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Purpose: Emergency and disaster management planning is an emerging role with limited practical guidance on how it should be implemented by community, disability, health and rehabilitation service providers. This study examined the emergency preparedness of service providers and how they viewed their role and contributions to disaster risk reduction, including their capacity and willingness to facilitate preparedness planning with their clients. Materials and Methods: A questionnaire was developed and administered nationally. Descriptive statistics, multivariate regression analyses, and thematic analysis of open-ended questions provide insight on the knowledge, tools and training needs of service providers to contribute to preparedness of themselves and the people they support. Results: Facilitating emergency preparedness with people with disability was strongly associated with a high level of mental preparedness, household preparedness scores, and completion of Person-Centred Emergency Preparedness (P-CEP) training. Perceived lack of funding, insufficient tools, and exclusion of emergency planning from job descriptions were negatively associated with facilitating emergency preparedness with clients. Conclusions: Study findings lay the groundwork for development of the role and capabilities of individual service providers including the need to equip disability, health and rehabilitation service providers with training and tools to prepare themselves and the people they support for emergencies. IMPLICATIONS FOR REHABILITATION: Participation in emergency training such as psychological first aid, evacuation drills, and Person-Centred Emergency Preparedness (P-CEP) can increase the personal preparedness of service providers. Rehabilitation professionals are advised to develop their capabilities in emergency preparedness before facilitating emergency planning with their clients. Rehabilitation professionals should connect with their local emergency services to learn about disaster risks and preparedness actions they can take to increase personal emergency preparedness for themselves and their clients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and compare responsiveness characteristics for the Foot Function Index revised short form (FFI-RS), RAND-12 Health Status Inventory (RAND-12), and Numeric Rating Scale (NRS), in patients with plantar fasciopathy receiving non-surgical treatment. Materials and methods: This study was conducted on a sub-group of patients from an ongoing randomised controlled trial. One-hundred fifteen patients were included. The patient-reported outcome measures (PROMs) were applied at baseline and after 6 months. Responsiveness was calculated using standardised response mean and area under the receiver operating characteristic (ROC) curve. ROC curves were used to compute the minimal important change (MIC) for the outcome measures. Results: The region specific FFI-RS had best responsiveness and the NRS at rest had lowest responsiveness. Conclusion: FFI-RS were marginally more responsive than the other PROMs. Responsiveness and MIC estimates should be regarded as indicative rather than fixed estimates. IMPLICATIONS FOR REHABILITATION: The region-specific Foot Function Index Revised Short Form could, based on responsiveness perspectives, be recommended as an outcome measurement for patients with plantar fasciopathy. Responsiveness and minimal important change estimates are indicative and should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Purpose: This review investigated the effectiveness of adjuvant therapy combined with constraint-induced movement therapy (CIMT) in improving the paretic upper limb functionality in adults with stroke sequelae during the subacute to chronic rehabilitation phase. Materials and methods: In this systematic review and meta-analysis of randomized controlled trials (RCT), electronic databases, including PubMed, Web of Science, CINAHL, and MEDLINE, were searched. We included RCTs that investigated the outcomes of adjuvant therapy (i.e. other therapies) added to CIMT compared with CIMT alone. Key trial findings were qualitatively synthesized and analyzed. This meta-analysis examined variables, such as mean scores and standard deviations, using the following outcome measures: Fugl-Meyer Assessment (FMA) upper limb items, Action Research Arm Test (ARAT), Amount of Use (AOU) of Motor Activity Log (MAL), and Quality of Movement (QOM) of MAL. Results: Eighteen eligible RCTs were included in the analysis. Adding CIMT to adjunctive therapy significantly improved FMA compared with CIMT alone (mean difference [MD] 4.02, 95% confidence interval [CI] 2.60–5.44; I2 = 85%; 15 studies; 330 participants). Similarly, the ARAT and MAL-AOU scores improved significantly. Conclusions: CIMT combined with several adjunctive therapies effectively improved upper limb function. IMPLICATIONS FOR REHABILITATION: In recent years, clinical trials combining other therapies with Constraint-induced movement therapy (CIMT) have become increasingly common. This study shows that combining CIMT with adjuvant therapy improves upper limb function. Different protocols of the CIMT in each study could be factor that impacted the results of Motor Activity Log. In clinical practice, the findings of this study into their treatment protocols to improve patient outcomes and ensure the effective application of evidence-based rehabilitation strategies. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to assess the efficacy of robot-assisted rehabilitation training on upper and lower limb motor function and fatigue in Parkinson's disease (PD), and to explore the best-acting robotic rehabilitation program. Methods: We searched studies in seven databases and the search period was from the build to 30 June 2023. Two researchers independently screened studies and assessed the quality of the studies for data extraction. Results: A total of 21 studies were included, 18 studies related to lower limbs rehabilitation and 3 studies related to upper limbs rehabilitation, involving a total of 787 participants. The results showed that robot-assisted rehabilitation significantly improved indicators of lower limb motor function UPDRS Part III (WMD = −3.58, 95% CI = −5.91 to −1.25, p = 0.003) and BBS (WMD = 4.24, 95% CI = 2.88 to 5.54, p < 0.001), as well as non-motor symptoms of fatigue (WMD = −13.39, 95% CI = −17.92 to −8.86, p < 0.001) in PD patients. At the level of upper limb function, there was no statistically significant difference in the outcome measures of PFS (WMD = −0.25, 95% CI = −4.44 to 3.93, p = 0.9) and BBT (WMD = 1.73, 95% CI = −2.85 to 6.33, p = 0.458). Conclusion: Robot-assisted rehabilitation significantly improved motor function, fatigue, and balance confidence in PD patients, but current evidence doesn't show that intelligent rehabilitation systems improve upper limb function. In particular, robotics combined with virtual reality worked best. IMPLICATIONS OF REHABILITATION: Robot-assisted rehabilitation significantly improves motor symptoms, lower limb motor function, fatigue, and balance confidence in Parkinson's disease (PD) patients. Robotics combined with virtual reality is the most effective application and should be encouraged. In the robotic rehabilitation of PD patients, the focus needs to be on the duration of the training and the long-term benefits it provides. [ABSTRACT FROM AUTHOR]

Purpose: Return-to-work coordinators (RTWCs) give people on sick leave individualized support and coordinate between different stakeholders, including physicians. The aim of this study was to explore physicians' experience of RTWCs and investigate factors that influence how much physicians collaborate with RTWCs, or refer patients to them, in primary, orthopaedic, and psychiatric care clinics. Materials and methods: Of the 1229 physicians responding to a questionnaire, 629 physicians who had access to a RTWC in their clinic answered to questions about collaborating with RTWCs. Results: Among physicians who had access to a RTWC, 29.0% collaborated with a RTWC at least once a week. Physicians with a more favourable experience of RTWCs reported more frequent collaboration (adjusted OR 2.92, 95% CI 2.06–4.15). Physicians also collaborated more often with RTWCs if they reported to often deal with problematic sick-leave cases, patients with multiple diagnoses affecting work ability, and conflicts with patients over sickness certification. Conclusions: Physicians who had more problematic sick-leave cases to handle and a favourable experience of RTWCs, also reported collaborating more often with RTWCs. The results indicate that RTWCs' facilitation of contacts with RTW stakeholders and improvements in the sickness certification process may be of importance for physicians. IMPLICATIONS FOR REHABILITATION: This study of physicians' experience of collaborating with return-to-work coordinators (RTWCs) observes that physicians reported more collaboration with or referrals to coordinators if they had a favourable experience of coordinators. The results indicate that physicians report more collaboration with or referrals to RTWCs if they had more problematic sick-leave cases to handle in the clinic. These findings imply that it might be possible to increase the collaboration between physicians and RTWCs in clinical settings by managing factors of importance. [ABSTRACT FROM AUTHOR]

