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Objective: To assess the cost-effectiveness of using cheaper-but-noisier outcome measures, such as a short questionnaire, for large simple clinical trials. Background: To detect associations reliably, trials must avoid bias and random error. To reduce random error, we can increase the size of the trial and increase the accuracy of the outcome measurement process. However, with fixed resources, there is a trade-off between the number of participants a trial can enrol and the amount of information that can be collected on each participant during data collection. Methods: To consider the effect on measurement error of using outcome scales with varying numbers of categories, we define and calculate the variance from categorisation that would be expected from using a category midpoint; define the analytic conditions under which such a measure is cost-effective; use meta-regression to estimate the impact of participant burden, defined as questionnaire length, on response rates; and develop an interactive web-app to allow researchers to explore the cost-effectiveness of using such a measure under plausible assumptions. Results: An outcome scale with only a few categories greatly reduced the variance of non-measurement. For example, a scale with five categories reduced the variance of non-measurement by 96% for a uniform distribution. We show that a simple measure will be more cost-effective than a gold-standard measure if the relative increase in variance due to using it is less than the relative increase in cost from the gold standard, assuming it does not introduce bias in the measurement. We found an inverse power law relationship between participant burden and response rates such that a doubling the burden on participants reduces the response rate by around one third. Finally, we created an interactive web-app (https://benjiwoolf.shinyapps.io/cheapbutnoisymeasures/) to allow exploration of when using a cheap-but-noisy measure will be more cost-effective using realistic parameters. Conclusion: Cheaper-but-noisier questionnaires containing just a few questions can be a cost-effective way of maximising power. However, their use requires a judgement on the trade-off between the potential increase in risk of information bias and the reduction in the potential of selection bias due to the expected higher response rates. Key messages: A cheaper-but-noisier outcome measure, like a short form questionnaire, is a more cost-effective method of maximising power in large simple clinical trials than an error free gold standard measure when the percentage increase in noise from using the cheaper-but-noisier measure is less than the relative difference in the cost of administering the two measures. We have created an R-shiny app to facilitate the exploration of when this condition is met at https://benjiwoolf.shinyapps.io/cheapbutnoisymeasures/ Cheaper-but-noisier outcome measures are more likely to introduce information bias than a gold standard but may reduce selection bias because they reduce loss-to-follow-up. Researchers therefore need to form a judgement about the relative increase or decrease in bias before using a cheap-but-noisy measure. We encourage the development and validation of short form questionnaires to enable the use of high quality cheaper-but-noisier outcome measures in randomised controlled trials. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to examine the mediating role of self-compassion in the relationship between guilt–/shame-proneness and self-forgiveness. The study is based on the Hall and Fincham's self-forgiveness model which indicated guilt and shame proneness as emotional predictors of self-forgiveness. The sample consisted of 300 participants. They completed online self-report questionnaires related to shame and guilt-proneness (TOSCA-3), self-compassion (Self-Compassion Scale) and self-forgiveness (State Self-Forgiveness Scale). The multiple mediation models were developed to assess the extent to which selfcompassion mediates the relationship between shame- and guilt –proneness and selfforgiveness. The results showed that self-compassion mediated the link between shame-proneness and self-forgiveness (Total indirect effect B=-.24 CI95% [-.331 -.164]), shame-proneness and self-forgiving feeling and action (Total indirect effect B=-.15 CI95% [-.195 -.101], and shame-proneness and self-forgiving beliefs(Total indirect effect B=-.10 CI95% [-.149 -.051]). Shame activated during a transgression leads to less understanding, forbearance and compassion toward oneself. This attitude inhibits self-forgiveness. [ABSTRACT FROM AUTHOR]

The present study was conducted to determine the extent of observation of patients' privacy by physicians and nurses and its relationship with patient satisfaction. This descriptive correlational study was conducted on 600 patients selected by convenience sampling. Based on the patients' points of view, the level of observation of patients' privacy and its dimensions, especially the psychosocial dimension, were reported to be higher in nurses than in physicians. Pearson's correlation coefficient showed a direct and significant relationship between the observation of privacy by the nurses and physicians and different dimensions of patient satisfaction. [ABSTRACT FROM AUTHOR]

