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Alcohol control strategies vary between countries and reflect differences in drinking cultures. This study explored how perceived effectiveness of alcohol control strategies varies according to individual characteristics and country of residence. A cross-sectional online survey was completed by 1910 university students in Denmark, England, Germany, Italy, Portugal, and Switzerland. It assessed the perceived effectiveness of 11 alcohol control strategies. Correlates included sensation-seeking, alcohol outcome expectancies, drink refusal self-efficacy, and Alcohol Use Disorders Identification Test (AUDIT) scores. Bivariate analysis using mixed-measures MANOVA and Pearson correlations were followed by linear regression to identify multivariate correlates. These analyses revealed that educational strategies (e.g. teaching people skills to resist peer pressure) were considered more effective than restrictive strategies (e.g. raising the legal drinking age). Perceived effectiveness was greater among women and lighter drinkers. Country of residence also explained unique variance. The findings highlight the need to consider the potential impact of drinking culture in alcohol-related harm-reduction strategies. [ABSTRACT FROM AUTHOR]

In recent decades, women's use of contraception has evolved. Women not only utilize contraceptives to prevent pregnancy, but also to manage menstruation and other factors related to their personal agency. Despite an abundance of available contraceptive options, many women struggle to navigate and address their contraceptive needs. A hundred and thirty-four female participants responded to an open-ended questionnaire about contraceptive messages and decision making in an online survey. Using Uncertainty Management Theory as a framework, we illustrate how the women make sense of and manage uncertainty from multiple contraceptive messages. Results highlighted the absence of desired information, and identified messages that women wish they had received from healthcare providers and others. Our findings suggest that women's understanding of contraceptives' side effects is a communicative process in which anecdotal evidence is often treated as medical fact and healthcare providers are viewed as ineffective and dismissive in relaying and addressing information about contraception. In the absence of satisfying healthcare interactions, women seek information elsewhere to make their contraceptive choices. [ABSTRACT FROM AUTHOR]

Emergency care at a primary health care (PHC) level must be strengthened to reduce overall mortality and morbidity in any country. Developing recommendations for improvement in this area should take into consideration the context and nuances of the current emergency care system and primary health care context. Contribution to policy from the experts in the cross-cutting fields of PHC and emergency care is lacking. This study aims to evaluate the strengths and weaknesses of emergency care in primary health settings and develop consensus-based recommendations for the strengthening of emergency care at this level. Using a modified Delphi technique, data were collected from various data sources to evaluate the strengths and weaknesses of emergency care at PHC level, from which recommendation statements were developed. These recommendations were proposed to a panel of experts using a Delphi survey to build consensus on 14 recommendations to strengthen emergency care at PHC level. Ten experts were recruited to participate (n = 10) with a response rate of 90% in round II and 80% in round III of Delphi. Recommendations broadly addressed the areas of education and training in emergency care, the role and placement of various actors, leadership in emergency care and the development of a national plan for emergency care. Consensus was reached in round II for 97.61% of the statements and after modification based on open-ended comments, 98.21% consensus was reached in round III. Strengthening emergency care at primary and subsequent levels of health care requires a coordinated effort and mandate from authority in order to effect real change. [ABSTRACT FROM AUTHOR]

This study evaluated the fidelity of competence committee (CC) implementation in Canadian postgraduate specialist training programs during the transition to competency-based medical education (CBME). A national survey of CC chairs was distributed to all CBME training programs in November 2019. Survey questions were derived from guiding documents published by the Royal College of Physicians and Surgeons of Canada reflecting intended processes and design. Response rate was 39% (113/293) with representation from all eligible disciplines. Committee size ranged from 3 to 20 members, 42% of programs included external members, and 20% included a resident representative. Most programs (72%) reported that a primary review and synthesis of resident assessment data occurs prior to the meeting, with some data reviewed collectively during meetings. When determining entrustable professional activity (EPA) achievement, most programs followed the national specialty guidelines closely with some exceptions (53%). Documented concerns about professionalism, EPA narrative comments, and EPA entrustment scores were most highly weighted when determining resident progress decisions. Heterogeneity in CC implementation likely reflects local adaptations, but may also explain some of the variable challenges faced by programs during the transition to CBME. Our results offer educational leaders important fidelity data that can help inform the larger evaluation and transformation of CBME. [ABSTRACT FROM AUTHOR]

