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Background: Advance care planning (ACP) allows patients to define their goals and preferences. Spending more time at home and less time in the hospital, along with avoiding death in the hospital, are often considered desirable outcomes of palliative care (PC). In 2015, 36% of cancer patients died in the hospital and 13% died at home in Norway. Method: From 2015 to 2022, this prospective controlled non-randomized intervention trial observed 144 cancer patients with or without an organized ACP conversation in primary health care and a summarizing palliative plan (ClinicalTrials.gov Identifier: NCT02170168, 23 June 2014). The patients were identified through contact with the local cancer outpatient clinic or hospital-based PC team. Results: A total of 128 patients died during the observation period. Of these, 67 patients had an organized ACP conversation and summarizing palliative plan (intervention (I) group) and 61 had not (control (C) group). Dying in the hospital was significantly less common for patients in the I group compared to the C group (17.9% vs. 34.4%; X2 (1, n = 128) = 4.55, p = 0.033). There were no differences between the groups in terms of where they spent their time in the last 90 days of life (home, nursing home, or hospital). Most patients (62%) preferred to die at home. The observed differences between the groups regarding preferred and actual places of death did not reach statistical significance. Conclusion: With organized ACP conversations in primary health care and a summarizing palliative plan, cancer patients died less often in the hospital in our observational study. A structured ACP approach integrating palliative care for cancer patients into primary health care can support patients´ preferences at the end of life. [ABSTRACT FROM AUTHOR]

It is important to provide the independent life support individuals with intellectual disabilities need in preparing for employment. The primary purpose of this study was to investigate the effectiveness of the Pre-Employment Independent Life Education Program (PILEP) design based on the needs to inform and support young adults. The research model is a pre-test post-test control group design. Thirty young adults with intellectual disabilities participated in the study. Also, included within the scope of the social validity study were the opinions of the participants and stakeholders in the PILEP. The PILEP consists of three modules: (1) Personal Care and Hygiene, (2) Preparation to Community Life and (3) Health and Safety. A mixed ANOVA (2x3) with two factors was performed to investigate the effectiveness of the PILEP. The results showed that PILEP was effective regarding the knowledge and skills of young adults. A significant difference (p <.05; η2 = 0.94) was found between the experimental group and control group with large effect size. In the social validity study, the opinions of the participants, their parents, employer, job teacher and lead waiter were interviewed. The opinions on the content, presentation, and implementation with multimedia design of the PILEP were positive. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to explore the effect of motor coordination on repetitive behaviors in children with Autism Spectrum Disorder (ASD) aged 5–15 years. Methods: The study employed the causal-comparative design, one of the correlational survey designs. The study was carried out with data obtained from parents of 241 children with ASD. The parents were administered the measurement tools of Gilliam Autism Rating Scale-2-Turkish Version to confirm the diagnosis of ASD, Demographic Information Form to obtain information about the child and the parent, Repetitive Behavior Scale-Revised-Turkish Version to evaluate the repetitive behaviors, and Developmental Coordination Disorder Questionnaire-07-Turkish Version to evaluate the motor coordination performance. The data were analyzed MANCOVA in the R package program. Results: The study results revealed that 72% of children with ASD had a risk of Developmental Coordination Disorder (DCD). The repetitive behaviors of children with and without DCD risk differed significantly. The severity and intensity of the repetitive behaviors of children with DCD risk were higher than those without DCD risk when age, gender, and comorbidity were taken under control. Conclusion: The motor coordination problems in children with ASD are effective on repetitive behaviors. [ABSTRACT FROM AUTHOR]

