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Introduction Consensual nonmonogamy (CNM) is a form of relationship practiced by many despite widespread stigma against it. In this study, we explore evidence of strong, persistent desire for CNM among some individuals, and look for commonalities among these individuals. Method Between February 2019 and June 2020, we conducted qualitative, semi-structured interviews with 51 US adults who had practiced CNM for between 3 and 50 years, recruited via community contacts and snowball method. Participants reported a broad diversity of sexual orientations and gender identities; 62.7% reported European/white ancestry. We conducted thematic analysis to examine evidence of strong, persistent desire for CNM and common characteristics and experiences among participants. Results We describe 7 sub-themes that suggest a strong desire for CNM, such as pursuing CNM early in life, experiencing difficulties in attempts at monogamy, and describing one’s desire for CNM as enduring or unchangeable. We then describe 9 characteristics and experiences that were common among participants, such as a preference for autonomy, not experiencing categorical distinctions among relationships, desiring to make life plans with multiple adults, and exposure to communities whose norms do not assume monogamy. Conclusions Our data indicate a pattern of desires, life choices, and self-perceptions suggesting that some individuals strongly desire and persistently pursue CNM (whereas others appear to be comfortable with both CNM and monogamy). Policy Implications Our results suggest that some individuals consistently desire and pursue CNM relationships, and therefore would benefit from efforts toward destigmatization and reduction of institutional disadvantage against the practice of CNM.

Background/objective Few studies have assessed the effect of lockdown on physical activity and eating behaviours in a population from the Autonomous Community of Andalusia in southern Spain. The aim of our study was to describe the effect of COVID-19 pandemic home lockdown on eating habits and lifestyle in the Andalusian population. Subjects/methods A cross-sectional observational study was carried out on a population from southern Spain, Andalusian population. An online questionnaire was shared through social networks and snowball sampling. A total of 1140 people filled in the questionnaire. The questionnaire consisted of 34 items classified into three sections: sociodemographic data, work and leisure activities and questions on food consumption. Each item offered pre- and post-lockdown information. Results The participants were classified into three age groups: 18-35, 36-65 and over 65. Statistically significant differences were found between the three groups, with the younger age group undergoing greater changes, increasing their physical activity and consumption of fresh food, and decreasing both their consumption of fast food at home and alcohol intake. Conclusions These findings suggest that, in the current social and health crisis, the citizens of southern Spain have become aware of the importance of maintaining an appropriate lifestyle to remain healthy, particularly the younger population with less well-consolidated habits.

This study aimed to evaluate the quality of life (QOL) of transgender (trans) people in Iran. In this cross-sectional study, participants were included in the study using the snowball sampling technique. Two hundred thirty-five transgender people from different provinces of Iran were identified and agreed to participate in the study. To measure the QOL of these individuals, we used the short form of the QOL SF-36 questionnaire, which was completed as self-administered. In this study, the highest and lowest mean scores of trans individuals’ QOL belong to the physical functioning (88.59 ± 13.81) and bodily pain (30.78 ± 25.68) domains, respectively. Moreover, the mean scores of mental health, emotional role, vitality, general health, and bodily pain domains were less than 50. Reassignment surgery, vocation, and age were significantly associated with quality of life score (P

This study examines the ways educators in the Kafr Qasim education system commemorated and coped with the 1956 massacre carried out by the Israeli Border Police that claimed the lives of civilians including women and children. It examines intergenerational relationships and the dynamic between the local and the Israeli education systems. The study provides qualitative data analysis based on 29 interviews with past and present educators. Snowball sampling was used to recruit participants, and open in-depth interviews were conducted. The study findings show intergenerational differences in attitudes and ways of coping of educators in Kafr Qasim. The first generation from the 1950s until the 1970s is distinguished by its passive fear and great concern about the issue. The second generation from the 1970s until the 1990s evinces an awakening, and awareness of what happened to those educators, prompting consciousness-raising education and keenness to act. The third generation active from the 1990s until today is defined by the institutionalization of the massacre story into extensive educational activism aimed at deepening roots, a sense of heritage, and national identity.

The development of rigorous, high-quality clinical guidelines increases the need for resources and skilled personnel within guideline-producing organizations. While collaboration between organizations provides a unique opportunity to pool resources and save time and effort, the collaboration presents its own unique challenges. To assess the perceived needs and current challenges of guideline producers worldwide related to guideline development and collaboration efforts. Survey questions were developed by the Guidelines International Network and the US GRADE Network, pilot-tested among attendees of a guideline development workshop, and disseminated electronically using convenience and snowball sampling methods. A total of 171 respondents representing 30 countries and more than 112 unique organizations were included in this analysis. The survey included free-response, multiple-choice, and seven-point Likert-scale questions. Questions assessed respondents’ perceived value of guidelines, resource availability and needs, guideline development processes, and collaboration efforts of their organization. Time required to develop high-quality systematic reviews and guidelines was the most relevant need (median=7; IQR=5.5–7). In-house resources to conduct literature searches (median=4; IQR=3–6) and the resources to develop rigorous guidelines rapidly (median=4; IQR=2–5) were perceived as the least available resources. Difficulties reconciling differences in guideline methodology (median=6; IQR=4–7) and the time required to establish collaborative agreements (median=6; IQR=5–6) were the most relevant barriers to collaboration between organizations. Results also indicated a general need for improvement in conflict of interest (COI) disclosure policies. The survey identified organizational challenges in supporting rigorous guideline development, including the time, resources, and personnel required. Connecting guideline developers to existing databases of high-quality systematic reviews and the use of freely available online platforms may facilitate guideline development. Guideline-producing organizations may also consider allocating resources to hiring or training personnel with expertise in systematic review methodologies or utilizing resources more effectively by establishing collaborations with other organizations.

BackgroundStructural racism mediates all aspects of Black life. The medicalization of pregnancy and childbirth, and its detrimental impacts on Black birth, is well documented. The Black Lives Matter movement has elevated the national consciousness on all aspects of Black life, but significant attention has been directed toward the murder and dehumanization of Black men and boys. Black midwives, caring for Black people, using the Midwives Model of Care© which consistently demonstrates its efficacy and better outcomes for Black people, are uniquely positioned to witness the physical and psychosocial experiences of birthing Black boys in America.MethodsBetween 2011 and 2013, the first author conducted interviews with 22 Black midwives to understand their perceptions of, and experiences in, predominantly white midwifery education programs and professional organizations. Convenience and snowball sampling were used. This paper investigates previously unreported and unexamined data from the original study by focusing on the witness and insight of nine midwives who provided care for Black mothers of boys during pregnancy and childbirth.FindingsThe data presented three themes: It’s a Boy: On Restlessness and Complicated Uneasiness; Desensitization of Black Death; and, Physiological Impacts of Toxic Stress.ConclusionsThe findings demonstrate that caring for Black people must be simultaneously theorized and executed within an anti-racist, relationship-centered, reproductive justice framework. Black midwives are uniquely positioned to do this work. Greater attention, in practice and in research, is needed to investigate the birth experiences of Black mothers of boys.

