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Background: The Health Service is among the largest employers in Britain and has the potential to provide supported work for significant numbers of people who have been long-term unemployed as a result of mental health problems.Aims: The study set out to investigate the feasibility and impact of employing mental health service users as health care assistants within an assertive outreach team.Method: Forty-five clients of the assertive outreach team were randomly assigned to receive either standard case management (n = 21) or to case management plus additional input from a consumer-employee (n = 24) working as a health care assistant (HCA) to the team.Results: Clients allocated to the HCAs were more engaged with treatment as reflected in lower rates of non-attendance at appointments, higher levels of participation in structured social care activities and significantly fewer unmet needs in the domains of daytime activity, company, finances, transport and access to benefits. There were no differences between groups in terms of social networks (size or subjective quality) or in satisfaction with the service received.Conclusions: Employing service consumers in front-line caring roles is feasible and may contribute to improved client engagement with services. [ABSTRACT FROM AUTHOR]

Background: Reports of the benefits of employing consumers of mental health services as mental health workers tend to focus on the views of other professionals.Aim: To provide a first hand account of the experience of being a consumer-employee healthcare assistant (HCA) within an assertive outreach team and to examine the effect on other team members.Method: Semi-structured interview schedules were administered to the HCAs (n = 2) and a range of measures given to other team members (n = 10).Results: Perceived benefits to clients include a positive role model and having a worker with personal understanding of pertinent issues. Benefits to the team included effects on attitudes to, and practices with, clients. Concern was expressed about sickness level and its impact on the service.Conclusion: The employment of consumer-employees has much to offer mental health services but issues for consideration include appropriate support. [ABSTRACT FROM AUTHOR]

Wendee M Wechsberg,1–4 Irene A Doherty,1 Felicia A Browne,1,5 Tracy L Kline,1 Monique G Carry,6 Jerris L Raiford,6 Jeffrey H Herbst6 1Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, Research Triangle Park, 2Gillings Global School of Public Health, University of North Carolina, Chapel Hill, 3Psychology in the Public Interest, North Carolina State University, Raleigh, 4Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, 5Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, 6Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA Abstract: The southeastern US sustains the highest high school dropout rates, and gangs persist in underserved communities. African American female adolescents who drop out of school and are gang members are at substantial risk of exposure to severe violence, physical abuse, and sexual exploitation. In this study of 237 female African American adolescents 16–19 years of age from North Carolina who dropped out or considered dropping out, 11% were current or past gang members. Adolescents who reported gang membership began smoking marijuana at a mean age of 13, whereas those who reported no gang membership began at a mean age of 15 years (P

Alexandra M Minnis,1,2 Irene A Doherty,1,3 Tracy L Kline,1 William A Zule,1 Bronwyn Myers,4,5 Tara Carney,4 Wendee M Wechsberg1,3,6,7 1RTI International, Research Triangle Park, NC, 2School of Public Health, University of California, Berkeley, CA, 3University of North Carolina, Chapel Hill, NC, USA; 4Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, 5Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; 6North Carolina State University, Raleigh, 7Duke University School of Medicine, Durham, NC, USA Background: Inequitable gender-based power in relationships and intimate partner violence contribute to persistently high rates of HIV infection among South African women. We examined the effects of two group-based HIV prevention interventions that engaged men and their female partners together in a couples intervention (Couples Health CoOp [CHC]) and a gender-separate intervention (Men’s Health CoOp/Women’s Health CoOp [MHC/WHC]) on women’s reports of power, communication, and conflict in relationships. Methods: The cluster-randomized field experiment included heterosexual couples from a high-density South African township in which neighborhoods were randomized to one of the intervention arms or a control arm that received the WHC only. Participants completed in-person study visits at baseline and 6-month follow-up. We examined group differences using one-way analysis of variance and multivariable regression models.Results: Of the 290 couples enrolled, 255 women remained in the same partnership over 6 months. Following the intervention, women in the CHC arm compared with those in the WHC arm were more likely to report an increase in relationship control (ß=0.92, 95% confidence interval [CI]: 0.02, 1.83, P=0.045) and gender norms supporting female autonomy in relationships (ß=0.99, 95% CI: 0.07, 1.91, P=0.035). Women in the MHC/WHC arm were more likely to report increases in relationship equity, relative to those in the CHC arm, and had a higher odds of reporting no victimization during the previous 3 months (MHC/WHC vs WHC: odds ratio =3.05, 95% CI: 1.55, 6.0, P=0.001; CHC vs MHC/WHC: odds ratio =0.38, 95% CI: 0.20, 0.74, P=0.004).Conclusion: Male partner engagement in either the gender-separate or couples-based interventions led to modest improvements in gender power, adoption of more egalitarian gender norms, and reductions in relationship conflict for females. The aspects of relationship power that improved, however, varied between the couples and gender-separate conditions, highlighting the need for further attention to development of both gender-separate and couples interventions. Keywords: gender, partner interventions, empowerment, HIV prevention

