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Objective Group Well-Child Care (GWCC) has been described as providing an opportunity to enhance well-being for vulnerable families experiencing psychosocial challenges. We sought to explore benefits and challenges to the identification and management of psychosocial concerns in Group Well-Child Care (GWCC) with immigrant Latino families. Methods We conducted a case study of GWCC at an urban academic general pediatric clinic serving predominantly Limited English Proficiency Latino families, combining visit observations, interviews, and surveys with Spanish-speaking mothers participating in GWCC, and interviews with providers delivering GWCC. We used an adapted framework approach to qualitative data analysis. Results A total of 42 mothers and 9 providers participated in the study; a purposefully selected subset of 17 mothers was interviewed, all providers were interviewed. Mothers and providers identified both benefits and drawbacks to the structure and care processes in GWCC. The longer total visit time facilitated screening and education around psychosocial topics such as postpartum depression but made participation challenging for some families. Providers expressed concerns about the effects of shorter one-on-one time on rapport-building; most mothers did not express similar concerns. Mothers valued the opportunity to make social connections and to learn from the lived experiences of their peers. Discussions about psychosocial topics were seen as valuable but required careful navigation in the group setting, especially when fathers were present. Conclusions Participants identified unique benefits and barriers to addressing psychosocial topics in GWCC. Future research should explore the effects of GWCC on psychosocial disclosures and examine ways to enhance benefits while addressing the challenges identified.

Abstract. Parent behaviors strongly predict child responses to acute pain; less studied are the factors shaping parent behaviors. Heart rate variability (HRV) is considered a physiological correlate of emotional responding. Resting or “trait” HRV is indicative of the capacity for emotion regulation, while momentary changes or “state” HRV is reflective of current emotion regulatory efforts. This study aimed to examine: (1) parent state HRV as a contributor to parent verbal behaviors before and during child pain and (2) parent trait HRV as a moderator between parent emotional states (anxiety, catastrophizing) and parent behaviors. Children 7–12 years of age completed the cold pressor task (CPT) in the presence of a primary caregiver. Parents rated their state anxiety and catastrophizing about child pain. Parent HRV was examined at 30-second epochs at rest (“trait HRV”), before (“state HRV-warm”), and during their child’s CPT (“state HRV-cold”). Parent behaviors were video recorded and coded as coping-promoting or distress-promoting. Thirty-one parents had complete cardiac, observational, and self-report data. A small to moderate negative correlation emerged between state HRV-cold and CP behaviors during CPT. Trait HRV moderated the association between parent state catastrophizing and distress-promoting behaviors. Parents experiencing state catastrophizing were more likely to engage in distress-promoting behavior if they had low trait HRV. This novel work suggests parents who generally have a low (vs. high) HRV, reflective of low capacity for emotion regulation, may be at risk of engaging in behaviors that increase child distress when catastrophizing about their child’s pain.

Models of perfectionism and stress have become increasingly complex, yet perseverative cognition has been largely absent from these models and remains under-represented in the perfectionism and stress literature. This research makes several key advances by testing the perseverative cognition hypothesis in relation to perfectionism and daily stress in a community sample of 100 working professionals. We collected data over a 7-day period using a multi-method daily diary design including self-report measures of daily experiences and daily heart rate variability (HRV), which is thought to reflect physiological adaptation to stress. HRV was measured daily using 15-min samples at the end of each day. Data were aggregated across days and analyzed using path analysis. Results showed self-critical perfectionism predicted poorer adaptation to stress directly and indirectly through perseverative cognition pathways (i.e., the combined effect of daily stress and event-focused rumination). However, considering the impact of daily stress alone did not show detrimental effects on HRV. Perfectionistic strivings was not related to perseverative cognition pathways, but it showed a small positive direct effect on HRV. Findings highlight perseverative cognition as a useful framework for understanding perfectionism and physiological adaptation to stress, and this research points toward the development of an integrative bio-psycho-social model of perfectionism and stress vulnerability.

Prior work suggests that individuals with an eating disorder demonstrate task-based and overall differences in sociocognitive functioning. However, the majority of studies assessed specifically anorexia nervosa and often employed a single experimental paradigm, providing a piecemeal understanding of the applicability of various lab tasks in denoting meaningful differences across diverse individuals. The current study was designed to address these outstanding issues. Participants were undergraduate females who self-identified as having an official (n = 18) eating disorder diagnosis or disordered eating behaviours with no diagnosis (n = 18), along with a control group (n = 32). Participants completed three social tasks of increasing complexity with different outcome measures, namely a gaze cueing task, passive video-watching using eyetracking, and a task to measure preferred social distance. Results diverged as a function of group across tasks; only the control group produced typical social attention effects, the disordered eating group looked significantly more at faces, and the eating disorder group demonstrated a significantly larger preferred social distance. These results suggest variations in task efficacy and demonstrate that altered sociocognitive functioning extends beyond official eating disorder diagnosis.

Attractive self-interaction processes in antibody formulations increase the risk of aggregation and extraordinarily elevated viscosity at high protein concentrations. These challenges affect manufacturing and application. This study aimed to understand the self-interaction process of Infliximab as a model system with pronounced attractive self-interaction. The association mechanism was studied by a multi-method approach comprising analytical ultracentrifugation, dynamic light scattering, small angle X-ray scattering, self-interaction bio-layer interferometry and hydrogen-deuterium exchange mass spectrometry. Based on our results, both Fab and Fc regions of Infliximab are involved in self-interaction. We hypothesize a mechanism based on electrostatic interactions of polar and charged residues within the identified areas of the heavy and the light chain of the mAb. The combination of fast and reliable screening methods and low throughput but high resolution methods can contribute to detailed characterization and deeper understanding of specific self-interaction processes.

