Cross-sectional Survey Research Articles

The impact of COVID-19 on resident doctors as the frontline in health services

As the number of confirmed cases of COVID-19 increases, the workload due to the pandemic can affect health workers and increase the risk of psychological stress. Psychological factors such as anxiety can cause various physiological responses, including gastroesophageal reflux disease (GERD) symptoms. The persistent symptoms of GERD can reduce the patient's quality of life. A cross-sectional survey was conducted in October 2021 at the Dr. Zainoel Abidin Regional General Hospital, Banda Aceh. A total of 91 Specialist Medical Education Program responded to the study. Data from respondents were collected through the generalized anxiety disorder-7 (GAD-7), GERD-Q, and WHOQOL-BREF questionnaires. The statistical analysis used was the contingency coefficient test. The results showed that 9.9% of respondents experienced suggestive GERD, minimal anxiety (92%), and good quality of life (51.6%). There was a significant relationship between anxiety levels and quality of life and the GERD prevalence of Specialist Doctor Education Program Participants during the COVID-19 pandemic (p<0.05). Most Specialist Medical Education Program participants did not suffer from GERD with minimal anxiety, followed by mild and moderate anxiety. The majority had a good and moderate quality of life during the COVID-19 pandemic.

Exploring the Roles, Functions, and Work Experiences of Nurse Scientists in the Veterans Health Administration.

The aim of this project was to describe nurse scientists' roles, functions, and work experiences in the Veterans Health Administration (VHA). Nurse scientists play a critical role in shaping the culture of clinical inquiry and closing the gap between knowledge and practice. A cross-sectional survey was used to collect information on sociodemographics, workload, research, clinical practice, education, and time/effort. Data were examined using descriptive statistics and χ2 analyses. One hundred forty-four nurse scientists completed the survey. These nurse scientists serve dynamic and critical roles in conducting research, implementing evidence-based practice, and reforming policy. Research effort was limited due to workload and infrastructure constraints. Better research infrastructure was associated with higher research productivity and funding. This survey highlights the needs and challenges nurse scientists experience in conducting research and advancing VHA's mission. Given the national shortage of PhD-prepared nurses, long-term strategies are needed to attract, hire, and retain nurse scientists in healthcare systems.

Usage of temporary anchorage devices: A cross-cultural and cross-sectional survey of orthodontists in Australia and the UK

Detailed insight regarding the use of temporary anchorage devices (TAD) in Australia and the United Kingdom (UK) is lacking. The primary aim of the present cross-sectional survey was to investigate TAD usage among UK-based and Australian-based orthodontists. The secondary objectives were to compare TAD-related preferences and protocols between orthodontists in the two countries. A pilot-tested electronic questionnaire was distributed to members of the British Orthodontic Society and the Australian Society of Orthodontists. Questions pertained to their demographic details, and current use of TADs including protocols, treatment objectives and factors influencing their use. A total of 192 responses were recorded (Australia: 122; UK: 70). One hundred and forty-two respondents (74.0%) reported using TADs as part of their orthodontic treatment, 77.0% in Australia (n=94) and 68.6% in the UK (n=48). Molar protraction was the most common procedure for which TADs were reportedly used (Australia: n=118; 87.2%, UK: n=36; 75.0%). "Loosening" was the most prevalent reported complication overall (n=124; 90.1%). "Confidence", "insufficient postgraduate education" and "availability of equipment" were the factors that most influenced the decision not to provide TADs. Most orthodontists in both countries provided TADs. TAD protocols of orthodontists in both countries were reported. Similarities and differences regarding TAD-related clinical practices and procedures, complications and factors influencing the use of TADs and reasons for not using TADs were explored. Information from the present study can provide baseline data for future related studies in each country and for comparison of TAD usage in other countries.

