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Purpose To identify possible technological solutions that can contribute to stroke patients' participation at home. Methods In this qualitative case study, data on factors that negatively influenced participation at home were collected via semi-structured interviews with stroke patients (n = 6). Additionally, data on possible technologies to improve this participation were collected via a group interview with experts (n = 4). The domains "cognition, mobility, self-care, and getting along" (International Classification of Functioning, Disability and Health) guided the data collection and interpretation; open, axial and selective coding was part of the analysis. Results Patients reported 21 factors negatively influencing participation at home, including psychological, cognitive, and physical factors. Experts suggested technological solutions regarding these factors to increase participation of stroke patients; digital assistants, apps, and virtual reality were frequently mentioned. To facilitate the use of these technologies, experts indicated the importance of involving patients in their design. They also suggested that rehabilitation specialists and family members could support the uptake and use of technologies. Conclusions Various technologies were identified by experts as having the potential to improve the participation of stroke patients in their homes. Future research may study the influence of these technologies on the actual participation of stroke patients at home.Implications for rehabilitationThe identified technological solutions can support rehabilitation specialists in guiding stroke patients towards technologies that can support a patient's participation at home.Rehabilitation specialists can be champions in introducing, recommending and promoting technologies to stroke patients and their families, as well as in training them to use technologies.Virtual reality as a technology can be part of rehabilitation, not only to train stroke patients in daily life activities but also to increase empathy and understanding in caregivers and carers on stroke impairments.Rehabilitation specialists can recommend technologies integrated in daily life and presented as general consumer goods; stroke patients are more likely to adopt these kind of technologies.

OBJECTIVE Direct-to-consumer marketing has the potential to increase demand for specific treatments, but little is known about how to best market evidence-based psychotherapies to veterans with posttraumatic stress disorder (PTSD). The objective of this study was to gain an understanding of marketing messages that may impact veteran demand for prolonged exposure (PE) and cognitive processing therapy (CPT). METHOD Veterans (n = 31) with full or subthreshold PTSD participated in semistructured interviews that queried attitudes about PTSD and recovery, current knowledge of PE and CPT, and reactions to existing educational materials. A 2-stage qualitative coding and analytic strategy was used to identify primary themes related to the marketing of PE and CPT. RESULTS Veterans viewed the treatments' effectiveness as their primary selling point but questioned the credibility of improvement descriptions that didn't fit with their experiences or beliefs about PTSD. Participants had difficulties distinguishing CPT from non-trauma-focused approaches in which they had previously participated, leading to skepticism about promised treatment effects and decreased interest. Without targeting, women veterans assumed information regarding PTSD treatment options applied only to men. CONCLUSIONS Examination of the impact of a direct-to-consumer marketing campaign including these messages on PE and CPT demand is needed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objectives People who are referred for colonoscopy, following an abnormal colorectal cancer (CRC) screening result, are at increased risk of CRC. Despite this, many individuals decline the procedure. The aim of this study was to investigate why. Methods As little is currently known about non-attendance at follow-up colonoscopy, and follow-up of abnormal screening results is a nurse-led process, we decided to conduct key informant interviews with Specialist Screening Practitioners ([SSPs] nurses working in the English Bowel Cancer Screening Program). Interviews were conducted online. Transcripts were assessed using inductive and deductive coding techniques. Results 21 SSPs participated in an interview. Five main types of barriers and facilitators to colonoscopy were described, namely: Sociocultural, Practical, Psychological, Health-related and COVID-related. Key psychological and sociocultural factors included: ‘Fear of pain and discomfort associated with the procedure’ and ‘Lack of support from family and friends’. Key practical, health-related and COVID-related factors included: ‘Family and work commitments’, ‘Existing health conditions as competing priorities’ and ‘Fear of getting COVID-19 at the hospital'. Conclusions A range of barriers and facilitators to follow-up colonoscopy exist. Future studies conducted with patients are needed to further explore barriers to colonoscopy. Practice implications Strategies to reduce non-attendance should adopt a multifaceted approach.

OBJECTIVE: To examine the expectations of informal caregivers, nurses, and dementia trainers regarding the support of (physical and psychosocial) human needs by humanoid social assistive robots (SARs) in dementia care.METHODS: A qualitative study was conducted with 11 homogeneous focus groups of informal caregivers, nurses and dementia trainers providing dementia care at home, in adult daycare centers, or in nursing homes. A qualitative content analysis was performed using a concept- and data-driven coding frame.RESULTS: Focus group discussions with 52 individuals were held. Participants reported mostly positive expectations and stated that SARs could offer potential support in all components of human needs, especially in avoiding danger (e.g. recognise danger, organise help), communication/contact with others (e.g. enable telephone calls, provide company), daily activities (e.g. remind of appointments, household obligations), recreational activities (e.g. provide music), eating/drinking (e.g. help cook), and mobility/body posture (e.g. give reminders/instructions for physical exercise). Participants also mentioned some negative expectations in all human needs, predominantly in communication/contact with others (e.g. loss of interpersonal interaction) and avoiding danger (e.g. scepticism regarding emergencies).CONCLUSION: Participants stated that SARs had great potential to provide assistance in dementia care, especially by reminding, motivating/encouraging and instructing people with dementia. Informal caregivers and nurses also considered them as useful supportive devices for themselves. However, participants also mentioned negative expectations, especially in communication/contact with others and avoiding danger. These findings demonstrate the support caregivers and dementia trainers expect from humanoid SARs and may contribute to their optimisation for dementia care.

Objective Explore sequential patterns in students’ interactions with patients expressing emotional concerns in a medical interview. Methods Concepts and principles from conversation analysis (CA) were used to examine the turn-by-turn sequential organization of student actions in eleven video-taped medical interviews. We used results from an earlier coding with an interaction analysis system (VR-CoDES) in a previously published paper as a point of reference. Results By using CA instead of VR-CoDES as our primary investigative method we observed that student turns previously coded as elicitations to simulated patients’ expressions of emotion were often preceded by subtle patient initiatives. Students encouraged further elaboration by displaying their understanding of the emotional issue as a story telling still in progress. Students’ expressions of understanding however, gave little room for further elaboration. Finally, students often addressed emotional issues as a medical issue and offered professional advice. Conclusions Students’ actions seemed specifically designed to display interest in the patients’ initiatives to talk about emotional experiences without departing from their initial interview task or violating norms for professional conduct. Practice implications Educators and practitioners should reconsider how the medical interview may shape expectations for professional conduct and can thereby unintentionally restrict students’ empathy development.

Context Patients and family caregivers perceive burden in care at the end of life differently even when the patient is a physican. . Objective We describe how older adult physicians as prospective patients (hereafter “physician-patients”) and family caregivers of physician-patients view burden in care at the end of life. Methods Interviews with physician-patients (N=28) and family caregivers (N=26) of physician-patients who had died were conducted as part of a shared decision-making study. Both groups expressed concerns with burden at the end of life. We coded and analyzed descriptions of burden using inductive and deductive approaches to coding sub-themes as in qualitative description. We then created a conceptual model depicting the relationships among the concepts, returning to the interviews to verify respective contexts. Results Unilateral actions taken at different points in the illness trajectory by both groups suggested different concerns about burden occurring in parallel. While everyone anticipated burden associated with care at the end of life, physician-patients made legal and financial arrangements to minimize this burden. Nevertheless several family caregivers described the burden that they experienced. We propose a conceptual model to guide future research and care. Conclusions Physician-Patients ‘ clinical insights drive their attempts to alleviate burden on their families. However, family caregivers still experienced burden. Recognizing the parallel perspectives of burden may inform the type and timing of interventions to effectively minimize burden and provide compassionate care to both patients and families at the end of life.

