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Children exhibit substantial variation in their early math skills, with pronounced achievement gaps by socioeconomic status (SES) observable even before formal schooling. These SES-related differences in math skills are long-standing and globally observed, prompting investigations into how SES variations in home math environment contribute to early math development. The present study employed a mixed-methods design to examine the relations among SES, key aspects of home math environment, and early math skills in a non-Western context. The sample comprised 122 Chinese parents and their preschool children (Mage = 5.25 years, 52% female) from diverse SES backgrounds. Quantitative analyses indicated that low-SES parents experienced higher math anxiety (large effect) but also placed greater value on math (small effect). Although the frequency of formal math activities did not differ by SES, high-SES parents engaged more in informal math activities and provided math talk with higher quantity and diversity (small effects). Crucially, the study identified parents' math anxiety and the frequency of informal activities as mediators of SES-related differences in early math skills. Qualitative analyses further revealed that low-SES parents viewed math as essential for future success but defined it more narrowly, focusing mainly on formal practices of concrete skills. The implications for future research and practice are discussed. Public Significance Statement: This study suggests that lower socioeconomic status parents experience higher math anxiety but place significant value on math, often focusing on formal practices such as workbook tasks. In contrast, higher socioeconomic status parents are more likely to engage their preschoolers in informal math activities, like comparing quantities during play, which are linked to stronger math skills. These insights underscore the need to support families across socioeconomic status backgrounds in incorporating playful, informal math learning into everyday routines to foster preschoolers' early math development. [ABSTRACT FROM AUTHOR]

This article critiques policies aimed at income redistribution within the framework of Marx's critique of political economy. The 'Neoliberal' characterization of capitalist history, the tendency to divide capitalism into distinct sub-periods or phases, continues to play a significant role for describing changes to social policy in the United States. Prominent academics and public intellectuals continue to hold spirited debates over whether or not welfare spending in the United States has become less generous over the years, owing to increasing 'neoliberalization' of the American economy. This mixed-methods research paper analyzes trends in social welfare spending and income inequality for the United States. To supplement the analysis, a novel dataset on Distributional National Accounts from the Bureau of Economic Analysis is also analyzed. Evidence suggests previous concerns in the literature are unfounded and are not borne out by empirical evidence. [ABSTRACT FROM AUTHOR]

Unequal representation can result from politicians' biased perception of public opinion. Existing research has focused on the numerical accuracy with which politicians estimate preferences distributions in surveys. This method ignores politicians' broader assumptions about public preferences; e.g. regarding their crystallization, salience, malleability, and measurability in surveys. We address these assumptions in a novel two-stage research design using redistributive tax policy in Germany as a case. Interviews with parliamentarians show that voters are perceived as uninformed, disinterested, and susceptible to anti-tax mobilization by business representatives. Support for taxing the rich in polls is dismissed as superficial and irrelevant for political behavior. In a second step, we verify these assumptions in twelve focus groups with high- or low-educated citizens. They largely confirm the assumed indifference and anti-tax attitudes. An education gap in tax preferences cannot be identified. Support expressed in previous surveys tends to disappear in conversations, which aligns with politicians' experiences. [ABSTRACT FROM AUTHOR]

Purpose: Acupuncture for cancer care is safe and effective and can be provided in group or individual settings. Previously, group acupuncture (GA) has been compared with individual acupuncture (IA) for specific cancer-related symptoms or patient experience, but has not correlated symptoms with patient experience between GA and IA. This service evaluation, using a mixed-methods design, aimed to compare GA with IA for symptom-related outcomes, and patients experience and explore their inter-relationships, in order to inform future development of the service. Methods: Cancer patients referred to the acupuncture service in a UK NHS hospital received six treatments of GA or IA. Outcomes were gathered using Measure Yourself Concerns and Wellbeing (MYCaW) questionnaires pre- and post-treatment. Experience of acupuncture was gathered post-treatment using a questionnaire and analysed using reflexive thematic analysis. Results: Forty-eight participants’ data were analysed. There were statistically significant improvements in outcomes overall, with no difference between GA and IA. Most participants had a positive experience; IA participants focused more on the relationship with their acupuncturist, whilst GA participants focused more on environmental factors. For a few GA participants, the group experience was negative, but data synthesis revealed this did not impact symptom-related outcomes. Conclusion: In both GA and IA arms, symptom-related outcomes mostly improved alongside a positive experience. For those participants for whom GA was not an ideal setting, there was no effect on symptom-related outcomes. These results may be of relevance when establishing acupuncture services in supportive cancer care settings. [ABSTRACT FROM AUTHOR]