The role of universities in health promotion has been strengthened by institutional policies and the Health Promoting Universities movement. Together they seek to identify behaviours that are harmful to the health of university students and implement programs or interventions to promote the health of students within the physical environment of universities. However, the COVID-19 pandemic rapidly increased the number of students learning by distance. Under these circumstances, there is an increased need to assess the knowledge, attitudes and health practices of students in distance learning. To develop a KAP (knowledge, attitude and practice) questionnaire on the health of distance learning students. Development was carried out in four stages: 1) literature review to identify existing health programs in universities; 2) formulation of questions based on WHO theoretical frameworks, National Health Promotion Policy and the literature review; 3) selection of interdisciplinary expert judges and submission of the KAP-Health questionnaire for analysis of appearance, efficiency/consistency, clarity/understanding, pertinence of content and sequence of items; and 4) content validation by applying the content validity coefficient (CVC). The mean CVCs obtained were all equal to or greater than 0.96, 0.95 and 0.93 for the Knowledge, Attitudes and Practices domains, respectively; all comfortably above the cut-off score of 80% (CVCt = 0.80). At this stage of the study, the judges consider the content of the KAP-Health questionnaire adequate to identify issues related to the health of students in distance learning. However, it is important to note that the next step is to test the usefulness of this questionnaire. We believe that our KAP-Health instrument is both original and useful for planning institutional policies in order to implement assertive strategies to promote the health of remote-learning students in Brazil and in other parts of the world. [ABSTRACT FROM AUTHOR]

The multi-dimensional concept of empowerment is context specific, uniquely defined in various cultures, and challenging to measure. The aim of this study was to develop a scale for measuring empowerment among adolescent girls in Nepal. Twenty-nine items related to empowerment were drawn from formative, participatory research conducted in southern Nepal to comprise a draft empowerment scale. A case/control survey among 300 adolescent Nepali girls was then conducted to refine the scale. Factor analysis determined the most parsimonious scale and identified the underlying structure of items, resulting in the The Power In Nepali Girls (PING), a two-factor, 16-item empowerment scale. Factor 1 items address decision-making power and treatment in family and society. Factor 2 items address knowledge, education, and skills development. We used the 16-item scale to assess the impact of a social and financial skills program on empowerment among adolescent girls residing in southern Nepal. The PING scale is a culturally- and population-specific measure that can be used to quantify the impact of empowerment programs in Nepal among adolescent girls. The methods used also serve as a template for future work aiming to design context-specific measures of empowerment using community-engaged approaches. [ABSTRACT FROM AUTHOR]

This study aimed to understand the link between exposure to a sexual health course and nursing students' Third-year nursing students (N = 191; 83 experimental and 59 controls) were enrolled in a semi-experimental pre-and post-test study. It was found that the students who took the sexual health course had a lower belief in sexual myths than the students who did not take the course. While the sexual myth scale total average before the course was 63.65 ± 19.36, the post-course mean score was 48.64 ± 16.6. With sexual health education, individuals' false beliefs and risks regarding sexual health are reduced. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of sexual education provided via WhatsApp on the level of sexual knowledge and sexual myths in midwifery students in Turkey. Methods: Students were randomly divided into WhatsApp education, conventional education, and control groups. Data were collected using a Questionnaire Form, the Sexual Health Knowledge Test, and the Sexual Myth Scale. Results: Post-education and one-month-follow-up the Sexual Health Knowledge Test medians in the control group (24.0 and 27.0 respectively) were significantly lower than those of the WhatsApp (31.0 and 32.5 respectively) and conventional education groups (30.5 and 32.0 respectively) and Sexual Myth Scale medians in the control group (70.0 and 67.0 respectively) were significantly higher than those of the WhatsApp (55.5 and 60.0) and conventional education groups (53.0 and 55.0, respectively) (p <.001). There was no difference between WhatsApp and conventional education groups in terms of the Sexual Health Knowledge Test and Sexual Myth Scale scores (p > 0.05). Conclusion: Sexual education provided by conventional methods and via WhatsApp increased sexual health knowledge and decreased sexual myths. [ABSTRACT FROM AUTHOR]

Various treatments aimed for posttraumatic stress disorder (PTSD) have been developed for Veterans, but many are not formatted for use in groups, do not address common psychiatric comorbidities, and include inherent barriers (e.g., substantial time commitment). This program evaluation study aimed to examine the effectiveness of a five-session treatment, a Rational Emotive Behavior Therapy (REBT)- Informed Group focused on changing irrational beliefs to address comorbid depression and anxiety (as well as anger and guilt) among post-9/11 Veterans with PTSD. Participants (n = 47) completing the REBTInformed Group demonstrated significant reductions at posttreatment in depression and PTSD symptoms. Compared to Veterans in a ten-session treatment-as-usual group (n = 47), there was no significant difference in PTSD symptom improvement despite the reduction in number of sessions. The study demonstrates that a five-week group treatment for PTSD comorbid with depression or anxiety in post-9/11 Veterans -- a therapy that may be uniquely suited to a military or Veteran population, but potentially generalizable to civilians as well -- can lead to significant reductions in depression and PTSD symptoms. Future directions include development of a manual for dissemination and replication of findings of the REBT-Informed Group to other military or Veterans Affairs medical centers. [ABSTRACT FROM AUTHOR]