Flipping the classroom involves delivering video material - or alternatives such as print materials or audio recordings - prior to a lecture/ class session. The session is then dedicated to active learning. Our study evaluated this format during the teaching of rheumatology to third year medical students. Students were sent relevant video materials before the lecture sessions. During the sessions they were divided into groups and engaged in patient scenario problem solving. Each group was provided with 'A to E' response cards in order to answer SBA questions relevant to the patient problem. 87/106 students evaluated this format via a strongly disagree (1) to strongly agree (5) Likert scale and provided mean scores of 3.7 to 4.1 for statements allied to better understanding, preparedness, peer and teacher interaction, peer to peer problem solving, motivation, usefulness, achievement of learning outcomes and a desire for future classes to be delivered in this way. Qualitatively, students commented that this format allowed for active engagement, discussion, consolidation of knowledge, immediate feedback, application of theory to real life patient problems and the ability to watch and revisit the video material as necessary. Potential downsides included the lack of an electronic voting system, the perceived heavy workload and that this form of interaction may not be best suited to East Asians. The flipped classroom allows for worthwhile reflection of clinical knowledge and subsequent application. The findings from this initial study are encouraging and we plan to continue work on evaluating this format alongside other forms of delivery. [ABSTRACT FROM AUTHOR]

In 2008-2011 Forsyth County, North Carolina experienced a four-fold increase in syphilis rising to over 35 cases per 100,000 mirroring the 2021 state syphilis rate. Our methodology extends current models with: 1) donut geomasking to enhance resolution while protecting patient privacy; 2) a moving window uniform grid to control the modifiable area unit problem, edge effect and remove kriging islands; and 3) mitigating the "small number problem" with Uniform Model Bayesian Maximum Entropy. Data is 2008-2011 early syphilis cases reported to the NC Department of Health and Human Services for Forsyth County. Results were assessed using latent rate theory cross validation. We show combining a moving window and a UMBME analysis with geomasked data effectively predicted the true or latent syphilis rate 5% to 26% more accurate than the traditional, geopolitical boundary method. It removed kriging islands, reduced background incidence rate to 0, relocated nine outbreak hotspots to more realistic locations, and elucidated hotspot connectivity producing more realistic geographical patterns for targeted insights. Using the Forsyth outbreak as a case study showed how the outbreak emerged from endemic areas spreading through sexual core transmitters and contextualizing the outbreak to current and past outbreaks. As the dynamics of sexually transmitted infections spread have changed to online partnership selection and demographically to include more women, partnership selection continues to remain highly localized. Furthermore, it is important to present methods to increase interpretability and accuracy of visual representations of data., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fox et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In 2001, the primary and secondary syphilis incidence rate in rural Columbus County, North Carolina was the highest in the nation. To understand the development of syphilis outbreaks in rural areas, we developed and used the Bayesian Maximum Entropy Graphical User Interface (BMEGUI) to map syphilis incidence rates from 1999-2004 in seven adjacent counties in North Carolina. Using BMEGUI, incidence rate maps were constructed for two aggregation scales (ZIP code and census tract) with two approaches (Poisson and simple kriging). The BME maps revealed the outbreak was initially localized in Robeson County and possibly connected to more urban endemic cases in adjacent Cumberland County. The outbreak spread to rural Columbus County in a leapfrog pattern with the subsequent development of a visible low incidence spatial corridor linking Roberson County with the rural areas of Columbus County. Though the data are from the early 2000s, they remain pertinent, as the combination of spatial data with the extensive sexual network analyses, particularly in rural areas gives thorough insights which have not been replicated in the past two decades. These observations support an important role for the connection of micropolitan areas with neighboring rural areas in the spread of syphilis. Public health interventions focusing on urban and micropolitan areas may effectively limit syphilis indirectly in nearby rural areas., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Fox et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study examined the relationship between demographic factors, job characteristics, relations between Certified Registered Nurse Anesthetists (CRNAs) and administration, and conflict between work and personal responsibilities using structural equation modeling to determine levels of burnout, job