Completed Questionnaires Research Articles

Relationship Between Social Isolation, Loneliness and Psychological Well-Being in Inflammatory Bowel Disease Patients: The Mediating Role of Disease Activity Social Isolation in Inflammatory Bowel Disease.

To evaluate the relationship between social isolation, loneliness and psychological well-being in patients with inflammatory bowel disease (IBD). Additionally, we examined the mediating effect of disease activity on the relationships between social isolation, loneliness and psychological well-being. Cross-sectional descriptive study. A total of 218 participants were recruited from outpatient clinic at a university hospital in Turkey and from the community membership of the patient support group. Participants provided their socio-demographic and disease-related information and completed (online and paper based) the Turkish Lubben Social Network Scale-6, the Turkish UCLA Loneliness Scale Short Form and the Turkish Psychological Well-being Scale. The data were analysed using univariate linear regression analysis. This study adhered to the STROBE checklist for reporting. The majority of the participants (72%) were socially isolated, and over half (54.1%) reported moderate to high levels of loneliness. Participants also had low psychological well-being. Linear regression analysis revealed that high loneliness level and social isolation were negative predictors of psychological well-being. The results revealed that the effect of social isolation and loneliness on psychological well-being was mediated by disease activity. In line with the findings, it can be recommended to enhance social support and networks, along with regular psychological evaluation, should be integrated into the holistic care approach for IBD patients. The findings of this study hold significant implications for the management and support of patients with IBD, particularly within clinical settings in Turkey. Patients were invited to complete questionnaires. The investigators explained the study's content and purpose, and addressed any concerns during the data collection process.

Working in emergency services in Germany: cross-sectional data on violence experience and perception

Abstract Background Violence in emergency medical services (EMS) continues to be a topic of concern. Experiencing violence impedes the workers’ wellbeing, thus impairing the coverage and quality of EMS. We explored employment-related factors associated with violence experience and perception. Methods We conducted an anonymous online-based survey among EMS staff in Germany (09.2023-01.2024). Participants reported on their work setting, frequency of violent experiences and perception of violence. Descriptive statistics and logistic regression were calculated. Results Of 224 participants with completed questionnaires, 86 reported to have been exposed to physical violence (PV) in the past 12 months (Median number of events=2.00) and 129 reported to have experienced non-physical violence (NPV; Median number of events=5.00) with the majority of participants reporting that all cases occurred during assignment (n(PV)=79; n(NPV)=86). Of those, 78 reported PV by patients and 5 by colleagues, while in NPV cases 113 participants experienced violence by patients and 40 by colleagues. Women had a higher probability of reporting PV experiences compared to men (OR = 2.214, p=.010). Reporting NPV experiences was negatively associated with age between 45 and 49 (compared to ≤ 24 years, OR=.291, p=.019) and having worked for the current employer for ≥16 years (OR=.339, p=.035). Participants who have experienced violence in the past year had a higher likelihood of perceiving a general increase in the prevalence of violence in EMS (PV: OR = 6.766, p<.001; NPV: OR = 1.688, p=.047). Conclusions Younger EMS workers with juniority have a higher probability of reporting experiencing NPV. Women are more likely to report experiencing PV. It remains to be explored, if these associations refer to the experiences of violence, to reporting frequency or both. Regardless, the majority of respondents perceive an increase in violence within the work setting of EMS, especially if they have been subjected to it themselves. Key messages • EMS professionals experience significant levels of physical and non-physical violence originating from patients and colleagues. • Sex, age and seniority may affect the likelihood of EMS professionals of experiencing physical or non-physical violence.

