisition, analysis, classification, communication, visualization, and predictive engine. The framework, being modular, can be easily modified to personalize the graphic interface to the needs of the subject who has to use the BCI and it can be integrated with different classification strategies, communication paradigms, and dictionaries/languages. The implementation of a scenario and some experimental results on healthy subjects are also reported and discussed: the modules of the proposed scenario can be used as a starting point for further developments, and application on severely disabled people under the guide of specialized personnel. [ABSTRACT FROM AUTHOR]

This study aimed to explore the family profile of adolescent-to-parent abuse cases. Concretely, this paper examines whether or not there is a different family profile of parent-abuse offenders compared with other types of offenders and with non-offender adolescents. The sample included 90 adolescents who were clustered into three groups (parent-abuse offenders, other type of offenders, and non-offender adolescents). Participants completed measures of quality of communication with parents and parents' educational styles. They were also evaluated using a brief interview with questions about family structure. Results indicate offenders who assault their parents have a different family structure and dynamics. Differences were found concerning the type of household, family size, and family incomes. In addition, parent-abuse offenders reported a lower quality of communication with both parents perceiving them as less warm, more rejecting, and less inductive than did the other groups. [ABSTRACT FROM AUTHOR]

Use of electronic health records (EHR) within clinical encounters is increasingly pervasive. The digital record allows for data storage and sharing to facilitate patient care, billing, research, patient communication and quality-of-care improvement-all at once. However, this multifunctionality is also one of the main reasons care providers struggle with the EHR. These problems have often been described but are rarely approached from a philosophical point of view. We argue that a postphenomenological case study of the EHR could lead to more in-depth insights. We will focus on two concepts-transparency and multistability-and translate them to the specific situation of the EHR. Transparency is closely related to an embodiment relation in which the user becomes less aware of the technology: it fades into the background, becoming a means of experience. A second key concept is that of multistability, referring to how a technology can serve multiple purposes or can have different meanings in different contexts. The EHR in this sense is multistable by design. Future EHR design could incorporate multistable information differently, allowing the provider to focus on patient care when interacting with the EHR. Moreover we argue that the use of the EHR in the daily workflow should become more transparent, while awareness of the computer in the specific context of the patient-provider relationship should increase. [ABSTRACT FROM AUTHOR]

Most internationally recognized instruments for the screening and diagnosis of autism spectrum disorder have been developed in the USA, which calls into question the degree of their cultural adaptation to diverse populations. The aim of this study is to examine the characteristics of social communication in typically developing Croatian-speaking participants (N = 220) using ADOS-2-defined item-level normative values. Croatian subjects showed the expected ("typical") results in the domain of verbal communication, slightly atpical results in nonverbal communication (primarily gesture use), and more significant deviations in pragmatics (offering and asking for information), relative to the expectations of the ADOS-2. As ADOS-2 has become an important component of thorough ASD diagnostic evaluations worldwide, identifying methods for increasing the cross-cultural validity is essential. [ABSTRACT FROM AUTHOR]

Describing neural connectivity between pre-frontal and parietal brain regions and anxiety in children and adolescents with Autism Spectrum Disorder (ASD) has the potential to inform diagnosis and treatment decisions. This study aimed to identify the neural connectivity patterns between the prefrontal cortex (PFC) and parietal regions in young autistic males, and to determine if Generalised Anxiety Disorder (GAD) was associated with these communication patterns. Forty-one males with ASD aged between 6 and 18 yr (M age = 10.76 yr, SD = 3.14 yr) and their mothers were recruited as volunteer participants from the Gold Coast region, Australia. After assessments, participants received 3 min of eyes-closed and 3 min of eyes-opened EEG data-collection under resting conditions. EEG data from the frontal and parietal regions were investigated for their connectivity via Granger Causality (GC). There were significant correlations between the PFC-to-parietal region GC connectivity indices and total GAD scores, and also for the core components of GAD, but these were restricted to the alpha-wave frequency with only minimal beta-wave significant results. No significant correlations between parietal-to-PFC regions and GAD were present. Communication from the decision-making region (PFC) to the spatial reasoning (parietal) regions appeared to be aimed at instigating increased motor activity associated with GAD. [ABSTRACT FROM AUTHOR]

