Personal Consequences Research Articles

Critical Incident Stress in Healthcare Education: An Integrative Review.

Healthcare professionals' repeated exposure to critical incidents can cause various physical and psychological symptoms with potentially severe personal and professional consequences. Healthcare students' exposure to critical incidents begins during their clinical education. Despite known consequences, healthcare education has yet to implement a standardized approach for preparing students for critical incidents. Critical incident stress management, one identified program, has been utilized in healthcare organizations. However, formal critical incident stress management programs may not be appropriate for healthcare education with requirements to educate students on the clinical knowledge, skills, and judgment needed during critical incidents. The purpose of this review was to determine the state of the science related to critical incident stress in the context of healthcare education. A literature search was conducted, and peer-reviewed articles were included. Four articles were identified for inclusion, signaling a need for more research on critical incident stress in healthcare education. The available literature suggests that students are impacted by critical incident stress. The studies in this review did not incorporate critical incident stress or components of critical incident stress management programs into their overall curricula or educational programs. The studies did demonstrate that students may be positively or negatively influenced by critical incident stress. Critical incident stress programs are not widely incorporated into healthcare education; however, it has been demonstrated that a standardized approach to preparing and supporting students is needed. Future studies need to determine if critical incident stress should be integrated into healthcare education and the outcomes.

Effect of internet shutdown on postgraduate trainees in Manipur: A qualitative study

Background & objectives Internet shutdowns, although rare can be imposed by governments or affiliated entities and can intentionally disrupt online information and communication systems. While justified for maintaining public order, these shutdowns cause substantial economic losses, public suffering, and reputational damage. The internet shutdown in Manipur, initiated on May 3, 2023, due to civil unrest, has affected various sectors. The impact on doctors, amidst an era where internet access is considered as an integral part of practice, warrants deeper exploration of the challenges faced during such a prolonged shutdown period. Therefore, this study was conducted to explore the impact of internet shutdown among postgraduate trainees from two tertiary care hospitals in Manipur. Methods A study was conducted in two tertiary healthcare centers in Manipur from July to August 2023 among medical postgraduate trainees. Participants were selected using purposive sampling. Twenty-two in-depth interviews (IDIs) were conducted, recorded, and transcribed verbatim. Thematic analysis was done to identify codes, categories and themes. Results This qualitative study was undertaken among postgraduate trainees in two different academic institutes. A total of 21 IDIs were carried out. The major themes emerged from the study, namely, impact on professional life, impact on personal life, social consequences and coping. Internet shutdown affected patient care such as seeking timely opinions from consultants, delays in sharing patient reports and inconveniences in the hand-off process and the academic performance of postgraduate trainees like unavailability of study materials or keeping up with recent advancements. On a personal level, it negatively affected communication with family and friends, mental well-being and caused inconvenience in shopping and transactions. The study also found some positive impacts, such as less screen time leading to better sleep and increased physical activities. Interpretation & conclusions The findings of this study suggest that the internet shutdown significantly affected both the professional and personal aspects of postgraduate trainees’ lives in Manipur. The implementation of a targeted ban on social media platforms and the establishment of designated internet access points are proposed as potential alternatives.

Sex-Specific Sensory Profiles Discriminate Between Sensitization at Twelve Weeks in Patients with Acute Low Back Pain: A Retrospective Study.

