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Background: A deep knowledge of the healthcare system and the organization of neurology departments is important for planning and optimizing changes to facilitate the successful implementation of anti-amyloid antibodies treatments., Objective: We aimed to assess the necessary changes prior to introducing these therapies in our setting., Methods: We conducted a key informant survey among heads of departments of neurology from 16 hospitals in Spain. The questionnaire comprised questions about changes in the organization and functioning of the departments of neurology with the introduction of anti-amyloid drugs, changes in diagnosis and patient care, use of diagnostic techniques, patients, families and public information, resources allocation, and research., Results: Sixteen key informants completed the survey. They strongly agreed that the introduction of anti-amyloid drugs will impact the functioning of neurology services, especially in hospitals with dementia units. Consensus was reached regarding referring all Alzheimer's disease patients eligible for therapy to dementia units. There was also agreement on the need to expand the neurology services, day hospital units, extend visit durations, and hire more professionals, especially neurologists, neuropsychologists, and nuclear medicine physicians. Furthermore, consensus was achieved on increasing the use of MRI, amyloid PET, cerebrospinal fluid biomarkers, APOE genotyping, and the necessity of advancing blood biomarkers and tau tracers., Conclusions: Our study highlights the need for extensive changes within Spanish neurological departments to effectively integrate anti-amyloid antibodies. Implementing these changes is essential for the timely and equitable adoption of novel therapies., Competing Interests: Declaration of conflicting interestsDr Jordi A Matias-Guiu is an Editorial Board Member of this journal but was not involved in the peer-review process of this article nor had access to any information regarding its peer-review. Dr Jordi A Matias-Guiu has received honoraria as advisor and speaker from Araclon Biotech, Eisai, Esteve, Exeltis, Fujirebio, and KRKA. Dr David Perez-Martinez has received honoraria as speaker from Roche, Lilly, Exeltis, Neuraxpharm, and Krka. Dr Jose Miguel Lainez has received honoraria as speaker, consultation fees and research grants from: Abbie, Allergan, Eli Lilly, Dr Reddýs, Lundbeck, Merck, Novartis, Pfizer, Prim, Roche, and Teva. Data availabilityThe dataset is available from the corresponding author upon reasonable request.

Background: Reserves' mechanisms explain inconsistencies between accumulation of neuropathological damage and clinical manifestations. Leisure activities are believed to promote reserves., Objective: This study evaluates whether cognitive, social, and physical leisure activities performed over life-span predict current cognitive functioning in normal aging and Alzheimer's disease (AD) continuum., Methods: 35 AD, 24 amnestic-Mild Cognitive Impairment (a-MCI) patients, 21 individuals with subjective cognitive complaint (SCD), and 25 controls underwent a questionnaire developed to quantify leisure activities in different life periods, the Addenbrooke's Cognitive Examination-Revised (ACE-R), and T1-weighted 3T-MRI scans for brain volumetrics and cortical thickness quantification. Partial/total leisure activities' scores and demographic and brain variables were entered as predictors, while ACE-R scores as dependent variables in linear regression analyses., Results: Current level of cognition was predicted by (i) social and physical activities performed in middle age and current cognitive activity in AD; (ii) cognitive and social activities performed in middle age, current age and cortical thickness in a-MCI; (iii) recreational activities the set of lifetime, current age, and brain features in SCD; (iv) education and the set of lifetime leisure activities over lifespan in controls., Conclusions: This study shows a funnel effect due to gradual reduction of stimulatory activities in the transition from healthy aging to AD. Reserve indices taking into account different types of stimulatory activities allow to capture even smallest residual effects of reserves accumulated over lifespan, until their complete depletion at advanced AD stages. These results may help target tailored interventions during normal and pathological aging., Competing Interests: Declaration of conflicting interestsL.S. and M.B. are Editorial Board Members of this journal but were not involved in the peer-review process of this article nor had access to any information regarding its peer-review. The remaining authors have no conflict of interest to report.