Knowledge of tuberculosis among physicians working at community health stations in Vietnam

Tuberculosis (TB) remains a significant health problem worldwide, including in Vietnam, where around 174,000 newly diagnosed cases and 13,200 patients died in 2018. There are challenges in the diagnostic process, treatment, and follow-up. The physicians with knowledge of TB working at commune health stations play an essential role in this struggle. The primary purpose of this study was to evaluate knowledge of TB and related factors among physicians working at community health stations in the Northern provinces of Vietnam. A cross-sectional survey was implemented on 335 physicians working at community health stations in 5 Northern provinces in Vietnam from September 2019 to October 2020. The result showed that the TB knowledge of physicians was not good. There were some severe knowledge gaps concerning at-risk groups, the main symptoms of TB, sputum tests for both diagnosis and follow-up and management of attack therapy. The TB training participants had better TB knowledge than others (aOR=1.68; 95%CI: 1.047-2.712). This study underlines the importance of clinical experience and TB training to TB knowledge. We suggest that a TB training plan is required for physicians. Our survey results could inform the process of defining the physicians who work at community health stations' role in TB management in the future.

Prevalence and Correlates of Dry Eye in a German Population Sample.

In this cross-sectional survey, we assessed the prevalence of dry eye disease (DED) in a representative German population sample. In addition, we examined the associations between DED, health-related quality of life (HRQoL), and level of fatigue. Finally, we further validated the German version of the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and present norm data of the German population. A random sample of German residents aged 16 years and older was recruited between October and December 2021. All participants completed the SPEED, Short Form 36, and Multidimensional Fatigue Inventory 20 questionnaires. Of the 2495 participants who completed the survey, 450 (21.6%; 95% confidence intervals 20.0-23.1) reported a SPEED total score of ≥4, indicating a positive screening for DED. DED was significantly more common in women and older age. Participants who screened positive for DED reported significantly higher levels of fatigue and lower values in all domains of HRQoL. A receiver operating characteristic curve of the SPEED was generated using an ophthalmologist's diagnosis. The area under the curve was estimated to be 0.886 (95% confidence intervals 0.858-0.913). A cutoff score ≥4 seemed to be appropriate as an indicator of DED. Cronbach's α was excellent (0.95). DED is common in the German population. We confirmed associations with sex, age, HRQoL, and fatigue level, indicating a high burden of DED. The German version of the SPEED is a valid instrument for the assessment of DED symptoms.

Investigation of digital competence of elementary school teacher in West Nusa Tenggara: A cross-section survey study

As educational facilitators, teachers should have good digital competence to successfully integrate technology into the learning process. This cross-sectional survey research method was conducted on the needs of digital elementary teachers in West Nusa Tenggara. Respondents were 213 primary school teachers from 10 districts in West Nusa Tenggara, Indonesia. The data collection process is conducted online and is anonymous to maintain the privacy of respondents using the Google Form platform. The data analysis used was the Mann-Whitney U test, as we wanted to compare the competencies of male and female teachers. Moreover, the researchers also conducted FGDs with Heads of Education Bureau in 10 districts of NTB to verify the results in this area. The results of this study show that the digital competence primary school teachers either man or woman teachers are still low. In addition, the teacher's skills in using computers, the Internet, and software in the classroom are minimal. The opportunities for teachers to use the Internet are quite high, but teachers do not use it for classroom learning. Teachers believe that technology can help them withhold concepts or knowledge from students. However, teachers also fear the negative effects if children interact with Technology too often.

Development of manufacturing engineering program of Bulacan State University using employability tracer study