Background/objective: Low back pain (LBP) is the leading cause of disability worldwide, resulting in enormous socio-economic and personal consequences. Sensory profiles during the acute back pain stage will predict central sensitization symptoms in the chronic pain stage, as central sensitization is the main mechanism behind nociplastic pain and pain chronicity. Therefore, our objective was to establish overall and sex-specific sensory profile cut-off points that distinguish symptoms of central sensitization at 12 weeks, using a retrospective prognostic cohort study design. Methods: Two hundred and seventeen patients with acute LBP (<6 weeks) were assessed using Receiver Operator Characteristic analyses. Measurements were taken at baseline using the Adolescent/Adult Sensory Profile and follow-up by the Central Sensitization Inventory at 12 weeks, based on the established Central Sensitization Inventory cut-off points for the overall population at ≥30 and ≥40, female patients at ≥33, and male patients at ≥25. Results: In female patients, a Sensory Sensitive cut-off point of ≥30.5 significantly distinguished central sensitization symptoms at 12 weeks, resulting in the following values: Area Under the Curve = 0.81 (95% CI = 0.73; 0.89), sensitivity = 0.89, specificity = 0.63, prevalence = 0.36, positive predictive value = 0.56, negative predictive value = 0.80, and Youden's index = 0.52. Conclusions: The Sensory Sensitive profile distinguishes female patients with acute LBP with and without central sensitization symptoms at 12 weeks. This cut-off point may be useful in identifying individual sensory preferences and addressing maladaptive behavioral responses to sensory stimulation in clinical practice to prevent chronicity.

What Should Primary Prevention in Burnout Look Like? Promoting Attributes, Roles and Social Networks with Instrumental Outcomes

AbstractBurnout remains a vexing issue for healthcare workers, educators and policy makers. Continuing high prevalence rates have focused the need for new and innovative approaches. The deleterious personal and professional consequences of burnout when it does develop place this focus on primary prevention. Yet despite its benefits, primary prevention initiatives have several barriers to engagement which impact their effectiveness. In this article, the authors explore potential barriers to engagement with primary level prevention of burnout amongst physicians-in-training, many of which are rooted in the social and professional contexts of training. Understanding the motivations of physicians-in-training should be used to guide the development of initiatives which combine protection against burnout with relevant goal-directed, instrumental outcomes. Three principles which can guide initiatives combining these features are explored. Promoting curiosity and curiosity-led enquiry combines a well-established protective attribute with educational and professional benefits. Curiosity-led endeavours can be developed into areas of special interest and competence, harnessing the protective benefits of self-efficacy and peer acknowledgement. Finally, special interests and the professional roles to which they lead foster the development of professional social networks and mentorship relationships. These are protective, particularly for physicians-in-training navigating role and organisational transitions. Supporting interventions with instrumental outcomes is both beneficial in engaging investment and also sustainable across the career-span. Burnout remains a challenging issue, and while programmatic interventions continue to have a role, the benefits of broader primary preventative approaches should be considered in terms of the potential engagement and sustainability advantages they confer.

Where do we go from here? The personal impact of adverse events and complications in surgeons: Results from a cross-sectional study.

Medical error is an inevitable part of modern healthcare, with a potential harmful impact for the patient and the surgeon. The phenomenon of negative personal responses for healthcare workers in the aftermath of adverse events is described as the "second casualty" and can involve significant physical and psychological distress. We present results from a cross-sectional survey of surgeons and their experience in the aftermath of adverse events or complications. Following ethical approval an anonymous online survey was distributed to all training and consultant surgeons in the Republic of Ireland. Data collected included basic demographics, personal response to an adverse event, coping strategies, contributing factors and perception of potential support structures. A total of 110 responses were received representing surgeons with a broad range of experience and specialty. Eighty-nine percent (n=98) of surgeons described negative psychological symptoms in the aftermath of adverse events. The predominant responses were anxiety, guilt and low mood. Sixty-seven percent (n=74) reported that their training did not prepare them for the personal impact of events but found informal peer and family support to be beneficial and were open to the implementation of formal support structures. Surgeons suffer in the aftermath of negative outcomes and feel unprepared to manage the personal consequences. Institutions and representative bodies must step forward to change culture and develop supports for surgeons in the aftermath of adverse events and complications.

A scoping review to examine health care professionals' experiences as family caregivers.

