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Experiencing stigma is associated with a range of negative outcomes for people with mental health disorders. However, little is understood about the contemporary stigma experiences of young people with anxiety and depression. This study aimed to describe these experiences using semi-structured qualitative interviews. Thirteen young people (aged 16–24 years) who self-reported a primary diagnosis of depression and/or anxiety were interviewed about their stigma experiences. Many experiences and perceptions of stigma were common to all participants. Six themes were developed through thematic analysis of participants' descriptions. The first theme, 'stigma is pervasive', pertains to the way that stigma is expressed to and experienced by all young people with anxiety and depression. Three themes describe the content of stigma experienced by participants: they felt denied, minimised, and blamed (e.g., seen as 'faking it' for attention, to avoid responsibility or to follow trends); seen as less than others; and treated as socially undesirable. Finally, two themes describe stigma's consequences: self-doubt and internalisation; and withdrawal. Some of these themes differ from prior accounts of the stigma experienced by people with anxiety and depression, indicating that the conceptualisation and measurement of stigma in young people need updating to remain relevant. Highlights: There is a scarcity of research about the stigma experienced by young people with anxiety and depression. We conducted a thematic analysis of semi-structured interviews to gain insight into these experiences. Participants described being invalidated (denied, minimised, and blamed) as a prominent and distinct theme of the stigma they experienced. This has not previously been described in mental illness stigma literature. Conceptualisations and measures of stigma that are used in research with adolescents who have anxiety and depression should be updated to improve research validity. [ABSTRACT FROM AUTHOR]

Gestational diabetes is treated with medical nutrition therapy, delivered by healthcare professionals; however, the optimal diet for affected women is unknown. Randomised controlled trials, such as the DiGest (Dietary Intervention in Gestational Diabetes) trial, will address this knowledge gap, but the acceptability of whole-diet interventions in pregnancy is unclear. Whole-diet approaches reduce bias but require high levels of participant commitment and long intervention periods to generate meaningful clinical outcomes. We aimed to assess healthcare professionals' views on the acceptability of the DiGest dietbox intervention for women with gestational diabetes and to identify any barriers to adherence which could be addressed to support good recruitment and retention to the DiGest trial. Female healthcare professionals (n 16) were randomly allocated to receive a DiGest dietbox containing 1200 or 2000 kcal/d including at least one weeks' food. A semi-structured interview was conducted to explore participants' experience of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo software. Based on the findings of qualitative interviews, modifications were made to the dietboxes. Participants found the dietboxes convenient and enjoyed the variety and taste of the meals. Factors which facilitated adherence included participants having a good understanding of study aims and sufficient organisational skills to facilitate weekly meal planning in advance. Barriers to adherence included peer pressure during social occasions and feelings of deprivation or hunger (affecting both standard and reduced calorie groups). Healthcare professionals considered random allocation to a whole-diet replacement intervention to be acceptable and feasible in a clinical environment and offered benefits to participants including convenience. [ABSTRACT FROM AUTHOR]

Aim: Nutrition challenges are common during childhood cancer treatment and can persist into survivorship, increasing the risk of non‐communicable diseases. Evidence‐based practice and implementation of nutrition interventions/education for childhood cancer survivors has been poorly investigated and may influence their future health. This study aimed to explore the nutrition interventions/education needs of childhood cancer survivors and the barriers and facilitators to delivering follow‐up services in New Zealand. Methods: Semi structured interviews were conducted with childhood cancer survivors and/or their families (n=22) and health professionals (n=9) from a specialist paediatric oncology centre in New Zealand. Interviews were audio‐recorded and transcribed verbatim. Transcripts were analysed inductively using thematic analysis. A multi‐level consensus coding methodology was used where each theme and associated subthemes were discussed with the study team for confirmation to ensure accurate coding and analysis. Results: Three themes emerged from the analysis: (1) the current survivorship care pathway does not provide adequate interventions/education, (2) weight and dietary changes are common challenges and (3) requirements for interventions/education in survivorship are varied. Common nutrition‐related concerns included fussy eating/limited dietary intake, poor diet quality, difficulties with tube weaning, and challenges with weight gain. Participants expressed a desire for education on healthy eating alongside information about cancer‐related nutrition issues, such as learned food aversions. A preference for clear referral pathways and multifaceted interventions tailored to individual patient needs was identified. Conclusion: The trifecta of treatment side effects, negative feeding practices and poor messaging from health professionals creates a challenging environment to optimise nutrition. A stepped care model matching the intervention intensity with the childhood cancer survivors is required. Education for healthcare professionals will improve the delivery of timely interventions/education and monitoring practices. [ABSTRACT FROM AUTHOR]

OBJECTIVE: 1) To evaluate the impact of the Futuros Fuertes intervention on infant feeding, screen time, and sleep practices and 2) To use qualitative methods to explore mechanisms of action. METHODS: Low-income Latino infant-parent dyads were recruited from birth to 1 month and randomized to Futuros Fuertes or a financial coaching control. Parents received health education sessions from a lay health educator at well-child visits in the first year of life. Parents received two text messages per week that reinforced intervention content. We assessed infant feeding, screen time, and sleep practices via surveys. body mass index z-score (BMI-z) was measured at 6 and 12 months. Seventeen parents from the intervention arm participated in a semi-structured interview that explored parental experiences with the intervention. RESULTS: There were n = 96 infant-parent dyads randomized. Fruit intake was higher in the intervention group at 15 months (1.1 vs 0.86 cups p = 0.05). Breastfeeding rates were higher in intervention participants at 6 months (84% vs 59% p = 0.02) and 9 months (81% vs 51% p = 0.008). Mean daily screen time was lower among intervention participants at 6 months (7 vs 22 min p = 0.003), 12 months (35 vs 52 min p = 0.03), and 15 months (60 vs 73 min p = 0.03). Major qualitative themes include 1) parental trust in intervention messaging 2) changes in feeding and screen time parenting practices, 3) text messages supported behavior change for parents and family members, and 4) varying effectiveness of intervention on different health behaviors. CONCLUSIONS: Low-income Latino infants participating in the Futuros Fuertes intervention had modestly healthier feeding and screen time practices compared to control participants. [ABSTRACT FROM AUTHOR]