Parental responses to negative emotion, one key component of emotion socialization, may function to increase (or decrease) reactive aggression over time via indirect effects on emotion dysregulation. However, despite its transdiagnostic relevance, very little research has examined this developmental risk pathway, and no studies have done so during the volatile and vulnerable transition to adolescence. The current study uses a sample of clinically referred youth (N = 162; mean age = 12.03 years; 47% female) and their parents to examine supportive and non-supportive parental responses to negative emotion using a multi-method (questionnaire, ecological momentary assessment [EMA], observation), multi-informant approach (child-, parent-, clinician-rated). Emotion dysregulation and reactive aggression were assessed via child report during a 4-day EMA protocol completed concurrently and 9 months later. Multivariate structural equation modeling was used to examine direct and indirect paths from parental responses to emotion to daily reports of emotion dysregulation and reactive aggression. Consistent with hypotheses, parental responses to emotion predicted reactive aggression via effects on emotion dysregulation. This indirect effect was present for supportive and non-supportive parental responses to emotion, such that supportive parental responses decreased risk, and non-supportive responses increased risk. Moreover, findings indicated differential prediction by informant, and this was specific to supportive parental responses to emotion, whereby child-reported support was protective, while parent-reported support, unexpectedly, had the opposite effect. The clinical significance of integrating supportive and non-supportive parental responses to negative emotion into etiological and intervention models of reactive aggression is discussed.

Weak macromolecular interactions assume a dominant role in the behavior of highly concentrated solutions, and are at the center of a variety of fields ranging from colloidal chemistry to cell biology, neurodegenerative diseases, and manufacturing of protein drugs. They are frequently measured in different biophysical techniques in the form of second virial coefficients, and nonideality coefficients of sedimentation and diffusion, which may be related mechanistically to macromolecular distance distributions in solution and interparticle potentials. A problem arises for proteins where reversible self-association often complicates the concentration-dependent behavior, such that grossly inconsistent coefficients are measured in experiments based on different techniques, confounding quantitative conclusions. Here we present a global multi-method analysis that synergistically bridges gaps in resolution and sensitivity of orthogonal techniques. We demonstrate the method with a panel of monoclonal antibodies exhibiting different degrees of self-association. We show how their concentration-dependent behavior, examined by static and dynamic light scattering and sedimentation velocity, can be jointly described in a self-consistent framework that separates nonideality coefficients from self-association properties, and thereby extends the quantitative interpretation of nonideality coefficients to probe dynamics in highly concentrated protein solutions.

There has been limited research into the individual, social, and environmental factors for infection risk among patients in the home healthcare (HHC) setting, where the infection is a leading cause of hospitalisation. The aims of this study were to (1) explore nurse perceptions of individual, social, and environmental factors for infection risk among HHC patients; and (2) identify the frequency of environmental barriers to infection prevention and control in HHC. Data were collected in 2017-2018 and included qualitative interviews with HHC nurses (n = 50) and structured observations of nurse visits to patients' homes (n = 400). Thematic analyses of interviews with nurses suggested they perceived infection risk among patients as being influenced by knowledge of and attitudes towards infection prevention and engagement in hygiene practices, receipt of support from informal caregivers and nurse interventions aimed at cultivating infection control knowledge and practices, and the home environment. Statistical analyses of observation checklists revealed nurses encountered an average of 1.7 environmental barriers upon each home visit. Frequent environmental barriers observed during visits to HHC patients included clutter (39.5%), poor lighting (38.8%), dirtiness (28.5%), and pets (17.2%). Additional research is needed to clarify inter-relationships among these factors and identify strategies for addressing each as part of a comprehensive infection control program in HHC.

A robust knowledge of biodiversity distribution is essential for designing and developing effective conservation actions. The choice of a suitable sampling method is key to obtaining sufficiently accurate information of species distribution and consequently to improve biodiversity conservation. This study applies multi-method occupancy models to 36 common bird species associated with small ponds in the province of Murcia (south-eastern Spain), one of the most arid regions of Europe, in order to compare their effectiveness for detecting different bird species: direct observation, combined observation and video monitoring and mist netting captures. The results showed that the combined method and direct observation were similar and most effective than mist netting for detecting species occupancy, although detection rates ranged widely among bird groups, while some large species were poorly detected by all the methods used. Average detectability did not increase during the breeding period. The chosen approach is particularly applicable to both single- and multi-species bird monitoring programmes. However, we recommend evaluating the cost-effectiveness of all the available methods in order to reduce costs and improve the success of sampling designs.

Selective mutism (SM) is an anxiety disorder in which a child fails to speak in some situations (e.g., school) despite the ability to speak in other situations (e.g., home). Some work has conceptualized SM as a variant of social anxiety disorder (SAD) characterized by higher levels of social anxiety. Here, we empirically tested this hypothesis to see whether there were differences in social anxiety (SA) between SM and SAD across behavioral, psychophysiological, self-, parent-, and teacher-report measures. Participants included 158 children (Mage = 8.76 years, SD = 3.23) who were classified into three groups: children with SM and who were also highly socially anxious (SM + HSA; n = 48), highly socially anxious children without SM (HSA; n = 48), and control children (n = 62). Children participated in a videotaped self-presentation task, following which observed SA behaviors were coded, and salivary cortisol reactivity was measured. We also collected child, parent, and teacher reports of children’s trait SA symptoms. The SM + HSA and HSA groups had similar observed non-verbal SA behavior, cortisol reactivity, and trait SA symptom levels according to parent and child reports, but SM + HSA children had significantly higher SA according to teacher report and observer-rated verbal SA behavior relative to the HSA group. As expected, control children had lower cortisol reactivity and SA across all measures relative to the other groups. Although SM and SAD in children share many similarities, SM may be characterized by greater SA in certain social contexts (e.g., school) and is distinguishable from SAD on behavioral measures of verbal SA.

An informal caregiver (ICG) is an individual who provides care (unpaid) to a person with a disability or disease. ICGs report the extreme time spent as an ICG lowers their availability to participa...

Luxury brands across the globe have made inroads into emerging markets (EM). While some brands have succeeded in one EM, they have failed to replicate their success in others. We investigate the drivers of luxury brand sales in EM using a multi-method approach. First, through a qualitative study, we identify which market characteristics of EM (market heterogeneity, competition from unbranded products, socio-political governance, and resources and infrastructure) affect luxury brand sales, with a firm’s marketing effort and a market’s financial freedom being important contingencies. Second, we empirically test the insights using data from 88 luxury brands and robust econometric analyses. Our results show that market characteristics influence luxury sales and that the effects of such market characteristics on luxury brand sales are heterogeneous. We also find significant moderating effects of marketing efforts and financial freedom. Our study thus extends the literature on the marketing of luxury brands and EM.

