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(1) Background: A significant proportion of cancer survivors report experiencing a cognitive 'fog' that affects their ability to think coherently and quickly, and reason with clarity. This has been referred to as cancer-related cognitive impairment (CRCI). CRCI has extensive impacts on the daily lives of people living with or beyond cancer, including occupational, social, and psychological functioning. Oncology health professionals report feeling under-resourced to effectively assess the needs of an individual with CRCI and then provide optimal care and referral. (2) Methods: The objective of this project is to develop and provide an initial validation of the first purpose-built unmet needs assessment for CRCI: the Unmet Needs Assessment of Cancer-Related Cognitive Impairment Impact (COG-IMPACT). We will use a multiple-stage, co-design, mixed-methods approach to develop and provide an initial validation of the COG-IMPACT. (3) Results: The primary anticipated result of this research is the production of the COG-IMPACT, the first purpose-built unmet needs assessment for CRCI. The assessment could be used by health professionals to understand the unmet needs and facilitate optimal care and referral for cancer survivors, by survivors to elucidate their supportive needs and advocate for their care, and by researchers to examine the correlates of unmet needs relating to CRCI, as well as how best to support people with CRCI. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of perceived stress and mental health problems among medical professionals (MPs), their professional help-seeking is extremely low. This qualitative study explored MPs' stressors, stress-coping, barriers and facilitators of professional help-seeking. 10 MPs (30% male, M age = 34.8 years) were recruited by purposive-sampling for views from different roles/settings. Thematic analyses revealed five central stressors: emerging novel diseases, challenges from technology-advancement, patient-communication difficulties, lack of workplace mental health care culture, excessive workload/manpower shortage. Participants predominantly used peer support/supervision and de-stress activities for stress-coping. Five factors affecting professional help-seeking were time constraint versus flexibility, mental health stigma versus de-stigmatization, concern over confidentiality/anonymity versus sense of privacy, worry about damage on professional role versus least work disruption, doubts of service providers versus perceived efficacy. All participants indicated a preference for online mental health service delivery. Results reflected unmet needs and service gaps from MPs' perspectives for the development of future interventions. [ABSTRACT FROM AUTHOR]

Although mental health professionals' mental health problems are gaining increased attention, there is little systematic research on this topic. This study investigated the frequency of crisis experiences among mental health professionals and examined how they approach these experiences in terms of their personal and social identities. An online survey was conducted among mental health professionals in 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg (N = 215), containing questions about personal crisis experiences, help sought, service use, meaningfulness of lived experiences, causal beliefs of mental illness and psychotherapeutic orientation. Social identification was assessed via semantic differential scales derived from preliminary interview studies. To investigate relationships between the variables, explorative correlation analyses were calculated. Results showed a high frequency rate of crisis experiences, substantial rates of suicidal ideation and incapacity to work and high service use. Most participants regarded their experiences as meaningful for their personal identity. Meaningfulness was positively related to a psychosocial causation model of mental illness, to psychodynamic psychotherapeutic orientation and to a high degree of disidentification with users and crisis experienced colleagues. The (paradoxical) disintegration of personal and social identity of may be understood as a strategy to avoid stigmatization. A more challenging coping style among professionals is discussed. [ABSTRACT FROM AUTHOR]

In the health professions, altruism is a foundational value upon which professional privilege is built. This imperative towards self-sacrifice for the benefit of others is a key component of what it means to be professional. This paper explores how altruism operates as a coded mechanism of exclusion and oppression for disabled health professionals. Analysis is based on interviews with fifteen Canadian disabled healthcare professionals in medicine, nursing, occupational therapy, and social work about their experiences of inclusion and exclusion. Themes including the disproportionate sacrifice of time, resources, and income emerged, as did the need to manage political disclosure, often embodying the role of the 'super-crip' with patients/clients and colleagues so as to maintain others' faith in their professional competence and their professional privilege. Further discussion includes questions of how to 'crip' altruism as a professional value and the role of altruism as an ableist force within the health professions. Altruism, the idea of helping others even at cost to oneself, is an important value for health professionals. Disabled health professionals sacrifice more than non-disabled healthcare professionals to meet this obligation. Disabled healthcare professionals may work without accommodations, putting in extra time and effort to prove their altruism. Disabled healthcare professionals experience that disclosing disability may mean their colleagues will treat them as patients. [ABSTRACT FROM AUTHOR]

Purpose: Supporting autistic speech-language pathologists (SLPs) is critical to expanding diversity within the field of speech-language pathology. The purpose of this study is to better understand how autistic SLPs reconcile tensions between their personal and professional experiences and negotiate the intersection of these identities. Method: Five certified SLPs, each of whom had a formal autism diagnosis or self-identified as autistic, engaged in a one-on-one semistructured conversation. The recorded interviews were transcribed manually. Following grounded theory analysis, multiple levels of coding were performed to construct a theoretical interpretation of the data. Results: Four themes arose from the analysis. In the first, participants described their outlooks on their autistic identities and how these have changed over time. The second theme concerns interpersonal tensions and conflicts related to communication differences across neurotypes. In the third, participants reflected on the stigma and ableism they face in their careers, and concerns about disclosing their autistic identity in the workplace. The fourth comprised participants' neurodiversity-affirming approaches to clinical practice with autistic clients. Conclusions: This study represents a first step toward understanding the unique strengths of autistic SLPs and the challenges they face. They can be better supported throughout their education, training, and careers. Our field must embrace and promote the neurodiversity paradigm to truly support all our colleagues and clients. [ABSTRACT FROM AUTHOR]