<span lang="EN-US">Tracer study is one of the continuous quality improvement tools for curriculum development. The graduates are invited to answer the tracer form to determine their employability. Since the Manufacturing Engineering program in Bulacan State University (BuLSU) is the youngest engineering program, there is minimal data on graduates available, especially on the details of their first jobs, such as the first job related to the program, time taken to land their first job, gross monthly salary, and learning competencies. The demographic profile of the manufacturing engineering graduates from 2015 to 2019 is preserved and remains strictly confidential for the safety of their identification. Correspondingly, the study applied a cross-sectional retrospective survey method. Moreover, 67.41% of manufacturing engineering graduates responded. The employment rate of manufacturing engineering graduates was 93.38%, whereas regular or permanent in their current employment was 84.40%. Furthermore, data show that they are employed within less than a month, 50.97% of responses. Lastly, the primary learning competency that manufacturing engineering graduates consider is critical thinking skills, with a response rate of 86.11%, followed by problem-solving skills, with 81.94% responses, while third was communication skills, with a rate of 78.08%. Ultimately, the recommendations for further curriculum and program improvement are exhibited.</span>

Psychosocial Self-efficacy and its Association with Selected Potential Factors Among Adults with Type 1 Diabetes: A Cross-Sectional Survey Study.

The management of type 1 diabetes, a non-preventable chronic disease, leads to a high physical and psychological burden on the individual. Digital health technology can improve a person's psychosocial self-efficacy and thereby contribute to improved diabetes self-care. The aim of this study was to explore associations between psychosocial self-efficacy and demographic-, disease specific-, well-being as well as digital health technology (DHT) related factors among adults with type 1 diabetes. A primarily web-based cross sectional survey was conducted among adults with type 1 diabetes in Sweden (n = 301). Psychosocial self-efficacy was assessed using the Swedish version of the Diabetes Empowerment Scale, Swe-DES-23. The survey also contained questions related to demographic-, disease specific-, well-being as well as digital health technology related variables. Higher well-being scores and lower HbA1c levels were associated with higher psychosocial self-efficacy in multiple linear regression analysis. In multivariate analysis, gender, body mass index, well-being scores, and HbA1c levels showed association with psychosocial self-efficacy. None of the DHT factors were found associated with psychosocial self-efficacy. In this study, higher well-being score and lower self-reported HbA1c levels were associated with higher psychosocial self-efficacy in both univariate- and multivariate analysis and accounted for 30% of the variation in psychosocial self-efficacy in the regression model. Thus, measures to improve psychosocial self-efficacy in adults with type 1 diabetes may help maintain their psychological well-being and blood glucose control.

A cross-sectional survey of patients prescribed elemental feed in the UK

A cross-sectional survey of patients prescribed elemental feed in the UK

Comparing harm reduction and overdose response services between community-based and public health department syringe service programmes using a national cross-sectional survey

Syringe services programmes (SSPs) are an evidence-based strategy to reduce infectious diseases and deliver overdose prevention interventions for people who use drugs. They face regulatory, administrative, and funding barriers that limit their implementation in the US, though the federal government recently began providing funding to support these efforts. In this study we aim to understand whether the organisational characteristics of SSPs are associated with the provision of syringe and other overdose response strategies. We examine four outcomes using the National Survey of Syringe Services Programs (NSSSP) (N=472): syringe distribution, naloxone distribution, fentanyl test strip (FTS) availability, and buprenorphine implementation. These outcomes are assessed across three organizational categories of SSPs-those operated by public health departments (DPH), community-based organizations (CBOs) with government funding, and CBOs without government funding-while adjusting for community-level confounders. The proportion of SSPs by organizational category was 36% DPH, 42% CBOs with government funding, and 22% CBOs without government funding. Adjusting for community-level differences, we found that CBO SSPs with government funding had significantly higher provision of all four syringe and overdose response services as compared to DPH SSPs and across three of the four services as compared to CBO SSPs without government funding. CBO SSPs without government funding still had significantly higher provision of three of the four services as compared to programmes maintained by the DPH. CBO SSPs have strong potential to expand overdose response services nationally, particularly if provided with sustained and adequate funding. Communities should aim to provide funding that does not hinder SSP innovation so they can remain flexible in responding to local needs. This study was supported by Arnold Ventures (20-05172).

Current gaps in emergency medicine core content education for oncologic emergencies: A targeted needs assessment.