Self-efficacy, perceived social support, and resilience in caregivers of first-stroke patients are closely related, while the interaction mechanism remains unclear. This research explores the mediation effect of self-efficacy in the relationship between perceived social support and resilience in caregivers of first-stroke patients in China. Convenience sampling was designed and used to recruit participants from the General Hospital of Northern Theater in Shenyang, Liaoning Province, China, from February to October 2022, in which 207 self-reported participants completed the Connor-Davidson Resilience Scale (CD-RISC), Multidimensional Scale of Perceived Social Support (MSPSS) and General Self Efficacy Scale (GSES). In addition, the mediation effect of self-efficacy between perceived social support and resilience was determined by the PROCESS macro for SPSS. Among the 207 caregivers of patients with first-stroke, the mean CD-RISC, MSPPS and GSES scores were (72.17 ± 11.28), (71.17 ± 8.99), and (29.64 ± 5.03) respectively. Caregivers' self-efficacy was positively correlated with perceived social support (r = 0.439, p < 0.01) and resilience (r = 0.730, p < 0.01). Self-efficacy served a mediation function partially between perceived social support and resilience, whose effect accounted for 52.90% of the total. Both simple and mediation roles of perceived social support and self-efficacy are established in the relationship of resilience among caregivers of first-stroke patients. Positive social support and self-efficacy are two important targets for future interventional studies, and interventions on them may synergistically improve resilience. Hence, the nurses and community workers should correctly evaluate social support and self-efficacy, confirm the health education requirements, and implement counseling intervention to protect and improve the health of first-stroke patients and their families. [ABSTRACT FROM AUTHOR]

Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact. 1) compare characteristics for individuals who before stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators. Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan–Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed. A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension. Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator. Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified. [ABSTRACT FROM AUTHOR]

People post-stroke experience increased loneliness, compared to their healthy peers and loneliness may have increased during COVID due to social distancing. How social distancing affected loneliness among people after stroke is unknown. Bandura's self-efficacy theory suggests that self-efficacy may be a critical component affecting individuals' emotions, behaviors, attitudes, and interpretation of everyday situations. Additionally, previous studies indicate that self-efficacy is associated with both loneliness and social participation. This study investigates relationships among self-efficacy, social participation, and loneliness in people with stroke. Determine how social participation affects the relationship between self-efficacy and loneliness in people with stroke during the COVID-19 pandemic. 44 participants were community-dwelling individuals, ≥ 6 months post-stroke who participated in a 2-hour phone interview. A regression-based mediation analysis was conducted using these measures: Participation Strategies Self-Efficacy Scale, Activity Card Sort for social participation, and UCLA Loneliness Scale for loneliness. The total effect of self-efficacy on loneliness was significant (b = -0.36, p =.01). However, social participation fully mediated the relationship between self-efficacy and loneliness (indirect effect, b = -0.11, 95% CI [−0.24, −0.01]; direct effect, b = -0.25, 95% CI [−0.03, 0]). Self-efficacy is associated with both social participation and loneliness in people with stroke in this cross-sectional study. Mediation analysis findings suggest that interventions focused on increasing social participation may prevent or potentially alleviate loneliness in people with stroke who have low self-efficacy. [ABSTRACT FROM AUTHOR]

Background: Although there are a growing number of studies investigating the benefits of music therapy interventions with patients diagnosed with cancer, few studies have taken an approach that specifically examines indices of perceived well-being in women with breast cancer. Overcoming these challenges can be an important step in the recovery process. Purpose: The purpose of our study was to know the positive influence of responsive music therapy through gong sounds, emitted live, on different areas of well-being of women with breast cancer. Methods: Four individual sessions of responsive music therapy with live gong sounds were conducted in which three women (M = 54; SD = 5.57) participated both in the music therapy program and in the completion of the Functional Assessment of Cancer Therapy – Breast (FACT-B) and a semi-structured interview with ad hoc designed questions about perception of qualitative aspects. Results: The results showed that the music therapy sessions significantly improved, p =.043 < 0.05, various domains of perceived well-being in women with breast cancer. Discussion: This article highlights several key benefits associated with music therapy and various indices of well-being in women with breast cancer, identifies the limitations of the study, and discusses the findings. It is considered necessary to replicate this practice in future studies that include a larger sample and age range over longer follow-up periods. Translation for Health Education Practice: The text highlights the importance of considering music therapy as a complementary intervention in comprehensive cancer care programs, which may be relevant to health educators when considering intervention and support approaches for cancer patients. Health education interventions targeting the enhancement of cancer patients' well-being should incorporate music therapy techniques. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) has been associated with decreased symptoms of depression and anxiety in the general population, but more consistent evidence is needed in the university population. Purpose: Investigate the association between physical activity and depressive and anxiety symptoms in undergraduates. Methods: 100 university students (23 ± 4 years, 47% female) were included in this cross-sectional study. We performed multiple linear regression analyses to investigate the association between the main variables. Results: The physical activity (MET/min/week) had a significant association with depressive (F(2, 97) = 15.104, p <.001; adjusted R2 =.222) and anxiety symptoms (F(2, 97) = 11.853 p <.001; adjusted R2 =.180), explaining these outcomes in approximately 22% and 18%, respectively. Moderate or vigorous physical activity did not have an association with depressive (B = −0.10, t = −0.700, p =.486) or anxiety symptoms (B = −0.11, t = 0.725, p =.470). Discussion: Individuals with high levels of physical activity have lower depressive and anxiety symptoms than individuals with lower levels of PA. Translation to Health Education Practice: Increasing the level of physical activity may be a viable strategy to reduce symptoms of anxiety and depression in university students. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) [ABSTRACT FROM AUTHOR]

Background: Maintaining a pleasant work environment and striking a healthy work-life balance are critical for improving employee well-being and performance. The Job Stress and Health model sheds light on acute challenges that employees confront as a result of numerous work-related or external variables. The COVID-19 epidemic has resulted in abrupt changes in work habits and lifestyles, resulting in severe stress and disruptions to people's physical and mental health around the world. Purpose: During the pandemic, this study was undertaken to investigate employee work pattern choices, such as work from home, blended work, or work from the office. Methods: This study examined how work pattern decisions affected HEI employees' well-being during the COVID-19 epidemic using the Job Stress and Health model and an online survey. To investigate work model preferences and challenges, demographics, work patterns, and well-being indicators including sleep and performance were collected and evaluated using descriptive and inferential statistics. The study questionnaire was close-ended and prepared in English. Results: Even after the pandemic, a significant proportion of employees preferred the blended work paradigm, showing the long-term impact of the shift in work habits. Furthermore, the shift in work schedules has had an impact on employee well-being, particularly changes in sleep patterns. Discussion: Even though the employees of higher education are adaptable and accept a blended work model, it is important to note that work-related stress and inefficiency can arise depending on the resource requirements. Also, physical and mental health aspects while working remotely or in a blended model need consideration, especially when implemented in the long term. Translation to Health Education Practice: Understanding the effects of these work pattern choices on employee well-being is critical for organizations to adopt policies that foster a healthy work environment and assist employees in reaching optimal work-life balance. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) . [ABSTRACT FROM AUTHOR]

Shock is circulatory insufficiency, inadequate oxygen delivery, and cellular hypoxia. Intravenous fluids are essential for shock management. Despite treatment, patients can face persistent shock with ongoing hypotension, contributing to higher mortality. This analysis aims to quantify hypotensive non-traumatic cases in an Australian ambulance service, determine persistent hypotension prevalence, and assess paramedic-administered intravascular fluids' impact on blood pressure changes. This study is a retrospective analysis of prehospital fluid resuscitation by New South Wales Ambulance paramedics during 2022. Hypotension is defined as a systolic blood pressure of ≤ 90 mmHg, and persistent hypotension is a systolic blood pressure consistently below 90 mmHg across all observations, with a final blood pressure below 90 mmHg. This study aimed to determine the volume of fluid resuscitation at which a plateau in population-level systolic blood pressure response is observed, by calculating the derivative of the fitted logistic regression model. Moreover, this analysis identified the relative contribution of factors influencing the probability of an attempt at intravenous or intraosseous access using machine learning. Among 796,865 attendances, 23,049 (2.9%) involved non-traumatic patients with hypotension. In total 7,388 (32.1%) of the hypotensive cases resulted in persistent hypotension, of which 3,235 (43.8%) received Hartmann's solution and 1,745 (53.9%) received at least 500 ml of fluids but still had hypotension. The model showed that systolic blood pressure tends to stop increasing after 500–600 milliliters of fluid are given. This suggests that, on average, giving more fluid than this may not raise blood pressure further in a prehospital setting, though individual patient needs can differ. The top four factors from the machine learning shows that as initial respiratory rate goes up, the probability of intravascular access rises. Transport times less than 20 min are associated with a smaller chance of access and younger patients are less likely to receive an attempt. Finally, extremes of systolic blood pressure are more likely to receive access attempts. This study found that three percent of non-traumatic attendances have at least one episode of hypotension, and that more than half of these have persistent hypotension. Only 44% of persistently hypotensive received fluids, and half of persistently hypotensive patients stayed hypotensive despite a reasonable volume of prehospital crystalloids. [ABSTRACT FROM AUTHOR]