Background Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions. Methods This retrospective multi-method study investigated the decision-making process of physicians in a pediatric tele-triage service provided in Israel. The first section of the study investigates several measures relating to patient safety in the telemedicine setting. Two physicians reviewed a random sample of 339 parent-physician consultations conducted via a pediatric telemedicine service provided by a healthcare organization during 2014–2017. The consultations were analyzed for factors that may have affected the online physicians’ decisions, with an emphasis on the appropriateness of the diagnoses and the reasonableness of the decisions. The online physicians’ decisions were also compared to the subsequent outcomes (i.e., parental compliance with the recommendations and medical follow-ups within the healthcare system) after each consultation. The second section of the study (using a qualitative approach) consisted of interviews with 15 physicians who work in the pediatric telemedicine service, in order to explore their subjective experiences and efforts for assuring patient safety. The physicians were asked about factors that may have affected their reaching an appropriate diagnosis and a reasonable decision while maintaining patient safety. Results The first section of the study demonstrates high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), as well as low levels of false-positive (2.65%) and false-negative (5.3%), good sensitivity (82.85%), and high specificity (96.15%). A high association between the online decisions and the subsequent outcomes was also observed. The second section of the study presents physicians’ means for ensuring high patient safety – by implementing a range of factors that helped them reach appropriate diagnoses and reasonable decisions. Conclusions The results show overall high patient safety in the pediatric tele-triage service that was examined. However, decision makers must strive to implement additional means for further enhancing the clinicians’ ability to reach accurate diagnoses and provide optimal treatments within the tele-triage settings – with the aim of ensuring patient safety.

Background Exploring the cultural context of intergenerational continuity of warm and harsh parenting informs parents motivations to adopt specific parenting behaviours. Objective Parents’ perceptions of being parented in the past and their current parenting as well as adolescents’ perceptions of current parenting were explored applying a multi-method approach. Methods Following written informed consent, a total of 24 interviews with 10 families (dyads of 14 parents and ten adolescents) from Udupi taluk in southern India was conducted. In the first stage, in-depth interviews were conducted with parent participants (Generation 1 (G1)) and in the second stage, adolescents (Generation 2 (G2)) participated in the photovoice component. Multiple forms of data including photographs, journals and interviews facilitated using the SHOWeD model were collected and were analysed thematically using ATLAS.ti(v.8). Results Subtle changes in reinforcing culture-specific gender norms between generations were elicited. Differences in communication, granting autonomy to female adolescents, and in disciplining methods between G1 and G2 were observed. Warm parenting was transmitted between generations while harsh parenting in G1 in the presence of external social support was discarded in favor of warm parenting in G2. Conclusion We provide evidence for perceptions of parenting and adolescent behaviors across two generations. Transmission of warm parenting and interruption in the cycle of harsh parenting in the presence of external social support were significant findings. Related theoretical and methodological applications are discussed.

BackgroundCOVID-19 changed access to healthcare, including vaccinations, in the United Kingdom (UK). This study explored UK women’s experiences of accessing pertussis vaccination during pregnancy and infant vaccinations during COVID-19.MethodsAn online cross-sectional survey was completed, between 3rd August-11 th October 2020, by 1404 women aged 16+ years who were pregnant at some point after the first UK lockdown from March 23rd, 2020. Ten follow-up semi-structured interviews were conducted.ResultsMost women surveyed were pregnant (65.7%) and a third postnatal (34.3%). Almost all women (95.6%) were aware that pertussis vaccination is recommended in pregnancy. Most pregnant (72.1%) and postnatal women (84.0%) had received pertussis vaccination; however, access issues were reported.Over a third (39.6%) of women had a pregnancy vaccination appointment changed. COVID-19 made it physically difficult to access pregnancy vaccinations for one fifth (21.5%) of women and physically difficult to access infant vaccinations for almost half of women (45.8%). Nearly half of women (45.2%) reported feeling less safe attending pregnancy vaccinations and over three quarters (76.3%) less safe attending infant vaccinations due to COVID-19. The majority (94.2%) felt it was important to get their baby vaccinated during COVID-19.Pregnant women from ethnic-minorities and lower-income households were less likely to have been vaccinated. Minority-ethnicity women were more likely to report access problems and feeling less safe attending vaccinations for both themselves and their babies.Qualitative analysis found women experienced difficulties accessing antenatal care and relied on knowledge from previous pregnancies to access vaccines in pregnancy.ConclusionDuring the ongoing and future pandemics, healthcare services should prioritise equitable access to routine vaccinations, including tailoring services for ethnic-minority families who experience greater barriers to vaccination.HighlightsAccess to pregnancy vaccines in the United Kingdom was disrupted by the COVID-19 pandemic.UK women reported difficulties in physically accessing vaccine appointments and feeling less safe accessing vaccine appointments for themselves when pregnant and for their babies during COVID-19, with women from ethnic minorities in the UK were more likely to report difficulties.Vaccine services must ensure equitable access to vaccine appointments during the ongoing COVID-19 pandemic including tailoring services for lower income and ethnic minority families.

Trauma exposure is highly prevalent among children globally, and is associated with elevated rates of PTSD. The goal of this study was to systematically evaluate the effects of multiple informants and multiple screening measures on the identification of specific PTSD symptoms and rates of PTSD diagnoses. Participants in this study included 350 maltreated children from two cohorts, one recruited from Connecticut (N=130), and the other from Vermont (N=220). Both cohorts completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED) before a PTSD self-report measure. The KSADS psychiatric interview was also completed with the Connecticut cohort, with best-estimate ratings generated using parent and child interview, child self-report, and teacher questionnaire data. In addition to the SCARED and PTSD self-report scale, parents of the Vermont cohort completed the Child Behavioral Checklist. Significant differences emerged between parent and child report of sleep, nightmares, concentration, and irritability problems, suggesting the need for multiple informants in PTSD screening. Children also under-reported nightmares when asked in the context of a trauma-specific screening tool. As child trauma is associated with a broad range of psychiatric sequelae, comprehensive assessment using both general symptomatology and trauma-specific measures is recommended, since children often shut down when completing trauma measures.