Health workforce cohort studies are uncommon in low-and middle-income countries (LMICs), especially those in sub-Saharan Africa. Describe the methodology and lessons learned from establishing and maintaining the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) health professional cohort study in South Africa. WiSDOM is a prospective longitudinal cohort study that commenced in 2017. The cohort focuses on the eight professional groups of clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. Annual, electronic follow-up surveys have been conducted in 2018, 2019 and 2020 with informed consent. Key steps in establishing the WiSDOM cohort include consultation, communication and marketing, stakeholder feedback, resources and infrastructure. Retention strategies consist of an electronic database, detailed cohort contact information, cohort engagement, communication and feedback, short survey tools, and appropriate incentives. We obtained an overall response rate of 89.5% at baseline in 2017, 79.6% in 2018, 68.3% in 2019 and 72.8% in 2020. The largest decline in response rates is for medical doctors: 66.0% response rate in 2018, 53.2% in 2019 and 58.2% in 2020. However, for each of the three follow-up surveys, we have obtained response rates in excess of 80% for clinical associates, dentists, nurses, oral hygienists, pharmacists and physiotherapists. Since baseline, the outright refusals have remained very low at 4.7%. The multiple logistic regression analysis showed that self-identified race was the only significant socio-demographic difference between medical doctor respondents and non-respondents. Black African doctors and Indian doctors were 2.0 and 2.6 times more likely respectively to respond than White doctors (p < 0.05). Other LMICs can learn from WiSDOM's lessons of establishing and maintaining a health professional cohort that aims to generate new knowledge for health system transformation. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore if consequent use of chest X-ray (CXR), when the physician is not sure of the diagnosis of pneumonia after clinical examination and CRP-testing, favors a more restrictive prescribing of antibiotics. This was an intervention study conducted between September 2015 and December 2017. Two intervention primary health care centers (PHCCs) and three control PHCCs in the southeast of Sweden. All patients were referred for CXR when the physician´s suspicion of pneumonia was 'unsure', or 'quite sure' after CRP-testing. Control units managed patients according to their usual routine after clinical examination and CRP-testing. A total of 104 patients were included in the intervention group and 81 patients in the control group. The inclusion criteria of the study were clinically suspected pneumonia in patients ≥18 years, with respiratory symptoms for more than 24 h. Main outcome measure: Antibiotic prescribing rate. In the intervention group, 85% were referred for CXR and 69% were prescribed antibiotics, as compared to 26% and 77% in the control group. The difference in antibiotic prescribing rate was not statistically significant, unadjusted OR 0.68 [0.35–1.3] and adjusted OR 1.1 [CI 0.43–3.0]. A total of 24% of patients with negative CXR were prescribed antibiotics. This study could not prove that use of CXR when the physician was not sure of the diagnosis of pneumonia results in lowered antibiotic prescribing rate in primary care. In cases of negative findings on CXR the physicians do not seem to rely on the outcome when it comes to antibiotic prescribing. Routine use of chest X-ray when the clinical diagnosis of pneumonia is uncertain has not been proven to result in lowered antibiotic prescribing rate. Physicians do not fully rely on chest X-ray outcome and to some extent prescribe antibiotics even if negative, when community-acquired pneumonia is suspected. Chest X-ray is already used in one out of four cases in routine primary care of pneumonia patients in Sweden. [ABSTRACT FROM AUTHOR]

