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The importance of enhancing social and emotional skills in educational settings has gained prominence, with many countries and organizations embracing the Social and Emotional Learning (SEL) framework to equip individuals with the tools needed for shaping a self-identity, emotional regulation, goal achievement, empathy, nurturing relationships, and responsible decision-making and overall well-being. In this paper, we aim to connect the globally acknowledged Collaborative for Academic, Social, and Emotional Learning SEL framework with international policies that underscore the importance of social and emotional skills in the school context. To accomplish this goal, we first provide a brief overview of the key components of the SEL framework. Subsequently, we explore two significant educational policies within the European context. The first policy is the World Health Organization Health Promoting Schools initiative. We present its objectives, a WHO-affiliated program example, the promoted and assessed competencies of students, and its results, connecting its framework with the CASEL SEL approach. The second focus is the Organisation for Economic Co-operation and Development Study on Social and Emotional Skills, describing its developmental process and the assessment framework. Finally, we describe the alignment of SEL with these European educational policies and illustrate their role in advancing and improving the evaluation of SEL initiatives in educational environments.

The purpose of this study was to quantify and compare interprofessional skills among first year pharmacy students who participated in healthcare and non-healthcare setting service-learning experiences. This was a survey-based pre/post comparison of interprofessional attitudes among student pharmacists during a first professional year service-learning course comparing two cohorts at healthcare-related sites versus non-healthcare sites. The Interprofessional Attitudes Scale (IPAS) was administered to students in fall 2021 and spring 2022. Healthcare and non-healthcare sites were compared using unpaired t-testing comparing the mean sums of Likert scores. This longitudinal cohort survey encompassed a total of 110 of 117 eligible first-year pharmacy students completed the pre-survey, (96% response rate), and 78 of 112 eligible students completed the post-survey (71% response rate). From pre to post survey, there was a positive increase of the mean Likert scores in all five IPAS subsections. There was no significant difference of mean Likert scores displayed between the sample of healthcare and non-healthcare students from the pre-survey to the post-survey in each of the five IPAS subsections. There was no difference in pre/post mean Likert scores of the five subsections of the IPAS in first-year pharmacy students, regardless of placement at healthcare or non-healthcare related sites.

Adolescence is a critical period for developing social and emotional habits important for mental well-being (Kessler et al., 2005). Half of all mental health conditions start by age 14, and the average delay between onset of symptoms and intervention is eight to ten years (Wang et al., 2007). Youth with mental health conditions are particularly vulnerable to social exclusion, discrimination, stigma, educational difficulties, risk-taking behaviors, and worsening physical health. Youth often do not get the help they need due to ongoing stigma and barriers in accessing mental health treatment. For example, in Wisconsin, 30% of the population live in a county designated as a Health Professional Shortage Area (Health Resources & Services Administration, 2023).

Preparing students enrolled in healthcare programs for industry is paramount. While providing administrative and clinical education is essential, students must understand the health literacy levels of the population they serve and work diligently to ensure the population understands and comprehends the health information. Adults with low or limited health literacy levels need help understanding health information and making informed decisions. Research shows that improvements in health literacy result in decreased ER visits, medication errors, increased patient satisfaction, and better health outcomes. Health literacy is an issue throughout the world. This reflection seeks to provide a narrative comparing health literacy concerns in the United States and Spain. The objective is to shed light on the need for all colleges and universities to teach students about health literacy and how to determine patients' health literacy levels. Increasing students' understanding can improve the comprehension and awareness of patients and the population that they serve, thus leading to more appropriate health decisions and outcomes.

Purpose: Globally, countries with both developed and developing economies are struggling to secure sufficient participation in vocational education to generate the range and quantum of skills required for their communities and realising national social and economic goals. In an era of high aspiration, vocational education and the occupations it serves are increasingly seen as being a less than desirable outcome by young people and their parents. Hence, there is a need to identify means by which to inform and engage young people in considering vocational education and the occupations it serves. The case study discussed in this paper is contextualised within the Australian state of Queensland, which, like many other countries is struggling to have a workforce sufficient to meet communities' healthcare needs as its population both grows and ages. Methods: The study data were collected from 1) interviews with healthcare-related stakeholders including health industry representatives, teachers or practitioners, and healthcare providers, 2) focus groups with senior secondary students, and 3) surveys with these participant groups. It provides a descriptive analysis of efforts to secure greater participation by young people in allied health roles, and, in particular, young Australian Indigenous people. Findings: The study participants included those from regional and metropolitan centres and from state and independent schools, and in all of which the focus on engagement was central. Findings indicated that engagement was necessary to advise young people about these occupations, the effective preparation for them, and likely retention in the workforce. Conclusion: This study highlights the need for intentional strategies to engage young people, their parents/guardians and with those efforts likely needing to be organised and enacted at the local level. This requires collaboration and engagement from education, industry, and local communities. Essentially, a systemic approach is required, specifying roles for government, employers, educational systems, and teachers and parents who engage directly with young people. In all, engagement, advice and opportunities locally are all emphasised in the study reported here.