Background: Dispensing of antibiotics without a prescription (DAwP) has been widely practised among community pharmacies in Saudi Arabia despite being illegal. However, in May 2018, the law and regulations were enforced alongside fines. Consequently, we wanted to evaluate the impact of these changes. Methods: A study was conducted among 116 community pharmacies in two phases. A pre-law enforcement phase between December 2017 and March 2018 and a post-law enforcement phase one year later. Each phase consisted of a cross-sectional questionnaire-based survey and a simulated client method (SCM) approach. In the SCM, clients presented with either pharyngitis or urinary tract infections (UTI). In SCM, for each phase, all 116 pharmacies were visited with one of the scenarios. Results: Before the law enforcement, 70.7% of community pharmacists reported that DAwP was common with 96.6% and 87.7% of participating pharmacies dispensed antibiotics without a prescription for pharyngitis and UTI respectively. After the law enforcement, only 12.9% reported that DAwP is still a common practice, with only 12.1% and 5.2% dispensing antibiotics without prescriptions for pharyngitis and UTI respectively. Conclusion: law enforcement was effective. However, there is still further scope for improvement. This could include further educational activities with pharmacists, physicians and the public.

Facilitated attention toward angry stimuli (attention bias) may contribute to anger proneness and temper outbursts exhibited by children with high irritability. However, most studies linking attention bias and irritability rely on behavioral measures with limited precision and no studies have explored these associations in young children. The present study explores irritability-related attention biases toward anger in young children (N = 128; ages 4-7 years) engaged in a dot-probe task with emotional faces, as assessed with event-related brain potential (ERP) indices of early selective attention and multi-method assessment of irritability. Irritability assessed via semi-structured clinical interview predicted larger anterior N1 amplitudes to all faces. In contrast, irritability assessed via a laboratory observation paradigm predicted reduced P1 amplitudes to angry relative to neutral faces. These findings suggest that altered early attentional processing occurs in young children with high irritability; however, the nature of these patterns may vary with methodological features of the irritability assessments. Future investigations using different assessment tools may provide greater clarity regarding the underlying neurocognitive correlates of irritability. Such studies may also contribute to the ongoing debates about how to best define and measure irritability across the developmental spectrum in a manner that is most informative for linkage to neural processes.

Contamination fear and washing compulsions are among the most common symptoms of obsessive compulsive disorder (OCD). Though these symptoms have traditionally been viewed as being driven by a desire to avoid harm, recent research has highlighted the importance of feelings of incompleteness (INC) or not-just right experiences (NJREs) in this symptom dimension. However, no study to date has examined the extent to which INC/NJREs may be associated with treatment response for contamination symptoms. The current study used a multi-method approach to examine the role of INC/NJREs in treatment of contamination symptoms. Participants (n = 88) with elevated contamination symptoms, half of whom met for an OCD diagnosis, engaged in three sessions of exposure and response prevention (ERP) targeting contamination fears, and completed self-report and in vivo measures of INC/NJRES and contamination symptoms. ERP was associated with significant reductions in INC/NJREs. Further, changes in INC were associated with changes in contamination symptoms, independent of changes in harm avoidance. Greater discomfort in response to an in vivo NJRE task at pre-treatment predicted poor treatment response, though a self-report measure of INC did not predict response. These findings provide novel evidence for the importance of INC/NJREs in contamination-based OCD and its treatment.

Background COVID-19 vaccines are advised for pregnant women in the United Kingdom (UK) however COVID-19 vaccine uptake among pregnant women is inadequate. Methods An online survey and semi-structured interviews were used to investigate pregnant women’s views on COVID-19 vaccine acceptability for themselves when pregnant, not pregnant and for their babies. One thousand one hundred eighty-one women, aged over 16 years, who had been pregnant since 23rd March 2020, were surveyed between 3rd August–11th October 2020. Ten women were interviewed. Results The majority of women surveyed (81.2%) reported that they would ‘definitely’ or were ‘leaning towards’ accepting a COVID-19 vaccine when not pregnant. COVID-19 vaccine acceptance was significantly lower during pregnancy (62.1%, p p Conclusion Safety information on COVID-19 vaccines must be clearly communicated to pregnant women to provide reassurance and facilitate informed pregnancy vaccine decisions. Targeted interventions to promote COVID-19 vaccine uptake among ethnic minority and lower-income women may be needed.

Twin studies can help us understand the relative contributions of genes and environment to phenotypic trait variation including attentional and brain activation measures. In terms of applying methodologies like electroencephalography (EEG) and eye tracking, which are key methods in developmental neuroscience, infant twin studies are almost non-existent. Here we describe the Babytwins Study Sweden (BATSS), a multi-method longitudinal twin study of 177 MZ and 134 DZ twin pairs (i.e. 622 individual infants) covering the 5 - 36 month time period. The study includes EEG, eye tracking and genetics, together with more traditional measures based on in-person testing, direct observation and questionnaires. The results show that interest in participation in research among twin parents is high, despite the comprehensive protocol. DNA analysis from saliva samples was possible in virtually all participants, allowing for both zygosity confirmation and polygenic score analyses. Combining a longitudinal twin design with advanced technologies in developmental cognitive neuroscience and genomics, BATSS represents a new approach in infancy research, which we hope to have impact across multiple disciplines in the coming years.

Introduction Alexithymia, a trait encompassing difficulties identifying and describing one's feelings, and a tendency to focus externally, is positively associated with both non-suicidal self-injury (NSSI) and risky drinking. The relationships between alexithymia and both behaviours are well researched, however, it is unclear whether both associations are explained by similar behaviour-specific expectancies . The primary aim of the present research was to investigate and compare the indirect relationships between alexithymia and both behaviours through NSSI and drinking specific expectancies and refusal self-efficacy. The secondary aim was to compare lab-based and questionnaire-based measures of expectancies. Methods A sample of 259 students (80.31% female, Mage =19.98; SD = 1.49) answered a series of questionnaires and completed lab-based expectancy tasks to measure the variables of interest. Results Alexithymia was indirectly associated with both NSSI and risky drinking through behaviour-specific refusal self-efficacy. Thus, students with high levels of alexithymia may believe they are incapable of resisting engaging in self-injury or consuming alcohol in circumstances that warrant them to place attention on and/or appraise their feelings. Further, alexithymia was indirectly associated with NSSI through stronger affect regulation and weaker communication expectancies. However, alexithymia was not indirectly associated with risky drinking through drinking-specific expectancies. Limitations Cross-sectional methods preclude conclusions regarding temporal ordering. Conclusion Theoretically, these findings suggest that anticipated outcomes of NSSI and risky drinking may be different for university students. Clinically, the current results support interventions that challenge behaviour specific thoughts and beliefs for students who have difficulties identifying and describing feelings.