The core content of emergency medicine (EM) residency training includes the management of oncologic emergencies; however, documented knowledge gaps continue to exist in this subtopic. This study represents a targeted needs assessment as indicated by Step 2 of Kern's curriculum design to determine the specific training gaps to be addressed within the oncologic EM curriculum. A multi-institutional cross-sectional survey of oncologists (surgical and medical) and emergency physicians (attendings and residents) was conducted during 2023 at five institutions. The voluntary survey consisted of general and specialty-specific questions exploring gaps in oncologic emergency-specific training/education topics. Descriptive statistics reported responses as frequencies and percentages. Of the 833 surveys sent across the five sites, 302 (36.3%) were accessed by link; of these, 271 (89.7%) surveys were completed. There were no differences in the responses between early and later respondents and no differences in the characteristics of respondents between sites. A vast majority of the oncologist and EM groups (91.2% and 83.0%, respectively) reported a belief that emergency physicians would benefit from additional oncologic emergency training. Our survey identified 16 important topics for inclusion in an oncologic EM curriculum, including five topics not present on the 2022 Model of Clinical Practice of Emergency Medicine. Based on this needs assessment, an oncologic EM curriculum should include the topics listed under oncologic emergencies in the 2022 Model of the Clinical Practice of Emergency Medicine along with our respondent-identified topics of radiation therapy adverse effects, stem cell transplant complications, and the management of cancer-specific postsurgical complications, pain, and common diseases in patients with cancer.

Prevalence of skin problems caused by insulin pump therapy and associated factors in children with type 1 diabetes mellitus: A large cross-sectional survey in China

AimsTo document the prevalence of skin problems associated with insulin pump use and identify contributing factors among children with type 1 diabetes mellitus in China. MethodsIn total, 461 children were recruited from an online community (i.e., a Wechat group) of pediatric patients with T1DM. A self-developed questionnaire was filled in by parents, collecting the information on social demographics, disease, and insulin pump therapy related characteristics and skin problems. We applied the Mann–Whitney U test, Chi square test and logistic regression analysis to identify the factors associated with skin problems. ResultsOf the 461 responders, 308 (66.8 %) children were reported to have skin problems. More specifically, 38.8 % had pigmentation changes, 22.3 % allergy/dermatitis, 20.2 % scaring, 11.5 % pain, 10.8 % infection, 10.6 % subcutaneous lipohypertrophy, and 6.1 % lipoatrophy. Logistic regression analysis showed that independent associated factors of skin problems were the caregiver’s educational level as college or above, patient having skin allergies, and using the Brand 2 insulin pump (p values < 0.05). ConclusionsThe present study documents the prevalence of skin problems and identifies associated factors, such as caregiver’s education, patients skin allergies, and using a specific brand of pump. Health education should address these factors in addition to the traditionally emphasized factors.

Treatment with immunosuppressants did not increase the risk of COVID-19 in pemphigus patients: A single-center survey-based study

BackgroundThe prevalence and outcomes of coronavirus 2019 (COVID-19) among patients using glucocorticoids and immunosuppressants remain controversial. AimThe study aims to investigate the impact of immunosuppressants especially glucocorticoids on patients in the Autoimmune Bullous Diseases Cohort of West China Hospital (AIBDWCH) during COVID-19. MethodsWe conducted a cross-sectional survey from December 7, 2022, to February 8, 2023, using questionnaires administered either face-to-face or by phone. COVID-19 cases were classified as confirmed, probable, or suspected according to World Health Organization criteria. Patients were divided into Group A (confirmed and probable cases) and Group B (suspected and other cases). The impact of glucocorticoids and immunosuppressive agents on COVID-19 disease and progression was evaluated with logistic regression models. ResultsThis study included 111 patients with pemphigus. Overweight patients had a reduced risk of confirmed COVID-19 (odds ratio [OR] 0.35 [95 % CI 0.13–0.97], p = 0.045). Patients treated with a medium dose of prednisone during the pandemic had a lower incidence of COVID-19 compared to those on low doses, though the difference was not statistically significant. No independent effects of age, sex, comorbidities, and therapies were observed. No significant differences were found in COVID-19 symptoms among different therapy groups. ConclusionsTreatment with immunosuppressants, particularly glucocorticoids at low-to-medium doses, did not elevate COVID-19 risk in pemphigus patients. Consistent outcomes across treatments confirm the safety of these therapies during the pandemic.