To increase community health knowledge, the El Paso Health Education and Awareness Team (EP-HEAT) was established at Paul L. Foster School of Medicine. The Medical Student Run Clinic (MSRC) emphasizes community health care access. "Promotores de salud" (community health workers) increase health care awareness and connect predominantly underserved communities with resources. Surveys were conducted to determine how EP-HEAT and MSRC patients' communication with promotores affected their access to health care and communication skills. Surveys demonstrated that 91% of EP-HEAT members agreed that working with promotores improved their communication ability. All MSRC patients surveyed stated interacting with promotores helped improve health care communication in various ways.

Students at school need to develop a character of responsibility in learning discipline (Re-LeaD) after the COVID-19 pandemic (CV-19P), or face-to-face meetings (FTF) are a concern. The character of Re-LeaD as a form of student success in the future. Aims to research determine the individual blended counselling model of the behaviouristic counselling approach to increase Re-LeaDs and the effectiveness of the individual blended counselling model of the behaviouristic counselling approach to increase Re-LeaDs. Individual counselling with a behaviouristic process combines FTF chat and counselling with an e-counseling website. Research and development are limited to five steps (1) study problem; (2) hypothetical draft model; (3) model feasibility test through guidance and counselling reviews; (4) revising model; (5) testing effectiveness model. The instrument used is the Re-LeaD scale and expert review on the feasibility model. Data analysis with the reliability coefficient between reviewers and Cohens Kappa, then t-test to test the model's effectiveness. The results of the study concluded that the blended counselling model with a behaviouristic counselling approach is feasible to be applied by school counsellors to increase Re-LeaDs students based on an average rating of more than 3.09 (scale 4) from reviews by experts and guidance and counselling practitioners (0.621 with sig. 0.000 < 0.05). The individual blended counselling with behaviouristic counselling approach can also effectively increase Re-LeaDs students in the higher category (21.5) than before the intervention (10.75) and sig. 0.000 < 0.05. Counsellors can use individual blended counselling with behaviouristic methods as one of the counselling strategies to increase Re-LeaDs.

Immunization is a highly cost-effective investment in health, proven to be an effective tool in controlling and eliminating dangerous infectious diseases. Health science students require evidence-based knowledge to tackle challenges in healthcare, particularly in the field of vaccination. The aim of the current study is to asses students' knowledge on vaccinations and further explore their feedback after attending Educating Vaccination Competence web-based course (EDUVAC web-based course). Students from five Higher Educational Institutes voluntarily participated in the EDUVAC web-based course. The course provided various study materials, including PowerPoint presentations, videos, quizzes, texts, and references to reputable websites. It also offered small assignments and self-tests for self-evaluation. An online questionnaire was available to students before and after they completed the EDUVAC web-based course. The mean knowledge score on vaccines increased significantly after the EDUVAC web-based course (p<0.001). The majority of the students (95%) felt that the web-based course has benefitted them for their future career and 96.4% would encourage other students to attend the EDUVAC web-based course. Overall, our findings suggest that EDUVAC is a valuable resource for those seeking to enhance their understanding of vaccination.

The purpose of this project was to determine the extent to which physiotherapists affiliated to occupational health services undertake the full clinical audit cycle. A sample of convenience was used to select physiotherapists that were in attendance over two conference days. Those who verbally consented to take part were asked to complete a survey and place it in an envelope which was immediately sealed to maintain confidentiality of responses. The majority of physiotherapists undertook clinical audit practice (94%). The common frequency of clinical audits was annually (77%). Most physiotherapists did not contribute their clinical audit outcomes into any quality improvement initiatives (42%). Occupational health services should encourage physiotherapists affiliated to them to identify and link their outcomes into broader quality improvement initiatives so that the full audit cycle can be completed.