satisfaction, and turnover intention among CRNAs during COVID-19 surges. Survey data were collected from CRNAs practicing in Massachusetts and Texas through an email link distributed by their respective state associations of nurse anesthetists. Results of the structural equation modeling showed a decrease in feedback, low CRNA-administration relations scores, and prioritizing work over personal responsibilities were predictive of CRNA burnout. In addition, burnout levels were correlated with job satisfaction and turnover intention. Based on these findings, employers could decrease CRNA burnout and turnover by creating organizational strategies focused on improving job feedback, relationships between CRNAs and administrators, and work-life integration. Through these approaches, healthcare managers and leaders may support CRNA resiliency and retention, particularly during times of professional change, such as the COVID-19 pandemic., Competing Interests: Name: Joshua Lea, DNP, MBA, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Ian Doherty, BSN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Lynn Reede, DNP, MBA, CRNA, FNAP Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Christine Brown Mahoney, PhD, MS, BS Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Objectives: Severe skeletal muscle loss (sarcopenia) is associated with poor cancer outcomes, including reduced survival and increased treatment toxicity. Our goal was to evaluate if sarcopenia was associated with worse survival outcomes and chemotoxicity in EOC patients undergoing primary platinum and taxane-based chemotherapy., Methods: EOC patients diagnosed between 06/2000 and 02/2017 who received treatment with platinum and taxane-based chemotherapy were included. CT abdominal images closest to the time of diagnosis were retrospectively evaluated for skeletal muscle area at the 3rd lumbar vertebrae. Measurements were obtained with use of TomoVision® radiological software (SliceOmatic - version 5.0, Quebec, Canada). Sarcopenia was defined as Skeletal Muscle Index (SMI) ≤ 41. Data analysis included Kaplan-Meier plots to assess survival, and unpaired t-tests were used to compare the means by groups., Results: 201 EOC patients were evaluated. Sixty-four percent (128/201) met criteria for sarcopenia (SMI ≤ 41) at time of diagnosis. The mean overall survival did not differ between patients with SMI > 41 and SMI ≤ 41 (36.5 vs 40.8 months, p = 0.4, respectively). No difference in frequency of dose reduction, dose delay, hospital admissions, changes in regimen, blood transfusion, or toxicity was noted. There was no difference in distribution of toxicity grade., Conclusion: Sarcopenia was not associated with worse survival outcomes or chemotoxcity in EOC patients receiving first-line platinum and taxane-based chemotherapy in this cohort. Future prospective studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival, performance status, and quality of life., Competing Interests: Declaration of competing interest None of the authors have any financial or personal conflicts of interest. The authors declare that they have no competing interests., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Depression often starts in adolescence making it an ideal time to intervene. We developed a universal cognitive behavioural therapy-based programme (MEMO CBT) to be delivered via multimedia mobile phone messages for teens., Methods: We conducted a prospective multicentre, randomised, placebo-controlled superiority trial in 15 high schools in Auckland, New Zealand, comparing MEMO CBT with a control programme [MEMO control] matched for intensity and type of message but with alternative content not targeting depression. The primary outcome was the change in score on the Children's Depression Rating Scale-Revised from baseline to 12 months. Secondary outcomes included the change in scores in the self-reported Reynold's Adolescent Depression Rating Scale-Second Edition, the Moods and Feelings Questionnaire, suicidal ideation using selected items from the Youth Risk Behaviour Survey, the Pediatric Quality of Life questionnaire, 12-month period prevalence of the diagnosis of depressive disorder using the Kiddie-Schedule for Affective Disorders and Schizophrenia, and students' ratings of their satisfaction with the programme., Results: Eight hundred and fifty-five students (13-17 years old, mean 14.3 years) were randomly assigned to MEMO CBT (426) or to MEMO Control (429). Participants (68% female) had a mean CDRS-R at baseline of 21.5 (SD: 5). Overall 394 (93%) from the intervention group and 392 (91%) from the control group were followed up at 12 months. At the end of the intervention (approximately 9 weeks) the mean CDRS-R scores were 20.8 in the intervention group versus 20.4 in the control group, and at 12 months they were 22.4 versus 22.4 (p value for difference in change from baseline = 0.3). There was no obvious association between the amount of the intervention viewed by participants and outcomes., Conclusions: There was no evidence of benefit from the mobile phone CBT intervention compared with a control programme. Universal depression prevention remains a challenge., (© 2017 Association for Child and Adolescent Mental Health.)

