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Purpose: Antarctic expeditions are exceptional physiological challenges. Sleep plays a critical role in athletic performance, recovery, and wellness, with sleep disturbances having a negative impact on health and performance. Methods: The authors investigated sleep, fatigue, and recovery profiles of the longest solo unsupported one-way polar ski journey across Antarctica. A 33-year-old woman covered 1484.53 km from Hercules Inlet to the South Pole, finishing at the Ross Ice Shelf, in 70 days and 16 hours. Questionnaires on sleep (Pittsburgh Insomnia Rating Scale and Karolinska Sleepiness Scale), fatigue (Subjective Assessment of Fatigue), recovery (Total Quality Recovery), and wellness were completed at different time points (before, during, and after the expedition). Results: Average daily sleep time was between 4 and 5 hours, increasing to 7 hours for the final part of the expedition. Satisfaction of sleep and lack of energy deteriorated as the expedition progressed, alongside signs of clinical insomnia. Fatigue and muscle soreness increased with increasing milage, with extreme levels and very poor recovery toward the end of the expedition. Despite this, the adventurer continued to perform on extremely high levels. Postexpedition scores returned to baseline, demonstrating the incredible adaptation and ability to recovery. The postexpedition interview showed that prior experience of an Antarctic expedition may have prepared the athlete and made her more resilient for this challenge. Conclusions: The data provide unique insights into Antarctic expeditions and may help us understand the limits of human performance when planning future expeditions of this nature. Female athletes are capable of extreme challenges, breaking established performance boundaries. [ABSTRACT FROM AUTHOR]

Background/Objectives: Randomized controlled trials that deliver physical activity interventions have demonstrated benefits for older adults across numerous health outcomes. However, too little attention has been directed to ensuring that such trials are measuring patient-relevant outcomes. To support outcome selection for future trials, the objective of this study was to understand what outcomes related to their physical activity participation older adults find important. Methods: We conducted 12 semistructured interviews with adults aged 65 years and older and analyzed interview transcripts with a reflexive thematic analysis. Results: Older adults desired diverse outcomes from their physical activity participation, ranging from generic (e.g., quality of life) to specific (e.g., leg strength). Relevant outcomes were classified under five themes: physical, clinical, social, psychological, and overarching, each with respective subthemes. Conclusions: The outcomes that older adults found important were plentiful and rooted in a desire to improve their quality of life. Some of the outcome themes have been reported frequently in past trials (e.g., physical), but others have not (e.g., social). Future researchers should be aware of, and responsive to, the priorities of older adults when designing trials and defining outcomes. Significance/Implications: This study will help to improve outcome selection for future trials of physical activity with older adults. In alignment with a patient-oriented research philosophy, this study will also ground future outcome selection in the priorities of older adults. [ABSTRACT FROM AUTHOR]

Physical activity improves the well-being of persons living with dementia but few exercise programs include them. The Dementia-Inclusive Choices for Exercise (DICE) toolkit aims to improve exercise providers' understanding of dementia and ability to support persons living with dementia in physical activity. We evaluated the co-designed DICE toolkit with exercise providers using a mixed-methods approach comprising pre/post questionnaires and interviews and reflection diaries. Among 16 participants, self-efficacy for exercise delivery to persons living with dementia and both knowledge and attitudes toward dementia significantly improved. Thematic analysis suggested participants (a) had a deeper understanding of the variability of dementia, (b) were planning for equitable access for persons living with dementia, (c) planned to promote social connection through exercise, and (d) were optimistic for future engagement with persons living with dementia. The DICE toolkit may improve exercise providers' knowledge and confidence to plan proactively to support persons living with dementia in programs and services. [ABSTRACT FROM AUTHOR]

Technology in libraries has played an essential role in serving today's communities. This study provides an overview of the integrated library systems/software (ILSs) used in libraries in South Sulawesi, Indonesia. It aims to highlight the strengths and possibilities of ILSs and briefly explain their advantages and disadvantages along with the cost of implementation. The data was gathered from questionnaires sent via an online survey and from direct interviews with certain academic libraries over the period of 2019 to 2020. Fifty-three of 67 libraries that fulfilled the study have implemented an ILS. To deeply understand the application, a direct interview with some libraries was conducted to learn the advantages and disadvantages. The result of the study showed that the most used ILSs are SLiMS and INLISlite and other programs like Apollo, Athenium Light, Simpus, Spektra, Jibas, KOHA, and Openlibrary. The budget spent is an average of300 USD. While the ILSs have helped these libraries improve services, IT expertise and adequate resources are needed, especially when the systems present problems. An easy-to-use system that costs less will potentially be used in this area of research. This study will be particularly helpful for any library in Indonesia. These findings may also be generalized to libraries in other countries facing economic and technological similarities. [ABSTRACT FROM AUTHOR]

Although research identifies analytical and storytelling skills as the two broad human capital inputs required to perform people analytics, further research is required to better understand how People Analysts that is, the enactors of people analytics, perceive the impact of these skills on their performance. Accordingly, this study draws on the human capital resource (HCR) and HCR complementarity frameworks to investigate the individual and collective impact of analytical and storytelling skills on People Analysts perceived job performance. A mixed‐method sequential explanatory research design is adopted, finding mixed results. Consistent with existing research, results from Phase 1 find People Analysts perceive storytelling skills to be positively associated with their job performance. However, contrary to existing claims, the findings reveal that analytical skills are only perceived to be significant in influencing People Analysts job performance when combined with storytelling skills, supporting a complementarity HCR relationship. To further explain the findings from Phase 1, Phase 2 involved collecting data from 50 people analytics professionals via semi‐structured interviews. Results from the thematic analysis reinforce the survey findings while also illustrating that People Analysts perceive the complementarity relationship between analytical and storytelling skills as important for improving job performance. Accordingly, we argue that debate in this area should be reframed to acknowledge the necessity of complementarities in building people analytics capabilities. [ABSTRACT FROM AUTHOR]

Most people with intellectual disabilities have comorbid health conditions, which will impact optimization of sporting performance. Classification is used in Paralympic events to ensure that those with similar levels of functional ability compete fairly against each other. An evidence-based approach needs to be developed for athletes with intellectual disabilities to be classified in relation to their overall functional capacity into competition groups of similar ability. This research builds on previous work using the taxonomy of The International Classification of Functioning, Disability and Health (ICF) to group athletes with intellectual disabilities into comparable competition groups as an approach to Paralympic classification. Three groups of athletes—Virtus, Special Olympics, and Down syndrome—are compared using the ICF questionnaire indicating functional health status in relation to sporting performance. The questionnaire was found to discriminate between athletes with Down syndrome and other athletes, and an approach to using a cutoff score to develop competition classes is explored. [ABSTRACT FROM AUTHOR]

This article explores the gaps in strategic human resource management (SHRM) research exposed by the COVID‐19 pandemic in order to guide future SHRM research in the context of environmental crises. Using evidence from Danish companies and public organizations collected using a mixed‐methods sequential design, we discuss whether existing SHRM frameworks can adequately frame and deliver the academic knowledge needed to address the novel challenges posed by the pandemic. We formulate guidelines for future research that will shape discussions of the role of SHRM in building organizational resilience in the face of environmental crises. [ABSTRACT FROM AUTHOR]

Objective: This mixed methods study examined student and parent experiences with anxiety and preferences for campus-based programming to address anxiety. Participants: College students (n = 156) completed a survey, and 20 students participated in focus groups. Parents of college students (n = 85) completed a survey, and 12 parents completed a phone interview. Methods: Students and parents completed surveys about trait worry, mental health literacy, and preferences for proposed programming. Descriptive statistics were calculated. Students participated in focus groups, and parents completed interviews regarding their experiences and preferences. Thematic analysis was conducted with the coded focus group and interview transcripts. Results: Quantitative and qualitative findings revealed specific program preferences (eg scheduling). Qualitative findings highlighted mismatches between student and parent perspectives and opportunities for parental skill building. Conclusions: Students and their parents are open to and eager for campus programming that provides education, skills, and support for college students with anxiety. [ABSTRACT FROM AUTHOR]