The outbreak of novel corona virus (COVID-19) pandemic possesses the potential to arise an unprecedented growth of mental health care needs among the general population. The present study aims to understand the knowledge of possible symptoms, stress and anxiety triggers and mental health care needs related to COVID-19 pandemic among the general population of India. A web-based cross-sectional survey was conducted across India. In order to conduct the survey, an online survey tool (semi-structured questionnaire) was prepared using google forms. Apart from having an informed consent, the survey tool comprised 42-item questions addressing the background characters of the participants and the pertinent issues related to the study. Snowball sampling technique was adopted in the study, and the questionnaire was sent to the contacts of the surveyors. All the participants were further requested to forward the tool in their respective contacts. A total 284 respondents were covered under the survey. More than 50% of participants reported having some professional loss in the current pandemic lockdown phase and 74% of the respondents reported having stress about their business or employment in the coming times. Majority (77%) of respondents agreed on the importance of professional mental help but 40% reported not likely to take professional help if they experience extreme stress and anxiety due to COVID-19. The educated people realise the significance of mental health care needs but majority of them decline to take a professional help even after realising the extreme anxiety. It is imperative for the government to amplify the awareness programmes addressing the mental health care needs and its importance during the COVID-19 pandemic.

Although the information-motivation-behavioral (IMB) skills model is a functional and well-known model for HIV/AIDS prevention, there are criticisms surrounding this model, including how the role of emotion in preventing high-risk behaviors has been neglected. The present study intends to investigate the prediction of psychological factors affecting HIV/AIDS prevention among people at high risk for HIV/AIDS by the modified IMB skills model in Iran. Two hundred sixty-nine individuals with high-risk sexual behaviors were selected by snowball sampling and completed the international HIV/AIDS questionnaire, the IMB questionnaire in high-risk sexual behaviors, and the emotion efficacy scale. The findings indicated that the predicted variance increased by 59% as emotion efficacy entered the suggested model, which improves the goodness-of-fit of the model with the data (χ2 = 175.50, RMSEA = 0.056, GFI = 0.99, AGFI = 0.97, CFI = 0.99, NFI = 0.97, TLI = 0.96, AIC = 89.43). The new modified model provides a stronger prediction of healthy behaviors and prevention of high-risk behaviors in the context of HIV/AIDS, which can inform HIV/AIDS-related health planning.

Depression accounts for a large share of the global disease burden, with an estimated 264 million people globally suffering from depression. Despite being one of the most common kinds of mental health (MH) disorders, much about depression remains unknown. There are limited data about depression, in terms of its occurrence, distribution, and wider social determinants. This work examined the use of novel data sources for assessing the scope and social determinants of depression, with a view to informing the reduction of the global burden of depression. This study focused on new and traditional sources of data on depression and its social determinants in two middle-income countries (LMICs), namely, Brazil and India. We identified data sources using a combination of a targeted PubMed search, Google search, expert consultations, and snowball sampling of the relevant literature published between October 2010 and September 2020. Our search focused on data sources on the following HEALTHY subset of determinants: healthcare (H), education (E), access to healthy choices (A), labor/employment (L), transportation (T), housing (H), and income (Y). Despite the emergence of a variety of data sources, their use in the study of depression and its HEALTHY determinants in India and Brazil are still limited. Survey-based data are still the most widely used source. In instances where new data sources are used, the most commonly used data sources include social media (twitter data in particular), geographic information systems/global positioning systems (GIS/GPS), mobile phone, and satellite imagery. Often, the new data sources are used in conjunction with traditional sources of data. In Brazil, the limited use of new data sources to study depression and its HEALTHY determinants may be linked to (a) the government’s outsized role in coordinating healthcare delivery and controlling the data system, thus limiting innovation that may be expected from the private sector; (b) the government routinely collecting data on depression and other MH disorders (and therefore, does not see the need for other data sources); and (c) insufficient prioritization of MH as a whole. In India, the limited use of new data sources to study depression and its HEALTHY determinants could be a function of (a) the lack of appropriate regulation and incentives to encourage data sharing by and within the private sector, (b) absence of purposeful data collection at subnational levels, and (c) inadequate prioritization of MH. There is a continuing gap in the collection and analysis of data on depression, possibly reflecting the limited priority accorded to mental health as a whole. The relatively limited use of data to inform our understanding of the HEALTHY determinants of depression suggests a substantial need for support of independent research using new data sources. Finally, there is a need to revisit the universal health coverage (UHC) frameworks, as these frameworks currently do not include depression and other mental health-related indicators so as to enable tracking of progress (or lack thereof) on such indicators. Supplementary Information The online version contains supplementary material available at 10.1007/s11524-021-00559-6.

South Africa is a patriarchal society where women are routinely disadvantaged and subjugated, and this disadvantage is compounded by the social inequities experienced by women with physical disabilities. Patriarchal and ablest societal representations and myths work to stigmatize the sexuality of women with physical disabilities, creating barriers to participating in mutually fulfilling and equitable sexual partnerships. A dearth of information on sexual health and sexual health services tailored to the needs of persons with disabilities also creates vulnerabilities for women with physical disabilities as they engage in romantic relationships. Women with physical disabilities are more vulnerable to abuse, including emotional abuse by intimate partners than women without disabilities. The aim of this study is to explore how acquiring a physical disability from a motor-vehicle accident impacts women’s romantic relationships and sense of their own sexuality, and how their altered embodiment intersects with experiences of emotional abuse and shaming societal norms. Women with acquired physical disabilities were recruited via snowball sampling and screened for eligibility, and 18 women met entrance criteria. All interview guides were translated into isiXhosa, the preferred language of participants, and trained interviewers conducted interviews. Data was analysed using thematic analysis. Women described ending romantic relationships and experiencing emotional abuse since acquiring a disability; the influence of societal norms and “culture” on romantic relationships; and the impact of disability on motherhood, and positive experiences in romantic relationships. Although some positive experiences were described, most of the findings point to the pressing need for sexual and reproductive health care services for women with physical disabilities. These services need to inform, protect, and support women through the process of reclaiming their sexual identities, and assist in the prevention of abuse.

Understanding the internal diversity of transgender communities is essential for developing optimal, inclusive policies and service provision. To date, research on this topic remains scarce in Chile. We conducted a survey study describing sociodemographic characteristics (age, sex assigned at birth, onset age, nationality, education, sex work, having a partner, having children, sexual orientation, religiousness, gender identification, and gender affirmation pathways). A snowball sample of 377 self-identified transgender adults living in Chile (Mage = 31.88, rangeage = 18–67) was collected for the purpose of this study. According to their sex assigned at birth, 139 participants were female and 238 male. Results revealed that sex assigned at birth was significantly associated with almost all the sociodemographic variables. Eight gender self-identification categories were obtained based on self-declaration. These gender identification categories varied according to sex assigned at birth. Finally, four patterns (clusters) of gender affirmative actions were identified among participants. These patterns indicated that the longer the gender affirmation pathway time, the greater the invasiveness level of the medical procedures used. Sex assigned at birth moderated the association between gender affirmation pathways and gender identity categories. Results were discussed highlighting the heterogeneity found in terms of sociodemographic characteristics, gender identification, and gender affirmation pathways.

This paper explores the influence of innovation approaches on innovation performance and firm performance among Indian biotechnology firms. Further, it aims to discuss the interceding role of innovation performance between innovation practices and firm performance. A criteria-based snowball sampling method was adopted for data collection. The collection of data was carried out using a web survey from 200 biotechnology firms located across India. The data is analysed using a covariance-based structural equation modelling (SEM) technique. The results indicate that the adoption of innovation practices positively influences the firms’ innovation and overall performance. Furthermore, the results confirm the mediating role of innovation performance between innovation approach adoption and firm performance. Firms, particularly from the biotechnology industry, can use these results to assess their performance and formulate or modify their strategy to improve their innovation and overall performance.

