Completed Interviews Research Articles

Benefits, Challenges, and Strategies for Increasing Women Coaches in Elite Sport

Despite tremendous growth in sport participation of girls and women following Title IX in 1972, women’s participation as sport coaches did not follow the same trajectory. In fact, women remain significantly underrepresented in sport coaching. Research highlights ongoing barriers within the sport industry's patriarchal structure, and although strategies have been proposed to improve women’s representation, the lack of progress over the past two decades indicates limited effectiveness. A better approach is essential to address this issue across individual, interpersonal, organizational, and societal levels. The purpose of this study is to interview participants within the U.S. cross-country skiing program, Trail to Gold (T2G), to learn about its programming and implementation, with an eye toward learning from this comprehensive, multidimensional approach to help advance women coaches in all elite sports. Eight coaches and administrators who participated in the T2G program completed semi-structured interviews. Interviews were transcribed verbatim and reviewed by participants for accuracy. Key themes were identified using both inductive and deductive qualitative analysis methods, with final themes confirmed by triangulation. T2G participants highlighted the importance of a supportive environment, robust networking, and effective sponsorship to advance women in coaching roles. This study expands the recommended strategies to increase women’s representation in sports coaching by learning from women coaches and administrators who work in environments that value and actively pursue gender parity. Continued support for women coaches is essential for gender equality, enhanced team performance, and a more inclusive sporting environment.

Attitudes and barriers to mobile mental health interventions among first-year college students: a mixed-methods study

Objective This mixed-methods study examined attitudes, barriers, and preferences for mobile mental health interventions among first-year college students. Participants 351 students (64% women; 51% non-Hispanic White; 66% Heterosexual) from two campuses completed self-report assessments and 10 completed individual semi-structured interviews. Methods Paired t-tests compared attitudes for various mHealth applications and logistic regressions examined sociodemographic and clinical characteristics of mental health app users. Themes, topics, and quotes from interviews were derived through rapid qualitative analysis. Results Mental health applications were less used and perceived to be less helpful than other mHealth applications. Past mental health app use was best predicted by past use of formal mental health care. Conclusions Mobile health interventions have significant potential to diversify mental health services for students. Despite limited engagement with these resources, openness to digital interventions among students is quite high. Improving intervention features and increasing problem-recognition to facilitate help-seeking may result in greater uptake.

Technology ownership, use, and perceptions of web-based program design features for older adults prescribed oral anticancer medication.

Older adults are often prescribed oral anticancer agents (OAAs). Technology-based interventions may offer medication and symptom support. We aimed to evaluate technology ownership, use, and preferred design features of a supportive web-based program using a multimethod design utilizing surveys and semi-structured interviews. Patients were recruited from a National Cancer Institute-designated Comprehensive Cancer Center. Eligibility included those: (1) ≥65years of age; (2) prescribed a Food and Drug Administration-approved OAA; (3) English speaking; (4) able/willing to complete telephone interviews. Interviews were audio-recorded and transcribed verbatim. Cohen's Kappa was used to evaluate inter-rater reliability and calculated at 0.87. Participants (N=30) were predominantly female (70%), White (83.3%), with metastatic disease (90%). The mean age was 74.9years. Ninety percent owned a smartphone, 66.7% owned a tablet, and 90% owned a computer. Nearly 57% reported using smartphones frequently for cancer-related purposes. Four themes with corresponding subthemes were identified: (1) comfort with technology; (2) reasons for technology use for health-related purposes (research of cancer, cancer treatment, and related symptoms/side effects; using the portal to manage health; and appointment and medication reminders); (3) recommended design features for a web-based program (OAA medication-specific information; calendars & medication alarms/reminders; symptom management & symptom trackers; and tutorials and testimonials); and (4) adaptations for older adults (simple navigation; larger font; use of layperson's terms; use of pictures, graphics, and color coding; and voice activation). Older adults use technology for health-related purposes. Specific web-design features and adaptations are needed to enhance usability among older adults.