Health and social care systems must confront the challenge of supporting a growing elderly population and their caregivers. Family caregivers who are healthcare professionals are part of this context, but their caregiving experiences remain unclear. This scoping review explored the experiences of healthcare professionals who are also family caregivers for older adults. A scoping review methodology identified and summarized pertinent studies. Searches were conducted in Medline, Embase, PsycINFO, CINAHL, and AgeLine. We sought articles published from each journals' inception to October 19, 2023. Inclusion criteria were English-language studies about healthcare professionals caring for older adult family members. Diverse research designs were included. Data were extracted and synthesized according to key themes. The review included 19 studies, highlighting four themes. Studies were published between 1994 and 2019, with most studies published before 2017. The overarching theme was "Expectations," where healthcare professional family caregivers faced multifaceted expectations from themselves, their families, and the healthcare system. Expectations also highlights the dual role of participants as both caregivers and healthcare professionals This complex interplay led to a theme related to personal consequences, including stress, guilt, and potential burnout, but also positive aspects of the dual roles. Studies described how dual roles could enhance the quality-of-care healthcare professional caregivers provided to their family members. Finally, support needs were identified, emphasizing the importance of workplace accommodations and support from the healthcare system and peers. The experiences of healthcare professional family caregivers are shaped by unique expectations, resulting in both positive and negative consequences. The support needs of this group are multifaceted, requiring workplace accommodations and tailored support within the healthcare system. Further research is needed to delve deeper into the nuances of their experiences and develop targeted interventions to alleviate the stress and challenges they face in their dual roles. Understanding the evolving needs of healthcare professional family caregivers over time can inform support strategies along the caregiving trajectory.

The concept of civil law incentives

Civil law incentives are characterised by both general legal and sectoral (specific) features. The dialectical combination of these features determines the civil law image of the category of “incentives”, which may be represented by the following provisions. In Ukrainian civil law, incentives are a type of legal means intended to positively ensure the fulfilment of obligations and other civil duties. Civil law incentives may be established not only by law, but also by agreement of the parties to civil legal relations themselves, which allows them to determine and implement the most appropriate incentive legal regime to ensure the fulfilment of the relevant obligations. The positive enforcement effect of civil law incentives is manifested in the fact that they influence the will of duty-bearers not through the threat of negative property consequences (especially negative personal consequences), but by means of a proposal expressed in the provisions of law or in the terms of contracts to perform a “meritorious” duty (duties) in exchange for receiving an incentive benefit. In contrast to the use of incentives in disciplinary legal relations, the provision of incentive benefits to “meritorious” performers of civil duties does not lead to a change in their civil status; incentive benefits in civil law are mainly associated with the occurrence of positive property consequences for ‘meritorious’ subjects (provision of monetary or other property rewards, cancellation of property liability, etc.) In the context of organising and conducting competitions, winners may also be awarded moral incentives. All parties, not just the party to whom the incentive is applied, are interested in the positive consequences of the use of incentives in civil legal relations. This is especially evident in contractual relations of obligation. The regulatory (security) function of civil law incentives is associated with the legal formalisation of achieving, first and foremost, private interests. The same conclusion applies to the educational function of this type of legal incentives.

On Defense: Academic Librarians in DEI Battleground States

As anti-DEI legislation sweeps the nation, workers in academic libraries are beginning to feel the impact. Three librarians working in states with passed or proposed anti-DEI legislation share their experiences and observations on the cultural, professional, and education shifts taking place on their campuses. Read how these librarians are learning to navigate the uncharted waters of intensifying retrenchment politics in their day-to-day work and the consequences of anti-DEI legislation for librarians at both public and private institutions. The Idea Lab authors shed light on the chilling-effect anti-DEI legislation has created on college campuses across the United States. One author describes the prospective personal and professional consequences for librarians engaging in DEI activities and outreach programs. Another author considers the way librarians are embedded DEIAJ into their daily practices and performing small acts of resistance to maintain DEI efforts despite looming political and administrative pressures. The final author critiques a collective shift in librarianship behaviors to sidestep DEI efforts through self-censorship, in order to fly under legislative and administrative radars.