The Royal College of Physicians and Surgeons of Canada (RCPSC) recently redesigned the Canadian neurosurgery residency training curriculum by implementing a competency-based model of training known as Competence by Design (CBD) centered around the assessment of Entrustable Professional Activities (EPAs). This sequential explanatory mixed-methods study evaluated potential benefits and pitfalls of CBD in Canadian neurosurgery residency education. Two four-month interval surveys were distributed to all Canadian neurosurgery residents participating in CBD. The surveys assessed important educational components: CBD knowledge of key stakeholders, potential system barriers, and educational/psychological impacts on residents. Paired t-tests were done to assess changes over time. Based on longitudinal survey responses, semi-structured interviews were conducted to investigate in-depth residents' experience with CBD in neurosurgery. The qualitative analysis followed an explanatory approach, and a thematic analysis was performed. Surveys had 82% average response rate (n = 25). Over time, most residents self-reported that they retrospectively understood concepts around CBD intentions (p = 0.02). Perceived benefits included faculty evaluations with more feedback that was clearer and more objective (53% and 51%). Pitfalls included the amount of time needed to navigate through EPAs (90%) and residents forgetting to initiate EPA forms (71%). There was no significant change over time. During interviews, five key themes were found. Potential solutions identified by residents to enhance their experience included learning analytics data availability, mobile app refinement, and dedicated time to integrate EPAs in the workflow. This study was the first to assess resident-perceived benefits and pitfalls of the neurosurgery CBD training program in an educational framework context. In general, residents believed that theoretical principles behind CBD were valuable, but that technological ability and having enough time to request EPA assessments were significant barriers to success. Long-term studies are required to determine the definitive outcomes of CBD on residents' performance and ultimately, on patient care. [ABSTRACT FROM AUTHOR]

This paper aimed to explore the differences in subjective experiences of intoxication depending on drinking location and drink type. Methods: Data came from 32,194 respondents to The Global Drug Survey (GDS) 2015, an annual, cross-sectional, online survey. Respondents selected their usual drinking location (home alone: home with partner/family: house parties: pubs/bars or clubs) and usual drink (wine; beer/cider/lager; spirits or alcopops/coolers). They indicated how many drinks they required to reach three stages of intoxication (feeling the effects; an ideal stage of intoxication; and the tipping point) and how frequently they reached each stage. Results: Drink type affected grams of alcohol reported to reach the tipping point: 109 gm wine, 127 gm alcopops, 133 gm of beer, and 134 gm of spirts. Respondents who drank at home alone, or in clubs reached their tipping point more frequently compared to other locations. Conclusions: Where people drink, and the type of alcohol they drink, affected the amount of alcohol reported to reach different stages of intoxication. Understanding why different drinking locations, and drink types lead to a need for greater consumption to reach an ideal state of drunkenness, such as social cues from other people who drink, may enable people to reduce their drinking. [ABSTRACT FROM AUTHOR]

Objectives: Government guidelines aim to promote sensible alcohol consumption but such advice is disconnected from people's lived experiences. This research investigated how people construct personal thresholds of 'too much' alcohol. Design and measures: One hundred fifty drinkers completed an online survey (Mage = 23.29(5.51); 64.7% female). Participants were asked whether they had an intuitive sense of what constitutes too much alcohol. They wrote open-ended descriptions of how that threshold had been established and how it felt to approach/exceed it. These qualitative accounts were coded using thematic analysis and interpreted with an experiential theoretical framework. Results: Personal thresholds were based on previously experienced embodied states rather than guidelines, or health concerns. Describing the approach to their threshold, 75% of participants fell into two distinct groups. Group 1's approach was an entirely negative embodied experience (nausea/anxiety) and Group 2's approach was an entirely positive, embodied experience (relaxed/pleasurable). These groups differed significantly in awareness of alcohol's effects, agency and self-perceptions, but not on alcohol consumption. Exceeding their threshold was an entirely negative embodied experience for all. Conclusion: These findings illustrate that people are guided by experientially grounded conceptions of consumption. Interventions could target different groups of drinker according to their embodied experience during the approach to 'too much' alcohol. [ABSTRACT FROM AUTHOR]

Existing research suggests that repeated bullying victimization is associated with lower levels of educational attainment. However, it is difficult to ascertain whether a true causal association exists since previously reported associations may be confounded by genetic and shared environmental factors that affect both repeated bullying victimization and overall educational attainment. The present study aimed to address this issue by analyzing a sample of sibling pairs from the National Longitudinal Survey of Youth 1997 to examine between-family associations (where observable confounds are controlled for) and within-family associations (where observable and unobserved genetic and shared environmental confounds are controlled for). The results revealed that bullying victimization significantly reduced the odds of high school and college graduation when estimating between-family effects, but were rendered nonsignificant once within-family effects were controlled for. Implications of these results for future research on bullying victimization and educational attainment are discussed. [ABSTRACT FROM AUTHOR]

Background: As medical marijuana legislation becomes more common, concerns arise about the overconcentration of dispensaries, raising questions about the number of medicinal marijuana dispensaries (MMD) needed to serve medicinal users. Objectives: This paper applies niche-marketing theory-which suggests dispensaries market to specific types of people-to examine if MMDsmight be targeting recreational users. Observed differences between dispensary populations and between dispensary clients and local residentsmay indicate that dispensaries are drawing in patients based on factors other than medical need. Methods: Data were collected via exit surveys with patients at four dispensaries in Long Beach, CA. A total of 132 patients were surveyed regarding demographic data, purchase information, medical condition, and nearest cross street for their home address. Census tract information was collected for every dispensary. Results: Chi-squared tests show significant associations between dispensary visited and race (χ2 = 31.219, p < 0.001) and significant associations between medical condition and dispensary visited (χ2 = 22.123, p < 0.05). Lastly, we found that all four of the dispensaries had patients who were different from community residents in some characteristics. Conclusions: There were significant differences relating to race,medical condition, and distance traveled across dispensaries. Results suggest dispensary users do not necessarily reside in the same area in which dispensaries are located and do not necessarily reflect the local population. Taken together these results provide some support for market segmentation. [ABSTRACT FROM AUTHOR]