The Performance of Staff at the Arusha Regional Immigration Office: An Investigation into the Influence of Job Enrichment Practices

The inefficiency and low morale of Immigration staff in Tanzania have led to significant concerns regarding their performance. Over 40% of Immigration Department staff report low job satisfaction, and employee productivity has declined by 25% over the past three years. The persistent issues of inefficiency and low morale threaten to undermine these functions, thereby justifying the need for this study. This study assesses the influence of job enrichment practices on the performance and job satisfaction of Immigration Department staff in Arusha. The study employed a descriptive research design guided by a pragmatism research philosophy, which balances both subjective and objective perspectives to address the complex issues related to job performance and satisfaction. The study also used Job Characteristics Theory (JCT), which posits that certain job characteristics such as skill variety, task identity, task significance, autonomy, and feedback enhance employee motivation and performance. Data was collected through questionnaires and interviews with a sample size of 52 respondents whereby 47 staff completed questionnaires and 5 leaders were interviewed. A purposive sampling technique was used to ensure that participants with direct experience in job enrichment practices were included. The questionnaires were analyzed using descriptive statistical methods, including frequencies, percentages, means, and standard deviations. The qualitative data from the interviews were analyzed using thematic analysis. The findings reveal that job characteristics significantly impact job performance. This study highlights the significant role that job enrichment and job satisfaction play in enhancing the performance of Immigration Department staff in Arusha. The findings suggest that focusing on improving job characteristics that contribute to job satisfaction can lead to a more motivated and productive workforce. It is recommended that the Immigration Department adopt strategies that promote job enrichment, such as providing opportunities for skill development, increasing employee autonomy, and ensuring a supportive work environment.

Comparative efficacy of oral and vaginal probiotics in reducing the recurrence of bacterial vaginosis: a double-blind clinical trial

ObjectiveThe primary goal of this study is to discern the optimal adjuvant treatment for patients diagnosed with bacterial vaginosis, focusing on reducing recurrence rates.MethodsThis study is a double-blind clinical trial with no previous similar trials conducted to date. The study population consisted of non-pregnant, married women visiting teaching hospitals’ clinics in Mashhad, complaining of vaginal discharge. After informed consent and questionnaire completion, samples were obtained from vaginal discharge surrounding the cervix of clinically diagnosed bacterial vaginosis patients. Using Gram staining, a gold standard method for bacterial vaginosis diagnosis, samples were examined under a microscope according to the Nugent score. After initial treatment with metronidazole, patients were divided into two groups receiving either vaginal or oral probiotics.ResultsOf the 55 participating women, 20 were in the vaginal probiotic group and 35 were in the oral probiotic group. No significant demographic or clinical differences existed between groups at baseline. The Nugent score decreased from 8.5 to 3 in the vaginal group and from 9 to 3 in the oral group, suggesting the effectiveness of both treatments. While the difference between groups was not statistically significant, each group showed significant improvements from their initial states (p-value < 0.001).ConclusionNo significant difference was observed in the effectiveness of oral versus vaginal probiotics in reducing the recurrence of bacterial vaginosis after routine treatment. Therefore, the type of probiotic to be used could be chosen based on patient preference.

Purging frequency and number of purging methods as indicators of severity in bulimia nervosa: Interactive effects with binge eating episodes.

In the Diagnostic and Statistical Manual of Mental Disorders-5, severity of bulimia nervosa (BN) is defined by the frequency of purging behaviour. Previous research suggests the number of purging methods as an alternative rating. The current analysis investigated characteristics (sociodemographic and treatment-related variables, body mass index [BMI], eating disorder-specific and general psychopathology) of persons with BN as a function of purging frequency and number of purging methods in order to examine which approach might be better suited for indicating severity of BN. Two-hundred and sixty-one persons (98.5% female; mean age 25.2years, SD=9.41; mean BMI 22.0kg/m2, SD=3.79) with BN completed self-report questionnaires on eating disorder-specific and general psychopathology at admission to inpatient (n=214) or daypatient (n=47) treatment. Higher severity based on either purging frequency or number of purging methods tended to relate to lower BMI and higher eating disorder-specific and general psychopathology. In addition, binge-eating frequency differentially related to eating disorder-specific and general psychopathology as a function of severity groups. This study partially supports the utility of both purging frequency and the number of purging methods as indicators of severity in persons with BN. However, focussing only on purging behaviours may be short-sighted as it appears necessary to consider the number of binge-eating episodes as well when evaluating severity of BN.