The optimal initial vascular access strategy for out-of-hospital cardiac arrest (OHCA) remains unknown. Our objective was to evaluate the association between peripheral intravenous (PIV), tibial intraosseous (TIO), or humeral intraosseous (HIO) as first vascular attempt strategies and outcomes for patients suffering OHCA. This was a secondary analysis of the Portland Cardiac Arrest Epidemiologic Registry, which included adult patients (≥18 years-old) with EMS-treated, non-traumatic OHCA from 2018–2021. The primary independent variable in our analysis was the initial vascular access strategy, defined as PIV, TIO, or HIO based on the first access attempt. The primary outcome for this study was the return of spontaneous circulation (ROSC) at emergency department (ED) arrival (a palpable pulse on arrival to the hospital). Secondary outcomes included survival to: admission, discharge, and discharge with a favorable outcome (Cerebral Perfusion Category score of ≤2). We conducted multivariable logistic regressions, adjusting for confounding variables and for clustering using a mixed-effects approach, with prespecified subgroup analyses by initial rhythm. We included 2,993 patients with initial vascular access strategies of PIV (822 [27.5%]), TIO (1,171 [39.1%]), and HIO (1,000 [33.4%]). Multivariable analysis showed lower odds of ROSC at ED arrival (adjusted odds ratio [95% CI]) with TIO (0.79 [0.64–0.98]) or HIO (0.75 [0.60–0.93]) compared to a PIV-first strategy. These associations remained in stratified analyses for those with shockable initial rhythms (0.60 [0.41–0.88] and 0.53 [0.36–0.79]) but not in patients with asystole or pulseless electrical activity for TIO and HIO compared to PIV, respectively. There were no statistically significant differences in adjusted odds for survival to admission, discharge, or discharge with a favorable outcome for TIO or HIO compared to the PIV-first group in the overall analysis. Patients with shockable initial rhythms had lower adjusted odds of survival to discharge (0.63 [0.41–0.96] and 0.64 [0.41–0.99]) and to discharge with a favorable outcome (0.60 [0.39–0.93] and 0.64 [0.40–1.00]) for TIO and HIO compared to PIV, respectively. TIO or HIO as first access strategies in OHCA were associated with lower odds of ROSC at ED arrival compared to PIV. [ABSTRACT FROM AUTHOR]

Emergency medical services (EMS) clinicians are tasked with early fluid resuscitation for patients with sepsis. Traditional methods for prehospital fluid delivery are limited in speed and ease-of-use. We conducted a comparative effectiveness study of a novel rapid infusion device for prehospital fluid delivery in suspected sepsis patients. This pre-post observational study evaluated a hand-operated, rapid infusion device in a single large EMS system from July 2021-July 2022. Prior to device deployment, EMS clinicians completed didactic and simulation-based device training. Data were extracted from the EMS electronic health record. Eligible patients included adults with suspected sepsis treated by EMS with intravenous fluids. The primary outcome was the proportion of patients receiving goal fluid volume (at least 500 mL) prior to hospital arrival. Secondary outcomes included in-hospital mortality, disposition, and length of stay. Multivariable logistic regression was used to compare outcomes between 6-month pre- and post-implementation periods (July-December 2021 and February-July 2022, respectively), adjusting for patient demographics, abnormal prehospital vital signs, and EMS transport interval. Of 1,180 eligible patients (552 in the pre-implementation period; 628 in the post-implementation period), the mean age was 72 years old, 45% were female, and 25% were minority race-ethnicity. Median (interquartile range) fluid volume (in mL) increased between the pre- and post-implementation periods (600 [400,1,000] and 850 [500–1,000], respectively). Goal fluid volume was achieved in 70% of pre-implementation patients and 82% of post-implementation patients. In adjusted analysis, post-implementation patients were significantly more likely to receive goal fluid volume than pre-implementation patients (adjusted odds ratio (aOR) 2.00, 95% confidence interval (CI) 1.51–2.66). Pre-post in-hospital mortality was not significantly different (aOR 0.91, 95% CI 0.59–1.39). In a single EMS system, sepsis education and introduction of a rapid infusion device was associated with achieving goal fluid volume for suspected sepsis. Further research is needed to assess the clinical effectiveness of infusion device implementation to improve sepsis patient outcomes. [ABSTRACT FROM AUTHOR]

This systematic review aims to identify the diagnostic accuracy of posterior circulation stroke (PCS) by paramedics and the causes and duration of delay in its recognition. A systematic search using CINAHL Plus, MEDLINE, Scopus, and PubMed was performed. All databases were searched up to May 25, 2022. Studies were included where patients were adults, assessed by paramedics, and PCS was the primary diagnosis. Bias was assessed using the Newcastle-Ottawa Scale and the Effective Practice and Organization of Care tool. Results have been described by proportions, and both sensitivity calculations and subgroup analysis were performed utilizing MedCalc. A total of 797 titles/abstracts and a subsequent 87 full texts were screened, of which 15 were included. There were 5395 patients who were assessed by paramedics and had a confirmed diagnosis of PCS. Among five studies containing both true positive and false negative data, there were 98 (45.8%) true positives. PCS patients lost an average of 27 min (p < 0.001) compared to anterior stroke patients in the prehospital setting. One study revealed that educational intervention, including implementing the finger-to-nose test, increased the sensitivity for diagnosis from 45.8 to 74.1% (p = 0.039) and decreased the time from door to computed tomography from 62 to 41 min (p = 0.037). There is a substantial lack of evidence regarding the diagnosis of PCS by paramedics. Despite the low quality of evidence available, overall, the sensitivity for paramedic PCS diagnosis appears to be poor. Further investigation is required into paramedics' diagnosis of PCS and the use of educational interventions. Prospective Register of Systematic Reviews Registration Number: CRD42022324675. [ABSTRACT FROM AUTHOR]

Globally, very few settings have undertaken prehospital randomized controlled trials. Given this lack of experience, there is a risk that such trials in these settings may result in protocol deviations, increased prehospital intervals, and increased cognitive load, leading to error. Ultimately, this may affect patient safety and mortality. The aim of this study was to assess the effect of trial-related procedures on simulated scene interval, self-reported cognitive load, medical errors, and time to action. This was a prospective simulation study. Using a cross-over design, ten teams of prehospital clinicians were allocated to three separate simulation arms in a random order. Simulations were: (1) Eligibility assessment and administration of freeze-dried plasma (FDP) and a hemoglobin-based oxygen carrier (HBOC), (2) Eligibility assessment and administration of HBOC, (3) Eligibility assessment and standard care. All simulations also required clinical management of hemorrhagic shock. Simulated scene interval, error rates, cognitive load (measured by NASA Task Load Index), and competency in clinical care (assessed using the Simulation Assessment Tool Limiting Assessment Bias (SATLAB)) were measured. Mean differences between simulations with and without trial-related procedures were sought using one-way ANOVA or Kruskal-Wallis test. A p-value of <0.05 within the 95% confidence interval was considered significant. Thirty simulations were undertaken, representing our powered sample size. The mean scene intervals were 00:16:56 for Simulation 1 (FDP and HBOC), 00:17:22 for Simulation 2 (HBOC only), and 00:14:24 for Simulation 3 (standard care). Scene interval did not differ between the groups (p = 0.27). There were also no significant differences in error rates (p = 0.28) or cognitive load (p = 0.67) between the simulation groups. There was no correlation between cognitive load and error rates (r = 0.15, p = 0.42). Competency was achieved in all the assessment criteria for all simulation groups. In a simulated environment, eligibility screening, performance of trial-related procedures, and clinical management of patients with hemorrhagic shock can be completed competently by prehospital advanced life support clinicians without delaying transport or emergency care. Future prehospital clinical trials may use a similar approach to help ensure graded and cautious implementation of clinical trial procedures into prehospital emergency care systems. [ABSTRACT FROM AUTHOR]