Background In the absence of a cure for the majority of rare diseases, the disease management aims to provide optimal supportive care. The goal of this study was to assess supportive care needs in patients with chronic rare diseases. Methods Cross-sectional mixed-method study was conducted using validated self-report scales and open-ended questions to assess supportive care needs. Participants affected by rare diseases across Germany were contacted via patient organizations and centers for rare diseases. N = 304 participants with 81 different rare diseases completed the study, 81.6% were female, mean age was 44.2 years (SD = 12.8, range 16–74). The quantitative results regarding supportive care needs were compared to a reference population of patients affected by cancer (N = 888). Main outcomes were unmet supportive care needs of patients with rare diseases, as assessed by the Supportive Care Needs Survey (SNCS-SF34) and an open-ended question on support wishes. Results Patients with rare diseases did not feel sufficiently supported with regard to psychological support, health system and information, physical and daily living, patient care and support, and sexuality needs. The unmet supportive care needs were significantly higher in the patient sample with rare diseases compared to the SCNS-SF34 reference sample of patients with cancer. 60% of patients with rare diseases did not feel sufficiently socially supported. Conclusions Patients affected by rare diseases have high unmet support needs in all areas studied. Multidisciplinary care, including psychological support and the provision of information regarding the healthcare system, treatment options, disease course and sexuality, might help address these needs.

Contains fulltext : 233751.pdf (Publisher’s version ) (Open Access) Attentional deficits as well as attentional biases towards negative material are related to major depression and might maintain chronicity. However, studies investigating attentional deficits and attentional biases in chronic, treatment-resistant depressed are lacking. The aim of the current study was to compare measures of attentional deficits and attentional bias between chronic, treatment-resistant depressed outpatients and never-depressed control participants. Attentional deficits were assessed with the attentional control scale (ACS) and the Stroop Color naming task. Attentional bias was measured with the exogenous cueing task (ECT) and an emotional Stroop task. Chronic, treatment-resistant depressed patients (n=80) showed significantly more attentional deficits than never-depressed controls (n=113) on the ACS and Stroop color-naming task. However, in contrast with hypotheses, no differences were found between chronic, treatment-resistant depressed patients and never-depressed individuals on the ECT or emotional Stroop task. The current findings indicate that chronic, treatment-resistant depressed patients present attentional deficits. The results however question whether this patient group shows attentional biases for negative material. Future research should include comparisons of chronic, treatment-resistant and non-chronically depressed patients. If replicated, these current results might indicate that focusing on improving attentional deficits could be a more promising target for treatment than addressing attentional biases. 9 p.

After a person experiences an acquired brain injury (ABI), there can be grieving for what has been lost. Little is known about the loss felt by relatives of people with ABI. This study investigates concepts of loss among individuals with ABI and their families. Forty participants, recruited from a brain injury charity client pool, took part in a semi-structured interview. Of the participants, 17 were in dyadic relationships (53% spouses, 41% parent/child and 6% sibling relationships). They also completed the Brain Injury Grief Inventory (BIGI; Coetzer, B. R., Vaughan, F. L., & Ruddle, J. A. (2003). The Brain Injury Grief Inventory. Unpublished Manuscript. North Wales Brain Injury Service, Conwy & Denbighshire NHS Trust) as a quantitative measure of loss after ABI. Five main themes emerged from the interviews: loss of person; loss of relationships; loss of activity/ability; loss of future; unclear loss. There were distinct differences qualitatively between individuals and relatives and only two dyads experienced similar loss, but there were no significant differences in loss as measured quantitatively by the BIGI. The differences between relatives’ loss and individuals with ABIs’ loss are discussed. This research suggests that it is important when supporting families to consider individual experiences, because even though the loss originates from the same injury, the loss as experienced may substantially differ among those affected by it.

During the early twentieth century, research on child eating targeted the type of food children ingested and the adequacy/deficiency of nutrients in their diets. Simultaneously, psychologists were studying how parents socialize their children into becoming adults. Subsequently, a multidisciplinary field emerged regarding the development of child eating behaviors grounded in the idea that parents play an important role in socializing children’s eating. Early studies showed that patterns of general parenting were associated with child eating and obesity risk. However, subsequent studies focusing on feeding children provided a more proximal target for studying eating behaviors in the family context. Consequently, the construct of feeding styles emerged in the literature. Numerous studies over the past two decades have shown that feeding styles are differentially associated with child outcomes, with the most consistent relationships found between the indulgent feeding style, problematic child eating, and higher weight status. Interest in feeding styles led to the question of the stability of feeding styles over situations and time. Whether parents exhibit the same feeding behaviors across meals and situations or whether feeding varies over time is an important question for prevention research. This chapter covers the stability of common self-reported and observed feeding in studies among families with low-income levels. Additionally, the direction of effects—whether child weight predicts parental feeding or if parental feeding predicts later child weight—is also presented. Intervention programs may choose to target parental feeding behaviors at young ages to prevent the development of childhood obesity.