The aim of this study was to explore perceptions of mental health services from the perspectives of adolescents with no prior service experience. Thirty students in the Transition Year (fourth year) of secondary school participated in this study: 22 females and 8 males, aged 15 to 16. There was equal distribution across rural and urban settings. Participants had no prior experience of accessing mental health services. Data were collected in secondary school settings in the Republic of Ireland. An interpretive description approach guided this study. Data were collected through individual interviews. To complement interviews, participants drew images of mental health care environments and mental health staff members; drawings were not subjected to analysis. Data (participant interviews) were analyzed using qualitative content analysis. Three themes were identified. Participants suggested that "mental health services" differed from "psychiatric services," with the latter term perceived more negatively. Uncertainty about how to access these services was voiced. Considering the vulnerability of adolescents to the experience of mental distress, education around mental health services is warranted. It is expected that provision of education in this area would enhance service delivery, improve adolescents' help-seeking behaviors for mental distress, and reduce stigma.

Objectives: The aim of this study was to investigate the variables that may affect treatment continuation in children aged 6 to 12 years who were newly diagnosed with ADHD. Methods: A total of 132 children diagnosed with ADHD and their parents participated in the study. Sociodemographic and clinical risk factors affecting continuation of treatment were examined using logistic regression analysis. Results: Multiple model examination revealed that greater age increased the risk of treatment discontinuation 1.824 times (p = 0.003) while a lower total length of paternal education increased the risk of discontinuation (1/0.835) 1.198 times (p = 0.022). Other variables emerging as significant in the univariate model lost that significance in the multiple model. Conclusions: Understanding the variables associated with medication discontinuation in ADHD in different populations and taking these variables into account in the development of health policies, will be useful in improving the long-term devastating effects of the disorder.

Background: Long-term care services are funded primarily by Medicaid long-term services and support in the United States, where eligibility is based on care needs of the individual with intellectual and developmental disability alone. Impact of Medicaid waiver services on self-reported caregiver needs is not well understood. Method: Caregivers (n = 405) of individuals with intellectual and developmental disabilities across four states (NY, OH, TX, and PA) completed an online survey. Results: Caregivers reported a moderate degree of burden and susceptibility of stress-induced health breakdown. Despite controlling for the activities of daily living of the care recipient, caregivers of individuals with Medicaid Waiver services reported greater difficulty managing medications (p = 0.013) and finding paid help (p < 0.001) than caregivers of individuals without services.

Ethical decision-making is often evaluated in the literature through deontological and teleological approaches, commonly referred to as ethical positions. Ethical decision-making requires an awareness of ethical sensitivity and ethical dilemmas. It involves understanding the emotional experiences of others and assisting them. In cases of alexithymia, where there is difficulty in understanding and expressing emotional experiences, empathy may be limited, and emotions may not be effectively used. In this research, the impact of the level of alexithymia on ethical positions in students of the School of Health Services, along with demographic variables, was evaluated. In this descriptive research using a quantitative research approach, data was obtained using the "Ethical Position Scale-EPQ" and the "Toronto Alexithymia Scale-TAS." Analysis was performed using the reliability testing, t-test, One-Way ANOVA Test, LSD multiple comparison test, and Pearson Correlation and Regression Analysis test were used. In ethical decision-making, it has been found that women are more idealistic than men, while men tend to be more alexithymic and deficient in outward thinking. As students' levels of alexithymia increase, they are determined to adopt a more relativistic approach. It has been observed that relativism increases and idealism decreases significantly among individuals with high alexithymia scores. These findings indicate that the level of alexithymia has a significant impact on ethical positions. The fact that individuals with high levels of alexithymia adopt a subjective position that is less concerned with the consequences of an action on others and resembles egoism suggests that these individuals may have difficulty in empathizing due to emotional inadequacy.