“They knew the same struggles”: perceptions of a group coping skills intervention in patients with chronic graft-versus-host disease

PurposeChronic graft-versus-host-disease (cGVHD), an inflammatory condition affecting allogeneic hematopoietic cell transplantation (HCT) survivors, is associated with a range of debilitating physical and psychological sequela. Yet HCT recipients with cGVHD are virtually absent from survivorship intervention research. We conducted a randomized clinical trial to evaluate the feasibility and preliminary efficacy of a multidisciplinary group coping skills intervention (Horizons) tailored to meet these patients’ unique needs. For this follow-up qualitative analysis, we evaluated the perceived impact of the Horizons intervention by the group participants.MethodsWe purposefully selected a subset of Horizons participants (n = 19) to complete audio-recorded exit interviews via semi-structured interview guide. We used rapid analysis to characterize participant feedback in three domains: (1) motivations to participate, (2) perceived benefits of participation, and (3) impacts of participation.ResultsFindings highlight participants’ motivations to participate centered on desires to connect with others living with cGVHD and to help future patients. Perceived benefits of participation focused on the following categories: (1) connecting with other survivors, (2) learning about cGVHD, and (3) learning coping strategies to manage specific cGVHD symptoms. Impacts of participation on everyday life variably reflected categories of (1) increased sense of empowerment to contact their care team with questions and concerns, (2) increased support and validation in their struggles with cGVHD, and (3) renewed motivation or progress toward personal and health-specific goals.ConclusionStudy findings demonstrate participants’ appreciation for a group-based opportunity to connect with others living with cGVHD and strengthen skills for navigating cGVHD challenges. Results support the ongoing need for evidence-based interventions to improve quality of life among HCT survivors.Trial registrationwww.ClinicalTrials.gov, identifier NCT04479995. Date of Registration: July 21, 2020.

Ward-Based Staff Perspectives on Their Preparedness to Recognize Patient Deterioration: An Interpretive Description Study.

Despite an overall decline in serious adverse events in hospitalized patients, approximately one third of inpatient mortality continues to relate to adverse events impacting patients on general wards. The preparedness of nurses, midwives, and nursing assistants (collectively referred to as ward-based staff) to recognize patient deterioration is therefore seen as critical. The aim of this study was to explore ward-based staff perspectives regarding their preparedness to recognize patient deterioration. An interpretive description approach was utilized to interview 16 participants from a single-center regional hospital. The participants included nurses, midwives, and nursing assistants who worked exclusively on wards. The participants were purposely selected to complete semistructured interviews. Data were analyzed using a six-step thematic analysis, and the study followed the Standards for Reporting Qualitative Research checklist. Three main themes (with subthemes) were identified: (a) feeling prepared (experience, intuitive awareness, early warning systems), (b) promoting preparedness (multimodal education, debriefing, collegial support), and (c) being unprepared (undergraduate education, knowledge deficit, staffing related concerns, psychological response to incident, unforeseen barriers). The findings suggest strategies for increasing knowledge and confidence in all ward-based staff, allowing them to feel better prepared to recognize clinical deterioration. Moreover, based on the results, ward-based staff strongly perceive experience, clinical shortfalls in undergraduate education, collegial support networks, mentorship, psychological response to incidents, and multimodal education to be key contributors to preparedness.

Supporting Transition Resilience Among Newcomer Groups (STRONG): Examining effectiveness and acceptability in urban public schools.

The Supporting Transition Resilience Of Newcomer Groups (STRONG; Hoover et al., 2019) program was developed to support mental health among newcomer refugee and immigrant students by (1) promoting positive adjustment during resettlement through a trauma-informed, strengths-based approach, contextualized to meet the needs of refugee and immigrant youth; and (2) improving access to services through school-based programming. The purpose of this study was to examine the acceptability and effectiveness of STRONG on the mental health and resilience of refugee and immigrant students using a group randomized waitlist control design. A sample of 64 newcomer students (Mage = 13.9, SD = 3.11; 41% female) was recruited to participate in the STRONG program, representing 19 different countries of origin and diverse ethnicities (44% Latiné; 34% Asian; 13% Middle Eastern/North African; 8% African/Black). Additionally, teachers or administrators from each participating STRONG school completed interviews, while group facilitators (e.g., clinicians and bilingual teachers) were invited to participate in focus groups. This study provides preliminary evidence that STRONG supports newcomer mental health, with students in the immediate treatment group showing reductions in anxiety/depression and externalizing symptoms compared to the waitlist. Qualitative findings provide additional support for the acceptability and benefits of this intervention. However, coping efficacy unexpectedly decreased, and several interactions with school type (e.g., high school vs. elementary) emerged. Additional research is warranted to further evaluate this promising intervention for newcomer youth.