Dichotic listening is the high-level auditory process which enables the perception of different verbal stimuli delivered simultaneously to the right and left ears (binaural integration), as well as the perception of a verbal stimulus presented to one ear while ignoring a different stimulus in the other ear (binaural separation). Deficits in central auditory processing have been reported in children with learning disabilities. The present study aimed to compare dichotic listening performances in right-handed impaired readers (IR) and non-impaired readers (non-IR) according to age. For this, a cross-sectional study was conducted in 120 IR (56 males and 64 females) divided into five age groups and 120 non-IR (63 male and 57 female) matched on chronological age (8 to 9 years; 9 to 10 years; 10 to 12 years; 12 to 18 years; adult). They were tested for binaural integration and binaural separation, allowing for the calculation of dichotic aptitude (DA), ear prevalence (EP), and attentional shift index (ASI). A series of ANOVAs showed an effect of age and of the reading group for all the dichotic-related measures, except for EP. Binaural separation scores were lower in IR who also showed more intrusive responses compared to non-IR. These intrusive responses, which were more frequent on the right ear for IR, decreased with age in both groups. Overall, these results suggest that dichotic listening scores improve with age as the central auditory pathways mature. However, whatever the age, performances are lower in IR than in non-IR. This might be explained by an incomplete maturation of the auditory pathways in IR; an early start for long-term follow-up and auditory training is suggested. [ABSTRACT FROM AUTHOR]

Doctors’ mental wellbeing is a critical public health issue. Rates of depression, anxiety, and substance use are higher than in the general population. Regulating unwell doctors who pose a public risk is challenging, yet there is little research into how medical regulators balance the need to protect the public from harm against the benefits of supporting and rehabilitating the unwell doctor. We analysed judgments from Australia, New Zealand, Ireland, United Kingdom, Ontario, and Singapore between 2010 and 2020 relating to impaired doctors. We found similarities in how decision-makers conceptualise impairment, how they disentangle impairment from associated conduct or performance complaints, and how regulatory principles and sanctions are applied. However, compared to other jurisdictions, Australian courts and tribunals tended to prioritise deterrence above the rehabilitation of the impaired doctor. Supporting impaired doctors’ recovery, when appropriate, is critical to public protection and patient safety. [ABSTRACT FROM AUTHOR]

If a physician is acting on behalf of or reporting to any third parties with respect to the care of a patient, the physician must inform the patient accordingly at the outset and, where appropriate, during the course of any interactions. If any aspect of caring for the patient is beyond the capacity of a physician, the physician must consult with or refer the patient to another appropriately qualified physician or health professional who has the necessary capacity. Editorial One of the central missions of the World Medical Association (WMA) in its role as the global organization of physicians is to ensure the highest possible standard of ethical practice of the medical profession. The physician should respect colleagues' patient-physician relationships and not intervene unless requested by either party or needed to protect the patient from harm. [Extracted from the article]

Purpose/Objective: In this commentary, I call for rehabilitation psychologists to support and advocate for trainees and psychologists with disabilities across the profession as an extension of the foundational principles of the study. Research Method/Design: I reviewed the literature on psychologists and psychology trainees with disabilities, as well as the foundational principles of rehabilitation psychology. Results: A growing body of literature documents both the presence of psychologists and psychology trainees with disabilities and the barriers that they often encounter in the field. One of the foundational principles of rehabilitation psychology and the acknowledgment of the insider-outsider perspective of disability, which holds that disabled individuals, by nature of their lived experience, have unique perspectives on disability that enrich our overall understanding of it. Conclusion/Implications: Through their combination of lived experience and professional expertise, disabled psychologists and trainees bring a critical insider-professional perspective to the field, both inside and outside of rehabilitation psychology. It is both important and in line with our foundational principles that rehabilitation psychologists advocate for psychologists and trainees with disabilities in all settings, so that their important insider-professional perspective on disability can continue to advance the field. [ABSTRACT FROM AUTHOR]

Physician health is strongly connected to patient health outcomes such that barriers to seeking help and medical care for impaired physicians may compromise patient safety and quality of care. It is important to understand and identify barriers that may reduce the likelihood of physicians seeking help. Using medical licensure questions that necessitate self-reporting of health conditions is one of the ways regulatory bodies such as the College of Physicians and Surgeons of Alberta (CPSA) seeks to protect the public and ensure physician competency. The objective of this paper is to review the current body of literature on the impact of these medical licensure questions on physician health-seeking behavior as well as patient care. Five online databases (Scopus, APA PsychINFO, Web of Science, PubMed, and MEDLINE) were searched using combined key terms to identify relevant articles. Based on the inclusion and exclusion criteria, nine primary quantitative studies were selected. Results suggest that licensure applications with questions on previous impairments and mental health condition acts as both a barrier to reporting and to seeking care. These findings highlight the need for further research in examining the utility of health licensure questions in identifying impaired physicians and their impact on the quality of patient care. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUDs) do not discriminate. Anyone can be affected regardless of age, sex, ethnicity, socioeconomic status, or profession. Nurses with SUDs present serious risks to both their patients and the nursing profession. Frontline nurses' responsibility to provide patients with safe, high-quality care may be too great a challenge for those with SUDs, resulting in adverse consequences. Early recognition and treatment of nurses with SUDs promotes patient safety and retention in the profession. For this reason, all nurses and other health care professionals should be able to recognize behaviors associated with SUDs and should be familiar with the available treatment modalities. A guide to early recognition, diagnosis, and treatment of substance-related disorders among colleagues in the workplace. [ABSTRACT FROM AUTHOR]

This study explores and compares the impact of in-person and online versions of a Research-based Theatre production named "Alone in the Ring," aimed at increasing knowledge and fostering positive attitudes towards persons with disabilities in healthcare professions. The study examines changes in attitudes towards disabled persons in healthcare professions, levels of engagement in the play and knowledge about the experiences and challenges of disabled individuals in healthcare professions. It also investigates possible actions to increase inclusion for disabled persons in healthcare education and practice. Disabled students face numerous barriers in healthcare education and practice, many of which are rooted in stigma and negative attitudes. Research-based Theatre promotes experiential learning to address these attitudes and stereotypes. The performance "Alone in the Ring" is based on a comprehensive study of the experiences of disabled students and clinicians in health professions, aiming to promote inclusion for students with disabilities in these fields. This study uses a pre-test and post-test design with two comparison groups. The study employed an explanatory sequential mixed method design to explore the impact of online versus in-person Research-based Theatre teaching in healthcare education. Participants were graduate health students (N = 198); 100 watched the in-person version and 98 watched the online version. Surveys were administered before and after the performance. Participants were also invited to share their experiences in semi-structured interviews and their responses were analyzed using thematic analysis. Results indicated that students generally felt more comfortable with disabled persons in healthcare professions in the post-survey compared to the pre-survey, with online participants reporting greater comfort and higher engagement than those in-person. Knowledge of disabled persons' experiences and challenges, as well as possible actions to increase belonging and inclusion, improved significantly for both groups from pre- to post-performance, with online participants showing a greater change. Qualitative data revealed that online theatre was perceived as authentic and beneficial for accessibility, engagement and emotional impact on students, though challenges included potential distractions and technological issues. Positive correlations were found between changes in knowledge, positive attitude and engagement, suggesting that increased engagement and a shift in attitudes can promote knowledge and awareness of the inclusion of disabled persons in healthcare professions. These results support the use of online theatre-based academic teaching that experientially engages students, increases empathy and can promote more inclusive healthcare educational settings for disabled persons. [ABSTRACT FROM AUTHOR]