The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term 'personality,' while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself. [ABSTRACT FROM AUTHOR]

Background: Familial hypercholesterolemia (FH) is an inherited disease which causes premature atherosclerotic cardiovascular disease. However, less than 10% of individuals with FH have been identified. Objective: To assess parental perspectives for inclusion of FH on routine newborn screening (NBS) and to highlight potential benefits, harms, and ethical concerns. Methods: Telephone interviews of two groups were conducted: 1) parents of children diagnosed with FH, and 2) parents of children diagnosed with a genetic condition through NBS. Stratified purposive sampling was used to ensure adequate representation. The 11 telephone interviews were conducted in 30-min sessions guided by a semi-structured interview script. At the beginning of the interview, participants were educated on the NBS process and FH. The interviews were transcribed verbatim, and a thematic analysis was performed in multiple steps. Results: All interviewees indicated that they would be interested in having their child be screened for FH on the newborn screen. Reasons supporting screening during the newborn period included knowing their child's diagnosis, the ability to screen family members for FH, incorporation of lifestyle changes, and access to preventive care. Negatives surrounding screening during the newborn period included increased stress or anxiety, knowledge, stigma, and the delay from diagnosis to initiation of pharmacotherapy for FH. Conclusion: While these interviewees were in favor of NBS for FH, further education of parents and clinicians is needed to ensure proper implementation. The results of this study may be useful to formulate family notification and care protocols for newborns diagnosed with FH and other diseases. Significance: What is already known on this subject? Familial hypercholesterolemia is a common inherited disorder that predisposes to early cardiovascular disease, but most affected individuals are not diagnosed. Childhood cholesterol screening is an effective but underutilized diagnostic tool. Previous studies report parents find childhood cholesterol screening acceptable, but it is not known if screening newborns would also be acceptable. What does this study add? Interviewees found screening newborns for familial hypercholesterolemia acceptable and would agree to screen their own newborn. The ability to screen other family members and access to early treatment were important factors in their decision to screen. Education of clinicians about familial hypercholesterolemia was an important concern raised by interviewees. [ABSTRACT FROM AUTHOR]

This study aimed to explore how foster carers conceptualize and engage in self-care using interviews with 8 participants. Results suggest that self-care practices are an important component of maintaining the physical and mental health of foster carers, preventing burn-out and enhancing therapeutic parenting practices. Several barriers to self-care are identified, including systemic barriers as well a foster carers' own feelings of guilt for prioritizing their own needs. Results indicate that self-care requires a collaborative approach between foster carers and the broader child welfare system. Improved self-care specific training, resources and coaching from agencies were also identified as important outcomes. [ABSTRACT FROM AUTHOR]

Background: Chronic pain and ADHD are common conditions among youth that negatively impact functioning. This review fills a critical gap by summarizing current research on chronic pain and ADHD comorbidity, and it proposes a conceptual model of shared associations and underlying mechanisms. Objective: The aims of the current study were to: (1) review the extant literature and present estimates of the prevalence of comorbid non-headache chronic pain and ADHD in youth and (2) describe potential shared mechanisms for ADHD and chronic non-headache pain in youth. We also outline future directions to inform future research and interventions directed to youth with comorbid pain and ADHD. Design: A scoping review of the literature was performed in MEDLINE, PsycInfo, and Cochrane Database of Systematic Reviews using a wide range of search terms related to pain, Attention Deficit-Hyperactivity Disorder, childhood, adolescence, and young adulthood. Results: Eleven published studies were included in the review. These studies examined the prevalence of chronic pain among youth with ADHD, the prevalence of ADHD in chronic pain samples, and the association between chronic pain and ADHD among youth. Findings revealed results from studies indicating a higher prevalence of ADHD among youth with chronic pain and a higher prevalence of chronic pain in samples of youth with ADHD. Conclusions: Findings from this scoping review suggest an association between chronic pain and ADHD among youth. Little research was found to examine the etiology of this association. Future studies should examine underlying mechanisms of comorbid chronic pain and ADHD. [ABSTRACT FROM AUTHOR]