Technology enhanced learning (TEL) is now common practice in the field of medical education. One of the primary examples of its use is that of high fidelity simulation and computerised mannequins. Further examples include online learning modules, electronic portfolios, virtual patient interactions, massive open online courses and the flipped classroom movement. The rise of TEL has occurred primarily due to the ease of internet access enabling the retrieval and sharing of information in an instant. Furthermore, the compact nature of internet ready devices such as smartphones and laptops has meant that access to information can occur anytime and anywhere. From an educational perspective however, the current utilisation of TEL has been hindered by its lack of understanding of learners' needs. This is concerning, particularly as evidence highlights that during medical training, each individual learner has their own learning requirements and often achieves competency at different rates. In view of this, there has been interest in ensuring TEL is more learner aware and that the learning process should be more personalised. Adaptive learning can aim to achieve this by ensuring content is delivered according to the needs of the learner. This commentary highlights the move towards adaptive learning and the benefits of such an intervention., Competing Interests: Provenance: externally peer-reviewed No conflicts of interest All authors contributed equally to this article and agreed the final version following re edits. No previous work by ourselves has been published on this aspect.

While the place of portfolios in medical training is established, there are limits to their use. This article discusses the potential use of digital badges to complement portfolios, as these provide a transparent overview of a learner's level of competence.

Flipping the classroom centres on the delivery of print, audio or video based material prior to a lecture or class session. The class session is then dedicated to more active learning processes with application of knowledge through problem solving or case based scenarios. The rationale behind this approach is that teachers can spend their face-to-face time supporting students in deeper learning processes. In this paper we provide a background literature review on the flipped classroom along with a three step approach to flipping the classroom comprising implementing, enacting and evaluating this form of pedagogy. Our three step approach is based on actual experience of delivering a flipped classroom at the University of Hong Kong. This initiative was evaluated with positive results. We hope our experience will be transferable to other medical institutions.

The present study investigated the connections between religious affiliation, quality of life (QOL) and measures of academic performance. Participants (n = 275) were recruited from the School of Medicine within a New Zealand university. Religious affiliation was classified according to three subcategories: Christian (n = 104), Eastern religion (n = 34) and non-religious (n = 117). The participants completed the World Health Organisation quality of life questionnaire (WHOQOL-BREF) and the World Health Organisation Spiritual, Religiousness, and Personal Beliefs questionnaire immediately before their lecture time. The main findings of the study indicated that participants from different religious affiliations expressed different spiritual QOL perceptions. However, these different expressions did not translate into their perceptions related to hours of study and academic achievement. In addition, the QOL measures did not relate to academic achievement estimation but did predict hours of study. Greater hours of study were related to greater physical health but lower psychological health and poorer engagement in developing social relationships. Data from a small focus group (n = 4) revealed that these students believed that having a belief system assisted them when coping with the academic learning environment, although little difference could be found between external religious orientations and internal belief systems.

African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16-19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.