The current study aimed to estimate the prevalence of depression, anxiety, and suicidality and their correlated factors among high school students in Jordan. A descriptive cross-sectional correlational research design was used. Data were collected using self-reported questionnaires completed by students attending high schools in Jordan. Data show that anxiety and depression are prevalent among adolescents and are associated with higher risk of suicide and disease prevalence. Twenty-seven percent of the variance in suicidality is explained by anxiety and depression. This finding indicates that the most significant predictor of suicidality is anxiety and depression among high school students. Results show that mental health issues are a genuine general health issue among high school students. Health care professionals should routinely screen for mental health problems among young people. Mental health and well-being advancement programs should be coordinated and directed by all parties involved in youth mental health. [Journal of Psychosocial Nursing and Mental Health Services, 59(8), 43–51.] [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine the effects of ethical leadership on job satisfaction, affective commitment and burnout of health care employees, considering frustration tolerance and emotional stability as moderating variables. Design/methodology/approach: A questionnaire was used to survey health care professionals working in private and public Austrian health-care organizations (hospitals, nursing homes, rehabilitation centers and sanatoriums). The questionnaire consisted of items from well-established scales. The collected data (n = 458) was analyzed using correlation and regression analyzes. Findings: Findings indicated that ethical leadership is significantly positively related to job satisfaction (r = 0.485, p < 0.01) and affective commitment (r = 0.461, p < 0.01) and is significantly negatively related to burnout (r = −0.347, p < 0.01). The results also suggest that frustration tolerance (ß = 0.101, p < 0.1) and emotional stability (ß = 0.093, p < 0.1) moderate the relationship between ethical leadership and burnout. Furthermore, a moderation effect of emotional stability in the ethical leadership and affective commitment relation was indicated. No moderation effect was found for frustration tolerance or emotional stability for the relationship between ethical leadership and job satisfaction. Practical implications: Ethical leadership emphasizes the socio-emotional dimension in a leader-employee relationship, which can easily be neglected in times of staff cuts and work overload. Leadership training should include the development of skills in how to visibly act as a moral person, as well as how to set clear ethical standards and communicate them to employees. Originality/value: This study adds value to the limited evidence on the beneficial role of ethical leadership in health care settings. In addition, frustration tolerance and emotional stability have not before been investigated as moderators. [ABSTRACT FROM AUTHOR]