We aimed to explore participants' experiences of mental health during an acceptance and commitment therapy (ACT)-based guided self-help intervention to support weight management in adults with overweight or obesity during the COVID-19 pandemic (SWiM-C: Supporting Weight Management during COVID-19). We conducted semi-structured telephone interviews with twenty participants and used reflexive thematic analysis to identify patterns of meaning across the dataset relevant to mental health. Four themes were conceptualized: i) Mental health changes associated with SWiM-C, ii) External factors negatively impacted mental health and intervention engagement, iii) Use and impact of coping responses, and iv) Intervention preferences based on psychological needs. Findings suggest that participants were exposed to multiple factors, both related to and external to the intervention, that negatively impact their mental health, yet ACT-based aspects of the SWiM-C intervention appeared to support participants to adaptively manage the decline in their mental health. The findings can be used to inform the development of future weight management interventions, such as through intervention personalization and the inclusion of more strategies that target emotional regulation. Trial registration: ISRCTN 12107048, [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the association between receipt of chiropractic services and initiating a prescription for opioids among adult patients with noncancer spinal pain in a Canadian community health center. In this sequential explanatory mixed methods analysis, we conducted a retrospective study of 945 patient records (January 2014 to December 2020) and completed interviews with 14 patients and 9 general practitioners. We used Cox proportional hazards regression analyses, adjusted for patient demographics, comorbidities, visit frequency, and calendar year to evaluate the association between receipt of chiropractic care and time to first opioid prescription up to 1 year after presentation. Qualitative data were analyzed thematically and integrated with our quantitative findings. There were 24% of patients (227 of 945) with noncancer spinal pain who received a prescription for opioids. The risk of initiating a prescription for opioids at 1 year after presentation was 52% lower in chiropractic recipients vs nonrecipients (hazard ratio [HR], 0.48; 99% confidence interval [CI], 0.29-0.77) and 71% lower in patients who received chiropractic services within 30 days of their index visit (HR, 0.29; 99% CI, 0.13-0.68). Patients whose index visit date was in a more recent calendar year were also less likely to receive opioids (HR, 0.86; 99% CI, 0.76-0.97). Interviews suggested that self-efficacy, access to chiropractic services, opioid stigma, and treatment impact were influencing factors. Patients with noncancer spinal pain who received chiropractic care were less likely to obtain a prescription for opioids than patients who did not receive chiropractic care. [ABSTRACT FROM AUTHOR]

Background: Exercise has the potential to attenuate the high levels of cardiovascular morbidity and mortality present in kidney transplant recipients (KTRs). Despite this, activity levels in KTRs remain low. The aim of this qualitative study was to explore the barriers and facilitators of exercise in KTRs. Methods: Thirteen KTRs (eight males; mean ± SD; age 53 ± 13 years; estimated glomerular filtration rate 53 ± 21 ml/min/1.73 m2) were recruited and completed semistructured one‐to‐one interviews at University Hospitals of Leicester NHS Trust. All KTRs were eligible if their kidney transplant was completed >12 weeks before interview and their consultant considered them to have no major contraindications to exercise. All interviews were audio recorded, transcribed verbatim and subject to framework analysis to identify and report themes. Results: Themes were organized into personal, behavioural and environmental factors based on social cognitive theory. Facilitators of exercise were largely internal: enjoyment, exercise for general health and health of the transplanted kidney and desire to maintain normality. Social interaction, support and guidance of healthcare professionals and goal setting were perceived as motivational. Harming the kidney, a lack of guidance, self‐motivation and accessibility were barriers to exercise. Conclusion: These results provide detailed insight into the development of interventions designed to increase physical activity in KTRs. They provide strong evidence that specific exercise guidelines are required for this population and that the healthcare system could have a key role in supporting KTRs to become more physically active. Interventions need to be multifaceted to appeal to the differing levels of support desired by KTRs. Patient or Public Contribution: KTRs were involved in the development of the interview topic guide to ensure all relevant topics were explored. [ABSTRACT FROM AUTHOR]

Food pantries are responsible for the direct distribution of food to low-income households. While food pantries may be concerned about the nutritional quality of the food they are serving, they may have limited resources to adopt and implement nutrition policies to support efforts to promote high nutritional quality of the food served. Guided by the RE-AIM (Reach, Effectiveness or Efficacy, Adoption, Implementation, Maintenance) framework, this qualitative study explored the degree of implementation of nutrition policies at food pantries, as well as the barriers to implementation in those pantries that had not adopted a nutrition policy. Semistructured interviews were conducted with 10 food pantry directors: seven pantries with a formal nutrition policy and three with an informal nutrition policy. Using a thematic analysis method, results demonstrated themes from the interviews with policy-adopting pantries to be barriers, enforcement, delivery of the policy, unexpected consequences, and fidelity to the policy. A targeted intervention that builds on this research and focuses on building the capacity of food pantries to develop, adopt, and implement nutrition policies as well as helping to increase fidelity to the policy would be beneficial to continue to improve the food donated and distributed at food pantries. By supporting food pantries in the development, adoption, and implementation of nutrition policies, researchers can play an important role in improving the quality of food in the emergency food network. [ABSTRACT FROM AUTHOR]

We examined how adoptive families manage and respond to contact with children's birth siblings living elsewhere within a nationally representative sample of 96 families who adopted a child between 01 July 2014 and 31 July 2015. We harnessed prospective, longitudinal data to determine the extent to which plans for contact between adopted children and birth siblings living elsewhere materialised over time. We present adoptive parents' views and experiences of the contact over four years, together with an analysis of factors that were thought to have prevented, hindered and/or enabled contact between adopted children and their birth siblings. The information shared by the adoptive families illustrates the challenges they faced in promoting sibling contact; in weighing up the complexities associated with managing contact in the short term against the anticipated benefit for their child in the longer term; of balancing a commitment to sibling contact with the psychological needs of their child; and of organising contact within the context of interactions with other families involved and social work professionals. On the basis of these findings, we make recommendations pertaining to the management of both letterbox and face-to-face contact and life story work, and underscore the importance of investing in sibling relationships. [ABSTRACT FROM AUTHOR]