Many children who require hospitalization in the pediatric intensive care unit (ICU) are unable to or have difficulty communicating through speech, whether because of preexisting or acute conditions. Children who are unable to be heard and understood using only speech benefit from aided augmentative and alternative communication (AAC), including in hospital settings. This qualitative interview study sought to understand the perspectives of nurses on care and support for children who use or would benefit from aided AAC in the pediatric ICU. Participants were six nurses who worked in pediatric intensive care at a tertiary care unit of a children's hospital in the United States. Three main themes were identified related to nurses' views about supporting children's communication: (a) Caring for the Whole Child, (b) Needing Support from Others and Moving between Roles, and (c) Working with Available Resources and Demands. Nurses emphasized the importance of a holistic approach to care, the impact of others' support and knowledge, and a desire for building greater capacity for promoting children's access to effective communication. Findings offer insight that could improve patient-centered care for children with complex communication needs and support for nurses themselves, particularly within the broader context of ICU liberation. [ABSTRACT FROM AUTHOR]

Background: Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. Aim: This study's aim was to explore ethical challenges in relation to person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. Research design: The study had a qualitative descriptive design. Participants and research context: Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. Ethical considerations: The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. Findings: The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person's autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one's own and the staff's health. Discussion: The ethical challenges meant being torn between the person's individual needs and protecting the group and society, with clashing ethical principles as a consequence. Conclusions: The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs. [ABSTRACT FROM AUTHOR]

Background: Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL's experience. Research aim: The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. Research design: A qualitative descriptive design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. Participant and research context: Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. Ethical considerations: This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. Findings: UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. Conclusions: The UBCCNL's experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed. [ABSTRACT FROM AUTHOR]

Background: Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. Research Question: What factors contribute to Moral distress among physiotherapists and how do they cope? Objectives: To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. Research Design: A 2017–2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. Participants and Context: Israeli physiotherapists from various occupational settings recruited via professional networks. Ethical Considerations: The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. Findings: Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. Discussion: Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. Conclusions: Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies. [ABSTRACT FROM AUTHOR]

Background: Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research. Research aim: The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides). Research design: The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the consequences of broken trust. Participants: Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online. Ethical considerations: The study's methods were reviewed by the University of Pittsburgh Institutional Review Board. Findings: Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging. Discussion: Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal. Conclusion: Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, many people with intellectual disabilities living in care facilities could not receive visitors. Health authorities suggested the use of digital social contact as an alternative for in-person visits. We examined how people with intellectual disabilities living in care facilities experienced the use of digital social contact with their informal social network throughout 2020. Residents, their relatives, volunteer visitors, direct support staff, and care facility managers (N = 283) completed an online questionnaire, of whom 35 participated in an interview. Video calling and in-person visits were among the most common forms of staying in touch. Experiences with digital social contact depended on residents' abilities and support needs, and on preconditions, such as staff availability. The first phases of the pandemic led to experiences of possibilities and benefits of using digital social contact as complementary to in-person contact for people with different levels of intellectual disability, also after the pandemic. [ABSTRACT FROM AUTHOR]

Our study aims to describe the status of workplace violence against medical students during clinical practice, which consists of its prevalence, types, perpetrators, students' responses and influences on them, reasons for workplace violence and to determine some relevant factors of this issue through both quantitative questionnaire and qualitative interview. A descriptive cross-sectional study with mixed methods was conducted on 320 students from the second-year to the sixth-year classes at Hanoi Medical University from August 2022 to February 2023. The questionnaire was based on the WHO questionnaire survey 'Workplace violence in the health sector – country case studies research instruments – Geneva 2003'. 10 students from quantitative research who completed the questionnaire, experienced at least one type of workplace violence and consented to continue taking part in the research were chosen for in-depth interviews. The prevalence of students witnessing and/or experiencing workplace violence was 35.6% and 19.4% of the sample population had experienced at least one kind of workplace violence. Medical staff were the most common perpetrators. 86.8% of students who were exposed to workplace violence did not report the incidents for a variety of reasons. The major reasons leading to workplace violence related to patients, patients' relatives and students, among which the first-ranked ones were the patients' education level and their unsatisfied expectations. Some relevant factors to workplace violence against medical students were determined by quantitative analysis such as students' grade (OR = 3.09) and region (OR = 3.31) and were explored additionally by qualitative interview such as the student management of the instructors, students' personality, attitude and appearance as well as hospital environment. Based on the research findings, establishing prevention methods, which require action from both individuals (students, medical staff) and organizations (universities, hospitals) is recommended. [ABSTRACT FROM AUTHOR]

Aims: To explore the care experiences of informal carers of people with chronic conditions in hospitals and identify areas for improvement in the context of comprehensive care delivery. Design: A explanatory sequential mixed‐method study. Methods: This study was conducted, involving a survey with 182 carers and interviews with 31 carers of individuals who attended an Australian hospital. Descriptive analysis of quantitative data was performed using RStudio, while thematic analysis of qualitative data was conducted using NVivo. Results: The findings revealed seven overarching components of care that influenced carers' hospital experiences and their perceptions of care quality. Areas requiring improvement were identified within these categories. Conclusion: This review identifies common perspectives of informal carers of people with chronic conditions in hospital settings and highlights important areas that require attention to improve carers' hospital care experiences. Carers should be welcomed, involved, informed and supported during hospital attendance to foster the most positive care experiences. Implications: Healthcare professionals should involve carers in assessment, shared decision‐making and the care process and recognise and address carers' needs. Impact: The findings revealed the carer's hospital experiences in the context of comprehensive care delivery and identified areas requiring improvement. Reporting Method: The CROSS and the COREQ guidelines were followed. Patient or Public Contribution: The study protocol was presented to stakeholders from two hospitals in Australia, a Patient and Carer Advisory Board (attached to the parent project: evaluating Quality of Care (eQC)) and the Australian Commission on Safety and Quality in Health Care, and discussions were held to assess the relevance and significance of this study to clinical practice and health policy. [ABSTRACT FROM AUTHOR]

Aims: Based on the two‐factor model of caregiving appraisals, this study aims to (1) investigate the relationships between competence in dementia care and job satisfaction (work attitudes in positive aspect) and turnover intention (work attitudes in negative aspect) among formal caregivers in nursing homes, and (2) examine the mediating roles of positive aspects of caregiving (caregiving appraisals in positive aspect) and caregiving burden (caregiving appraisals in negative aspect) in the above associations. Design: A cross‐sectional design was used. Structural equation modelling was employed to test the proposed model. STROBE checklist guides the reporting of this study. Methods: Using the multistage cluster sampling method, 407 formal caregivers were selected from 43 nursing homes across 7 districts/counties in China. Results: The proposed model shows a good model fit. Competence in dementia care shows significant positive associations with increased job satisfaction and decreased turnover intention among formal caregivers in nursing homes. Caregiving burden and positive aspects of caregiving mediate the relationships between competence in dementia care and both job satisfaction and turnover intention. Furthermore, the relationship between positive aspects of caregiving and job satisfaction is stronger than that with turnover intention, but the relationship between caregiving burden and turnover intention is not stronger than that with job satisfaction. Conclusions: The results demonstrate that the two‐factor model of caregiving appraisals effectively elucidates the associations and underlying mechanisms between competence in dementia care and formal caregivers' work attitudes. Specifically, two crucial conclusions are drawn: (1) competence in dementia care is associated with higher levels of job satisfaction and lower levels of turnover intention among formal caregivers in nursing homes; (2) caregiving burden and positive aspects of caregiving serve as parallel mediators in these associations. Implications for the Profession and/or Patient Care: Policymakers and nursing homes managers should implement a series of measures aimed at formal caregivers in nursing home. Specifically, allocating more resources to enhance the competence in dementia care of formal caregivers is crucial, given its significant association with elevated job satisfaction and reduced turnover intention. Besides, positive and negative caregiving appraisals emerge as proximal factors influencing work attitudes of formal caregivers. Therefore, intervention projects focused on formal caregivers in nursing home should target enhancing positive experiences and alleviating caregiving burden. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objectives: To explore the postoperative kinesophobia of patients after percutaneous coronary intervention (PCI) and its related factors. Background: Percutaneous coronary intervention is an effective method to treat coronary heart disease (CHD), and cardiac rehabilitation is an important auxiliary method after PCI. However, the compliance of patients with cardiac rehabilitation after PCI is not good, among which kinesophobia is an important influencing factor. Design: A descriptive cross‐sectional design was implemented, and the high‐quality reporting of the study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. Methods: In total, 351 inpatients who underwent PCI in three tertiary grade‐A hospitals in China were selected by convenient sampling method. We use one‐way ANOVA and multiple linear regression analysis to determine the relevant related factors. Results: The kinesophobia of patients after PCI was negatively correlated with chronic illness resource utilization and sense of personal mastery, and positively correlated with illness perception. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery entered the regression equation, which could explain 78.1% of the total variation. Conclusion: The level of kinesiophobia of patients after PCI is high. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery are the related factors of kinesiophobia of patients after PCI. Relevance to Clinical Practice: By reducing the level of exercise fear of patients after PCI, patients are more likely to accept and adhere to the cardiac rehabilitation plan, thus improving their prognosis and improving their quality of life. Patient or Public Contribution: The patient underwent PCI in the research hospital. Researchers screen them according to the inclusion criteria and invite them to participate in this study. If they meet the requirements, participants will answer the research questionnaire face to face after signing the informed consent form. [ABSTRACT FROM AUTHOR]