An ecological perspective of psychological distress predictors among minoritized populations facing a collective crisis: the case of Arab-Palestinians during the COVID-19 pandemic in Israel

ABSTRACT The study examined predictors of psychological distress among Arab-Palestinians in Israel during COVID-19 from an ecological perspective. Participants (n = 665) completed questionnaires assessing their sense of danger, resource loss, social support, barriers to accessing formal support, social exclusion and ethnic discrimination, and depression, anxiety, and somatization. Our structural equation model accounted for 68% of the psychological distress variance. Individual, interpersonal, community, and socio-political variables were significantly interrelated, and associated with psychological distress. The socio-political context of Arab-Palestinians highlighted specific challenges and resilience factors. Results underscore the necessity of a holistic approach and context-sensitive policies to address psychological distress among minoritized populations.

Patient’s Perceptions and Experiences about the Root Canal Treatment: A Survey among Patients Visiting Nobel Medical College

Introduction: One major drawback of root canal therapy (RCT) is that most people don't know enough about it. To effectively address the issue, it is imperative to comprehend and identify the elements that impede or discourage patients from undergoing Root Canal Treatment. A survey of the literature reveals a dearth of information regarding patients' understanding and acceptability of root canal treatment (RCT) in the Nepali community. Objective: The objective of the study was to determine how well-informed patients were about root canal treatment at Nobel Medical College and Teaching Hospital in Biratnagar. A wide-ranging patient viewpoint on the matter was sought by means of a patient survey. Methods: This survey was conducted with the help of prestructured questionnaire consisting of 15 questions, distributed to random 250 patients coming to the outpatient department of Conservative dentistry and Endodontics at Nobel Medical College and Teaching Hospital. The completed questionnaires were then analyzed to assess patients’ experiences, concerns, and perceptions about RCT. Results: There is a lack of awareness among patients regarding RCT. Conclusion: The people need to be made more aware of the importance of maintaining a healthy dentition and the consequences that follow if this isn't done. If patients were fully informed about endodontic procedures, more might consider having them.

Cybersecurity behaviours of the employees and students at the Estonian Academy of Security Sciences

PurposeThe purpose of this study is to identify the most common characteristics that make Internet users at the Estonian Academy of Security Sciences (SKA) vulnerable to various threats. This includes password management habits, online banking, shopping and payment behaviours, time spent online, use of public Wi-Fi, gaming and watching movies online. Additionally, the study seeks to review the dangers users encounter and how cautious they are, such as which online activities they consider the most dangerous and which they perceive as safe.Design/methodology/approachThe data used in this paper is based on an overview of relevant literature, highlighting previous studies and methodologies and explaining why the human factor is considered the weakest link in cybersecurity. This research aims to help characterise the patrons of the SKA and make suggestions for future training and research. For this purpose, the students, administrative employees and academic staff of the SKA were investigated. A five-point scale questionnaire with 54 questions was used as the methodology of the study, considering the following four scales: risky behaviour, conservative behaviour, risk exposure behaviour and risk perception behaviour. The results are interpreted based on the literature, and data obtained from the completed questionnaires were analysed using Excel’s Data Analysis ToolPak. The results are presented mostly as tables and bar charts.FindingsThe research results show that the cybersecurity behaviour of employees and students is generally at a good level. However, some aspects of conservative behaviour need increased attention, such as the use of USB and other external media, opening links in emails too readily, monitoring the authenticity of visited websites and deleting browsing history before logging out. Cyber training has a noticeable effect on behaviour, particularly in the context of password management.Originality/valueNo previous research on cyber behaviour has been conducted in the context of Estonian higher education, despite the increasing number of cyber-attacks in this sector.