Emotional divorce is the individual emotional closure of the conjugality cycle. This study aimed to identify common and distinct aspects of the individual emotional divorce process from the different positions held by individuals in decision-making for separation/legal divorce. It is a qualitative research, with narrative approach and cross-sectional data. Twelve men and twelve women, regardless of sexual orientation, divorced or not from their first marriage, participated in the study. The Snowball sampling technique was used. Data collection was performed through semi-structured interviews. Sociodemographic questionnaire and interview scripts were used. Data analysis was performed through thematic analysis. Four positions held by participants in the decision-making for separation/legal divorce were chosen: initiators, non-initiators, spokesperson initiators, and active non-initiators. From the four positions, the similarities and differences in the process of emotional divorce in relation to the feelings commonly experienced by those who experience divorce were listed: fear, relief, sadness, anger, hope and personal growth, coping strategies, and the resumption of love life. Significant similarities were found in the process of elaborating emotional divorce between initiators and active non-initiators and between non-initiators and spokesperson initiators.

Gay and bisexual men who have sex with men (GBM) carry a disproportionate HIV infection burden, approximating 66% of all new HIV infections in 2017. GBM’s social networks may influence health and health risk perceptions, including HIV risk. One such social network is the bear subculture, which accounts for approximately 14–22% of the gay community. Previous research on GBM who identify as bears indicated that these men are more likely to engage in sexual practices such as condomless anal sex (CAS). The purpose of this study was to describe the sexual decision-making process among GBM who identify as bears. Utilizing a grounded theory approach, 25 in-depth semi-structured interviews were conducted with men who identify as bears, ranging in age from 22 to 77 years. Participants were recruited using purposive and snowball sampling. A theory grounded in the data entitled The Theory of Making Sexual Decisions Among Men Who Identify as Bears emerged that described how these men may make sexual decisions. The theory is constructed of one core category, “Making Sexual Decisions,” and four categories with subcategories: “Interacting with the Bear Subculture,” “Searching for Sexual Partners,” “Engaging in Sexual Activities,” and “Reflecting on Consequences.” Clinicians caring for this population should be aware of the complex nature of sexual decisions, potentially allowing for HIV risk reduction strategies for GBM who identify as bears. As HIV infection continues to disproportionately impact GBM, health policy campaigns may develop initiatives that include men who identify as bears.

Due to coronavirus disease 2019 (COVID-19) nursing practice is facing enormous challenges. Nevertheless, nursing science was hardly actively represented as a mouthpiece for the practice in the public discussions on the COVID-19 pandemic. Therefore, the question arises which projects with a focus on nursing and COVID-19 have been carried out at Austrian universities. Overall, six projects were identified using the snowball method. Of the studies one showed that an increased wearing time of masks is associated with an increased stress level for nursing personnel. An additional study result showed that almost 50% of lay people used masks incorrectly. Individual experiences, interventions undertaken and solution approaches from the perspective of the nursing staff with respect to ethical challenges in nursing homes were collected in a further project. This and other projects show that nursing science, with its knowledge and as a voice for nursing practice, has taken the initiative and contributes to the COVID-19 discourse. Additionally, the findings of the projects can be used as a basis for making future political decisions.

Filipino American women experience breast cancer disparities including being diagnosed with breast cancer at a younger age and at a later stage. More Filipino women have breast cancer tumors that are ER-negative or overexpress Her2-neu. These disparities could be effectively minimized with screening mammograms. This study aims to determine factors that influence mammogram adherence in Filipino American women using Andersen’s Behavioral Health Model of Services for Vulnerable Populations as the conceptual framework. Logistic regression models determined the influence of predisposing, enabling and need variables with mammogram adherence. Among all variables—breast cancer literacy, mammogram reminder, sociocultural deterrents, cultural beliefs, and years of residence in the United States—only a mammogram reminder from a healthcare provider was significantly associated with mammogram adherence. Convenience and snowballing sampling generated a group of women who were highly-educated Filipinas limiting the generalizability of the study’s findings.

Background Peripheral intravenous catheters (PIVC) are commonly used in hospital worldwide. However, PIVC are not exempt from complications. Catheter-related bloodstream infections (CRBSI) increase morbidity and mortality rates, and costs for the healthcare organization. PIVC care is shaped by the complex mix of professional and organizational culture, such as knowledge gaps, low perception of impact of PIVCs on patient safety, or lack of hospital guidelines. Aim To explore determinants of decision-making about the prevention of PIVC-BSI among nurses in Spanish hospitals. Methods We conducted a descriptive qualitative study with semi-structured interviews in three public hospitals, the Balearic Islands Health Care Service in Spain. We considered hospital ward nurses working routinely with inpatients at any of the three hospitals for enrolment in the study. We approached relevant informants to identify suitable participants who recruited other participants through a ‘snowball’ technique. Fourteen inpatient nurses from the hospital took part in this study between September and November 2018. We employed several triangulation strategies to underpin the methodological rigour of our analysis and conducted the member checking, showing the information and codes applied in the recording of the interviews to identify the coherence and any discrepancies of the discourse by participants. We used the COREQ checklist for this study. Findings We identified four major themes in the analysis related to determinants of care: The fog of decision-making in PIVC; The taskification of PIVC care; PIVC care is accepted to be suboptimal, yet irrelevant; and chasms between perceived determinants of poor PIVC care and its solutions. Conclusion The clinical management of PIVCs appear ambiguous, unclear, and fragmented, with no clear professional responsibility and no nurse leadership, causing a gap in preventing infections. Furthermore, the perception of low risk on PIVC care impact can cause a relevant lack of adherence to the best evidence and patient safety. Implementing facilitation strategies could improve the fidelity of the best available evidence regarding PIVC care and raise awareness among nurses of impact that excellence of care.

Background The flare-up of Covid-19 in India caused open turmoil and pressure on emotional wellbeing among university students. At first, it was about course finishing; later, the issues moved to assessment. This scourge increases mental issues, stress, dissatisfaction, sorrow, and nervousness. Aim The aim of this study was to assess the mental health and behaviour of Mizoram University students during the Covid-19 lockdown period. Methods This study was a cross-sectional investigation, and a snowball method sampling technique was utilised for obtainging information from the students. Results There were 65.2% of students who revealed that they were giving more consideration to their emotional wellbeing during this pandemic. More than half of the participants (67.2%) reported no expanded worry of stress from scholastic work, and 65.2% reported that they were paying more attention to their emotional wellbeing and mental health following the pandemic. Further, 69.7% reported that they were spending more time exercising. Nearly 55% of students took part in Zoom classes, with a length of 35 to 40 min. About 65.7% of students gained proficiency in their course by means of a learning management system. Students performed activities at home during the lockdown period, watching TV (75.4%), reading books (38.7%), and on writing assignments (34.8%); and 34.5% of the students viewed news from TV, newspapers, and social media about the Covid-19 pandemic each day. Conclusion The positive effects on psychological wellbeing may have helped the students adapt to other negative effects and expanded pressure on emotional wellbeing. This pandemic impact will probably be engraved on every individual surveyed.