Background: Nurse leaders face high pressure, but self-leadership can help them thrive. Nursing students, therefore, should develop this skill before graduation. Purpose: To investigate nursing students' self-leadership perceptions and associated factors, and to reveal when and how self-leadership strategies are utilized. Methods: An explanatory sequential mixed-methods design with interpretative description; 943 nursing students were surveyed and 13 were selected for qualitative analysis. Descriptive data were collected, and self-leadership was assessed using the Revised Self-Leadership Questionnaire. Focus group interviews were analyzed through thematic and content analysis. Results: Students who were employed, were involved in student clubs or organizations, held managerial roles, and had career goals exhibited higher self-leadership perceptions. Qualitative findings revealed that staying in comfort zones, overthinking, and procrastination hinder self-leadership, while self-respect, self-awareness, and self-determination enhance it. Conclusions: Nurse educators should design interventions that enable students to take on planning roles, advance at their own pace, and engage in opportunities to develop their self-leadership skills. [ABSTRACT FROM AUTHOR]

Collaboration is widely recognized as essential for mitigating resource dependency and effectively fulfilling public responsibilities. Meanwhile, the use of information technology is expected to enhance communication and strengthen interactions among collaboration participants. Given the substantial annual investments in IT and collaboration initiatives, public managers need to understand how technology, particularly collaborative tools, can be leveraged to achieve better collaboration outcomes. This case study examines the use of collaborative technology in an intraorganizational collaboration context, employing a mixed-methods approach that begins with an experiment followed by semi-structured interviews. The findings reveal that the use of collaborative technology alone does not guarantee improvements in the collaboration process or performance. Achieving desired outcomes requires a supportive organizational and technological environment characterized by sustained leadership, thorough planning, active stakeholder engagement, robust communication mechanisms, and a commitment to continuous learning. Most importantly, genuine collaboration and engagement from all parties involved are key to success. [ABSTRACT FROM AUTHOR]

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Diarrheal disorders significantly contribute to child morbidity and mortality in vulnerable populations such as fishing communities. This study aimed to determine the prevalence of diarrheal disorders among under-five children and to identify the behavioral and environmental risk factors associated with diarrhea using Social Cognitive Theory (SCT). Additionally, the study explored feasible action points to mitigate these adverse factors. A community-based, explanatory sequential mixed-methods study was conducted in four fishing villages of Karaikal, India. The study included a cross-sectional survey of 155 households, followed by environmental surveillance and focus group discussions (FGDs). Data were collected using structured questionnaires, observational checklists, and water and food quality assessments. Quantitative data were analyzed using logistic regression models, while thematic content analysis was applied to qualitative findings. The prevalence of diarrhea among under-five children was 30.3%. Key behavioral and environmental factors associated with diarrheal disorders included unawareness, uncovered cooked foods, and poor sanitation practices. Additionally, chemical and bacterial contamination of drinking water and food adulteration were prevalent. FGDs identified multiple-intervention strategies, including handwashing promotion, sanitation improvements, and enhanced healthcare access. The findings of this study would help in the development of key messages for designing context-specific behavior change communication interventions. [ABSTRACT FROM AUTHOR]

Objectives: Very little is known about the role of self-compassion on performing artists' mental health. This project had two primary aims. First, was to examine the relationship between self-compassion and mental health among performing artists in dance, music, and acting. Second, was to test a brief compassion-based intervention to establish proof of concept for future work. Method: Two sequential studies recruiting Australian performing artists were conducted. In Study 1, a cross-sectional online survey of performing artists explored patterns of association between self-compassion and mental health. In Study 2, participants engaged with a brief compassion-based intervention including an online workshop and daily meditation over 3 weeks. Descriptive pre-post data combined with thematic analysis of semi-structured interview transcripts identified performer perspectives of the compassion-based intervention. Results: In Study 1, 211 participants were included in the final cross-sectional analysis, which showed that the intention to be self-compassionate was associated with lower symptoms of depression and anxiety, and higher wellbeing, even while controlling for several key demographic and risk factors (stress, alcohol use, and body appreciation). In Study 2, ten participants completed the intervention with medium-large improvements in self-compassion and small improvements in wellbeing and body appreciation. Qualitative data demonstrated that participants experienced self-compassion to be helpful, however fears of lowering standards existed. Participants feedback from this study can now directly inform future compassion-based interventions among performers. Conclusion: While acknowledging the small sample size, these findings suggest that self-compassion may help performing artists manage various forms of internal, interpersonal, and environmental distress. These findings warrant progression to controlled evaluation of compassion-based interventions within larger samples of performing artists. [ABSTRACT FROM AUTHOR]