Background: Type 2 diabetes mellitus, cardiovascular disease and chronic obstructive pulmonary disease contribute significantly to societal and individual impact globally. High-quality management of these long-term health conditions is important to prevent deterioration of health, although potentially more complex for patients with intellectual disabilities in residential care. Disease management in this context particularly benefits from complete and accurate recording of disease management. Without complete records, long-term health conditions are more difficult to track due to the level of uncertainty regarding which clinical examinations have and have not been performed. This study therefore aims to examine the recording routines of quality indicators for disease monitoring for chronically ill patients with intellectual disabilities in Dutch residential care. Methods: This retrospective study utilised medical record data from a large Dutch long-term care provider. We assessed the occurrence of cardiovascular disease (ICPC-2 codes K74, K75, K76, K89 and K90), type 2 diabetes mellitus (T90, T90.02) and/or COPD (R91, R95). For adults with intellectual disabilities and long-term condition, we analysed data entries in an 18-month period (between July 2020 and December 2021). Observed consultation rates were calculated and presented in median with interquartile range and contrasted against the baseline number of consultations in primary care. Information on recorded quality indicators was presented in frequencies and percentages. Findings: Of the three long-term conditions investigated, the most common was type 2 diabetes mellitus (8.6%; n = 287), followed by cardiovascular disease (5.8%; n = 195) and COPD (3.0%; n = 101). Of those who received management for their long-term condition from their contracted GP, patients with type 2 diabetes mellitus, cardiovascular disease, or COPD had fewer consultations in 2021 than the Dutch baseline. Discussion of lifestyle was often not recorded. Disease monitoring quality indicators were recorded more often but at a lower frequency than expected. Conclusions: Because of the infrequent recording of quality indicators, recording of management of long-term conditions for patients with intellectual disabilities in long-term care appears suboptimal. Although this may not directly harm individual patients, it may jeopardise the quality of management of long-term conditions, as suboptimal recording limits opportunities for evaluation and improvement. Within a broader trend towards data-driven work methods in healthcare, recording of quality indicators requires attention from practice, research and policy.

Background: People with intellectual disabilities living in group homes often have complex health needs, are high health service users and need support from their service provider to access health services. In Australia, little is known about the types and amounts of these supports. Methods: A case study was conducted on a large Western Australian disability provider of group homes to 160 people with intellectual disability. Over an 18-month period, including during the COVID-19 pandemic, the study quantified health service use in hospital- and community-based settings, ways by which the person was supported to access health care and the impact on other people supported by the provider. Economic costs of supporting access to health services were estimated. Findings: Overall, the disability provider supported 160 people in accessing health services an average of 23 times each (n = 3617, median = 20, interquartile range = 10-33) over the 18 months. Support included staff attending with the person (96%), following up with guardian/decision-maker (50%), additional resourcing via overtime or staff backfills (6%) and transport (94%). The average cost of supporting one health visit was estimated at $78.51 AUD (2021). Impact on the person's household included loss of opportunity for housemates (30%), reduced supervision within the home (79%) and longer timeframes to complete care needs (32%). The impact of COVID-19 restrictions saw a reduction in allied and mental health service use that did not return to prepandemic levels following the cessation of restrictions. Primary care, specialist, outpatient, pathology and emergency service use was also lower in the postrestriction period compared to the prepandemic period. Conclusions: For people living in group homes, the disability provider plays an essential role in supporting health service access, primarily through the provision of support staff and transport. The change in health service utilisation following the COVID-19 restriction period indicates that altered health system priorities can potentially exacerbate access inequality for people with intellectual disability.

Background: People with learning disabilities experience health and social inequalities, and research that could improve health services may not be implemented in real-life settings. Building stakeholder networks that can share and implement research findings may address this. This paper presents a framework for building a stakeholder network that maximises the likelihood of research recommendations being implemented in practice. This was developed as part of the 'Making Positive Moves' (MPM) study, which explores the experiences of people with learning disabilities following discharge from a residential stay within a hospital inpatient setting. Methods: We reviewed the literature on existing theoretical frameworks to support the development of a model for dissemination of the MPM findings. Stakeholder categories were identified through consultation with the MPM researchers, experts by experience and the steering group and a hub and spoke model to represent all stakeholder categories was created. These categories include person moving; family of the person moving; specialist schools; social care; care providers; regulators; third sector organisations; policy organisations; academic community; and NHS professionals. After establishing the categories, we consulted with people with learning disabilities and other stakeholders and conducted online searches to create a stakeholder database. Through information gathering and direct contact with stakeholders, we assessed levels of interest, power and engagement to determine which stakeholders to prioritise in our dissemination activities. The Stakeholder Wheel was created to present the data captured within the database and engagement profiles in an illustrative way. Findings: We use two stakeholder sub-categories, user-led organisations and care providers, to demonstrate the methodological approach. The examples illustrate how a scoring system helped us to identify high-priority stakeholders who we then contacted to collaborate within developing our dissemination strategy to maximise the impact of the MPM research findings. Conclusions: We developed a framework to map stakeholders for the MPM study and enable targeted dissemination to increase the impact of the research. This approach has the potential to reduce health inequalities among people with learning disabilities by increasing the awareness of and ability to implement evidence-based recommendations in real-life settings. The stakeholder mapping framework could be applied to research projects associated with learning disabilities to bridge the gap between research and practice and reduce health inequalities.