Much has been written around the meaning and impact of grief and grieving on people's lives following the death of a person, and anticipatory grief/grieving is receiving increased attention in nursing and healthcare. However, the impact of anticipatory grief on an autistic male adult has received far less research exposure than that of neurotypical (non-autistic) adults. This article, 'written' in the form of a letter by the author to community nurses, seeks to address this. The intention is to initiate reflective discussions around anticipatory grief and grieving, as current and future support will be stimulated on the part of community nurses through dialogue between those on the autistic spectrum and community nurses. Ultimately, the aim of this article is to help improve the support provided by community nurses to autistic individuals. [ABSTRACT FROM AUTHOR]

Within the framework of the current drive to transform psychology in South Africa, this paper highlights "other" axes of identity that are arguably largely overlooked within the field. The conversation exposes the discipline of psychology – specifically within the South African context – and its many unexamined assumptions concerning "expected" identities of psychologists – specifically, those along heterosexual and able-bodied lines. By engaging in an autoethnographic conversation, the two authors, both "other", practising psychologists – one queer, one disabled – share and reflect on some of their experiences of feeling othered in their chosen profession. Drawing on parts of queer theory, critical disability literature, as well as the theoretical framework of biopolitical power, we start to make sense of our experiences of difference, deviance, and defiance. How the field of psychology marginalises "other" psychologists, and the impacts on those who bear the oppressions, is exposed; and a conversation is begun in which the discipline's assumptions around compulsory forms of identity – straight, not disabled, among others – are disrupted in productive ways. [ABSTRACT FROM AUTHOR]

Exposure to potentially traumatic events (PTEs) at work can have a negative impact on the psychological health and work life of child protection workers (CPWs). The most common form of work-related PTE experienced by CPWs consists of aggressive behaviours from the youths or their parents. This study aims to identify modifiable work-related variables that might influence the probability of experiencing impaired mental health and professional adjustment following a PTE. The participants were CPWs from two youth social services organizations in Canada. A survey was administered to CPWs within one month of a work-related PTE (Time 1; n = 176), two months after the PTE (Time 2; n = 168), six months after the PTE (Time 3; n = 162), and 12 months after the PTE (Time 4; n = 161). Lagged linear mixed models allowed for the independent variables measured at Time 1, Time 2, and Time 3 to predict the outcome variables as measured on the next assessment (Time 2, Time 3, and Time 4, respectively). The outcomes of interest were insomnia symptoms, depressive symptoms, anxiety symptoms, and post-traumatic stress symptoms, as well as presenteeism (inadequate work performance) and professional quality of life. Confidence in one's own ability to cope with service user aggression negatively predicted depressive, anxiety, and post-traumatic stress symptoms as well as presenteeism, and positively predicted professional quality of life. The perception of job safety negatively predicted depressive, anxiety, and post-traumatic stress symptoms, and positively predicted professional quality of life. Finally, psychological demands from work positively predicted all mental health outcomes as well as presenteeism, and negatively predicted professional quality of life. This study identified work-related variables that could be modified in an attempt to prevent the negative impacts of exposure to work-related PTEs, especially, aggressive behaviours from the service users. Modifiable work-related variables – self-efficacy, the perception of job safety, and psychological demands from work – predict mental health variables and professional adjustment following exposure to a potentially traumatic event in child protection workers. [ABSTRACT FROM AUTHOR]

Frontline workers are tasked with enabling the employment of disabled people. They engage with an ableist narrative that constructs disabled people as less worthy, less productive, and subordinate when they formulate contrasting narratives of disabled people as productive and capable workers. To better understand how frontline workers engage with the ableist narrative, focus group interviews were conducted with frontline workers (counsellors, employment specialists, and market coordinators) within the Norwegian Labour and Welfare Administration. Focus group interviews generate interaction data resulting from discussions amongst informants revealing aspects of frontline work assumed to be otherwise less accessible, such as success stories. The primary finding is that frontline workers bring up success stories when they are talking about disability and work inclusion. Three narrative practices of these success stories are explored, each with specific contexts and circumstances: learning, motivating, and disability branding. While these narratives aim to redress disabled people's subordinated position, they still display ableist norms, thus suggesting that an ableist paradox exists in frontline workers' success stories. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to explore the perceptions and experiences of registered nurses (RNs) practising with a disability or impairment, and to describe the strategies they used to support their role as an RN. Background: Despite the availability of anti-discrimination guidance, nurses practising with a disability or impairment described varying levels of understanding and support available to them from colleagues and managers. Methods: A descriptive qualitative study allowed us to explore and describe RNs' experiences and perceptions of their interactions with colleagues and managers in clinical practice. This process uncovered what was important to the participants, including strategies they used to ensure they practised safely. Participants took part in a 60-90 minute interview that gathered their experiences and perceptions of working with a disability or impairment as defined by the RN. The semi-structured interview schedule, with one main question and prompt questions, enabled participants to share their individual stories. Thematic analysis was undertaken. Participants: Ten RNs -- nine female and one male -- were selected purposively because they identified as living and working with a disability or impairment. Findings: Four themes were identified. Impairment or disability? -- Nurse participants preferred to articulate the impact of the disability or impairment on them, rather than defining those terms. Telling others captured the decision-making process they went through on whether to disclose their disability or impairment at work. Participants described fear or reluctance to disclose; this decision was also influenced by whether their disability or impairment was visible or invisible. Getting support pulled together some of the concerns nurses had about the lack of organisation-wide support. The perceived lack of support affected the nurse's desire to ask for help and often resulted in the nurse organising their own support resources. Impact in the workplace -- The nurse participants had developed unique strategies to ensure they nursed safely. Conclusion: For participants, the ability to define the impact of their disability or impairment on their working lives was more important to them than selecting a definition of "disability or impairment". All participants were committed to safe nursing practice. The degree of visibility of the disability or impairment influenced the nurse's willingness to disclose or ask for help. A visible disability was acute or obvious and a less visible disability reflected the post-acute, rehabilitative, or chronic stage. However, overall, because many of the nurses did not feel safe to disclose their disability or impairment, ask for help, or know where to go to access support, accommodations were not made for them in the workplace. [ABSTRACT FROM AUTHOR]

