Personal Discomfort Research Articles

Lichen planus ruber, current therapy: a systematic review

Background. Lichen planus ruber is a common inflammatory disease of skin and mucous membranes with a chronic relapsing course, resistance to conventional therapy, diverse clinical manifestations and capacity of tumourisation. Dermatosis is often comorbid with various underlying gastrointestinal, cardiovascular illnesses and endocrinopathies. Women are more impacted than men (ratio 1.4:1), the disease lasts from 5 to 40 years.Objectives. Assessment of the efficacy and safety of current therapies for lichen planus ruber.Methods. The PubMed, Web of Science, Medline, eLibrary and Scopus databases were mined for randomised controlled studies on treatment of this dermatosis in the period of 2014–2020, and selected impactive publications within 1991–2012 were also included in the review. The following keywords were used: lichen planus [красный плоский лишай], systemic and local drugs [системные и местные препараты], phototherapy [фототерапия], physiotherapeutic methods of treatment [физиотерапевтические методы лечения]. Publications in peer-reviewed journals had priority. Content and descriptive analyses were used as research tools.Results. Therapy for lichen planus ruber is multicomponent including a wide range of techniques, mostly immune-stimulating but often unproved for efficacy and safety. Selected studies are small-sample. The review presents feasible drug-based and physiotherapeutic methods to tackle lichen planus ruber, their application by the disease clinical presentation and prevalence, patient’s personal discomfort, psycho-emotional status and comorbidity. We describe the mechanisms of action, clinical efficacy, application types and noxious side effects in practiced albeit sometimes contentious therapies.Conclusion. Further well-designed research is warranted to aim at enhanced efficacy, safety and long-term remission in therapy for lichen planus ruber.

“They Assume That You’re Not Having Sex”: A Qualitative Exploration of How Paediatric Healthcare Providers Can Have Positive Sexuality-Related Conversations with Youth with Disabilities

Every individual should have equal access to sexuality-related information and services. Regrettably, societal stigma revolves around the sexuality of youth with disabilities, with a common misconception that they are asexual, and therefore do not need to be taught about sexuality and sexual health. Healthcare providers (PHCPs) have reported barriers to having sexuality-related conversations with youth with disabilities, such as lack of time and personal discomfort. As such, we sought to examine what might facilitate PHCPs to have conversations about sexuality with their paediatric clients and families. A qualitative focus group study using a descriptive exploratory approach was conducted. Five PHCP participants from a paediatric rehabilitation hospital participated in a focus group. Five young adult (YA) participants with a self-reported disability took part in a separate focus group or individual interviews. Descriptive thematic analysis was used to identify, analyze, and report themes in the data. Results showed that persisting assumptions impede children and youth with disabilities from exploring their sexuality; that autonomy, safety, trust, and consent are critical topics that should be addressed in sexuality-related clinical conversations; and that sexuality-related services should be improved by providing greater disability-specific information, having age-appropriate discussions from an early age, and increasing interdisciplinary care. Normalizing sexuality-related discourse in clinical settings may help youth with disabilities construct a healthy sexual identity, fulfill their sexual needs, and develop adequate skills to deal with sexual situations safely and appropriately.

A Multifaceted Intimate Partner Violence Communication Skills Curriculum Increases Screening Among Internal Medicine Residents.

Background: Intimate partner violence (IPV) is common, yet physicians do not routinely screen patients for IPV. There are no clear recommendations for best educational practices for physician trainees that improve screening rates. Materials and Methods: We implemented an IPV curriculum combining didactics and communication skills training for internal medicine residents. Didactics included definitions, risk factors, screening recommendations, and documentation; communication skills training included developing unique screening and response phrases; and two simulated patient exercises. The primary outcome was screening documentation rates as measured through pre- and postcurriculum chart review. Secondary outcomes included knowledge, comfort, and attitudes measured through pre- and postcurriculum administration of an adapted Physician Readiness to Manage Intimate partner violence Survey (PREMIS). Postcurriculum semistructured interviews provided further details regarding behaviors and attitudes. Results: Forty residents completed the curriculum. 29/40 (73%) completed both pre- and postsurveys. Fifteen participated in semistructured interviews. Residents demonstrated increased screening documentation postcurriculum (p < 0.05). Residents showed improvement in 80% of objective knowledge questions, and in all perceived knowledge and comfort-based questions (p < 0.01). Statistically significant improvement was noted in many attitudinal domains, including reported screening rates (p < 0.05). In the semistructured interviews, participants reported experiencing both practice-based improvements and ongoing screening barriers. Practice-based improvements included increased screening comfort and frequency, and strengthening of the doctor-patient relationship. Ongoing screening barriers included time, resistance to practice change, competing medical needs, and personal discomfort. Conclusions: A multifaceted IPV curriculum for residents significantly improved documentation rates, knowledge, comfort, and attitudes. Residents reported increased comfort with screening and strengthened patient relationships but acknowledged ongoing barriers to screening.