Background: The COVID-19 pandemic highlighted the negative impact of moral injury on nurses' well-being. However, there is a lack of research about generational differences among nurses, particularly on newer nurses who have been identified as having a higher rate of intention to leave., Objective: This study examines generational differences among nurses on moral injury, well-being, resilience, and intention to leave their nursing position and profession., Methods: This is a secondary analysis of cross-sectional data from registered nurses in clinical practice in Ohio between July and August 2021. Data on demographics, moral injury, resilience, and well-being were collected using an online survey. Participants were categorized into 4 generational groups based on their age in 2021: Baby Boomers (57-75 years old), Generation X (42-56 years old), Generation Y (27-41 years old), and Generation Z (12-26 years old). Descriptive and inferential statistics, including logistic regression and analysis of variance, were employed for analysis., Results: Significant generational differences were found in years of clinical experience, moral injury, resilience, and well-being. Baby Boomers reported higher well-being and resilience and lower moral injury. Notably, the intention to leave the profession was more strongly associated with well-being and moral injury levels than with the years of experience or generational group., Conclusions: The findings suggest that interventions to improve nurse retention should prioritize enhancing well-being and addressing the root causes of moral injury. Tailored strategies addressing the needs of different generations are necessary for mitigating the adverse effects of current healthcare challenges on nurse attrition., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Patients with head and neck cancer (HNC) have to cope with a multitude of treatment-related adverse effects that impact their quality of life (QoL) post-treatment completion. The presence of family resilience could potentially foster individual resilience and might contribute to patients' QoL. However, this interconnection has not been confirmed., Objective: To explore the relationships between family resilience, individual resilience, and QoL in patients with HNC and to determine whether individual resilience in HNC patients functions as a mediator between family resilience and QoL., Methods: From September 2022 to June 2023, a cross-sectional survey was conducted among 185 patients with HNC recruited through convenience sampling from a tertiary care hospital in Jiangsu Province, China. Self-report measures of family resilience, individual resilience, and QoL were assessed. Relationships were examined by Pearson's correlations. Structural equation models were used to assess whether individual resilience played a mediating role between family resilience and QoL., Results: There were significant positive correlations between QoL and both family resilience ( r  = 0.43, P  < .01) and individual resilience ( r  = 0.59, P  < .01). Moreover, family resilience had an indirect influence on QoL through its effect on individual resilience (β = 0.319, 95% CI: 0.336-0.815)., Conclusion: Family resilience emerges as a significant positive factor capable of enhancing QoL for patients with HNC by bolstering their resilience. To mitigate the detrimental effects of inadequate individual resilience on QoL of patients with HNC, it is advised to implement interventions focused on enhancing family resilience., China Clinical Trials Registry Number: ChiCTR2300067612., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: This research was conducted to explore the mediating effect of perceived social support and health literacy on the relationship between decisional dilemmas and participation in shared decision-making among Chinese parents of premature infants., Design and Methods: This cross-sectional study recruited 225 Chinese parents of premature infants in a neonatal ward of a Chinese hospital through convenience sampling. Data were collected from August 2022 to February 2023 using 5 self-administered instruments. Structural equation modeling and multiple mediation tests were applied to explore the interplay among perceived social support, health literacy, decisional dilemmas, and participation in shared decision-making. The study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines., Results: Decisional dilemmas were found to negatively impact participation in shared decision-making. Perceived social support and health literacy were identified as partial mediators in this relationship, collectively accounting for a mediation effect of -0.413, which represents 50.0% of the total effect., Conclusion: The findings elucidate a multifaceted model of factors influencing participation in shared decision-making among Chinese parents of premature infants. Prompt recognition of these variables can enable nursing professionals to incorporate tailored management strategies within patient-centered care frameworks, thereby enhancing decisional outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Young Arab American women are at risk for cardiovascular disease, but there is limited data on their physical activity (PA) engagement., Objectives: The aim of this study was to examine the relationship between PA and its correlates in young Arab American women. The objectives of this study were to: (1) describe self-reported lifestyle PA behaviors of young Arab American women and (2) examine the relationship between their self-reported lifestyle PA, device-measured lifestyle PA (combined moderate / vigorous and steps), and potentially associated factors (demographics, physical measures, individual factors, and behavior cognition factors)., Methods: This cross-sectional study was conducted with women 18 to 35 years of age and Arab American (n = 50) in the Midwest Region of the United States. Participants wore ActiGraph GT3X-BT monitors for 7 days; self-report measures included the International Physical Activity Questionnaire, demographics, acculturation, discrimination, religiosity, self-efficacy, and social support., Results: The mean age of participants was 25.5 years ( SD : 5.5; range: 18-35). Per ActiGraph, the average daily steps were 5946 ( SD : 2783); only 24% met the moderate-intensity PA guidelines. Self-efficacy was significantly associated with increased moderate-to-vigorous PA ( B  = 0.37; P  = .012)., Conclusion: The average daily steps for the young Arab American women in this study were of low active classification. More than 75% of the women failed to meet the recommended weekly moderate / vigorous PA guidelines. Our study supports the importance of targeting and tailoring PA interventions on young Arab American women who have low self-efficacy for overcoming barriers to lifestyle PA., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Sleep problems are common in adults with ADHD and may be bidirectionally associated with ADHD severity and other psychiatric symptoms. We investigated the prevalence of positive screenings for various sleep disorders, and their association with psychiatric comorbidities in a large sample of adults with ADHD from a specialized outpatient clinic., Methods: We included data of 3,691 adult patients diagnosed with ADHD, who had filled out a screener for sleep disorders (Holland Sleep Disorders Questionnaire (HSDQ)) as part of routine diagnostic assessment. The HSDQ screens for the sleep disorders insomnia, parasomnia, hypersomnia, circadian rhythm sleep disorders (CRSD), restless legs syndrome (RLS)/periodic limb movement disorder (PLMD), and sleep-related breathing disorders (SBD). As delayed sleep phase syndrome (DSPS) is very frequent in ADHD, we additionally screened for DSPS. Psychiatric comorbidities were diagnosed through clinical assessment and the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus, which assesses 26 psychiatric disorders following the classification of the DSM-5. All data were retrieved from the electronic patient files., Results: Mean age was 35.4 and 49.4% of the patients were female. About 60% of the adults with ADHD screened positive for any sleep disorder. Highest prevalences were found for symptoms of DSPS (36%), insomnia (30%), and RLS/PLMD (29%). Sleep problems in adults with ADHD were associated with comorbid depression, anxiety, substance use disorder, personality disorder, and post-traumatic stress disorder., Conclusion: Adults with ADHD often report sleep problems, which are associated with specific psychiatric comorbidities. Systematic screening for sleep disorders in adult patients with ADHD can contribute to a better understanding of their complaints and may aid improved and integrated treatment for the sleep and psychiatric problems., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The Brief COPE is a widely used coping instrument, but there is a paucity of research regarding its ability to measure coping among sexual minority (SM) persons., Objective: This study determined the psychometric properties of the Brief COPE and identified coping domains among a sample of SM individuals., Methods: An online survey was conducted with 530 SM persons in the United States. Participants completed the dispositional version of the Brief COPE. Confirmatory factor analysis (CFA) determined construct validity. Cronbach's alpha examined the reliability of resulting domains. Exploratory structural equation modeling (ESEM) was employed to identify coping domains and criterion-related validity was assessed by examining the relationship of the domains with substance use measures (alcohol, cannabis, and drug use)., Results: CFA replicated the original 14-factor structure. ESEM identified 3 second-order domains with acceptable fit (chi-square [χ 2 ] = 905.81; degrees of freedom [d f ] = 334, P  < .001; comparative fit index [CFI] = 0.90; root mean square error of approximation = 0.06; 90% confidence interval = 0.05-0.06; and standardized root mean residual = 0.08). The 3 second-order domains demonstrated good reliability: adaptive (ω = 0.84), support (ω = 0.85), and disengaged coping (ω = 0.84). Disengaged coping exhibited the strongest correlations with substance use outcomes., Conclusions: Findings provide evidence to support the reliability and validity of the Brief COPE and validates its use with SM persons., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Multiple individual sleep health dimensions (satisfaction, regularity, and duration) are associated with diabetes symptoms, precursors to micro-and macrovascular complications, among young adults with type 1 diabetes mellitus (T1DM). Nearly half of young adults with T1DM develop vascular complications; however, modifiable contributors of diabetes symptoms, including sleep health, have been understudied., Methods: This cross-sectional quantitative descriptive study involved the completion of multiple validated self-report questionnaires and the collection of raw continuous glucose monitor and diary data over a 14-day period. The sleep health composite score was calculated by summing the number of dimensions with "good" sleep health. Chronotype was estimated with the 19-item Morningness-Eveningness Questionnaire. Multiple linear regression analyses were conducted to evaluate the associations between the independent variables (sleep health composite and chronotype) and diabetes symptom burden. Covariates, including age, race, sex at birth, T1D duration, continuous subcutaneous insulin infusion use, and hemoglobin A1C (HbA1C), were considered to determine their contribution to these relationships., Results: One hundred nineteen young adults with T1DM who were aged 18 to 26 years were included in this study from 2 cohorts. Higher sleep health composite scores were associated with a lower overall diabetes symptom burden, even after adjusting for covariates in the linear regression models. Initially, a later chronotype was linked to a higher diabetes symptom burden, but this association became insignificant after accounting for HbA1C levels., Conclusion: Improving multiple dimensions of sleep health may alleviate the diabetes symptom burden among young adults with T1DM., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Psychosocial predictors of breastfeeding and changes in those factors during pregnancy, along with the relationship of those changes with both breastfeeding and smoke use and exposure, are not well explored., Research Aim: The aim of this study was to identify distinct trajectories of psychosocial determinants of breastfeeding and smoking in pregnant women., Methods: We used a longitudinal study design and data from a randomized controlled trial conducted among smoke-exposed pregnant women and their infants. Participants were recruited early in pregnancy and were surveyed at ≤ 16 and 32 weeks gestation, delivery, 3 and 6 months postpartum for breastfeeding intentions, initiation, continuation, and smoke use and exposure. Psychosocial variables associated with breastfeeding were measured at baseline and 32 weeks gestation using the Mitra index, a structured questionnaire that assesses barriers and facilitators of breastfeeding intentions. Latent class growth analysis was performed using Mitra scores to identify distinct subgroups of participants with different trajectories. Sociodemographic characteristics, breastfeeding, and tobacco smoke use and exposure were compared across classes., Results: Three or four trajectories were identified for each of the six Mitra scores. Trajectories for all Mitra scores were associated with breastfeeding intention and initiation. Overall, Mitra, knowledge, self-efficacy, social support, and time barrier classes all differed by tobacco smoke use or exposure., Conclusion: Trajectories of breastfeeding knowledge, self-efficacy, social support, and time to breastfeed/social barriers are associated with tobacco smoke use and exposure during pregnancy. Encouragement to breastfeed and to cease and avoid tobacco smoke should start early in pregnancy, focusing on these determinants to improve health outcomes., Competing Interests: Disclosures and Conflicts of InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: At the time of this research, Anna Alikhani was a doctoral student, and Patricia Markham Risica was on her dissertation committee.