Effect sizes are commonly interpreted using heuristics established by Cohen (e.g., small: r = .1, medium r = .3, large r = .5), despite mounting evidence that these guidelines are mis-calibrated to the effects typically found in psychological research. This study’s aims were to 1) describe the distribution of effect sizes across multiple instruments, 2) consider factors qualifying the effect size distribution, and 3) identify examples as benchmarks for various effect sizes. For aim one, effect size distributions were illustrated from a large, diverse sample of 9/10-year-old children. This was done by conducting Pearson’s correlations among 161 variables representing constructs from all questionnaires and tasks from the Adolescent Brain and Cognitive Development Study® baseline data. To achieve aim two, factors qualifying this distribution were tested by comparing the distributions of effect size among various modifications of the aim one analyses. These modified analytic strategies included comparisons of effect size distributions for different types of variables, for analyses using statistical thresholds, and for analyses using several covariate strategies. In aim one analyses, the median in-sample effect size was .03, and values at the first and third quartiles were .01 and .07. In aim two analyses, effects were smaller for associations across instruments, content domains, and reporters, as well as when covarying for sociodemographic factors. Effect sizes were larger when thresholding for statistical significance. In analyses intended to mimic conditions used in “real-world” analysis of ABCD data, the median in-sample effect size was .05, and values at the first and third quartiles were .03 and .09. To achieve aim three, examples for varying effect sizes are reported from the ABCD dataset as benchmarks for future work in the dataset. In summary, this report finds that empirically determined effect sizes from a notably large dataset are smaller than would be expected based on existing heuristics.

Background People with dementia are not routinely offered rehabilitation services despite experiencing disability associated with the condition and accumulating evidence for therapies such as exercise, occupational therapy, and cognitive or physical rehabilitation. It is important to understand the needs and preferences of people with dementia regarding rehabilitation services. The aim of this study was to explore thoughts and beliefs about rehabilitation amongst people with dementia and their families. Methods Interviews with people with dementia and family members regarding their experience of care following diagnosis and their attitudes and beliefs about rehabilitation for dementia. Surveys with older people with cognitive impairment and/or a diagnosis of dementia to determine preferences for services and understanding of rehabilitation programs. Results Interviews with 13 participants (n = 6 people living with dementia with mean age 60 and n = 7 care partners) revealed gaps in care post diagnosis. People reported having to seek out services and frequently sought out services which were rehabilitative in nature. Survey data (n = 91 participants, average age 82) showed that most people had heard of rehabilitation (92%) or had experience of rehabilitation (49%) at some point. There was a wide range of services identified as being beneficial. Rehabilitative interventions including case management, exercise and memory strategies were considered desirable. Conclusions People with dementia report having a wide variety of needs. There are gaps following diagnosis where people with dementia report having to seek out their own services. Some interview participants (who tended to be younger) clearly articulated the need for tailored interventions which maximised independence and quality of life. Survey participants, who were on average older, reported that they would participate in individually applicable rehabilitative therapies if they were available.

BackgroundRelatively poor UK cancer outcomes are blamed upon late diagnosis. Despite most cancer patients presenting to their GP with symptoms, diagnostic delay remains a common theme, with many clinical and non-clinical factors responsible. Early diagnosis is key to improving outcomes and survival. This paper reports the multi-method process to design a complex intervention to improve the timely diagnosis of symptomatic cancer.MethodsA review of reviews, survey, discrete choice experiment, qualitative interviews and focus groups, all informed a realist evidence synthesis. This in turn informed the design of a complex intervention, guided by the Behaviour Change Wheel framework using a multi-step process.ResultsKey themes from the realist evidence synthesis included effective safety netting at practitioner and practice system level, increased vigilance and lowering referral thresholds. Qualitative findings explored the tensions, barriers and facilitators affecting suspected cancer referral. The Think Cancer! intervention is an educational and quality improvement workshop directed at the whole primary care team. Bespoke cancer safety netting plans and appointment of cancer champions are key components.ConclusionsThink Cancer! is a novel primary care early cancer diagnosis intervention, requiring evaluation through a cluster randomised control trial.

BackgroundThe availability of a COVID-19 vaccine has been heralded as key to controlling the COVID-19 pandemic. COVID-19 vaccination programme success will rely on public willingness to be vaccinated.MethodsWe used a multi-methods approach – involving an online cross-sectional survey and semi-structured interviews - to investigate the views of parents’ and guardians’ on the acceptability of a future COVID-19 vaccine. 1252 parents and guardians (aged 16+ years) who reported living in England with a child aged 18 months or under completed the survey. Nineteen survey respondents were interviewed.FindingsMost participants reported they would definitely accept or were unsure but leaning towards accepting a COVID-19 vaccine for themselves (Definitely 55.8%; Unsure but leaning towards yes 34.3%) and their child/children (Definitely 48.2%; Unsure but leaning towards yes 40.9%). Participants were more likely to accept a COVID-19 vaccine for themselves than for their child/children. Less than 4% of participants reported that they would definitely not accept a COVID-19 vaccine for themselves or their children. Participants that self-reported as Black, Asian, Chinese, Mixed or Other ethnicity were almost 3 times more likely to reject a COVID-19 vaccine for themselves and their children than White British, White Irish and White Other participants. Respondents from lower income households were also more likely to reject a COVID-19 vaccine.The main reason for vaccine acceptance was for self-protection from COVID-19. Common concerns were around COVID-19 vaccine safety and effectiveness, which were largely prompted by the newness and rapid development of the vaccine.ConclusionTo alleviate concerns, information on how COVID-19 vaccines are developed and tested, including their safety and efficacy, must be communicated clearly to the public. To prevent Inequalities in uptake, it is crucial to understand and address factors that may affect COVID-19 vaccine acceptability in ethnic minority lower-income groups who are disproportionately affected by COVID-19.

Objective Eating disorders (EDs) are characterized by dysregulated responses to palatable food. Using a multi-method approach, this study examined responses to palatable food exposure and subsequent ad libitum eating in women with binge-eating disorder (BED: n = 64), anorexia nervosa (AN: n = 16), and bulimia nervosa (BN: n = 35) and 26 healthy controls (HCs). Method Participants were exposed to palatable food followed by an ad libitum eating opportunity. Affective and psychophysiological responses were measured before and during the task. Results Participants with EDs reported greater negative affect, particularly fear, following the food cue exposure, whereas HCs reported no change. BN and BED groups reported greater urge to binge after the food cue exposure, whereas AN and HC groups reported no change. Respiratory sinus arrhythmia levels, skin conductance and tonic skin conductance levels increased during food exposure for all groups. Across baseline and during the food exposure, the BED group had lower respiratory sinus arrhythmia levels relative to the BN and HC groups. The BED group consumed significantly more palatable food than the AN group. Conclusions 'Palatable' food stimuli elicited more negative affect, particularly fear, in individuals with EDs; and this, rather than psychophysiological responses, distinguishes individuals with EDs from those without.