Abstract. Background: Australia's Mindframe guidelines provide media professionals with advice on ways to safely report on suicide. Aims: We aimed to examine the extent to which Australian newspaper articles on Robin Williams' suicide conformed to the Mindframe recommendations. Method: We searched Factiva for relevant articles appearing in Australian newspapers during the 5 months following Williams' death on August 11, 2014. We retrieved the text of these articles from Factiva and, wherever possible, sourced scanned copies from the National Library of Australia. Trained coders rated the articles for quality, using a 10-item coding framework derived from the Mindframe guidelines. Results: Our search yielded 303 articles. In general, there were high levels of adherence to the Mindframe guidelines, with 67% of articles adhering to at least eight (80%) of the Mindframe guidelines. Limitations: We may have missed some articles and the coders' task involved some subjective judgments. Conclusion: Australian newspaper reporting of Robin Williams' suicide was largely consistent with the Mindframe guidelines. In particular, there was good adherence to recommendations designed to minimize the risk of imitative acts, which is positive. The poorer performance of articles in terms of recommendations to do with public education about suicide may be a missed opportunity.

Objective To identify current patient and provider engagement methods that utilize technology in allergy and immunology clinics, hospitals and at home. Data Sources Apple App Store and Google searches for allergy and immunology technology apps, PubMed search of literature involving keywords of: website, technology, EMR, medical devices, disparity in technology, coding for remote patient monitoring and artificial intelligence. Study Selections Studies that addressed the keywords were included and narrowed down based upon their applicability in the allergy and immunology clinic. Results There has been rapid innovation in the digital healthcare space with expansion of EMR services and the patient portal, creation of allergy and immunology specific medical devices and apps with remote patient monitoring capabilities, and website and artificial intelligence development to interact with patients. Conclusion These technological advances provide distinct advantages to the provider and patient, but also have a burden of time for evaluation of the data for the provider and disparate access to certain technologies for patients. The development of these technologies has been fast-tracked since the start of the Covid-19 pandemic. With the explosion in telehealth and medical device development, advancement of medical technology is not showing any signs of slowing down. It is paving a new way to interact with patients in the future.

PURPOSE Addressing financial toxicity among cancer patients is a complex process that requires a multifaceted approach, particularly for rural patients who may face additional cost-related barriers to care. In this study, we examined interventions being implemented by financial navigation staff at various cancer centers that help address financial toxicity experienced by oncology patients. METHODS We conducted semistructured interviews with a convenience sample of financial navigation staff across 29 cancer centers in both rural and urban areas in 7 states. Interviews were audio-recorded and transcribed. Descriptive coding and thematic analysis techniques were used to analyze the data. FINDINGS Thirty-five participants were interviewed, the majority of whom worked in cancer centers located in rural counties. Participants identified the use of screening tools, patient education, and access to tailored financial assistance resources as best practices. Immediate resource needs included additional financial navigation staff, including lay navigators and community health workers, to promote linkages to local resources. Suggested clinical areas for intervention included proactive and early implementation of financial assessments and discussions between providers and patients, along with training and access to regularly updated resources for those in financial navigator/counselor roles. Participants also discussed the need for policy-level interventions to reform health systems (including employment protections) and health insurance programs. CONCLUSIONS Implementing proactive methods to screen for and address financial needs of patients is essential to improving cancer-related outcomes. Additional programs and research are needed to help establish systematic and standardized methods to enhance financial navigation services, especially for underserved rural communities.

Alcohol is a highly toxic substance and has teratogenic properties that can lead to a wide range of developmental disorders. Excessive use of alcohol can change the structural and functional aspects of developed brain and other organs. Which can further lead to significant health, social and economic implications in many countries of the world. Convincing evidence support the involvement of microRNAs (miRNAs) as important post-transcriptional regulators of gene expression in neurodevelopment and maintenance. They also show differential expression following an injury. MiRNAs are the special class of small non coding RNAs that can modify the gene by targeting the mRNA and fine tune the development of cells to organs. Numerous pieces of evidences have shown the relationship between miRNA, alcohol and brain damage. These studies also show how miRNA controls different cellular mechanisms involved in the development of alcohol use disorder. With the increasing number of research studies, the roles of miRNAs following alcohol-induced injury could help researchers to recognize alternative therapeutic methods to treat/cure alcohol-induced brain damage. The present review summarizes the available data and brings together the important miRNAs, that play a crucial role in alcohol-induced brain damage, which will help in better understanding complex mechanisms. Identifying these miRNAs will not only expand the current knowledge but can lead to the identification of better targets for the development of novel therapeutic interventions.

Engineering of cellular biomolecules is an emerging landscape presenting creative therapeutic opportunities. Recently, several strategies such as biomimetic materials, drug-releasing scaffolds, stem cells, and dynamic culture systems have been developed to improve specific biological functions, however, have been confounded with fundamental and technical roadblocks. Rapidly emerging investigations on the bioengineering prospects of mammalian ribonucleic acid (RNA) is expected to result in significant biomedical advances. More specifically, the current trend focuses on devising non-coding (nc) RNAs as therapeutic candidates for complex neurological diseases. Given the pleiotropic and regulatory role, ncRNAs such as microRNAs and long non-coding RNAs are deemed as attractive therapeutic candidates. Currently, the list of non-coding RNAs in mammals is evolving, which presents the plethora of hidden possibilities including their scope in biomedicine. Herein, we critically review on the emerging repertoire of ncRNAs in neurological diseases such as Alzheimer’s disease, Parkinson’s disease, neuroinflammation and drug abuse disorders. Importantly, we present the advances in engineering of ncRNAs to improve their biocompatibility and therapeutic feasibility as well as provide key insights into the applications of bioengineered non-coding RNAs that are investigated for neurological diseases., GRAPHICAL ABSTRACT

OBJECTIVES Clinical event debriefing (CED) can improve patient care and outcomes, but little is known about CED across inpatient settings, and participant experiences have not been well described. In this qualitative study, we sought to characterize and compare staff experiences with CED in 2 hospital units, with a goal of generating recommendations for a hospital-wide debriefing program. METHODS We conducted 32 semistructured interviews with clinical staff who attended a CED in the previous week. We explored experiences with CED, with a focus on barriers and facilitators. We used content analysis with constant comparative coding to understand priorities identified by participants. We used inductive reasoning to develop a set of CED practice recommendations to match participant priorities. RESULTS Three primary themes emerged related to CED barriers and facilitators. (1) Factors affecting attendance: most respondents voiced a need for frontline staff inclusion in CED, but they also cited competing clinical duties and scheduling conflicts as barriers. (2) Factors affecting participant engagement: respondents described factors that influence participant engagement in reflective discussion. They described that the CED leader must cultivate a psychologically safe environment in which participants feel empowered to speak up, free from judgment. (3) Factors affecting learning and systems improvement: respondents emphasized that the CED group should generate a plan for improvement with accountable stakeholders. Collectively, these priorities propose several recommendations for CED practice, including frontline staff inclusion. CONCLUSIONS In this study, we propose recommendations for CED that are derived from first-hand participant experiences. Future study will explore implementation of CED practice recommendations.