Objective: The current study sought to clarify and harness the incremental validity of emotional dysregulation and unawareness (EDU) in emerging adulthood, beyond ADHD symptoms and with respect to concurrent classification of impairment and co-occurring problems, using machine learning techniques., Method: Participants were 1,539 college students ( M age  = 19.5, 69% female) with self-reported ADHD diagnoses from a multisite study who completed questionnaires assessing ADHD symptoms, EDU, and co-occurring problems., Results: Random forest analyses suggested EDU dimensions significantly improved model performance ( p s < .001) in classifying participants with impairment and internalizing problems versus those without, with the resulting ADHD + EDU classification model demonstrating acceptable to excellent performance (except in classification of Work Impairment) in a distinct sample. Variable importance analyses suggested inattention sum scores and the Limited Access to Emotional Regulation Strategies EDU dimension as the most important features for facilitating model classification., Conclusion: Results provided support for EDU as a key deficit in those with ADHD that, when present, helps explain ADHD's co-occurrence with impairment and internalizing problems. Continued application of machine learning techniques may facilitate actuarial classification of ADHD-related outcomes while also incorporating multiple measures., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The number of validated questionnaires that assess the level of breastfeeding competence of primary care professionals who attend lactating mothers is limited., Research Aim: To validate the CAPA (Competència en l'Atenció Primària sobre Alletament [Breastfeeding Competence in Primary Care]) questionnaire into Spanish in collaboration with professionals from the primary care services of the Comunidad de Madrid (Spain)., Methods: In this multicentric study, four bilingual healthcare professionals translated the CAPA questionnaire into Spanish and back-translated it into Catalan. The cross-cultural adaptation included a discussion by an expert committee, a review by a philologist, and a pilot study that involved 13 healthcare residents. We randomly selected professionals from specialties involved in breastfeeding. The re-test was conducted 3 weeks later, aiming to avoid changes in the studied population. We performed a factor analysis to identify underlying constructs and hypothesis-testing to assess the validity of the questionnaire and estimated the Cronbach Alpha and intraclass correlation coefficient (ICC) to assess its reliability., Results: A total of 198 professionals participated by responding to the questionnaire. Factorial analysis showed that the questionnaire was unidimensional. Hypothesis testing showed that, of all the considered professional groups, midwives achieved the highest mean score ( M  = 131.7, SD  = 10.9, p  < 0.001). Amongst the other professionals, only 26.5% achieved a basic level of breastfeeding competence. The Cronbach alpha and ICC were 0.852 (95% CI [0.821, 0.880]) and 0.890 (95% CI [0.800. 0.937])., Conclusions: The Spanish CAPA questionnaire is a valid and reliable tool for assessing breastfeeding basic competence among primary care professional groups who attend lactating mothers., Competing Interests: Disclosures and Conflicts of InterestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Pain is a common, severe symptom related to endometriosis. Despite this prominent feature, there is limited literature regarding its description and use of integrative treatment methods., Objective: We aimed to describe endometriosis-related pain characteristics, severity, and association with an integrative approach encompassing pharmacological and non-pharmacological methods., Methods: A cross-sectional descriptive correlational study was conducted using convenience sampling of adult women with endometriosis-related pain. Three questionnaires were utilized: a demographic and general health questionnaire, a visual analog pain scale (VAS), and the short-form McGill pain questionnaire (SF-MPQ)., Results: Participants included 93 women with a mean general pain level of 6.2/10 (SD = 2.7) on the VAS. The total mean pain score on the SF-MPQ was 26.25/45 (SD = 10.1). Sixty-four women (68.8%) reported experiencing pain at the time of completion of the questionnaire (mean: 1.6/4, SD = 1.3). All participants utilized analgesia; those who used opioids reported a higher overall mean pain score of 2.3 (SD = 1.3) than patients who did not use opioids reported a mean of 1.4 (SD = 1.2; z  = 9.59; P  < .001). Present pain intensity was significantly higher for women using opioids than those not using opioids. In all, 77 women (82.8%) used integrative methods to alleviate the pain symptoms. Women who utilized nutritional therapy as part of the non-pharmacological method experienced lower mean (SD) overall pain (4.4 [2.5]) compared with patients who did not utilize nutritional therapy (6.75 [2.5]; P  < .01)., Conclusions: More studies are needed to find evidence-based treatment options for women for integrative pain relief for endometriosis-related pain., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs, notably the skin, joints, and kidneys. The primary goal in managing SLE is to enhance patients' quality of life (QoL). Illness perception can influence QoL in patients with chronic disease. We assessed illness perception in juvenile SLE (jSLE) patients and its effect on patient's and parental QoL., Method: Patients diagnosed with jSLE according to the SLICC 2012 criteria between January and November 2023 were included. Patients' illness perceptions were gaged using the brief illness perception questionnaire (B-IPQ), while patient's and parental QoL were evaluated using PedsQL and WHOQOL- BREF, respectively., Results: The study comprised 32 patients and 32 parents, predominantly female (78.1%). Musculoskeletal involvement was the most common (65.6%), followed by mucocutaneous (59.4%), renal, and hematological involvement (50% each). Neuropsychiatric involvement was absent. The median SLEDAI-2K score at the last outpatient clinic visit, which was documented in the patient's file was 2 (0-18) and was not correlated with the B-IPQ score (r = 0.121, p = .51). A significant negative correlation was found between B-IPQ and patient QoL, indicating poorer QoL in patients with negative illness perceptions (r = -0.576, p < .001). No correlation was observed between parental QoL and B-IPQ ( p => .05). Of note, 56.3% of patients had poor QoL, scoring below the PedsQL cut-off, while 43.8% of parents had poor QoL for general health, scoring below the WHOQOL-BREF cut-off for general health., Conclusion: Although disease perception did not correlate with disease activation in jSLE, it significantly impacted patient QoL. Enhancing patients' perceptions of jSLE may improve their overall QoL., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Human milk feeding rates in the United Kingdom are a public health concern. Changes to United Kingdom policy and practice are needed to improve lactation support. These should be informed by those with lived experience of human milk feeding and those who provide support., Research Aim: The aim of this study was to identify research, policy, and practice priorities for increasing human milk feeding rates using insights from a wide range of stakeholders. A secondary aim was to evaluate the influence of a World Café on individual attendees and their interactions within the organizations and communities of which they are a part., Methods: The research employed a participatory qualitative design, incorporating a cross-sectional survey and World Café discussions. World Café is a novel approach to engaging stakeholders in discussion, resulting in consensus-building and participatory-driven recommendations. A pre-event survey was completed by a self-selected sample of 67 participants; 37 of these (55%) took part in World Café discussions or an online focus group. World Café discussions and the online focus groups were recorded and transcribed verbatim. Following the World Café, 12 participants (32%) completed a post-event survey, and eight (22%) completed an additional follow-up survey at 2 months., Results: Priority policy and practice changes were identified, including enhancing education, the need for dedicated funding for human milk feeding support, the need to include family within support provision, and the need to change policy regarding media representations of infant feeding. In addition, World Café methodology proved valuable for facilitating networking and instigating changes in relation to support., Conclusion: World Café generated stakeholder agreed-on priorities for research and policy. Many of the recommendations from historical policy and guidance continue to be areas for further development., Competing Interests: Disclosures and Conflicts of InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Since the completion of this project AB has commenced training to become a peer supporter with The Breastfeeding Network. The authors declare no other conflicts of interest.

Introduction: As of 2019, the United States houses 5.3 million Chinese Americans (CA), with 689,000 being older adults. The purpose of this study was to examine the relationships between social determinants of health (SDOH) and acculturation on quality of life in CA older adults, an underresearched area., Methods: Using a quantitative correlational descriptive design, CA older adults ( n = 110) in NYC with chronic pain were examined. Data were collected by utilizing the PRAPARE Screening Tool, Asian American Acculturation Scale, and SF-12 Questionnaire., Results: Regression revealed a negative correlation between SDOH and quality of life ( p = .001). The acculturation's impact was nonsignificant ( p = .647)., Discussion: While SDOH significantly impacted the quality of life, acculturation did not significantly predict the quality of life for older Chinese American adults with chronic pain. Further research is warranted to explore the nuanced dynamics between acculturation, SDOH, and quality of life in this population., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Context-specific measures with adequate external validity are needed to appropriately determine psychosocial effects related to screening for cognitive impairment., Methods: Two-hundred adults aged ≥65 y recently completing routine, standardized cognitive screening as part of their Medicare annual wellness visit were administered an adapted version of the Psychological Consequences of Screening Questionnaire (PCQ), composed of negative (PCQ-Neg) and positive (PCQ-Pos) scales. Measure distribution, acceptability, internal consistency, factor structure, and external validity (construct, discriminative, criterion) were analyzed., Results: Participants had a mean age of 73.3 y and were primarily female and socioeconomically advantaged. Most had a normal cognitive screening result (99.5%, n  = 199). Overall PCQ scores were low (PCQ-Neg: x ¯ = 1.27, possible range 0-36; PCQ-Pos: x ¯ = 7.63, possible range 0-30). Both scales demonstrated floor effects. Acceptability was satisfactory, although the PCQ-Pos had slightly more item missingness. Both scales had Cronbach alphas >0.80 and a single-factor structure. Spearman correlations between the PCQ-Neg with general measures of psychological distress (Impacts of Events Scale-Revised, Perceived Stress Scale, Kessler Distress Scale) ranged from 0.26 to 0.37 ( P 's < 0.001); the correlation with the World Health Organization-Five Well-Being Index was -0.19 ( P  < 0.01). The PCQ-Neg discriminated between those with and without a self-reported subjective cognitive complaint ( x ¯ = 2.73 v. 0.89, P  < 0.001) and was associated with medical visit satisfaction ( r  = -0.24, P  < 0.001) on the Patient Satisfaction Questionnaire. The PCQ-Pos predicted self-reported willingness to engage in future screening ( x ¯ = 8.00 v. 3.00, P  = 0.03)., Conclusions: The adapted PCQ-Neg is an overall valid measure of negative psychological consequences of cognitive screening; findings for the PCQ-Pos were more variable. Future studies should address measure performance among diverse samples and those with abnormal screening results., Highlights: The PCQ scale is an overall valid measure of psychological dysfunction related to cognitive screening in older adults receiving normal screen results.PCQ scale performance should be further validated in diverse populations and those with abnormal cognitive screening results.The adapted PCQ may be useful to both health research and policy stakeholders seeking improved assessment of psychological impacts of cognitive screening., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Persell receives unrelated research funding from Omron Healthcare Co. Ltd. Dr. Wolf reports unrelated research funding from the Gordon and Betty Moore Foundation, RRF Foundation for Aging and Eli Lilly, Glaxo Smith Klein, and personal fees from Pfizer, Sanofi, Luto UK, University of Westminster, and Lundbeck. All other authors have no conflicts of interest to disclose. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was self-funded. Additional training support was provided to the corresponding author by the National Institute of Aging-funded Claude D. Pepper Older Americans Independence Center at Northwestern University (P30AG059988). The supporting agency had no role in designing the study, interpreting the data, writing, and publishing the report.