Asthma morbidity disproportionately impacts children from low-income and racial/ethnic minority communities. School-supervised asthma therapy improves asthma outcomes for up to 15 months for underrepresented minority children, but little is known about whether these benefits are sustained over time. We examined the frequency of emergency department (ED) visits and hospital admissions for 83 children enrolled in Asthma Link, a school nurse-supervised asthma therapy program serving predominantly underrepresented minority children. We compared outcomes between the year preceding enrollment and years one-four post-enrollment. Compared with the year prior to enrollment, asthma-related ED visits decreased by 67.9% at one year, 59.5% at two years, 70.2% at three years, and 50% at four years post-enrollment (all p-values< 0.005). There were also significant declines in mean numbers of total ED visits, asthma-related hospital admissions, and total hospital admissions. Our results indicate that school nurse-supervised asthma therapy could potentially mitigate racial/ethnic and socioeconomic inequities in childhood asthma.

The number of school-aged students with diverse linguistic and cultural backgrounds is increasing across the United States. This survey identifies strategies school nurses use for communicating to families with limited English proficiency and describes recommendations to improve language needs. The online survey was completed by K-12 school nurses and data were analyzed using descriptive statistics. Among the 52 participants, only 23% (n = 12) indicated that resources they were currently using to interpret health information always met their language needs, with the most common resource described as school personnel who can speak the language needed for interpretation. To improve communication, most (73%; n = 38) participants described preferences for in-person resources and estimated that if on-demand interpreter resources were readily available, they would use on-demand resources for approximately 3.6 hours per week. By improving linguistic and cultural competencies among students and families with limited English proficiency, school nurses can improve student health outcomes.

Healthcare Professionals Working in Schools (HPWS) are responsible for providing health services to students and play a role in providing education to prevent illnesses, including tickborne diseases (TBD). Providing TBD education to children has been shown to increase prevention behaviors and knowledge of TBD symptoms, but little is known regarding the current state of TBD awareness among HPWS. In spring 2019 we conducted a cross-sectional knowledge, attitudes, and practices (KAP) survey of HPWS in two states with a high incidence of Lyme disease (LD) to inform design of TBD prevention programs. The survey queried general knowledge of TBDs, school practices regarding TBDs, and availability of TBD resources. Overall, higher confidence, experience, risk perception, prior training on TBD, and more years employed as a HPWS were independently associated with knowledge of LD transmission, symptoms, and correct tick removal practices. State and local health departments should consider prioritizing engagement with HPWS to provide educational opportunities about tickborne diseases.

Telehealth is rapidly expanding; however, few studies have investigated hybrid models that include synchronous and asynchronous components. While research recognizes the importance of tailoring interventions to meet individual child needs, we have yet to understand how to tailor interventions to parent characteristics. This study examined how baseline parent characteristics (n = 25) were related to asynchronous material usage in a hybrid coaching via telehealth intervention for potty training in children with autism. Results suggested that parents with lower baseline competence used the asynchronous materials more frequently than parents with higher baseline competence and were more likely to make greater gains in parent competence between pre- and post-intervention. There were no differences between groups on the acceptability of the intervention. Future research should examine multiple baseline parent characteristics in a larger sample to better understand how to tailor interventions to meet both parent and child needs.

Objective: This study examined the relationships between ADHD symptomatology, the motivations for physical activity (PA) according to self-determination theory, and the acceptability of three PA promotion technologies (active video game, mobile application, and telehealth) according to the dimensions of the unified theory of acceptance and use of technology-2 (UTAUT2). Method: A total of 312 women, aged 30.7 ± 7.1 years, followed for obesity with an average body mass index of 34.5 ± 7.8 kg/m[superscript 2], were included in this sub-analysis. Results: Fifty-seven individuals (18.3%) were identified with positive screening symptoms of ADHD. No differences emerged regarding acceptability of technology-based PA. However, individuals with positive screening for ADHD tended to have higher scores for acceptability of active video game on the UTAUT2 dimensions of effort expectancy and hedonic motivation. Conclusion: This study suggests that active video game may be more appropriate than other technologies for individuals with obesity and ADHD symptoms

Objective: Our study examined the impact of sex, ADHD subtype, and comorbid illnesses (depression/anxiety) on the timing of diagnosis and treatment for ADHD. Method: To analyze ADHD patients, four health databases were used to assess subtype, comorbid mood, and antidepressant or anxiolytic drug exposure. Analyses were stratified by sex and age. Standardized mean differences measured intergroup differences. Results: Females with ADHD were identified at older ages and had higher rates of depression and anxiety diagnoses and treatments before and after their initial ADHD diagnosis. Predominantly inattentive ADHD patients were diagnosed later and more likely to receive mood disorder diagnosis and treatment than hyperactive impulsive ADHD patients. Conclusions: Results suggest a more complex ADHD presentation in females, potentially causing late diagnosis and delayed treatment.