Despite suicide ideation being one of the most frequently reported health issues impacting tertiary students, there is a paucity of research evaluating the efficacy of preventive interventions aimed at improving mental health outcomes for students studying at two tertiary institutes. The current study evaluated the efficacy of the "Talk-to-Me" Mass Open Online Course (MOOC) in improving tertiary students' abilities to support the mental health of themselves and their peers via a randomised controlled trial design, comparing them to a waitlist control group. Overall, 129 tertiary students (M = 25.22 years, SD = 7.43; 80% female) undertaking a health science or education course at two Western Australian universities were randomly allocated to either "Talk-to-Me" (n = 66) or waitlist control (n = 63) groups. The participants' responses to suicidal statements (primary outcome), knowledge of mental health, generalised self-efficacy, coping skills, and overall utility of the program (secondary outcomes) were collected at three timepoints (baseline 10-weeks and 24-weeks from baseline). Assessment time and group interaction were explored using a random-effects regression model, examining changes in the primary and secondary outcomes. Intention-to-treat analysis (N = 129) at 10-weeks demonstrated a significant improvement in generalised self-efficacy for "Talk-to-Me" compared to the control group (ES = 0.36, p =.04), with only the "Talk-to-Me" participants reporting increased knowledge in responding to suicidal ideation (primary outcome). This change was sustained for 24 weeks. Findings provide preliminary evidence suggesting that the "Talk-to-Me" MOOC can effectively improve tertiary students' mental health and knowledge of how to support themselves and others in distress. ACTRN12619000630112, registered 18-03-2019, anzctr.org.au. [ABSTRACT FROM AUTHOR]

Adolescents' ethnic-racial identity (ERI) exploration, resolution, and affirmation inform their approach and avoidance attitudes toward intergroup contact, but the potential mechanisms through which this occurs have been underexplored. Given the evidence that adolescents with higher ERI exploration, resolution, and affirmation also report higher self-esteem, and self-esteem is theorized to facilitate openness to intergroup contact, the current study explored the role of self-esteem as a mediator of the relation between adolescents' ERI and their intergroup contact attitudes. Participants were 4606 adolescents (Mage = 16.35, SD = 1.16; 37.5% White, 27.1% Black, 20.7% Latinx, 11.7% Asian American, 3% Native American) from the U.S. Southwest and Midwest. The three waves of data were collected between March 2017 and March 2018. Results from longitudinal multigroup path models indicated that across all ethnic-racial groups there were positive direct relations between Wave 1 (W1) ERI resolution and W2 self-esteem (7 months later). In turn, W2 self-esteem was positively related to W3 approach attitudes (12 months later) and negatively related to W3 avoidance attitudes. The relations between ERI resolution and both approach and avoidance attitudes were fully mediated by self-esteem across all ethnic-racial groups. Notably the baseline values (W1) of all mediation and outcome variables (W2, W3) were included, suggesting that ERI resolution at baseline predicted increases in self-esteem, which predicted subsequent increases in approach attitudes and decreases in avoidance attitudes. ERI exploration and affirmation were not significant predictors of later self-esteem or contact attitudes. These findings suggest that of the three dimensions of ERI examined, resolution is the primary driver of the increases in self-esteem that inform adolescents' attitudes towards interaction with ethnic-racial outgroup members. [ABSTRACT FROM AUTHOR]

Network modeling of the social, communication and restrictive/repetitive behaviors (RRBs) included in the definition of Autism Spectrum Disorder was performed. The Autism Diagnostic Interview-Revised (ADI-R) assessed behaviors in 139 pre-school cases at two cross-sections that averaged 34.8 months apart. Cross-sectional networks were based on the correlation matrix of the ADI-R behavioral items and the "bootCross" method was developed and enabled the estimation of a longitudinal network. At both stages, RRB items/nodes formed a consistent peripheral cluster, while social and communication nodes formed a core cluster that diverged with time. These differences in the nature and evolution of the RRB and socio-communicative dimensions indicate that their inter-behavior dynamics are very different. The most central behaviors across stages are proposed as prime targets for efficient therapeutic intervention. [ABSTRACT FROM AUTHOR]

The evaluation of the overlap between the ADOS BOSCC and Standard BOSCC as well as the exploration of child characteristics that may predict change are important steps in consolidating data-driven definitions of "improvement". Participants were seen between 2 and 5 times with Standard BOSCC and ADOS BOSCC observations over the course of early intervention trials (Grzadzinski et al. in J Autism Dev Disord 46:2464, 2016; Kim et al. in Autism 23:5, 2019). Results showed consistency between the Standard BOSCC and ADOS BOSCC, highlighting the utility of both as metrics of change and treatment outcome across contexts. Baseline characteristics may play a role in the tailoring of early intervention to maximize treatment outcome and may offer guidance when determining which outcome measures to use. [ABSTRACT FROM AUTHOR]