Background: Breastfeeding is crucial in providing infants with needed nutrition and immunity to foster their healthy growth and development; yet, optimal support from health workers is critical for it to be successful., Aim: To determine factors influencing tangible breastfeeding support among health workers in Nigeria., Methods: This cross-sectional study was conducted in Nigeria's six geopolitical zones between August 2022 and February 2023 among health workers ( N  = 2,922). Data were gathered through an interviewer-administered, validated questionnaire. Significant factors of tangible breastfeeding support were identified through multivariable logistic regression, and corresponding odds ratios with 95% confidence intervals were reported., Results: The mean age of the health workers was 28.6 ( SD  = 9.3) years. Just 45% (1,316) achieved optimal scores for tangible breastfeeding support. Only 31.4% (918) of lactation support providers/specialists practice tangible breastfeeding support and half (50.6%, 1,479) had a favorable attitude towards providing tangible breastfeeding support. About two-fifths (39.3%, 1,148) engaged caregivers in reviewing breast milk storage procedures, whereas, 54.6% (1,595) and 78.0% (2,279) of health workers assisted with breast pumps and breastfeeding attachment respectively. The odds of having optimal tangible breastfeeding support were higher for health workers aged 52 years or older compared to those aged under 20 years (aOR 1.88, 95% CI [1.13, 3.12]), a positive attitude (aOR 1.43, 95% CI [1.22, 1.69]), availability of a breastfeeding champion (aOR 1.47, 95% CI [1.21, 1.79]), 1.69]), provision of breast-pump videos (aOR; 2.33, 95% CI [1.85, 2.95]), and hand-expression videos (aOR; 1.41, 95% CI [1.02, 1.79]). (duplication)., Conclusion: Health workers' tangible breastfeeding support in Nigeria is suboptimal and is driven by age, service level, attitude, availability of breastfeeding champions, and appropriate practice aids. Targeted interventions to improve health workers' attitudes, technical skills, provision of aids, and task shifting to non-specialists are needed for optimal tangible breastfeeding support., Competing Interests: Disclosures and Conflicts of InterestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Systemic Lupus Erythematosus (SLE) warrants an early diagnosis and prompt management. Delay in diagnosis can result in repeated flares, permanent damage, and even death. There is a large variability in the time taken to diagnose SLE across the world. We undertook this study to determine the time taken for diagnosis of SLE in India and to identify the factors associated., Methods: Patients with SLE diagnosed within the previous 1 year as per Systemic Lupus Erythematosus International Collaborating Clinics criteria (SLICC) 2012 criteria were included in a cross-sectional multicentre questionnaire-based survey. Demographic profile, self-reported socioeconomic status as per Kuppuswamy classification of socioeconomic status (version 2022) (SES), and several healthcare related parameters including referral pattern were recorded. Median time taken for diagnosis was used to demarcate early or late diagnosis and associated factors were explored., Results: We included 488 patients with SLE from 10 rheumatology centres. The median time to diagnosis was 6 months Interquartile Range (IQR 3,14.7) and within 3 months in about one third [150(30.7%)]. Very early diagnosis ( < 1 month) was established in 78(16.0%) patients. The mean SLE Disease Activity Index (SLEDAI) at diagnosis was 10.28 + 7.24. In univariate analysis, an older age, lower SES, non-southern state of residence and larger family size were significantly associated with late diagnosis. In the multivariate analysis, higher SES (AOR 0.95, 95% CI: 0.92-0.98), multiple organ system involvement at initial presentation (AOR1.75 95%CI: 1.08-2.84) and place of residence in south Indian states (AOR1.92 95%CI: 1.24-2.97) had lesser odds of being associated with late diagnosis. Distance from the closest medical centre/professional did not influence the time to diagnosis. Majority of patients had first consulted a medical graduate (42.5%) or postgraduate doctor (48.2%), and referral to rheumatologist was largely done by postgraduate (65%) doctors. More than half of our patients (61%) self-finance their treatment., Conclusion: Median time to diagnosis of SLE was 6 months, 1/3rd being diagnosed within 3 months and 78(16.0%) with 1 month of symptom onset. Delay in diagnosis was noted in those belonging to lower socioeconomic strata and those with single organ disease. Distance to the health care facility did not influence time to diagnosis., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Eating behaviors, which are shaped during childhood, are one of the important factors influencing children's growth. This study aimed to investigate the variations in eating behaviors among Vietnamese preschool children aged 3 to 6 years using the Children Eating Behavior Questionnaire (CEBQ) and their association with anthropometric Z -scores. A cross-sectional study was conducted on 10 172 children from 36 to 72 months old, recruited from three different socioeconomic regions of Hanoi. Differentiation of eating behaviors between two sexes was observed across all age groups, but most obvious at 36 to 48 months of age. The subscales of emotional overeating (EOE), enjoyment of food (EF), and desire to drink (DD) were higher in 60- to 72-month age groups and vice versa for slowness in eating (SE) and emotional undereating (EUE) subscales. Analyses using the general linear model showed that CEBQ subscales were associated with anthropometric Z -scores in both girls and boys., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Caregiving in the African American community is informed by strong cultural expectations but may be associated with negative experiences and poor mental health outcomes., Objective: The purpose of this convergent mixed-methods study is to understand the relationship between caregiving experiences and mental health and explore stress management strategies in African American family caregivers of adults with chronic or disabling conditions., Methods: African American family caregivers (N = 100) were recruited using community-engaged methods and completed a sociodemographic questionnaire, the Caregiver Reaction Assessment scale, and the Center for Epidemiologic Studies Depression (CES-D-10) Scale. A subsample (n = 24) participated in semi-structured interviews. Data were analyzed using linear regression and content analysis. A matrix was developed to integrate quantitative and qualitative results., Results: Participants were on average 59 years old. Most were women and provided care to a parent. Lack of family support ( B  = 1.37, P  = .03) and impact of caregiving on caregivers' finances ( B  = 1.74, P  = .004), schedule ( B  = 2.92, P  < .001), and health ( B  = 3.26, P  < .001) were associated with depressive symptoms and were reported as stressful experiences. Negative interactions with the care recipient and caring for multiple people emerged as other sources of stress. Participants used independent and interpersonal coping strategies, as well as strategies to facilitate their caregiving role to reduce their stress. Values of reciprocity, limited use of community-based resources, and mental health stigma emerged as important cultural considerations., Conclusions: Our findings suggest the need for culturally-sensitive interventions to improve communication and care coordination within African American family caregiving networks and educational programs about mental health and caregiving resources endorsed by trusted community sources., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Supported accommodations (SAs) are key components of community mental health care, but little is known about residents' care pathways. This study analysed the care pathways of residents of SAs, and factors associated with their age of entry and length of stay., Methods: A random sample of SAs' residents in Portugal was interviewed and a questionnaire was specifically developed to assess their care pathways. Associations between sociodemographic and clinical characteristics, age of entry and length of stay, were analysed using hierarchical regression., Results: Overall, 213 residents of 43 different SAs participated. Their mean age was 55 years. Most were male, single, pensioners and had early-onset psychotic disorders. On average, they integrated the current SA at around 50 years old and had a 4.5 year length of stay. Most participants had been in another SA before (35.0% in more supported, 33.8% in less supported and 6.3% in similarly supported SAs)., Conclusions: Findings suggest that residents spend several years in the residential pathway, with a significant proportion moving to more supported SAs. This calls for increasing the number of SAs with different typologies and developing coordinated community supports.