Objective: To determine whether completion of an online mental health self-assessment by patients who are waiting in the emergency department can save clinician time taken to complete clinical assessment and documentation. Methods: Patients presenting to a psychiatric emergency department for a period of 6 months were allocated by week of presentation to either the intervention arm (online mental health self-assessment, followed by a clinical interview) or the control arm (usual assessment) arm on a random basis. Time at the beginning and end of the interview was recorded and used to derive interview time. Similarly, time at the beginning and end of the clinical documentation was recorded and used to derive the time to complete clinical documentation. Results: Of 168 patients who presented during the study period, 69 (38.55%) agreed to participate, 33 completed the usual assessment and 30 completed the online mental health self-assessment followed by a clinical interview. Patients receiving usual care had a statistically significant, t (61) = 2.15, p = 0.035, longer interview duration (M = 48.7 minutes, SD = 19.8) compared with those in the online mental health self-assessment arm (M = 38.9 minutes, SD = 15.9). There was no statistically significant difference between groups for documentation time, t (61) = −0.64, p = 0.52. Conclusion: Online mental health self-assessment was associated with a statistically significant reduction in interview time by approximately 10 minutes without increasing documentation time. While online mental health self-assessment is not appropriate for all patients in the emergency department setting, it is likely to yield greater benefits in less acute settings. [ABSTRACT FROM AUTHOR]

Young adults thrust into the role of caregiving for parents with young-onset dementia (YOD) face unique challenges during their formative years. While existing research acknowledges the crucial role of young adult caregivers, a gap persists in understanding how this group experiences and redefines their identity amidst these circumstances, along with the psychological and societal challenges encountered. This knowledge deficit hinders the identification of suitable social support, adversely affecting the personal growth and well-being of these young adult caregivers. In this single-case study, we used a combination of a semi-structured interview and photovoice to explore the journey of a 19-year-old caregiver, Alice, whose mother had been diagnosed with dementia in the preceding 3 years. Through this unique perspective, we aimed to illuminate how caregiving for a mother with YOD may profoundly redefine familial roles and relationships. Over 3 months, Alice captured significant life moments through photography, selecting meaningful images for bi-weekly meetings. These images served as pivotal themes, triggering in-depth conversations during subsequent interviews to provide nuanced insights into her life experiences. Findings reveal four major themes faced by a young caregiver: (1) challenges adapting to an unexpected role, (2) navigating the complex emotional terrain of losing a loved one to YOD, (3) prioritizing the well-being of the healthy parent, and (4) expressing a profound desire for both informal and formal support. These results underscore the intricate identity and emotional challenges faced by young adult caregivers, emphasizing the urgency of addressing their unique needs through family-centered systemic support services. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore factors influencing functioning in psychiatric outpatients, both separately and in combination. The primary objectives were to determine predictors of functioning, assess their significance in a combined analysis, and quantify their collective predictive power. Method: A sample of 137 psychiatric outpatients diagnosed with bipolar disorder, borderline personality disorder, or attention deficit hyperactivity disorder (ADHD) participated in this cross-sectional study, undergoing semi-structured diagnostic interviews for psychiatric and personality disorders. Participants also completed assessments of current functioning, personality traits (temperament and character), attachment style, and childhood trauma. Linear regression models were employed to analyse the relationships between these factors and level of functioning. Results: The majority of temperament and character traits and attachment dimensions, as well as having a personality disorder, predicted impaired functioning, but comorbidity and childhood trauma did not. When all variables were taken into account in a multiple regression analysis, only the temperament and character traits Harm Avoidance and Self-directedness remained significantly predictive (p =.006 and.003, respectively). These two factors explain about one-third of the variance. Conclusions: Personality traits—more specifically, the temperament trait Harm Avoidance and the character trait Self-directedness—are strong predictors of functioning among psychiatric outpatients. Interestingly, when accounting for these factors, traditionally associated variables, such as attachment, comorbidity, and childhood trauma, lost their significance as predictors. These findings underscore the pivotal role of specific personality traits in understanding and predicting the functioning of psychiatric patients. [ABSTRACT FROM AUTHOR]

Frequent presentations to emergency departments contribute to increased service demands and healthcare costs. Literature suggests these adult presentations may be influenced by childhood adversity. This qualitatively driven, mixed methods study explored the self‐perceived role of childhood adversity in the health of adults who frequently attended Australian Emergency Departments and their perceptions of the healthcare they received. Data were collected using validated instruments and semi‐structured interviews with 12 purposefully sampled adults who frequently attended emergency departments. Qualitative data were analysed using interpretive phenomenological analysis. Three major themes were identified—The experience of childhood adversity: articulating challenges related to childhood trauma, and the subsequent impacts on participants' health, behaviours, relationships and sense of control; Pursuing safety: exploring action participants took to keep themselves and others safe, with this requirement extending into adulthood and influencing Emergency Department presentations; and Seeking humanising healthcare: identifying challenges participants experienced while seeking care in the Emergency Department. Participants perceived their mental health to be profoundly affected by their past experiences of trauma, leaving them feeling vulnerable at times and more likely to experience re‐traumatisation in the Emergency Department. Feelings of stigmatisation during Emergency Department encounters led participants to employ self‐protection strategies creating further barriers to recovery. Participants described Emergency Departments as often failing to comprehensively address their healthcare needs. They offered suggestions for more effective care interventions. Findings highlight the need for further research to inform policy and practice when designing and implementing interventions for these adults. Consolidated Criteria for Reporting Qualitative Research (COREQ) guided study reporting. [ABSTRACT FROM AUTHOR]

An understanding of the prevalence and risk factors of parental mental health problems is important for early intervention and prevention measures and shaping services for parents and their children. However, large representative surveys of parental mental health problems and associated risk factors are lacking. The aim of this study was to estimate prevalence rates of parental mental health problems using a standardised measure of psychiatric morbidity (General Health Questionnaire; GHQ‐12), in a representative sample of parents and caregivers of children and young people (2–19 years) in Northern Ireland. Further, this study explored associated risk factors of parental mental health problems. A random household survey of parents and children was conducted between June 2019 and March 2020. Parental responses on demographic, economic, familial and psychological measures were collected (N = 2815) and 22% of parents and caregivers screened positive for mental health problems. The STROBE checklist for observational research was adhered to. Multivariate logistic regression indicated that being in receipt of benefits, having poor family support, a history of adverse childhood experiences, a history of exposure to politically motivated violence (the Troubles), and a child with conduct problems and poor health were all independent risk factors of increased parental mental health problems. Findings will help to inform future commissioning and development of services and broaden understanding of the correlates of parental mental health problems. [ABSTRACT FROM AUTHOR]

Background: Two‐thirds of pregnancy‐related deaths occur from 1 day to 1 year after birth, and medical complications frequently occur after birth. Postpartum health concerns are often urgent, requiring timely medical care, which may contribute to a reliance on acute care. One approach to improving postpartum health is to investigate birthing parents' accounts of acute care use in the months after birth, which is what we did in this study. Methods: This mixed‐methods study included questionnaire responses, semi‐structured interviews, and chart review of 18 English‐speaking individuals who used acute care in the 90 days after birth in the southeastern United States. Interviews were conducted remotely, recorded, and professionally transcribed. Qualitative data were inductively coded to iteratively develop categories and themes with respect to contributors and barriers to postpartum acute care use. Results: Birthing parents engaged in complex decision‐making processes to decide where and when to seek postpartum acute care in response to their urgent health concerns. Many described fear and uncertainty about their postpartum health. Most participants contacted a healthcare practitioner before using acute care, followed their guidance, and were treated or otherwise reassured at the acute care visit. Discussion: These findings suggest multilevel opportunities for strengthening healthcare systems, including better‐preparing individuals for the postpartum period and structuring care to accommodate birthing parents and include their support systems. The insights from this study can inform multilevel strategies for strengthening healthcare so that birthing parents are safe and well postpartum. [ABSTRACT FROM AUTHOR]