The use of embodied conversational agents in mental health has increased in the last years. Several studies exist describing the benefits and advantages of this technology as a complement to psychotherapeutic interventions for the prevention and treatment of depression, anxiety, or post-traumatic stress disorder, to name a few. A small number of these works implement capabilities in the virtual agent focused on the detection and prevention of suicidality risks. The work presented in this paper describes the development of an embodied conversational agent used as the main interface in HelPath, a mobile-based application addressed to individuals detected with any of the suicidal behaviours: ideation, planning or attempt. The main objective of HelPath is to continuously collect user's information that, complemented with data from the electronic health record, supports the identification of risks associated with suicidality. Through the virtual agent, the users also receive information and suggestions based on cognitive behaviour therapy that would help them to maintain a healthy condition. The paper also presents the execution of an exploratory pilot to assess the acceptability, perception and adherence of users towards the virtual agent. The obtained results are presented and discussed, and some actions for further improvement of the embodied conversational agent are also identified. [ABSTRACT FROM AUTHOR]

Recent research has begun to explore the specific social challenges experienced by persons with Tourette syndrome (TS); however, it does not specifically address the challenges that often arise interpersonally as part of people's communicative interactions and these interactions socially construct the individual and collective well-being of all involved. This study conducted semi-structured interviews with 18 adults who identified as having TS in order to investigate the ways in which others respond behaviorally to TS behaviors and the ways TS behaviors are misinterpreted within interpersonal interactions. Thematic analysis was used to identify themes common within participant responses. All participants reported receiving unwanted attention from others in response to their TS symptoms. Unwanted attention was further divided into six emergent subthemes, including verbal harassment, physical abuse, staring, general bullying, getting into trouble, and being kicked out. Three types of misunderstandings were also reported in interpersonal interactions: misunderstanding communicative intention, misunderstanding TS, and misunderstanding the cause of TS behaviors. Applying attribution theory, it is determined that it is ultimately the misattribution of communicative intent to TS behaviors that causes many misunderstandings reported by adults with TS and leads to a plethora of interpersonal, communicative challenges. Importantly, these misunderstandings are what ultimately contribute to much of the unwanted attention described by the participants in this study and documented in previous work, highlighting the value of a greater awareness of how misunderstandings take place with respect to TS. [ABSTRACT FROM AUTHOR]

Understanding the development of behavioral and mental health issues among adolescents, particularly those from immigrant families, is a key area of concern. Many prior studies have focused on the role of societal (country-of-destination) language skills, but we know less about the role played by the use of the heritage language in families. We examined this latter relationship with a focus on changes in heritage language use and internalizing and externalizing problems, and how family relations moderate this relationship. We used the first two waves (2010/2011 and 2011/2012) of the Children of Immigrants Longitudinal Survey in Four European Countries (CILS4EU) data collected from Germany (n = 1614; Mage = 14.8 years, 50% female), the Netherlands (n = 1203; Mage = 14.7 years, 54% female), Sweden (n = 1794; Mage = 14.2 years, 53% female), and England (n = 1359; Mage = 14.6 years, 50% female). Our results suggest that increased use of heritage language is associated with fewer externalizing problems only in families with greater family cohesion and parental warmth (in Germany and the U.K.) and with fewer internalizing problems only in families with higher parental monitoring (in the Netherlands and Sweden). Good family relations are thus an important precondition for increased heritage language use to lead to improved behavioral and mental health for children of immigrants. [ABSTRACT FROM AUTHOR]

Historically, racial socialization (RS) literature has focused on the content and frequency of RS messages communicated between Black parents and youth. In an effort to examine the potential added benefit of receiving RS messages from non-parental agents, three hierarchical linear regressions were tested among a sample of Black youth (ages 14–21). Black youths' acquisition of protection and bicultural coping messages from parents were associated with their belief in racial protection messages along with select relevant covariates. Black youths' acquisition of protection and racial stereotyping messages from parental agents and racial stereotyping messages from non-parental agents were associated with their belief in racial stereotyping messages. Finally, Black youths' belief in bicultural coping messages were association with their acquisition of protection, racial stereotyping, and bicultural coping messages from parental agents and racial stereotyping and bicultural coping messages from non-parental agents. Findings underscore the enduring role parental and non-parental figures serve in Black youths' racial socialization experiences across ecological contexts. As such, future interventions and community-based programs should be oriented towards equipping parents and supports for Black youth (e.g., including multiracial families) with the competency to communicate racial pride and skillfully support Black children's management of racialized experiences. Highlights: Parental agents remain a primary agent of racial socialization messages among Black youth. Non-parental agents are influential in youths' endorsement of bicultural coping and racial stereotyping messages. Racial protection messages were the most salient type of message among the Black youth in our study such that specific parent and youth factors may impact Black youths' belief in racial protection messages. [ABSTRACT FROM AUTHOR]