Introduction The purpose of this study was twofold: (a) explore how Black women perceive their roles as nursing professionals during the COVID-19 pandemic, and (b) how Black women in nursing mobilized themselves to respond to the disproportionate numbers of Black Americans impacted by COVID-19. Method I conducted semistructured interviews with 6 Black women nursing professionals (5 nurse practitioners and 1 registered nurse). Data were analyzed in 3 cycles: eclectic coding, focused coding, and identifying subthemes and major themes in the data. Results I identified 1 major theme, educating as motherwork, from the data with the following subthemes: educating our own and balancing education with advocacy. Discussion Participants provided education to Black patients about controlling underlying health conditions and making lifestyle changes to reduce the impact of COVID-19. They advocated for changes in health care that reflect the needs and sociohistorical experiences of Black Americans to improve the overall quality of health care. This type of Black women's motherwork or reproductive labor reflects a sense of Black consciousness stemming from their identity as Black women and their recognition of the importance of women in Black families and communities. Participants educated and advocated for Black patients while negotiating their own experiences with systemic racism in health care as Black women nursing professionals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction Little is known about whether sexual and gender minority (SGM) youth and young adults with suicidal ideation receive adequate mental healthcare in the Netherlands. The aim of this study was to examine healthcare experiences and needs of SGM young adults and how formal and informal mental healthcare can be improved to support SGM youth with suicidal ideation. Methods In 2018 and 2019, qualitative interviews were conducted among (1) SGM young adults with a history of suicidal ideation (n = 23, age 18 to 35), (2) parents of SGM youth with suicidal ideation (n = 16), and (3) professionals and volunteers who work with SGM youth (n = 14). Thematic analysis was used for coding and analyzing the interviews. Results Analyses yielded several themes for all groups of participants. Similar themes related to addressing suicidal ideation and SGM issues were found across the three participant groups. Participants perceived a lack of knowledge among professionals regarding SGM issues and perceived that suicidal ideation was sometimes inadequately addressed. Participants expressed the need for training and information on addressing SGM issues and suicidal ideation for parents and professionals. Conclusions Formal mental healthcare is not yet affirmative of SGM identities. Informal and formal healthcare should be improved to address sexual orientation, gender identity, and suicidal ideation. Policy Implications Findings underpin the need for improving skills and knowledge of mental healthcare professionals to better support SGM youth with suicidal ideation. Parents would benefit from accessible information on SGM-related themes and suicidal ideation.

BACKGROUND Opioid misuse during pregnancy has been associated with adverse infant outcomes including preterm birth, stillbirth, and neonatal opioid withdrawal syndrome. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an on-going state-based surveillance system of maternal behaviors, attitudes, and experiences prior to, during, and after pregnancy. Methods: We analyzed qualitative comments related to opioid use during pregnancy collected in 2016 from an open-ended prompt at the end of the PRAMS survey in 35 states (N = 40,408). Key word searches were conducted on the open-ended responses (n = 9,549) to identify opioid-related content with an automated function using Microsoft Excel. All responses from the initial screening (n = 1,035) were manually reviewed, and 69 responses were confirmed to relate to the respondent's personal experience with opioid use during pregnancy. Content analysis was conducted by 3 independent coders; key themes were compiled, discussed, and finalized by the coding team. Results: Five key themes related to opioid use during pregnancy were identified: (1) gratitude for treatment, recovery, and healthy infants; (2) pregnancy as motivation to seek treatment; (3) difficulty finding prenatal care providers with training in substance use disorders; (4) concern about the effects of treatment on the infant; and (5) experiences of discrimination and stigma in the hospital around the time of delivery. Conclusions: Women may be aware of the potential impact of opioid use during pregnancy on the health of their infants and motivated to seek treatment. Findings may help inform new and ongoing initiatives designed to improve care and reduce stigma for women needing or seeking treatment.

Background: Successful rehabilitation is essential to improve the physical and mental outcomes of people with lower limb amputation(s). Individuals have different goals and expectations of successful rehabilitation and experience issues that affect their quality of life. Objectives: To determine factors affecting lower limb prosthetic rehabilitation from people with amputation(s), important for studies focusing on prosthetic and socket design and fitting because they provide context of need and user issues. Study design: Thematic analysis of semistructured interviews. Methods: Ten people with amputation(s) were self-selected from a survey identifying factors affecting lower limb prosthetic rehabilitation. The telephone interviews were semistructured exploring the biggest impactors on and frustrations with rehabilitation and the socket. A thematic analysis was completed by following the undermentioned steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and reporting. Results: Five distinct but interrelated themes were identified: External to Prosthesis, Body Impactors, Consequences of Ill-Fit, Prosthesis Irritants, and Work and Social Impact. Those living with amputation(s) mentioned prosthetic-related issues affecting their work and social life, including difficulties wearing their prosthesis all day, the socket's rigidity, and the ability to participate in hobbies. Conclusions: The study provides new insights into the issues experienced during prosthetic rehabilitation, highlighting impacts beyond just physical health consequences. The study provides an evidence base for areas of the rehabilitation journey which could be improved to improve the quality of life of people with amputation(s)

BACKGROUND: The lived experiences of adults with intellectual disability (ID) during the Coronavirus Disease 2019 (COVID-19) need to be considered when developing and implementing support for maintaining the quality of life outcomes for this population. OBJECTIVE: This study was conducted to capture and analyze adults’ lived experiences with ID during the COVID-19 pandemic. METHODS: A qualitative study with focus groups was conducted that included two groups of adults with ID; graduated (N = 4) and enrolled (N = 5) students from a postsecondary education (PSE) program. Questions were formulated based on societal feature areas that may be affected during unplanned historical events. Data were analyzed utilizing Vivo coding. RESULTS: Four themes (employment, daily living, social, well-being) and eleven subthemes emerged during the interviews. Participants described the impact of COVID-19, such as learning, and implementing new procedures in the workplace, taking on increased responsibilities at home, and the uncertainty of their future. CONCLUSIONS: Findings indicated the need for support for adults with ID to be established before unplanned events to maintain their outcomes as productive members of society. Implications include the need for increased support from immediate support systems.

Background The patient-directed PREPAREforYourCare.org program empowers patients to participate in advance care planning (ACP) discussions with clinicians. Our goal was to determine whether PREPARE could reciprocally increase clinician ACP communication. Methods In a secondary analysis of two trials evaluating the efficacy of PREPARE plus an easy-to-read advance directive (AD) versus an AD alone, patients were included if they were ≥55 years old, English- or Spanish-speaking, and had ≥2 chronic conditions. We audio-recorded postintervention primary care visits and used the validated clinician-patient participation coding scheme to calculate the number of clinician ACP utterances concerning information-giving, recommendations, or supportive talk. We examined differences by study arm using mixed effects negative binomial models, stratifying by language. To assess possible mediation, we adjusted for active patient participation (e.g., asking questions or stating preferences). Results Three hundred ninety-three visits were audio-recorded (177 in PREPARE arm and 216 in AD-only arm). Recordings included 179 clinicians (mean 2.2 [SD 1.9] patients each). Patients' mean age was 66 ± 8 years, 31% had limited health literacy, and 25% were Spanish-speaking. Exactly 67% of recordings included information-giving, 85% recommendations, and 62% supportive talk. PREPARE resulted in 51% more clinician supportive talk versus the AD alone (mean 4.5 [8.9] vs. 2.9 [6.0] utterances; incidence rate ratio 1.51 [95% CI 1.02-2.24]). Effects were most pronounced among Spanish speakers. There were no differences in information-giving or recommendations. After adjusting for active patient participation, no differences in supportive talk remained. Conclusions The patient-directed PREPARE program was associated with greater clinician supportive ACP communication with older adults compared with an AD alone; the effect was most pronounced among Spanish speakers and was mediated by active patient participation. Thus, PREPARE helps patients be more engaged communicators, which in turn encourages clinicians to be more supportive of patients. Enhanced patient-clinician communication represents an important mechanism by which PREPARE may decrease disparities in ACP.

Background : The high rate of medicalization in a woman reduces her ability to give birth and negatively impacts labor. Negative birth emotion in a midwife affects the quality of care. METHOD : This research is a descriptive qualitative research. The sampling technique was purposive sampling consisting of 10 respondents based on inclusion and exclusion criteria setted by the researcher. Data was obtained by conducting in-depth interviews. Data was analysed by reducing data, presenting data, coding, categorizing, and drawing conclusions. RESULTS : Three themes that identified the causes of labor trauma to midwives in this study were complications, pain during labor and post sc, and the absence of a baby sitter. Besides being caused by having previous illnesses, providers who are impatient and prioritize their agendas cause women experience complications that make them traumatized. The attitude of providers and things around women can influence women's perceptions of women's pain. The absence of a baby sitter causes theintense stress for women during pregnancy. CONCLUSION : Providers should have good effective communication skills and pay attention to women's mental readiness during pregnancy and birth. The government ensures that the services provided during childbirth focus on the needs of women so as to reduce the number of trauma.