Introduction:Script concordance testing (SCT) is a method of assessment of clinical reasoning. We developed a new type of SCT case design, the evolving SCT (E-SCT), whereby the patient’s clinical story is “evolving” and with thoughtful integration of new information at each stage, decisions related to clinical decision-making become increasingly clear. Objectives:We aimed to: (1) determine whether an E-SCT could differentiate clinical reasoning ability among junior residents (JR), senior residents (SR), and pediatricians, (2) evaluate the reliability of an E-SCT, and (3) obtain qualitative feedback from participants to help inform the potential acceptability of the E-SCT. Methods:A 12-case E-SCT, embedded within a 24-case pediatric SCT (PaedSCT), was administered to 91 pediatric residents (JR:n = 50; SR:n = 41). A total of 21 pediatricians served on the panel of experts (POE). A one-way analysis of variance (ANOVA) was conducted across the levels of experience. Participants’ feedback on the E-SCT was obtained with a post-test survey and analyzed using two methods: percentage preference and thematic analysis. Results:Statistical differences existed across levels of training:F = 19.31 (df = 2);p < 0.001. The POE scored higher than SR (mean difference = 10.34;p < 0.001) and JR (mean difference = 16.00;p < 0.001). SR scored higher than JR (mean difference = 5.66;p < 0.001). Reliability (Cronbach’sα) was 0.83. Participants found the E-SCT engaging, easy to follow and true to the daily clinical decision-making process. Conclusions:The E-SCT demonstrated very good reliability and was effective in distinguishing clinical reasoning ability across three levels of experience. Participants found the E-SCT engaging and representative of real-life clinical reasoning and decision-making processes. We suggest that further refinement and utilization of the evolving style case will enhance SCT as a robust, engaging, and relevant method for the assessment of clinical reasoning. [ABSTRACT FROM PUBLISHER]

Objective:The project aimed to test of the quality and acceptability of researcher-developed Short Message Service (SMS) messages designed to support fathers of infants aged 12 months or less.Background:The findings of previous studies suggest antenatal and postnatal depression among fathers’ impacts negatively on the health of family members.Method:Draft messages were first modified based on expert review. In a second phase, parents (mothersn = 56; fathersn = 46; unknownn = 4) were recruited through two early childhood parenting services to rate the clarity, usefulness and relevance of the 70 SMS messages using a paper-based survey. In a third phase, 15 fathers were recruited to receive texts at different times over three weeks.Results:Findings suggest that SMS items were easily understood by the majority of parents, with only 3% of responses indicating an item was ‘not easily understood’. Feedback from parents indicated that negatively rated SMS messages were considered as either poorly phrased, lacking enough information or as not offering sufficient support. The majority (88%) of the SMS items were also rated as ‘useful’ by the parents.Conclusion:Fathers’ responses indicated that receiving the texts at different times was acceptable and that message content was relevant to their fathering. The study has produced a set of brief text messages suitable and acceptable to new fathers and their partners. [ABSTRACT FROM PUBLISHER]

The article focuses on a study regarding factors that associated with family medicine residency match rates and extent to which such factors differ across medical school settings. It mentions a report by American Academy of Family Physicians related to family medicine with graduate placement rates. It also mentions the association of educational opportunities with higher match rates in family medicine.

This article reports on an exploratory study regarding the memorable message narratives that students attending a U.S. southern historically Black college and university (HBCU) shared as most influential in their current sexual practices. A larger national research project was conducted to generate formative data regarding HBCU student's knowledge of human papillomavirus (HPV), their comfort levels discussing sexuality, and the social, sexual, and memorable messages that guide their behaviors, practices, and beliefs regarding sexuality. From this larger data set, the authors focused on 114 narratives provided by participants. Using thematic analysis, this article delineates source-based themes of memorable messages that provide insight into how current sexual beliefs, attitudes, and practices are informed by a variety of socializing agents. Implications for future research, theorizing, and practice are discussed. [ABSTRACT FROM PUBLISHER]

We investigated the effects of physical, psychological, and sexual violence on the health status of women attending antenatal clinics at two tertiary hospitals in rural Thailand. We asked 421 pregnant women at 32 weeks gestation or later to complete a survey questionnaire. Participants reported high rates of psychological abuse (53.7%); threats, acts of physical abuse, or both (26.6%); and sexual violence (19.2%). Women abused during pregnancy had poorer health compared with nonabused women, in role emotional functioning, vitality, bodily pain, mental health, and social functioning. Given the high prevalence of violence and poor health status, routine screenings by maternity services is urgently required. [ABSTRACT FROM PUBLISHER]