Background: This study examined the conflicts between different generations working in US emergency departments (ED). We sought to record generational differences involving communication preferences, perceived areas of conflict, work motivations, and attitudes regarding work-life balance. Methods: We developed a survey to assess the physician perspective on generational conflict in the ED. The survey was distributed to members of the American College of Emergency Physicians, a professional organization comprising emergency medicine physicians in the USA. Results: We received 696 completed responses. Men represented 60% of respondents and the largest proportion of respondents were emergency physicians working in community settings (53%); 11% were residents. Generation representation was smallest for Traditionalist (2%) and largest for Gen X (43%). Seventy percent reported observing conflict due to generational communication with the largest frequency being once a week (26%). In the associated open-ended questions, 247 (33%) provided 316 anecdotal descriptions of observed conflict. Responses clustered into seven themes (ordered by frequency): Work Ethic, Treatment Approach, Technology Application, Entitlement, Professionalism, Work Life/Balance, and Communication Style. Comparing Work Ethic responses, 52–70-year-olds reported that younger providers are less interested in "accomplishing anything" while 26–34-year-olds resented that attitude. Respondents completing the open-ended questions regarding preventing and responding to conflict provided some insight into helpful strategies including actions supportive of clear communication and standardized policies and expectations. Only 5% of respondents reported that they had discussed generational communication in department meetings with the odds of a woman reporting conflict being less than males (p =.01). Conclusion: Conflicts in the ED in the USA can be attributed to how an individual views the values of someone from another generation. Understanding the frequency and areas of generational conflict in the ED can help medical leaders find strategies to mitigate negative workplace interactions. [ABSTRACT FROM AUTHOR]

Purpose: Vocational rehabilitation (VR) involves complex skills, and often inter-disciplinary teams need to work effectively to meet the needs of stakeholders. Research highlights important influences on effective teamwork, including funding systems, team structure, policies and procedures, and effects of professional hierarchies. This qualitative study aimed to explore these issues in-depth including how factors interact to produce problems and solutions. We focused on identifying challenges and opportunities for VR teams working in the Aotearoa-New Zealand context which may also be transferrable to other settings. Methods: Qualitative descriptive instrumental case study involving focus groups and interviews with two VR teams (n = 14). Teams worked in musculoskeletal injury and were geographically diverse. Reflexive thematic analysis was used to analyse the data. Results: Analysis constructed three overarching themes: Having the Power, Being Human, and VR is Not for Everyone. Achieving trusting relationships within the team was paramount. This was achieved through seeing everyone as equal, and as human. Equality within the team was particularly important for professionals that occupied different positions of power in a wider professional hierarchy. VR specialist skills (experience and postgraduate qualifications) were often under-recognised, leading them to have little power in VR decision making processes. VR professionals also experienced competing demands between client needs and business drivers. Conclusion: Findings offer detail of processes teams engage in to create effective team relationships and manage systemic factors to facilitate positive outcomes. Additionally, findings highlight opportunities in decision-making processes for VR medical certification that may increase job satisfaction and better utilize skills and expertise. [ABSTRACT FROM AUTHOR]