BACKGROUND: Preventing tuberculosis (TB) in children needs the family to be engaged; however, limited studies about how the family engages in TB prevention. AIM: This aimed of study was to develop the process of family engagement in TB prevention for children with household contact of TB patient. METHODS: Guided by Straussian grounded theory, we developed a substantive theory from 14 primary caregivers in West Java-Indonesia as the key participants of families whose child ≤5 years old received TB screening and preventive therapy, and have had an adult in the household with active TB diagnosis. Data were collected by in-depth interviews and analyzed by coding procedures. RESULTS: Sustaining togetherness aimed to maintain the children’s health, which underpinned three main stages that consisted of “moving from fear to realization,” “making the family’s collective decision,” and “holding on together.” CONCLUSION: Implications for nursing practice in providing optimum care of preventing TB among children through engagement of family.

Objective The purpose of this study was to demonstrate how analyzing social media posts can uncover microaggressions and generate new cultural insights. We explore why Korean women hesitate to seek recommended gynecological care and how microaggressions visible in social media reveal insights for counteracting such harmful messaging. Materials and Methods We scraped the posts and responses on social media related to unmarried women’s uncomfortableness or unpleasantness in receiving gynecological care. We conducted content analyses of the posts and responses with the microaggression framework to identify both the types of microaggressions occurring within and outside the clinic as well as the responsible perpetrators. With an open-coding and subsequent deductive coding approach, we further investigated the socio-cultural context for receiving gynecological care as an unmarried woman in South Korea. Results Our analysis uncovered that mothers, male partners, and superficially supportive social media responders contribute to pre- and post-visit microaggressions toward unmarried women seeking gynecological care whereas healthcare providers contribute to only mid-visit microaggressions. We also exposed how social media was not only revealing but also reinforcing the suppression of women’s health care. Discussion Mid-visit microaggressions are currently addressed by cultural competence education, but pre- and post-visit microaggressions are overlooked. We uncover the gaps in current practices of informatics and public health methods and suggest ways to counteract online and offline microaggressions. Conclusions Social media provides valuable information about the cultural context of health care and should be used as a source of insights for targeted interventions to improve health care, in this case for unmarried Korean women.

We report 1-year follow-up outcomes from a randomized controlled trial involving parents resolving separation or divorce-related disputes and reporting high levels of intimate partner violence (IPV). We compared traditional litigation to two mediation approaches designed to protect parent safety (i.e., shuttle and videoconferencing) at a court-annexed mediation division. The sample was not nationally representative, limiting generalizability. We found no significant differences across conditions in parent reports of satisfaction with the process, level of continuing IPV or interparental conflict, parenting quality, parent functioning, or child functioning. Parents in traditional litigation, relative to parents in mediation, reported significantly more social support. Also, parents in videoconferencing, versus those in shuttle, mediation reported more PTSD symptoms from IPV. Based on coding of legal records, no significant condition differences emerged in relitigation rates in the family court case or charges of study case IPV-related incidents. Given few differences across study conditions, including in satisfaction levels, in contrast to the immediate outcomes, the 1-year follow-up findings do not clearly favor mediation or litigation. We conclude that when both parents in cases with reported high IPV are willing to mediate, mediation designed with safety protocols and carried out in a protected environment by well-trained staff may be an appropriate alternative to traditional litigation. We consider implications of our findings;for example, we discuss implications of the form of videoconferencing mediation examined for conducting online mediation, including during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Introduction Patient-centered care is concordant with patient values and preferences. There is a lack of research on patient values and preferences for pulmonary embolism (PE) testing in the emergency department (ED), and a poor physician understanding of patient-specific goals. Our aim was to map patient-specific values, preferences, and expectations regarding PE testing in the ED. Method This qualitative study used constructivist grounded theory to identify patient values and expectations around PE testing in the ED. We conducted semi-structured interviews with ED patients who were being tested for PE in two EDs. Patients who were waiting for PE imaging or D-dimer results were approached and consented to take part in a 30-minute audio-recorded interview. Each interview was transcribed verbatim and analyzed using constant comparative coding. The interview script was modified to maximize information on emerging themes. Major themes and subthemes were derived, each representing an opportunity, barrier, or value to address with patient-centered PE testing. Results From 30 patient interviews, we mapped four major themes: patient satisfaction comes from addressing the patient's primary concern (for example, their pain); patients expect individualized care; patients prefer imaging over clinical examination for PE testing; and patients expect 100% confidence from their emergency physician when given a diagnosis. Subthemes included symptomatic relief, finding a diagnosis, receiving tests, rapid progression through their care, perception of highly accurate CT scans, willingness to seek a second opinion, direct physician communication, and expectation of case-specific testing with cognitive reassurance. Conclusion Addressing each of these four themes by realigning ED processes could provide patient-centered PE testing.

The current prospective study of 126 older adults examined the new problems and iatrogenic events developing in post-acute rehabilitation. Data were extracted from the electronic health record and a consensual agreement process was used for coding. Of the 578 new problems, 66% ( n = 381) were not related to the primary problem treated at the hospital; 41.7% ( n = 241) were iatrogenic adverse events. The median problem-free duration was 3 days and median duration to a moderate to severe problem was 8 days. Medication-related adverse events were common. This study did not show that comorbidity or functional level should be used in determining the likelihood of older adults developing new problems or iatrogenic events during post-acute rehabilitation. Inferential findings suggest older adults with a psychiatric diagnosis, cognitive impairment, or failure to thrive may require extra measures, such as comprehensive assessment and early intervention, to prevent new problems and iatrogenic events. [ Research in Gerontological Nursing, 14 (6), 293–304.]

Abayneh Tunje,1,2 Degu Jerene,1,3 Inger Kristensson Hallström1 1Child and Family Health, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; 2School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 3KNCV Tuberculosis Foundation, The Hague, NetherlandsCorrespondence: Abayneh Tunje Tel +251920011972Email abayneh_tunje.tanga@med.lu.seBackground: Adolescents with HIV are faced with challenges when taking care of their medication, which affects their treatment adherence. Therefore, this study aimed to explore the experiences and needs of adolescents living with HIV regarding their antiretroviral therapy adherence and retention in care in southern Ethiopia.Methods: An inductive qualitative study design was applied to explore adolescents’ experiences and needs regarding antiretroviral treatment adherence and retention in care in southern Ethiopia. Eighteen adolescents were selected from five HIV care and treatment facilities by purposive sampling. The interviews followed an interview guide, translated into the participants’ national language. The interviews were transcribed verbatim and the first author developed a coding frame for the analysis by using NVivo software including meaning units and codes, which were discussed by all authors. Then, sub-themes and themes were identified and analyzed by qualitative content analysis.Results: The results were described in two themes: barriers and facilitators for treatment adherence and retention in care. Barriers were described in seven subthemes and facilitators in three subthemes. Forgetting to take medication, hiding information, or non-disclosure of HIV status, being afraid to collect treatment drugs, being in an orphanage, and school activities were described as barriers while support from health care workers, families, personal motivation to cope with medication-related problems were described as facilitators for antiretroviral therapy adherence and retention in care.Conclusion: Adherence is a major challenge among adolescents living with HIV in Ethiopia, with barriers that are unique to this age group and their living conditions. Therefore, interventions should be targeted to address privacy barriers, stigma, and lack of support.Keywords: antiretroviral therapy adherence, adolescents, disclosure, HIV, qualitative study, retention in care

Long non-coding RNAs (lncRNAs) are functionally versatile molecules that regulate gene expression at all levels of biological organization. RNA modulation, at the moment, has emerged as a powerful therapeutic technique to treat human diseases. Lately, lncRNAs have been acknowledged as key players in human metabolism and, indeed, implicated in the etiology of many common diseases other than cancers, where they can perhaps serve as reliable markers to determine disease status or assess outcomes of an intervention. Here, in this review, we cite examples of such lncRNAs, discuss their mechanistic role in human diseases and their genetic association, quote potential biomarkers found in human blood, summarize the methods for therapeutic targeting lncRNAs and examine the progress of lncRNA based drugs in clinical trials. Thus, we propose that lncRNAs serve as both a biomarker and an effective therapeutic target with promising clinical utility to manage human metabolic diseases.