Mobility as a Service (MaaS) bundle uptake: a case study in Milan, Italy

Recent applications of Mobility as a Service (MaaS) platforms have highlighted certain limitations in accurately identifying integrated mobility packages (MaaS bundles) that align with users’ needs and preferences while also supporting the financial viability of businesses. This study explores the interest of university community members in adopting and paying for MaaS bundles, aiming to determine whether their preferences differ from those of the general population commonly analyzed in existing research. The research method involved the design and administration of a survey instrument, resulting in 1949 completed computer-assisted web interviews collected between May and June 2023. The willingness to pay (WTP) for different MaaS bundles was estimated based on users’ responses to stated preference choice tree experiments. Results reveal that 45.2% of respondents showed no interest in any proposed MaaS bundle, 29.5% towards only one specific MaaS bundle. Conversely, 25.3% of respondents expressed interest in two or more MaaS bundles. Public transport (PT) pass holders showed a higher WTP for MaaS bundles compared to PT pass non-holders, with a WTP an additional 17.5–28.3% over what they currently pay for their PT pass. The findings reveal a positive attitude among university community members toward MaaS bundles, especially among PT pass holders. This underscores an opportunity for MaaS providers to target this group with tailored bundles that complement existing transport choices, thereby increasing user satisfaction and financial viability.

"Now I can see it works!" Perspectives on Using a Nutrition-Focused Approach When Initiating Continuous Glucose Monitoring in People with Type 2 Diabetes: Qualitative Interview Study.

Food choices play a significant role in achieving glycemic goals and optimizing overall health for people with type 2 diabetes (T2D). Continuous glucose monitoring (CGM) can provide a comprehensive look at the impact of foods and other behaviors on glucose in real time and over the course of time. The impact of using a nutrition-focused approach (NFA) when initiating CGM in people with T2D is unknown. This study aims to understand the perspectives and behaviors of people with T2D who participated in an NFA during CGM initiation. Semistructured qualitative interviews were conducted with UNITE (Using Nutrition to Improve Time in Range) study participants. UNITE was a 2-session intervention designed to introduce and initiate CGM using an NFA in people with T2D who do not use insulin. The intervention included CGM initiation materials that emphasized the continuous glucose monitor as a tool to guide evidence-based food choices. The materials were designed to support conversation between the CGM user and diabetes care provider conducting the sessions. A rapid matrix analysis approach was designed to answer two main questions: (1) How do people who participate in an NFA during CGM initiation describe this experience? and (2) How do people who participate in an NFA during CGM initiation use CGM data to make food-related decisions, and what food-related changes do they make? Overall, 15 people completed interviews after completion of the UNITE study intervention: 87% (n=13) identified as White, 60% (n=9) identified as male, mean age of 64 (SD 7.4) years, mean T2D duration of 7.5 (SD 3.8) years, and mean hemoglobin A1c level of 7.5% (SD 0.4%). Participants fluently discussed glycemic metrics such as time in range (percent time with glucose 70-180 mg/dL) and reported regularly using real-time and retrospective CGM data. Participants liked the simplicity of the intervention materials (eg, images and messaging), which demonstrated how to use CGM data to learn the glycemic impact of food choices and suggested how to adjust food choices for improved glycemia. Participants reported that CGM data impacted how they thought about food, and most participants made changes because of seeing these data. Many of the reported changes aligned with evidence-based guidance for a healthy lifestyle, including prioritizing nonstarchy vegetables, reducing foods with added sugar, or walking more; however, some people reported behavior changes, such as skipping or delaying meals to stay in the target glucose range. A few participants reported that the CGM amplified negative feelings about food or eating. Participants agreed that pairing nutrition information with CGM initiation instructions was helpful for their diabetes care. In general, the NFA during CGM initiation was well received and led to positive changes in food choices and behaviors during a 2-month intervention.