Background: Many nurses join the profession because they have altruistic intentions, but some nurses experience barriers to acting on altruistic intentions which may be a source of job dissatisfaction or burnout., Objective: The purpose of this study was to evaluate construct validity, internal consistency, and convergence reliability of the Nursing Altruistic Execution Scale (NAES), a novel instrument assessing the perceived ability to help others through work., Methods: The NAES was developed based upon a literature review examining altruistic behavior as a motivator for nursing work, with expert feedback for instrument refinement. Participants completed the NAES, Copenhagen Burnout Inventory Work-Related Burnout Scale, and Satisfaction of Employees in Health Care Survey. Exploratory factor analysis examined construct validity and factor loadings. Confirmatory factor analysis verified consistency in factor structure. Linear regression assessed for convergence reliability with burnout and job satisfaction., Results: The sample included 843 acute care hospital nurses surveyed in January-March 2023. Exploratory factor analysis revealed a two-factor solution, named altruistic engagement with work and workplace barriers to altruism . Nine instrument items were retained and demonstrated strong internal consistency (Cronbach's alpha 0.79). There was a significant relationship between both factors of the NAES and both burnout and job satisfaction, demonstrating that greater altruistic execution is associated with lower burnout and greater job satisfaction., Conclusion: Preliminary findings support the use of the NAES as a valid and reliable scale. Findings show there is correlation between altruistic intentions and burnout. Interventions aimed at enhancing altruistic execution may reduce nurse burnout and thereby improve retention., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Quality nursing care and ethical responses to patient pain and suffering are very important in the preoperative period. However, few studies have addressed these variables., Objective: This study aimed to examine the relationship between compassionate care and preoperative anxiety from the perspective of hospitalized patients., Methods: The current study was a cross-sectional descriptive one. The participants were selected using convenience sampling. The data were collected using a demographic questionnaire, Burnell Compassionate Care Tool, and Amsterdam Preoperative Anxiety and Information Scale (APAIS). The collected data were analyzed with SPSS software (version 22) through descriptive and inferential statistics at a significance level of 0.05 ( p < .05)., Participants and Setting: This study was conducted on 704 candidates for surgery in the internal and surgical wards of a large teaching hospital located in the south of Iran from December 2022 to March 2023., Ethical Considerations: The protocol for this study was reviewed and approved by the University Ethics Committee., Findings: The patients' average age was 36.61 ± 13.07. The average preoperative anxiety and need for information scores were 13.80 ± 2.66 and 7.44 ± 1.47, respectively. The average score of importance was 3.03 ± 0.19, and the average score of the extent of compassionate care provision was 1.22 ± 0.15. There was a significant relationship between preoperative anxiety with importance and the extent of compassionate care provision (r = 0.68, p < .001), r = -0.72, p < .001, respectively). A comparison of the demographic characteristics, need for information, importance, and provision of compassionate care showed that the extent of compassionate care provision had the greatest contribution in explaining preoperative anxiety (β = 0.50; p < .001)., Conclusion: Even though patients' preoperative anxiety was high and providing compassionate care in the preoperative period had a great role in relieving their anxiety, many participants appear to have received little compassionate care. To this end, nursing managers should pay attention to the quality of compassionate care in the preoperative stage. Besides, healthcare staff should receive the necessary training in compassionate nursing care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Ways to help older adults overcome barriers to performing regular exercise is a challenge to nurses., Objective: The study evaluated the acceptability of a portable exercise bike for arm/foot pedaling among older patients with cardiovascular diseases (CVDs)., Methods: Participants reported their physical activity levels using the International Physical Activity Questionnaire (short form) and thereafter performed two 6-minute-long arm/foot pedal biking sessions using a portable exercise bike. Participants provided qualitative feedback (one open-ended question) on the bike while exercising and completed the quantitative Acceptability Use Questionnaire following the two exercise sessions., Results: Twenty-five older adults (52% male and 48% female), with a mean (SD) age of 70 (6.4) years and a body mass index of 30 (7.4), completed the study. Most participants performed moderate to light physical activity at home with a daily mean (SD) sitting/sedentary time of 8 (3.4) hours. The mean scores from the Acceptability Use Questionnaire and the participants' comments alluded to the bike's multitasking utility and acceptability. Three broad themes derived from the qualitative analysis were: (1) the acceptability of the bike with participants who had musculoskeletal problems; (2) the ability to operate and use the bike for aerobic exercise engaging both arms and legs; and (3) the importance of overall utility, ease of use, and cost of the bike., Conclusions: The portable exercise bike was found acceptable in a group of older adults with CVDs. The bike has the potential to be applied in home-based exercise interventions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The health benefits associated with recreational running are challenged by the occurrence of running-related injuries (RRIs). Effective preventive measures require knowledge of sport injury etiology. Psychological factors such as perfectionism, mental toughness, and passion are believed to predispose to sports injury by influencing training behaviors, motivation to run, and suppression of feelings of fatigue and pain. Yet their association with RRIs are understudied., Hypothesis: Perfectionism, mental toughness, and passion predict an increased risk of RRIs in recreational runners., Study Design: Prospective cohort study., Level of Evidence: Level 3., Methods: A total of 143 recreational runners (age 34.9 ± 13.9 years, 37% women) with a response rate of 76.5% answered an online questionnaire about their characteristics, running behaviors, and psychological variables (perfectionism, mental toughness, and running passion) as well as a sports injury survey. Then, as a primary outcome, RRIs were recorded biweekly for 6 months. The incidence of injuries was expressed as RRI per 1000 hours of running. The association between predictive factors and RRIs was estimated using logistic regression., Results: The incidence of RRIs during follow-up was 5.16 per 1000 hours of running. The knee was the location injured most often (26.4%), followed by the foot (18.9%) and lower leg (13.2%). Higher obsessive passion (OP) for running (odds ratio [OR], 1.11; 95% CI, 1.04-1.20) and perfectionistic concerns (OR, 1.22; CI,1.05-1.41) were associated with a greater risk of RRIs, as were previous injury (OR, 2.49; CI,1.10-5.70), weekly running distance (OR,1.10; CI, 1.03-1.16), and both supinated (OR, 4.51; CI, 1.11-18.30) and pronated (OR, 3.55; CI, 1.29-9.80) foot type. Following a running schedule (OR, 0.24; CI, 0.09-0.66) was associated with a lower risk of RRIs., Conclusion: History of previous RRI, pronated and supinated foot type, weekly running distance, perfectionistic concerns, and OP increased RRI risk in recreational runners. Following a running schedule was a protective factor., Clinical Relevance: Multiple factors, including runners' psychological characteristics, predict RRIs. These findings can inform the development of injury risk management strategies., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

School refusal behaviors in adolescents have deleterious immediate and long-term consequences and are associated with mental ill-health such as anxiety and depression. Understanding factors that place youth at higher risk of school refusal behavior may assist in developing effective management approaches. We investigated parental and adolescent factors that may be associated with school refusal behaviors by specifically focusing on the role of parental and adolescent emotion dysregulation, their anxiety and depression, and parental rearing style. First, we hypothesized that adolescents with school refusal behaviors, as well as their parents, will report higher levels of emotion dysregulation, anxiety, and depression compared to their counterparts without school refusal behaviors. Furthermore, we hypothesized that multivariate models testing the role of parental and child factors concurrently will show that parental (emotion dysregulation, anxiety and depression, and rearing styles) and adolescent (emotion dysregulation, anxiety, and depression) factors are associated with school refusal behaviors. One hundred and six adolescents aged 12 to 18 years and their parents completed an online questionnaire measuring both parental and adolescent emotion dysregulation, anxiety, depression, parental rearing styles, and adolescents' school refusal behaviors. Adolescents with school refusal behaviors reported greater anxiety and depression, with their parents showing greater emotion dysregulation. Multivariate analyses showed that parental emotion dysregulation and adolescent age were associated with school refusal behaviors independently. Future management for school refusal behaviors should consider age-tailored approaches by incorporating training for parental emotion regulation skills., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The term "cultural humility" is often used, but both society and professionals, including nurses, lack a clear understanding of its meaning. This study examined the relationships, predictors, and differences of nurse leaders' cultural humility in nursing practice, as perceived by hospital nurses., Methodology: A quantitative transverse and correlational study was implemented with a convenience sample of 350 Jordanian registered nurses (RNs)., Results: Nurses "agreed" on the presence of nurse leaders' cultural humility in nursing practice, but it was low. Working rotating shifts, holding a Baccalaureate degree in nursing or less, and having graduated from a private university predicted the perceived nurse leaders' cultural humility in nursing practice. Most differences in perceived nurse leaders' cultural humility in nursing practice came from nurses who worked rotating shifts when compared to those who worked day shifts., Discussion: Nurse leaders must practice open communication and embrace a receptive mind-set, as this will help eradicate the tendency of nurse leaders to believe they know "know-it-all.", Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Amid the increasing trend and huge impact of mental illness, psychosocial support (PSS) has been asserted to support individuals' recovery. Unfortunately, about 80% of affected people cannot access care as needed. Meanwhile, digital technology has a considerable role in closing service gaps., Aims: This convergent parallel mixed methods study examines existing mental health service utilization, users' needs for PSS, and feasibility of online PSS development., Methods: A cross-sectional interview survey was conducted using a semi-structured questionnaire at a super tertiary psychiatric hospital in Thailand from March to May 2023, with three groups of service users, having self-perceived conditions/diagnosis of schizophrenia ( n  = 100), mood disorders ( n  = 84), and others including alcohol and substance use, anxiety and personality disorders ( n  = 52). Four focus group discussions with three user groups ( n  = 16) and one multidisciplinary provider group ( n  = 7) were parallelly executed. Quantitative and qualitative data were convergently analyzed using descriptive and inferential statistics, and thematic and content analysis., Results: Critical shortcomings of PSS were indicated by 75.8% of user participants. Six common types of self-determined PSS were psychoeducational program, support group, skills training, counseling, supported employment, and complimentary therapy. While psychoeducational program was feasible, support group, and counseling were possibly featured within the 'all-at-once' online intervention development., Conclusions: PSS development based on users' needs can promote clinical and personal recovery outcomes, and close the service gaps. Users with mood disorders have the potential for online interventions. Peer-provider formalization, co-production approach, community engagement, digital literacy, infrastructures, and equal access factors are crucial for sustainable development.