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Purpose To assess employees' experiences of the workers' compensation claim process for psychological trauma, stress or a mental health condition sustained during the course of work in the police and emergency services sector. Methods 14,868 employees (69.4% male, response rate = 22%) from around Australia participated in Answering the Call: the Beyond Blue National Mental Health and Wellbeing Study of Police and Emergency Services, and were asked questions regarding their workers' compensation experiences for mental health reasons. Results 14% of all employees in police and emergency services organisations had made a workers' compensation claim for mental health reasons. Only 8.2% of employees making a claim had a positive experience (95% CI 6.6–9.8) while 70.3% had a poor experience (95% CI 67.6–73.0). Two-thirds of employees who had made a claim reported that the process was unsupportive and stressful, and over half reported that it had an overall negative impact on their recovery. Employees with poor overall support from their managers and those who perceived negative stigma about mental health in their workplace were more likely to report poor experiences. Conclusions The workers' compensation process is perceived negatively by most police and emergency services employees who have experience with it, and a majority found that it negatively impacted on their recovery. Ways to reform the system to better support employees experiencing significant functional impairments related to mental health issues should be urgently considered. [ABSTRACT FROM AUTHOR]

Background: Interpersonal and technical skills are required for the care of people living with substance use disorders. Considering the applicability and usability of online courses as continuing professional education initiatives, this study aimed to describe the content design process of an introductory-level healthcare-centered Massive Open Online Course (MOOC). Methods: The content of the course was informed through needs assessment, by using three sources: (a) narrative literature review, (b) Delphi health experts panel consensus, and (c) focus groups conducted with people living with substance use disorders. The data from the empirical research phases were analyzed through qualitative Thematic Analysis. Results: The product of this research project is the introductory-level Massive Open Online Course "Healthcare: Developing Relational Skills for the Assistance of People Living with Substance Use Disorders" which approaches health communication and empathetic relational professional skills as a means of reducing stigmatization of people living with substance use disorders. Conclusions: Diverse strategies for designing distance education initiatives have to consider different views on the subject being approached in such courses. The product presented in this paper has the potential to be an educational tool for topics traditionally not addressed in Brazilian continuing education and can be used as a model to the design of online courses directed to the development of work-related skills for the healthcare professions. [ABSTRACT FROM AUTHOR]

Objective: There is a gap in knowledge regarding serious disciplinary matters concerning health professionals under the Health Practitioner Regulation National Law Act 2009 (hereafter 'National Law'). The present study applies a typology of misconduct to the first 7 years of available tribunal cases under the National Law brought against the five most populous regulated health professions with the overarching goal of mapping the relationship between type of misconduct and outcome. As subquestions, the study examined whether the ostensibly uniform law is producing consistency of outcomes, both between the professions and between jurisdictions. Methods: All publicly available Australian tribunal-level decisions concerning complaints of serious misconduct and/or impairment brought against the five most populous regulated health professions (nurses and midwives, doctors, psychologists, pharmacists, and dentists) were gathered from 1 July 2010 to 30 June 2017. Decisions were coded for case and respondent attributes, the type/s of misconduct alleged, whether proved, and the relevant disciplinary outcome. Respondent attributes were: profession, sex, legal representation, and certain identified 'risk' factors from previous studies. The type of allegation was coded based on five main categories or heads of misconduct, with subtypes within each. Outcomes for proved conduct were coded and categorised for severity. Analyses of cases was conducted using SPSS, version 21 (IBM, New York, NY, USA). Data was subject to statistical analysis using Pearson's Chi-squared test with an α value of 0.05. Results: Major variations were identified in outcomes across the professions, with doctors being subject to less severe outcomes than other professions, in particular compared with nurses, even when the same main head of misconduct was in issue. Differences in legal representation did not completely account for such variation. Marked disparities were also identified between outcomes in different states and territories, suggesting that the National Law is not being applied in a uniform manner. Conclusion: Tribunal cases reflected complaint data in that: (1) male practitioners were greatly over-represented as respondents; (2) outcomes were most severe for sexual misconduct and least severe for clinical care; and (3) doctors faced less severe outcomes than other professions. There were also significant variations in severity of outcome by jurisdiction. Variations were more pronounced when deregistration was the focus of analysis. What is known about this topic?: Existing research on complaints data under the National Law in place since 2010 has suggested that doctors may be receiving less severe outcomes than other professions at board level. There is a gap in knowledge concerning serious disciplinary matters heard by tribunals. Unlike data on complaints against regulated health professionals collated by AHPRA, legal tribunals, which hear only the most serious matters, do not record data on cases in a consistent or centralised form. What does this paper add?: This study is the first to compare tribunal outcomes for the five most populous professions by reference to the type of misconduct proved. The finding that different professions are receiving different outcomes for the same malfeasance is novel. Other novel findings include significant variations in severity of outcome by jurisdiction, more pronounced variations in outcomes by both profession and jurisdiction when deregistration was the focus of analysis and variations in outcome according to legal representation. What are the implications for practitioners?: There are major implications for policy makers and decision makers in terms of whether the National Law is operating consistently, with important outcomes for practitioners in terms of equitable and fair treatment when facing disciplinary charges. [ABSTRACT FROM AUTHOR]