The objective of this study is to investigate the prevalence of autism (ASD) symptoms, i.e. , social difficulties, repetitive behaviors, and communicational problems, among children born extremely preterm (EP) compared to a reference group, and to investigate possible antecedents of ASD symptoms among EP children. Method is a national Norwegian cohort of 11 year old EP children, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness, and/or deafness. Parents and teachers reported ASD symptoms using The Autism Spectrum Screening Questionnaire (ASSQ). Social difficulties, repetitive behaviors, communicational problems, and a total ASSQ score were presented. Combined ratings on the ASSQ was defined as parent and/or teacher scoring the child ≥ 98th percentile of the reference group, which was the population-based Bergen Child Study. Of eligible children, 216 (64%) EP and 1882 (61%) reference children participated. EP children had significantly higher mean scores and combined ratings on social difficulties (14.5% vs. 4.1%, OR: 3.2), repetitive behaviors (23.7% vs. 4.0%, OR: 6.4), communicational problems (23.1% vs. 4.8%, OR: 5.4), and the total ASSQ score (18.3% vs. 3.4%, OR: 5.7) compared to reference children. Only no prenatal steroids, IQ 70–84, and mental health problems at 5 years of age were significantly associated with ASD symptoms at 11 years of age. EP children were at increased risk of social difficulties, repetitive behaviors, and communicational problems, and approximately one out of five were reported as high scorers of ASD symptoms. No prenatal steroids use, IQ in the lower range, and mental health problems at 5 years of age were associated with ASD symptoms. [ABSTRACT FROM AUTHOR]

Autism (ASD) and schizophrenia spectrum disorders (SCZ) are neurodevelopmental conditions with overlapping and interrelated symptoms. A network analysis approach that represents clinical conditions as a set of "nodes" (symptoms) connected by "edges" (relations among symptoms) was used to compare symptom organization in the two conditions. Gaussian graphical models were estimated using Bayesian methods to model separate symptom networks for adults with confirmed ASD or SCZ diagnoses. Though overall symptom organization differed by diagnostic group, both symptom networks demonstrated high centrality of social communication difficulties. Autism-relevant restricted and repetitive behaviors and schizophrenia-related cognitive-perceptual symptoms were uniquely central to the ASD and SCZ networks, respectively. Results offer recommendations to improve differential diagnosis and highlight potential treatment targets in ASD and SCZ. [ABSTRACT FROM AUTHOR]

Sleep problems are prevalent among autistic children and children with Rare Genetic Neurodevelopmental Disorders (RGND). Behavioral interventions are commonly used to treat sleep problems, with most involving extinction. While effective, the occurrence of a response burst (i.e., temporary worsening of the behavior) can result in a temporary increase in parent and child distress, and negatively affect treatment adherence. Thus, it is important to develop less restrictive treatment options. This study used a single case multiple baseline design to investigate the effectiveness and acceptability of less restrictive behavioral interventions (i.e., specifically excluding extinction) for sleep problems in ten autistic children and children with RGND (M = 7.3 years). Results demonstrated a reduction in sleep disturbance including unwanted bed-sharing, night wakings and sleep onset delay for 3/3, 5/5 and 6/7 children respectively, which were maintained at follow-up. Interventions were rated favorably by parents. The clinical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Parental involvement is positively associated with children's psychological development and school outcomes; however, there is limited longitudinal evidence for how home-based parental involvement contributes to adolescents adapting positively to the school environment. The current study examined whether and how home-based parental involvement impacts socio-emotional adjustment during the first year of middle school using a stress coping perspective and attachment theory. Two waves of data from the China Education Panel Survey (CEPS, 2013–2014 and 2014–2015) were analyzed. A total of 8475 Chinese students in grade 7 and their parents were selected from the CEPS database. We examined the effects of two types of home-based parental involvement (i.e., parent–adolescent communication and time spent with children, reported by the adolescent's father or mother) on adolescents' socio-emotional adjustment (reported by the adolescents). The mediating role of the parent–adolescent relationship and adolescents' support-seeking in the relationship between home-based parental involvement and adolescents' socio-emotional adjustment was also investigated. Our results reveal that two types of home-based parental involvement positively predicted adolescents' socio-emotional adjustment over time. Furthermore, the results of our four mediation models indicate that two types of home-based parental involvement were positively associated with adolescents' socio-emotional adjustment via increased adolescents' support-seeking and a close parent–adolescent relationship. The theoretical and practical implications are discussed. Highlights: The importance of parent-adolescent communications and parent-adolescent activities on student socio-emotional well-being in the first year in middle school with national longitudinal data. A high-quality of parent-adolescent relationship mediates the association between home-based parental involvement and adolescents' socio-emotional adjustment. Home-based parental involvement can facilitate adolescents' socio-emotional adjustment by encouraging support-seeking from parents. [ABSTRACT FROM AUTHOR]