Relationship between erectile dysfunction and alexithymia in male patients with implantable cardioverter defibrillators: a cross-sectional study.

Implantable Cardioverter-Defibrillator (ICD) implantation is a life-saving intervention for individuals at risk of life-threatening arrhythmias. However, the psychosocial impact of ICD implantation extends beyond its cardiovascular benefits, potentially influencing emotional well-being and sexual health. This can lead to erectile dysfunction, which, is often associated with alexithymia. Both erectile dysfunction and alexithymia can significantly affect the psychological well-being of both patients and their partners. This study examines the association of erectile dysfunction with alexithymia in patients after ICD implantation. Additionally, we investigate potential moderators of this association. Patients (N=165) completed self-rating questionnaires: Toronto Alexithymia scale (TAS-20), International Index of Erectile Function (IIEF-5), Adjustment disorder - new module (ADNM-20). Descriptive statistics, correlations, multivariate linear regressions, and moderation analysis were conducted. The determinants of erectile dysfunction in ICD patients were explored in a regression model explaining 22% of the total variance. The ADNM-20 subscale preoccupation was found to significantly moderate the relationship between the alexithymia subscale externally oriented thinking and erectile dysfunction (R2 = 0.02, p=0.03). We did not find evidence for a relationship between externally oriented thinking and erectile dysfunction at low to average levels of preoccupation. However, evidence for such a relationship was found at high levels of preoccupation, where more externally oriented thinking was related to more erectile dysfunction. The intersection of alexithymia and erectile dysfunction represents a promising avenue for future research, offering opportunities to unravel the intricate connections between emotional processing and sexual health. Enhancing insights into this relationship could lead to innovative interventions that address the needs of individuals struggling with both conditions, fostering improved emotional expression, intimate relationships, and sexual satisfaction.

19 How are paediatric tertiary care hospitals structured to respond to the needs of children with medical complexity during acute deteriorations? A landscape study in Canada

Abstract Background Children with medical complexity (CMC) are at risk of unplanned healthcare visits especially due to acute clinical deteriorations. Complex care (CC) programs help facilitate the needs of CMC. Objectives To identify the organizational and administrative resources available for the care of CMC in Canadian tertiary care paediatric hospitals and to assess how physicians believe these resources are adapted to the specific urgent needs of CMC. Design/Methods In this observational study, key informants representing complex care (CC) and paediatric emergency medicine (PEM) services from 15 paediatric tertiary care hospitals in Canada completed cross-sectional structured questionnaires. Participants were identified through national research networks (Pediatric Emergency Research Canada (PERC), Pediatric Inpatient Research Network (PIRN) and by snowball sampling. Utilizing the Lime Survey web application, two questionnaires (one for PEM, one for CC) were develop based on a literature review and following Burns methodology. Verbal questionnaires were administered via a secured teleconference application or completed digitally. Descriptive data were generated using Excel and SPSS v.29. Results From 09/2022 to 09/2023, 93% (28/30) key informants completed questionnaires (15 PEM, 13 CC, Table 1). Across the 15 sites, 12 had a CC program or clinic. Information about established CC programs was available for 10 sites (Table 2), from participating CC informants: 4/10 offered outpatient services; 6/10 offered inpatient and outpatient services; 8/10 offered last minute appointments for CMC. CC programs had variable staffing: mostly physicians (median 3 FTE, range: 0.2-6) and nurse practitioners (0.75 FTE, range: 0-9) or registered nurses (0.9 FTE, 0-8). CC informants reported offering an ED consultation service at 8/10 sites, while 6/12 PEM participants reported access to such a service. CC informants reported that their program rarely offered consultations during weekends (2/10) or nights (1/10). Across all sites, PEM informants reported good access to documents to help with continuity of care including emergency care plans (13/15), medical history (14/15), goals of care (13/15). Using an 11-point scale, CC informants rated their hospital’s median ability to meet the outpatient needs of CMC as 6.5 (range: 0-10), and their ED’s median ability to meet the needs of CMC as 7 (range 5-10). PEM informants reported their median ability to meet the needs of CMC as 8 (range 6-9). Informants made suggestions to improve the ED care of CMC (Table 3). Conclusion There exists wide variation in the structures caring for CMC and their availability in case of acute needs. National collaboration between CC and PEM teams may facilitate the design of programs to improve the acute outpatient care of CMC.