Diet-related chronic disease remains a public health concern, and low intake of fruits and vegetables disproportionately affects low-income populations. Healthy food incentive (HFI) projects can help close the nutrition gap among low-income populations by increasing purchasing power and access to fruits and vegetables. This study aimed to qualitatively explore lessons learned and best practices from Food Insecurity Nutrition Incentive Grant Program (FINI) grantees across the United States. Thirty semistructured interviews were conducted with FINI grantees and stakeholders in 2018, eliciting best practices and promising findings, policy implications, and knowledge gaps and opportunities to pursue that inform program refinement and sustainability. Telephone and in-person interviews were conducted with FINI grant recipients from 2015 to 2016, specifically, recipients of FINI-funded multiyear community-based projects and large-scale projects. Our results highlighted (1) range of projects and scope, (2) program promotion and awareness, (3) community-based partnerships, (4) technical assistance and peer interactions, (5) measurement and evaluation, (6) program challenges, and (7) future directions and recommendations. Grantees reported a "trifecta of benefits" that affects low-income consumers, farmers, and food retailers. Our findings contribute to understanding how to implement HFI programs in a variety of settings and highlight the variations that can exist between programs, as well as the need for increased technical assistance and synergy between programs (communities of practice). Overall, these findings can help to inform implementation and practice of healthy food incentive programs and the Farm Bill and other policy discussions. [ABSTRACT FROM AUTHOR]

Research has identified discrimination and a lack of knowledgeable providers as major barriers for transgender and gender diverse (TGD) individuals seeking care, which contributes to greater stress and significant health disparities affecting this population. However, research involving TGD youth is limited. The aim of this study, therefore, was to describe TGD adolescents' experiences, concerns and needs in healthcare settings, including their feedback on themes previously identified by healthcare providers (i.e. discomfort with gender‐related topics, reasons for not asking patients about gender and previous training regarding gender diversity). The authors conducted semi‐structured interviews with 12 TGD‐identified adolescents aged 14–17, living in Minnesota, USA in 2017–2018. Inductive thematic analysis was used to summarise participant comments into themes and subthemes. Two main themes were directly relevant to concerns and needs of TGD youth in healthcare settings and their views on healthcare providers' concerns: (a) asking about gender and pronouns and (b) training for healthcare providers. Findings suggest the need for revisions to clinic materials, infrastructure and protocols. Adding training to all general medical and nursing education to increase knowledge, comfort and competence around gender identity would further improve care and ultimately reduce healthcare disparities affecting TGD youth. [ABSTRACT FROM AUTHOR]

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non‐Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health‐seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two‐Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self‐identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma‐informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families. [ABSTRACT FROM AUTHOR]

Young peoples' acceptance and use of nontraditional, descriptive identity labels (e.g., pansexual, genderqueer) require nurses to consider moving beyond use of traditional terms (e.g., gay, transgender). This mixed methods study explores (a) labels used by sexual orientation and gender identity (SOGI) minority youth, (b) their expressed importance and meaning of these labels, and (c) differences in label usage. Sixty-six SOGI minority adolescents in British Columbia, Minnesota, and Massachusetts (mean age = 16.6) participated in "go-along" interviews; during interviews, 42 (63.6%) commented on labels. Chi-square and t tests were used to compare traditional versus nontraditional labels across participant demographic categories. Inductive thematic analysis was used to identify representative themes. Approximately, 1/3 of participants used nontraditional sexual orientation identity labels; this finding was associated with a trans identity and nontraditional gender labels. Using terminology that is meaningful and representative to the youth themselves has potential to facilitate representative research and welcoming environments in practice. [ABSTRACT FROM AUTHOR]

College may be considered a gateway to success, yet access to college is limited for young adults with autism. Given the research recommendations to elicit student experiences and to communicate among universities to improve college access, success, and equity, the present study examined the questions: What factors are perceived as pathways to success or barriers to success by college students on the autism spectrum? What university provided accommodations and/or support services do they prefer? Participants from four universities completed surveys and semi-structured interviews. Findings from the multi-university study suggest the need to provide transition planning and systematic non-academic social and emotional supports from the start of the college experience as well as specific training for faculty, staff, and peers. [ABSTRACT FROM AUTHOR]

Purpose: Access to primary care can help mitigate the negative impacts of social inequity that disproportionately affect Indigenous people in Canada. Despite this, however, Indigenous people cite difficulties accessing care. This study seeks to understand how Indigenous mothers—typically responsible for the health of their infants—living in urban areas, experience selecting and using health services to meet the health needs of their infants. Results provide strategies to improve access to care, which may lead to improved health outcomes for Indigenous infants and their families. Methods: This qualitative interpretive description study is guided by the Two-Eyed Seeing framework. Interviews were conducted with 19 Indigenous mothers and 5 primary care providers. Results: The experiences of Indigenous mothers using primary care for their infants resulted in eight themes. Themes were organized according to three domains of primary care: structural, organizational and personnel. Conclusions: Primary care providers can develop contextual-awareness to better recognize and respond to the health and well-being of Indigenous families. Applying culturally safe, trauma and violence-informed and family-centred approaches to care can promote equitable access and positive health care interactions which may lead to improved health outcomes for Indigenous infants and their families. [ABSTRACT FROM AUTHOR]