Clinical and psychosocial context of HIV perinatally infected young mothers in Harare, Zimbabwe: A longitudinal mixed-methods study.

The lives of adolescents and young people living with HIV (LHIV) are dominated by complex psychological and social stressors. These may be more pronounced among those perinatally infected. This longitudinal mixed-methods study describes the clinical and psychosocial challenges faced by HIV perinatally infected young mothers in Harare, Zimbabwe to inform tailored support. HIV perinatally infected young mothers were recruited in 2013 and followed up in 2019. In 2013, they completed a structured interview, clinical examination, psychological screening and had viral load and drug resistance testing. A subset completed in-depth interviews (n = 10). In 2019, they were re-interviewed and had viral load testing. Data were analyzed using STATA 15.0. and thematic analysis. Nineteen mothers aged 17-24 years were recruited in 2013. Eleven (57.9%) were successfully recontacted in 2019; 3 had died, 2 had relocated and 3 were untraceable. In 2013, all 19 mothers were taking antiretroviral therapy (median duration 8 years, range 2-11 years) and median CD4 count was 524 (IQR 272). In 2013, eight mothers (42.1%) had virological failure (≥1000 copies/ml) (3 of whom subsequently died) and 7 (36.8%) had evidence of drug resistance. In 2019, the proportion with virological failure was 2/11 (18.1%). Six of 11 (54.5%) had switched to second line therapy. In 2013, 64.3% were at risk of common mental disorder and this risk was higher at follow-up (72.7%). Qualitative data highlighted three pertinent themes: HIV status disclosure, adherence experiences and, social and emotional support. Findings from this study underscore the significant clinical, social and psychological challenges faced by perinatally infected young mothers. The high rates of virological failure, drug resistant mutations, mental health issues and mortality observed in this population indicate the need for tailored and comprehensive health and support services to assist these young mothers.

EVALUATING VIRTUAL MONTESSORI DEMENTIA TRAINING USING NORMALIZATION PROCESS THEORY AMONG VA NURSING HOME STAFF

Abstract This paper uses Normalization Process Theory (NPT) to examine staff impressions of Montessori-based program training and implementation at Veterans Affairs Community Living Centers (VA CLCs; nursing homes). We conducted a mixed-methods evaluation of Montessori Approaches to Person-Centered Care (MAP-VA) at eight VA CLCs. Trainings were conducted as either a live virtual course or a pre-recorded asynchronous class. Two NPT constructs, coherence building and cognitive participation, informed qualitative interview questions, surveys, and analyses focused on staff movement from knowledge to action during initial implementation. Data collection included staff-completed standardized post-training exams (N=906), post-training evaluations (N=761), and optional validated surveys on perceptions of Montessori training (N=307). Champions (peer-leaders) from each CLC completed semi-structured qualitative interviews post-training (N=22). The majority of staff (83%-90%) passed all courses. Staff evaluated the training highly (80%+ agreement) on learning relevant new knowledge and confidence applying new skills. On average, staff felt MAP-VA would become a normal part of their work (7.68/10 scale) and reported increased familiarity with Montessori approaches after training (p =.002). Qualitative interview data from staff trained in Montessori supported three themes concordant with the NPT dimensions of coherence building and cognitive participation. Montessori virtual training resulted in high levels of coherence and cognitive participation among multidisciplinary staff, evidenced by high knowledge, self-efficacy, and readiness to act. The asynchronous and synchronous trainings were accessible, relevant, and supported diverse learners. Virtual dementia training can be an effective and efficient method of teaching nursing home staff about Montessori approaches to reduce responsive behaviors.