As a global issue, peer victimization is closely associated with adolescent mental health. Although previous research has explored the relationship between peer victimization and mental health in some contexts, the school context, particularly within the Chinese cultural context, has not received sufficient attention. Based on the Healthy Context Paradox, this study aimed to explore the moderating role of school-level victimization in the relationship between individual-level peer victimization and mental health. This study tested two hypotheses by using a multilevel design: higher individual-level and school-level peer victimization are associated with higher depressive symptoms and lower life satisfaction (Hypothesis 1); school-level victimization moderates the association between individual-level peer victimization and mental health (Hypothesis 2). Participants were 39,720 adolescents (50.41% females; M age  = 13.68, SD  = 2.39) across 292 Chinese schools. They completed a set of questionnaires, including the Center for Epidemiologic Studies Depression Scale, the single-item Life Satisfaction Questionnaire, the Peer Victimization Scale, and demographics. The multilevel model indicated that both individual-level and school-level peer victimization were positively correlated with depressive symptoms and negatively correlated with life satisfaction. In schools with lower levels of victimization, there was a stronger association between individual peer victimization and adolescent mental health. A potential explanation for these results might be the victimization visibility and perceived severity in different contexts. These findings extended the discussion of the Healthy Context Paradox within the Chinese school context and provided valuable insights for developing school support strategies for victimized adolescents. School management might play a significant role in affecting the mental health of victimized adolescents., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Individuals with long COVID report diverse symptoms lasting weeks or months after initial infection, causing significant psychosocial distress. Navigating health care interactions are often difficult for these individuals due to the diffuse nature of their symptoms, a lack of effective treatment options, and skepticism from some providers. To better understand these challenges, this study sought to further describe the lived experience of individuals with long COVID. A survey was conducted with individuals evaluated for long COVID at a specialty clinic (n = 200), which included questions about prior conditions, symptoms, use of medical and support services, and information and resource needs. Participants reported a mean of 10.75 persistent symptoms, the most common being fatigue and difficulty concentrating, with broad effects on daily functioning. Participants saw a mean of 5.92 providers for treatment of their symptoms, and 88.5% identified health care providers as a trusted source of information. Interest in research findings (60.5%) and opportunities for participation (47.5%) were moderate and varied by COVID vaccination status. Unvaccinated individuals (n = 27) also reported less trust in government sources of information, less college education, lower household income, and greater likelihood of having public insurance. Our findings suggest that individuals with long COVID experience many ongoing and complex symptoms with diverse effects on daily living; that health care providers are an important source for public health messaging about long COVID; and that unvaccinated individuals are likely to have differing needs and receptiveness to information than vaccinated individuals with long COVID.

This study aimed to estimate workers' occupational lifetime exposure to chrysotile and examine the respiratory symptoms and lung cancer risk. A total of 112 workers were interviewed about their occupational histories. Exposure modeling using information on the determinants of exposure was used to estimate chrysotile emissions. The cumulative lifetime exposure was then assessed for each worker. Respiratory symptoms were obtained using a validated questionnaire. Lung cancer mortality rate was also predicted using a model. Almost all the workers were male and young (mean age = 30 years, SD = 7). The estimated lifetime occupational chrysotile inhalation exposure ranged from 0.0001 to 0.0486 f/mL.years (median = 0.0018 f/mL.years, IQR = 0.486). A high prevalence of cough symptom (11.7%), and low estimated cancer risk (<1%) were reported. In conclusion, the lung cancer risk among our cohort of workers was at a low level because of lower cumulative lifetime occupational chrysotile exposure., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Problems related to gambling and digital gaming have been a topic of concern for years. Less attention has been paid to the probable psychosocial factors behind these problems. While previous studies have established links between stress, loneliness, and addiction, there is a lack of longitudinal research investigating how stress and loneliness affect addictive behaviors, including problem gambling and gaming., Aims: This study uses multilevel mixed-effects generalized linear models to analyze the between- and within-person effects of stress and loneliness on gambling and gaming problems. The interaction between stress and loneliness was also investigated., Methods: A representative sample of Finns ( N  = 1,530) answered a survey in 6-month intervals between spring 2021 and autumn 2023; 49.22% of the sample took part at all six time points. The Problem Gambling Severity Index and the Internet Gaming Disorder Test were used to measure gambling and gaming problems. The three-item UCLA Loneliness Scale was used to assess loneliness, and the Perceived Stress Scale was used to evaluate stress., Results: After controlling for gender and age, loneliness was found to increase only gaming problems at both the between- and within-person levels, but not gambling. In contrast, stress enhanced both gambling and gaming problems at the between- and within-person levels. Additionally, loneliness and stress were found to have negative interaction suggesting that their combined effect was lower than their separate effects., Conclusion: The findings provide longitudinal insight into the psychosocial vulnerabilities behind problem gambling and gaming, which can be helpful in designing targeted interventions.

The results of this study suggest that a decreased vascularization of the median nerve after releasing the carpal tunnel predicts an inferior clinical improvement assessed by the Boston Carpal Tunnel Questionnaire., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Camouflaging, the strategies that some autistic people use to hide their differences, has been hypothesized to trigger mental health ramifications. Camouflaging might reflect ubiquitous impression management experiences that are not unique to autistic people and similarly impact the mental health of non-autistic people., Aims: We first examined whether individuals in the general population camouflage and manage impressions while experiencing mental health repercussions, and how gender and neurodivergent traits modified these associations. We then assessed how camouflaging and impression management arose from internalized stigma, and their inter-relationships in shaping mental health outcomes., Methods: Data were collected from 972 adults from a representative U.S. general population sample, with measures pertaining to camouflaging, impression management, mental health, internalized stigma, and neurodivergent traits. Multivariate hierarchical regression and moderated mediation analyses were used to address the two research aims., Results: Both camouflaging and self-presentation (a key component of impression management) were associated with mental health presentations in the general population, which overlapped with those previously reported in autistic people. These associations were more pronounced in women compared with men and were of different directions for individuals with higher autistic traits versus higher ADHD traits. Internalized stigma might be a key stressor that could elicit camouflaging and impression management through social anxiety, which in turn might lead to adverse mental health outcomes., Conclusions: These findings advance the conceptual clarity and clinical relevance of camouflaging and impression management across social and neurodiverse groups in the general population. The ramifications of camouflaging and impression management underscore the need to alleviate internalized stigma for better mental health across human groups.

Background: Adolescence is a critical period for mental health and social exclusion, a key social determinant of mental health. Early intervention approaches are key to mitigating the impact of mental ill-health during adolescence, however social exclusion can create additional barriers to accessing care., Aim: We aimed to better understand help-seeking experiences of adolescents facing co-occurring social exclusion and mental ill-health, including sources of support, barriers and preferences for service provision., Method: Cross-sectional data were analysed, from the 2022 Mission Australia Youth Survey ( N  = 18,800). Adolescents aged 15 to 19 years were recruited from around Australia, through schools, community organisations and digital platforms. Indices of four domains of social exclusion (housing, finances, relational and education/employment) were created using existing Youth Survey variables, and supplemented with demographic characteristics, psychological distress and help-seeking behaviours (perceived need, mental health supports, barriers to access and preferences). Relationships between social exclusion domains, mental health concerns and help-seeking behaviours were explored using logistic regression models., Results: A total of 9,743 young people reported having needed mental health support, yet only 58.1% reportedly sought support ( n  = 5,565). Social exclusion domains were associated with different help-seeking behaviours: housing challenges with higher help-seeking (OR = 1.28; 95% CI [1.15, 1.42]); relational difficulties and edu-employment issues with lower (OR = 0.75; 95% CI [0.68, 0.83] and OR = 0.82; 95% CI [0.75, 0.89]). Stigma, confidentiality concerns, cost and not knowing where to seek help were common barriers to help-seeking; those experiencing social exclusion more likely to report these. Participants reported a strong preference for face-to-face support., Conclusions: This study highlights the additional needs and challenges faced by adolescents dealing with both social exclusion and mental ill-health. With greater barriers to help-seeking, concerted efforts are needed to reduce stigma, improve mental health literacy and increase access to trusted information sources. Further initiatives should focus on structural factors that socially exclude young people and exacerbate inequitable access to mental healthcare.