Purpose: Promoting a child's healthy growth and development in the first six years of life is critical to their later health and well-being. Indigenous infants experience poorer health outcomes than non-Indigenous infants, yet little is understood about how parents access and use health services to optimize their infants' growth and development. Exploring the experiences of Indigenous mothers who select and use early childhood development (ECD) services provides important lessons into how best to promote their access and use of health services. Methods: This qualitative interpretive description study was guided by the Two-Eyed Seeing framework and included interviews with 19 Indigenous mothers of infants less than two years of age and 7 providers of ECD services. Results: Mainstream (public) and Indigenous-led health promotion programs both promoted the access and use of services while Indigenous-led programs further demonstrated an ability to provide culturally safe and trauma and violence-informed care. Conclusions: Providers of Indigenous-led services are best suited to deliver culturally safe care for Indigenous mothers and infants. Providers of mainstream services, however, supported by government policies and funding, can better meet the needs of Indigenous mothers and infants by providing cultural safe and trauma and violence-informed care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To develop an understanding of how Indigenous mothers experience selecting and using health services for their infants can assist nurses in improving their access to care. This understanding may ultimately lead to improved health outcomes for Indigenous infants and their families. Background: Access to acute care services is important to minimise morbidity and mortality from urgent health issues; however, Indigenous people describe difficulties accessing care. Indigenous infants are known to use the emergency department frequently, yet little is known about the facilitators and barriers their mothers experience when accessing these services. Design: This study undertook a qualitative, interpretive description design. Methods: This article adheres to the reporting guidelines of COREQ. Data collection methods included interviews and a discussion group with Indigenous mothers (n = 19). Data analysis was collaborative and incorporated both Indigenous and Western ways of knowing, through the application of Two‐Eyed Seeing. Results: A thematic summary resulted in six themes: (a) problematic wait times; (b) the hidden costs of acute care; (c) paediatric care; (d) trusting relationships; (e) racism and discrimination; and (f) holistic care. Conclusions: The experiences of Indigenous mothers using acute care services for their infants suggest a role for culturally safe and trauma and violence‐informed care by health providers in the acute care context. Relevance to Clinical Practice: Nurses can improve access to acute care services for Indigenous mothers and infants through the provision of culturally safe and trauma and violence‐informed approaches care, by building rapport with families, providing care that is respectful and nonjudgemental, eliminating fees associated with using acute care services and linking families with cultural resources both in hospital and within the community. [ABSTRACT FROM AUTHOR]

The American Academy of Pediatrics recommends screening parents for postpartum depression during pediatric primary care visits. Unfortunately, many women who screen positive do not obtain treatment. Providing mental health services for women in the same location as their children's primary care may facilitate treatment, but few such clinics exist. We designed a qualitative study to evaluate women's perceptions and experiences with receiving mental health services from psychiatrists embedded in a safety-net pediatric primary care clinic. Semistructured interviews were conducted with women receiving mental health care from embedded psychiatrists in a safety-net pediatric clinic. Data were analyzed using an inductive approach. Twenty women participated. Five major themes emerged: 1) barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services ; 2) benefits of embedded care, including convenience, low barrier to entry and trust; 3) motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; 5) treatment modality preferences, including concerns about medications and a preference for psychotherapy. Postpartum women face many barriers to psychiatric care. Mental health care embedded within the pediatric setting lowers barriers to care during this critical period. These insights should inform further collaboration between adult psychiatrists and pediatric care providers. [ABSTRACT FROM AUTHOR]

Background: Pediatric emergency care provision in the United States is uneven. Institutional barriers to readiness in the general emergency department (GED) are known, but little is understood about the frontline providers. Our objective was to explore the lived experiences of emergency medicine (EM) providers caring for acutely ill children in the GED and identify opportunities to optimize their pediatric practice. Methods: This grounded theory study used theoretical sampling with snowball recruitment to enroll EM physicians and advanced practice providers from 25 Wisconsin GEDs. Participants completed one‐on‐one, semistructured interviews. Audio recordings were transcribed and coded by a multi‐investigator team drawing on theory produced from comparative analysis. Results: We reached theoretical saturation with 18 participants. The data suggested that providers felt competent managing routine pediatric care, but critically ill children outstripped their resources and expertise. They recognized environmental constraints on the care they could safely provide, which were intensified by unanticipated knowledge gaps and lack of awareness regarding pediatric practice guidelines. A fragmented medical network to support their pediatric practice was identified as a challenge to their care provision at critical junctures. Due to lack of guidance and feedback, providers internalized their experience with critically ill children with uncertainty, which limited learning and practice change. They benefited from meaningful relationships with pediatricians and pediatric subspecialists, targeted education, timely consults, and looped feedback about care provided and patient outcomes. Conclusions: General ED providers struggled with critically ill children because they could not anticipate their pediatric‐specific knowledge gaps and only realized them at critical junctures. EM providers were isolated and frustrated when seeking help; without guidance and feedback they internalized their experience with uncertainty and were left underprepared for subsequent encounters. The data suggested the need for provider‐focused interventions to address gaps in pediatric‐specific continuing medical education, just‐in‐time assistance, and knowledge transfer. [ABSTRACT FROM AUTHOR]

This 2-year study investigated the accommodations and support services preferred by college students with autism spectrum disorder using sequential mixed methods non-experimental survey and semi-structured follow-up interviews. Students with autism spectrum disorder reported using both academic and non-academic supports with frequency (e.g. extended time on exams, transition program), using academic supports in line with other disability populations, and using non-academic supports connecting them one-to-one with a faculty member or coach as preferred (e.g. academic coach, counselor, faculty mentor). Findings suggest a need for university disability service centers, counseling services, and faculty to work together to develop systematic support systems for college students with autism spectrum disorder. [ABSTRACT FROM AUTHOR]