FINANCIAL HARDSHIP IS ASSOCIATED WITH REPEATED STRESSORS AS MEASURED BY STRESSOR DIVERSITY

Abstract Financial hardship supplements traditional measures of socioeconomic status (i.e., education, income) to elucidate how the insufficiency of socioeconomic resources is experienced. Financial hardship may impact health by differentiating exposure to stressors in daily life. This study examined how three domains of financial hardship (i.e., material, behavioral, and psychological) relate to daily stressor concentration (e.g., experiencing many stressors that are all arguments versus fewer stressors spread across arguments, work stress, home overloads). Higher stressor concentration has been associated with poorer health and well-being across adulthood. The present analyses used data from the Midlife in the United States study wave 3 (2016-2020), in which 1,024 participants (ages = 43-90, 57% female) completed 8-day daily diary interviews. Measures of financial hardship include material indicators of poverty, healthcare, and financial aid; psychological perceptions of financial situation; and behaviors including payments, earnings, and spending. Daily stressor concentration was calculated using 1- the Gini diversity index. In a regression model accounting for age, sex, daily stressor exposure, and education, a higher total score of financial hardship was associated with higher stressor concentration (b = 0.07, SE = 0.03, p <.01). This result replicated across material (b = 0.26, SE = 0.09, p <.01) and psychological domains (b = 0.11, SE = 0.04, p <.01) of financial hardship, and the findings were exacerbated with older age (ps <.05). Experiencing repeated stressors in specific domains may be a mechanism by which insufficient economic resources can worsen health outcomes for adults as they age.

CARE TRANSITION EXPERIENCES OF HISPANIC PATIENTS WITH DEMENTIA FOLLOWING EMERGENCY DEPARTMENT DISCHARGE

Abstract Older patients report fragmented emergency department (ED) care, including insufficient communication with clinicians and inadequate referrals to outpatient care and social services. These challenges are likely even greater for those with cognitive impairment (CI) and their care partners (CPs) and especially for non-English speaking populations, where language differences bring additional challenges. This study seeks to fill a gap in the literature by exploring ED discharge care transition experiences for Hispanic patients with dementia. Ten dyads - consisting of a patient with CI or dementia diagnosis and their CP - were enrolled in the ED and completed semi-structured interviews (via video or telephone) 1 week later addressing their ED and post-discharge experiences. Interviews investigated participants’ experiences in the ED and subsequent care transitions back to the community. Interviews were recorded, transcribed and coded by three research team members for thematic content, adopting a combined deductive-inductive approach until thematic saturation was reach across all dyads. Prespecified codes were adapted using the National Quality Forum’s Quality Measurement Framework on ED Transitions of Care and included eight outcomes for ED transitions of care: accessibility of services, shared decision-making, connection and alignment, care coordination, information sharing/communication, safety, healthcare utilization/costs, and experience of care. Key study findings emphasize patient and care partner priorities of shared decision-making with the ED treating team, how patients and care partners manage language barriers and cognitive impairment challenges and identifying factors that either support or hinder the quality and safety of ED discharge care and transitions back home.

Pelaksanaan Manajemen Rekrutmen Tenaga Pendidik Dalam Meningkatkan Mutu Pendidikan di Madrasah Aliyah Nurul Yaqin Kabupaten Merangin

AbstractThis study aims to learn how to carry out management recruitment of educators in improving the quality of education in Madrasah Aliyah Nurul Yaqin starting from needs analysis, analysis of selection, determination of the right candidate, selection of the most appropriate method, choice according to needs, selecting new candidates for teaching staff, to the placement of new teaching staff, the results and supporting and inhibiting factors. This study uses qualitative descriptive methods. From the results of this study, the data found can conclude that the implementation of management recruitment of educators in improving the quality of education in Madrasah Aliyah Nurul Yaqin is done in a simple and familial way. The steps taken are analysis of needs, by analyzing the conditions of the madrasah environment into the vacancy of the existing position. Job analysis, by determining the general requirements of prospective educators to fill the required vacancies, such as S1 education qualifications. Determine the right candidate, through external sources (from outside) the madrasah environment. Choose the most appropriate method, through teaching staff or school staff and advertising on social media. Calling candidates who meet the requirements tailored to the needs of madrasah and Madrasah Head policies. Selecting prospective new educators through administrative examinations or application documents as well as a complete and easy interview process by the Head of Madrasah. Placement of new teaching staff is done directly to fill the position needed at that time in accordance with the decision of the Head of Madrasah. The results of the implementation of the management of recruitment of educators by the madrasah were declared good, because every stage had been carried out. Keywords: management, recruitment of educators, quality of education