Alcohol screening and brief intervention in primary care reduce harmful alcohol use but are rarely conducted in Brazil. This study describes health professionals’ perceptions of patients’ harmful alcohol use. A modified grounded theory approach drawing on purposive sampling was used to secure interviews from thirty-three primary care professionals between September and November 2018. Data analysis was iterative; initial coding was developed by the full research team and refined using formative and axial coding. Alcohol symptomology varied and professionals associated harmful alcohol use with patients’ economic hardship. Although health professionals rarely identified alcohol-related problems among their patients, when alcohol problems were identified, it was often through consultations about other symptoms. Compared to drug use, low to moderate alcohol use was not considered harmful, supported in part by a widespread acceptance of alcohol use. Brazil’s universal primary care system uses a collaborative care model to support integrated treatment of medical and mental health conditions, but alcohol screenings often occur only after problems manifest. Given limited early identification of harmful alcohol use in primary care, it is necessary to improve professionals’ training related to alcohol screening and brief intervention to reduce alcohol-related disability-adjusted life years.

Background Alcohol-exposed pregnancy (AEP) is an ongoing concern, especially within low-resource, high-risk areas such as rural American Indian/Alaska Native (AIAN) communities. Brief, preconceptual AEP-reduction interventions are popular in such areas but have a small impact on alcohol use. Developing a strategic alcohol change plan is a key program component; however, there is little research on strategy selection, especially within contexts that positively or negatively impact selection (e.g., cultural strengths, trauma, collective efficacy within AIAN communities). This study qualitatively analyzed strategies chosen to reduce alcohol use by AIAN women participating in a culturally tailored, brief, preconceptual AEP-reduction intervention. Methods One hundred-sixty Northern Plains AIAN women who were participating in a brief AEP-reduction program developed a plan to accomplish an alcohol reduction/abstention goal at the first and last program sessions. The plan included choosing 1 or more strategies to (1) achieve the goal, (2) mitigate barriers, and (3) use cultural strengths. Qualitative analysis of the data involved thematic open and structured coding of all 3 strategies separately. We also examined how many different themes (different individual strategies) participants reported for each strategy component. Results Most participants reported only 1 strategy (theme) for each of the 3 components. Common goal-achieving and barrier-mitigation strategies included positive social supports and avoiding negative or alcohol-involved social environments. Other strategies involved circular logic (e.g., the strategy to reduce drinking was to drink less). Both traditional and western cultural strengths were reported as important resources, although many participants had no cultural resource strategy. Conclusion Programs aimed at reducing AEPs may need to provide participants more support to develop strong strategies to reduce alcohol use when implemented within areas with high levels of trauma and contextual barriers that can impact strategy selection. Such support could include ways to improve health on both interpersonal and community levels.

Objective To explore contraceptive decision making among recently pregnant patients with a history of opioid use disorder. Study Design We conducted semi-structured qualitative interviews, based on principles of the Ottawa Decision Support Framework, with 20 recently pregnant individuals diagnosed with opioid use disorder at a tertiary care medical center in Massachusetts. We audio-recorded the interviews and they were transcribed verbatim. We analyzed our interview data using inductive and deductive coding. Results Participants value the availability of barrier methods as a means of preventing both sexually transmitted infections and pregnancy. For some participants, housing instability makes storing contraceptive methods and managing personal hygiene related to bleeding patterns difficult. For others, housing instability impacts their overall fertility goals. Side effects including weight gain, interactions with mood stabilizing medications, concern regarding post-operative opioids, or intrinsic aspects of a method that serve as reminders of opioid use may be unacceptable given the risk of relapse. The relapsing and remitting arc of recovery make remembering important aspects of both short- and long-acting contraceptive method use difficult, yet participants offer strategies to aid in doing so. Conclusion When choosing a contraceptive method participants in our study exhibit similarities to individuals with other chronic medical conditions as well as motivations specific to opioid use disorder. Their contraceptive decisions are grounded in integrating a method into a chaotic life, preventing relapse, and protecting future fertility. Implications Our data highlight how lived experiences at the intersection of active opioid use disorder and recovery fundamentally shape the lens through which pregnancy-capable individuals with opioid use disorder view their contraceptive decisions.

Objective: To explore effective therapeutic strategies to promote recovery from first episode of psychosis and minimize its relapse. Study Design: Qualitative study. Place and Duration of Study: Karwan-e-Hayat Psychiatric Care and Rehabilitation Center, Karachi, from Mar to Jun 2019. Methodology: Seventeen participants were recruited through purposive sampling and data was collected through in-depth interviews. Qualitative thematic content analysis was done through generation of a coding scheme. Results: Almost half i.e., 8 (47%) had experience of 10 years, while 7 (41%) had 15 years’ experience, and 2 (12%) had 30 years’ experience as psychiatrists. Analysis of the interview transcripts revealed three main themes related to psychiatrists’ views on interventions for first episode of psychosis to prevent relapse: (1) duration of first episode of psychosis (2) compliance and rate of recovery after first episode (3) effective interventions for first episode psychosis. Conclusion: The effective interventions to promote recovery from first psychosis episode and minimize its relapse included multiple combinations of integrated stage-specific approaches necessitating antipsychotics (pharmacological) and psychosocial support (non-pharmacological).

The researched issue is the impact of infection caused by a new type of coronavirus in the environment of a day care centre. The importance of the issue is given by the fact that the topic directly concerns the lives of all actors connected with the environment offering social services. The purpose was to use the stories obtained from the helpers in order to look at the subjective picture which shows the current situation of the actors. With the onset of the pandemic and the introduction of anti-pandemic measures, they are coming into a specific situation and are facing (up to now) an unknown challenge. The aim of this paper was to use qualitative research tools in order to capture the authentic statements of respondents in a particular environment and try to avoid purposeful interpretations to which the topic may lead. In addition to the description of the stories of the respondents, the study also presents seven key topics arising after data collection and subsequent coding. The argumentation depends on the attitude of the interviewed respondents. The conclusions of the qualitative study offer a starting point for understanding the current serious situation, give the opportunity to understand the phenomenon in a more comprehensive form of authentic statements, and can be used for research into possible impacts of coronavirus crisis on actors in day care centres.

Shiferaw Letta,1 Fekadu Aga,2 Tesfaye Assebe Yadeta,1 Biftu Geda,3 Yadeta Dessie4 1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia; 4School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCorrespondence: Shiferaw LettaSchool of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box: 235, Harar, EthiopiaTel +251911771934Email shife1973@gmail.comBackground: All types of diabetes can damage the heart, blood vessels, eyes, kidneys, nerves and increase the overall risk of disability and premature death. Diabetes mellitus requires a range of self-care practices, scientifically recommended to control the glycemic level and maintain the patient’s health. However, perceived barriers that hinder patients from fully implementing these diabetes self-care practices and obstacles have not been thoroughly explored. Therefore, this study aimed to explore the barriers to diabetes patients’ self-care practices from the perspective of health care providers in two public hospitals in Harar City, Eastern Ethiopia.Methods: Researchers conducted an exploratory qualitative study among 26 health care providers working in two public hospitals from March to June 2021. The study participants were recruited from different disciplines working on diabetes care. Interviews were conducted in the Amharic language until the saturation point was reached. The interviews were tape-recorded, transcribed, and translated to English. Each transcript was read, re-read, and then exported to ATLAS.ti 7 software for coding. Field notes were used to supplement verbatim transcriptions. Initial codes were generated. The consistency between the two coders and their alignment with research questions were checked and applied to all subsequent transcripts after reached on consensus. The thematic analysis was employed in line with the primary set research question.Results: Researchers identified barriers to diabetes patients’ self-care practices such as system, health care providers, and patient-level. These barriers were categorized under three main themes: lack of organized diabetes care services, limited collaborative care practices, and perceived lack of knowledge on self-care practices. In addition, the lack of multidisciplinary team care, lack of training for health care providers on diabetes self-care practices, and availability of laboratory tests and diabetes medication were prominent barriers.Conclusion: Multi-level barriers to diabetes patients’ self-care practices such as system, health care providers, and patients were identified. Therefore, interventions targeting proper service integration, building providers’ and patients’ capacity on diabetes self-care practices, and ensuring the sustainability of laboratory tests and medication supplies are essential. These interventions need to be accomplished through multi-level stakeholders’ engagement and one-to-one or group interventions covering the multi-level challenges.Keywords: diabetes, self-care, barriers, health care providers, holistic care, Eastern Ethiopia