Taking offense: An emotion reconsidered

Taking offense: An emotion reconsidered

Practice Patterns of Central Venous Catheter Placement and Confirmation in Pediatric Critical Care.

Optimal practices for the placement of central venous catheters (CVCs) in critically ill children are unclear. This study describes the clinical practice of pediatric critical care medicine (PCCM) providers regarding CVC placement, including site selection, confirmation practices and assessment of complications. Two-hundred fourteen PCCM providers responded to an electronic survey, including 170 (79%) attending physicians, 30 (14%) fellow physicians, and 14 (7%) advanced practice providers. PCCM providers most commonly place internal jugular (IJ) and femoral CVCs, with subclavian CVCs and peripherally inserted central catheters (PICCs) placed less commonly (IJ 99%, femoral 95%, subclavian 40%, PICC 19%). The IJ is the most preferred site (128/214 (60%)); decreased infection risk is the most common reason for preferring this site. The subclavian is the least preferred site (150/214 [70%]) due to concern for increased risk of complications (51%) and personal discomfort with the procedure (49%). One-hundred twenty-six (59%) of respondents reported receiving formal ultrasound (US) or echocardiography training. Respondents reported using dynamic US guidance for placement in 90% of IJ, 86% of PICC, 78% of femoral, and 12% of subclavian CVCs. Plain radiography (X-ray) was the most preferred modality for confirming CVC tip position (85%) compared with US (9%) and no imaging (5%). Most providers reported using X-ray to evaluate for pneumothorax following upper extremity CVC placement, with only 5% reporting use of US and none relying on physical exam alone. This study demonstrates wide variability in PCCM providers' CVC placement practices. Potential training gaps exist for placement of subclavian catheters and use of US.

Effects of early intervention on parenting stress after preterm birth: A meta-analysis.

Preterm infants have a higher risk of development disorders. Prematurity can be considered a source of stress, in both children and their parents, due to the high number of interventions that they require. Early intervention (EI) programmes have shown to have a positive influence on the neurodevelopment of children with neurological risk. On the other hand, parenting stress has a negative influence on the development of any child. This systematic review aimed to identify the effect of EI programmes on decreasing parenting stress suffered by parents of preterm babies. Systematic review and meta-analysis of experimental studies in accordance with the PRISMA declaration guidelines were applied in this work. Fifteen randomized clinical trials were included whose methodological quality was assessed using the PEDro scale. Stress data extraction was meta-analysed using the inverse variance method in a random effects model. Statistical heterogeneity was assessed with the I2 heterogeneity statistic. The domains most commonly reported in the trials were the childcare-related stress (Child Domain), personal discomfort (Parent Domain) and computation of both (Total Stress). The results showed significant (P < 0,05) and clinically relevant differences in favour of the EI programme group at 18 months and 5 years. This review found moderate to strong evidence of the impact of EI programmes on the reduction of parenting stress in parents of preterm babies. These findings offer useful insights regarding the delivery of current support and the development of future family interventions. Finally, recommendations are provided for future intervention evaluation studies in this area.

Validation study of the Italian version of Temporal Focus Scale: psychometric properties and convergent validity

BackgroundOver the last decade, international research has produced a large number of studies that have stressed the importance of temporal focus in various aspects of the lives of individuals, groups and organizations. This first Italian validation study of the Temporal Focus Scale (TFS) has shown a reliable measurement to assess the tendency of individuals to characteristically think about different periods of their lives.MethodsTFS/I was administered to a sample of 1458 participants, while three other convenience samples (N1 = 453; N2 = 544; N3 = 168) were used for convergent validity testing.ResultsConfirmatory factor analysis confirmed a three-factor solution (including 10 items) with good indices of fit to data, e.g., χ2 = 49.533, CFI = 0.992, TLI = 0.986, RMSEA = 0.034, RMSEA 90% CI .018–.048. Convergent validity assessment confirmed predictive indications with variables such as life satisfaction, optimistic/pessimistic orientation, perceived general self-efficacy, self-regulatory modes, anxiety, depression.ConclusionThe temporal focus has proven to be a significant feature associated with various aspects of both well-being and personal discomfort. By virtue of its good psychometric properties, the TFS can be an integrative tool along with others for a better evaluation of the person’s profile in different contexts such as education, coaching, psychotherapy, counseling and career guidance.

Dispositional Empathy and Emotional Intelligence in terms of Perfectionistic Automatic Thoughts.