Background: Ukrainians staying in Sweden under the EU mass refugee directive may face challenges due to traumas caused by the invasion that started on February 24, 2022. Part of an European Social Fund (ESF) project, our study showed that a brief trauma-focused group intervention onsite helped to increase health and mental-health literacy. The intervention has not yet been adapted online. Methods: This pilot study during six months aimed to investigate the feasibility, acceptability and outcome in perceived trust, anxiety/stress, and perceived health after this brief trauma-focused group intervention online. A second aim was to observe perceived acceptability of the group intervention with different ways of online intervention. Local coaches, interpreters, the authors, and local experts participated. A mixed-methods design with participatory methodology and evaluation were used. Data was collected with a short questionnaire in Ukrainian. Additionally, at the end of each set, we orally asked about perceived trust and integrity. There were six sets of five group sessions per set, a total of 30 sessions. Each group met online five times for 2 h, a total of 10 h excluding pre- and post-assessment. Breathing exercises sought to reduce stress among the participants. Results: The group intervention had both strengths and limitations. Baseline data were obtained from 136 participants, mostly females (75.7%). Answers to pre- and post-questionnaires showed that perceived anxiety/stress was significantly reduced (N = 91, chi-2 20.648, df = 6, p <.02). Perceived health significantly improved between pre- (mean 63.6) and post (77.2) (N = 77, t = −8.08, df = 66, p <.001). Older participants were vulnerable with higher stress and lower mean perceived health after the intervention. Four out of ten needed individual psychosocial support online.The participants' open questions were analyzed with qualitative content analysis, giving five general categories and 25 sub-categories and the theme "Strong efforts to cope with Swedish system". Conclusion: Trust and reduced anxiety level changed after the intervention and a combination online of small, closed group meetings with the possibility of personal acquaintance, trust and individual follow-up psychosocial support for those in need to be paid attention to for future refugee support services, particular an online format. [ABSTRACT FROM AUTHOR]

Background: Professional standards and the Codes of Ethics from the International Council of Nurses and American Nurses Association are frameworks driving professional practice and are linked to positive patient and nursing outcomes. Objective: To describe qualitative themes extracted from narrative responses on how nurses' personal values influence nursing care and converge with quantitative results assessing personal values, professional values, and the practice environment, a key component of nurse satisfaction and subsequent care quality. Methods: A convenience sample of nurses across 19 sites within a large nonprofit healthcare system was surveyed. Quantitative measures included the Short Schwartz's Value Survey for personal values, the Nurses Professional Values Scale-3 for professional values, and the Practice Environment Scale of the Nursing Work Index, assessing practice settings. Concurrently, nurses were asked, "How do your values influence the care you provide?" Responses were examined using a descriptive qualitative method for thematic analysis. Results: The sample included qualitative (n = 408) and quantitative (n = 671) responses. Six qualitative themes emerged: patient-centered care, professionalism/integrity of practice, advocacy, dissonance, golden rule/ethics of reciprocity (religiosity), and perseverance. Themes converged with the mean personal values of achievement, self-direction, universalism, benevolence, tradition, and conformity, and diverged with hedonism, security, and stimulation. All professional values factor means and work environment subscale means converged. Conclusions: Findings highlight convergence and divergence between qualitative and quantitative responses from nurses, offering new insights into the themes of dissonance, perseverance, and religiosity. The findings present valuable opportunities to enhance recruitment and retention strategies. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare professionals (HCPs) play a critical role in suicide prevention and clinical guidelines recommend inquiring about suicidality as part of medical history and diagnosis. Emerging evidence indicates a lack of implementation of such policies in clinical practice. However, to date, no comprehensive mixed-methods study has examined this issue in the field of oncology. Methods: A preregistered mixed-methods study was conducted with oncological HCPs (N = 20) from various professions, using semi-structured interviews and validated questionnaires. Employing an explorative theory-generating approach, qualitative content analysis was applied to the interviews. The different data sources are integrated and contrasted. Comparisons according to sociodemographic variables (profession, age, and gender) and frequency distributions were used to examine the questionnaire data. Results: Most HCPs reported direct or indirect experiences with suicidality in cancer patients. Nineteen HCPs did not routinely explore suicidality, of whom five reported not inquiring about it at all. Those who explored suicidality were more confident, less emotionally overwhelmed and reported higher subjective knowledge. HCPs also differed regarding their endorsement of suicide myths. Conclusion: The study highlights difficulties with active suicide exploration and differences among HCPs. Integrating these findings into education and training could improve HCPs’ skills and reduce disparities, supporting successful suicide prevention.Highlights: Mixed-Methods study on suicide prevention from oncology experts’ perspective. Experts experience different manifestations of suicidality in cancer patients. Recommendations to actively explore suicidality are not adequately followed. Differences in knowledge, confidence, and stigmatization. Common, but also diverging agreement with suicide myths. [ABSTRACT FROM AUTHOR]