Varying rates of complications have been reported for prehospital sedation with ketamine, and the relationship to dosing has not been studied on a large scale. We evaluated the association between prehospital ketamine dosing and rates of intubations and other adverse events in patients with behavioral emergencies. Using the 2018/2019 ESO public-use research datasets, we included all non-traumatic, adult behavioral and drug-related EMS encounters with ketamine administration. Based on consensus guidelines, we stratified patients into "above" and "at/below" the maximum dosing for sedation (2 mg/kg IV/IO or 5 mg/kg IM) using the highest single dose of ketamine given. We created propensity scores for matched subjects using 1:1 propensity score matching. Using logistic regression, we compared rates of intubation and other airway interventions, antipsychotic coadministration, improvement reported by EMS, hypoxia, hypotension, and cardiac arrest between the two groups. We included 2383 patients: 478 in the above and 1905 in the at/below dose group. Above-dose ketamine was associated with a higher rate of intubation or supraglottic airway placement (6.4% v 3.3%, OR 2.0, 95% CI 1.00–3.90). Other airway interventions were similar (40.0% v 40.0%, OR 1, 95% CI 0.80–1.30). The above-dose group also showed a higher rate of improvement noted by EMS clinicians (92.5% v 88.7%, OR 1.6, 95% CI 1.01–2.40). The rates of antipsychotic coadministration, hypoxia, hypotension, and cardiac arrest were similar between the cohorts. Patients given ketamine doses above consensus recommendations for sedation appeared more likely to receive prehospital intubation but not more likely to experience other adverse events. [ABSTRACT FROM AUTHOR]

Helicopter EMS (HEMS) is a well-established mode of rapid transportation for patients with need for time-sensitive interventions, especially in patients with significant traumatic injuries. Traditionally in the setting of trauma, HEMS is often considered appropriate when used for patients with "severe" injury as defined by Injury Severity Score (ISS) >15. This may be overly conservative, and patients with a lower ISS may benefit from HEMS-associated speed or care quality. Our objective was to perform a meta-analysis of trauma HEMS transports to evaluate for possible mortality benefit in injured cases defined by an ISS score >8, lower than the customary ISS cutoff of >15. A broad search of the literature was performed including PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials, and Google Scholar from the years 1970 to 2022. The gray literature and reference lists of included publications were also examined. We included studies with the outcome of mortality in HEMS vs control in trauma transports from scene of injury for patients (adult or pediatric) with ISS > 8. Nine eligible studies were used in the final analysis: six in the primary analysis and three in sensitivity analysis due to patient overlap. All studies reported statistically significant survival benefit in HEMS compared to control group. The minimum survival odds ratio (OR) benefit observed was OR 1.15 (95% CI 1.06–1.25) and maximum was OR 2.04 (95% CI 1.18–3.57). Risk of bias tool (ROBINS-I) application yielded moderate to low risk of bias, mainly due to the observational nature of the studies included. There was a statistically significant survival benefit in patients with ISS > 8 when HEMS was used over traditional ground ambulance transportation, although novel and more inclusive trauma triage criteria may be more appropriate in the future to guide HEMS utilization decision-making. Restricting HEMS to trauma patients with ISS >15 likely misses survival benefit that could be afforded to the subset of trauma patients with serious injury. [ABSTRACT FROM AUTHOR]

Child maltreatment, which encompasses harmful behaviour such as physical, sexual, psychological, and neglect, remains a global concern. In global efforts to prevent violence against women and girls, a strategic shift has emerged to actively engage men as key stakeholders. There is a growing recognition that men must be placed at the centre of these efforts. This study aimed to determine the predictors of child maltreatment perpetration in Sarawak based on retrospective recall of men's childhood adversities, men's gender roles, men's attitudes, and men's attachment styles. This cross-sectional study was conducted in Sarawak, Malaysia, from August 2022 to January 2023. The research used multistage cluster sampling to recruit 800 married men. The study findings showed 33.6% of the men admitted to having perpetrated one or more different forms of maltreatment on their children. Neglectful behaviours were the most prevalent with 27.3%, followed by physical and psychological perpetration. Through hierarchical logistic regression, men's childhood adversities were a critical predictor (AOR = 1.0, 95% CI:.1.0, 1.1, p <.001). Men with avoidant attachment styles were less likely to admit to perpetration (AOR = 0.5, 95% CI:0.3, 0,8, p =.002). In conclusion, this study emphasises the need for prevention activities like childhood adversities screening among men to improve their well-being and help them heal from past trauma. [ABSTRACT FROM AUTHOR]

As the Syrian situation has worsened since 2011, many aspects of the society have been affected, most notably the education of children. The internally displaced persons (IDPs) camps in Northwest Syria, especially in rural areas, are left with limited access to education for children, resulting in all the consequences that follow. Abjad initiative for education established Iqraa project to deliver education in those areas and adapted a modified educational strategy that differs from known conventional schooling in the region. The modified strategy is based on attendance, in class behaviour and performance in weekly formative assessments and linked it to final exam scores. Among fourth grade students (N = 35), the study showed strong positive statistically significant correlation between these parameters and final exam (0.780***, 0.893*** and 0.961*** respectively). Low performance on any of these parameters allowed to flag and refer students that need support to special assistant and safeguarding teachers. The study explored the relationship of these parameters to social factors through a survey done with families and revealed an important role of parents' education, number of people sharing the tent and distance from classroom tent on children's attendance and attainment. Regarding challenges that have been reported by parents, it has only been found that the distance from the classroom tent is statistically significant with the children's attendance (p = 0.042*). Negatively significant correlations were found between the children's behaviour within the classroom and final exam scores with the number of people sharing their tent (r = - 0.459, r = - 0.524) respectively. The proposed strategy can be replicated in many emergency areas. Furthermore, findings of this study can be further explored by policy makers, funders, and social experts to better understand the impact of long-term IDP settlement in camps on children's education and development. [ABSTRACT FROM AUTHOR]

The present study aimed to examine the relation between resilience and posttraumatic growth among young Ukrainian refugees. The sample comprised 102 Ukrainian students who fled the war in their country and found shelter in Romania. They were enrolled in Romanian universities. They filled out self-reported scales measuring resilience, posttraumatic growth, and hope two years after the military conflict between Russia and Ukraine started. Results indicated positive associations between resilience, posttraumatic growth, and hope. The link between resilience and posttraumatic growth was fully mediated by hope. We discuss these findings considering their practical implications for fostering the well-being of vulnerable youth, such as Ukrainian refugees. [ABSTRACT FROM AUTHOR]

Informal fostering arrangements can relieve pressure on parents and promote social mobility for children from poor households in sub-Saharan Africa. However, the motivation of host households to invest in fostered children would determine the extent of the benefits. This study uses Multiple Indicator Cluster Survey (MICS) data on children 6–12 years with both parents alive in five West African countries (Gambia, Ghana, Guinea-Bissau, Sierra Leone and Togo) to assess the relationship between foster status and school attendance in two time periods: 2005–2006 and 2017–2018. Multilevel logit regressions are used to estimate the likelihood of ever attending school. The results indicate that the likelihood of attending school for fostered children relative to non-fostered children was negative and statistically significant in 2017–2018 but was not different in 2005–2006. Further, the negative association between foster status and school attendance was larger for children in richer households in both time periods. These findings highlight the need for further research to provide insight into the dynamics of fostering children to higher socioeconomic status households. [ABSTRACT FROM AUTHOR]

Cognitive ability, as the initial human capital, has been the focus of academic research for many years. However, few human capital studies have focused on non-cognitive ability and explored its socio-economic value. With the inclusion of non-cognitive ability, the human capital study has got rid of the shortcoming of single-dimensional abilities and the socio-economic value of non-cognitive ability has been gradually explored. Therefore, it is of great academic and practical significance to explore the factors influencing children's non-cognitive ability. Using the CFPS database in 2018, this study investigates the effects and mechanisms of family economic capital on the non-cognitive ability of children. The robustness test is also used to further verify the reliability of the conclusions. The results reveal that family economic capital is significantly associated with children's non-cognitive ability, and this effect is biased by the subject. In addition, the mediating effect model suggests that family economic capital affects children's non-cognitive ability mainly through family education expenditure and family time investment. Therefore, helping families improve their economic capital, education expenditure and time investment contributes to promote the development of their children's non-cognitive ability, which will effectively raise human capital stock and help China achieve economic transformation as soon as possible. [ABSTRACT FROM AUTHOR]