Rasch analysis of the new general self efficacy scale: an evaluation of its psychometric properties in older adults with low vision

BackgroundWhile general self-efficacy is known to relate to achievement in many areas, it has rarely been evaluated in individuals with low vision. Here we explore the psychometric properties and targeting of the New General Self Efficacy Scale (NGSES) using Rasch analysis in data collected from older adult clinical trial participants with low vision.MethodsParticipants (n = 121) completed pre-intervention telephone questionnaires (i.e., NGSES, Activity Inventory (AI), Beck Depression Inventory (BDI), SF-36, and the Telephone Interview for Cognitive Status (TICS). Rasch analysis using the Method of Successive Dichotomizations (MSD) was applied to NGSES, AI, and BDI datasets to estimate person and item measures, and ordered rating category thresholds.NGSES infit mean square statistics and standard errors were analyzed to test whether data fit Rasch model requirements, and targeting was assessed by comparing distributions of person and item measures. Multiple linear regression evaluated the influence of participant characteristics on NGSES person measures.ResultsThere was a significant difference (p = 0.01) in the distributions of NGSES person measures (mean = 0.85, range -2.1-3.2) and item measures (mean = 0, range -1.0-0.72). Infit mean square statistics and standard errors for item and person measures conformed to expectations of the Rasch model.Greater NGSES person measure was related to lower BDI person measure (β = -0.48, p < 0.0005, 95% CI -0.67—-0.28) and higher AI person measure (β = 0.11, p = 0.047, 95% CI 0.0013 – 0.22) after controlling for cognitive status (TICS). Other variables including SF-36, visual acuity, and patient demographics were not related to NGSES person measure.ConclusionsWhile NGSES person measures estimated from a low vision patient population conformed to basic Rasch model requirements, the significant differences in the person and item measure distributions indicate poor NGSES targeting, specifically a ceiling effect. Therefore, there is limited discrimination between persons at the upper end of the scale. While further work can evaluate how self-efficacy may be associated with other factors in the low vision patient population, the ceiling effect found in this study cautions interpretation of NGSES results for those with high general self-efficacy.Trial registrationPre-registered on clinicaltrials.gov, identifier NCT04926974.

Relationship between emotional intelligence and quality of healthcare among nurses.

Healthcare organizations worldwide face intense competition for survival in an ever-changing environment. This study aims to examine the relationship between emotional intelligence (EI) and quality of healthcare (QHC) among Jordanian nurses working in governmental hospitals. This study was conducted using a descriptive correlational design and included a sample of 172 nurses. Participants from five governmental hospitals in Jordan completed online self-administered questionnaires, including the Nurse-Assessed Quality of Nursing Care Scale and the Genos Emotional Intelligence Concise Scale, along with sociodemographic data. The participating nurses demonstrated a high level of EI (M = 3.809, SD ± 0.484) and a very high level of QHC (M = 4.260, SD ± 0.372). A statistically significant correlation was found between the total quality of healthcare variables and the total EI variable (r = 0.739, p < 0.01). Additionally, statistically significant correlations were observed between the QHC and EI, as well as their respective dimensions (r = 0.357-0.739). EI was found to be a significant predictor of the QHC (F = 34.872, p ≤ 0.001), with a positive correlation between the two variables (r = 0.733). EI accounted for 59.8% of the variation in the QHC. EI is a key predictor of QHC. It plays an essential role in recruiting, staffing, promoting, and nurturing employees, making it a crucial criterion for achieving excellence in healthcare organizations.