Because of their focus on the acquisition of new technologies, local energy communities are increasingly being recognised as major players in the current energy transition and revealing the valuable role of technological solutions in sustainable development. Nevertheless, the success of these communities is not limited to the acquisition of technologies. Instead, it is strongly dependent on citizen participation. Prior literature has focused much more on the institutional and policy factors than on the roles of citizens and their participation in such communities, and indirectly on sustainability. To address the lack, this study aims to explain the determinants of citizen participation in local energy communities by developing a research model grounded on the stimulus-organism-response (S-O-R) framework, and then through a mixed-methods design, study the impact of technological factors as a stimulus on more social outcomes, namely the organism and response behaviours. Our results highlight the strong impact of sustainable technologies and gamification in citizens' attitudes. Moreover, the research model reveals a strong influence of empowerment and pro-environmental behaviour in the citizen intention to participate in local energy communities. [ABSTRACT FROM AUTHOR]

Background: Physical activity is important for children's physical, mental and cognitive wellbeing, but many children are insufficiently active. Schools offer a promising setting in which to enable positive health behaviours and teachers can play an influential role in facilitating pupils' physical activity. The aim of this study was to use pupils' physical activity data from wearables to inform teacher-led strategies to improve pupils' physical activity outcomes. Methods: Participants included 11 teachers/classes, and 228 pupils aged 8–11 years from eight primary-schools in England. Baseline pupil physical activity was measured for 2 weeks using a commercially available accelerometer, before data visualisations were used to inform teacher-led strategies with the aim of improving pupils' physical activity. These strategies were then implemented, with physical activity being measured post-data-sharing discussions. Mixed-methods analysis explored the feasibility of using data visualisations to inform teachers' understanding of their pupils' physical activity and the development and implementation of teacher-led, school-specific strategies to increase pupils' physical activity. Results: Teachers understood and reflected on the data visualisations and used their knowledge of the school context to develop and implement bespoke school-specific strategies across the school day which successfully increased physical activity. Strategies included altering the physical or social environment, providing more opportunities and addressing physical activity inequalities. Teachers were encouraged when data showed increases in pupils' physical activity and many expressed the desire to continue addressing physical activity, with a particular focus on the least active pupils. Conclusion: These findings suggest that data-driven insights could be used effectively to inform school-based, teacher-led strategies to increase physical activity. [ABSTRACT FROM AUTHOR]

The lack of cross-cultural research on Domestic Violence (DV) for Latinx populations has left a disparity in culturally-informed frameworks and guidelines for best practice. This study proposes that understanding cultural constructs of DV contributes to the formulation of culturally-relevant programmes. Forty-one participants (21 from the UK and 20 from Peru) responded to a mixed-methods designed study that examined the definition of DV and blame attribution, using the Domestic Violence Blame Scale (DVBS). Results revealed the Peruvian public had significantly higher levels of blame attribution in societal, situational and victim blaming than the UK public. However, both the UK and Peru had aligning perpetrator blame attitude scores. This study also found crucial differences when defining DV, its associated characteristic behaviours, and the perception of who can be affected by DV. These findings could be implemented into existing practices to account for the needs of Latinx populations living in the UK. [ABSTRACT FROM AUTHOR]