Adverse Childhood Experiences (ACEs) have been associated with increased risk factors for HIV transmission, but the causal pathway is uncertain. This study documents the prevalence of ACEs by gender and their association with HIV risk factors and assesses depressive symptoms as mediating this relationship. A cross-sectional survey was conducted in 2019 among a representative sample of men and women, aged 18–24 years, living in an informal settlement in Accra, Ghana. Data on sociodemographic characteristics, ACEs, ten HIV risk factors (five sexual behaviors, HIV/AIDS knowledge, sexual assault, three substance use behaviors), and depressive symptoms were collected. Multiple logistic regression models were estimated to assess the independent association between four or more ACEs and each of the ten HIV risk factors. Structural equation models examined depressive symptoms as a mediator in these associations. A third (34.6%) of participants reported four or more ACEs, and among those who experienced four or more ACEs 60% were men and 40% were women. Gender did not modify the effect of the association between four or more ACEs and HIV factors and therefore the multiple regression analysis was not stratified by gender. After controlling for sociodemographic covariates and depressive symptoms, having experienced four or more ACEs was associated with alcohol use (OR = 3.88; 95% CI: 1.34, 11.21), injection drug use (OR = 2.78; 95% CI: 1.15, 6.73), low knowledge of HIV (OR = 3.59; 95% CI: 1.43, 9.00), sexually transmitted infection (OR = 3.70; 95% CI: 1.15, 11.96), and sexual assault (OR = 3.58; 95% CI: 1.07, 12.05). There was some evidence that depressive symptoms could be mediating the association between reporting four or more ACEs and ever having a sexually transmitted infection. The mitigation of ACEs and depressive symptoms has the potential to decrease HIV risk factors and thus reduce the risk for HIV transmission among youth living in informal settlements. [ABSTRACT FROM AUTHOR]

Objectives: The present study examined how activity engagement mediates the association between personality and cognition. Methods: Participants were middle-aged and older adults (Age range: 24–93 years; N > 16,000) from the Midlife in the United States Study, the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Wisconsin Longitudinal Study of Aging. In each sample, personality traits and demographic factors were assessed at baseline, engagement in cognitive, physical, and social activities was assessed in a second wave, and cognition was measured in a third wave, 8 to 20 years later. Results: Random-effect meta-analyses indicated that lower neuroticism and higher extraversion, openness, and conscientiousness were prospectively associated with better cognition. Most of these associations were partly mediated by greater engagement in physical and cognitive activities but not social activities. Physical activity accounted for 7% (neuroticism) to 50% (extraversion) and cognitive activity accounted for 14% (neuroticism) to 45% (extraversion) of the association with cognition. Conclusion: The present study provides replicable evidence that physical and cognitive activities partly mediate the prospective association between personality traits and cognitive functioning. [ABSTRACT FROM AUTHOR]

Objectives. In recent years, workplace accidents have imposed a considerable cost on industries. Accident proneness is one of the most influential factors known to cause unsafe behaviors and occupational accidents. Therefore, the present study investigated the validity and reliability of the accident proneness questionnaire in industries. Methods. The questionnaire was developed to measure accident proneness in industries – the developed instrument was distributed in East Azarbaijan industries (1100 questionaries). Content validity, confirmatory factor analysis and exploratory factor analysis were used to examine the construct validity, and Cronbach's α and the test–retest method were used to examine the reliability and reproducibility of the instrument. Results. In the face validity section, the impact score of all items was determined to be >1.5. In the content validity section, the content validity index (CVI) and the content validity ratio (CVR) were higher than the standard value of 0.42. The Cronbach's α coefficient for all dimensions was 0.914. Conclusion. The findings of the study show that the accident proneness questionnaire in industries has acceptable validity and reliability, and can be used as a comprehensive, practical, robust and reliable instrument to investigate the accident proneness of different industries. [ABSTRACT FROM AUTHOR]

A non-inferiority trial is usually conducted to investigate whether a new drug/treatment is no worse than a reference drug/treatment by a small, pre-specified, non-inferiority margin. This study aimed to assess the non-inferiority of the difference between two binary-outcome treatments in a matched-pairs design based on the method of variance of estimates recovery (MOVER). The processes for estimating the confidence interval of a single proportion included in the MOVER are the Wilson score interval, Agresti – Coull interval, Jeffreys interval, modified Jeffreys interval, score method with continuity correction, and arcsin interval. The performance of the six MOVER tests, the fiducial test, and the restricted maximum likelihood estimation test were evaluated by comparing their type I error rates and power at different pre-assigned levels and with varying combinations of parameters. The evaluation results showed that the modified Jeffreys MOVER test can be a competitive alternative to the other recommended tests. It can control type I errors well, and its power is not inferior to other methods. The proposed tests were illustrated with three real-world examples. [ABSTRACT FROM AUTHOR]

AbstractFueled in part by recent applications in neuroscience, the multivariate Hawkes process has become a popular tool for modeling the network of interactions among high-dimensional point process data. While evaluating the uncertainty of the network estimates is critical in scientific applications, existing methodological and theoretical work has primarily addressed estimation. To bridge this gap, we develop a new statistical inference procedure for high-dimensional Hawkes processes. The key ingredient for the inference procedure is a new concentration inequality on the first- and second-order statistics for integrated stochastic processes, which summarize the entire history of the process. Combining recent martingale central limit theorem with the new concentration inequality, we then characterize the convergence rate of the test statistics in a continuous time domain. Finally, to account for potential non-stationarity of the process in practice, we extend our statistical inference procedure to a flexible class of Hawkes processes with time-varying background intensities and unknown transition functions. The finite sample validity of the inferential tools is illustrated via extensive simulations and further applied to a neuron spike train data set. [ABSTRACT FROM AUTHOR]

The event of a student dropping out from an academic program depends on several factors namely course content, change in interest, financial problems among many others. These factors vary interdependently with different phases of the academic program. We assume that the factors put different amount of academic stresses on a student in different phases of the program. We formulate and analyze such an accumulated-stress model under the assumption that the attrition time at each phase follows the Kumaraswamy distribution. A hazard-rate based approach is used to model the accumulated stress through different phases. At each phase the stress levels vary. Accordingly, we estimate the model parameters based on the frequentist approach. Extensive simulation experiments indicate satisfactory performance of the estimators. A synthetic dataset related to students' dropout has been analyzed for illustrative purpose. [ABSTRACT FROM AUTHOR]

Through qualitative interviews with seven professional and technical writers (PTWs) who majored in literature or creative writing, this study examines how students’ emotions and beliefs about English as literary brought them to major in English but also limited their confidence in pursuing writing careers. Findings suggest that PTW concentrations in traditional English departments must account for their majors’ affinity for the literary while also providing sufficient coursework that helps them understand how English actually leads to specific writing careers. [ABSTRACT FROM AUTHOR]

It is of great interest to compute optimal exact confidence intervals for the success probability (p) in a binomial distribution, the number of subjects with a certain attribute (M) or the total number of subjects (N) in a hypergeometric distribution, and the mean λ of a Poisson distribution. In this paper, efficient algorithms are proposed to compute an admissible exact interval for each of the four parameters when the sample size (n) or the random observation X is large. The algorithms are utilized in four practical examples: evaluating the relationship between two diseases, certifying companies, estimating the proportion of drug users, and analyzing earthquake frequency. The intervals computed by the algorithms are shorter, and the calculations are faster, demonstrating the accuracy of the results and the time efficiency of the proposed algorithms. [ABSTRACT FROM AUTHOR]