Objectives: The New Orleans Maternal Child Health Coalition convenes to support and amplify the work of New Orleans-based individuals and organizations working to reduce disparities and protect the health of birthing families in the New Orleans area. The objectives of this qualitative study were to identify successes, challenges, and areas of growth for the Coalition and develop broadly generalizable recommendations for similar groups seeking to mobilize and advance health equity in their own communities. Methods: Using purposive sampling, we conducted semi-structured interviews with 12 key informants from within and outside of the Coalition. Interviews were transcribed verbatim, and data was analyzed using inductive and deductive coding approaches. Results: We identified themes relating to the barriers and facilitators to the maintenance of the Coalition, as well as opportunities to advance the mission of the Coalition. Some themes included structural- and systemic-level barriers to achieving the mission, varying perspectives on the effectiveness of the Coalition, opportunities to enhance the operations of the Coalition's work, and opportunities to involve other individuals, particularly those with lived experience, and non-MCH related sectors in Coalition's work. Conclusions for Practice: As the maternal health crisis continues, coalitions like the New Orleans MCH Coalition provide a vehicle to amplify the mission-driven work of people and organizations. Recommendations put forth by the Coalition can also be utilized by coalitions in other jurisdictions. Significance: What is Already Known on this Subject?: Black–White disparities in maternal and child health (MCH) have a longstanding history within the United States (US) and these disparities are mirrored in New Orleans, LA. The New Orleans Maternal and Child Health Coalition was founded to support the collective efficacy of numerous individuals and organizations to protect the health of birthing families in the community. What Does this Study Add?: We identified the key barriers and facilitators to achieving the Coalition's mission and building collective power to achieve MCH equity in the greater New Orleans area. Such evidence is a crucial contribution during this time when rates of maternal mortality and morbidity continue to rise throughout the country. This study amplifies the importance of community-driven work to address disparities in MCH and enhance health equity. [ABSTRACT FROM AUTHOR]

Background: Online synchronous learning in higher education frequently struggles to overcome the social presence gap, resulting in dissatisfaction and poor learning outcomes. Objectives: This study examined the effectiveness of desktop‐based virtual reality (VR) social platforms compared to video conferencing (VC) platforms in enhancing students' learning gains and experiences in online synchronous learning. Methods: The study used a within‐subject design, involving 34 college students in two online lecture modules, one via a VR social platform and another through a VC platform. Knowledge assessments occurred pre‐ and post‐modules and after 1 week. Students also completed post‐module questionnaires to evaluate their learning experience, in terms of social presence, easiness of use and perceived emotions. In‐depth interviews provided further insights into their experiences with both platforms. Results: The study showed that using VR social platforms for online synchronous learning enhanced immediate knowledge, especially in students less interested in the content, yet it did not notably impact long‐term knowledge retention. Despite no significant findings in social presence from questionnaires, interviews indicated that the VR's heightened interactivity might be offset by the effect of not seeing others' real appearances in promoting social presence. Furthermore, the VC platform was found to be easier to use, attributed to its familiarity and user‐friendliness. Finally, students experienced increased fun, awe and interest, along with reduced boredom, when using the VR social platform. Conclusion: The findings highlight the potential of VR to enrich online learning while underscoring the need for effective strategies facilitating a smooth integration into educational settings. Lay Description: What is currently known about this topic: Social presence is crucial in online learning.VC platforms may fail to efficiently bridge the social presence gap.VR social platforms can enhance students' experience in online education. What does this paper add: Compares VR and VC effects on learning gains and experiences.Highlights VR's potential to boost immediate knowledge gains.Reveals VR's benefits for emotional engagement. Implications for practice or policy: Suggests integrating VR for more engaging online education.Underlines the need for user‐friendly VR technology.Advocates for training to maximize VR's educational benefits. [ABSTRACT FROM AUTHOR]

Background: Our study analysed 46 articles on computer‐aided translation (CAT) and its educational uses. We explored two main areas: CAT technologies in learning and teaching, and the research methodologies of these studies. Objectives: Our review covered the types of CAT technologies used, their applications in different learning settings, theoretical backgrounds and their pros and cons. We also looked at the research designs, participant demographics and data collection methods used in these studies. Methods: We conducted an extensive search across academic databases using relevant keywords and employed open coding to analyse and categorize the content of identified articles, focusing on aspects related to CAT technologies in educational contexts. Results and Conclusions: Our findings showed the use of 22 distinct CAT technologies, with Google Translate being the most common. The studies mostly used empirical research methods and questionnaires. University students were the primary participants. CAT technologies were applied in various contexts, including language learning, translation teaching, cross‐cultural learning and foreign language lectures. We identified five key theoretical foundations for CAT use. Benefits included bridging language barriers, vocabulary enhancement, and grammar improvement as well as providing reference and feedback for writing and translation. Challenges included inaccuracies and inappropriate translations. However, most studies showed a positive impact of CAT on learning outcomes. Based on our analysis, we offer recommendations for educators and researchers in the field. This review provides a thorough understanding of CAT's applications and effects in education, guiding future advancements in this area. Lay Description: What is currently known about the subject matter: CAT tools enhance language learning and teaching.Inaccuracies in CAT translations affect learning.CAT tools are primarily used in language learning contexts. What this paper adds: Explores CAT tools in non‐language learning contexts.Identifies challenges and benefits of CAT technology.Highlights importance of theoretical foundations in CAT research The implications of study findings for practitioners: Guidance on effective and ethical CAT tool use is crucial.Need for strategies to improve CAT translation accuracy.Recommends expanding CAT applications in diverse contexts.Emphasizes developing machine translation literacy. [ABSTRACT FROM AUTHOR]

Background: The use of computer‐assisted reading comprehension is of critical importance in the context of promoting effective and engaging literacy education in the digital age. It provides students with the opportunity to work at their own pace and convenience, thereby facilitating self‐directed learning and accommodating various learning preferences and schedules. Objectives: The objective of the study was to investigate the impact of computer‐assisted and direct strategy teaching on reading comprehension, reading comprehension self‐efficacy and reading comprehension metacognitive awareness. An experimental application based on the SQ4R strategy was conducted in the direct strategy teaching (DST) and computer‐assisted strategy teaching (CAST) programmes. In the DST group, the implementation of the SQ4R strategy was conducted through direct strategy teaching, whereas in the CAST group, the same activities were carried out with the assistance of computer‐based resources. The principal objective of the study was to evaluate the efficacy of computer‐assisted strategy instruction. Methods: This study employed a combined sequential descriptive design, integrating qualitative and quantitative research models. The study was conducted with 61 fourth‐grade students, enrolled in three classrooms of a public school situated in the central district of Kastamonu, Turkey, which is characterised by a moderate socioeconomic level. The quantitative component of the study was designed as a pre‐test–post‐test control group experimental study. The qualitative component of the study comprised focus group interviews and observation. Two experimental groups and one control group were established in the course of this study. In the quantitative dimension of the combined sequential descriptive model, the Reading Comprehension Test, Metacognitive Reading Comprehension Scale, and Reading Comprehension Self‐Efficacy Scale were employed as data collection instruments. In order to collect data in the qualitative dimension, semi‐structured interview and observation forms were employed. Furthermore, the researcher's diaries, maintained throughout the research process, were employed as a data source. The quantitative data were analysed using the following techniques: arithmetic mean, frequency, percentage, standard deviation, ANOVA and covariance analysis (ANCOVA). A descriptive analysis was employed for the evaluation of the qualitative data. Results and Conclusions: Upon examination of the post‐test scores of the CAST, DST and control group students in the Reading Comprehension Test, it was observed that the CAST group exhibited the highest average. A statistically significant difference was also identified between the CAST group and the control group. Nevertheless, no statistically significant difference was identified between the DST group and the control group. Nevertheless, an examination of the mean scores reveals that the DST group exhibited considerably higher Reading Comprehension Test scores. Lay Description: Computer aided tools can be used to teachvarious reading strategies.CAST can help students improve their readingcomprehension.CAST can contribute to students' reading andcomprehension motivation.CAST can offer customised learning materialsaccording to the individual needs of the students. [ABSTRACT FROM AUTHOR]