Uterine contractions monitoring is essential during pregnancy progression for due date prediction and the screening of preterm deliveries, i.e., those related to labour contractions occurring before 37 weeks of gestation. As there are different kinds of uterine contraction, distinguishing between true labour ones and normal physiological ones during pregnancy is not trivial. Thus, early identification is necessary for the effective and efficient care of pregnant women to avoid unnecessary and costly hospitalization. In this regard, while classical clinical methods proved their limitations, real-time monitoring of uterine contractions is now possible thanks to a new technique called ElectroHysteroGraphy which measures the uterine electrical activity that is a proxy for the mechanical activity of the muscles of the uterus. An exhaustive and comprehensive literature review was conducted to retrieve and report the state-of-the-art of the methods to distinguish labour contractions from pregnancy contractions. A systematic search was run on different search engines using a search string. A snowball sampling approach was applied to the references of the retrieved articles to identify further appropriate papers. According to this, the relevant references included in the bibliography of each analysed article led to other appropriate articles. Thus, papers dealing with the methods to distinguish labour from pregnancy (normal physiological) contractions and published between 2001 and 2020 were selected. Linear and nonlinear methods have been developed for uterine contractions signals (EHG/EMG) analysis to distinguish labour from pregnancy contractions. Nonlinear methods yielded better results compared to the linear methods, but not all nonlinear methods are promising in terms of clinical application.

Opioid use disorder among women of childbearing age has reached epidemic proportions. In rural regions of the United States, recruiting perinatal women who use nonmedical opioids to participate in research is wrought with challenges, including barriers such as community stigma, lack of transportation, and time constraints. The current study describes our process and challenges of recruiting pregnant and postpartum women in rural Indiana consisting of women who misuse opioids and those who do not. We employed multiple strategies to recruit participants. Methods included (1) sampling from healthcare facilities based on referrals from front-desk staff and frontline healthcare workers; (2) dissemination of flyers and brochures within healthcare facilities and the community, supported with onsite research assistant presence; (3) digital methods coupled with snowball sampling; and (4) local community talks that provided information about the study. Our multiple recruitment efforts revealed that building relationships with community stakeholders was key in recruiting women who use nonmedical opioids, but that digital methods were more effective in recruiting a larger sample of pregnant and postpartum women in a short amount of time. We conclude by making several recommendations to enhance academic-community partnerships in order to bolster sample sizes for prolonged research studies. Furthermore, we highlight the need to destigmatize addiction in order to better serve hard-to-reach populations through research and practice.

The unexpected emergence of a novel and dangerous virus widely known as coronavirus (COVID-19) has brought in global health crisis and has socioeconomically disrupted the lives of people to a significant extent. In order to curb the spread of the contagious infection, nationwide lockdown and sometimes shutdown is announced by the state which has adversely affected the lives of many members of transgender community who are solely dependent on social interactions for their livelihood such as begging in streets and trains, entertaining in marriage functions and baby showers, engaging in prostitution. Consequently, the lost livelihood, clogged income stream, exhausted savings, burden of debt have imbued psychological distress among them. This study has analyzed the association of social distancing and lockdown constraints to psychological outcomes (i.e., depression, anxiety issues, financial stress, lack of social support, and loneliness) among transgender people amid COVID-19. Transgender participants (N = 150, mean age = 42.5) were selected through snowball sampling from India who responded to the questionnaire through both online platform and offline modes. Findings show that there is positive association between any two of the variables and the degree of association is quite reasonable with the range from 0.534 to 0.945. Further, in order to evaluate the hypothesis a series of regression analysis is conducted. Results highlight the negative impact of social distancing and lockdown constraints on psychology of transgender individuals.

Study design: This is a qualitative, phenomenological study. Objective: To investigate media portrayal of spinal cord injury (SCI) as perceived by people with SCI and explore its impact on their lived experience. Setting: People with SCI living in Australia. Method: Twenty-four participants, recruited using purposive and snowball sampling, completed in-depth, semi-structured interviews. Thematic data analysis followed an inductive, iterative process. Results: Participants perceived media portrayed SCI through a narrow lens, describing how people with SCI were ‘absent’ or portrayed as either ‘pity or pedestal’. Participants said media portrayed an inaccurate picture of their lived experience that perpetuated misunderstandings of SCI. This portrayal fostered unreasonable public expectations and assumptions about living with SCI, which presented in the participant’s lives as uncomfortable interactions and inappropriate remarks. The impact for participants was a burden to explain SCI and justify what it meant for them. People with SCI would like media to portray a broader, more authentic representation of SCI to improve public understanding and to reduce the negative impact on their lives. Conclusion: People with SCI perceived a narrow and inaccurate portrayal of SCI in media that overlooked potential quality of life, overshadowed health and life domains they considered important and reinforced the idea that SCI can be overcome. People with SCI were mostly concerned with what was absent in media portrayal of SCI rather than what was present. Action for change lies in promoting information, expanding narratives and raising awareness to diverse abilities of people with SCI.

BACKGROUND: Patient-perpetrated sexual harassment adversely affects healthcare organizations, staff, and other patients, yet few institutions have clear policies to address it. Understanding the challenges to addressing patient-perpetrated harassment can inform development of institutional guidelines and interventions. OBJECTIVE: To identify challenges and stakeholder-driven recommendations for addressing patient-perpetrated sexual harassment of women staff and patients at Veterans Health Administration (VA) facilities. DESIGN: We conducted qualitative interviews with 24 staff, clinicians, and administrators across four VA healthcare facilities. PARTICIPANTS: We used snowball sampling to identify stakeholders with expertise in overseeing care environments, providing care to women patients, and/or managing disruptive patient behavior. APPROACH: We interviewed participants in-person or via phone using a semi-structured guide. Two members of the research team analyzed the interview data using the constant comparative method. KEY RESULTS: Participants identified challenges to addressing patient-perpetrated harassment of women staff and patients that were interrelated and spanned multiple levels. Perceived organizational-level challenges included a climate of tolerance for harassment, lack of formal policies, and insufficient leadership support. At the staff level, perceived challenges included ambiguity around defining harassment, fear of negatively impacting patient-staff dynamics, and competing priorities. Finally, participants identified patient-level challenges, including patient characteristics such as age, cognitive impairment, and psychiatric diagnoses that complicated assessments of intentionality and culpability. Participant recommendations focused on development and implementation of policies, reporting systems, public norms campaigns, staff and patient education, and bystander intervention training. CONCLUSIONS: VA offers unique opportunities for studying patient-perpetrated harassment of women staff and patients due to its majority-male patient population, culture informed by military gender norms, and commitment to reducing harassment at its facilities. Our findings highlight the complexity of addressing patient-perpetrated harassment and underscore the need for systemic, multilevel interventions.

As institutions are key pillars of groundwater resource management (GRM) it is important to determine the institutional constraints to GRM. This study used qualitative research methods to identify such constraints in western Iran. The participants were 37 key informants involved in GRM in Khorramabad county, including experts, representatives of relevant authorities, and members of local institutions. Snowball sampling was used to select the sample. Participants underwent in-depth individual interviews that were documented and transcribed for qualitative analysis. Open coding revealed 260 codes and 54 subcategories relevant to institutional constraints to GRM, which were further classified using axial coding. Using selective coding, a storyline was created, detailing the relationships among several of the categories, subcategories, and concepts. The results showed that the main phenomenon is “institutional structural and functional weakness”. Some conditions are contextual and allow the phenomenon to occur and some conditions have affected it. Regarding the contextual conditions, some cultural elements act as barriers to GRM. The inability of institutions involved in GRM to deal with unauthorized actors because of legal weakness (in both formulation and enforcement) also affects the phenomenon. In addition, weak organizational management due to centralized planning and complex bureaucracy affect the phenomenon. This research on causal conditions also indicates that groundwater exploitation in the form of drilling unauthorized wells and engaging in unplanned and unauthorized extraction is the most important cause of the phenomenon. The most important strategy of the institutions to overcome the phenomenon is to implement water engineering and control measures.