Community-based strategies for preventing non-communicable diseases, particularly cardiovascular diseases, are of great importance.This study aimed to formulate a policy brief to identify and prioritize community-based strategies to prevent cardiovascular disease in Iran.This multi-method study was conducted over three phases. In the first phase, rapid review, community-based strategies which mentioned to people's participation had been identified. PubMed and Scopus had been searched. In the second phase, a focus group discussion (FGD) was held by the participation of 15 experts from different disciplines to have been summarized and finalized the community-based strategies to prevent cardiovascular disease as policy options. Content analysis method was used. In the third phase, policy options were prioritized. In addition, the points of interest and the appropriate budget were suggested for each policy option by using the Delphi method with the participation of 15 experts.Community-based approach includes six strategies: engagement of non-governmental and charitable organizations, use of health marketing strategies, activating the role of community health workers, implementing of mobile health programs, social prescribing, and peripheral medicine.‌‌‌ Utilizing Community health workers, using mobile health and engaging NGOs and charities were ported in higher levels. In all policy options, public-private partnership as the best investment as well as the Ministry of Health as the best focal point were proposed.Implementing multiple prevention strategies in the form of public engagement, incorporating prevention programs delivered by community health workers and increasing public-private partnership financial support may be effective in reducing cardiovascular disease.

Despite growing recognition of the importance of workforce diversity in health care, limited research has explored diversity among eating disorder (ED) professionals globally. This multi-methods study examined diversity across demographic and professional variables. Participants were recruited from ED and discipline-specific professional organizations. Participants’ (n = 512) mean age was 41.1 years (SD = 12.5); 89.6% (n=459) of participants identified as women, 84.1% (n = 419) as heterosexual/straight, and 73.0% (n = 365) as White. Mean years working in EDs was 10.7 years (SD = 9.2). Qualitative analysis revealed three themes resulting in a theoretical framework to address barriers to increasing diversity. Perceived barriers were the following: “stigma, bias, stereotypes, myths”; “field of eating disorders pipeline”; and “homogeneity of the existing field.” Findings suggest limited workforce diversity within and across nations. The theoretical model suggests a need for focused attention to the educational pipeline, workforce homogeneity, and false assumptions about EDs, and it should be tested to evaluate its utility within the EDs field.

Background and objectives In Lithuania, injecting heroin and other illicit opioids has dominated high-risk drug use since about 2000. More recently, patients have reported a high-risk use of amphetamines. Newly diagnosed HIV cases among people who inject drugs peaked in 2002 and 2009 and drug-related deaths have been on the increase. Yet research has reported a limited number of available harm-reduction programs. This study aimed to estimate the size of high-risk drug using populations in Lithuania and to apply these estimates in assessing the coverage of opioid substitution treatment (OST) and needle and syringe programs (NSP). Methods We used indirect prevalence estimation methods (HIV and Mortality Multiplier, Capture-Recapture, Truncated Poisson and the Multivariate Indicator Method) to obtain annual prevalence estimates of the population of high-risk opioid users (HROU) and of people who inject drugs (PWID) in Lithuania in 2015/2016. We computed the coverage of OST (the annual percentage of HROU in these programs) and NSP (the number of provided syringes per PWID per year), using the prevalence estimates and the data from drug services. Results There were between 4854 and 12,444 HROU and between 8371 and 10,474 PWID in Lithuania in 2015/2016. In addition, we obtained a preliminary estimate of 4742–7000 high-risk amphetamine users. This constitutes around 2.5–6.5 HROU and 4.4–5.3 PWID per 1000 inhabitants aged 15–64. On average, 9.9–25.5% of HROUs were in OST and an average PWID in Lithuania obtained 19–29 syringes via NSPs during the study period. Conclusions While the current prevalence of high-risk drug use in Lithuania is comparable to other European countries and for PWID, it is above the average; and the coverage of OST and NSP services in this population is markedly lower than in most countries of the European Union and warrants further investment.

Background: Evaluations of complex interventions compared to usual care provided in palliative care are increasing. Not describing usual care may affect the interpretation of an intervention’s effectiveness, yet how it can be described remains unclear. Aim: To demonstrate the feasibility of using multi-methods to describe usual care provided in randomised controlled trials (RCTs) of complex interventions, shown within a feasibility cluster RCT. Design: Multi-method approach comprising usual care questionnaires, baseline case note review and focus groups with ward staff completed at study end. Thematic analysis of qualitative data, descriptive statistics of quantitative data, followed by methodological triangulation to appraise approach in relation to study aim. Setting/participants: Four general medical wards chosen from UK hospitals. Purposive sampling of healthcare professionals for usual care questionnaires, and focus groups. Review of 20 patients’ notes from each ward who died during admission or within 100 days of discharge. Results: Twenty-three usual care questionnaires at baseline, two focus groups comprising 20 healthcare professionals and 80 case note reviews. Triangulation of findings resulted in understanding the usual care provided to the targeted population in terms of context, structures, processes and outcomes for patients, families and healthcare professionals. Usual care was described, highlighting (1) similarities and embedded practices, (2) heterogeneity and (3) subtle changes in care during the trial within and across sites. Conclusions: We provide a feasible approach to defining usual care that can be practically adopted in different settings. Understanding usual care enhances the reliability of tested complex interventions, and informs research and policy priorities.