Background: The world is moving towards digitalization and intelligence. Programming has become an essential development competency. Even though many countries are currently making great efforts to expand programming education, the programming education in these countries shows an imbalance in geographical and gender dimensions. We found that few studies paid attention to rural girls' programming learning in developing countries. Objectives: This study focuses on programming learning among rural girls in a developing country (China) from an educational equity perspective. We investigated the level and the changes in these girls' self‐efficacy and interest in programming. Methods: We conducted a three‐month (12‐week) semester of programming teaching for rural fifth‐grade girls. Two rounds of data collection were conducted at the mid‐semester (first‐measure) and the end of the semester (second‐measure), with semi‐structured interviews at the end of the semester. Results and conclusions: The results showed that rural girls' programming self‐efficacy was at a moderate‐to‐high level and remained stable, but there were no gender differences in programming self‐efficacy between boys and girls in the second‐measure. Girls' self‐efficacy was positively correlated with interest, and programming education could help girls to increase their interest in programming, but boys and girls did not show gender differences in their programming interest in second‐measure. Interestingly, we found that girls' perceived programming knowledge acquisition was significantly higher than overall programming efficacy. Takeaways: These findings provide meaningful implications for programming education in less developed areas and female early programming education. Lay Description: What is already known about this topic: There is a significant gender imbalance in the programming field and females were severely underrepresented.Potential causes for these issues might be women's lack of confidence and interest in programming.Previous studies have shown that female college students in computer science showed insufficient confidence in programming at school, which made them avoid becoming programmers and choose other careers after graduation.Female students' low confidence and interest in programming might have already existed in their earlier studies, such as high school or even elementary school. What this paper adds: Rural fifth‐grade girls' programming self‐efficacy was at a moderately high level, with no significant differences compared to boys, and maintained a stable level throughout the entire learning period.Rural girls held a high level of programming interest at the beginning, which was reinforced by programming education, and there was no gender difference in programming interest.Rural girls' perceived programming knowledge acquisition was significantly higher than overall programming efficacy.Rural girls' self‐efficacy was positively correlated with interest. Implications for practice and/or policy: In rural areas, fifth‐grade girls and boys had approximate self‐efficacy and interest in programming.Providing early programming education to girls in rural areas can increase their interest in programming. [ABSTRACT FROM AUTHOR]

Background: Gender stereotypes about women and men are prevalent in computer science (CS). The study's goal was to investigate the role of gender bias in computer‐supported collaborative learning (CSCL) in a CS context by elaborating on gendered experiences in the perception of individual and team performance in mixed‐gender teams in a hackathon. Dataset: The dataset of this study was collected at a 3‐day CSCL hackathon aimed at gaining knowledge on designing educational games. We assigned the 28 participants of the hackathon to mixed‐gender groups and asked them to fill out a questionnaire, including collective self‐esteem scales, before the start. During the hackathon, we again asked the participants to complete team progress evaluation surveys individually after each workday. Lastly, we interviewed 11 participants to elaborate on the quantitative findings with qualitative data. Methodology: We applied an exploratory mixed‐method approach using quantitative survey data at several time points during the hackathon, which was analysed with clustering and descriptive statistics and complemented with qualitative coding of interviews with participants. Results: The results demonstrate that social and psychological aspects of gender are important for understanding the outcomes and perceptions of gender in a CS hackathon. The analysis further suggests that collective self‐esteem can be used as a key variable to assess gender differences in CSCL studies, providing explanatory benefits. More broadly, results gave reason to believe that CSCL in the CS domain currently severely fails to account for gender representation. Interviewed participants raised substantial concerns about the underlying gender stereotypes prevalent in communication, team roles, and work division. We provide recommendations for practitioners seeking to create gender‐inclusive and counter‐stereotypical CSCL and wider, critical proposals for how we, as researchers, can assess gender with appropriate methodologies and interventions in computer science education. Lay Description: What is already known about this topic?: In the field of computer‐supported collaborative learning (CSCL), most studies argue that group work supports the development of social, cognitive, and online collaborative teamwork skills and creates a more inclusive learning environment.Because women represent non‐majority users in CSCL, especially when applied in the computer science domain, this notion is questioned by studies finding that diversity inclusion in CSCL is hampered through gender stereotypes still present in CS and impacts women's and other gender minorities' learning experiences.Another problem is that the role of gender in CSCL research has scarcely been addressed by the CSCL community yet. Thus, research methodologies trying to reveal gender differences seldomly address gender majority‐minority relations in learning in understanding the role of gender in shaping these learning experiences. What this paper adds?: Emerging from this research gap, the main contribution of our study is to investigate the validity and explanatory power of operationalizations of gender that consider gender not as the biological sex of the learner but as a social construct operating in the specific learning context.Thus, we demonstrate the benefits of considering differentiation in gender identity and gender perception to understand differences in individual learning experiences and the role of gender in the context of a CSCL hackathon in computer science education.We draw on an innovative exploratory mixed method design to contribute to the methodological discourse in CSCL research concerning gender. Specifically, we demonstrate how gender differences in perceptions of mixed‐gender groups can be meaningfully operationalised via the social and psychological aspects of gender in CSCL in CS that is gender identity, self‐esteem and belonging in computer science CSCL. The implications of study findings for practitioners: This study gives the following recommendations for CSCL technical and pedagogical designers:(1) Designing with and for women and minority‐specific privacy considerations.(2) Creating gender‐representative and gender‐affirming communication infrastructures, counter‐stereotypical roles in the teams and gender‐balanced group constellation, along with pedagogical and teaching practice that is open for including women's perspectives in grounded and participatory design processes.(3) In terms of CSCL hackathons, I might also consider doing community‐based hackathons that attract women and minorities, for instance, through connecting women and minority non‐profit organisations with student developers, as in "Think Global Hack Local Hackathons". [ABSTRACT FROM AUTHOR]

Young adults with intellectual and developmental disabilities (IDD) on college campuses are vulnerable to exclusion and a lack of social participation. However, peers can provide meaningful supports to young adults with IDD in the area of social/communication skills. The purpose of this study was to enhance the conversation skills of four young adults with IDD (ages 22–23) during their regular lunch breaks on a university campus. The dependent variable was percent of conversational engagement during 10-min audio recorded sessions as measured using partial interval recording procedures. Typically developing peers served as peer coaches and provided structured or natural supports. Experiment 1 used an alternating treatments design to compare the effects of peer coaching alone vs. peer coaching + goal setting with two adjacent baseline conditions and a final student-choice condition. Results for Experiment 1 indicated peer coaching alone and the additive effects of goal setting was more effective than natural supports only. Experiment 2 used a withdrawal design to compare the effects of young adults with IDD speaking with fellow classmates with disabilities vs. peers without disabilities. Participants in Experiment 2 demonstrated higher levels of conversational engagement when speaking with peers without disabilities in a natural manner. Social validity of the different peer-mediated interventions was overall high for all participant types as reported on questionnaires and exit interviews. We provide implications for practice and suggestions for future research related to peer-mediated interventions for young adults with IDD on college and university campuses. [ABSTRACT FROM AUTHOR]

The objectives were to assess the self-efficacy and consistent condom use by people living with HIV (PLHIV). A cross-sectional, comparative study was carried out in outpatient clinics in Ceará State, Brazil, with a sample of 190 PLHIV, 95 serodiscordant and 95 seroconcordant. Interviews were conducted using the Socio-Demographic, Clinical, Epidemiological and Vulnerability Form and the Condom Use Self-Efficacy Scale. Descriptive analysis, associations between variables, odds ratio and 95% confidence interval were determined. P < 0.05 was considered statistically significant. Of the sample, 43.1% consistently used condoms (50.5% serodiscordant and 35.7% seroconcordant). Serodiscordant PLHIV without guidance on HIV prevention (P = 0.027) and without access to testing (P = 0.002) had lower self-efficacy and 11.5 times more chances for inconsistent condom use (P = 0.006), while those satisfied with follow-up in health were less likely to use condoms inconsistently (P = 0.011). We conclude that there is low consistent use of condoms among PLHIV, which increases the risk of HIV transmission and the acquisition of other sexually transmitted infections. Consistent condom use was greater among serodiscordant individuals, although there was no difference in self-efficacy in condom use between the groups. [ABSTRACT FROM AUTHOR]