Objective: Orthorexia Nervosa is a new eating disorder and is known as an excessive control of quality of the eaten foods. During postpartum period, related to the physiological and medical changes, it was stated that most of the women have concerns about their body image and therefore they have tendency to change their lifestyle, and it can lead mothers to Orthorexia Nervosa. The aim of this study was to assess the Orthorexia Nervosa tendencies of postpartum women and investigate the related factors. Methods: This descriptive study was carried out among postpartum women between 1st December 2018-1st February 2019. We contacted with the women via e-mails through a social media group special for postpartum women which had 10.350 members at the time of study. The minimum sample size for universe was estimated as 370 women, assuming 95% confidence interval and 5% sampling error. The questionnaire consists of two parts: the general features of participants and the ORTO-11 questionnaire. Results: The mean ORTO-11 scale score of all participants (N=511) was 22.68±4.09 (min=12; max=35) and had statistically significant relationship with age, working status, vocation, family style, the understanding of being healthy, physical activity, diet status and the order of nutrition status. According to cut-off point, 87.7 % (n=426) of the participants were found to be at risk of developing Orthorexia Nervosa. Conclusions: The tendency toward Orthorexia Nervosa was greater among mothers in postpartum period. Also the mothers who change their eating habits and change the physical activity status after delivery had higher ON tendency than others. So the postpartum period is very important to follow up the mothers about ON and such eating disorders because of the changing lifestyle habits. Family physicians have a critical role in this regard with their preventive medicine qualifications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Community Health Workers (CHW) are a category of social workers described in many countries' health systems as responsible for engaging people in their residences and communities, and other non-clinical spaces to enable access to health services, especially in low-income areas. These professionals have been exposed to numerous new risks during the COVID-19 pandemic. OBJECTIVE: This study describes how the COVID-19 pandemic is perceived by CHWs who work in poor communities or slums in Brazil. METHODS: We conducted an online survey with a random sample of 775 CHWs operating in 368 municipalities of the 26 Brazilian states. At a confidence level of 95%, results of the survey were subject to a maximum sampling error of 4%. RESULTS: Our data indicate that the negationist agenda increases the challenges to the performance of CHWs within low-income communities, preventing the consensus on the necessity of social distancing, business closures and other measures to face the COVID-19 pandemic. CONCLUSION: The pandemic imposes unexpected challenges on the usual modes of interaction of public health officers with poor communities. This study provides evidence that these challenges have been ignored or minimized in Brazilian policy prescriptions for primary care in the face of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives: Health system responsiveness is a complicated issue that guides researchers in determining an efficient methodology to enhance the understanding of health care systems' perspectives. This study examined the relationship between patients' experience profiles and their satisfaction with medical outcomes. Design: The authors used 11 items from the Taiwanese Annual National Health Insurance survey and used latent class analysis (LCA) to develop experience profiles for 2012 Traditional Chinese Medicine (TCM) patients. A logistic regression model was developed to explore differences in patients' satisfaction with their treatment outcome across four groups identified using the LCA, with adjustment for demographic factors. Subjects: Patients' experiences with medical services in TCM in 2015. Outcome measures: Patients' satisfaction with their treatment outcome. Results: Participants (N = 2012) were divided into four groups. Regardless of gender and age, Group 2 (nall) held the lowest satisfaction with treatment outcome relative to those reported by the other three groups (odds ratios with p-value: Group 1 [pall]: 7.40, Group 3 [nComm]: 1.37, Group 4 [Skip]: 2.20, p < 0.001). Respondents with a more favorable patient experience reported higher satisfaction with treatment outcome. Conclusions: An increased favorable treatment experience in TCM (such as positive accessibility and better interpersonal relationships with providers) is associated with higher satisfaction with treatment outcome. The World Health Organization emphasizes that traditional medicine integrated with Western medicine can play an important role in achieving the goal of "Health for All." Health authorities should develop strategies aimed at enhancing patients' experiences in TCM to contribute to a positive care process. [ABSTRACT FROM AUTHOR]

Introduction: The promotion of a positive birth experience has been a main goal of the World Health Organization's (WHO) recent work on improving maternity care. The purpose of this study was to assess the cesarean rates, the prevalence of birth practices, perinatal outcomes, and maternal satisfaction, in women involved with the respectful maternity care (RMC) support groups in Sao Paulo, Brazil. Methods: This was a cross‐sectional study of women with low‐risk pregnancies who were assisted by professionals recommended by the RMC groups. An online questionnaire was administered. Variables to assess birth practices were classified as positive, negative, or unspecified according to the WHO guidelines. The Pearson chi‐square tests and odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were computed to assess differences between the groups. Results: Five‐hundred and eighty women completed the questionnaire. The cesarean rate was 14.7%, and the operative vaginal birth rate was 9.5%. The VBAC rate was 87.1%, and there was no significant difference in risk for cesarean between women with or without a prior cesarean. Of all women, 83.1% had a midwife's assistance and 75.5% hired a doula; 81.4% gave birth in a nonlithotomic position. The practices of enema, fasting and episiotomy were all under 2%. All 5‐minute Apgar scores were ≥7. Most (83.1%) women reported having a positive birth experience. Conclusions: Woman's engagement with the birth support groups and a transdisciplinary team focused on RMC are key elements to achieve positive perinatal outcomes and high women's satisfaction. [ABSTRACT FROM AUTHOR]

This pilot study was conducted using a sample of 374 Portuguese occupational therapists to evaluate burnout levels and prevalence among occupational therapists as well as to relate those levels to practitioner age, gender, client age, years of professional activity, and area of practice. The Copenhagen Burnout Inventory questionnaire (Portuguese version) and a sociodemographic questionnaire was used. Results showed that ∼23%, 44%, and 45% of occupational therapists presented with client-related burnout, personal burnout (PB), and work-related burnout, respectively. Higher rates of burnout were observed across all dimensions as the age of the professionals increased, with more years of working increased the client-rated rate, and client age increased the PB rate. Outcomes suggest a need to implement intervention programs to promote personal and organizational strategies to prevent burnout. [ABSTRACT FROM AUTHOR]