This study was planned to determine the relationship between the attitudes of nursing students towards death and dying patients and their empathic tendencies. This study was conducted with a descriptive and correlational design. The research was completed with 176 students. Positive significant relationship found between between the FATCOD and ETS scores. It was observed that a 1-point increase in the Empathic Tendency Scale score caused an increase of 0.502 points in the FATCOD score. İt is recommended providing training sessions with simulation applications for nursing students to prepare them for end-of-life care experiences., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Hate-motivated behaviour (HMB) ranges from microaggressions to criminal acts and is a public health concern with wide-ranging consequences., Aims: The current study aimed to examine the mental health correlates of HMB perpetration, victimisation and co-occurring victimisation/perpetration., Methods: Participants ( n  = 447) completed an online cross-sectional survey assessing demographic factors, HMB (perpetration and victimisation), positive mental wellbeing and symptoms of depression and anxiety., Results: HMB victimisation was associated with lower positive mental wellbeing and increased symptoms of anxiety and depression. However, neither HMB perpetration nor co-occurring perpetration/victimisation were associated with any of the three mental health outcome measures., Conclusion: Experiencing HMB as a victim is linked to increased psychological distress. Additional research, which focuses on sampling populations who are known to be at greater risk for involvement in HMB, is needed to fully understand the impact of the victim-offender overlap on mental health outcomes.

The study aimed to compare the quality of life (QoL) in two communities with different exposures to conflict and investigate the inter-relationship between posttraumatic stress disorder (PTSD), social support, and QoL. This is a cross-sectional with 413 participants. Study instruments included the PTSD module of the Composite International Diagnostic Interview (CIDI), the World Health Organization Quality of Life BREF (WHOQoL-BREF), and the Multidimensional Scale of Perceived Social Support (MSPSS). The family domain of social support was protective of both PTSD and QoL. Except for the relationship between community's location and the physical subscale of the QoL, a hierarchical regression analysis showed that all the independent variables were significantly associated with the QoL domains. Direct exposure to crises impaired QoL more than areas indirectly exposed. PTSD and the family domain of social support play a significant role in the QoL outcome. This suggests that therapeutic intervention to improve QoL should target these key variables., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background/aims: Suicidal Ideation (SI) is a risk factor for suicide, a leading cause of death amongst young men globally. In this study we assess whether sustaining a serious physical combat injury is associated with SI and whether leaving service mediates this association., Methods: We analysed data from male UK Armed Forces personnel who sustained a combat injury in Afghanistan and a frequency-matched comparison group who did not sustain such an injury (the ADVANCE cohort). SI was measured from the Patient Health Questionnaire-9 item 'thoughts that you would be better off dead or of hurting yourself in some way'., Results: Approximately, 11.9% ( n  = 61) of the uninjured group, 15.3% ( n  = 83) of the overall injured group, 8.5% ( n  = 13) of an Amputation injury (AI) subgroup and 17.6% ( n  = 70) of a Non-Amputation Injury (NAI) subgroup reported SI in the past 2 weeks. The NAI subgroup reported greater likelihood of SI (Relative Risk Ratio (RR) = 1.44, 95% confidence interval (CI) [1.04, 2.00]) compared to the comparison group, whereas the overall injured group (RR = 1.23, 95% CI [0.90, 1.68]) and AI subgroup (RR = 0.65, 95% CI [0.36, 1.18]) did not. Leaving service fully mediated the association between sustaining a NAI and SI (natural direct effect RR = 1.08, 95% CI [0.69, 1.69])., Conclusions: UK military personnel with NAI reported significantly higher rates of SI compared to demographically similar uninjured personnel, while those who sustained AIs reported no significant difference. Leaving service was associated with greater rates of SI for both injured and uninjured personnel and fully mediated the association between sustaining a NAI and SI., Competing Interests: Conflict of interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C. Williamson is currently in receipt of a PhD studentship via the King’s Centre for Military Health Research Health and Wellbeing Study funded by the Office for Veterans’ Affairs, UK Government. N. T. Fear is part funded by a grant from the UK Ministry of Defence and is and an unpaid trustee of a charity supporting the wellbeing of service personnel, veterans and their families. A. Bennett is a serving member of the Royal Air Force. The views expressed are those of the author(s) and not necessarily those of the Office for Veteran’s Affairs or the Ministry of Defence.

The Me Too Movement has reshaped cultural awareness about sexual violence but little is known about how this shift may have coincided with changes in the reporting of sexual violence. The current study is the first to use the National Crime Victimization Survey to compare pre-#MeToo and post-#MeToo reports of sexual violence across three different blocks of time (Time 1: 2014-2015; Time 2: October 2017-September 2019; Time 3: October 2019-September 2021). Comparisons include prevalence rates of overall sexual violence, self-reports of sexual violence, official police reports of sexual violence, and situational characteristics of sexual violence (offender was a stranger, victim injury, victim services used). We also examine gender (women/men) and racial (White women/non-White women) differences in sexual violence reporting. Using formal comparisons, we find a significant increase in the rates of overall sexual violence as well as self-reports and stranger-offender reports of sexual violence between the pre- (Time 1) and the first post-#MeToo time point (Time 2). However, these increases are no longer evident in Time 3. In addition, the changes between the pre- (Time 1) and the first post-#MeToo time point (Time 2) are driven primarily by White women's reporting of sexual violence, and we find no significant changes in the rates of sexual violence experienced by men nor non-White women during these time periods., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Partnerships that effectively engage in certain key structural and process functions are more likely to meet their research goals and contribute to longer-term health equity outcomes. Ongoing evaluation of partnerships' level of achievement of these key functions, along with their fidelity to the guiding principles of community-based participatory research (CBPR), is therefore essential to understand how they can achieve desired partnership outcomes. This article describes the validated Measurement Approaches to Partnership Success (MAPS) Questionnaire and the use of an accompanying Facilitation Guide in helping members of CBPR partnerships evaluate their partnership's state of development and interpret findings to improve its structure, processes, and outcomes. We describe the conceptual framework guiding the development of the MAPS Questionnaire and its 81-item across seven key outcome dimensions, along with 28 items measuring precursor characteristics of CBPR partnership outcomes. The Facilitation Guide provides general guidelines for sharing, interpreting, and applying results within partnerships using a participatory process, definitions and items for each dimension, an example of presenting summary means, and dimension-specific reflective questions for discussion. We offer recommendations for practical uses of the MAPS Questionnaire and Facilitation Guide. Whether used as a comprehensive tool or by dimension, the MAPS Questionnaire is conceptually sound and empirically validated for evaluating how CBPR partnerships can achieve long-standing success. CBPR partnerships at any stage of development will find the MAPS Questionnaire and Facilitation Guide useful in measuring and interpreting indicators of partnership success, sharing results, and improving their ability to contribute to achieving health equity goals.