Purpose: To explore the recalled experience of pregnancy and motherhood in women diagnosed with Autism Spectrum Disorders (ASD) without intellectual disabilities, focusing on sensory perceptions and mood. Methods: We retrospectively evaluated, through an ad-hoc structured interview, the sensory sensitivity during the pre-partum, the peri-partum, and the post-partum of thirty-three mothers with ASD and thirty-two neurotypical mothers. Participants also underwent a psychometric assessment about autistic traits, general sensory sensitivity, and post-partum depressive symptomatology. Results: Mothers with ASD recalled a higher sensitivity than the comparison group across the three time-points; however, during the peri-partum their recalled hypersensitivity decreases, and in the post-partum it returned as high as before childbirth. The difference in the length of recall between groups did not statistically influence our results. Higher levels of autistic traits correlated with higher depressive post-partum symptomatology. Conclusions: Mothers with ASD seem to recall their experience of pregnancy, childbirth, and post-partum period differently from neurotypical mothers, particularly in terms of hypersensitivity. The correlation with depressive symptoms and the potential role of oxytocin and of long-term memory (encoding and recollection) are discussed. Further exploring these aspects might give fundamental hints to provide tailored support to mothers with ASD during pregnancy and motherhood. [ABSTRACT FROM AUTHOR]

Aim: To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities. Design: Mixed‐methods explanatory sequential. Methods: In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web‐based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper‐and‐pencil questionnaire. Twenty semi‐structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays. Results: Participants spent approximately one‐quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision‐making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care. Conclusion: Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions. Impact: This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills. Reporting Methods: MMR checklist. Patient/Public Contribution: None. [ABSTRACT FROM AUTHOR]

Aim(s): To describe advanced practice nursing (APN) in the French healthcare landscape and to provide insights on how the role is defined and implemented and how the role is perceived by physicians. Design: A mixed‐method approach incorporating qualitative and quantitative data to offer a global understanding of APN implementation in France was used. Methods: Data were collected through questionnaires and interviews with APNs and physicians in diverse healthcare settings in France. The questionnaire assessed the roles, relationships with physicians and patients and the perceived implementation success of APNs. In‐depth interviews explored experiences, definitions, challenges and perspectives of APNs. A thematic analysis was applied to the qualitative data to complete the quantitative exploration. Descriptive analyses were performed for quantitative data. Results: A total of 41 APNs and 12 physicians were involved in this study between December 2022 and March 2023. The findings underscore APN as a pivotal, independent profession integrating advanced clinical expertise and interprofessional skills. The challenges encountered by APNs include role ambiguity, ongoing resistance and the need to address institutional barriers. Despite the fact that 73.2% of APNs reported that their role was well implemented, only 17.1% had clearly defined roles at the outset. Conclusion: This study revealed the dynamic and evolving nature of APN in France, highlighting its challenges and opportunities. Despite facing role ambiguity and resistance, APNs play a crucial role in the healthcare system. Implications for the Profession and/or Patient Care: The results highlight the need for specific interventions to tackle challenges and facilitate successful integration of APN. These insights lay a foundation for future research and interventions aimed at boosting the impact and acceptance of APN in France, potentially influencing policy modifications and professional development. Impact: Problem Addressed: The study aimed to enhance comprehension of the implementation and role of advanced practice nursing (APN) in France. It focused on defining APN in the French context, identifying barriers and facilitators to its implementation and evaluating its impact. Main Findings: The study revealed that APN in France is evolving with expanded competencies and clinical autonomy, but faces challenges like role ambiguity and professional resistance. Key findings include the successful integration of APNs in healthcare settings, positive relationships with medical doctors and patient satisfaction. However, the study also highlighted the necessity to resolve role ambiguity and to improve the understanding and acceptance of APN roles among healthcare professionals for successful APN integration. Impact of the research: This research will primarily impact healthcare systems and policy‐making in France, guiding the future development and integration of APN roles. It is also relevant for healthcare professionals, particularly nurses and physicians, by providing information about the evolving nature of APN and its benefits in patient care. Globally, the study contributes to the broader discourse on APN, offering insights that could inform APN implementation strategies in other countries facing similar healthcare challenges. Reporting Method: COREQ—STROBE. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: To describe intensive care unit nurses' experiences of moral distress during the COVID‐19 pandemic, and their recommendations for mitigative interventions. Design: Interpretive description. Methods: Data were collected with a purposeful sample of 40 Canadian intensive care unit nurses between May and September 2021. Nurses completed a demographic questionnaire, the Measure of Moral Distress—Healthcare Professionals survey and in‐depth interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were categorized and synthesized using reflexive thematic analysis and rapid qualitative analysis. Results: Half of the nurses in this sample reported moderate levels of moral distress. In response to moral distress, nurses experienced immediate and long‐term effects across multiple health domains. To cope, nurses discussed varied reactions, including action, avoidance and acquiescence. Nurses provided recommendations for interventions across multiple organizations to mitigate moral distress and negative health outcomes. Conclusion: Nurses reported that moral distress drove negative health outcomes and attrition in response to moral events in practice. To change these conditions of moral distress, nurses require organizational investments in interventions and cultures that prioritize the inclusion of nursing perspectives and voices. Implications for the Profession: Nurses engage in a variety of responses to cope with moral distress. They possess valuable insights into the practice issues central to moral distress that have significant implications for all members of the healthcare teams, patients and systems. It is essential that nurses' voices be included in the development of future interventions central to the responses to moral distress. Reporting Method: This study adheres to COREQ guidelines. Impact: What Problem did the Study Address?: Given the known structural, systemic and environmental factors that contribute to intensive care unit nurses' experiences of moral distress, and ultimately burnout and attrition, it was important to learn about their experiences of moral distress and their recommendations for organizational mitigative interventions. Documentation of these experiences and recommendations took on a greater urgency during the context of a global health emergency, the COVID‐19 pandemic, where such contextual influences on moral distress were less understood. What Were the Main Findings?: Over half of the nurses reported a moderate level of moral distress. Nurses who were considering leaving nursing practice reported higher moral distress scores than those who were not considering leaving. In response to moral distress, nurses experienced a variety of outcomes across several health domains. To cope with moral distress, nurses engaged in patterns of action, avoidance and acquiescence. To change the conditions of moral distress, nurses desire organizational interventions, practices and culture changes situated in the amplification of their voices. Where and on Whom Will the Research Have an Impact on?: These findings will be of interest to: (1) researchers developing and evaluating interventions that address the complex phenomenon of moral distress, (2) leaders and administrators in hospitals, and relevant healthcare and nursing organizations, and (3) nurses interested in leveraging evidence‐informed recommendations to advocate for interventions to address moral distress. What Does this Paper Contribute to the Wider Global Community?: This paper advances the body of scientific work on nurses' experiences of moral distress, capturing this phenomenon within the unique context of a global health emergency.Nurses' levels of moral distress using Measure of Moral Distress—Healthcare Professional survey were reported, serving as a comparator for future studies seeking to measure and evaluate intensive care unit nurses' levels of moral distress.Nurses' recommendations for mitigative interventions for moral distress have been reported, which can help inform future interventional studies. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objective and intervention: To explore contextual factors influencing residents' intentions to register with one of the new-coming GPs established as a result of a municipally driven GP coverage intervention in a disadvantaged neighbourhood in Copenhagen with a GP shortage. Design: A qualitative study design informed by realist methodology was used to conduct the study. Data were obtained through a survey with residents (n = 67), two focus group interviews with residents (n = 21), semi-structured interviews with the project- and local community stakeholders (n = 8) and participant observations in the neighbourhood. The analysis was carried out through systematic text condensation and interpreted and structured by Pawson's layers of contextual influence (infrastructural and institutional). The concept of collective explanations by Macintyre et al. and Wacquant's framework of territorial stigmatisation were applied to analyse and discuss the empirical findings. Subject and setting: Residents from five local community organisations in a disadvantaged neighbourhood in Copenhagen. Main outcome measures: Infrastructural and institutional contextual factors influencing residents' intentions to register with one of the new-coming GPs. Results: Infrastructural contextual factors included the national shortage of GPs, the administration fee for registering with a new GP, and the neighbourhood's reputation as being feared and unattractive for GPs to establish themselves. Institutional contextual factors included mistrust towards municipal authorities and the new-coming GPs shared by many residents, the duration without a local GP, GPs' reputation and a perceived lack of information about the GP coverage intervention, and an experience of not being involved. Conclusion and implication: Infrastructural and institutional contextual factors influenced residents' intentions to register with one of the new-coming GPs. The findings will be helpful in adjusting, implementing, and disseminating the intervention and developing and implementing future complex interventions in disadvantaged neighbourhoods. KEY POINTS: GP coverage interventions in disadvantaged neighbourhoods with a GP shortage should address contextual factors influencing residents' intentions to register with new-coming GPs The neighbourhood's negative reputation led residents to question the GPs' motives for coming and whether they would stay permanently Residents' mistrust of both municipal authorities and the new GPs, combined with a lack of information and a feeling of exclusion from the decision-making process, influenced residents' intentions to register negatively Residents needed more information on the GPs' ambitions and intentions for choosing their neighbourhood to be convinced that they would be there permanently [ABSTRACT FROM AUTHOR]