Nutrition plays a crucial role in human and planetary health, as prevailing nutritional patterns significantly contribute to the global non-communicable disease pandemic. Moreover, the global food system is inextricably linked to planetary health deterioration. The relevance of nutrition for individual and planetary health is insufficiently addressed in German medical schools. Here, we present a two-week course for medical students in the 8th semester at Charité - Universitätsmedizin Berlin on nutrition and fasting in the context of human and planetary health. The course was developed iteratively along the Kern cycle for medical curricula and underwent evaluation through a mixed-methods design spanning across two consecutive semesters. Assessment involved quantitative questionnaires and qualitative interviews. The main exploratory outcome was the overall module rating. Further outcomes encompassed in-depth evaluations of specific aspects, including content, teaching methods, instructor performance, and subjective experiential aspects. The conceptualisation resulted in a highly participative two-week course of 37.5 h. The main learning objectives aimed at the acquisition of technical competences and personal competencies in four areas: (1) the role of nutrition in health and disease; (2) the exploration of global food systems; (3) communication on subjects of nutrition; (4) culinary medicine. Various interactive didactic methodologies were used. 77.8% (n = 27) of the participants rated the course as very good or good. The conviction that nutrition influences health and disease increased over the course (Wilcoxon signed rank test, z = -2.82, p = 0.005, r = 0.57). In the qualitative interviews (n = 8) the course content, its didactical diversity and the positive group experience were appreciated. Our results indicate that it could be worthwhile to further incorporate nutrition curricula in medical education. [ABSTRACT FROM AUTHOR]

Background: Autism Spectrum Disorder (ASD) presents early communication and social challenges, necessitating timely and accessible intervention. Pre-school Autism Communication Therapy (PACT), a parent-mediated intervention, empowers parents to facilitate their child's development. However, accessibility issues often hinder families from accessing evidence-based intervention. This pilot study assessed the feasibility of videoconferencing-based PACT as a precursor for a multicenter randomized controlled trial. Methodology: A mixed-methods approach integrated quantitative retrospective measures and semi-structured interviews. Participants included children diagnosed with ASD who received PACT, and PACT-trained professionals with videoconferencing experience. Feasibility was assessed through audio and video quality, internet stability, and session length. Professionals' experiences were analyzed using a qualitative thematic analysis. Autism severity, parent–child interaction, and therapeutic changes were also described. Results: Nine parent–child dyads and eight PACT therapists were included in the study. Videoconferencing-based PACT intervention proved feasible, with 95.1% of the 41 sessions rated as feasible on the scale. Technical challenges such as audio quality (7.3%) and screen sharing (19.1%) have emerged, which therapists circumvented to maintain intervention quality. Autism severity and parent–child interaction showed positive trends, supported by qualitative findings reporting increased parental confidence and enhanced synchrony. The core components of PACT were successfully adapted to the remote setting. Conclusion: This pilot study suggests that delivering PACT via videoconferencing is a feasible approach to enhance the accessibility of evidence-based interventions for ASD. Larger-scale research with rigorous controls is required to validate these promising findings. An ongoing multicenter randomized trial aims to address this gap. [ABSTRACT FROM AUTHOR]

This study evaluates the implementation of the 7S framework and Documented Information Processing (DIP) in the Office of Student Organizations at President Ramon Magsaysay State University (PRMSU) across seven campuses. The research employs a mixed-methods approach, combining qualitative and quantitative data to assess the efficiency of IT equipment, office management, and administrative processes related to student organizations. Data were gathered from 20 Supreme Student Government (SSG) Presidents through surveys, interviews, and focus group discussions. Findings indicate that the overall implementation of 7S practices--Sort, Set in Order, Shine, Standardize, Sustain, Safety, and Savings--was satisfactory, though specific areas such as "Set in Order" and "Savings" received lower satisfaction ratings in certain campuses. Similarly, the evaluation of DIP for student organization recognition, renewal, and activity approval showed high satisfaction, with most respondents acknowledging the proper documentation and processing of organizational requirements. However, gaps in IT infrastructure, office supplies, ventilation, and electricity supply emerged as key concerns affecting operational efficiency. The study underscores the need for institutional improvements, particularly in IT equipment procurement, to support student organization functions. It also highlights PRMSU's commitment to ISO standards and the Sustainable Development Goals (SDG 17) by strengthening administrative processes. The findings serve as the basis for a project proposal aimed at enhancing student services and operational frameworks. Future studies may explore long-term impacts of improved IT integration on student organization performance and engagement. [ABSTRACT FROM AUTHOR]