Because professional ethical engagement is essential to the delivery of high-quality healthcare services, health professions education programs must have effective instructional practices to train future healthcare providers of various disciplines to practice ethically. As research has found reflection to be an effective instructional practice for educating adult learners and teaching professional ethics, promoting health professions students' tendency to reflect by boosting their reflective capacity may be helpful. Therefore, the study sought to examine the relationships between reflective capacity and professional ethical engagement to offer quantitative evidence for the significance of reflection in professional ethical engagement among health professions students. Correlational analyses revealed a strong, positive relationship between reflective capacity and professional ethical engagement in health professions students. Reflective capacity, specifically reflection-on-action and self-appraisal, could predict professional ethical engagement in health professions students. These findings provided insights into the reflective capacity and professional ethical engagement in health professions students. However, further research on the relationship between reflective capacity and professional ethical engagement in adult learners of health professions is needed.

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Background: Due to the progressive deterioration of motor, cognitive, and psychological function, individuals with Huntington's disease (HD) rely heavily on family caregivers, including children in the home. This "young carer" role can result in responsibilities that are inappropriate for the child's age and abilities. Also referred to as parentification, this experience can result in both positive and negative outcomes for the child, spanning multiple domains of health and well-being. Objective: To explore the manifestation of parentification among young carers of a parent with HD. Method: Directed content analysis, guided by a literature-derived framework of parentification, was utilized for this qualitative study. Participants included 28 young carers (mean age of 16.6 (± 2.6)) who self-identified as engaging in caregiving activities related to HD with the majority providing care for 1-3 years (53.6%)--averaging 25.4 h of care per week. Results: Three main themes with subthemes emerged--(1) being a young carer [perceptions of caregiving, learning to be a caregiver, caregiver burden, coping], (2) living with a new normal (school and friends, feeling unheard/alone, support system, personal growth), and (3) facing HD as a young carer (stigma and isolation, parent/child relationship, end of life, genetic risk). Conclusions: Young carers in the context of HD experience many attributes and consequences of parentification generally present among young carers of ill parents. However, HD specific findings emerged from this study that can be used to inform clinicians and direct future research aimed at guiding policy and developing tailored support services.

Background: Part C of the Individuals with Disabilities Education Act mandates that eligible children under age three receive free access to early intervention (EI) through state-based programs. Despite a robust "Child Find" system, enrollment remains lower than expected. Community and medical professionals often rely on parent report of service utilization to gauge whether children are receiving developmental services. Understanding the reliability of parent report of EI can guide strategies to increase EI participation. Objective: To assess the extent to which parental reports of Part C EI services agree with state-based service records. Method: We address this research objective among 162 children and their parents from marginalized communities in Boston, MA and New Haven, CT who were identified as having a higher likelihood of autism and participated in a randomized controlled trial to facilitate access to autism evaluation and treatment. Parents reported whether their child was currently receiving EI services at four time points and released their child's EI service records from state agencies. Results: Overall agreement between parent and service records was 70% and ranged from fair to moderate and service-specific agreement ranged from 46% to 81.6%. Sensitivity, specificity, and positive/negative predictive values ranged widely for both overall and service-specific EI use. We found no differences in agreement by sociodemographic characteristics, but agreement was higher when children received EI services at home. Conclusions: Our findings support community and medical professionals' elicitation of children's EI service use from parents, especially for participation in EI overall and for physical and occupational therapy.

International students in Australia risk financial insecurity and as a result, may make suboptimal health decisions. Limited research has explored the experiences of international students' health-related financial decision making. In-depth interviews were conducted with 31 international students to explore how financial situation influences their decisions in Australia. Data were thematically analysed. Findings highlight that limited income can impact overall wellbeing and health-related decision making. When making financial health-related decisions, participants prioritised urgent health needs and education. Participants who perceived their financial situation limited were less willing to spend money on mental health services, social activities, and food. This study suggests that students may consider the long-term financial benefits of studying abroad when making decisions, but they do not consider the long-term health implications of stress and wellbeing. Enabling students to improve their financial situation and lower their expenses could enhance wellbeing and facilitate health-related decision making.

