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Abstract Purpose A qualitative study was carried out to explore obese adolescents' understanding of physical activity, perceptions of the ideal body type and to identify facilitators of and barriers to physical activity. Methods Twenty‐two adolescents 12–18 years of age and 14 of their parents were recruited from an obesity intervention programme in Brooklyn, New York, from June to November 2017. Data were collected using focus groups and individual semi‐structured interviews, followed by interpretative phenomenological analysis of the transcripts. Results The adolescents wanted to ‘lose some weight’, but not to be ‘thin’ or ‘look hungry’. Most females desired a ‘slim‐thick’ figure, which was ‘a flat stomach with big thighs, and curvy’. Fun and support from parents, peers and programme staff facilitated achieving their physical activity goals. Barriers included low self‐efficacy, inactive families, fear of neighbourhood gangs and crime and perceptions that the parks were small and overcrowded, with limited physical activity options for adolescents. Conclusion These findings highlight the need to consider local norms concerning body image when designing obesity interventions. To effectively reduce childhood obesity in New York City, policy should prioritize the promotion of public safety, improvement of neighbourhood parks and increase options for physical activity. Patient or Public Contribution The voices and narratives of patients and their families informed this study.

Abstract Background No validated instruments for the evaluation of patient satisfaction in colposcopy do exist. Therefore, this study reports on the development of a Patient’s Experience and Attitude to Colposcopy questionnaire. Methods Patients who recently received colposcopy participated in a focus group. A panel of experts evaluated the transcriptions and agreed on a 15-item draft questionnaire. The draft questionnaire was completed by 68 women who subsequently came for a colposcopy. For construct validation, Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed as well as reliability analysis. Concurrent validity was assessed with the 4-item Patient Health questionnaire (PHQ-4). Results Construct validation resulted in an 8-item patient perception scale with good psychometric properties (Cronbach’s alpha: 0.76) and excellent model fit. Two subscales could be discriminated: patient procedure perception scale (alpha: 0.89) and caregiver attitude perception scale (alpha: 0.71). Both subscales intercorrelated moderately (r = 0.28, p = 0.045). The subscale patient perception correlated significantly with the PHQ-4 scale and its anxiety subscale, not with the depression subscale. Conclusions We developed a Patient’s Experience and Attitude to Colposcopy questionnaire with adequate psychometric properties. Future application in out-patient clinics should further evaluate its clinical relevance.

Abstract Background Proximal and distal factors interact to shape children’s development and well-being. The present study aimed to examine socioeconomic status (SES), linguistic skills, and language background as concurrent predictors of socio-emotional and behavioural outcomes in heritage bilingual and monolingual children attending preschool. Methods Parents of 1810 children (mean age = 63.42 months ± 7.36), attending preschool in Italy, completed the Four Factor Index of SES and the Strengths and Difficulties Questionnaire (SDQ). Teachers (n = 99) completed a questionnaire on children’s linguistic skills and emotional and behavioural profiles. A subsample of 995 children was administered an expressive vocabulary task in Italian. Results Regression analyses showed that linguistic skills were the only concurrent predictor of conduct problems, as well as the dominant predictor of hyperactivity/impulsivity, peer problems, and better prosocial behaviour. SES was negatively related to ADHD traits, peer problems, and prosocial behaviour. Finally, heritage bilingualism background was associated, although not as a primary predictor, with increased emotional problems, peer relationship problems, and lower teacher-rated emotional and behavioural skills. However, it was the main factor positively associated with prosocial behaviour. Conclusions The implications of these findings for research in this area and for educational policy are discussed, highlighting the need for a multidimensional perspective that includes linguistic skills and SES in the assessment of children’s emotional and behavioural outcomes.

Abstract Background To compare the outcome of eyes with a macula-on giant retinal tear (GRT) detachment treated with pars-plana-vitrectomy (PPV) depending on the used endotamponade. Methods All consecutive cases with a macula-on GRT-associated rhegmatogenous retinal detachment (RRD) managed with PPV between 2007 and 2022 were retrospectively assessed depending on the selected endotamponade. By reviewing medical charts and surgical protocols the pre- and intraoperative parameters were analysed in detail. The number of vitreoretinal (VR) procedures needed for reattachment, the redetachment rate and the functional outcome were evaluated. Eyes treated with primary silicone oil (SO) tamponade were compared to eyes with primary gas tamponade. Cases with pre-existing conditions affecting outcome e.g. macula-off situation, history of trauma, status after complicated cataract surgery, former VR surgery or proliferative vitreoretinopathy grade C or higher were excluded. Results Overall, 51 eyes of 45 patients with a macula-on GRT detachment were treated with PPV and SO (n = 32; 63%) or gas (n = 19; 37%) endotamponade in the observed period. Eyes with primary SO tamponade underwent on average 2.3 (SD 0.8) VR procedures and had a redetachment rate of 13% (n = 4). Eyes with gas tamponade showed a higher redetachment rate of 32% (n = 6) with a mean number of 1.6 (SD 1.0) PPV procedures. Postoperative best-corrected visual acuity (BCVA) was significantly better in eyes with primary gas tamponade (mean logMAR BCVA 0.32; SD 0.30) compared to eyes with SO (mean logMAR BCVA 0.60; SD 0.42; p = 0.008). Conclusions Surgical management of GRT-associated RRDs is complex. In clinical routine often SO is used as endotamponade. Because of known disadvantages (second procedure necessary for SO removal, unexplained SO-related visual loss, secondary glaucoma, SO emulsification) some VR surgeons prefer a gas tamponade. In our cohort, eyes with a gas compared to SO tamponade showed higher redetachment rates. However, the final postoperative BCVA was significantly better in eyes with gas compared to SO tamponade. Trial registration The trial protocol was approved by the local ethics committee on 25th of November 2022 (Ethikkommission der Universität Regensburg, Votum 22-3166-104).