Background and Objectives: Substance use in community college students has been explored in only a handful of studies. Differences in population characteristics and substance use between 2- and 4-year students suggest that different factors may promote and thwart this behavior. Cumulative risk is a parsimonious methodology that provides better model stability and more statistical power, yet it has only been recently used in substance use research. The aim of this study is to investigate multiple aspects of substance use risk in a population in need of substance use prevention and intervention services.Methods: We conducted a cross-sectional study of community college students (N = 288; 75% female) examining the relative contributions of different domains of cumulative risk (eg, life stressors, academic stressors, and mental health diagnoses) to develop different profiles of risk across substance use classes (ie, alcohol, cigarette, marijuana, and hard drug use).Results: Cumulative risk analyses indicated that alcohol and tobacco use were associated with the domains of life stressors and peer/family substance use, marijuana use with peer/family substance use and stressful childhood experiences, and hard drug use with peer/family substance use, lack of social support, low access to care, and stressful childhood experiences.Discussion and Conclusions: Different strategies for prevention and intervention may be necessary to effectively address different forms of substance use in this population.Scientific Significance: The risk domain profiles related to specific drugs may lead to targeted interventions to reduce substance use in community college students. (Am J Addict 2020;29:97-104). [ABSTRACT FROM AUTHOR]

Context: Healthcare professionals are crucial in the identification and accessibility to treatment for people with substance abuse. The objective of the study was to assess students’ knowledge towards substance use disorders and examine the consequences of these on health. Substance abuse is a social problem, not in India alone, but the entire world. The use of drugs has its own culture and history, which varies from country to country. The problem of substance abuse is growing at an explosive rate and in just little over a decade it has spread its malevolent tentacles to almost every part of the globe surmounting almost all barriers of race, caste, creed, religion, sex educational status, economic strata etc.As the first experience of substance abuse often starts in adolescence, and studies have shown that drug use is mainly related to cigarette and alcohol consumption, an initial exploration of substance abuse prevalence, including cigarette and alcohol, seems to be the first step in preventing and controlling drug consumption. [ABSTRACT FROM AUTHOR]

Background and Objectives: Identical latent classes of substance use for 7 to 8 grade and 9 to 12 grade American Indian (AI) youth living on or near reservations suggest that patterns of substance use are established early among these youth. This study examines relationships of substance-related factors to latent class membership and whether these relationships differ by grade group.Methods: In-school surveys were administered to 1503 7 to 8 grade and 1995 9 to 12 grade students from 46 schools on or near reservations during the 2009/2010 to 2012/2013 school years. Four-class latent class models of substance use were specified and five classes of substance-related factors (peers, substance availability, perceived harm, family, early initiation), plus grade level and gender, were evaluated as predictors.Results: For 7 to 8 grade students, substance-related factors differentiated nonusers from users, while for 9 to 12 graders, these factors also differentiated types of users. Early initiation and peer factors were strongly related to class membership, while other factors were less strongly related.Discussion and Conclusions: Early initiation of alcohol or marijuana is strongly related to being in a substance-using class for AI youth. Because these youth tend to initiate use earlier that other US youth, prevention resources should be targeted to reaching them and their families before age 12.Scientific Significance: Predictors of latent classes of substance use were identified for reservation-based AI youth. While the classes were identical for 7 to 8 grade and 9 to 12 grade youth, predictors varied across grade group, which may inform how best to develop prevention efforts unique to middle and high school AI youth. [ABSTRACT FROM AUTHOR]

Healthcare professionals are crucial in the identification and accessibility to treatment for people with substance abuse. The objective of the study was to assess students’ knowledge towards substance use disorders and examine the consequences of these on health.1 Substance abuse is a social problem, not in India alone, but the entire world. The use of drugs has its own culture and history, which varies from country to country. The problem of substance abuse is growing at an explosive rate and in just little over a decade it has spread its malevolent tentacles to almost every part of the globe surmounting almost all barriers of race, caste, creed, religion, sex educational status, economic strata etc. As the first experience of substance abuse often starts in adolescence, and studies have shown that drug use is mainly related to cigarette and alcohol consumption, an initial exploration of substance abuse prevalence, including cigarette and alcohol, seems to be the first step in preventing and controlling drug consumption. [ABSTRACT FROM AUTHOR]

This article reviews the strengths and weaknesses of the current requirements for continuing professional education for psychologists to renew their license to practice. Whereas most states already require completion of classroom or workshop instruction during each license renewal cycle, the authors argue for a more comprehensive system of continuing professional development (CPD) that will focus on the ongoing assessment of competence throughout the professional's career and thus better ensure public protection from the incompetent or unethical practitioner. The authors describe the major elements of this more comprehensive CPD process and how adoption of such a system in psychology licensing laws would require participation in a variety of learning activities that focus on professional engagement, practice relevant topics and better assessment of instructional outcomes; provide peer input and monitoring to better identify gaps in knowledge or skills; and reduce instances of professional isolation that could lead to lapses in judgment and decision making, occupational stress, and ultimately impairment or burnout. Challenges for the profession to move to a system of CPD, and the need for studies that can determine whether using CPD in licensure renewal requirements actually produce the desired outcomes, are also addressed. [ABSTRACT FROM AUTHOR]