Unlocking determinants of smart construction: an integrated model of UTAUT2, TTF, and perceived risk for IoT acceptance in AEC industry

PurposeThe Internet of Things (IoT) offers substantial potential for improving efficiency and effectiveness in various applications, notably within the domain of smart construction. Despite its growing adoption within the Architecture, Engineering, and Construction (AEC) industry, its utilization remains limited. Despite efforts made by policymakers, the shift from traditional construction practices to smart construction poses significant challenges. Consequently, this study aims to explore, compare, and prioritize the determinants that impact the acceptance of the IoT among construction practitioners.Design/methodology/approachBased on the integrated model of Unified Theory of Acceptance and Use of Technology (UTAUT2), Task-Technology Fit (TTF), and perceived risk. A cross-sectional survey was administered to 309 construction practitioners in China, and the collected data were analyzed using structural equation modeling (SEM) to test the proposed hypotheses.FindingsThe findings indicate that TTF, performance expectancy, effort expectancy, hedonic motivation, facilitating conditions, and perceived risk exert significant influence on construction practitioners’ intention to adopt IoT. Conversely, social influence and habit exhibit no significant impact. Notably, the results unveil the moderating influence of gender on key relationships – specifically, performance expectancy, hedonic motivation, and habit – in relation to the behavioral intention to adopt IoT among construction practitioners. In general, the model explains 71% of the variance in the behavioral intention to adopt IoT, indicating that the independent constructs influenced 71% of practitioners’ intentions to use IoT.Practical implicationsThese findings provide both theoretical support and empirical evidence, offering valuable insights for stakeholders aiming to gain a deeper understanding of the critical factors influencing practitioners’ intention to adopt IoT. This knowledge equips them to formulate programs and strategies for promoting effective IoT implementation within the AEC field.Originality/valueThis study contributes to the existing literature by affirming antecedents and uncovering moderators in IoT adoption. It enhances the existing theoretical frameworks by integrating UTAUT2, TTF, and perceived risk, thereby making a substantial contribution to the advancement of technology adoption research in the AEC sector.

Expert opinion regarding early screening, patient awareness, and telemedicine practices in Indian settings

Objective: To collect clinicians’ perspectives regarding the significance of early screening, patient awareness, and telemedicine practice in routine Indian settings for diabetes management. Methodology: The study employed a 25-item questionnaire to gather insights from specialists across different Indian settings regarding their perspectives on early screening, patient awareness, and telemedicine practices among diabetologists. Results: According to the cross-sectional survey, 59% of respondents believed that regular awareness programs were helpful in the early screening of diabetes among high-risk individuals. Meanwhile, 64% of clinicians reported that clinical-level screening was a more effective tool for early screening. Around 74% of clinicians reported that microvascular complications namely diabetic retinopathy, diabetic neuropathy, and diabetic kidney diseases should be targeted during early screening of diabetes. The American Diabetes Association (ADA) risk score was the most commonly used risk score for early diabetes screening, according to 54% of clinicians. Moreover, 67% of clinicians reported that 11 to 25% of diabetic individuals had complications of lipitension, and 64% reported that 11 to 20% of T2DM individuals had depression. Regarding telemedicine, 65% of clinicians preferred to use it occasionally. However, at an individual level, factors like cost, literacy, less familiarity with using the tool, and emotional reasons hindered the effective adoption of telemedicine, as reported by 56% of clinicians. Conclusion: The survey highlighted the effectiveness of awareness programs and clinical-level screening for early diabetes management, emphasizing the importance of targeting microvascular complications. Increased prevalence of complications like lipitension and depression was noted in diabetic individuals. Telemedicine, though recognized as valuable, faces challenges due to individual-level factors.