Researchers seeking to engage in projects related to Tribal communities and their citizens, lands, and non-human relatives are responsible for understanding and abiding by each Tribal nation's research laws and review processes. Few studies, however, have described the many diverse forms of Tribal research review systems across the United States (US). This study provides one of the most comprehensive examinations of research review processes administered by Tribal Research Review Boards (TRRBs) in the US. Through a systematic analysis, we consider TRRBs' online presence, online documentation, and themes across documents, for five entity types: Tribal nations and Tribal consortiums, Tribal colleges and universities, Tribal health organizations, Indian Health Services, and other Tribal organizations. Results include an assessment of online presence for 98 potential TRRBs, identification of 118 publicly available online documents, and analysis of 41 themes across four document types: Tribal research codes and TRRBs' guidelines, applications, and post-approval documents. Altogether, this research provides a macro-level analysis of the most common types of TRRBs in the US in an effort to increase researchers' understanding of these important processes as they prepare to ethically engage Tribal communities in research. These results aim to empower Tribal decision makers as they align their TRRBs' online visibility and documentation with community priorities and strengthen their protections for the rights and wellbeing of their citizens and community. Ultimately, by expanding our knowledge of TRRBs across the US, this contribution seeks to uphold Tribal sovereignty in research and promote ethical approaches to research with Indigenous communities.

Teaching equitable clinical practice is of critical importance, yet how best to do so remains unknown. Educators utilize implementation science frameworks to disseminate clinical evidence-based practices (EBP). The Health Equity Implementation Framework (HEIF) is one of these frameworks, and it delineates how health equity may be concomitantly assessed and addressed in planning the implementation of an EBP. The HEIF therefore lays a strong foundation to understand and explain barriers and facilitators to implementation through an equity lens, making it well-suited for use by medical educators. Three equity-focused frames of reference within the model include (1) the clinical encounter, (2) societal context, and (3) culturally relevant factors, herein referred to as domains. The HEIF provides a structure for prospective and retrospective assessment of how EBP are taught and ultimately incorporated into clinical practice by trainees, with specific attention to delivering equitable care. We present three examples of common topics in internal medicine, contextualized by the three equity domains of the HEIF. We additionally acknowledge the limitations of this framework as a research tool with complex features that may not be suitable for brief teaching in the clinical environment. We propose a 360-degree learner assessment to ensure implementation of this framework is successful. By encouraging trainees to explore the narrative experiences of their patients and examine their own implicit biases, the HEIF provides a structure to address gaps in knowledge about delivering equitable care.

Autistic people experience more co-occurring health conditions and, on average, die younger than non-autistic people. Despite growing awareness of health inequities, autistic people still report barriers to accessing healthcare. We aimed to explore the experiences of autistic people accessing healthcare, shining a light on the complex interplay of relevant factors and to explain, at least in part, the possible reasons underling health disparities and adverse health outcomes. This is a qualitative study from an autistic research team. Data were collected from 1248 autistic adults as part of a large, mixed-methods, international survey exploring barriers to primary healthcare. This article reports the qualitative findings, following a thematic analysis. Using our exploratory findings, we then constructed a model to explain the reported experiences. Respondents reported a variety of barriers. Here, our article gives voice to their stories, in their own words. Themes included: early barriers; communication mismatch; doubt -- in oneself and from doctors; helplessness and fear; and healthcare avoidance and serious adverse health outcomes. Our constructed model outlines a chronological journey through which healthcare access barriers may lead to adverse health outcomes. Our findings also build on the double empathy problem, situating this in a medical context, proposing a triple empathy problem.

Background: The role of participatory health research (PHR) is increasingly acknowledged by funding bodies, researchers and civil society globally; however, it continues to be under-represented in the speech and language therapy (SLT) research literature. This collaborative research approach is associated with the increased application of research evidence, and the generation of positive impacts in practice, policy, health systems and society. Aims: To increase researchers' and other participatory partners' understanding of PHR, and to demonstrate its applicability to research in the SLT field. Methods & Procedures: This aim is achieved through a discussion on PHR, its principles, benefits and challenges, and the evaluation of its impact. A recently developed evaluation framework to support the implementation of best engagement practices is examined, and recommendations for how this framework can be used to plan and evaluate engagement in participatory stuttering research is presented. Main contribution: This paper serves as an important conversation on the value of PHR to SLT research, and presents guidance to support its increased implementation in this research field. Conclusions & Implications: Conclusions & Implications: PHR remains an under-represented research approach in the SLT literature, despite increasing evidence demonstrating its effectiveness and value. It offers a potential solution to the research-practice gap, and challenges the ongoing research hierarchies by democrating the process of knowledge production.