PURPOSE: On-The-Go (OTG) references are those that clinicians make within a tight deadline at the point of patient care to direct critical decisions. We conducted this study to assess the knowledge level of orthopaedicians on clinical usefulness and quality appraisal of different reference methods along with their attitude towards its utility for practice. MATERIALS AND METHODS: A web-based survey was administered through Google Forms among the members of the Tamil Nadu Orthopaedic Association (TNOA) by snowball sampling method. The survey was designed by the Quality Appraisal Committee (QAC) of Orthopaedic Research Group (ORG) with 17 items. Association and correlation analysis were done between different responses in the survey to find out ways to improve the reference practices. RESULTS: 177 participants with a mean age of 43.5 years completed the survey. About 45.8% (n = 81) of participants had prior knowledge on the Oxford Levels of Evidence. However, they were not familiar with using them for critical appraisal of evidence. About 86.5% (n = 153) of participants were worried about the quality of the content they seek for reference. Among the reference sources, online research articles were used by 54.2% (n = 96), digital applications by 21.4% (n = 38), digital textbooks by 15.2% (n = 27), and other methods like peer discussion by 5.1% (n = 9). A significant association was noted between the participants who chose level I studies for their reference and their familiarity with the concept of fragility (p = 0.006) and heterogenicity (p = 0.021) and types of bias (p = 0.003). A significant association was noted between participants with active journal subscription and their familiarity with the concept of spin (p = 0.016) and their knowledge of the heterogeneity of study results (p = 0.019). We found a significant association between age (

Moving from the role of resident into that of a young attending is one of the most anticipated transitions in a medical trainee's career path. Radiation oncology residency training is typically apprentice-style focused in the outpatient setting, which carries additional unique challenges. Twenty-seven junior attendings at academic institutions within their first 5 years of practice were sent an online open-ended questionnaire in 2018 regarding aspects of their practice using a snowball sampling method. Responses were collected, and a thematic analysis was conducted in which two independent reviewers coded the responses. Nineteen junior attendings (70%) from 18 institutions completed the questionnaire. General themes included the importance of cultivating relationships for peer support and to be professional and polite as confidence was gained to enable them to be seen as an attending. All respondents felt that bringing an open mind, balance, and adaptability was crucial in their transition. Respondents stayed up to date on literature and practices by subscribing to journals, courses, and participation in resident education. Forty-two percent of young attendings were matched with a mentor at their new institution through a formal mentor-mentee relationship. Respondents wished that they had more autonomy during residency to prepare for independent practice. Transitioning from residency to a junior attending provides unique stressors and challenges. Allowing for residents to have more autonomy during their training, such as a senior resident clinic, may help improve this transition by providing an opportunity for independent decision-making with guidance as appropriate.

Drug abuse, the driver of human self-destruction, is rapidly increasing among university students and is emerging as a global health concern. Students who abuse drugs are lagging in respect of academic performance, achievement, and other co-curricular activities. This study aims to investigate the differences in academic performance between drug abusers and non-abusers, and the factors associated with drug abuse among university students in Bangladesh. The study was a cross-sectional survey among the students of five public and semi-public universities in Bangladesh. The sample size was drawn by using the snowball sampling technique. Face-to-face interviews were used to collect data, and the data were analyzed using SPSS 25.0. Of the 436 participants, 54.59% (n = 238) were drug abusers. Male students (68.43%) were found to be significantly (p

Objectives The current study was designed to investigate the relationship between positive religious coping, perceived stress, and depressive symptoms among Palestinian adults in response to the emergence of coronavirus (COVID-19), and the quarantine system implemented in the city of Tulkarem, Palestine. Methods A correlational study was conducted to examine the relationship between study variables. Participants were 400 Palestinian adults, involving 172 males and 228 females, living in the city of Tulkarem, Palestine, during the spread of coronavirus. Participants were selected using convenience and snowball sampling techniques. Results Pearson’s correlation coefficient was used to test the relationship between positive religious coping, depressive symptoms, and perceived stress. Findings revealed a statistically significant negative correlation between positive religious coping and depressive symptoms (r = − .17, p

Globally, sickle cell disease (SCD) is a common, yet often neglected, non-communicable disease. Community health worker (CHW) interventions have been shown to improve outcomes for chronic diseases but have not been evaluated with SCD. This study assessed the interest in and feasibility of establishing a network of CHWs to support care of people with SCD in Kumasi, Ghana. Using in-depth interviews with key stakeholders (N = 15) identified through purposive and snowball sampling from January to March 2020, we gathered focused information about interest in and feasibility of establishing a network of CHWs. Respondents were chosen for their knowledge and oversight of health services for people with SCD. Latent content analysis was used to examine the data. Participants expressed interest in establishing a network of CHWs to better support care for people with SCD. Three primary themes emerged from the data: (1) support by CHWs could be beneficial for people with SCD; (2) using existing CHW networks for SCD services would be best; and (3) funding of expanded CHW network might be a problem. We advocate for the mobilization of resources to expand the current network of CHWs to include a focus on SCD in Kumasi, Ghana. Participants believe that it is feasible to use CHWs to improve care outcomes of people with SCD. There is potential for findings from this exploratory project to be adapted and implemented in other settings throughout sub-Saharan Africa, as well as areas of higher income countries where there are higher proportions of people living with sickle cell.

This study estimated the prevalence, genotype distribution, and the factors associated with oral human papillomavirus (HPV) in people who use crack-cocaine (PWUCC) in a remote Brazilian region. This cross-sectional study used community-based snowball sampling methods for participant recruitment. Socio-demographic, economic, drug use, and health-related information was collected from 278 PWUCC in the cities of Braganca and Capanema in northern Brazil. HPV diagnosis and genotyping were performed by a real-time polymerase chain reaction. Logistic regression identified the factors independently associated with oral HPV. In total, 111 (39.9%) PWUCC had HPV DNA. Several genotypes were identified, some of them with high oncogenic potential. Crack-cocaine use ≥40 months, unprotected sex, more than 10 sexual partners in the last 12 months, oral sex, exchange of sex for money or illicit drugs, oral mucosa lesions, not having access to public health services, and the absence of vaccination against HPV was all associated with HPV DNA. This study identified important epidemiological characteristics of oral HPV infection among PWUCC—a highly marginalized risk population—underlining the high prevalence of oral HPV with oncogenic potential and the urgent need for control and prevention measures, especially vaccination against this virus. It is necessary to understand the prevalence and risk factors of oral HPV in risk populations as people who use crack-cocaine.

To examine the pathways from pre-migration sexual violence to suicide-related risk via the lack of important social networks among North Korean refugee women living in South Korea. As part of a larger study, cross-sectional social network data from 273 North Korean refugee women aged 19 or older (M = 41 years; range = 19–69) were collected by self-reported surveys from April to May 2014 in South Korea. Snowball sampling was used for participant recruitment. We analyzed whether lack of network diversity and lack of kin ties mediated the association between pre-migration sexual violence and suicide-related risk in two multivariable mediation analyses. The prevalence of past-year suicide-related risk was 34.4% in our study sample, and 31.1% of the participants reported at least one type of pre-migration sexual violence. Pre-migration sexual violence was associated with increased suicide-related risk. Lack of network diversity (b = 0.03, 95% CI 0.01–0.07) and lack of kin ties (b = 0.03, 95% CI 0.01–0.08) partially mediated this association. Assessment of pre-migration sexual violence victimization needs to begin at an early stage of resettlement. Study findings highlight the urgent need to create suicide prevention programs that incorporate social network interventions, especially for North Korean refugee women who have experienced sexual violence during migration.