PERFIL DE PACIENTES VÍTIMAS DE POLITRAUMATISMOATENDIDOS EM UM HOSPITAL PÚBLICO NA REGIÃO OESTE DO PARÁ – BRASIL

In Brazil, polytrauma is considered a serious health problem, which causes personal, social and economic consequences, generating an increase in spending on traumatic emergency services, rehabilitation and care. The objective of this study was to characterize the admission profile of patients with multiple trauma treated at a public hospital in the western region of the state of Pará. This is an epidemiological, descriptive research, with a quantitative approach through secondary data, from December 2017 to December 2021. In view of this, this research presents 1056 patients diagnosed as multiple trauma, where the ICD "Fractures involving multiple regions of a lower limb" was recorded in 55.02% of the sample, with an age group over 60 years, with a prevalence of males with 62.1% coming from the municipality of Santarém-PA, with secondary causes as "Falls without specification" with 58.3% of the occurrences, and in relation to the seasonal period, in this study the highest numbers were identified in September 2021, with a total of 57 records. Regarding the profile of the patients in the primary ICD T06.0, the male gender was predominant, followed by an age group over 60 years, coming from the municipality of Santarém-PA. As for the most common cause of polytrauma, we found "unspecified falls", contrasting with data that point to traffic accidents as the main cause of polytrauma. It was also found that the victims of multiple traumas had a very small sample for the primary ICD T06.0, with the majority coming from Santarém-PA. Thus, greater epidemiological control of this ICD is necessary to reduce possible underreporting.

Issues of application of paragraphs 4-1, 5 of Part 1 of Article 284 of the Criminal Code of Ukraine by the Supreme Court in respect of a convict who died before the completion of cassation proceedings

The article is devoted to the analysis of the problems which may arise at the stage of review by the Supreme Court of criminal proceedings in case of simultaneous existence of two legal facts which are the grounds for closing criminal proceedings: the expiration of the law which established the criminal unlawfulness of an act (clause 41, part 1, Article 284 of the Criminal Code of Ukraine) and the death of a convicted person, but whose close relatives insisted on the deceased’s rehabilitation (clause 5, part 1, Article 284 of the CPC of Ukraine). To achieve the purpose of this study, the author, using the systematic, generalising, comparative and analysis methods, has identified the common and distinctive features of both grounds for closing criminal proceedings provided for in clauses 41, 5 of Part 1 of Article 284 of the Criminal Code of Ukraine. The common features include the fact that they are non-rehabilitating in terms of the consequences for the convicted person; they are related to the occurrence of a legal fact: 1) adoption or amendment of the law of Ukraine on criminal liability and 2) death of the convicted person at the stage of cassation proceedings. The author identifies the will of a particular person to implement the principle of presumption of innocence as distinctive. In particular, for the court to make a decision based on clause 41 of Part 1 of Article 284 of the Criminal Code of Ukraine, active (volitional) behaviour of the convict is required, while for the application of clauses 5 of Part 1 of Article 284 of the Criminal Code of Ukraine, passive (conclusive) behaviour of the deceased convict’s close persons is sufficient. It is due to this difference that the author states that the Supreme Court has no right to close the proceedings based on clause 41 of Part 1 of Article 284 of the Criminal Code of Ukraine without the consent of the convicted person. The article also examines the powers of the Supreme Court to continue the trial of proceedings aimed at rehabilitation of a deceased convict. The author emphasises that the cassation court cannot refuse to consider the application of the deceased’s relatives for rehabilitation only on the grounds that the act for which he/she was convicted was decriminalised by the legislator. In this regard, the author proposes appropriate amendments to the Criminal Code of Ukraine. In addition, the author examined the existing limits of cassation proceedings within which the cassation court may conduct a criminal investigation and make decisions with a view to rehabilitating a convicted person.

I struggle with your fidgeting: A qualitative study of the personal and social impacts of misokinesia.

Misokinesia, the reduced tolerance to others' repetitive bodily movements, impacts individuals' personal, social, and professional lives. The present study aimed to elucidate the factors contributing to Misokinesia Sensitivity (MKS) by exploring the subjective experiences of affected individuals, thereby guiding future empirical research and informing clinical awareness. Using a qualitative approach, we conducted semi-structured interviews with 21 participants from an online support group on Facebook. Data were analyzed through thematic analysis to uncover patterns and themes in their lived experiences. The thematic analysis revealed three main themes: internal cognitive and affective impacts, external social impacts, and pragmatic factors related to MKS triggers and responses. These findings provide a foundational understanding of MKS, highlighting its significant personal and social consequences and suggesting areas for targeted interventions. The insights gained aim to enhance clinical recognition and support the development of effective management strategies for those affected by MKS.