Interactions between task complexity, task repetition, and task motivation in L2 writing

This study explores the interplay between task repetition and task motivation in second language (L2) writing, specifically focusing on syntactic complexity, accuracy, and lexical complexity (CAL). Aligning with Dörnyei’s call to balance cognitive and affective factors in task-based language teaching (TBLT), the research involved 100 advanced mid-level learners of English as a second language (ESL) aged between 18 and 20 years. Participants completed both simple and complex argumentative writing tasks in a counterbalanced order, with a one-week interval between tasks. A perception questionnaire was administered immediately after each task performance to validate cognitive task complexity manipulations. Subsequently, participants repeated the same tasks with the same time interval, complemented by the completion of a task motivation questionnaire after each task. Written essays were collected and analysed for CAL measures. Employing a multivariate multilevel approach, the results were triangulated with self-report data. Findings indicate that task repetition significantly impacted CAL in L2 writing, with a positive moderation effect by task complexity. Additionally, task motivation enhanced syntactic complexity in both simple and complex tasks, with negligible effects on accuracy. Notably, task motivation exerted a more substantial influence on students’ repeated task performance concerning lexical complexity. The study’s results offer theoretical and pedagogical insights for TBLT researchers and L2 writing practitioners.

Combined MRI, high-resolution manometry and a randomised trial of bisacodyl versus hyoscine show the significance of an enlarged colon in constipation: the RECLAIM study

BackgroundColonic motility in constipation can be assessed non-invasively using MRI.ObjectiveTo compare MRI with high-resolution colonic manometry (HRCM) for predicting treatment response.DesignPart 1: 44 healthy volunteers (HVs), 43 patients with irritable...

Phrenic Nerve Sonography Alterations in Patients with ALS: Insight with Clinical and Neurophysiological Findings.

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder, and although the diagnosis is primarily based on clinical criteria, ENMG, as the "gold standard", does not always show detectable changes. Therefore, our study suggests that alterations in echogenicity and heterogeneity of the phrenic nerve (PN) may serve as potential additional diagnostic tools for ALS. Methods: Our study included 32 patients in the ALS group and 64 individuals in the control group. Each participant underwent an interview and completed questionnaires to collect clinical and demographic data, including age, gender, height, body mass index (BMI), hip and waist circumference, duration of illness, ALS-FRS-R score, comorbidities, and medication use. Ultrasound examinations of the PN were performed by two authors using a high-resolution "Philips EPIQ 7" ultrasound machine equipped with a linear 4-18 MHz transducer. The ALS group participants underwent PN sonography and conduction examinations, arterial blood gas (ABG) analysis, respiratory function tests (RFT), and electroneuromyography (ENMG). Results: The study demonstrated that the phrenic nerve is significantly smaller on both sides in patients with ALS compared to the control group (p < 0.01). Changes in the homogeneity and echogenicity of the PN were also observed on both sides. On the right side, 43.8% of the nerves showed heterogeneity, 40.6% were isoechoic, and 21.9% were hyperechoic. On the left side, 59.4% of the nerves exhibited heterogeneity, 34.4% were isoechoic, and 28.1% were hyperechoic. Moreover, sonography on both sides showed significant correlation with ALS-FRS-R, COMPASS-31, and ENMG results. Conclusions: Our study highlights the importance of phrenic nerve ultrasound as a promising supplementary diagnostic tool for ALS. The significant differences in phrenic nerve size, echogenicity, and homogeneity between patients with ALS and the control group demonstrate that ultrasound imaging can detect morphological changes in the phrenic nerve. Incorporating phrenic nerve ultrasound into routine diagnostic protocols could improve early detection, enhance disease monitoring, and offer a more comprehensive understanding of the neurodegenerative processes in ALS.

Stress and Quality of Life of Parents of Children With POLR3-Related Leukodystrophy: A Cross-Sectional Pilot Study.