There is an increasing interest in product recovery, closed-loop supply chains, and reverse logistics (RL) for mitigating environmental impairment. Although RL is becoming a mandatory policy in developed countries, it is still in an embryonic stage in some industrial sectors of emerging economies. The purpose of this study is twofold: (1) identify the critical factors to the successful implementation of RL in the Brazilian pharmaceutical care process (PCP) and (2) determine the cause-and-effect relationships among them. We use snowball sampling to select the relevant RL studies and deductive reasoning and classification to identify the critical factors and a grey decision-making trial and evaluation laboratory (DEMATEL) to evaluate the cause-and-effect relationships among them. The study revealed management, collaboration, information technology, infrastructure, policy, financial and economic, end-of-life management practices, and logistic performance factors as the most relevant factors to the successful implementation of RL in the Brazilian PCP. The end-of-life management practices were identified as the most critical factor, and information technology was identified as the least critical factor. We further determined the end-of-life management practices and policy have the strongest casual relationship. The municipal PCP coordinators can use the findings of this study to formulate mitigating strategies to identify and eliminate barriers to the successful implementation of RL in the Brazilian PCP.

This project explores lay victims’ conceptions of environmental crime and environmental injustice through in-depth interviews with a snowball sample of people affected by, and former employees of, the Chem-Dyne Superfund site in Hamilton, Ohio, USA. Qualitative content analysis revealed that participants used the following criteria to define both environmental crime and environmental injustice: illegality, intentionality, harm and safety, and unfairness. These findings have important implications for studies of environmental crime and environmental injustice: (1) Lay victims’ conceptions of environmental crime and environmental injustice are multidimensional concepts; (2) lay victims’ conceptions of environmental crime and environmental injustice are mostly anthropocentric; (3) there is significant conceptual overlap between environmental crime and environmental injustice in lay victim accounts; and (4) lay victims’ conceptions of environmental crime and environmental injustice are similar to, yet distinct from, formal and academic definitions.

Study design Qualitative descriptive study with inductive thematic content analysis. Objectives To explore how individuals living with paraplegia in South Africa experience sex and intimacy and how they perceive the related health services and support they received whilst adapting to life post injury. Setting Community based in Cape Town, South Africa. Methods Purposive and snowball sampling were combined to enrol ten individuals with paraplegia who were all users of the public health system and had been injured for more than 1 year. Semi-structured interviews were conducted, and data analysed using inductive thematic content analysis. Results Four categories were derived and captured by the overarching theme of 'a journey to reclaiming sexuality', as depicted by each participant. Psychological consequences of the injury led to challenges with sex and intimacy including a strong emphasis on partner satisfaction. A perceived lack of support mechanisms particularly in relation to poor timing of health services and insufficient peer support led to a lack of understanding and difficulties adjusting to changes in sexual function. Meaningful relationships including elements of sex and/or intimacy were rediscovered following a re-adjustment period although participants often felt disabled by society as socio-cultural norms, such as gender concepts, influenced each individual journey. Conclusions Complex interactions between intrinsic psychological factors, such as low sexual self-esteem and external factors such as socio-cultural norms, affect sex and intimacy in individuals with paraplegia in this novel context. South Africa's health system should be strengthened to support optimal sexual outcomes of persons with a spinal cord injury.

University students are at high risk of exhibiting problematic Internet use as they tend to spend a lot of time online. The present study aimed to test the hypothesis that procrastination would mediate the relationship between flow and problematic Internet use in a sample of 178 Greek University students, 67% of whom were females using a snowball sampling technique. Results revealed that flow was positively related to problematic Internet use (r = 0.36). In addition, mediation analysis revealed that academic procrastination mediates the relationship between flow and problematic Internet use. Findings suggest the more pleasurable is the Internet activity, the more the students tend to procrastinate towards meeting their academic obligations, and this is related to long hours of Internet use. Findings enrich previous literature on problematic Internet use and could potentially inform policies aiming to protect students’ health and well-being.

Energy theft is among the dominant problems confronting the Nigerian electricity sector. Therefore, this study examined the factors underlying the perpetration of this illegal act among electricity consumers in Lagos and Ibadan metropolis, Nigeria. Rational choice perspective and situational crime prevention perspective were employed as theoretical guide. Data were generated using in-depth interview and key-informant interview methods. Snowball sampling was utilised for the selection of 59 electricity consumers engaging in energy theft, while nine officials of two electricity distribution companies were purposively chosen. Findings indicated that electricity tapping was the most common form of energy theft. Most of the electricity consumers engaging in energy theft considered it a rational response to the ineptitude and inefficiency of electricity distribution companies.

Human papillomavirus (HPV) vaccine offers protection of between 80 and 100% for anogenital warts and 60–80% in reducing the incidence of pre-malignant lesions from cervical cancer. However, uptake remains low in Nigeria among adolescent girls. This study was a qualitative study that assessed mothers’ acceptability and concerns regarding uptake of HPV vaccine by their adolescent daughters. In-depth interviews were conducted with 20 mothers of adolescents girls aged 9–15 years. A snowballing sampling technique was adopted to select the mothers within the community. Consent was obtained for the use of audiotapes, which were transcribed verbatim with thematic analysis of data. Mothers were between the ages of 30–49 years and most of them were traders. Almost all of the women have heard about cervical cancer, but their knowledge about cervical cancer and HPV vaccine was low. Despite their low knowledge, most of the mothers accepted that the vaccine is good and was willing for their adolescent daughters to take the HPV vaccine for the prevention of HPV. However, cost of the vaccine, side effects, and potential exposure of their daughters to promiscuity after taking the vaccine for protection were the major concerns expressed by the mothers as regards to HPV vaccine uptake by their daughters. Findings highlight the need for health promotion and education programs about cervical cancer, HPV, and HPV vaccine to increase awareness and knowledge among mothers of adolescent girls. Also, HPV vaccination should be included as part of routine immunization for female adolescents.

This qualitative research aims to explore the life stories of the itinerant elderly in shelter homes and vagrancy by the series of semi-structured interviews with fourteen folks in Kuala Lumpur, Malaysia. The data was collected using the snowball sampling and analyzed by using interpretative phenomenological analysis that managed to categorize the data into various themes and subthemes. Results showed that although there are variations in the living patterns and living environment at the care homes and public places, the destitute elderly’s mental condition matched to a great extent because they were in the same phase of life. The study recommends the establishment of temporary residences for elderly living in the streets to improve their health, hygiene, security, and shelter facility along with the provision of some form of privacy in sheltered institutions and panopticon instead of being left homeless to respect their dignity and independence.

The COVID-19 pandemic has become a major public health challenge globally with countries of the world adopting unprecedented infection prevention and control (IPC) measures to urgently curtail the spread of the COVID-19 virus. The knowledge, attitudes and practices (KAP) of the people toward COVID-19 is critical to understanding the epidemiological dynamics of the disease and the effectiveness, compliance and success of IPC measures adopted in a country. This study sought to determine the levels of KAP toward COVID-19 among residents of north-central Nigeria. A cross-sectional online survey with a semi-structured questionnaire using a Snowball sampling technique was conducted during the national lockdown. Data collected were analyzed using descriptive statistics, analysis of variance (ANOVA), Pearson's correlation and regression tests. From a total of 589 responses received, 80.6, 59.6, 90.4 and 56.2% were from respondents between ages 18-39 years, males, had a college (Bachelor) degree or above and reside in urban areas respectively. Respondents had good knowledge (99.5%) of COVID-19, gained mainly through the internet/social media (55.7%) and Television (27.5%). The majority of the respondents (79.5%) had positive attitudes toward the adherence of government IPC measures with 92.7, 96.4 and 82.3% practicing social distancing/self-isolation, improved personal hygiene and using face mask respectively. However, 52.1% of the respondents perceived that the government is not doing enough to curtail COVID-19 in Nigeria. Pearson's correlation showed significant relationship between knowledge of COVID-19 and attitude towards preventive measures (r = 0.177, p = 0.004, r = 0.137, p = 0.001). Although 61.8% of the respondents have no confidence in the present intervention by Chinese doctors, only 29.0% would accept COVID-19 vaccines when available. This study recorded good knowledge and attitudes among participants, however, community-based health campaigns are necessary to hold optimistic attitudes and practice appropriate intervention measures devoid of misconceptions.