Academic procrastination in Ecuadorian university students: An explanatory model based on academic motivation

Academic procrastination is a multifaceted variable that encompasses different affective, cognitive, and behavioral factors, and has a high incidence in university students with important negative academic, personal, and social consequences. As such, this study aims to explain the levels of academic procrastination in relation to academic motivation and certain sociodemographic variables. The sample was composed of 117 students belonging to the University of Cuenca, Ecuador, they completed a questionnaire of sociodemographic variables, academic motivation scale and academic procrastination scale. Results showed high levels of intrinsic and extrinsic motivation, as well as low levels of amotivation, together with a medium level of total academic motivation and academic procrastination in the participants. The logistic regression model with ordinal response evidenced a 19% reduction in fit when considering the dimensions of intrinsic motivation, extrinsic motivation, and amotivation, only intrinsic motivation was statistically significant in explaining academic procrastination, while total academic motivation and sociodemographic variables did not contribute significantly to the model. These findings confirm the importance of academic motivation, mainly intrinsic motivation, in the understanding of academic procrastination. The theoretical and practical implications of the results are discussed, highlighting their relevance in explaining this phenomenon and benefiting students.

Effectiveness of Nutrition Education on Weight Loss and Body Metrics Among Obese Adults: An Interventional Study.

Background Obesity has detrimental personal, societal, and economic consequences and raises the risk of developing chronic diseases such as diabetes and cardiovascular diseases.Diet and exercise behaviors are frequently the focus of weight loss programs. Effective nutrition education is associated with a reduced risk of chronic diseases and body weight management.Individualized lifestyle and counseling sessions with follow-ups reduce weight loss compared to single combined sessions. Objectives The objective of this study was toassess the effectiveness of nutritioneducationintervention on weight loss among adults aged 18-40 yearsin Lahore through an interventional study. Methods This study was conducted in Lahore. According to the inclusion criteria, overweight/obese (Body Mass Index (BMI) ≥ 23 kg/m²), young (18-40 years old) men and women were part of this study. A total of 50 participants were randomized into two groups, one as the control group and the other one as the intervention group. Group counseling was provided to the control group. The intervention group was assessed individually through follow-ups for 3 months of online and on-campus sessions. Data was collected at four intervals at baseline, month 1, month 2, and month 3 through a self-administered assessment form. Data was analyzed using the statistical package for social science, SPSS version 25 (IBM Corp., Armonk, USA). Results Out of the 50 participants, 54% (27) were women while 46% (23) were men (mean age 29.90, SD = 6.26, BMI at baseline 32.18 kg/m², 26. 49 kg/m²), and randomized by a blinded researcher. At three months, the mean differences in BMI, waist circumference, waist-to-hip ratio, and body fat percentage between the groups were 3 kg (23.44 ± 0.58, 95% CI 22.86-24.02), 33.90 cm (95% CI 32.50-35.30), 0.86 (95% CI 0.74-0.98), and 24.79% (95% CI 18.00-31.58), respectively, in favor of the intervention group (p < 0.005). Conclusion This study demonstrates that a structured dietary intervention combined with physical activity guidance leads to significant weight loss and improved body composition in obese adults. These findings support the effectiveness of comprehensive weight loss strategies for managing obesity.

Digitalisation and Elderly Society - Universal Design as Detailed in Standards.

The paper discusses the role of standards to achieve the objective of Universal Design, with the case of equal access for elderly people in the digital society. The concrete background is the launching of 4 standards regarding different aspects of the digital society at present and in the future, their consequences for elderly persons and persons with disabilities and how to ensure diversity and inclusion for all through Universal Design. Our hypothesis suggests that well-conceived standards, developed collaboratively by all stakeholders, including individuals with various functional disabilities, could be an essential tool in ensuring that Universal Design is an integral part of technological development.