In this paper, we explore the perspectives of expert stakeholders about who owns data in a medical information commons (MIC) and what rights and interests ought to be recognized when developing a governance structure for an MIC. We then examine the legitimacy of these claims based on legal and ethical analysis and explore an alternative framework for thinking about participants' rights and interests in an MIC. [ABSTRACT FROM AUTHOR]

Precision medicine research is rapidly taking a lead role in the pursuit of new ways to improve health and prevent disease, but also presents new challenges for protecting human subjects. The extent to which the current "web" of legal protections, including technical data security measures, as well as measures to restrict access or prevent misuse of research data, will protect participants in this context remains largely unknown. Understanding the strength, usefulness, and limitations of this constellation of laws, regulations, and procedures is critical to ensuring not only that participants are protected, but also that their participation decisions are accurately informed. To address these gaps, we conducted in-depth interviews with a diverse group of 60 thought-leaders to explore their perspectives on the protections associated with precision medicine research. [ABSTRACT FROM AUTHOR]

Accessing BRCA1/2 data facilitates the detection of disease-associated variants, which is critical to informing clinical management of risks. BRCA1/2 data sharing is complex and many practices exist. We describe current BRCA1/2 data-sharing practices, in the United States and globally, and discuss obstacles and incentives to sharing, based on 28 interviews with personnel at U.S. and non-U.S. clinical laboratories and databases. Our examination of the BRCA1/2 data-sharing landscape demonstrates strong support for and robust sharing of BRCA1/2 data around the world, increasing global accesses to diverse data sets. [ABSTRACT FROM AUTHOR]

A 2011 National Academies of Sciences report called for an "Information Commons" and a "Knowledge Network" to revolutionize biomedical research and clinical care. We interviewed 41 expert stakeholders to examine governance, access, data collection, and privacy in the context of a medical information commons. Stakeholders' attitudes about MICs align with the NAS vision of an Information Commons; however, differences of opinion regarding clinical use and access warrant further research to explore policy and technological solutions. [ABSTRACT FROM AUTHOR]

Meaningful participant engagement has been identified as a key contributor to the success of efforts to share data via a "Medical Information Commons" (MIC). We present findings from expert stakeholder interviews aimed at understanding barriers to engagement and the appropriate role of MIC participants. Although most interviewees supported engagement, they distinguished between individual versus collective forms. They also noted challenges including representation and perceived inefficiency, prompting reflection on political aspects of engagement and efficiency concerns. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Chronic kidney disease (CKD) is associated with a range of symptoms, even at early stages. The importance of patient symptom experience is increasingly recognised, but validated symptom scores are lacking. Objectives: This study aimed to refine an existing symptom questionnaire for use with patients not requiring renal replacement therapy (RRT), carry out content validity testing and explore convergent validity by comparing symptom scores with quality of life (QoL). Design: A mixed‐methods approach involving questionnaires, semi‐structured interviews and a focus group. Participants: Patients with CKD not undergoing RRT and expert health professionals. Approach: Two hundred and nineteen patients completed an existing symptom questionnaire. The most commonly reported symptoms were identified, and descriptions refined in 11 semi‐structured interviews. The questionnaire design was reviewed by a focus group. Content validity was established by a panel of expert health professionals. Seventy patients completed both the symptom questionnaire and a health‐related QoL questionnaire (EQ‐5D‐5L). Results: Thirteen common symptoms were identified. During the content validity phase, 13/16 experts responded (81%); 10/13 symptoms had ‘excellent’ or ‘good’ evaluation scores, and the content validity index of the whole questionnaire was 0.81, falling within the recommended threshold. Total symptom frequency scores, number of symptoms and the frequencies of 10/13 individual symptoms were all strongly associated with health‐related QoL (EQ‐5D‐5L index score; p < 0.002 for all). Conclusion: This work has provided a new, validated symptom score for patients with CKD not requiring RRT for clinical management and research purposes. [ABSTRACT FROM AUTHOR]

Background: Studies have demonstrated a robust association between interpersonal callousness (IC) and the development of severe and chronic conduct problems (CP) in youth. Although children exhibiting IC are also believed to be at particularly high risk for developing psychopathic personality features in adulthood, there is little longitudinal evidence supporting this assumption, particularly after controlling for co-occuring CP severity. Methods: This study used data collected on a longitudinal cohort of boys (n = 508), with an oversampling of youth exhibiting elevated conduct problems. Analyses examined the unique and interactive association between latent growth curve trajectories of IC and CP assessed bi-annually from late childhood to early adolescence (~ages 10-13) and features of psychopathy in early adulthood (age ~ 24) assessed using the Psychopathy Checklist - Short Version (PCL:SV; Hart, Cox, & Hare, 1995). Results: Growth curve analysis indicated that initial levels of IC and CP in childhood (~age 10 intercept) both uniquely predicted the development of the interpersonal/affective features of adult psychopathy, and boys with a combination of high initial levels of IC and CP were at particularly high risk for developing the impulsive/antisocial features of the disorder. Boys who exhibited systematic increases in CP from late childhood to early adolescence also demonstrated higher adult psychopathy scores, but changes in IC across this developmental period did not significantly add to the prediction of adult psychopathy. Conclusions: Findings highlight the importance of developing targeted interventions for boys exhibiting severe IC and CP in childhood, as they appear to be at high risk for developing adult psychopathic features. [ABSTRACT FROM AUTHOR]

The article discusses research regarding rural grocery storeowners' perceptions of their communities, their business practices, and factors that influence their sustainability and the ability to support healthy food choices in Nebraska as of 2016. According to the article, storeowners reported on strategies that they employ to remain competitive by focusing on customer service and product quality. The public health aspects of obesity in America are examined, along with small U.S. stores.