Background: RNA polymerase III (POLR3)-related leukodystrophy is a rare, neurodegenerative disorder characterized by hypomyelination, hypodontia, and hypogonadotropic hypogonadism. Despite the challenges of caring for a child with POLR3-related leukodystrophy, few studies have examined parents' disease burden. We sought to investigate quality of life and stress levels amongst parents of children with POLR3-related leukodystrophy. Methods: 43 parents of 32 children completed questionnaires on demographics, stress, quality of life, coping mechanisms, and experience of injustice. Detailed clinical data was collected from all patients. Results: Mothers (t[27] = -8.66, P < .001) and fathers (t[16] = -4.47, P < .001) had lower quality of life scores compared to the normative population, yet 80% of parents' stress scores fell within the normal stress range. Parents' experience of injustice scores were high (>60). Correlations were found between and within parents' scores. Years since disease onset and certain life circumstances correlated to mothers' quality of life scores; however, no correlation was found between modifiable factors and fathers' quality of life scores. Helpful coping mechanisms included those that allowed parents to be involved in their child's life. Conclusions: This is the first study to assess stress and quality of life in this population. These results shed light on the importance of implementing services and social support to improve the well-being of parents.

Assessing the feasibility of the GOTT (Gabapentinoid and Opioid Tapering Toolkit) in a primary care setting in North-East England.

To assess the feasibility and possible impacts of implementation of systematic non-pharmacological interventions to reduce the level of prescribing of opioid and gabapentinoid analgesics for chronic non-cancer pain (CNCP), particularly high-dose prescriptions, through a proof-of-concept study in a deprived area (second lowest decile) primary care practice in North-East England. Twenty-five primary care staff (clinical and non-clinical) of which 18 clinicians received the intervention. All clinicians received an educational skills programme to support patient pain self-management, tailored on the clinicians' self-assessment of their learning needs, embedding both clinician skill learning and patient self-care resources for rapid access within consultations into a GP clinical management computer system. Clinical staff completed questionnaires before and after the GOTT intervention to assess levels of knowledge and confidence in their own skills to support chronic pain self-management across several domains. Prescription data were used to measure changes in opioid and gabapentinoid prescribing at the practice across the 12-month intervention and 30-month follow-up period. Prescribing of opioid and gabapentinoid/pregabalin decreased substantially in the practice across the intervention period (c. 90% in high-dose opioid [p = .0118], and 15% gabapentin/pregabalin prescriptions, respectively), over a one-year period during the COVID-19 pandemic. Follow-up analysis showed 100% and c.50% reductions, respectively, in December 2022. The questionnaire data showed an increase in clinician confidence in skills to enable self-management over the intervention period, overall (p = .044) and, specifically across three of the five domains measured: supporting behavioural change (p = .028), supporting self-care (p = .008), and managing difficult consultations (p = .011). The GOTT intervention program provided some initial evidence of a proof-of-concept for the implementation of a systematic non-pharmacological pain management skills and resources programme addressing lack of confidence in skills to introduce and support self-management and reduce use of strong opioids and gabapentinoids.

Analysis of Determinants of Envitonmrntal Awareness Among Beef Consumers

Objective: The objective of this study is to analyze the determinants of environmental awareness among beef consumers in Brazil, focusing on the acceptance of the Carbon Neutral Beef label. Theoretical Framework: The literature review covers the growing consumer concern for sustainability and animal welfare. The concept of Carbon Neutral Beef, developed by EMBRAPA, is discussed as a strategy to mitigate methane emissions in livestock production. Previous studies indicate that factors such as education, income, and environmental awareness influence consumers' willingness to pay more for sustainable beef. Method: The research employed a quantitative approach, applying a survey to beef consumers in Brazil. A total of 256 completed questionnaires were analyzed, and the data were processed using Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM). The Tobit econometric model was employed to identify the determinants of consumers' environmental awareness. Results and Discussion: The results show that most consumers prefer beef with sustainability attributes, influenced by income, education, and concern for the environment. The Tobit model indicated that variables such as educational level and household income are significant determinants of environmental awareness. These consumers are willing to pay more for beef that respects the environment and animal welfare. Research Implications: The study provides insights for the beef industry on the importance of adopting sustainable production practices. Originality/Value: The study provides insights for the beef industry on the importance of adopting sustainable production practices.