Community-based physical and social activity for older adults with mild frailty: a rapid qualitative study of a collaborative intervention pilot

BackgroundIntervening to modify frailty trajectories may be critical to maintain health and independence in later life. The Active Ageing Programme (AAP) is a 16-week community-based intervention for older people with mild frailty that combines physical activity and social interaction. The programme aims to positively impact resilience and wellbeing, changing the physical, mental and social factors that impact on frailty trajectories. We conducted a rapid qualitative study with the first cohort to understand the acceptability and feasibility of the AAP.MethodsPurposive sampling was used to identify and recruit staff and participants involved in the AAP for semi-structured interviews. The topic guides covered experiences and perceptions of training and referral, delivery and participation in activities, and benefits and challenges. Data from 20 interviews were analysed using a reflexive thematic approach with inductive coding. The Theoretical Domains Framework prompted consideration of potential individual, social and environmental factors influencing changes in behaviour and practice.ResultsSixteen AAP staff (10) and participants (6) completed interviews. Two themes were developed: combining motivating components; addressing what matters. The AAP brought together a number of components that supported its acceptability and successful implementation by motivating older people and staff and sustaining their engagement. These included the convenient and familiar location, the opportunity to improve physical health (participants) and to gain experience of an activity intervention, training and confidence (staff), and the variety of activities on offer. The programme was perceived to have potential to improve physical and mental health and increase the personal resources (e.g. knowledge, confidence, motivation) of those taking part. Areas identified as important for the AAP’s future sustainability and success were: tailoring recruitment practices; enhancing organisational communication; and strengthening support for participants to achieve long-term increased physical and social activity and resilience.ConclusionsOur findings suggest that community-based physical and social activity interventions targeting frailty may be acceptable, feasible and useful. Further work is needed to investigate the impact of such programmes on health and service utilisation. Efforts should be targeted at improving the potential for long-term sustainability of programmes and their impacts.

The feasibility of using the application developed to operationalize the Global Diet Quality Score in Ethiopia

BackgroundThe Global Diet Quality Score (GDQS) application is an electronic data collection tool developed to provide a standard, easy-to-use method for collecting low-cost, time-relevant data on diet quality.ObjectiveTo assess the feasibility and ease-of-use of the GDQS application and associated set of 3D cubes used as visual aids to assist the respondent with estimating amounts consumed at the food group level.MethodsThe study was conducted in August 2021 in two regions of Ethiopia with varied dietary practices. Face-to-face interviews were conducted in Amharic and Somali by 10 enumerators among 120 women to collect dietary data using the GDQS application. Feedback on each completed interview was collected from both the respondent and enumerator. Enumerators also participated in focus group discussions.ResultsEnumerators rated the GDQS application as easy to use after 85.8% of the interviews completed. They identified the automatic provision of food-specific probes to guide the interview, the automatic classification of reported foods, beverages, and ingredients into the corresponding GDQS food groups, and the ability to work offline as the main advantages of the application. Most respondents (78.3%) did not find it difficult to choose the cube that corresponded to the amount of each food group they reported consuming. Respondents’ feedback on the open recall of all foods, beverages and mixed dishes consumed the previous day and the use of 3D cubes was mostly positive.ConclusionThe results suggest that the GDQS application and cubes were easy to use and feasible for collecting data on diet quality in a low-income country setting.