There are approximately 3.1 million nurses in the Unites States (U.S. Census Bureau, 2016), and approximately 8% of them experience substance use disorders (Kunyk, 2015). Nurses with impaired practice are referred to peer assistance programs as they seek rehabilitation. As of 2016, 348 nurses in Texas Peer Assistance Program for Nurses were actively participating in the program for substance-abuse-related offenses. Over the last 6 years (2010–2016), 1,553 nurses were referred to Texas Peer Assistance Program for Nurses specifically for substance-abuse-related problems. These represent 2% of the population of nurses in Texas. The average age of participants was 40.1 years. Women represented 75% of participants, and 76% were registered nurses. About 41% successfully completed the program without relapsing, and 32% reported at least one relapse. Varieties of drugs were abused including prescription drugs and illegal drugs. Opioids were the most frequently abused class of drugs, followed by alcohol and stimulants. Most nurses obtained their drugs by diverting from patients. Contrary to what is in the literature, nurses working in long-term care, medical–surgical units, and home health care had the highest prevalence of impaired practice. Psychiatric comorbidity was not significantly associated with relapse, but self-report status was significantly associated with gender, age category, license type, relapse, and drug of choice. There was a significant inverse relationship between time it takes to enroll and number of abstinent days. Men were also more likely to be employed while in the program. [ABSTRACT FROM AUTHOR]

Nursing knowledge surrounding anesthesia providers' maintaining or obtaining employment after treatment of substance use disorder (SUD) is notably absent in the literature. An alternative method, dimensional analysis, allows for exploration of this concept from many perspectives, with social context as the basis from which to determine what barriers exist and how to prevail over them. Anesthesia practice is a socially constructed profession. The concept, barriers to reentry into nurse anesthesia practice, was explored and defined for purposes of identifying their impact on the recovering certified registered nurse anesthetist (CRNA). Defining the barriers places the CRNA one step closer to successful reentry into anesthesia practice. [ABSTRACT FROM AUTHOR]

The article presents the author's views on the need to support mental health care providers after their patients died of drug overdose. The experience of an adult psychiatry resident of handling a 26-year-old who was stabilized on buprenorphine and was found dead by his parents from an apparent overdose, is cited. Topics include the common emotions experienced by providers, the barriers to accessing treatment for opioid use disorder, and the need to prepare providers for drug overdose death.

Background and aims: This literature review investigates the scope of information regarding self-reported substance use by professionals and students in professional programs, with a focus on anticipated and actual effects of substances. Methods: A review of English, peer-reviewed journals and professional journals was conducted. Articles were included if they reported empirical findings of original research and specifically described an aspect of substance use (e.g. type of substance used, patterns of use, reasons for use) by professionals or students. Results: Of the 130 articles ultimately included, 105 involved anonymous self-administered survey methodology. Self-reported data about the effects of substance use or reasons for use were reported in 35 articles. Reasons for use included positive impact on performance and experience, such as fun, pleasure, sleep, enhanced work performance, improved attention and concentration, and relaxation. Predictive associations were analysed regarding demographic factors, mental health, type of profession, and area of specialisation. Conclusions: Little is known about the effects of substance use on the performance or experience of professionals or students in professional programs. Research is required that incorporates qualitative methodologies, elicits anticipated and actual effects of substance use, including controlled and beneficial patterns of use. Minimisation of research bias is key to future study of the effects of substance use by professionals or students in professional programs. [ABSTRACT FROM AUTHOR]

Evidence from physician health programs (PHPs) suggest that long-term continuums of step-down care are effective at achieving at or near a 15% relapse rate. Parallel to the PHP model, evidence from collegiate recovery programs (CRPs) cite a relapse rate from year to year of 8%. The CRP and PHP models involve long-term, comprehensive components of care and ancillary services oriented toward highly transformative abstinence-based recovery. This article identifies factors between the two models that facilitate recovery and discusses the implications for future research. [ABSTRACT FROM AUTHOR]

Relapse is the unauthorized use of any mind-altering substance, prescribed or not, after an individual has entered treatment for substance use (Darbro, 2011). Among nurses with impaired practice, the 5-year relapse rate is estimated at about 40% (Zhong, Kenward, Sheets, Doherty, & Gross, 2009), and the risk of relapse is highest in the first year of recovery (Clark & Farnsworth, 2006). Many factors influence susceptibility to relapse among nurses including presence of psychiatric comorbidities (Schellekens, de Jong, Buitelaar, & Verkes, 2015), history of criminal background (Zhong et al., 2009), spirituality and religiosity (Allen & Lo, 2010), and receiving prelicensure education in the United States (Waneka, Spetz, & Keane, 2011). The purpose of this study was to examine the correlates and predictors of relapse among nurses and to establish at what point they are most susceptible to relapse. This study was a retrospective secondary data analysis of nurses in Texas with impaired practice. The total number of participants was 1,553. The time it takes participants to enroll in a peer assistance program is negatively associated with length in program (p <.001). Conversely, there is a strong, positive, significant relationship between the number of days abstinent and the length in program (p <.001). More men compared with women (p =.037) were likely to be employed while participating in the program. Finally, participants who were referred for substance use disorders alone had 55% less risk of relapse. Those who used alcohol as their primary drug of choice had 1.7 times higher risk of relapse. [ABSTRACT FROM AUTHOR]

Fatigue has major implications on both patient safety and healthcare practitioner's well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a fatigued operator working (i.e. fatigue reduction), or reducing the likelihood that a fatigued operator will make an error (i.e. fatigue proofing). Recent progress mainly focussed on fatigue reduction strategies such as reducing work hours. Yet it has to be recognized that such approach has not wholly overcome the experience of fatigue. Our purpose is to investigate individual proofing and reduction strategies used by emergency physicians to manage fatigue-related risk. 25 emergency physicians were recruited for the study. Four focus groups were formed which consisted of an average of six individuals. Qualitative data were collected using a semi-structured discussion guide unfolding in two parts. First, the participants were asked to describe how on-the-job fatigue affected their efficiency at work. A mind map was progressively drawn based upon the participants' perceived effects of fatigue. Second, participants were asked to describe any strategies they personally used to cope with these effects. We used inductive qualitative content analysis to reveal content themes for both fatigue effects and strategies. Emergency physicians reported 28 fatigue effects, 12 reduction strategies and 21 proofing strategies. Content analysis yielded a further classification of proofing strategies into self-regulation, task re-allocation and error monitoring strategies. There is significant potential for the development of more formal processes based on physicians' informal strategies. [ABSTRACT FROM AUTHOR]

The article discusses the distinction between burnout in psychiatrists and major depressive disorder. Topics include the use of instruments to measure burnout in health professionals, effective techniques for burnout interventions in health care professionals, and the diagnostic criteria for major depressive disorder.