A Risk Tool for Evaluating Overuse Injury and Return-to-Play Time Periods in Youth and Collegiate Athletes: Preliminary Study.

Overuse injuries in youth athletes are associated with risks, including sports specialization, biological maturation, female sex, and workload measures. As no assessment tool exists to evaluate risk accumulation, we developed a novel risk factor scoring system (Sport Training Assessment of Risk [STAR]) to assess participants' risk of overuse injury and explore association with return-to-play (RTP) time periods. (1) STAR will reach an acceptable predictive threshold in the assessment of overuse injury in youth athletes. (2) Higher STAR scores will be associated with increased RTP time periods after injury. Longitudinal cohort study. Level 3. Youth athletes with an injury sustained during competitive sport completed questionnaires. Association of questionnaire variables with injury risk type was evaluated via logistic regression analyses, and unweighted and weighted versions of a total risk score were developed. RTP was defined by physician clearance per electronic medical record review. Mantel-Haenszel chi-square tests and Kendall's rank correlation coefficients were used to assess the relationship between weighted total risk score and RTP time periods. The weighted STAR model was analyzed with receiver operating characteristic (ROC) curves. The weighted STAR model trended toward an acceptable level of prediction for overuse (nonserious + serious) injury (area under the ROC curve [AUC], 0.66; 95% CI, 0.61-0.71), but was less predictive for serious overuse injury (AUC, 0.63; 95% CI, 0.55-0.71). Weighted total risk score was weakly associated with return to full play (ρ = 0.11; P < 0.01), and potentially with return to modified play (ρ = -0.08; P = 0.04). STAR may be a feasible tool for assessing overuse injury risk and RTP time periods in youth athletes but requires further development, as it did not reach an acceptable predictive threshold in this preliminary study. Clinicians can use STAR to assess overuse injury risk in youth athletes.

Referral, enrollment, and health care use in a comprehensive patient-centered management program for osteoarthritis of the hip and knee

ObjectiveOsteoarthritis management programs (OAMPs) have become a more common way to deliver patient-centered care. However, there is limited information on real-world use of these programs to guide implementation, payment policy, accessibility, and scaling in the United States. This paper describes 5-year use metrics for the Duke Joint Health Program, an OAMP embedded within a US academic health system. MethodThis analysis includes patients referred into the Program between October 2017 and April 2022. We generated descriptive statistics of referral and enrollment totals, demographics and patient-reported measures of enrollees, retention and healthcare use metrics (e.g., office visit frequency), and data capture rates for patient-reported outcomes. ResultsDuring the study period, 6863 patients were referred to the program and 4162 (61 ​%) enrolled. We observed statistically significant differences between those who did and did not enroll by age (mean difference ​± ​SE: 2.49 ​± ​2.8 years), sex (70.0 ​% vs 67.7 ​% female), race (65.1 ​% vs 55.3 ​% Caucasian/White), employment status (50.0 ​% vs 40.2 ​% retired), and insurance type (53.5 ​% vs 47.0 ​% Medicare). The median (Q1, Q3) number of visits was 2 (1, 4) and ranged from 1 to 67. The median (Q1, Q3) number of days from first to last program visit was 23 (0, 84) days. Questionnaire completion rates were 72 ​% at baseline, 46 ​% at 6 weeks, 39 ​% at 3 months, and 40 ​% at 6 and 12 months. ConclusionFindings can guide the planning, development, and implementation of future OAMPs and inform policies to ensure programs are accessible and equitable.