Evidence suggests that installing a classroom management system known as the Color Wheel reduced inappropriate behaviors and increased on-task behavior in second- and fourth-grade classrooms; however, no systematic studies of the Color Wheel had been disseminated targeting pre-school or kindergarten participants. To enhance our understanding of the Color Wheel System (CWS) as a prevention system, a multiple-baseline design was used to evaluate the effects of the Color Wheel on inappropriate vocalizations (IVs) in three general education kindergarten classrooms. Partial-interval time-sampling was used to record classwide IVs, which were operationally defined as any comment or vocal noise that was not solicited by the teacher. Time series graphs and effect size calculations suggest that the CWS caused immediate, large, and sustained decreases in IVs across the three classrooms. Teacher acceptability and interview data also supported the CWS. Implications related to prevention are discussed and directions for future research are provided. [ABSTRACT FROM AUTHOR]

The article examines a survey to asses the effectiveness of Cooking Matters for Adults (CMA), a cooking-based nutrition education program for low-income adults. The need for the development of common metrics to advance cooking-based nutrition education programs was mentioned. The components of the survey include dietary patterns, sociodemographics and psychometrics. It was found that the CMA Survey may be useful for similar nutrition-based programs.

The high prevalence of mental health disorders among incarcerated juveniles is a matter of national and global concern. Juvenile justice personnel need accurate screening measures that identify youth requiring immediate mental health services. The purpose of this study was threefold: (a) to examine the utility of the Massachusetts Youth Screening Instrument, Version 2 (MAYSI-2) in identifying juveniles with mental health concerns in a large sample of juveniles (N = 4,009), (b) to provide data regarding rates of identified mental health needs in incarcerated youth, and (c) to provide descriptive comparisons to other studies using the MAYSI-2. Mean scores of subscales were compared with the MAYSI-2 normative samples and other recent studies. Results indicated that this population has a high occurrence of mental health symptoms and there is high variability in the severity of the symptoms. In addition, a multivariate analysis of variance test found significant differences in mental health problems across ethnic groups. [ABSTRACT FROM PUBLISHER]

The purpose of the current study is to contribute to the knowledge base on the use of family education and support (FES) services by examining the longitudinal trajectories of FES receipt and multiple domains of child and family functioning. Using an extant data set of more than 9,000 youth and their caregivers, results indicate that families who received FES on entry into services had greater caregiver strain, and their children experienced greater emotional challenges than families who did not receive FES services. Furthermore, for families who received FES, the longitudinal results revealed an immediate effect of seeking additional services, decreasing caregiver strain 6 months after receipt of FES services, and improving child emotional functioning 6 to 18 months after initial receipt of FES services. The complex, lagged effects in the results are discussed in the context of the theorized cyclical course of family stress as exemplified by the Double ABCX model of adjustment and adaptation. Implications for future research of FES services are discussed, especially the need to develop a functional logic model and an operational definition of FES and its components. [ABSTRACT FROM PUBLISHER]

A structured psychosocial risk screening interview, the Prenatal Risk Overview, was administered to 733 women in prenatal care. Either a community health worker (CHW) or a registered nurse (RN) conducted the interview based on day of the week. A comparison of identified risk factors found no significant differences between study samples for six of 13 domains. For CHW interviews, significantly more participants were classified as Moderate/ High Risk for Depression, Lack of Telephone Access, Food Insecurity, and Housing Instability, and as High Risk for Lack of Social Support, Lack of Transportation Access, and Housing Instability. For RN interviews, significantly more participants were classified as High Risk for Alcohol Use. Community health workers successfully conducted psychosocial screening and elicited more self-reported risk than RNs, especially lack of basic needs. Comparing the hourly salary/ wage, the cost for CHWs was 56% lower than for RNs. Preliminary findings support use of paraprofessionals for structured screening interviews. [ABSTRACT FROM AUTHOR]

Purpose: To determine the physiotherapy-related needs of people with stroke at discharge, 6 months after discharge, and 1 year after discharge from hospital, and to examine the results stratified by participants' acute Functional Independence Measure (FIM) scores. Methods: A total of 241 adults with recent stroke were recruited into this longitudinal cohort study. As well as participating in a semi-structured interview that included questions about mobility needs and barriers, participants were asked to complete and return a closed-ended needs-assessment survey. Results: During the interview, participants reported needs and barriers related to motor control, walking, stairs, fatigue, prevention of falls, and access to physiotherapy services. The survey identified many more needs, including transfers, wheelchair use, higher-level balance and mobility skills, and access to physiotherapy and suitable exercise facilities. Frequencies of needs and barriers tended to be lower among participants with higher acute FIM scores. There was no consistent trend for needs and barriers to decrease over time. Conclusions: Over the first year after discharge from hospital, people with stroke report a large and varied number of persistent mobility-related needs. Physiotherapists have a role to play in advocating for adequate follow-up services and informing health policy with respect to the needs of their patients with stroke. [ABSTRACT FROM AUTHOR]