Comparison of Epidemiology, Demography, Treatment (Surgery and Radiotherapy), and Survival Between Aboriginal and Torres Strait Islander and Non‐Indigenous Women With Cervical Cancer in NSW, Australia in 2009–2018

ABSTRACTBackgroundHealth outcomes for Aboriginal and Torres Strait Islander people in Australia are significantly worse than in the non‐Indigenous population.AimTo evaluate demographic factors and treatment (surgery and radiotherapy) rates for cervical cancer and to compare these between the Aboriginal and non‐Aboriginal populations to identify any differences in outcomes or modifiable treatment differences between the populations.MethodsRetrospective cohort analysis of all patients in the state of New South Wales, Australia, diagnosed with cervical cancer between 2009 and 2018 using linked registry, treatment, and death data.ResultsThe crude incidence rate for cervical cancer in Aboriginal women in NSW (17.29/100,000) was more than double the rate among non‐Aboriginal women (6.77/100,000). Aboriginal women were diagnosed with cervical cancer, including metastatic disease, at a younger age. There was no significant difference in presentation stage, surgery or radiotherapy treatment rates, or overall survival at 5 years between the two populations.ConclusionAlthough access to cancer care looks similar as an aggregate in Aboriginal versus non‐Aboriginal populations, there were disparities with reduced access to care (patients who did not receive either radiotherapy or surgery) among Aboriginal patients who were socioeconomically disadvantaged or residing in remote areas. The lower age of cancer diagnosis among Aboriginal women may have effects on survivorship, including negative effects on fertility, loss of income, and other personal, social, and economic consequences. Efforts to improve access to care, including screening, diagnosis, and treatment, should be targeted toward younger Aboriginal women and those who are socioeconomically disadvantaged or those residing in remote areas.

The mechanisms of personalization

ABSTRACT This article draws on Max Weber’s account of legitimate authority to argue that there are three key mechanisms that drive the personalization of power in political regimes: the mobilization of charisma, the mobilization of legality or formal authority, and the mobilization of informal authority. The mobilization of charisma involves leaders using emotional connections with followers to undermine formal institutional constraints. The mobilization of legality refers to using legal discourses and procedures to expand formal executive powers. The mobilization of informal authority relies on leaders occupying strategic positions in patronage networks to undermine or expand formal authority. Each mechanism allows leaders to escape elite accountability through different means. The article illustrates these mechanisms through historical and contemporary examples. It argues that understanding these distinct mechanisms can help explain variation in trajectories and consequences of personalization across regimes. The framework advances theories of personalization by highlighting how personal power relies not just on disrupting elite coordination but on deploying different forms of authority.

Reducing Digital Inequities: The Role of Helping Professionals in Designing Just and Inclusive Strategies

This policy brief calls on social workers and other helping professionals to participate in efforts to address broadband internet access inequities. We first highlight continuing access inequities and their consequences for low-income persons, as well as older persons, minority group members, those with disabilities, and those living in rural areas. We then describe new initiatives to improve broadband access and digital literacy through state and local programs funded by the 2021 $65 billion federal Infrastructure Investment and Jobs Act. Finally, strategies are discussed for social worker engagement in such work, which include policy advocacy, contributing to the implementation of emerging programs, and serving as information conveyors to their clients concerning digital access and literacy training opportunities.

On the issue of the responsibility of convicts for evading serving sentences not related to isolation from society

The inevitability of punishment is the main condition for ensuring the effectiveness of its implementation. Institute of Responsibility persons evading serving criminal sentences, is intersectoral and represents a special legal form of response of the state, represented by authorized bodies and officials, to the behavior of convicts that does not meet established requirements. The core of this institution is the provisions of penal legislation. In the article, the author analyzes the legal consequences of persons evading serving sentences not related to isolation from society. The research objectives were: differentiation of types of legal liability for evasion from serving sentences, consideration of signs characteristic of malicious evasion from serving sentences not related to isolation from society, as well as analysis of judicial practice on these issues. Based on the results of the study, the author proposes a classification of convicts evading serving sentences, identifying signs of malicious evasion from serving sentences not associated with isolation from society, which vary depending on the type of punishment in question. The idea of the need to exclude the evaluative position of the courts when establishing the fact of malicious evasion of a convicted person from serving a sentence is substantiated, and it is also determined that replacing the unserved part of the sentence with a more severe one and adding restrictions previously established by the court are special types of criminal liability.