Background: This study explores how personality traits and mindfulness facets interact to influence perceived stress, focusing on a Chinese adult sample. It aims to address gaps in understanding the combined effects of dispositional and mindfulness factors on stress. Methods: A sequential explanatory mixed-methods design was employed. In the quantitative phase, 637 Chinese adults completed surveys measuring personality traits, mindfulness (attention, acceptance), and perceived stress. Hierarchical multiple regression, moderation, and mediation analyses were conducted. In the qualitative phase, semi-structured interviews with selected participants provided deeper insights into the quantitative findings. Results: Neuroticism (β = 0.29, p < 0.001) and conscientiousness (β = 0.15, p < 0.01) were positively associated with perceived stress, while mindfulness-acceptance (β = −0.25, p < 0.001) was a significant negative predictor. Neuroticism and mindfulness-acceptance uniquely explained 8 and 6% of the variance in stress, respectively. Mindfulness-attention moderated the relationship between agreeableness and stress, amplifying agreeableness' stress-buffering effect in individuals with low mindfulness-attention. Mediation analysis revealed mindfulness-acceptance partially mediated the agreeableness-stress link. Qualitative interviews underscored the role of personality and mindfulness in shaping stress responses and coping mechanisms. Conclusion: The findings highlight mindfulness-acceptance as a critical factor in reducing stress, particularly in individuals with agreeable personalities. These results support the development of mindfulness-based interventions targeting acceptance to enhance stress resilience across diverse personality profiles. [ABSTRACT FROM AUTHOR]

Background: Supportive policy is an important component of a whole-systems approach to increasing physical activity and reducing inequalities. There is a growing body of literature surrounding the design and effectiveness of national policy approaches to physical activity, but evidence related to local-level approaches is lacking. The aim of this study was to examine 'what works', and identify factors underpinning change, focused on work to embed physical activity in local policy and practice in Bradford, UK. Methods: A mixed-methods case study approach involved collecting data from cross-sectoral stakeholders directly or indirectly engaged in the physical activity agenda in Bradford over a period of three years (2021–2024). Data collection included focus groups, semi-structured interviews, researcher observations of key workshops and meetings, and surveys at two time-points (December 2021 and January 2024). Qualitative data were analysed using reflexive thematic analysis. Quantitative data were analysed using descriptive and inferential statistics. Results: Four themes were identified which embody conditions that appear to be critical for working towards physical activity being embedded in local policy & practice within the Bradford District. These included: collaboration and sector integration, co-productive working, governance and leadership, and cultivating a learning culture. The process of co-producing a district-wide strategy for physical activity was key to facilitating shared ownership of the physical activity agenda across different levels of the system, and for supporting and maintaining cross-sectoral collaboration. On average, survey respondents connected with four more local organisations in relation to the physical activity agenda in January 2024 than in December 2021. Conclusion: Taking a partnership approach, and fostering a culture of evidence-informed decision making, is key to embedding physical activity into policy and practice at a local level. Investing time to understand the aims and values of each partner, and potential synergies and tensions between them, can support the development of a positive and productive collaboration and, subsequently, more effective whole-system delivery and population-level increases in physical activity. [ABSTRACT FROM AUTHOR]

Introduction: A prescribing cascade occurs when new medications are prescribed to address an adverse drug reaction (ADR) associated with the preceding use of a medication, which may be mistaken as the onset of a novel disease or condition. The aim of this study was to evaluate the perceptions of hospital pharmacists regarding roles in preventing and minimizing prescribing cascades. Methodology: A qualitative, semi-structured interview, followed by a quantitative, questionnaire-based study, was carried out at the Shifa International Hospital (SIH; Islamabad, Pakistan). Discharge summaries of patients aged ≥ 60 years were collected to assess the prevalence of polypharmacy at SIH. Results: Discharge summaries of n = 350 patients were collected; 60.2% (n = 211) had comorbid conditions, and the co-occurrence of diabetes and hypertension were the most common. 37.8% (n = 132) were taking 8 or more medications. Eight (n = 8) hospital pharmacists participated in the qualitative study, and 4 major themes were identified in their perceptions regarding prescribing cascades. Fifty-two (n = 52) pharmacists were recruited in the quantitative phase. 86.5% (n = 45) of the participants reported long standing illness/chronic conditions; 67.3% (n = 35) noted the presence of comorbidities as a high risk, while 90.3% (n = 47) noted multiple prescribers, and 75.0% (n = 39) identified the ageing population as important risks factors for polypharmacy. Conclusions: The current research may inform the role and responsibilities of hospital pharmacists in outpatient and inpatient departments, and in interprofessional care teams, in preventing and minimizing prescribing cascades. [ABSTRACT FROM AUTHOR]