Objective: This research aimed to determine the stigma toward people with mental illness among mental health personnel and identify individual, professional, and contextual predictors., Methods: A descriptive, cross-sectional, and correlational design was used. The sample consisted of 218 mental health personnel working in Outpatient Psychiatric Units belonging to hospitals and Community Mental Health Centers in Chile. Stigma was evaluated using a scale of humanized treatment, a scale of social distance, and a scale of attitudes in health personnel. In addition, sociodemographic and professional information was collected from mental health personnel and contextual information, particularly the type of outpatient mental health center and the technical-administrative unit that groups all the health centers in a territory., Results: It was found that mental health personnel, in general terms, present low levels of stigma expressed in behaviors of comfort and support toward users, a desire for closeness and social interaction, and reduced stigmatizing beliefs and attitudes of infantilization toward individuals with MHPs. However, intimacy and trust were lower than expected.Only educational levels and health centers were related to stigma., Conclusions: The low levels of stigma may be due to the evolution of this phenomenon and the country's mental health policies., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Intranasal trigeminal function is important in detecting environmental stimuli. The impact of age-associated chemosensory dysfunction upon taste and olfaction is well described, but an understanding of trigeminal loss (chemesthesis) is lacking., Objective: The goal of this study was to characterize trigeminal function in a cohort of older adults and explore potential impacts., Methods: Twenty-eight participants over 50 years of age were recruited from the community as part of an aging cohort study. This nested cohort completed chemosensory questionnaires, patient-reported outcome measures (PROMs), and psychophysical testing for taste (taste strips), olfaction (Sniffin' Sticks), and trigeminal function (eucalyptol lateralization). Data were analyzed for associations between trigeminal function, olfactory, and taste psychophysical performance, patient-reported metrics, and demographic risk factors., Results: Patient-reported trigeminal impairment is less severe than other chemosensory loss, with mean visual analog scores (VAS, rated 0-100 from least to most severe) for smell (32.9 ± 34.2), taste (20.6 ± 28.4), and trigeminal sensation (9.5 ± 12.8). Despite low VAS scores, psychophysical trigeminal dysfunction was present in 10 (35.7%) subjects. Psychophysical olfactory and taste dysfunction were present in 16 (57.1%) and eight (28.6%) participants respectively. Hypercholesterolemia was associated with psychophysical trigeminal dysfunction (mean lateralization performance in hypercholesterolemia 57.7% ± 17.1 vs. 74.1% ± 10.4, p  = .008)., Conclusion: Intranasal trigeminal impairment is present in nearly one-third of aging adults when assessed by psychophysical methods but is under-recognized. Hyperlipidemia may be associated with trigeminal impairment. Future inquiries should better characterize these findings in larger and prospective cohorts., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: The launch of state certification for community health workers (CHWs) in Massachusetts in 2018 aimed to promote and champion this critical workforce. However, concerns exist about unintentional adverse effects of certification. Given this, we conducted 2 cross-sectional surveys to evaluate this certification policy., Methods: We conducted surveys of CHW employers and CHWs in 3 sample frames: community health centers and federally qualified health centers, acute-care hospitals, and community-based organizations. We administered the surveys in 2016 (before certification launch) and 2021 (after certification launch) to answer the following questions: Was certification associated with positive outcomes among CHWs after its launch? Did harmful shifts occur among the CHW workforce and employers after certification launch? Was certification associated with disparities among CHWs after its launch?, Results: Certification was associated with higher pay among certified (vs noncertified) CHWs, better perceptions of CHWs among certified (vs noncertified) CHWs, and better integration of certified (vs noncertified) CHWs into care teams. We found no adverse shifts in CHW workforce by sociodemographic variables or in CHW employer characteristics (most notably CHW employer hiring requirements) after certification launch. After certification launch, certified and uncertified CHWs had similar demographic and educational characteristics. However, certified CHWs more often worked in large, clinical organizations while uncertified CHWs most often worked in medium-sized community-based organizations., Conclusions: Our evaluation of Massachusetts CHW certification suggests that CHW certification was not associated with workforce disparities and was associated with positive outcomes. Our study fills a notable gap in the research literature and can guide CHW research agendas, certification efforts in Massachusetts and other states, and program efforts to champion this critical, grassroots workforce., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: A psychosocial problem faced by people with early-stage dementia (PwESD) is the perception of threats to personal dignity. Insights into its dynamics are important for understanding how it changes as dementia advances and to develop suitable interventions. However, longitudinal studies on this change in PwESD are lacking., Aims: To determine how perceptions of dignity and selected clinical and social factors change over 1 year in home-dwelling PwESD and the predictors associated with changes in perceptions of dignity over 1 year., Research Design and Methods: A longitudinal study was conducted. The sample included 258 home-dwelling Czech PwESD. Data were collected using the Patient Dignity Inventory (PDI-CZ), Mini-Mental State Examination, Bristol Activities of Daily Living Scale, Geriatric Depression Scale and items related to social involvement. Questionnaires were completed by the PwESD at baseline and after 1 year., Ethical Considerations: The study was approved by the ethics committee and informed consent was provided by the participants., Results: People with Early-Stage Dementia rated the threat to dignity as mild and the ratings did not change significantly after 1 year. Cognitive function, self-sufficiency, vision, and hearing worsened, and more PwESD lived with others rather than with a partner after 1 year. Worsened depression was the only predictor of change in perceived personal dignity after 1 year, both overall and in each of the PDI-CZ domains. Predictors of self-sufficiency and pain affected only some PDI-CZ domains., Conclusions: Perceptions of threat to dignity were mild in PwESD after 1 year, although worsened clinical factors represented a potential threat to dignity. Our findings lead us to hypothesise that perceived threats to personal dignity are not directly influenced by health condition, but rather by the social context., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: The COVID-19 pandemic demonstrated how vaccination decisions are influenced by misinformation, disinformation, and social pressures, leading to varied and inequitable uptake rates. In this study, we examined how COVID-19 vaccine messages received via social networks were associated with vaccine uptake in rural Alabama., Methods: From November 2021 through March 2022, we collected 700 responses to a telephone survey administered in 4 rural Alabama counties. We asked respondents to indicate whether certain social relationships (eg, family, businesses) tried to influence them to (1) obtain or (2) avoid a COVID-19 vaccine. We used χ 2 tests, Kruskal-Wallis tests, Mantel-Haenszel χ 2 tests, and Fisher exact tests to examine the associations between vaccination status and survey responses., Results: Respondents in majority-African American counties were significantly more likely than those in majority-White counties to have received ≥1 dose of COVID-19 vaccine (89.8% vs 72.3%; P  < .001). Respondents who received ≥1 dose had a significantly higher mean age than those who had not (58.0 vs 39.0 years; P  < .001). Respondents who were encouraged to get vaccinated by religious leaders were more likely to have received ≥1 dose ( P  = .001), and those who were encouraged to avoid vaccination by family ( P  = .007), friends ( P  = .02), coworkers ( P  = .003), and health care providers ( P  < .001) were less likely to have received ≥1 dose. Respondents with more interpersonal relationships that encouraged them to avoid vaccination were more likely to be unvaccinated ( P  < .001)., Conclusions: Interpersonal relationships and demographic characteristics appeared to be important in COVID-19 vaccine decision-making in rural Alabama. Further research needs to identify how to facilitate vaccine-positive interpersonal relationships, such as peer mentoring and trusted messenger interventions., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In the dynamic landscape of healthcare, nurses play a crucial role as ethical stewards, responsible for whistleblowing, nurse advocacy, and patient safety. Their duties involve ensuring patient well-being through ethical practices and advocacy initiatives., Aim: This study investigates the ethical responsibilities of nurses regarding whistleblowing and advocacy in reporting concerns about patient safety., Research Design: A cross-sectional study utilized cluster and simple random sampling to gather a representative sample of actively practicing registered nurses. Data collection involved a demographic form, Nurse Whistleblowing Intentions Scale, Nursing Advocacy Scale, and Clinical Decision-Making Scale., Participants and Research Context: The study utilizing a robust sample size determination formula for reliable findings included 96 diverse nurses, predominantly females. Engaged actively in direct patient care across various outpatients clinics. The recruitment process specifically sought individuals with expertise in safety protocols and reporting, contributing to a nuanced understanding of the study's focus., Ethical Considerations: Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. A thorough ethical review was conducted to guarantee participant protection and adherence to ethical principles., Results: Surveyed nurses demonstrated positive whistleblowing (Overall Mean Score: 3.58), high advocacy (Overall Mean Score: 12.2), and nuanced ethical decision-making for patient safety (Overall Mean Score: 15.78). Demographic factors, such as nationality and ethical training, significantly impacted whistleblowing intentions, while age, gender, and ethical training correlated with nursing advocacy behavior. Associations with experience and qualification emerged in ethical decision-making., Conclusion: The gained insights foster targeted interventions, improving ethical practices, advocacy, and informed decision-making in nursing. This study explores the intricate link between demographics and ethical considerations among surveyed nurses, acting as a catalyst for ongoing initiatives to strengthen the ethical foundation in healthcare sector., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study investigates factors related to the decision to (a) arrest or (b) mediate in domestic violence (DV) situations-nonmutually exclusive but highly differing decisions chosen a priori as being outcomes of interest. The sample included three types of professionals handling domestic violence cases in China: (a) Women's Federation (WF), (b) police, and (c) judicial personnel. The participants ( n  = 817) responded to a vignette describing a DV incident. Logistic regression revealed that legal, organizational, and attitudinal factors were associated with decision-making and varied by group. The findings suggest training and detailed instructions on handling DV., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Gender symmetry is a long-standing controversy in intimate partner violence (IPV) research. This study explored the gender directionality of IPV and differences in the quality of relationships between different dyadic patterns. IPV experiences and relationship quality of 371 heterosexual couples were examined. Results indicate that females reported more IPV perpetration than males. Generally, the male-only IPV and bidirectional IPV couples showed lower levels of relationship quality compared with female-only IPV and no-IPV couples. Future studies should realize that different dyadic types of IPV may have different mechanisms and consequences, and more attention should be paid to gender directionality., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.