Digital health intervention for children with ADHD to improve mental health intervention, patient experiences, and outcomes: a study protocol

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is the most prevalent childhood psychiatric condition with profound public health, personal, and family consequences. ADHD requires comprehensive treatment; however, lack of communication and integration across multiple points of care is a substantial barrier to progress. Given the chronic and pervasive challenges associated with ADHD, innovative approaches are crucial. We developed the digital health intervention (DHI)—CoolTaCo [Cool Technology Assisting Co-regulation] to address these critical barriers. CoolTaCo uses Patient-Centered Digital Healthcare Technologies (PC-DHT) to promote co-regulation (child/parent), capture patient data, support efficient healthcare delivery, enhance patient engagement, and facilitate shared decision-making, thereby improving access to timely and targeted mental health intervention for children at significant risk for poor outcomes. The present paper will describe our planned protocol to evaluate the efficacy of CoolTaCo via randomized control trial (RCT).Methods/designWe will recruit 60 children (ages 8–12) with ADHD who will be randomized to either immediate (n = 30) or delayed (n = 30) treatment (i.e., a waitlist control group). Among those randomized to immediate treatment, half will be assigned to DHI (delivered via a smartwatch and smartphone application), the other half to an active control treatment as usual (TAU). Unlike the DHI group, the TAU group will receive the smartwatch with no assigned activities, applications, or interventions on the devices. The intervention period will last 16 weeks; after a participant has been in the delayed treatment group for 16 weeks and has completed the post-waiting period assessment, they will be randomly assigned to either the intervention or active control group. Thus, 30 participants will complete the intervention, and 30 will complete the active control, with half of the total sample completing a waitlist period.DiscussionIndividuals with ADHD have complex needs. Despite improvement in outcomes following cognitive behavioral therapies (CBT) and pharmaceutical treatment, long-term maintenance is a challenge often not addressed by traditional medical approaches, and, as we described, ineffective approaches to information sharing across points of care create further barriers to progress. Our research will fill a significant gap in translating early treatment investments and gains into long-term, sustainable outcomes.This study was registered as a clinic trial at ClinicalTrials.gov (Digital Health Intervention for Children With ADHD, ID# NCT06456372) on 06/13/2024.

An exploration of intersectionality and school belonging in the permanent exclusion of Black Caribbean boys in schools in England: Implications for Educational Psychologists

AimsDisproportionately high exclusion rates of Black Caribbean Boys (BCBs) in England are considered from a school belonging perspective, particularly as mediated through teacher relations. The vulnerabilities of this group are considered, with intersectionality suggested as a critical concept.Method/RationaleBCBs are permanently excluded from schools in England at a rate three times higher than the general population. Permanent exclusion has been linked to a range of negative personal and socio-economic consequences, highlighting the need to address this disparity. School belonging mediates negative peer and parental influences and may be linked to school exclusion for some groups. Literature is reviewed considering belonging, linking belonginess threats to both pro-social and anti-social behaviour. The multi-dimensional nature of school belonging is noted. School belonging literature is reviewed, establishing the vital importance of teacher relationships. Evidence regarding BCB’s relationships with their teachers, often characterised by low expectations, differential treatment and racial bias, is considered.FindingsIt is argued that these negative relational influences constitute belonginess threats for BCBs. It is hypothesised that these, along with increased belongingness sensitivity amongst some BCBs, can drive increased anti-social behaviour, in some cases leading to school exclusion.LimitationsThis is a theoretical paper and further empirical research is needed into what constitutes school belonging for BCBs, whose lives are often impacted by various intersecting inequalities.ConclusionsInitiatives aiming to increase school belonging amongst BCBs, by improving their relationships with teachers, are suggested as a way of decreasing exclusions. A role for Educational Psychologists in supporting schools with evidence-based approaches to enhancing school belonging for this group is suggested.