BackgroundCompared to civilians and non-medical personnel, military medical doctors are at increased risk for sleep disturbances and impaired psychological well-being. Despite their responsibility and workload, no research has examined sleep disturbances and psychological well-being among the medical doctors (MDs) of the Swiss Armed Forces (SAF). Thus, the aims of the proposed study are (1) to conduct a cross-sectional study (labeled ‘Survey-Study 1’) of sleep disturbances and psychological well-being among MDs of the SAF; (2) to identify MDs who report sleep disturbances (insomnia severity index >8), along with low psychological well-being such as symptoms of depression, anxiety and stress, but also emotion regulation, concentration, social life, strengths and difficulties, and mental toughness both in the private/professional and military context and (3) to offer those MDs with sleep disturbances an evidence-based and standardized online interventional group program of cognitive behavioral therapy for insomnia (eCBTi) over a time lapse of 6 weeks (labeled ‘Intervention-Study 2’).MethodAll MDs serving in the SAF (N = 480) will be contacted via the SAF-secured communication system to participate in a cross-sectional survey of sleep disturbances and psychological well-being (‘Survey-Study 1’). Those who consent will be provided a link to a secure online survey that assesses sleep disturbances and psychological well-being (depression, anxiety, stress, coping), including current working conditions, job-related quality of life, mental toughness, social context, family/couple functioning, substance use, and physical activity patterns. Baseline data will be screened to identify those MDs who report sleep disturbances (insomnia severity index >8); they will be re-contacted, consented, and randomly assigned either to the eCBTi or the active control condition (ACC) (‘Intervention-Study 2’). Individuals in the intervention condition will participate in an online standardized and evidence-based group intervention program of cognitive behavioral therapy for insomnia (eCBTi; once the week for six consecutive weeks; 60–70 min duration/session). Participants in the ACC will participate in an online group counseling (once the week for six consecutive weeks; 60–70 min duration/session), though, the ACC is not intended as a bona fide psychotherapeutic intervention. At the beginning of the intervention (baseline), at week 3, and at week 6 (post-intervention) participants complete a series of self-rating questionnaires as for the Survey-Study 1, though with additional questionnaires covering sleep-related cognitions, experiential avoidance, and dimensions of self-awareness.Expected outcomesSurvey-Study 1: We expect to describe the prevalence rates of, and the associations between sleep disturbances (insomnia (sleep quality); sleep onset latency (SOL); awakenings after sleep onset (WASO)) and psychological well-being among MDs of the SAF; we further expect to identify specific dimensions of psychological well-being, which might be rather associated or non-associated with sleep disturbances.Intervention-Study 2: We expect several significant condition-by-time-interactions. Such that participants in the eCBTi will report significantly greater improvement in sleep disturbances, symptoms of depression, anxiety, stress reduction both at work and at home (family related stress), and an improvement in the overall quality of life as compared to the ACC over the period of the study.ConclusionThe study offers the opportunity to understand the prevalence of sleep disturbances, including factors of psychological well-being among MDs of the SAF. Further, based on the results of the Intervention-Study 2, and if supported, eCBTi may be a promising method to address sleep disturbances and psychological well-being among the specific context of MDs in the SAF.

Companies have a responsibility to uphold integrity when disclosing financial reports. This research examines Indonesian Stock Exchange-listed companies in the property and real estate subsector from 2017 to 2021, specifically focusing on the ownership structure of financial, leverage, and intellectual assets and their impact on the integrity of financial statements. Quantitative methods, including panel data regression and descriptive statistics, are used to test hypotheses. A purposive sampling technique was utilised, resulting in a sample of 16 companies and 70 observation data points. The results indicate that ownership by institutions, managers, financial leverage, and intellectual assets collectively impact the honesty of financial statements. According to the findings, leverage affects the integrity of financial accounts somewhat positively, whereas managerial ownership exerts an adverse impact. However, no significant influence was found between institutional ownership and intellectual capital in relation to financial statement integrity.