Background: Randomised controlled trials (RCTs) are a gold standard for evaluations in public health, economics and social sciences, including prevention of violence against women (VAW). They substantially reduce bias, but do not eliminate measurement error. Control arms often show change, but this is rarely systematically examined. Objective: We present a secondary analysis of data from the control arms of evaluations of VAW prevention programming to understand measurement variance over time, factors that may systematically impact this and make recommendations for stronger trial design and interpretation. Methods: We examine data from six RCTs and one quasi-experimental study, all of which used comparable measures. We look at change over time among control participants in prevalence of physical intimate partner violence (IPV), sexual IPV, and severe physical/sexual IPV, by participants' gender and study design (cohort vs. repeat cross-sectional). Results: On average, repeated assessments of past year IPV varied by 3.21 (95%Cis 1.59,4.83) percentage points for the studies with no active control arms. The prevalence at endline, as a proportion of that at baseline, on average differed by 17.7%. In 10/35 assessments from 4/7 studies, the difference was more than 30%. We did not find evidence of the Hawthorne effect or repeat interview bias as explanations. Our findings largely supported non-differential misclassification (measurement error) as the most likely error and it was a greater problem for men. Conclusions: Control arms are very valuable, but in VAW research their measures fluctuate. This must be considered in sample size calculations. We need more rigorous criteria for determining trial effect. Our findings suggest this may be an absolute change in prevalence of 7% and proportionate change of 0.4 or more (especially for studies in populations with lower IPV prevalence (<20%)). More elaborate pre-defined outcomes are necessary for determining impact (or possible harms) of VAW prevention interventions. [ABSTRACT FROM AUTHOR]

Unmet need for family planning (FP) remains prevalent worldwide. In Tanzania, 21.7% of women desire to delay pregnancy, but do not use modern contraception despite its free availability at local clinics. Our prior data suggest that this is related to complex gender and religious dynamics in rural communities. To understand how education about FP could be improved, we developed a discrete choice experiment (DCE) to rank preferences of six attributes of FP education. Results were stratified by gender. Sixty-eight women and 76 men completed interview-assisted DCEs. Participants significantly preferred education by a clinician (men = 0.62, p <.001; women = 0.38, p <.001) and education in mixed-gender groups (men = 0.55, p <.001; women = 0.26, p <.001). Women also significantly preferred education by a religious leader (0.26, p =.012), in a clinic versus church, mosque, or community centre (0.31, p =.002), and by a female educator (0.12, p =.019). Men significantly preferred a male educator (0.17, p =.015), whom they had never met (0.25, p <.001), and educating married and unmarried people separately (0.22, p =.002). Qualitative data indicate women who had not previously used contraception preferred education led by a religious leader in a church or mosque. FP education tailored to these preferences may reach a broader audience, dispel misconceptions about FP and ultimately decrease unmet need. [ABSTRACT FROM AUTHOR]

Objectives: Given the pervasiveness of emotional and behavioral deficits of individuals with Autism Spectrum Disorders (ASD), there is a pressing need for effective interventions to address their difficulties on Facial Expression Recognition and Emotion Understanding (FER/EU). Qunatiandi, a structured, app-based intervention program that is designed for Chinese children with ASD was utilized in this study. Three young children (two girls and one boy; age M = 4.94 years) completed an 8-week one-on-one intervention in a rehabilitation center setting. It was hypothesized that the three children would show greater progress in their FER/EU. Methods: In this study, a modified multiple probe across the program phases design was used; the dependent variable was the percentage of unprompted correct receptive identification responses for FER/EU tests during instruction and probes. Data were taken during baseline, the endpoint of instruction sessions, and a maintenance stage followed by intervention termination. Results: Findings of the study revealed that all participants demonstrated significant improvements in social acuity, gains were mostly achieved on emotion distinguishing and understanding (above 80% of accuracy). A similar scoring pattern was also found in the maintenance probe phase. Conclusion: The study is one of only a few early intervention projects to improve FER/EU skills for children with ASD using an app-based intervention. The results demonstrated that children with ASD can experience increases in emotion distinguishing and understanding skills. Maintenance probe results showed that the interventional effect can be maintained for a period of time after intervention. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to determine the long-term effect (18 months) of 40 g daily consumption of whole soy bean on metabolic syndrome (MetS) in apparently healthy women. Design: Single-system experimental design. Subjects and setting: Ninety women were randomly recruited from three communities in Qwa-Qwa, Free State province. Outcome measures: Dietary intake (24-h recall questionnaire), waist circumference (WC), blood pressure, fasting venous blood samples for total serum cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TRGs) and glucose analyses. Results: The prevalence of MetS was significantly (p < 0.001) reduced from 53.3% to 34.4% after the intervention. The most prominent risk factors were low serum HDL-C and high serum TRG levels followed by obesity (WC). After the intervention, the MetS group had significantly improved mean serum glucose (p = 0.013), systolic (p < 0.001) and diastolic (p < 0.001) blood pressure. No significant improvements were observed in the non-MetS group. Conclusions: The prevalence of MetS is high in black women residing in Qwa-Qwa. Despite the beneficial metabolic effects observed in this study, a relationship between soy protein consumption and MetS risk factors could not statistically be confirmed. However, soy is a source of good-quality protein and is often used in low-income households as a replacement for other more expensive protein sources and the use of soy should not be discontinued as it may have a beneficial effect on MetS and may play a role in preventing MetS. More research is needed in large-scale case-control studies to determine the effect of soy consumption on MetS risk factors. Social media message: Research has shown that soy may be beneficial for ameliorating some of the metabolic syndrome risk factors. [ABSTRACT FROM AUTHOR]