Background: Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post-stroke aphasia primarily falls within the purview of speech-language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub-Saharan Africa is associated with challenges. Aims: This study aimed to examine rehabilitation services for individuals with post-stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post-stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post-stroke aphasia. Methods & Procedures: A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle-Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech-language pathology services, speech-language pathology service delivery, access to speech-language pathology services, challenges in both delivery and access to speech-language pathology services and suggestions for improving speech-language pathology services. In-person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. Outcomes & Results: All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech-language pathologists, lack of awareness of speech-language pathology services for post-stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech-language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech-language pathology services are currently available in only a few cities). Conclusions & Implications: These findings emphasised the need to improve post-stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post-stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated.

Population-adjusted indirect comparison (PAIC) is an increasingly used technique for estimating the comparative effectiveness of different treatments for the health technology assessments when head-to-head trials are unavailable. Three commonly used PAIC methods include matching-adjusted indirect comparison (MAIC), simulated treatment comparison (STC), and multilevel network meta-regression (ML-NMR). MAIC enables researchers to achieve balanced covariate distribution across two independent trials when individual participant data are only available in one trial. In this article, we provide a comprehensive review of the MAIC methods, including their theoretical derivation, implicit assumptions, and connection to calibration estimation in survey sampling. We discuss the nuances between anchored and unanchored MAIC, as well as their required assumptions. Furthermore, we implement various MAIC methods in a user-friendly R Shiny application Shiny-MAIC. To our knowledge, it is the first Shiny application that implements various MAIC methods. The Shiny-MAIC application offers choice between anchored or unanchored MAIC, choice among different types of covariates and outcomes, and two variance estimators including bootstrap and robust standard errors. An example with simulated data is provided to demonstrate the utility of the Shiny-MAIC application, enabling a user-friendly approach conducting MAIC for healthcare decision-making. The Shiny-MAIC is freely available through the link: https://ziren.shinyapps.io/Shiny_MAIC/.

The principal investigator (PI) conducted this research study to explore the strategic cybersecurity defense IT Managers should implement to reduce healthcare data breaches. The PI conducted a systematic literature review and selected articles that addressed healthcare data security breaches, information disclosure, cybersecurity in healthcare, and IT Managers' lack of leadership competence. Also, various annotations from contextual, seminal, grey, and recent literature were used to find the research problem: The strategic cybersecurity defense IT Managers should implement to reduce healthcare data breaches has not been established. The PI collected secondary data from the Office of Civil Rights (OCR)/Department of Health and Human Services (HHS). The analysis, results, and findings are provided below in Part 9. Nevertheless, the routine interaction during health information exchange (HIE) on an interoperable network and the behavior of care providers and third parties who use computers and mobile devices to exchange patient data is an opportunity for cybercriminals to install malware or launch a ransomware attack to exploit potential vulnerabilities whether to steal sensitive data or compromise the network systems. Therefore, strategic cyber defense or an innovative security model would mitigate the threat. An exploratory design is used, and an epistemological approach supports the research method and design. The study is significant, and it will contribute to the body of knowledge the PI suggested for future research and provide major recommendations.

Purpose: This article explores the potential of using ChatGPT, an artificial intelligence--powered chatbot, as a tool to teach plain language writing to students in communication sciences and disorders (CSD). It addresses the importance of plain language writing in health care communication and identifies the challenges faced by graduate students in adopting plain language writing. Conclusions: Integrating ChatGPT into CSD education can empower students to develop effective plain language writing skills, with the potential of ultimately improving their communication skills and patient outcomes. The article highlights the potential positive impact of ChatGPT on clinical documentation and health communication, emphasizing the potential to enhance accuracy, consistency, productivity, efficiency, and language accessibility. While considering the limitations and ethical considerations of ChatGPT, the article concludes by emphasizing the need for a balanced approach that combines ChatGPT technology with human instruction to ensure responsible utilization and promote student competency in plain language writing.