Nurses' Use of mHealth Apps for Chronic Conditions: Cross-Sectional Survey.

Mobile health (mHealth) is increasingly used to support public health practice, as it has positive benefits such as enhancing self-efficacy and facilitating chronic disease management. Yet, relatively few studies have explored the use of mHealth apps among nurses, despite their important role in caring for patients with and at risk of chronic conditions. The aim of the study is to explore nurses' use of mHealth apps to support adults with or at risk of chronic conditions and understand the factors that influence technology adoption. A web-based cross-sectional survey was conducted between September 2022 and January 2023. The survey was shared via social media and professional nursing organizations to Australian nurses caring for adults with or at risk of chronic conditions. A total of 158 responses were included in the analysis. More than two-thirds (n=108, 68.4%) of respondents reported that they personally used at least 1 mHealth app. Over half (n=83, 52.5% to n=108, 68.4%) reported they use mHealth apps at least a few times a month for clinical purposes. Logistic regression demonstrated that performance expectancy (P=.04), facilitating condition (P=.05), and personal use of mHealth apps (P=.05) were significantly associated with mHealth app recommendation. In contrast, effort expectancy (P=.09) and social influence (P=.46) did not have a significant influence on whether respondents recommended mHealth apps to patients. The inability to identify the quality of mHealth apps and the lack of access to mobile devices or internet were the most common barriers to mHealth app recommendation. While nurses use mHealth apps personally, there is potential to increase their clinical application. Given the challenges reported in appraising and assessing mHealth apps, app regulation and upskilling nurses will help to integrate mHealth apps into usual patient care.

A Cross Sectional Survey of Factors Related to Cannabis Use as a Sleep Aid Among Canadian Cancer Survivors

ABSTRACT Objectives Poor sleep is a common side effect of cancer. Cannabis is increasingly used to manage cancer treatment-related symptoms, including sleep. This study investigated factors related to cannabis use for sleep among Canadian cancer survivors. Method Adult Canadian cancer survivors (N = 940) were recruited via the Angus Reid Institute and completed an online, cross-sectional survey. Univariate and multiple binomial logistic regression models identified factors associated with cannabis use for sleep. Results Of the participants (Mage = 64.5 yrs; Women = 51.1%; White = 92.9%), 25.1% (n = 236) currently use cannabis for sleep. Participants were at greater odds of using cannabis for sleep if they identified as a gender other than man or woman (AOR = 11.132), were diagnosed with multiple medical conditions (2:AOR = 1.988; 3+:AOR = 1.902), two psychological conditions (AOR = 2.171), multiple sleep disorders (AOR = 2.338), insomnia (AOR = 1.942), bone (AOR = 6.535), gastrointestinal (AOR = 4.307), genitourinary (AOR = 2.586), hematological (AOR = 4.739), or an unlisted cancer (AOR = 3.470), received hormone therapy only (AOR = 3.054), drink heavily (AOR = 2.748), or had mild insomnia (AOR = 1.828). Older participants (AOR=.972) and those with sleep apnea were less likely to use cannabis for sleep (AOR=.560). Conclusion Given its prevalence, research is needed to understand how factors associated with cannabis use as a sleep aid among Canadian cancer survivors may influence its use and effectiveness and whether these factors are barriers to accessing evidence-based treatments.

Barriers and facilitators to vascular access point-of-care ultrasound in haemodialysis: An international survey of haemodialysis clinicians.