Objective Older persons receiving home care express more cues and concerns compared to other clinical contexts. Increased health condition complexity requires a corresponding increase in nursing competence. The aim of this study was to explore how complexity of older persons’ health and nature of the visit influenced their expressed worries. Methods In this cross-sectional explorative study, we analysed older persons’ expressed worries (n = 508) identified by the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in 129 audio-recorded home care visits with older persons (≥65 years), collected in 3 city districts and 1 rural area in Norway. Results Expressed worries of 45 older persons were included in the analysis: 18 had low health complexity, 5 moderate and 22 high health complexity. The nature of the visit affected the number of expressed worries, health complexity did not. Most of the worries were expressed during basic nursing care visits and/or medication administration. Conclusion Findings suggest that home visit type may influence the older persons’ expressed worries. The complexity of the older persons’ health condition seems to have little impact on the expressed worries. Practice implications Knowledge about communication in different complexity of visits is important when planning care for older persons.

Occupational health medicine plays a critical role in prevention, recognition, and treatment of injuries and illnesses of workers. This article explores commonly billed occupational injuries and illnesses.

Direct observation (DO) of residents by supervisors is a highly recommended educational tool in postgraduate medical education, yet its uptake is poor. Residents and supervisors report various reasons for not engaging in DO. Some of these relate to their interaction with patients during DO. We do not know the patient perspectives on these interactions, nor, more broadly, what it is like to be a patient in a DO situation. Understanding the patient perspective may lead to a more complete understanding of the dynamics in DO situations, which may benefit patient wellbeing and improve the use of DO as an educational tool. We conducted a phenomenological interview study to investigate the experience of being a patient in a DO situation. Our analysis included multiple rounds of coding and identifying themes, and a final phase of phenomenological reduction to arrive at the essential elements of the experience. Constant reflexivity was at the heart of this process. Our results provide a new perspective on the role of the supervisor in DO situations. Patients were willing to address the resident, but sought moments of contact with, and some participation by, the supervisor. Consequently, conceptions of DO in which the supervisor thinks she is a fly on the wall rather than a part of the interaction, should be critically reviewed. To that end, we propose the concept of participative direct observation in workplace learning, which also acknowledges the observer’s role as participant. Embracing this concept may benefit both patients’ wellbeing and residents’ learning.

Background: The National Organization for Civil Registration (NOCR) of Iran has reported causes of death data by ICD-10 chapters for the first time in 2020. Methods: We used this report to review the share of ICD chapters among all deaths in each province and compare them with the Global Burden of Disease (GBD) study. Results: There are major changes in the distribution of causes of death between 2017 and 2018, especially in D50-D89 (Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism) from 0.76% to 38.94%, and I00-I99 (Diseases of the circulatory system) from 39.27% to 7.09%. Such dramatic changes are probably the results of changes in coding practices or definitions or issues in analysis. Conclusion: Causes of death reports should be timely, clear, and robust on methods. They should contain a minimum level of details, at least 3-digit ICD codes to be useful for public health and medical professionals.

Background Rare diseases (RD) are a diverse collection of more than 7–10,000 different disorders, most of which affect a small number of people per disease. Because of their rarity and fragmentation of patients across thousands of different disorders, the medical needs of RD patients are not well recognized or quantified in healthcare systems (HCS). Methodology We performed a pilot IDeaS study, where we attempted to quantify the number of RD patients and the direct medical costs of 14 representative RD within 4 different HCS databases and performed a preliminary analysis of the diagnostic journey for selected RD patients. Results The overall findings were notable for: (1) RD patients are difficult to quantify in HCS using ICD coding search criteria, which likely results in under-counting and under-estimation of their true impact to HCS; (2) per patient direct medical costs of RD are high, estimated to be around three–fivefold higher than age-matched controls; and (3) preliminary evidence shows that diagnostic journeys are likely prolonged in many patients, and may result in progressive, irreversible, and costly complications of their disease Conclusions The results of this small pilot suggest that RD have high medical burdens to patients and HCS, and collectively represent a major impact to the public health. Machine-learning strategies applied to HCS databases and medical records using sentinel disease and patient characteristics may hold promise for faster and more accurate diagnosis for many RD patients and should be explored to help address the high unmet medical needs of RD patients.

We are going through hard times that remind us that good health is the most important thing in life. The COVID-19 pandemic has immensely affected everybody. Measures taken by all countries, including Turkey, to prevent the spread of the coronavirus have deprived students (from preschool to university) of face-to-face education. While the pandemic has had a profound impact on parents and educators, children's lives have been stuck between the “new normal” and the pandemic. This paper investigated how children and their parents experienced the pandemic, how they interacted, and managed educational activities at home. This was a case study, which is a qualitative research method. The sample consisted of 15 families with different sociocultural and socioeconomic status (SES) living in five cities in four regions of Turkey. Data were collected through video-audio recordings, observation notes, and e-interviews. Data were analyzed using second-cycle coding and inductive content analysis. The COVID-19 pandemic caused economic problems, especially in low- and middle-SES families. Economic problems and mental stress impeded the marital interaction patterns of couples, negatively affecting children the most. Upper-SES parents received support from teachers for homeschooling, but other parents faced numerous setbacks and made numerous errors during home-based education, causing parents despair and concern for their children's future. Of all participants, the children of the parents with COVID-19 related health problems were affected by outbreak measures the most. These results can help raise all stakeholders' awareness of the current situation. Given that the COVID-19 pandemic may continue for the foreseeable future, it is believed that the suggestions made to parents and educators for homeschooling can help mitigate the future impacts of the pandemic, especially on preschoolers.

Many authors point to the low incidence of occupational diseases in our country. The reasons are poor-quality preventive examinations, the lack of interest of employers in identifying these diseases, and others. However, there are no works in the literature devoted to errors in the statistical coding of diagnoses of occupational pathology and their accounting. The study aims to improve the accounting of occupational diseases in Russia. We conducted the study using the information base of the Industry Register of Persons with Occupational Diseases, developed by Burnazyan State Medical Center of the FMBA, Russia, which operating in the industry since 2011. As of 31.12.2020, the register contains information on 2,056 patients with occupational diseases, from among the employees of enterprises and organizations served by healthcare institutions of the FMBA, Russia. Errors of incorrect coding of diagnoses for occupational diseases with violation of the classification principles in the used directive materials played a negative role. The development of plans for medical and social rehabilitation measures to reduce the incidence of occupational diseases among the people working in harmful conditions. It requires correct knowledge of morbidity indicators of this nosology. In order to improve the accounting of occupational diseases in Russia, it is necessary to switch to the system of coding diagnoses of this nosology, adopted in medical statistics, and make appropriate changes to the directive documents.