Association between modified dietary inflammation index score and lumbar vertebrae bone mineral density in patients with hypertension: data from NHANES—a population-based study

BackgroundThe modified Dietary Inflammation Index Score (M-DIS) is a scoring system used to quantify the inflammatory effects of nutrients and foods. Inflammation may affect Bone Mineral Density (BMD) and increase the risk of osteoporosis and fractures. The purpose of this study was to utilize data from the National Health and Nutrition Examination Survey (NHANES) to evaluate the relationship between M-DIS and lumbar vertebrae BMD in patients with hypertension.MethodsData from 2007 to 2008, 2009–2010, 2013–2014 and 2017–2018 NHANES cycles were collected for secondary analysis. Information provided by NHANES participants included complete dietary intake interviews and BMD measurements. M-DIS was calculated based on dietary intake interviews. Dual energy X-ray absorptiometry (DXA) was used to evaluate the average BMD of lumbar vertebrae (L1–L4). As an indicator of bone health, weighted multiple logistic regression and restricted spline analysis were utilized to study the relationship between M-DIS and lumbar vertebrae BMD in American patients with hypertension.ResultsA total of 3864 participants aged ≥ 20 years with complete data were included in this study. The proportion of osteopenia in the lumbar spine was 7.2%. After adjusting for confounding factors, negative correlations were observed between the BMD of each vertebral and its average BMD with M-DIS. In Model 3, the relationship between mean lumbar BMD and M-DIS was β = − 0.0103 (95% CI − 0.0160 to − 0.0046, P < 0.001). Notably, L1 showed a particularly significant negative correlation with β = − 0.0120 (95% CI − 0.0172 to − 0.0067, P < 0.001), while the proportion of osteopenia was highest in the L3 vertebra, accounting for 8.3%. Higher M-DIS was positively correlated with the incidence of osteopenia (OR 0.595, 95% CI 0.371–0.965, P = 0.041). Further analyses revealed that in hypertensive patients, elevated M-DIS in women was associated with lower lumbar BMD (P for nonlinearity = 0.093), while this trend was not significant in hypertensive men.ConclusionsThe results of this study suggest that a higher M-DIS (pro-inflammatory diet) is significantly associated with BMD in females with hypertension. These results indicate that female with hypertension who prefer a pro-inflammatory diet may be at an increased risk of osteopenia, highlighting the necessity for tailored dietary recommendations.

Is there a mental health wake following the COVID-19 pandemic on adolescents in a male juvenile prison?

Lingering effects of the COVID-19 pandemic loom large in the United States but are particularly of concern in prison settings. In the current study, we examine the ongoing mental health consequences of the pandemic among young people incarcerated in a male juvenile prison. Sequential mixed methods data were obtained-78 young people assigned male at birth completed surveys and 19 completed individual interviews. Seven staff were also interviewed about youth experiences during and following the pandemic. Youth survey results indicated racial and ethnic identity exploration, feeling less safe at night, and experiencing staff harassment were significantly associated with some negative mental health concerns, yet lingering COVID-19 policies were not. Triangulation with interviews underscored these findings by highlighting more specific concerns related to COVID-19, such as social isolation, loneliness, and concerns about the indirect effects the pandemic might have on court outcomes and educational goals. Overall, results of the current analysis provide evidence that incarceration continues to be traumatizing and harmful to youth mental health even following the pandemic. To a lesser extent, these results also imply that lingering effects of the pandemic and concurrent cultural and racial tensions have delayed impacts on the mental health of incarcerated youth during this tumultuous time. Taken together, study findings suggests juvenile prisons must implement readiness plans to mitigate these and other harmful effects of juvenile incarceration in the future.

An Outdoor Walking Program for Immigrant Muslim Older Adults: A Community-Based Participatory Intervention.