Background: Major depressive disorder (MDD) is characterized by impairments in emotional and cognitive functions. Emerging studies have shown that cognition and emotion interact by reaching identical brain regions, and the insula is one such region with functional and structural heterogeneity. Although previous literatures have shown the role of insula in MDD，it remains unclear whether the insular subregions show differential change patterns in MDD.Methods: Using the resting-state fMRI data in a group of 23 drug-free MDD patients and 34 healthy controls (HCs), we investigated whether the abnormal connectivity patterns of insular sub-regions or any behavioural correlates can be detected in MDD. Further hierarchical cluster analysis was used to identify the functional connectivity-clustering patterns of insular sub-regions.Results: Compared with HCs, the MDD exhibited higher connectivities between dorsal agranular insula and inferior parietal lobule and between ventral dysgranular and granular insula and thalamus/habehula, and lower connectivity of hypergranular insula to subgenual anterior cingulate cortex. Moreover, the three subregions with significant group differences were in three separate functional systems along anterior-to-posteior gradient. The anterior and middle insula showed positive correlation with depressive severity, while the posterior insular was to the contrary.Limitations: The small and unbalanced sample size, only included moderate and severe depression and the possible inter-individual differences may limit the interpretability.Conclusions: These findings provided evidences for the MDD-related effects in functional connectivity patterns of insular subregions, and revealed that the subregions might be involved in different neural circuits associated with the contrary impacts on the depressive symptoms. [ABSTRACT FROM AUTHOR]

Loss of function mutations in the SCN1A gene, which encodes the voltage-gated sodium channel Nav1.1, have been described in the majority of Dravet syndrome patients presenting with epileptic seizures, hyperactivity, autistic traits, and cognitive decline. We previously reported predominant Nav1.1 expression in parvalbumin-expressing (PV+) inhibitory neurons in juvenile mouse brain and observed epileptic seizures in mice with selective deletion of Scn1a in PV+ cells mediated by PV -Cre transgene expression ( Scn1a fl/+ / PV -Cre-TG). Here we investigate the behavior of Scn1a fl/+ / PV -Cre-TG mice using a comprehensive battery of behavioral tests. We observed that Scn1a fl/+ / PV -Cre-TG mice display hyperactive behavior, impaired social novelty recognition, and altered spatial memory. We also generated Scn1a fl/+ / SST -Cre-KI mice with a selective Scn1a deletion in somatostatin-expressing (SST+) inhibitory neurons using an SST -IRES-Cre knock-in driver line. We observed that Scn1a fl/+ / SST -Cre-KI mice display no spontaneous convulsive seizures and that Scn1a fl/+ / SST -Cre-KI mice have a lowered threshold temperature for hyperthermia-induced seizures, although their threshold values are much higher than those of Scn1a fl/+ / PV -Cre-TG mice. We finally show that Scn1a fl/+ / SST -Cre-KI mice exhibited no noticeable behavioral abnormalities. These observations suggest that impaired Nav1.1 function in PV+ interneurons is critically involved in the pathogenesis of hyperactivity, autistic traits, and cognitive decline, as well as epileptic seizures, in Dravet syndrome. [ABSTRACT FROM AUTHOR]

Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. [ABSTRACT FROM AUTHOR]

Introduction: The intoxicated person may cause harm to others, often requiring expert evaluation for the determination of guilt. The primary aim of this study was to determine the mechanisms of mistakes that led 17 doctors accused of working under the influence of alcohol to face malpractice. We also wanted to clarify what were the legal, professional, and financial consequences - depending on specific patient outcomes.Method: We based analysis on the review and meta-analysis of the past forensic evaluation reports of institution-run forensics programs. Furthermore, we apply thematic analysis using combination of grounded theory and Pierre Bourdieu's theoretical framework.Results: During the 2010-2016 timeframe, the regional forensic service opinionated on 17 physicians (3F, 14M) subjected to disciplinary action due to providing treatment under the influence of alcohol. In total, there were 157 patients potentially affected by malpractice - out of those, four were harmed; only one qualified for compensation. In the remaining 153 patients - only 11 persons reported having had awareness about the doctors' intoxication and apparent inability to perform the job, yet they agreed to receive care. Overall, in over 90% of patients, the physician did not harm anyone to a degree threatening patient's life. The supporting staff did not report experiencing distress either. The results of a blood test for the presence of alcohol were available for only four cases. Therefore, it was impossible to analyze the correlation between intoxication level and performance in providing care. All in all, in our analysis - less than 10% of 157 patients' care were compromised by provider's intoxication, either due to a mistake in diagnosis, medical procedure, or lacking communication skills.Conclusion: For physicians, working under the influence of alcohol is an uncommon phenomenon, but when it occurs - patients are at risk for receiving poor treatment. Presented analysis indicates that patients - just as much as supporting staff - frequently agree to receive supervision and care from a drunk doctor, despite possible harm. Therefore, it is evident that patients as much as supporting staff fear retaliation, leading to underreporting of these cases. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effects of a 1‐day acceptance and commitment therapy (ACT) workshop on the mental health of clinically distressed health care employees, and to explore ACT's processes of change in a routine practice setting. Design: A quasi‐controlled design, with participants block allocated to an ACT intervention or waiting list control group based on self‐referral date. Methods: Participants were 35 health care workers who had self‐referred for the ACT workshop via a clinical support service for staff. Measures were completed by ACT and control group participants at pre‐intervention and 3 months post‐intervention. Participants allocated to the waitlist condition went on to receive the ACT intervention and were also assessed 3 months later. Results: At 3 months post‐intervention, participants in the ACT group reported a significantly lower level of psychological distress compared to the control group (d = 1.41). Across the 3‐month evaluation period, clinically significant change was exhibited by 50% of ACT participants, compared to 0% in the control group. When the control group received the same ACT intervention, 69% went on to exhibit clinically significant change. The ACT intervention also resulted in significant improvements in psychological flexibility, defusion, and mindfulness skills, but did not significantly reduce the frequency of negative cognitions. Bootstrapped mediation analyses indicated that the reduction in distress in the ACT condition was primarily associated with an increase in mindfulness skills, especially observing and non‐reactivity. Conclusions: These findings provide preliminary support for providing brief ACT interventions as part of routine clinical support services for distressed workers. Practitioner points: A 1‐day ACT workshop delivered in the context of a routine staff support service was effective for reducing psychological distress among health care workers. The brief nature of this group intervention means it may be particularly suitable for staff support and primary care mental health service settings. The findings indicate that the beneficial effects of an ACT workshop on distressed employees' mental health were linked to improvements in specific mindfulness skills. Study limitations include non‐random allocation of participants to the ACT and control groups, and measurement of mediators and outcome at the same time point (3 months post‐intervention). [ABSTRACT FROM AUTHOR]