Qualitative accounts indicate there are sensory and communication related barriers to adequate childbirth and postnatal healthcare for autistic people. However, little quantitative work has explored the topic. This online survey study explored childbirth and postnatal experiences among 384 autistic and 492 non-autistic people. Compared with non-autistic people, autistic people were more likely to find the sensory aspects of birth overwhelming, and experienced lower satisfaction with birth-related and postnatal healthcare. Autistic people were more likely to experience postnatal depression and anxiety. The findings highlight that sensory and communication adjustments should be made to birth and postnatal healthcare for autistic people. The findings indicate the need for greater autism understanding among professionals and greater postnatal mental health support for autistic people. [ABSTRACT FROM AUTHOR]

Purpose: Marital violence and violence by non-marital partners are serious problems in Japan, and an increased incidence of intimate partner violence (IPV) using information and communication technology has been observed. Narcissism is a risk factor for IPV and is correlated with aggressive behavior in ego-threatening situations. Narcissism appears in two main types, namely, grandiose and vulnerable, which differ in the expression of aggressive behavior. This study examined anxious ego threat regarding the possible failure of a dating relationship and investigated whether the two types of narcissism lead to cyber dating abuse (CDA) in this type of ego-threat situation. Method: We conducted an internet questionnaire survey of 603 unmarried Japanese people (71% female, 29% male) aged 15 to 29 who had a dating partner. Results: In men, when relationship anxiety was high, grandiose narcissism predicted CDA, such as direct aggression to annoy or hurt the partner and intrusive behaviors, such as persistent messaging to track the partner. Grandiose narcissism was not associated with aggressive behavior toward a dating partner in the absence of anxiety concerning the dating relationship. Vulnerable narcissism was not associated with aggressive behavior toward a dating partner, regardless of the presence or absence of anxiety concerning the dating relationship. In women, no association was found between CDA and narcissism. Conclusion: In considering narcissism as a risk factor for CDA, it is insufficient to examine the relationship between narcissism and CDA. Both types of narcissism and threat to self-evaluation must be examined. [ABSTRACT FROM AUTHOR]

Purpose Pain and stress-related ill-health are major causes of long-term disability and sick leave. This study evaluated the effects of a brief psychosocial program, which previously has been tested for an at-risk population of employees. Methods The Effective Communication within the Organization (ECO) program, where supervisors and employees were trained in communication and problem solving, was compared to an active control consisting of psychoeducative lectures (PE) about pain and stress in a cluster randomized controlled trial. First-line supervisors were randomized to ECO or PE, and a total of 191 mainly female employees with self-reported pain and/or stress-related ill-health were included. The hybrid format programs consisted of 2–3 group sessions. Sick leave data was collected from social insurance registers, before and 6-months after the program. Secondary outcomes (work ability, work limitations, pain-disability risk, exhaustion symptoms, perceived stress, perceived health, quality of life, perceived communication and support from supervisors) were assessed at baseline, post intervention, and at 6-months follow-up. Results No effects were observed on primary or secondary outcome variables. Pain symptoms were common (89%), however a lower proportion (30%) were identified as at risk for long-term pain disability, which might explain the lack of evident effects. The Covid-19 pandemic affected participation rates and delivery of intervention. Conclusion In this study, preventive effects of the ECO program were not supported. Altogether, the findings point at the importance of selecting participants for prevention based on screening of psychosocial risk. Further research on workplace communication and support, and impact on employee health is warranted. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to explore the experiences of women living with severe mental illnesses making decisions about psychotropic medication use in pregnancy and breastfeeding, and what helped or hindered the decision-making process. Methods: We report on a qualitative study from 12 women who attended the pregnancy service between May 2018 and June 2019. Interviews occurred at 4–6 weeks postpartum on women with severe mental illnesses, which was nested within a larger mixed-methods study. Results: Three main themes were elicited from the participants' transcriptions and included (i) the decision-making process with subthemes of shared decision-making, consistency and complete care, collaboration and clear communication, and challenges of managing medication; (ii) how information is given, with subthemes of information delivery and communication breakdown; and (iii) breastfeeding dilemmas with subthemes of lithium and breastfeeding choice and autonomy regarding breastfeeding on medication. Conclusion: Findings offer understanding of patients' experiences in the decision-making and use of psychotropic medication during pregnancy and breastfeeding. Women living with severe mental illnesses, such as bipolar and psychosis, face difficult medication decisions due to uncertainty around use in pregnancy, potentially causing conflict with their dual role as both persons with a diagnosed mental illness but also new mothers. The clinician needs to provide comprehensible and concise information, giving space for a woman's voice to be heard to guide them from a position of hesitancy to one of assurance. Collaboration within a multidisciplinary team and external care providers combined with consistency of care assists this process. [ABSTRACT FROM AUTHOR]