Drawing from theories of affect, role strain and stress processes, we studied the impact of raising grandchildren on older mothers' relationships with the adult offspring whose children they raised, with particular attention to how these patterns differ by race and ethnicity. We used mixed-methods data collected from 531 older mothers regarding their relationships with 1935 of their adult children as part of the Within-Family Differences Study. Multilevel regression analyses showed that raising grandchildren was associated with greater mother-adult child closeness in Black families; however, in White families, raising grandchildren was associated with greater mother-adult child conflict. Qualitative analyses revealed that these differences could be explained by the tendency of Black grandmothers to emphasize positive aspects of raising grandchildren, compared to White grandmothers, who viewed raising grandchildren as demanding and who described their exchanges with their adult children as unequal. Overall, our findings reflect racial and ethnic differences in intergenerational solidarity. [ABSTRACT FROM AUTHOR]

This mixed-methods study examines the marketing of, and toxic ingredients found in, common personal care products (PCPs) such as shampoos or deodorants that are sold in the United States. Through qualitative analyses of the messaging presented by PCP packaging and quantitative analyses of the prevalence of toxic ingredients by product and target consumer, we reveal what we term "toxic personal care": the usage of products sold to consumers as minimally necessary, and perhaps even beneficial, to their personal well-being through gendered messaging, yet introduce consumers to chemical toxicity. Supporting research on postfeminist sensibilities, we find that products marketed to women are no more likely to contain toxic ingredients than those marketed to men, nor do lower-priced products contain more toxic ingredients. Instead, product descriptions perpetuate a "cult(ure) of confidence" that not only encourages the usage of PCPs equally across women and men through drawing from traditional gendered stereotypes, but also masks the similarities in ingredients and toxins. These findings have implications for understanding consumption, well-being practices, gendered marketing, and constructions of confidence in the United States, including monetary and possible health costs to consumers. [ABSTRACT FROM AUTHOR]

Background: Newborn hearing screening (NHS) programs were established globally to reduce the negative consequences of hearing loss. Limited information is available about NHS programs in Riyadh and Saudi Arabia generally. This study explored how NHS programs are conducted in healthcare settings for quality assurance. Methods: The concurrent triangulation mixed methods design was used to gather data from the supervisors of NHS programs who were invited to answer a questionnaire and set for a structured interview. The questionnaire consisted of two categories: the facility and test personnel, and the test protocol. The structured interview included two questions about these programs' opportunities and challenges. Results: Data were collected from 24 participants who represented 11 public and 13 private healthcare facilities in Riyadh. The results showed that nurses were the most test personnel who were primarily trained by audiologists. Less than half of NHS programs were supervised by audiologists. The combination of otoacoustic emissions and automated auditory brainstem responses was the most used test protocol. More than half of newborns who failed the first NHS were referred to audiology clinics within a month of the first screening. Most test personnel were not trained on how to counsel parents. The interview resulted in one core category, three themes, and 15 subthemes. Low parental awareness about the NHS was identified, with suggestions to educate parents on the NHS before and after the screening. Not all insurance companies include NHS in all their insurance classes. Conclusions: Establishing a tracking system and standardizing test protocols with a surplus of test personnel and equipment were identified as areas for improvement. The Council of Health Insurance in Saudi Arabia is recommended to include NHS as a mandatory screening for all patients in the private sector, either covered by insurance or cash-pay patients. [ABSTRACT FROM AUTHOR]