Objective To obtain novel perspectives regarding the effects that surgical training has on the well-being of trainees. Summary background data Improving trainee well-being is a national concern given high rates of burnout, depression, and suicide among physicians. Supporters of surgical trainees may offer new perspectives regarding the effects of surgical training and point to strategies to optimize trainee wellness. Methods This qualitative study employs semi-structured interviews of 32 support persons of trainees at a single tertiary care center with multiple surgical training programs. Interviews focused on perspectives related to supporting a surgical trainee. Interview transcripts underwent qualitative analysis with semantic and conceptual coding. Themes related to effects of training on trainee wellness are reported. Results Four themes were identified: (1)Who Can Endure the Most Hardship?-trainee attributes and programmatic factors contribute to trainees feeling the need to constantly endure the most hardship; (2)Consequences of Hardship-constantly enduring hardships has significant negative effects on wellness; (3)Trainees are Humans-trainees are people with basic human needs, especially the need for worth; (4)Research Time as Refuge-dedicated research time is treated as an oasis away from clinical hardships. Conclusions Perspectives from support persons can offer valuable insight into the wellness needs of surgical trainees. According to support persons, surgical training profoundly negatively impacts trainee wellness. Unlike during clinical training, dedicated research time is a period during which wellness can be prioritized. Programs should provide greater attention to mitigating the negative ramifications of surgical training and promoting wellness in a longitudinal fashion throughout training.

Introduction Alcohol and tobacco are commonly used together. Social influences within online social networking platforms contribute to youth and young adult substance use behaviors. This study used a sample of alcohol- and tobacco-related tweets to evaluate: (1) sentiment toward co-use of alcohol and tobacco, (2) increased susceptibility to tobacco use when consuming alcohol, and (3) the role of alcohol in contributing to a failed attempt to quit tobacco use. Methods Data were collected from the Twitter API from January 1, 2019 through December 31, 2019 using tobacco-related keywords (e.g., vape, ecig, smoking, juul*) and alcohol-related filters (e.g., drunk, blackout*). A total of 78,235 tweets were collected, from which a random subsample (n = 1,564) was drawn for coding. Cohen’s Kappa values ranged from 0.66 to 0.99. Results Most tweets were pro co-use of alcohol and tobacco (75%). One of every ten tweets reported increased susceptibility to tobacco use when intoxicated. Non-regular tobacco users reported cravings for and tobacco use when consuming alcohol despite disliking tobacco use factors such as the taste, smell, and/or negative health effects. Regular tobacco users reported using markedly higher quantities of tobacco when intoxicated. Individuals discussed the role of alcohol undermining tobacco cessation attempts less often (2.0%), though some who had quit smoking for prolonged periods of time reported reinitiating tobacco use during acute intoxication episodes. Conclusions Tobacco cessation interventions may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts. Implications Sentiment toward co-use of alcohol and tobacco on Twitter is largely positive. Individuals reported regret about using tobacco, or using more than intended, when intoxicated. Those who had quit smoking or vaping for prolonged periods of time reported reinitiating tobacco use when consuming alcohol. While social media-based tobacco cessation interventions like the Truth Initiative’s “Ditch the Juul” campaign demonstrate potential to change tobacco use behaviors, these campaigns may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts.

Measurement of social-pragmatic communication skills is essential for clinicians and researchers working with school-aged children on the autism spectrum. Many measures of these skills require time-intensive training and coding that is impractical for clinical assessment settings. Using a sample of 299 elementary school children (M = 8.6 years, sd = 1.7) with autism whose teachers completed the Children’s Communication Checklist-2, we evaluated the psychometric properties of the CCC-2, a commonly used measure of social-pragmatic skills in order to assist researchers and clinicians in identifying the utility of this measure related to their assessment needs. Our results indicate strong psychometric properties for the CCC-2 with this population and a 3-factor model fit: Structural Language, Pragmatic Communication, and Pragmatic Social. Evidence of racial/ethnic bias was found for the structural language factor. Clinical recommendations are provided for using the CCC-2 with students with autism as reported by teachers.

Numerous efforts are underway to train clinicians in evidence-based practices. Unfortunately, the field has few practical measures of therapist adherence and skill with which to judge the success of these training and implementation efforts. One possible assessment method is using behavioral rehearsal, or role-play, as an analogue for therapist in-session behavior. The current study describes aspects of reliability, validity and utility of a behavioral role-play assessment developed to evaluate therapist adherence and skill in implementing Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). TF-CBT role-play assessments were conducted with a sample of 43 therapists as part of a larger training study. The TF-CBT role-play assessments were independently coded for TF-CBT adherence and skill by a certified TF-CBT trainer and three clinical psychology doctoral students. Findings indicated good interrater reliability for the individual items (ICC: M = .71, SD = .15). Regarding utility, 67.19% (n = 43/64) of contacted therapists completed the role-play assessment, which took an average of 30 min (M = 31.42, SD = 5.65) to complete and 60 min (M = 62.84, SD = 11.31) to code. Therapists with a master’s degree were more likely to complete the role-play assessment than those with other degrees but no other differences in demographic variables, practice characteristics, or TF-CBT knowledge or training were found between participants and nonparticipants. Role-play assessments may offer an alternative to observational coding for assessing therapist adherence and skill, particularly in contexts where session recordings are not feasible.

BACKGROUND: The COVID-19 pandemic has compelled a global shift in healthcare service delivery towards virtualisation, including in Neurosurgery. Our study aims to elucidate the patient and neurosurgeon perceptions of virtual neurosurgery consultations (VNCs) and formulate a guidance algorithm based on our experience. METHODS: Between June 2020 and December 2020, we prospectively surveyed patients and neurosurgeons following their VNCs using a 10-item survey (four qualitative and six five-point Likert scale questions). Non-parametric hypothesis testing and grounded coding with inter-coder agreement was used to analyse quantitative and qualitative data, respectively. RESULTS: 106 patients and 10 neurosurgeons completed the survey. Wilcoxon rank-sum test revealed a statistically significant difference between the neurosurgeon and patient responses (p < 0.001). Patients perceived VNCs benefits to be enhanced efficiency (n = 142) and communication (28); and VNCs drawbacks as safety (46), technological (32), and administration (15) issues. Neurosurgeons perceived VNCs benefits to be enhanced efficiency (13), reduced COVID-19 exposure (2); and VNCs drawbacks as examination practicality (14), technological (6), and concerns for patients (6). Neurosurgeons perceived the relative indications for VNCs as postoperative follow-up clinics, and scan result discussions; and relative contraindications as neuro-oncology, new patients, and patients with worsening neurological symptoms. CONCLUSIONS: Our mirror-survey study provides preliminary evidence that VNCs render increased efficiency, communication, and safety in the current COVID-19 era. Going forward, we believe that further improvements in technology and administration are necessary, greater neurosurgeon appreciation of the patient-perceived benefits of VNCs is required, and neurosurgeons are to exercise clinical discernment on when to use VNCs.Key PointsWhat are the perceptions of patient and consultant neurosurgeons towards virtual neurosurgery consultations (VNCs)?Patient-perceived benefits of VNCs: enhanced efficiency/communication; VNC drawbacks: safety, technological, and administration issues. Neurosurgeon-perceived VNCs benefits of VNCs: enhanced efficiency, reduced COVID-19 exposure; VNC drawbacks: examination practicality, technological, and concerns for patients.Post-operative reviews and scan result discussions are perceived relative indications for VNCs; whereas new patient consultations, neuro-oncology and patients with new-onset neurological deficits are perceived relative contraindications for VNCs.Improvement in technology and administration is necessary; greater neurosurgeon appreciation of patient-perceived VNCs benefits is required, and neurosurgeons are to exercise clinical discernment on when to use VNCs.