In 2017, the U.S. Food and Drug Administration (FDA) announced a regulatory plan to reduce the nicotine content of cigarettes. This study examines the association of exposure to industry-sponsored corrective statements on perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes within the general US population. The study comprised 4975 US adult respondents of the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3). Multinomial logistic regression models were used to examine associations between exposure to tobacco industry corrective messages and perceptions of the addictiveness of low-nicotine cigarettes relative to typical cigarettes. In the overall population, 4.1% reported that low-nicotine cigarettes were much more addictive than typical cigarettes, 67.5% said they were equally addictive, while 28.4% reported they were slightly/much less addictive. Adults exposed to industry-sponsored corrective messages had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR 1.57; 95% CI, 1.13–2.19) than those who saw no corrective messages. Those exposed to the corrective messages specifically about the addictiveness of smoking and nicotine had higher odds of perceiving low-nicotine cigarettes as equally addictive as typical cigarettes (aOR, 1.73; 95% CI, 1.07–2.81) compared to those who saw no corrective message. Our findings suggest that exposure to court-ordered tobacco industry corrective statements may have reinforced perceptions on the addictive potential of nicotine. However, study findings indicate a need for campaigns specifically tailored to address misperceptions observed in this study. 67.5% of US adults perceived low-nicotine cigarettes and typical cigarettes as being equally addictive Exposure to court-ordered corrective statements increased the odds of equal addictiveness perception Exposure to corrective statements specifically tailored to addiction increased the odds of equal addictiveness perception [ABSTRACT FROM AUTHOR]

Purpose: Lower limb osteoarthritis (OA) is a prevalent condition that has a profound impact on an individual's life in several domains, including occupational activities. The objective of this study was to systematically describe and compare work-related outcomes (e.g., employment status, absenteeism, and productivity loss) in individuals with and without lower limb OA. Materials and methods: Five databases were searched until 17 June 2023. Studies were eligible for inclusion if they compared work-related outcomes between individuals with lower limb OA and healthy controls (e.g., people without OA or the general population). Results: Seven studies met the inclusion criteria of which two were included in a meta-analysis. Meta-analysis revealed that individuals with OA were less frequently in paid employment than control individuals (odds ratio: 0.25; 95% confidence intervals: 0.12, 0.53). Evidence from single studies indicated greater absenteeism and presenteeism and poorer functional capacity in people with lower limb OA compared to controls. Conclusions: This systematic review suggests that individuals with lower limb OA have poorer work-related outcomes than those without OA. Low study numbers and lack of consistency in the way work outcomes are defined and measured make accurate quantification of the impact of OA on work challenging. Prospero: registration number: CRD42020178820. IMPLICATIONS FOR REHABILITATION: Individuals with lower limb osteoarthritis (OA) are less frequently in paid employment and experience greater absenteeism and presenteeism and poorer functional capacity than people without OA. For holistic management of lower limb OA, healthcare providers should have conversations about any difficulties experienced at work and include outcome measures related to work. Clinicians should work with individuals with lower limb OA and employers to develop interventions to maximize work participation. [ABSTRACT FROM AUTHOR]

AbstractThe marketing authorization of a medicinal product is contingent upon demonstration of safety and efficacy in support of the product’s labeled conditions of use. To demonstrate safety, one group of adverse events that requires detailed consideration is common adverse reactions (ARs). ARs and their frequency are reported in prescription drug labeling in the US and EU. The determination of these adverse reactions generally takes a simple approach—usually, inclusion is through the frequency of reporting and whether the adverse event (AE) rate for the drug exceeds the placebo rate. This standard method does not account for confounders or multiplicity. To overcome these limitations, we propose a Monte Carlo approach to detect drug safety signals in clinical trials. We fit regression models incorporating covariates to assess the drug effect on the rate of AEs. Adjustment for multiplicity is carried out through the construction of simultaneous confidence intervals accounting for arbitrary correlations. A computationally efficient multiplier bootstrap approach using the Rademacher sequences is developed to generate random samples from the joint distribution of the estimators for all the AE rates. Compared to Bonferroni-based methods, the proposed method leads to narrower simultaneous confidence intervals and is more powerful in detecting potential safety signals. [ABSTRACT FROM AUTHOR]

Background and aims: This study explored the associations between symptoms of the Suicide Crisis Syndrome (SCS) at admission and self-harm and death by suicide post-discharge. The association between clinicians' emotional responses toward inpatients at admission and post-discharge self-harm and suicide death was also explored. Methods: Within the first 24-h of admission, patients completed a self-report measure of symptoms of SCS, and clinicians reported their emotional responses toward the patients. Follow-up data were obtained from the Norwegian Patient Registry and the Norwegian Cause of Death Registry. Results: Within 18 months post-discharge, 44 (12.7%) out of 347 patients had self-harmed, and five patients (1.4%) had died by suicide. At admission, patients who later self-harmed reported higher symptoms of SCS compared to the other patients. Clinicians reported more negative emotional responses toward the self-harm group. In a regression analysis, previous suicidal behavior and a diagnosis of "emotionally unstable personality disorder" (EUPD; F60.3) were associated with increased risk of self-harm post-discharge. Conclusion: The results indicated that patients with post-discharge episodes of self-harm are significantly different from patients who do not self-harm in terms of more intense symptoms of SCS during admission. Clinicians' negative emotional responses may be relevant in the assessment of the risk of post-discharge self-harm. [ABSTRACT FROM AUTHOR]

Background: Oral health of people with severe mental illness (SMI) remains an important public health issue, despite evidence pointing suboptimal dental health outcomes in this population. Aims: We test the hypotheses that individuals with SMI have lower contact with dental services and higher levels of fillings and extractions. We also examine effect modification by age-group. Methods: We used linked administrative data from general practitioner (GP), hospital and dental records to examine dental service use and treatments (extractions, fillings, crowns and x-rays) among the Northern Ireland hospital population between January 2015 and November 2019 (N = 798,564). Results: After adjusting for available socio-demographic characteristics, analysis indicated lower levels of dental service use (OR = 0.80, 95% CI = 0.77, 0.84), including lower likelihood of fillings (OR = 0.81, 0.77, 0.84) and x-rays (OR = 0.77, 0.74, 0.81), but higher levels of extractions (OR = 1.23, 1.18, 1.29) among patients with SMI. We also found effect modification by age-group, with older individuals with SMI less likely to have each of the four dental treatments. Conclusions: We suggest that in the general area of physical healthcare for people with SMI, oral healthcare is neglected. There is a need for improved understanding of the barriers to routine care and treatment, and development of psychoeducational interventions. [ABSTRACT FROM AUTHOR]

Chronotype is an established concept designed to capture the internal clock's phase in real-life conditions. It is vital in many aspects of daily life and can interfere considerably with numerous factors in a given population. Recognizing nonmodifiable and modifiable factors is crucial for identifying covariates of interest when studying the link between chronotype and health status. To date, chronotype and its related factors have not been extensively investigated. The present study aimed to explore the association of chronotypes with meal frequency, physical activity, and demographic factors among the Saudi population. This cross-sectional web-based questionnaire involved 1369 adults (aged 18 years and above) from the general public in Saudi Arabia and was conducted between March and May 2019. Chronotype was assessed using the reduced version of the original Horne and Ostberg morningness-eveningness questionnaire (MEQ). Meal frequencies and demographics data (age, gender, marital status, place of residence, educational level, employment status, income) were obtained. Physical activity level was also obtained using the international physical activity questionnaire. The MEQ scores group individuals into three categories: morning-type, neither-type, and evening-type. The neither-type individuals represented 41.6% (95% confidence interval [CI], 37.5% − 45.6%) of the study population, followed by the morning-type (34.1%; 95% [CI], 29.8% − 38.4%), then the evening-type (24.3%, 95% [CI], 19.6% − 28.9%). Chronotype was significantly associated with age, marital status, employment status and monthly income (All p < 0.05). Significant associations between chronotype with meal frequencies (number of meals per day, breakfast frequency, lunch frequency, and dinner frequency) and physical activity were also observed (All p < 0.05). This study highlights that meal frequencies and physical activity levels are associated with chronotype distribution. Furthermore, demographics, including age, marital status, employment status, and income, were associated with chronotype distribution. [ABSTRACT FROM AUTHOR]