This study explored lived experiences of sexuality for women with self-reported obsessive-compulsive disorder (OCD), with a particular focus on the felt impact of OCD on their sexual identities, practices and relationships, and their experiences of help-seeking. One hundred and thirty-four women completed an online qualitative survey. One Skype interview was also undertaken at the request of a participant. We analysed the data using reflexive thematic analysis and developed four themes: 'My distorted reality'; 'OCD as sex killjoy'; 'What is normal sex?', and 'I'm scared and you're not helping'. The participants reported experiencing anxiety around their 'true' sexuality and distinguishing between authentic sexual thoughts and intrusive thoughts. They managed the anxiety associated with intrusive thoughts by avoiding sex as much as possible, or altogether. Women who talked about sex in therapy experienced judgements about their sexuality and sexist advice. The analysis locates the distress the women experienced within a patriarchal and heteronormative social context. We argue that dominate discourses around sex and gender have material and embodied consequences for the participants as they navigated their sexual identities and relationships. [ABSTRACT FROM AUTHOR]

Negative attitudes towards lesbian women and gay men continue to exist in Southeast Asian countries. This study identified predictors of homonegativity that are generally consistent across the countries in the region. Using data from the seventh round of World Values Survey, we obtained parsimonious country-level logistic regression models for six of the 11 Southeast Asian countries: Indonesia (n = 3,200), Malaysia (n = 1,313), Myanmar (n = 1,200), the Philippines (n = 1,200), Thailand (n = 1,500), and Vietnam (n = 1,200). Results suggest that four values and one demographic variable are consistent predictors of homonegativity in Southeast Asia. Endorsements of equality, choice, and agnosticism were found to be consistent predictors of lower levels of homonegative attitudes, while the opposite was observed for endorsement of relativism and older people. That there are some consistent cultural predictors of lower levels of homonegativity may suggest a common emancipative logic in Southeast Asia. On the whole, however, the findings suggest that there may be no uniform (Southeast) Asian values system that constitutes sexual prejudice. This foregrounds the need for more contextually-sensitive and culturally-informed models of homonegativity to understand why negative attitudes persist in some countries but not in others, and to also guide the crafting of interventions that are more relevant to each country. [ABSTRACT FROM AUTHOR]

Background: Children with autism spectrum disorder (ASD) experience high rates of atypical eating behaviours, such as food neophobia. Mobile health (mHealth) interventions have been found to improve communication, behaviour and social skills for children with ASD. However, there is limited evidence examining mHealth nutrition interventions among children with ASD. Methods: The present study comprised a qualitative descriptive study that used qualitative content analysis to explore parent and child experiences with a novel mHealth nutrition intervention. Ten parent–child dyads provided user feedback and evaluation of the intervention. Data collection tools included a semistructured interview guide and a quantitative questionnaire with open‐ended questions. Data analysis of the interview transcripts and open‐ended questionnaire responses was an iterative process that continued until saturation was achieved. Descriptive statistics were used to analyse quantitative questionnaire data. Results: Analysis of the qualitative semistructured interviews led to emergence of three themes: (1) positive intervention outcomes; (2) parent suggestions for improvement; and (3) barriers to engagement. Each theme included subthemes. Questionnaire data revealed the ability to pick rewards and the virtual character that reinforced dietary goals ("Nutrition Ninja") were the most liked components of the application. Sending messages within the application and the Nutrition Ninja game were the least liked components of the application. Conclusions: Collectively, findings indicated that the app served as an interactive tool prompting dietary change and conversations within families. Yet, for some families, the intervention design, resistance to change or child disinterest hindered use and implementation of the intervention. Highlights: Parent and child engagement with the mHealth nutrition intervention resulted in gaining new skills, tools or knowledge for some of the participating families.Parents offered several suggestions that ranged from technical modifications to the design or functionality of the mobile app to overarching changes to the approach of the nutrition intervention itself.For some families, various components of the mobile app or family circumstances hindered parent or child engagement with the app technology or nutrition intervention. [ABSTRACT FROM AUTHOR]

Sexual and gender minority (SGM) adults in South Africa face high levels of violence and poor mental health outcomes. Interventions to prevent these negative health implications are hampered by a lack of representative data among this population. This study aims to quantify the associations between three forms of violent victimization and depressive symptoms in a sub-sample of SGM drawn from a population-based cross-sectional study in Gauteng, South Africa. Data come from the sixth Quality of Life survey conducted in South Africa's Gauteng province. Brief screeners assessed childhood sexual abuse (CSA), past-year intimate partner violence (IPV), non-partner violence, and depressive symptoms. Three survey-weighted logistic regression analyses were fit to model associations between elevated depressive symptoms and CSA, past-year IPV, and past-year non-partner violence, controlling for socio-demographics (age, race, sex, area of residence, education, socioeconomic status, and recent employment). N = 1,328 SGM respondents were included. Over 40% (n = 537) reported depressive symptoms, while 17% (n = 222) reported CSA, 5% (n = 67) reported IPV, and 16% (n = 208) reported non-partner violence. CSA and non-partner violence were associated with significantly higher odds of reporting depressive symptoms (aOR: 1.51, 95% CI [1.03, 2.23]; aOR: 1.84, [1.24, 2.73], respectively). IPV was not associated with elevated depressive symptoms (aOR: 1.17, [0.64, 2.16]). In all models, employment in the past 7 days was associated with significantly lower odds of reporting depressive symptoms. Recent and childhood violence is a major burden that is associated with elevated symptoms of depression among SGM in urban South Africa. Community-tailored interventions and policy-related advocacy related to employment and violence prevention may alleviate depressive symptoms in SGM adults in Gauteng. [ABSTRACT FROM AUTHOR]

Purpose: Several preliminary studies suggest dietary guanidinoacetic acid (GAA) might impact methyl group availability and/or methylation biomarkers, fueling ongoing debates. This study aimed to explore the relationship between dietary GAA intake and plasma indicators of the methylation cycle in individuals aged one year and older, using data from the 2001–2002 National Health and Nutrition Examination Survey (NHANES). Methods: Dietary information was obtained from individuals who completed a 24-hour Dietary Recall, with total daily intake of GAA calculated by aggregating all relevant food items. Relevant variables related to the methylation cycle, such as red blood cell (RBC) folate and serum folate, vitamin B12, total homocysteine (tHCy), and methylmalonic acid (MMA), were identified from the NHANES 2001–2002 laboratory assessments. Results: A total of 9,115 individuals (51.3% females) were included in the final analysis. Linear regression unveiled a significant association between higher GAA intake and diminished RBC folate (p < 0.001), serum folate (p < 0.001), and MMA levels (p = 0.007). It also revealed an elevation in tHCy levels with increased GAA intake (p < 0.001). These associations remained significant even after adjusting for demographic variables and dietary factors pertinent to the methylation cycle (p < 0.05). Conclusion: Our findings suggest that dietary exposure to GAA (resulting in conversion to creatine) could be considered a nutritional factor associated with the consumption of methyl groups in the general population. [ABSTRACT FROM AUTHOR]

Context: The role of political identities in determining attitudes to vaccines has attracted a lot of attention in the last decade. Explanations have tended to focus on the influence of party representatives on their sympathizers (partisan cues). Methods: Four representative samples of the French adult population completed online questionnaires between July 2021 and May 2022 (N = 9,177). Bivariate and multivariate analyses were performed to test whether partisan differences in attitudes to vaccines are best explained by partisan cues or by parties' differences in propensity to attract people who distrust the actors involved in vaccination policies. Findings: People who feel close to parties on the far left, parties on the far right, and green parties are more vaccine hesitant. The authors found a small effect of partisan cues and a much stronger effect of trust. More importantly, they show that the more politically sophisticated are less vaccine hesitant and that the nonpartisan are the biggest and most vaccine hesitant group. Conclusions: The literature on vaccine attitudes has focused on the case of the United States, but turning attention toward countries where disenchantment with politics is more marked helps researchers better understand the different ways trust, partisanship, and political sophistication can affect attitudes to vaccines. [ABSTRACT FROM AUTHOR]