In this study, we examined the self-perception of aging of young-old adults living in Turkey’s Central Anatolia Region within the scope of aging anxiety and future time perspective dimensions. This research is a descriptive study and in this study, phenomenology, a qualitative research method, was employed. The study group was selected by snowball and purposeful sampling methods. Participants were identified through the elderly relatives of the author/authors (snowball sampling). At the same time, purposeful sampling was used to ensure that the participants were in the 65–74 age range. The study group was composed of a total of 37 old individuals aged between 65 and 74 years living in Turkey. The interview instrument was a semi-structured questionnaire and included both open and close ended questions. The interviews conducted within the framework of the ‘personal information form’ and ‘semi-structured interview form’ administered to the participants and the data obtained by transcribing these interviews into written text were analysed by theoretical thematic analysis method by the researchers. The findings showed that aging anxiety, future time perspective and loneliness represent different sub-dimensions of self-perception of aging. The results of this study showed that the self-perceptions of aging of 65–74-year-old young-old adults living in Central Anatolia Region in Turkey are negative, and that these perceptions differ according to living arrangements but do not differ according to gender.

IntroductionEmergency medicine (EM) is a high-risk specialty for burnout. COVID-19 has had and will continue to have important consequences on wellness and burnout for EM physicians in Canada. Baseline data are crucial to monitor the health of EM physicians in Canada, and evaluate any interventions designed to help during and after COVID-19.ObjectivesTo describe the rates of burnout, depression, and suicidality in practicing EM physicians in Canada, just before the COVID-19 pandemic.MethodsA modified snowball method was used for survey distribution. Participants completed the Maslach Burnout Inventory – Health Services Tool (MBI-HSS), a screening measure for depression (PHQ-9), and a question regarding if the physician had ever or in the past 12 months contemplated suicide.ResultsA total of 384 respondent surveys were included in the final analysis: 86.1% (329/382) met at least one of the criteria for burnout, 58% (217/374) scored minimal to none on the PHQ-9 screening tool for depression, 14.3% (53/371) had contemplated suicide during their staff career in EM, and of those, 5.9% (22/371) had actively considered suicide in the past year.ConclusionCanadian EM physicians just before the COVID-19 pandemic had an alarming number of respondents meet the threshold for burnout, confirming EM as a high-risk specialty. This important baseline information can be used to monitor the physical and mental risks to EM physicians during and after COVID-19, and evaluate support for mental health and wellness, which is urgently needed now and post pandemic.

This paper introduces the use of co-nomination as a method to map research fields by directly accessing their knowledge networks organised around exchange relationships of intellectual influence. Co-nomination is a reputation-based approach combining snowball sampling and social network analysis. It compliments established bibliometric mapping methods by addressing some of their typical shortcomings in specific instances. Here we test co-nomination by mapping one such instance: the idiosyncratic field of CERN-based heavy flavour physics (HFP). HFP is a 'hyper-authorship' field where papers conventionally list thousands of authors alphabetically, masking individual intellectual contributions. We also undertook an illustrative author co-citation analysis (ACA) mapping of 2310 HFP articles published 2013-18 and identified using a simple keyword query. Both maps were presented to two HFP scientists for commentary upon structure and validity. Our results suggest co-nomination allows us to access individual-level intellectual influence and discern the experimental and theoretical HFP branches. Co-nomination is powerful in uncovering current and emerging research specialisms in HFP that might remain opaque to other methods. ACA, however, better captures HFP's historical and intellectual foundations. We conclude by discussing possible future uses of co-nomination in science policy and research evaluation arrangements.

The present study contributes elements to the literature for the understanding of those institutional factors of organizations that promote the creation of spin-offs in universities. Institutional barriers to spin-off creation within universities are addressed from a qualitative perspective. The study was carried out in Colombia, a country with low levels of innovation and entrepreneurship. Purposive and snowball sampling were employed to identify experts. Participants were selected in accordance with their extensive experience in entrepreneurship, innovation, or technology transfer. The sample size was decided by saturation criteria, and 15 interviews were selected with this method. The semi-structured interview was chosen for information collection, and a thematic analysis was employed for data interpretation. Several aspects which permit suggestions for the future spin-off research agenda were identified: perceptions of the university, teaching focus, academic cultures that reward publication as a means of knowledge transfer, restrictions for public university spin-offs in developing countries, few economic and non-economic incentives for entrepreneurship, trust as a determining cultural characteristic, and limitations to the understanding of the spin-off concept that affect their creation. These results may be extrapolated to Latin America and other developing regions with similar entrepreneurial ecosystems.

Term ‘Gender’ is very challenging and burdened with variety of meaning when it comes to its socialization though social norms in India. Even though the gender difference is an unsolicited issue in Indian society, its effect is very much reflected in Indian culture from office to home and lane to metros. Another major esteemed obsession due to gender shows that effect is life satisfaction, self-esteem, and mental health of adults. The major objective of this investigation was to scrutinize gender differences on self-esteem, life satisfaction, and mental health of male, female, and transgender of mainly studied in Rajasthan and Haryana state (India). This study is sampled differently in the process of Snowball sampling from 240 adults (80 males, 80 females, and 80 transgender) ranged in age 31–45 years. While collecting data, different collection observations like Cooper-Smith self-esteem inventory, life satisfaction scale, and general health questionnaire were used. In this study, only two measures of general health questionnaire namely anxiety/insomnia and severe depression were used in data analysis. This data is statistically analyzed with Chi-square test distribution and analyzed widely with ANOVA table and most importantly F test proceeding. Again, graphical representations showing 3D simulation among gender, F value and df value from F test and Chi-square test are thoroughly investigated. The findings revealed that self-esteem significantly positively correlated with life satisfaction; anxiety symptoms and severe depression significantly negatively correlated with both the self-esteem and life satisfaction. The main purpose behind using F test impotently revealed that gender balance is how it varies with self-esteem, life satisfaction, anxiety/insomnia, and severe depression. Overall, it shows an amazing result that reveals how males are significantly better on life satisfaction though females in case of mental health and self-esteem than transgender.