One of the most visible changes of the COVID-19 pandemic has been the swift and widespread adoption of telework. Existing knowledge on teleworking has been largely limited to employees from certain occupational groups who voluntarily engaged in telework, making it difficult to generalise prior findings. Using the Job-Demands Resources model as a theoretical framework, the objective of this study was to identify the job demands and job resources associated with telework satisfaction and telework performance during the pandemic. During a period of enforced teleworking during COVID-19 lockdown measures, this study surveyed employed individuals (N = 208) from Melbourne (Australia). Using ordinal logistic regression analyses, it was found that three job resources (home office comfort, technical support, and job security) were positively associated with both telework satisfaction and telework performance. Further, technical resources (job resource) was positively associated with telework satisfaction, whereas professional isolation (job demand) was negatively associated with telework satisfaction. During a mandated period of telework, this study identified several factors associated with important telework outcomes. As there has been a greater uptake of remote and hybrid working arrangements in Australia post-pandemic, these findings could help inform and optimise future telework policies. What is already known about this topic: Prior to the COVID-19 pandemic, teleworking was not a commonly used workplace practice. Existing knowledge on teleworking has been largely limited to employees from certain occupational groups who were interested in, and/or were able to engage in telework. The resulting selection bias might limit the generalisability of these findings to others with different abilities, preferences, and/or job types. What this topic adds: This study investigated the job demands and job resources associated with telework success during the COVID-19 pandemic. This study identified three job resources (home office comfort, technical support, and job security) associated with both telework satisfaction and telework performance. The findings from this study point to several telework environment, job, and organisational factors that managers and practitioners could consider when developing future telework guidelines within an Australian context. [ABSTRACT FROM AUTHOR]

Understanding the psychological wellbeing of people with cancer is a key component of assessment and intervention in quality cancer care. However, the unique experiences of rural cancer populations are less often explored than those from urban centres. The aim of this study was to perform a meta-analysis of Australian studies that compared the psychological wellbeing experiences of people with cancer from rural and urban locations. Five databases were searched, and 19 studies, involving 16,947 participants, assessing and comparing the psychological wellbeing of rural and urban populations with cancer were included. The analysis indicated that Australian rural cancer populations have greater odds of worse psychological wellbeing than those from urban areas (OR = 1.54, 95% CI [1.01, 2.35], p = 0.044). This disparity remains when cancer types are analysed separately, with a slightly smaller odds ratio for rural people with breast cancer (OR = 1.29, 95%CI [1.01, 1.64], p = 0.046) and a slightly larger odds ratio when cancers excluding breast cancer were reviewed (OR = 1.78, 95% CI [1.59, 2.01], p = <.001). Significant heterogeneity was found. Despite increasing emphasis in Australia on psychological wellbeing throughout the cancer journey, there remain significant disparities whereby rural people experience greater impacts upon their psychological wellbeing. The wellbeing of Australian rural populations with cancer remains an area in which clinical and political focus is imperative. Whilst screening is a necessary first step, additional clinical implications for improving rural access to appropriately skilled health professionals who provide oncology-specific assessment and intervention are suggested. What is already known: Cancer is a major public health issue, and its psychosocial impacts are substantial, not just on patients but on their families and the broader community. The prevalence of clinically significant psychological distress is higher amongst people with cancer than the general population. However, identification, treatment, and provision of psychological support is inconsistent across services and geographical areas, and notably lacking in rural areas. Disparities in screening, assessment and intervention for psychological wellbeing in people with cancer remain, despite the fact that systematic application of screening, appropriate referral, and intervention can improve quality of life and reduce healthcare costs associated with inpatient and outpatient cancer care. What this paper adds: This article extends outcomes from previous systematic reviews and analyses from Australia and internationally with the addition of meta-analytic methods. It was specifically designed to solely focus on Australian cancer populations. The results suggest that Australian rural populations with cancer may have anywhere from 30% to 70% greater odds of experiencing poorer psychological wellbeing than those from urban areas. This paper highlights ongoing disparities in rural psycho-oncology that may be impacting wellbeing outcomes from rural people in Australia, and urges psychologists, other health professionals, and policy-makers to proactively address these inequities with improved screening, assessment and intervention for their rural populations. [ABSTRACT FROM AUTHOR]

This study assessed the impact of the COVID-19 pandemic on psychosocial health among individuals with different levels of hearing ability. For this cross-sectional study, adults completed an online digits-in-noise test and survey. Participants were categorised into "good", "insufficient", or "poor" hearing groups. Survey questions included topics on depression, anxiety, distress, somatisation, and loneliness levels. Multiple logistic, linear, and negative binomial regressions examined differences in psychosocial health between hearing groups. Moderation analyses identified vulnerable subgroups. Mediation analyses examined mediating effects of pandemic measures on hearing ability and psychosocial health. Eight-hundred and sixty-five adults with or without hearing impairment. Individuals with poor hearing had a higher odds of having elevated anxiety levels and had higher somatisation levels compared to participants with good hearing. Chronic diseases significantly moderated the relationship between poor hearing ability and loneliness. Difficulties with communicating through facemasks, 1.5 m distance, plastic screens, and during video calls significantly mediated the relationships between hearing ability, anxiety and somatisation. Results highlight the elevated anxiety and somatisation levels experienced among individuals with hearing impairment during the COVID-19 pandemic. More awareness is needed of the negative impact pandemic measures can have on psychosocial health during future health crises. [ABSTRACT FROM AUTHOR]

We explored factors that predict readiness to change among consumers of pornography. We obtained a cross-sectional survey sample concerning problematic pornography use (N = 892; 59% female; 87% White; mean age = 40). The Change Questionnaire was appropriate for this population and produced two internally consistent factors – confidence to change and importance of change. Using a bootstrapping methodology, a combination of variables (demographic, spiritual/religious, psychological symptoms, past reduction efforts, and addiction symptoms) predicted desire to reduce pornography use among participants. Among those desiring to reduce their pornography use, well-being (lower symptoms of psychological distress), religiosity, and relationship variables predicted both confidence to change and importance of changing while perception of addiction predicted importance to change. Findings may be used to help develop models of desire to and readiness to change along with motivational interviewing-based interventions for individuals wishing to reduce their pornography consumption. Clients who are more motivated or ready to change are more likely to engage, persist, and improve in treatment for addictions. This study found that among consumers of pornography, many individuals report an interest in changing (i.e., reducing) their consumption. Specific factors that showed readiness for change in pornography consumption, include a personal sense of well-being, religiosity, a current romantic relationship, and the perception of pornography use as an addiction. [ABSTRACT FROM AUTHOR]

Breast cancer is especially prevalent among women. It can affect patients' sexual function, body image, and marital relations. The aim of present study was to investigate the relationship between body image and sexual function among women with breast cancer. This case–control study was done online on patients admitted to the clinic of breast cancer in 2021 in Jahrom, Iran. The sample consisted of 222 women (111 with breast cancer who had undergone mastectomy and 111 without breast cancer). To collect data, two questionnaires, female sexual function index and body image scale, were used. p < 0.05 was significant. Sexual dysfunction among women with breast cancer was 91%. The most common disorder was sexual arousal. Comparing sexual domains: desires disorder (OR: 3.11, 95% CI: 1.63–5.49), arousal disorder (3.31, 95% CI: 1.16–9.45), orgasm (OR: 4.08, 95% CI: 1.57–10.55), vaginal lubrication (OR: 2.68, 95% CI: 1.06–6.76), sexual satisfaction (OR: 2.65, 95% CI: 1.11–6.36), and painful intercourse (OR = 2.03 95% CI = 0.95–4.35) saw a decrease in the women with breast cancer group compared to the control group. The body image concern among women with breast cancer (51.56 ± 15.09) compared to the control (45.80 ± 16.82) was significant (OR = OR: 2.66, 95% CI: 1.22–5.81). Women with breast cancer undergo problems in sexuality and are afraid of their body image. Moreover, there is a correlation between sexuality and body image. Therefore, it is necessary to inform patients about the effects of treatments and the side effects of breast cancer on sexuality. Sexual dysfunctions are highly prevalent among women with breast cancer, and have been associated with body image. This study examined the relationship between body image and sexual function among women with breast cancer. Orgasm and libido, lubrication, and satisfaction decrease in women with breast cancer compared to healthy women. [ABSTRACT FROM AUTHOR]