Objective: Examine the feasibility and acceptability of a social identity-informed, online delivered, running and walking group program to support low-active post-secondary students' exercise behavior and well-being during the COVID-19 pandemic. Methods: A two-arm, non-blinded, parallel pilot randomized controlled trial was conducted whereby low-active post-secondary students at a Canadian university were equally randomized to an online delivered running/walking group program or an attention control condition. Primary feasibility and acceptability outcomes included program interest, study enrolment and retention, questionnaire completion, program attendance, program satisfaction, and affective exercise attitudes. Post-program interviews were conducted to ascertain participants' experiences with the program. Secondary outcomes included well-being, exercise behavior, social identity, social support, and exercise identity. Results: Ninety-two individuals were screened for eligibility, and 72 were equally randomized to the online group program or attention control condition. Recruitment exceeded the target sample size (60), study adherence and questionnaire completion were above 90%, program attendance was moderate (M = 5.03/8), self-report program satisfaction was moderate-to-high (M = 4.13/5), and there was no condition effect for affective attitudes. During interviews, participants expressed satisfaction with the program. They also discussed challenges with developing a shared sense of identity and social connection with group members via online platforms. There were small condition effects for exercise-related well-being and exercise identity and no condition effects for the remaining secondary outcomes. Social identity scores were moderate (M = 4.63/7). Conclusions: The STRIDE program was feasible and acceptable but should be delivered and piloted in-person before a full-scale efficacy trial is conducted. Trial Registration: ClinicalTrials.gov NCT04857918; 2021-04-20. [ABSTRACT FROM AUTHOR]

Capacity for death awareness and death anxiety in young people has been previously documented but the impact of Covid-19 is not currently known. Therefore, the aim of this study of this study was to explore young people's experiences and responses to the Covid-19 pandemic. Qualitative data was collected from young people via a two-stage process across the United Kingdom: Stage One consisted of an online questionnaire; Stage Two comprised online semi-structured interviews. Responses for Stage One of the study totalled 120 young people; 9 of these were interviewed for Stage Two of the study. Thematic analysis of data identified four themes relating to young people's experiences of the Covid-19 pandemic: death anxiety; mental health; normalising death; and identified support needs. Young people experienced heightened death anxiety due to the pandemic but death also became normalized for them and their mental health was negatively affected. [ABSTRACT FROM AUTHOR]

Given the limited information on physicians' practices at the time of pronouncing a patient's death, this study aimed to learn about the prevalence and purpose of internal medicine residents' practices, the obstacles to performing them and how they can be overcome. Responses to a questionnaire were analyzed using logistic regression, to compare respondents who did and did not have a ritual. Twenty-one interview transcripts were thematically analyzed. A total of 151 physicians responded to the questionnaire; 35 (22.3%) reported performing a private ritual at the time of patient death. Religious participants were 2.97 times more likely {CI: 1.18–7.41} to perform a ritual following a patient's death. Three main themes were found, indicating residents' need to pause and perform a practice to honor the patient, express their humanity, and cope with the overflow of emotions. Senior staff should support opportunities for residents to honor the moment of death. [ABSTRACT FROM AUTHOR]

Firearm carriage and possession predicts youth firearm violence victimization and perpetration. This study describes self-reported factors associated with firearm access, carriage, and possession among justice-involved youth. We conducted an exploratory, mixed-methods study. Participants were recruited from May 2022 to February 2023 from the Juvenile Justice Collaborative, a diversion program for justice-involved youth. We used online anonymous surveys to investigate exposures related to firearm access, carriage, and possession. We performed semi-structured interviews using the phenomenology framework. We used descriptive statistics to examine firearm exposures by participant demographics. We performed qualitative analyses using an iterative approach with constant comparison to identify key themes. We completed 28 surveys and 5 interviews. Most survey participants identified as male (57%) and Black (61%) with a median age of 18 years. Interview participants described the socialization and cultural normalization of firearms, most prominently among peers. Survey participants reported whether they had ever carried (25%) or possessed (21%) a firearm. Survey and interview participants endorsed protection in the context of increasing violence exposure over time as the primary motivation for firearm possession. Interview participants describe accessing firearms primarily through social networks while survey participants also reported access from strangers (25%) and licensed sellers/gun dealers (18%). In conclusion, justice-involved youth believe firearm carriage and possession may be needed for protection due to increasing violence exposure. Further investigation is necessary to determine interventions that may decrease firearm access, carriage, and possession among justice-involved youth. [ABSTRACT FROM AUTHOR]

International studies and the World Health Organization call for collaboration between media and mental health professionals to reduce the risk of imitative suicidal behaviour after suicide reporting – known as the Werther effect – and encourage individuals at risk to seek help. This study explores Portuguese psychiatrists' perceptions of the practices of journalists, their interaction with those professionals, and their perspectives on the national suicide coverage through an anonymous online questionnaire and ten semi-structured interviews. The questionnaire received 128 responses. Only about 24% of the Portuguese psychiatrists characterized their relationship with journalists as cooperative, and most of them considered suicide reporting to be sensationalist and irresponsible. More than 80% of the participants expressed the view that journalists do not know the guidelines for responsible suicide reporting, but more than 95% considered that they can contribute to suicide prevention. These findings suggest that there is a long way to go to build a constructive partnership for suicide prevention between psychiatrists and journalists in Portugal, focused on improving the quality of suicide reporting. We hope this study may inspire similar studies in other countries, since suicide is an international public health problem and collaboration between media and mental health professionals can help to prevent it on a global scale. [ABSTRACT FROM AUTHOR]

In most developed nations, there is a general trend of enrolling hearing-impaired children with special education needs in regular schools. Inclusive education refers to children with special education needs becoming part of a mainstream school like typically developing peers. A good method for evaluating the success of such programs is to assess teachers' attitudes towards inclusion. The inclusive education approach may be challenging to implement across all educational setups due to the lack of academic resources, expertise, and training towards inclusive education. This study explored teachers' attitudes and perceptions towards the inclusion of children with hearing impairment in regular schools in Karnataka state. A tool named 'Teachers Attitude Questionnaire' which was developed by Galis and Tanner was used to study the attitudes and perceptions of school teachers. The tool was then revised by considering geographic and cultural differences and was administered to 421 teachers across Karnataka. Analysis revealed a higher score in all the 4 domains of inclusive education which shows that most teachers had a positive attitude towards inclusive education. Results about teachers' attitudes towards inclusive education based on work experience, type of school, gender, medium of instruction, and level of teaching were statistically significant, p < 0.05. This study concludes that teachers' attitudes varied concerning the level of experience and level of teaching. The results of the current study also stress the need for awareness programs to bring more positive attitudes among teachers, to successfully implement inclusive education. [ABSTRACT FROM AUTHOR]

Background: Hookah smoking among adolescents is a growing public health concern, potentially fueled by a lack of awareness regarding its health risks. This study aimed to determine the risk factors associated with hookah smoking and explore adolescents' perceptions of its harmfulness, addictiveness and social acceptability. Methods: Between October 2019 and April 2020, 400 adolescents aged 12 to 18 years participated in an interviewer-administered survey including socio-demographic characteristics, past medical history, lifestyle behaviors, tobacco use of adolescents and their immediate circle, knowledge on hookah's health risks, perceptions of hookah's addictiveness and social acceptability. Results: Among adolescents 6.8% were regular hookah smokers, while 14.5% had tried hookah at least once. Adolescents who believed hookah was not addictive were more likely to perceive it as socially acceptable (p < 0.001). The perception of social acceptance increased by 1.68 times with each year of age, 2.05 times in the presence of a smoking teacher, and 10.14 times with having tried hookah once. Conclusions: This study highlights that adolescents' limited knowledge of hookah's negative health effects and addictive nature contributes to its social acceptance. Moreover, in addition to family members and friends, teachers significantly impact adolescents' hookah use and their perceptions of its harmfulness, social acceptability and addictiveness. [ABSTRACT FROM AUTHOR]