Hodgkin lymphoma has a bimodal age distribution with the first peak occurring within young adulthood and the second, among older adults. Although current therapy provides excellent disease control, survivors are at risk of developing treatment-related late effects (LEs). We sought to understand how survivors in active survivorship care perceived their role in treatment decision-making and when they acquired an understanding of LEs. Semi-structured interviews were conducted until saturation was reached. Themes were identified through direct content analysis and consensus coding by a multidisciplinary team of coders, including hematology/oncology providers, patient navigators, and survivor stakeholders. Seventeen interviews were conducted. Role in initial treatment decision-making fluctuated between passive and active engagement with providers identified as being crucial to this process. Half of interviewees (53%) expressed unmet information needs. Survivors reported having learned about LEs at multiple time points, spanning from before treatment commenced through when a LE was diagnosed. The majority (71%) expressed a desire to have learned about LEs before initial treatment ended. The impact of cancer and fertility discussions were also disclosed. Participants highlighted the importance of discussions on LEs early in the care continuum. These preliminary data will be incorporated in a planned treatment decision-making tool that incorporates information on potential LEs. Patient-centered communication approaches should be embraced to assist in treatment decision-making, while considering long-term health consequences. Survivors must be educated on their risk of LEs and encouraged to disclose their perspectives and preferences with their providers to optimize outcomes.

Self-forgiveness has been proposed as a method for moving on from transgressions committed against another person. Although definitions of self-forgiveness have proliferated in the scientific literature, little has been done to understand how the general public understands self-forgiveness. To understand similarities between scientific and lay definitions of self-forgiveness, we examined responses from 347 college students to the question “How would you define or describe self-forgiveness?” We used content coding to identify 21 codes to capture participants’ definitions. We also examined these codes within broad themes of internal versus relational focus, and whether the emphasis was on increasing positive or decreasing negative thoughts, feelings, and/or behaviors. Most participants (92.4%) included an internal focus in their definitions, while only about half (49.4%) included a relational focus. We found a significant overlap between how professionals have defined self-forgiveness and how this sample described self-forgiveness. We also found three additional themes to the process of self-forgiveness–using religion to cope, finding peace, and not judging others for their mistakes—that are not typically found in professional definitions. Pseudo self-forgiveness constructs were also found in some participants’ definitions of self-forgiveness, exemplifying the importance for future applied work (e.g., counseling applications, outreach programming) to address these pseudo self-forgiveness conceptualizations that may be held by some individuals seeking services.

Background: Alcohol use is a key preventable risk factor for serious injury. To effectively prevent alcohol-related injuries, we rely on the accurate surveillance of alcohol involvement in injury events. This often involves the use of administrative data, such as International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding. Objective: To evaluate the completeness and accuracy of using administrative coding for the surveillance of alcohol involvement in major trauma injury events by comparing patient blood alcohol concentration (BAC) with ICD-10-AM coding. Method: This retrospective cohort study examined 2918 injury patients aged ≥18 years who presented to a major trauma centre in Victoria, Australia, over a 2-year period, of which 78% ( n = 2286) had BAC data available. Results: While 15% of patients had a non-zero BAC, only 4% had an ICD-10-AM code suggesting acute alcohol involvement. The agreement between blood alcohol test results and ICD-10-AM coding of acute alcohol involvement was fair ( κ = 0.33, 95% confidence interval: 0.27–0.38). Of the 341 patients with a non-zero BAC, 82 (24.0%) had ICD-10-AM codes related to acute alcohol involvement. Supplementary factors Y90 Evidence of alcohol involvement determined by blood alcohol level codes, which specifically describe patient BAC, were assigned to just 29% of eligible patients with a non-zero BAC. Conclusion: ICD-10-AM coding underestimated the proportion of alcohol-related injuries compared to patient BAC. Implications: Given the current role of administrative data in the surveillance of alcohol-related injuries, these findings may have significant implications for the implementation of cost-effective strategies for preventing alcohol-related injuries.

OBJECTIVE Hookah tobacco use among young adults may be driven by misperceptions of health harms and addictiveness, appealing flavors, and social use. This study examined the effects of hookah prevention messages on participants' cognitive and emotional processing in a lab setting. METHOD One hundred twenty participants (61 susceptible never-users, 59 current users) were exposed to messages representing six categories: health risks only, health risks of social use, health risks of flavors, addiction risks only, addiction risks of social use, and addiction risks of flavors. Guided by the Limited Capacity Model of Motivated Mediated Message Processing, participants' psychophysiological responses (heart rate, skin conductance, facial action coding) were recorded while participants viewed the messages. Recognition memory and counterarguing were measured postexposure. RESULTS The combination of heart rate, skin conductance, both positive and negative facial action coding, and recognition memory indicated that social themed messages were more defensively processed than the other message types. Addiction-social messages, in particular, were least likely to be encoded. Further, defensive processing indicated by the psychophysiological and recognition data did not vary according to user status. Counterarguing was higher for users than for never-users across all message themes and risks. DISCUSSION Messages about health risks and addiction, whether or not they included information on flavors, evoked relatively similar responses. But social themed messages stand out as potentially problematic, especially addiction-social messages. Using psychophysiological and self-report measures extend opportunities to identify optimal hookah tobacco public education message features. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Kim McClean, Martyn Cross, Sue Reed Occupational Safety and Health Department, Edith Cowan University, Joondalup, Western Australia, AustraliaCorrespondence: Kim McClean Email k.mcclean@ecu.edu.auPurpose: Identification and mitigation of obesity-related risks to staff and healthcare organisations can occur using patient obesity data; however, a 2017/18 audit of obesity data accuracy was assessed to be poor. This study investigates the results of an intervention to improve obesity data recording and coding accuracy at an Australian hospital.Background: Increasing population obesity rates result in increased organisational and financial risks to hospitals. Australian obesity prevalence has steadily increased since 1995, and 42% of the Australian population is predicted to be obese in 2035. To reduce risks to healthcare staff who care for obese patients, complete and accurate obesity recording is required.Methods: Following a previous audit of obesity recording and coding accuracy of patients admitted to hospital with Type II diabetes, a 12-month intervention was undertaken, comprising staff education, introduction of tape measures and obesity decision-making tools, recording of patient volunteered height, regular reinforcement of obesity recording requirements and enhanced clinical coding of obesity. A re-audit was subsequently conducted to determine if the intervention impacted obesity recording and coding at the previously audited site.Results: Improved recording of obesity-related measures and obesity data accuracy were observed, including increased patient BMI, impacted by increased patient height measurements and increased patient weight measurements. Obesity recording accuracy increased due to the intervention, including increased sensitivity, increased negative predictive values and reduced false negatives.Conclusion: The obesity recording intervention was successful; however, as hospitals increasingly use electronic health records, improvement opportunities should be considered such as compulsory recording of patient weight and height, embedded BMI calculators and “check boxes” for recording impacts of obesity conditions on treatment. Immediate improvement of obesity recording in manual patient files can be achieved in the meantime by implementing targets of 100% weight, height and BMI recording, introducing education programs and auditing compliance.Keywords: obesity, obese, patient handling, coding, administrative data, intervention, training

Background The LGBTQ health disparities literature documents barriers to comprehensive and queer-inclusive care. Queer cisgender women and gender expansive individuals assigned female at birth experience myriad health disparities related to reproductive health, in part owing to the health care system. However, few studies have examined how queer individuals cope with and overcome barriers to queer-competent reproductive health care. This study aims to understand the strategies queer cisgender women and gender expansive individuals use to meet their reproductive health needs. Methods Investigators conducted interviews with 22 queer cisgender women and gender expansive individuals assigned female at birth about their experiences seeking reproductive health care services. We used inductive coding and thematic analysis to identify themes related to meeting reproductive health and health care needs. Results Findings highlight the prevalence of negative and harmful experiences while seeking reproductive health care. In response to these negative experiences, individuals developed active strategies to meet their health needs, including seeking information and community, seeking alternative models of care, and managing identity disclosure. Importantly, these strategies varied in effectiveness, depending on participants' social and economic advantage. Conclusions Queer individuals face numerous barriers to queer-competent reproductive health care when seeking reproductive health services. While queer patients are often resilient and creative, developing strategies to get their needs met, the presence of such strategies highlights the need for structural changes in the health system to better serve queer patients.