Participation of racial/ethnic minority and immigrant populations in research studies is essential to understand and address health disparities. Nonetheless, these populations are often underrepresented in research because of limited participation that may be due to barriers to participation such as fear and mistrust of research, lack of or limited access to healthcare and social services, time and employment constraints, participation-associated costs (e.g., travel costs), language barriers, undocumented status, and cultural differences. Brazilians comprise a rapidly growing immigrant population group in the United States (US), and there is a need to identify and understand factors affecting the health status of Brazilian immigrants that are amenable to intervention. Therefore, this paper presents effective strategies and lessons learned from outreach and recruiting Brazilian immigrants living in the US to enroll in maternal and child health research studies. Using a data recruitment log, we collected quantitative and qualitative data on recruitment strategies that were employed to recruit pregnant women and parents into six health research studies. Direct recruitment strategies included personal contacts of research staff and recruiting partners, and on-site, in-person outreach and recruitment at faith- and community-based events (e.g., meeting participants after church services, at faith-based community events), and private and social events (e.g., household parties) conducted by bilingual, bicultural research assistants who were members of the priority population. We also used snowball sampling as a recruitment strategy by asking enrolled participants to share information about our studies and encourage their family and friends to participate. Indirect recruitment methods included posting flyers at local businesses, social service agencies, faith-based and healthcare organizations, and posting announcements on social media (Facebook). Direct recruitment methods in combination with snowball sampling were the most successful strategies for recruiting Brazilian immigrant parents, while social media was an effective indirect method for recruiting first-time pregnant women. In addition, analyses of qualitative data found that research staff’s understanding of the sociocultural context of the target population combined with the use of linguistically and culturally sensitive recruitment strategies tailored to meet the needs of Brazilian immigrants was important for overcoming barriers to participation and facilitating successful recruitment and enrollment of participants. Study findings provide information on a suite of effective strategies and lessons learned for reaching, recruiting, and enrolling Brazilian immigrants in maternal and child health research. Future studies should continue to purposefully collect information on recruitment strategies and disseminate the findings, which will be instrumental in researchers’ efforts to increase participation of ethnic minority and immigrant populations such as Brazilians in health research.

Research on underutilized crops in Sri Lanka is limited. This study, conducted in Uva and Eastern provinces of southeastern Sri Lanka, is aimed at identifying common underutilized crops in the dominant agricultural farms, estimating their contribution to household income and food security, and understanding key actors’ (leaders of farmers’ associations, collectors/middlemen, and traders/wholesalers) knowledge of and preference for underutilized crops. Participatory rural appraisal methods were followed and snowball sampling was used for 88 semi-structured interviews with farmers who cultivate underutilized crops on their farms. In addition, 36 key actors were interviewed to explore their knowledge of and preference for potential underutilized crops. Thirty farming plots were visited to identify the composition of underutilized crops. Three mixed cropping agricultural farms—home gardens (mean area, 0.80 ha), chena (shifting cultivation, 0.82 ha), and off-season paddy lands (1.16 ha)—were observed. We identified 37 underutilized crops of which finger millet (60% of households) was most common, followed by cowpea (50%), cassava (41%), sweet melon (36%), and cashew nut (24%). Key actors prioritized four crops, namely finger millet (Eleusine coracana [L.] Gaertn.), cashew (Anacardium occidentale L.), cowpea (Vigna unguiculata L. Walp.), and mung bean/green gram (Vigna radiata L. R.Wilczek), as high potential underutilized crops. The contribution of underutilized crops to household income and food security in Uva and Eastern province was 31% and 16%, and 61% and 43%, respectively. An integrated approach can be undertaken in order to promote and sustain underutilized crops in the region for agro-biodiversity conservation and benefiting farmers.

This paper utilizes family leisure photographs to examine New Zealand society’s changing representations of fatherhood. Photographs are a useful lens for addressing such issues, as they can be interpreted as ways of understanding human life. They document sociological aspects of lives that we are unable to see easily from other sources. Over 100 years of family leisure photographs (a combination of archival family photograph albums and more recent albums sourced privately through advertising and snowball sampling) were analysed using visual qualitative thematic analysis. For analysis, a structured chronological approach was adopted to make the findings easy to follow and show the changing representations of fatherhood discourses over time. The findings show that family leisure photographs reflect a shift away from father as an invisible breadwinner in the early twentieth century, to participating in leisure consumption with the family in the post-war years, to visible and involved during the women’s liberation movement of the 1960s and 1970s, to the position of playmate-teacher in more recent decades.

Caregivers of youth with emotional and behavioral challenges can experience isolation, stigma, and a lack of resources as well as parental stress and caregiver strain. Few studies have qualitatively explored caregivers’ perceptions of raising girls with emotional and behavioral challenges. A team of researchers explored three research questions: (1) How do caregivers of girls with emotional and behavioral challenges perceive their experiences with their daughters at home and in school? (2) What do caregivers perceive to be the most helpful at home or school for their daughters, and (3) What are the constructs of parent coping among caregivers of girls with emotional and behavioral challenges? Researchers used a snowball sampling method to recruit and then conduct semi-structured interviews with 16 caregivers from urban, suburban, and rural areas. Results indicated that caregivers perceived their daughters’ behaviors to be complex, that schools failed to identify girls for services and used reactive rather than proactive services, and that therapy and medication were helpful to the daughters and families. Additionally, caregivers reported coping through focusing on outside activities and through the support of family and friends. Themes from this study were congruent with findings in caregiver strain literature. Caregivers also discussed managing the negative reactions of others and wanting to feel understood.

One of the contemporary management techniques aimed at eliminating unnecessary cost and waste while optimizing full benefit of projects, especially in the building and construction sector, is value engineering. This study assesses the implementation of value engineering in the Ghanaian construction sector. The study adopted cross-sectional survey with stakeholders consisting of architects, contractors, project managers, civil and structural engineers, and consultants of construction and consulting firms. Snowball sampling technique was used through its nucleus to reach construction firms and respondents who practice value engineering but are difficult to trace. Questionnaire was used to collect data using a five-point Likert scale. Quality control and renewal of old ideas emerged as the meaning of value engineering regarding construction professionals’ understanding of the concept. The factors that encourage values engineering implementation identified by the respondents include: reduced wastage of resources, quality improvements, reduced conflict and risks, efficient labour, creation of a climate of shared understanding, definition of programme objectives, early improvement, understanding of the needs and function, savings that can be redirected to add value, improved communication between the parties, and local material usage. Five main components identified as responsible for non-adoption of value engineering include: knowledge barrier, demand barrier, awareness barrier, readiness barrier, and human resource barrier. The study therefore concludes that value engineering stands feasible for implementation in the Ghanaian construction sector if the identified factors to the non-adoption are eliminated while adopting appropriate strategies to promote the factors that encourage its implementation.

Objective Describe the two-phase validation process for a taxonomy of skills learned through mindfulness practice. Methods Phase I (development) utilized 11 subject matter experts (SMEs) over 5 months. Phase II (judgment) enrolled 60 international SMEs from 116 invited through snowball sampling. They were mostly white (80%) or Asian (15%) women (70%) with longstanding personal mindfulness practices (M = 20 years; SD = 9.6) and extensive mindfulness teaching experience (M = 11 years; SD = 6.7); 59% > 50 years; 88% had graduate degrees. SMEs rated relevance and clarity to calculate Individual Content Validity Indices (I-CVIs) for each category per tier and average CVIs (ave-CVIs) for entire tiers. Participation rate was 52% and 42 SMEs rated secondary tiers. Results I-CVIs ranged from 0.57 to 0.97, suggesting the removal of one category from the primary tier, leaving an ave-CVI for relevance of 0.92 (range 0.73–0.97). Clarity ratings for the primary tier (ave-CVI = 0.75; range of I-CVI = 0.52–0.88) necessitated exploration of the subcategories of Awareness (second tier; N = 42) to refine description (ave-CVI = 0.80 for clarity; range 0.64–0.93) while showing excellent content validity for both relevance and fit (ave-CVI = 0.95; range 0.88–1.0 for both). Conclusions The eMindful Mindfulness Classification Construct™ (eMCC™) is a validated, atheoretical taxonomy of skills learned through mindfulness practice, created to support development of more precise mindfulness-based interventions (MBIs) that target skill deficits associated with clinical conditions. Further research will validate subcategories, associate specific practices per category, and assess MBIs designed to target specific skills from the eMCC™.