BackgroundLate stage diagnosis of oesophageal and gastric cancer is common, which limits treatment options and contributes to poor survival.AimTo explore patients' understanding, experience and presentation of symptoms before a diagnosis of oesophageal or gastric cancer.Design & settingBetween May 2016 and October 2017, all patients newly diagnosed with oesophageal or gastric cancer were identified at weekly multidisciplinary team meetings at two large hospitals in England. A total of 321 patients were invited to participate in a survey and secondary care medical record review; 127 (40%) participants responded (102 patients had oesophageal cancer and 25 had gastric cancer). Of these, 26 participated in an additional face-to-face interview.MethodSurvey and medical record data were analysed descriptively. Interviews were analysed using thematic analysis, informed by the Model of Pathways to Treatment.ResultsParticipants experienced multiple symptoms before diagnosis. The most common symptom associated with oesophageal cancer was dysphagia (n = 66, 65%); for gastric cancer, fatigue or tiredness (n = 20, 80%) was the most common symptom. Understanding of heartburn, reflux and indigestion, and associated symptoms differed between participants and often contrasted with clinical perspectives. Bodily changes attributed to personal and/or lifestyle factors were self-managed, with presentation to primary care prompted when symptoms persisted, worsened, or impacted daily life, or were notably severe or unusual. Participants rarely presented all symptoms at the initial consultation.ConclusionThe patient interval may be lengthened by misinterpretation of key terms, such as heartburn, or misattribution or non-recognition of important bodily changes. Clearly defined symptom awareness messages may encourage earlier help-seeking, while eliciting symptom experience and meanings in primary care consultations could prompt earlier referral and diagnosis.

Patient arrivals at the emergency department (ED) of hospitals has an unpredictable behavior. So that, adequate forecasting of this process can serve a management baseline to better allocate ED hum...

Introduction The COVID-19 pandemic has caused significant psychological distress to many people across the globe. Poor sleep quality may be linked to poor mental health and increased suicide ideation. To contextualise the risk factors associated with self-harm or suicidal ideation during the COVID-19 pandemic, this cross-sectional study examined links between poor sleep quality, individual experiences and self-harm risk. Methods N=1544 (Mage=44.3y) from 63 countries completed an online survey in March-April 2020. Participants reported their pandemic experiences as free text responses, which were examined quantitatively for frequent word usage using Linguist Inquiry and Word Count software. Pittsburgh Sleep Quality Index assessed poor sleep quality (cut-off score >8). Item-9 of Patient Health Questionnaire-9 measured the risk of self-harm. Results Individuals with poor sleep quality (45%) used more negative emotional tone and had greater use of anxiety or money-related words in their comments than good sleepers (all ps Discussion Poor sleep quality is linked to negative emotionality and increased risk of self-harm during the COVID-19 pandemic. Sleep is a modifiable factor; therefore interventions aimed at addressing sleep disturbances may improve resilience and reduce the risk of self-harm in vulnerable individuals.

Distress tolerance (DT) is a transdiagnostic construct linked to multiple psychiatric disorders. We conducted three studies using different methods to investigate the relationship between DT and body dysmorphic disorder (BDD). Study 1 found a significant relationship between low DT and more severe BDD symptoms in an adult community sample (N=81). In Study 2, we found a similar relationship between lower DT and greater BDD symptoms in a student sample (N=192). Furthermore, we found a unique relationship between greater BDD symptoms and lower self-reported tolerance of anger and sadness mood induction tasks. Greater BDD symptoms were not significantly associated with lower self-reported tolerance of a fear mood induction task. In Study 3, a clinical sample of individuals with BDD (N=40) reported lower DT than a sample of healthy controls (N=36). Findings suggest that low DT is a broad vulnerability factor related to BDD.

Background\ud There is widespread interest in whether psychosis exists on a continuum with healthy functioning. Previous research has implied that paranoia, a common symptom of psychosis, exists on a continuum but this has not been investigated using samples including both patients and non-patients and up-to-date taxometric methods.\ud \ud Aim\ud To assess the latent structure of paranoia in a diverse sample using taxometric methods.\ud \ud Method\ud We obtained data from 2836 participants, including the general population as well as at-risk mental state and psychotic patients using the P-scale of the Paranoia and Deservedness Scale. Data were analysed using three taxometric procedures, MAMBAC, MAXEIG and L-MODE (Ruscio, 2016), and two sets of paranoia indicators (subscales and selected items from the P scale), including and excluding the patient groups.\ud \ud Results\ud Eleven of the twelve analyses supported a dimensional model. Using the full sample and subscales as indicators, the MAMBAC analysis was ambiguous. Overall, the findings converged on a dimensional latent structure.\ud \ud Conclusions\ud A dimensional latent structure of paranoia implies that the processes involved in sub-clinical paranoia may be similar to those in clinical paranoia.

In the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to ‘successfully’ implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what ‘success’ looks like in terms of a decommissioning process.

Recent research shows that the number of students with an autism spectrum disorder (ASD) in higher education is increasing. However they seem to have lower academic success rates and lower chances of graduating from HE than their peer students. In this study we focused on the study skills and study strategies of bachelor students with ASD in comparison to their peer students without ASD. This study is the first to use a multi-method design to answer these questions, combining a self-report study strategies inventory and empirical think-aloud protocols. Three main research questions are dealt with in this study. First, do students with ASD find it more difficult to select relevant information in their study materials compared to their peer students? Next, are students with ASD worse in academic planning and purposeful acting for school in comparison to a group of control students? Finally, are students with ASD metacognitively weaker than bachelor students without ASD? No difference was found for motivation and fear of failure between the students with ASD and the typically developing peers. Students with ASD also performed equally well as controls for time managment. It was shown however that bachelor students with ASD had more problems with the selection of relevant information in study materials compared to peer students without ASD. Our results relate to the three dominant explanatory models for ASD (EF, ToM, CC). Importantly, they also contribute considerably to the available evidence in the field, determining a profile of both strengths and weaknesses in order to develop better and more specific guidance protocols for students with ASD in HE. Implications for guidance of HE students with ASD are discussed.

Objective – This paper reports on a study which assessed the preferences and behaviors of overnight library users at a major state university. The findings were used to guide the design and improvement of overnight library resources and services, and the selection of a future overnight library site. Methods – A multi-method design used descriptive and correlational statistics to analyze data produced by a multi-sample survey of overnight library users. These statistical methods included rankings, percentages, and multiple regression. Results – Results showed a strong consistency across statistical methods and samples. Overnight library users consistently prioritized facilities like power outlets for electronic devices, and group and quiet study spaces, and placed far less emphasis on assistance from library staff. Conclusions – By employing more advanced statistical and sampling procedures than had been found in previous research, this paper strengthens the validity of findings on overnight user preferences and behaviors. The multi-method research design can also serve to guide future work in this area.