The article presents a study focused on the development of an assessment tool for the clinical reasoning (CR) in orthopaedic manual physical therapy (OMPT) by using the theory-informed technique. Topics related to the study that are discussed includes use of modified Delphi method in the study, international education standards used in the assessment criteria and psychometric theory.

Background: Currently, antiretroviral therapy (ART) is recommended for all HIV-positive patients with tuberculosis (TB). The timing of ART during the course of anti-TB treatment is based on CD4 cell counts. Access to CD4 cell testing is not universally available; this constitutes an obstacle for the provision of ART in low-income countries. Objective: To determine clinical variables associated with HIV co-infection in TB patients and to identify correlations between clinical variables and CD4 cell strata in HIV/TB co-infected subjects, with the aim of developing a clinical scoring system for the assessment of immunosuppression. Design: Cross-sectional study of adults with TB (with and without HIV co-infection) recruited in Ethiopian outpatient clinics. Clinical variables potentially associated with immunosuppression were recorded using a structured questionnaire, and they were correlated to CD4 cell strata used to determine timing of ART initiation. Variables found to be significant in multivariate analysis were used to construct a scoring system. Results: Among 1,116 participants, the following findings were significantly more frequent in 307 HIV-positive patients compared to 809 HIV-negative subjects: diarrhea, odynophagia, conjunctival pallor, herpes zoster, oral candidiasis, skin rash, and mid-upper arm circumference (MUAC) <20 cm. Among HIV-positive patients, conjunctival pallor, MUAC <20 cm, dyspnea, oral hairy leukoplakia (OHL), oral candidiasis, and gingivitis were significantly associated with <350 CD4 cells/mm3. A scoring system based on these variables had a negative predictive value of 87% for excluding subjects with CD4 cell counts <100 cells/mm3; however, the positive predictive value for identifying such individuals was low (47%). Conclusions: Clinical variables correlate with CD4 cell strata in HIV-positive patients with TB. The clinical scoring system had adequate negative predictive value for excluding severe immunosuppression. Clinical scoring systems could be of use to categorize TB/HIV co-infected patients with regard to the timing of ART initiation in settings with limited access to laboratory facilities. [ABSTRACT FROM AUTHOR]

Objectives. To investigate the relationship between the length of a medical consultation in a general practice setting and the biopsychosocial information obtained by the physician, and to explore the characteristics of young physicians obtaining comprehensive, especially psychosocial information. Design. A prospective, longitudinal follow-up study. Setting. Videotaped consultations with standardized patients on two occasions were scored for the amount of biopsychosocial information obtained. Consultation length was recorded in minutes. Subjects. Final-year (T-1) medical school students (n = 111) participated in the project. On completion of their internship one and a half years later (T-2), 62 attended a second time, as young physicians. Main outcome measures. Content lists. Results. Pearson's r correlations between content and length at T-1 and T-2 were 0.27 and 0.66, respectively (non-overlapping confidence intervals). Psychosocial content increased significantly when consultations exceeded 13 minutes (15 minutes scheduled). Physicians using more than 13 minutes had previously, as hospital interns, perceived more stress in the emergency room and had worked in local hospitals. Conclusions. A strong association was found between consultation length and information, especially psychosocial information, obtained by the physicians at internship completion. This finding should be considered by faculty members and organizers of the internship period. Further research is needed to detect when, during the educational process, increased emphasis on communication skills training would be most beneficial for students/residents, and how the medical curriculum and internship period should be designed to optimize young physicians' use of time in consultations. [ABSTRACT FROM AUTHOR]