The websites of many physician health programs provide lists describing signs of impairment or indications to refer physician-employees for evaluation and possible treatment. This study aimed (1) to determine how many of these descriptions likely provide physicians' employers with sufficient evidence to legally request mental health examinations under the general regulations of the Americans with Disabilities Act (ADA); and (2) to find out who they described. The authors applied US Equal Employment Opportunity Commission guidance documents and sought expert legal advice to evaluate the descriptions for their consistency with the ADA. They used directed content analysis to review and code these descriptions into categories. Very few, if any, of the 571 descriptions appeared to provide sufficient evidence for employers to request an examination under the ADA. About 14%, however, could refer to physicians attempting to defend themselves, assert their ADA rights, or otherwise complain about the hospital; and 27% either described physicians who complain or else had discriminatory effects in one of several different ways. Leaders within the medical field should ensure that their policies and state laws pertaining to physician impairment comply with and incorporate the language of the ADA. They should also reevaluate the functions of these policies, laws, and physician health programs, and the implications for patient safety, physician wellness, suicide, and other important issues. [ABSTRACT FROM AUTHOR]

Background: Substance use disorder (SUD) is a national epidemic. The problem is underreported and gaps exist in nurses' knowledge pertaining to recognizing and reporting nurses with an SUD. The purpose of this research was to examine the effects of an educational intervention on SUD to meet the continuing education (CE) requirement for relicensure. Method: A quasi-experimental pretest-posttest design was used to determine whether an increase in scores occurred following completion of the National Council of State Boards of Nursing Learning Extension's online course, titled Understanding Substance Use Disorder in Nursing. Eighty-six nurses started the online course. Results: Sixty-eight of the 86 nurses completed the online course. An increase of 22% (p , .001) was observed when pre- and posttest scores were compared, suggesting an increase in nurses' knowledge about SUD. Conclusion: Online CE courses are an effective means to increase SUD knowledge for nurses. [ABSTRACT FROM AUTHOR]

Background: Substance abuse in adolescents and its outcomes is one of the important public health concerns. Objectives: The present study aimed at estimating the prevalence of substance abuse and evaluating some of its associated factors in Iranian adolescents. Methods: A self-administered questionnaire was completed by 730 randomly selected students with a mean age of 17.6-0.61 years during a cross sectional study in Yazd, a central province of Iran, during 2014. Theaimof the questionnairewasto obtain information on substance abuse and socioeconomic information. Logistic regression model and Chi-square, or Fisher exact test were used for statistical analysis using SPSS; and P < 0.05 was considered statistically significant. Results: The highest frequency of one time and more than one time drug usage among students pertained to hookah 41.1% and 31.1%, cigarette 17.5% and 8.1%, alcohol 10.8% and 7.5%, Opiates 4.1% and 0.8%, hashish, bang or marijuana 1.9% and 0.7%, stimulants and hallucinogens 3.4% and 0.8%, and glue and lighter gas 0.8% and 0.7%, respectively. Based on the results in logistic regression models, male gender (AOR:3.02), mathematical physics (AOR:1.8), hookah and alcohol experience (AOR:14.4 and 3.4) for regular smoking in Model 1; male gender(AOR:2.7), cigarette and hookah experience (AOR:3.2 and 7.6) for ever use of alcohol in Model 2; and male gender (AOR:2.5), mathematics course studding (AOR:1.6), poor educational condition (AOR:1.7), high level of father education (AOR:3.9), and tranquilizer experience (AOR:5.8) for ever use of illicit drugs in Model 3 were considered as predicting factors. For all the abovementioned, p-values were less than 0.05. Conclusions: In the present study, it was found that drug abuse is at a warning rate. The findings pointed to the need for interventional plans to improve adolescents' health with regards to substance abuse. Conducting more studies on this population is necessary to approve the observed results of the present study. [ABSTRACT FROM AUTHOR]

Objective To provide an overview of the evidence regarding outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns, and to explore if outcomes differ for specific concerns and professions. Methods A search in four databases (Medline, Embase, PsycINFO and CINAHL) was conducted from 1 January 1990 to 7 May 2017. Studies reporting on outcomes of nationwide and state-wide programmes aimed at remediation and rehabilitating healthcare professionals with performance concerns (ie, dentists, midwives, nurses, pharmacists, physicians, physiotherapists, psychologists and psychotherapists) were included. Results We included a total of 38 studies. More than half of the studies included programmes in the USA (57.9%), and a majority of studies focused on outcomes for physicians (78.9%) and on outcomes for substance use disorders (SUDs, 63.2%). Programme completion rates for SUDs were positive and approximately 80%-90% of participants were employed after treatment. Studies that reported on remediation outcomes for dyscompetence, almost all from Canada (7/8), showed varying results. One study compared outcomes for performance concerns in the same programme (ie, SUD and other mental and behavioural problems) and showed comparably successful results. No study specifically compared outcomes between professions. Conclusion The literature is dominated by outcomes for physicians in North American programmes, with positive outcomes for SUD and varying outcomes for dyscompetence. Based on our findings we cannot make valid comparisons in outcomes between professions and specific performance concerns, and we call for other programmes to report on outcomes for different professions and concerns. Because of the positive outcomes of physician health programmes, other countries should consider introducing similar programmes to support healthcare professionals getting back on track. [ABSTRACT FROM AUTHOR]