Utilising point-of-care ultrasound for assessment and cannulation of vascular access in people receiving haemodialysis has shown positive clinical results. Nonetheless, there is variation in how renal health care professionals worldwide embrace this method, and there's a lack of research on the factors that promote or hinder its adoption. To explore regional differences, and barriers and facilitators, to the use of point-of-care ultrasound for assessment and cannulation of vascular access in haemodialysis. Exploratory descriptive cross-sectional web-based survey. Healthcare clinicians working in haemodialysis responsible for cannulation of arteriovenous fistula or grafts. The survey was completed by 645 health care clinicians from 38 countries. 75% to 93% of respondents from Australia/New Zealand, Canada, Europe and United Kingdom/Ireland reported access to ultrasound, compared to 26% (n = 43/167) from the United States respondent's reported lower levels of ultrasound training than other regions. Facilitators for using ultrasound were: the availability of ultrasound training (87%, n = 558), to reduce miscannulations (76%, n = 255/336) and to improve patient outcomes (73%, n = 246/336). Point-of-care ultrasound barriers were lack of access to ultrasound education (82%, n = 196/239), lack of ultrasound machines (33%, n = 212/645) or believing that ultrasound was someone else's role (38%, n = 29/86). This study revealed national and regional differences related to haemodialysis point-of-care ultrasound. Understanding the regions requiring more education and implementation of ultrasound and what motivates staff, or deters from using ultrasound, is crucial for effectiveness of future implementation and workplace change initiatives.

Developing an Instrument to Measure Public Health Nurses' Competence Related to Breastfeeding Beyond 12 Months.

Health professionals need adequate competence to support breastfeeding beyond infancy. There is no established instrument to measure health professionals' competence regarding long-term breastfeeding. To respond to this shortcoming, the Long-Term Breastfeeding Competence Scale (LBCS) was developed. To develop and pilot an instrument that measures public health nurses' competence related to breastfeeding beyond 12 months in order to provide adequate breastfeeding counseling for families. This study was conducted as a cross-sectional online survey on public health nurses working in maternity and/or child health clinics. The relevance and clarity of the LBCS were assessed by an expert panel (N = 6). Public health nurses (N = 197) completed the LBCS, which consisted of a knowledge and skills dimension and an attitude dimension. Descriptive statistics were used to describe the characteristics of the study sample. The conceptual validity of the knowledge and skills dimension was assessed using the dichotomous Rasch analysis, and attitude dimension using the exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha. The distribution of the items was summarized by descriptive statistics. According to expert panel evaluations, the LBCS was found to meet the requirements for relevance and clarity (S-CVI 0.90). The internal consistency of the instrument was at a good level (α = 0.796) and met the requirements set for a new instrument. The LBCS is appropriate to determine public health nurses' competence related to breastfeeding beyond 12 months. The LBCS can be used to identify the need for education concerning breastfeeding beyond 12 months.

Unmet healthcare needs, access to services and experiences with health providers among persons with spinal cord injury in Australia.

Cross-sectional survey. Appropriate and timely lifelong access to healthcare following a spinal cord injury (SCI) is critical, yet unmet healthcare needs in this population are common. Poor experiences with healthcare providers can be a barrier to health-seeking behaviour, and we hypothesised that there would be an association between unmet healthcare needs and care experiences. This study aimed to: (1) describe healthcare provider utilisation in the past year, unmet care needs and satisfaction with healthcare services; (2) explore the association between experiences with healthcare providers and unmet healthcare needs; and (3) explore the association between healthcare provider utilisation and participant characteristics, including unmet healthcare needs. Community. Analysis of data for 1579 Australians aged ≥ 18, who were ≥ 1-year post-SCI and living in the community. Bayesian penalised regression was used to model six binary outcomes: unmet healthcare needs; the use of general practitioners (GPs), allied health practitioners, rehabilitation specialists;medical specialists; and hospitalisations in the past 12-months. Unmet needs were reported by 17% of participants, with service cost the common deterrent. There was evidence of an effect for provider experiences on unmet healthcare needs, but no evidence that unmet healthcare needs was associated with the use of GPs, allied health practitioners, and rehabilitation or medical specialists. Unmet healthcare needs were reported in the context of high healthcare use and large proportions of secondary conditions in a cohort with long-term SCI. Improved health access for people with SCI include better primary-secondary care collaboration is needed.