All common variants of primary progressive aphasia (PPA) exhibit naming deficits. Variants are distinguished by relative deficits in repetition (logopenic; lvPPA), object knowledge (semantic; svPPA), and agrammatism or articulation (non-fluent/agrammatic; nfavPPA; Gorno-Tempini et al., 2011). The Hopkins Action Naming Assessment (HANA) is a 30-item verb naming task that can distinguish between variants (Stockbridge et al., 2021). Item-level accuracy is driven by target verb frequency, semantic information density, and conceptual concreteness of the target word (Stockbridge, Venezia, et al., 2022). In this investigation, we examined whether word frequency, semantic density, concreteness, and age of acquisition (AoA) also shaped the incorrect responses patients provided. We hypothesised that error responses would vary in these dimensions as a function of PPA variant. The HANA was administered to 271 participants with PPA, resulting in 443 total administrations and 4,529 analysable error responses. Standardised differences between error and target responses for frequency, density, concreteness, and AoA were calculated and averaged for each patient. Analysis of variance (ANOVA) for correlated samples was used to compare variants and planned post-hoc analyses examined the effect of variant on each response quality. Participants were similar in age, sex, handedness, and education. There was a significant interaction between PPA variant and the standardised mean differences in lexical qualities (Pillai's Trace = 0.11, F(9, 747) = 3.19, p < 0.001). Univariate ANOVAs revealed significant differences in the semantic density of error responses relative to the target (F(3) = 7.91, p < 0.001, ηP2= 0.09), as individuals with lvPPA tended to produce error responses with greater semantic density than the target when compared to the words produced by individuals with nfavPPA (mean difference = 1.45, 95%CI = [0.60,2.29], p < 0.001; Figure 1). PPA variants also differed in the concreteness of their error responses relative to the target (F(3) = 5.99, p<0.001, ηP2 = 0.07), as error responses produced by individuals with nfavPPA were significantly more concrete than those with lvPPA (mean difference = 0.08, 95%CI = [0.02,0.13], p = 0.003) or svPPA (mean difference=0.08, 95%CI = [0.02,0.14], p = 0.007). Variants did not differ significantly in AoA or frequency of responses relative to their targets. All variants tended to produce more frequent words with a lower AoA than the target verb. Error responses tended to be more semantically dense, more concrete, higher frequency, and younger AoA than the target verb. However, PPA variants differed significantly in the extent to which these broader trends held true. These distinct patterns may be included as part of a larger diagnostic picture that to distinguish among PPA variants. [ABSTRACT FROM AUTHOR]

Objectives: Student-athletes are unique in their undertaking of full-time academic and athletic roles. Their dual roles impose a multitude of responsibilities in their daily lives, yet little is known about the factors that may negatively impact their ability to effectively manage these responsibilities. Participants: Data from a large sample of Canadian varsity athletes (N = 1,353) were used for the present study. Methods: The association between stress and difficulties managing daily responsibilities, while simultaneously investigating the roles of sleep difficulties and sense of belonging as contributing factors was examined. Results: Findings indicated that the moderated mediation model was significant, revealing that sleep difficulties were a significant mediator in the relationship between stress and difficulties managing daily responsibilities and that sense of belonging moderated the relationship between stress and sleep difficulties. Conclusions: The results expose complex ways that student-athletes' performances (academic and athletic) can be impaired, signaling the need to develop strategic actions toward prevention and management of stress among student-athletes. [ABSTRACT FROM AUTHOR]

Objective: Microaggressions are brief verbal, behavioral, or environmental indignities toward people of color. Methods: Cross-sectional study examining the association between demographics, alcohol culture, and witnessing or experiencing microaggressions among undergraduate students. Analysis based on the "Color of drinking" study data collected at University of Wisconsin-Madison, WI between November 2017 and January 2018. Results: African-American/Black students significantly witnessed and experienced more microaggressions than other students, with a Relative Risk Ratio (RRR) of 9.5 (CI 95%: 4.7–19.1) and a RRR of 7 (CI 95%: 3.4–14.3). For students of color, experiencing microaggressions was associated with considering leaving (RRR = 3.5, CI 95%: 2–6.2). Additionally, the witnessing and experiencing of microaggressions appears to be associated with the alcohol culture on campus. Conclusions: African-American/Black was the racial group that witnessed and suffered more microaggressions. The percentage of students witnessing microaggressions increased with the year in school. Alcohol use in the last 30 days, feeling impacted by other's use of alcohol, and avoiding certain areas due to alcohol consumption were associated with experiencing microaggressions among students of color. [ABSTRACT FROM AUTHOR]

College students use electronic nicotine delivery systems (ENDS) more often than any other US demographic group. In a novel application of the acquired preparedness model, we examined how proximal (e.g., cognitions) and distal (e.g., dispositional) influences accounted for ENDS use and dependence. Undergraduates (N = 1075; 72% female, 74% White) from seven US campuses completed an online survey between October 2019-March 2020. We modeled ENDS use and dependence, respectively, as zero-inflated Poisson distributions with impulsivity as an independent variable and perceived risks and benefits of e-cigarettes as mediators. Students higher in impulsivity perceived more benefits and, in turn, reported greater ENDS use and dependence. Curiosity and friends' use motivated ENDS initiation; stress management and nicotine motivated continued use. ENDS interventions should be tailored to students higher in impulsivity, as they hold more favorable perceptions of ENDS, and should enhance skills to manage stress and nicotine cravings. [ABSTRACT FROM AUTHOR]

To examine how public health policy was reinforced by peer workers who were called Public Health Ambassadors (PHAs) at a West Coast university during the COVID-19 pandemic. Descriptions of PHA community interactions were collected. Analyses were conducted using data from the 12-weeks of the 2020 Fall Quarter. In total, there were 5,112 interactions of which there were three types: (1) educational (4%), (2) noncompliance (90%), and (3) thanking (6%). About 1.3% of interactions were met with resistance. Overall, compliance with campus public health guidance was high. Trends suggest compliance fatigue may have occurred after the first four weeks as evidenced by increased noncompliance rates and test positivity rates. These results suggest the feasibility of the implementing US Centers for Disease Control and Prevention recommendations of using trusted messengers to reinforce critical behaviors to support community health. [ABSTRACT FROM AUTHOR]

Objective: To test the association between food insecurity and educational disruptions from the COVID-19 pandemic and the role of anxiety or depression in mediating this association. Participants: Representative sample of 2,282 City University of New York students. Methods: Using an April 2020 online survey, we estimated adjusted prevalence ratios (aPR) for educational outcomes based on food insecurity status, adjusting for age, sex, race/ethnicity, and degree level with weighted Poisson regressions with robust standard errors. Results: Prevalence of decreased ability to do schoolwork was greater in those with moderate (aPR = 1.12, 95% CIs 1.02, 1.23) and high (aPR = 1.18, 95% CIs 1.08, 1.2) levels of food insecurity compared to food-secure students. Results were similar for dropping/withdrawing from classes and expecting delays or uncertainty around graduation. Anxiety and depression mediated the relationship between food insecurity and educational outcomes. Conclusion: Findings emphasize the urgency of expanded food assistance and mental health services for college students. [ABSTRACT FROM AUTHOR]

Objective: To examine what factors impact college students in the United States who are deciding to initiate or continue mental health services. Participants: Spring 2021 undergraduate students (N = 453) at a large urban university. Methods: Online, cross-sectional survey with mental health service experience as the independent variable and social support, accessibility, attitudes toward mental health, mental health literacy, and trust of mental health professionals as the dependent variables, as well as thematic analysis of reasons to discontinue services. Results: Individuals with lower levels of social support and higher levels of mental health literacy were more likely to have received therapy. Participants tended to discontinue services because of negative experiences, accessibility problems, negative attitudes toward services, or they felt better. Conclusions: Mental health literacy, social support, and accessibility are significant predictors of college student service use and should be taken into consideration by university administration. [ABSTRACT FROM AUTHOR]

To assess the relationship between knowledge of long-acting reversible contraception (LARC) and intention to use LARC among female students. Participants consisted of a convenience sample of 292 female undergraduate and graduate students at a large midwestern university. We conducted a cross-sectional in-person survey and multivariate analysis of LARC knowledge and intention to use LARC. Total response rate was 84.9%. Among contraceptive users, 13.3% were using a LARC method. On average, respondents scored 4.8/10 (SD 2.5) on a 10-item LARC knowledge assessment. Higher levels of LARC knowledge were associated with the intent to use LARC in the future in our multivariate analysis (RR 1.7, 95% CI 1.14–2.54: p =.01). Common reasons for LARC hesitancy were a need for more information, safety concerns, and risk of undesirable side effects. Low LARC knowledge and students' self-identified need for further LARC information represent an opportunity for campus contraceptive interventions which empower students to make informed reproductive decisions. [ABSTRACT FROM AUTHOR]