Abstract Nutrition plays a crucial role in human and planetary health, as prevailing nutritional patterns significantly contribute to the global non-communicable disease pandemic. Moreover, the global food system is inextricably linked to planetary health deterioration. The relevance of nutrition for individual and planetary health is insufficiently addressed in German medical schools. Here, we present a two-week course for medical students in the 8th semester at Charité - Universitätsmedizin Berlin on nutrition and fasting in the context of human and planetary health. The course was developed iteratively along the Kern cycle for medical curricula and underwent evaluation through a mixed-methods design spanning across two consecutive semesters. Assessment involved quantitative questionnaires and qualitative interviews. The main exploratory outcome was the overall module rating. Further outcomes encompassed in-depth evaluations of specific aspects, including content, teaching methods, instructor performance, and subjective experiential aspects. The conceptualisation resulted in a highly participative two-week course of 37.5 h. The main learning objectives aimed at the acquisition of technical competences and personal competencies in four areas: (1) the role of nutrition in health and disease; (2) the exploration of global food systems; (3) communication on subjects of nutrition; (4) culinary medicine. Various interactive didactic methodologies were used. 77.8% (n = 27) of the participants rated the course as very good or good. The conviction that nutrition influences health and disease increased over the course (Wilcoxon signed rank test, z = -2.82, p = 0.005, r = 0.57). In the qualitative interviews (n = 8) the course content, its didactical diversity and the positive group experience were appreciated. Our results indicate that it could be worthwhile to further incorporate nutrition curricula in medical education.

Purpose: This research analyzes the effects of a Service-learning program on the development of civic attitudes and skills on preservice teachers (n = 98). They provided a direct service of motor sessions aimed at children with functional diversity. Method: The topic was approached using a mixed methodological approach. A pre- and posttest quantitative analysis was performed on the results obtained after applying the Civic Attitudes and Skills Questionnaire, and a qualitative analysis was performed on the content of follow-up journals. Results: The quantitative results indicated a significant positive posttest, and qualitative analysis explained the civic skills and attitudes that the preservice teachers acquired. Discussion/Conclusion: Service-learning is a useful method for promoting the civic attitudes and skills of preservice teachers. The acquired learning specifically affected the different dimensions involved in achieving meaningful learning, an improvement in the skills and attitudes that are essential characteristics of an inclusive teacher. [ABSTRACT FROM AUTHOR]

Abstract Background Low back pain is a common musculoskeletal condition which causes substantial disability globally. The biopsychosocial model of management has been recommended in national and international guidelines for the management of patients with chronic low back pain (CLBP). However, biopsychosocial approaches are predominantly delivered in high income countries (HICs), although the prevalence of LBP is substantially higher in low- and middle-income countries (LMICs) especially in Africa (39%; 95% CI 30–47). Understanding the effectiveness of BPS interventions in LMICs especially in Africa is underexplored, with substantial inequity between research from HICs and LMICs. Ghana is a LMIC where the effectiveness of biopsychosocial interventions has been underexplored. Therefore, the aim of this study was to explore the feasibility of delivering a physiotherapist-led BPS programme for the management of patients with CLBP in Ghana. Methods This was a mixed-methods, sequential, pretest-posttest feasibility study. Participants involved thirty patients with CLBP. The biopsychosocial intervention involved an exercise and patient education programme based on principles of cognitive behavioural strategies with emphasis on self-management. The biopsychosocial intervention was delivered for six weeks for each participant. Feasibility outcomes regarding management and processes were captured pre-intervention, post-intervention, and three-months post intervention. Semi-structured interviews were conducted post-intervention to explore participants’ experiences with the biopsychosocial intervention. Patients’ demographics were collected at baseline. Patient reported outcome measures such as intensity of pain, disability, pain catastrophising, kinesiophobia, self-efficacy, and general quality of life, were collected pre-intervention, post-intervention and at three-months follow-up. Qualitative analysis explored participants’ experiences regarding the acceptability of the biopsychosocial intervention. Results The results of this feasibility study demonstrated that the training programme was acceptable to physiotherapists. Recruitment rate (5 patient participants per week − 100% recruitment met), retention rate post-intervention (90%), data completion rate post-intervention (99.8%) and intervention fidelity (83.1%), all met feasibility thresholds. There were no adverse events. Qualitative data also demonstrated that the biopsychosocial intervention was acceptable to participants. Conclusion This study has established the potential to deliver a biopsychosocial intervention programme in a Ghanaian hospital setting. This biopsychosocial intervention therefore shows promise, and the result of the study provides a platform to develop future clinical studies.