Abstract: Background: Fruit and vegetable (F/V) intake assessment tools that are valid, reliable, brief, and easy to administer and code are vital to the field of public health nutrition. Objective: To evaluate three short F/V intake screeners (ie, a 2-item serving tool, a 2-item cup tool, and a 16-item F/V intake screener) among adults using multiple 24-hour dietary recalls (24-hour recalls) as the reference instrument and evaluate test–retest reliability of the screeners across a 2- to 3-week time period. Design: Validity and reliability study. Participants/setting: Two hundred forty-four adults for the validity study and 335 adults for test–retest reliability. Statistical analyses performed: Median values for F/V intakes were calculated for the screeners and 24-hour recalls. The Wilcoxon signed rank test was used to compare screeners with the 24-hour recalls. Deattenuated Pearson correlations were reported for validity and intraclass correlation coefficient used for reliability. Results: The estimated median daily servings/cups of F/V for the 2-item serving screener was lower, for the 2-item cup screener was equivalent for men but higher for women, and for the 16-item F/V intake screener were about the same when compared with 24-hour recall values. The deattenuated correlations comparing the 24-hour recalls with the screeners were positive but weak for the 2-item serving screener, and were positive and moderate in strength for the 2-item cup and 16-item F/V intake screeners. The test–retest intraclass correlation coefficients were all positive and fairly strong for all of the screeners. Conclusions: Although dietary screeners offer a more cost-effective, less burdensome way to obtain gross estimates to rank individuals with regard to F/V intake, these methods are not recommended for assessing precise intake levels. [Copyright &y& Elsevier]

Objectives To carry out a preliminary exploration and measurement of therapy expectancy in adults with intellectual disabilities through the development and psychometric evaluation of the therapy expectation measure (TEAM). Design The initial scale development phase combined top-down theory-driven and bottom-up data-driven processes to identify TEAM items and format. The subsequent scale evaluation phase piloted the TEAM and used correlational analyses to evaluate reliability and validity. Method Six adults with intellectual disabilities took part in semi-structured interviews about therapy expectancy and motivation to identify TEAM items. A further 22 participants piloted the measure for initial psychometric evaluation. Results Preliminary psychometric evaluation confirmed that the TEAM has acceptable test-retest reliability and internal consistency. Assessment of construct validity found a strong and positive relationship with a measure of general self-efficacy. Client expectations of therapy were largely positive and congruent with therapy as a goal-oriented process in which they will be an active participant. However, a number of individuals were unclear about the reason for referral and felt a low level of involvement in the process. Client and carer perceptions of referral understanding were significantly different. Conclusions The TEAM may help clinicians to identify potential barriers to engagement in therapy and find ways of enhancing the therapeutic experience of adults with an intellectual disability. Further psychometric evaluation of the TEAMM with larger samples is required to confirm the factorial structure of the scale and enhance its clinical utility. [ABSTRACT FROM AUTHOR]

The article reports on research conducted to explore the validity of the StepWatch Step Activity Monitor (SAM) in assessing stride count in persons with Parkinson's disease or multiple sclerosis. Researchers evaluated 20 patients. They found that the tool was valid for assessing stride count in patients with multiple sclerosis or Parkinson's disease.

High-intensity interval training (HIIT) is considered a novel and time-efficient method to reduce cardiovascular disease risk, a leading cause of mortality in kidney transplant recipients. However, research in this population is severely limited. The aim of this study was to understand kidney transplant recipients' perceptions and experiences of HIIT and their readiness to participate in HIIT. Individual, semi-structured interviews were conducted in adults with a kidney transplant (n = 13; 53±13 years). Interviews were audiorecorded, transcribed verbatim, and subjected to framework analysis. Overall, participants had a good knowledge of HIIT and were open to participation. Acknowledgment of the superior benefits to cardiovascular, mental, and general health, as well as the lower time commitment, were all motivators for participation. There were some heightened concerns around damaging the kidney and 'knowing your limits.' Personalization, physician's approval, and supervision were all important factors in participation. This study provides evidence that HIIT would be, in principle, largely accepted by recipients of a kidney transplant. However, several considerations are also identified in the present study, which would be essential to the success of any future efficacy trial or rehabilitation program. [ABSTRACT FROM AUTHOR]

The Veterans Health Administration (VHA) purchases community nursing home care; however, the administrative burden may lead nursing homes to avoid contracting with the VHA. This study aimed to describe how the VHA's purchasing policies impede or facilitate contracting with nursing homes. Semistructured interviews of key stakeholders in the VHA's community nursing home contracting process. We interviewed 15 VHA and 21 nursing home staff at 6 VHA medical centers and 17 nursing homes. VHA medical centers were selected from sites with the greatest magnitude of difference in quality rankings between VHA contracted and noncontracted nursing homes in the same market area. Qualitative content analysis of interviews. Five themes emerged: (1) VHA purchases nursing home care to fill gaps in geographic, specialty, and quality care needs; (2) business opportunities and the mission to care for Veterans motivate nursing homes to work with the VHA; (3) the VHA's reputation for unreliable or insufficient payment and inability of nursing homes to comply with federal wage standards serve as barriers to establishing contracts; (4) complexity of establishing a contract, ambiguity about new policies, and inadequate VHA staffing for the nursing home inspection team hinder the VHA's ability to establish contracts with nursing homes; and (5) nursing homes that have established corporate processes, nursing home administrators with prior experience working with the VHA, and relationships between VHA and nursing home staff serve as facilitators to establishing new nursing home contracts. Nursing homes will work with the VHA, but the process of executing VHA contracts is burdensome. Streamlining and standardizing the purchasing processes and ensuring timely payment may expand the number of nursing homes willing to contract with the VHA, thereby increasing choices for Veterans and becoming a model for other long-term care networks. [ABSTRACT FROM AUTHOR]