To explore Muslim immigrant older adults' experiences of a modified community-based outdoor walking program and identify factors that facilitate or hinder program acceptance and participation. An exploratory qualitative description single-group pilot study was designed and implemented in three phases: (1) pre-intervention focus group interviews; (2) intervention implementation with tracking of physical activity levels using personal activity monitors; and (3) postintervention individual interviews. Participants were recruited using a convenience sampling strategy in a mosque in Edmonton, Canada, in June 2019. After focus group discussions with participants, walking sessions were conducted for 10 weeks in a local accessible park with required amenities such as benches and restrooms. A fitness instructor delivered the weekly program that was followed by individual semistructured interviews to explore participants' satisfaction and program acceptance. Content analysis was used for qualitative data and sociodemographic, health and physical activity level (via step counts) data was documented for all participants. Thirteen participants with a mean age of 66.9 years completed the program. The majority of participants led a sedentary lifestyle. Participants identified three motivators that increased program satisfaction, which were socialising with peers, having a fitness instructor, and using Fitbit activity trackers. Difficulties with transportation and lack of appropriate educational components were areas for improvement that could enhance acceptability of the program. This study suggests that early incorporation of older immigrants' preferences increases acceptance of physical activity programs. Nurses' engaging in healthy lifestyle support for older immigrants can identify the influences on positive uptake of physical activity programs in this population. Immigrant Muslim older adults lack access to evidence-based physical activity programming that meets their cultural and religious preferences. This study provides some insights into ways to engage this population in similar programs. Community-dwelling older adults who participated in this study completed focus groups and interviews and engaged in the 10-week pilot intervention. Their input informed the modifications to the intervention.

Factors associated with willingness to perform expedited excisional treatment for patients at high risk for cervical precancer.

The 2019 ASCCP Risk-Based Management Consensus Guidelines prefer expedited treatment, defined as proceeding to excisional treatment without first performing colposcopic biopsy, for patients with screening results indicating a high risk of cervical precancer. In this mixed methods study, we explored clinician attitudes toward expedited treatment. In 2021, a national sample of 671 clinicians who performed colposcopy completed surveys; a subset (n = 41) of clinicians who performed colposcopy and/or directed patient treatment completed qualitative interviews. Among 671 colposcopists, 25.7 % were currently performing expedited treatment, 50.8% were not currently using expedited treatment but were willing to adopt this change, and 23.6% were not willing to perform expedited treatment. Binomial regression analyses indicated that internal medicine and family medicine clinicians (compared to Obstetrician-Gynecologists), and those practicing in academic medal centers (compared to private practice) had higher odds of currently performing expedited treatment; internal and family medicine clinicians also reported higher odds of being willing to adopt this change. Qualitative interviews highlighted benefits including improved cancer prevention among older patients, reduced loss to follow-up, reduction of time and expense for patients, and allowing shared decision-making. Concerns expressed related to future pregnancy complications, lack of available excisional treatment services (e.g., LEEP), patient preference, avoiding over- and under-treatment, and using biopsy results to plan excisional procedures. Approximately 25 % of colposcopists are currently performing expedited treatment, and an additional 50 % would be willing to adopt this practice for high-risk patients. Improving access to expedited treatment for appropriate patients could improve cervical cancer prevention.

A qualitative study about the public's perception of primary care providers.

With the growth of physician associates/assistants (PAs) and NPs providing primary care services, we sought to understand the public's perception of the different types of healthcare providers (HCPs) they might encounter in a clinical setting, such as primary care. This study aimed to evaluate public perceptions about various types of primary care providers (PCPs), identify public preferences for PCPs in relation to experience and training, and examine public preferences for PCP credentials. We conducted semistructured interviews with adults, and used inductive and deductive coding and reflexive thematic analysis to analyze the data. We reached thematic saturation after 12 completed interviews. Participants reported confusion about the types of HCPs they might encounter in a primary care setting (for example, physician, PA, NP). Participants who reported a preference for a physician valued more years in training and their role in the hierarchy of medicine; those who reported a preference for a PA or NP indicated that compassion, patience, and longer clinic visit times were most important to them. Previous reports suggested that the public might be confused by the different types of HCPs they might encounter during a primary care visit. Participants identified specific characteristics that are important when they are choosing their PCP. A direct, coordinated marketing campaign may be needed to educate the public and reduce confusion about different types of PCPs, how they contribute to safe and high-quality care, and ensure preference-concordant care.