The maladaptive nature of Perfectionistic Automatic Thoughts (PAT) increases the importance of evaluating the construct. This study aims to identify different clusters of PAT in undergraduates, and to check possible inter-cluster differences in the dimensions of dispositional empathy and emotional intelligence in a sample of 691 Spanish undergraduates (Mage = 23.1; SD = 5.26). The Perfectionism Cognitions Inventory, the Interpersonal Reactivity Index and the Trait Meta-Mood Scale were used. Three clusters with low (LPAT), moderate (MPAT) and high (HPAT) levels of PAT were identified. Statistically significant differences were observed between these clusters in terms of dispositional empathy and emotional intelligence dimensions. HPAT significantly scored higher than LPAT on Fantasy, Empathic Concern, Personal Discomfort and Perception, as well as in comparison with MPAT on Fantasy, Empathic Concern, Personal Discomfort and Perception. Moreover, MPAT obtained significantly higher scores on Comprehension and Repair than LPAT. Effect sizes for these differences were of a small magnitude, except for the HPAT and LPAT contrasts, whose differences were of a moderate magnitude.

Telehealth Training During the COVID-19 Pandemic: A Feasibility Study of Large Group Multiplatform Telesimulation Training.

Background:Video telehealth is an important tool for health care delivery during the COVID-19 pandemic. Given physical distancing recommendations, access to traditional in-person telehealth training for providers has been limited. Telesimulation is an alternative to in-person telehealth training. Telesimulation training with both remote participants and facilitators using telehealth software has not been described.Objective:We investigated the feasibility of a large group telesimulation provider training of telehealth software for remote team leadership skills with common neonatal cases and procedures.Methods:We conducted a 90-min telesimulation session with a combination of InTouch™ provider access software and Zoom™ teleconferencing software. Zoom facilitators activated InTouch software and devices and shared their screen with remote participants. Participants rotated through skill stations and case scenarios through Zoom and directed bedside facilitators to perform simulated tasks using the shared screen and audio connection. Participants engaged in a debrief and a pre- and postsurvey assessing participants' comfort and readiness to use telemedicine. Data were analyzed using descriptive statistics and paired t tests.Results:Twenty (n = 20) participants, five Zoom and eight bedside facilitators participated. Twenty-one (21) pre- and 16 postsurveys were completed. Most participants were attending neonatologists who rarely used telemedicine software. Postsession, participants reported increased comfort with some advanced InTouch features, including taking and sharing pictures with the patient (p < 0.01) and drawing on the shared image (p < 0.05), but less comfort with troubleshooting technical issues, including audio and stethoscope (p < 0.01). Frequently stated concerns were troubleshooting technical issues during a call (75%, n = 16) and personal discomfort with telemedicine applications and technology (56%, n = 16).Conclusion:Large group telesimulation is a feasible way to offer telehealth training for physicians and can increase provider comfort with telehealth software.

The Senior Sex Education Experience Study: Qualitative Data From Developing an Adult Sex Education Program

Older adults (OAs) account for an unprecedented proportion of STDs but receive limited sex education. We present preliminary data from the SEXEE study developing a sex education intervention for OAs 50+. The sample consisted of 17 OAs, ages 53 to 77, (M = 65, SD = 7.6; 64.7% female; 94.1% Caucasian) and seven primary care physicians, geriatricians, and other specialists (e.g. gynecologists), sampled purposively. Physicians completed a semi-structured interview to describe their experiences discussing sexual health with OAs, identify barriers to those discussions, and elicit recommendations for an educational curriculum. OAs participated in three separate focus groups to determine their interest in and suggestions for the intervention. Qualitative data underwent thematic coding separately by two researchers, with a third researcher resolving any discrepancy. One physician (14%) reported routinely assessing adults’ sexual health; others only in the context of a specific presenting concern (e.g. ED). Though the physicians considered sexuality important component of QoL, many reported barriers to assessment and treatment, including insufficient time, training, and knowledge; concerns about personal and patient discomfort; and patient complexity. Of the OAs interviewed, 15 (88%) endorsed high interest in attending a sex education program. The most commonly recommended educational topics among physicians and OAs included: sexual changes with aging and management strategies; STDs and risk factors; tools for enlarging the sexual repertoire, myths about late life-sexuality; masturbation, and dating. Findings extend previous observations about clinical barriers to sexual health discussions and provide new insights for developing a sex ed intervention for this population.

Does paracetamol improve quality of life, discomfort, pain and neuropsychiatric symptoms in persons with advanced dementia living in long-term care facilities? A randomised double-blind placebo-controlled crossover (Q-PID) trial

BackgroundThe objectives of this study are to determine the effects of regularly scheduled administration of paracetamol (acetaminophen) on quality of life (QoL), discomfort, pain and neuropsychiatric symptoms of persons with dementia living in long-term care facilities (LTCFs).MethodsA multicentre randomised double-blind placebo-controlled crossover trial for 13 weeks (January 2018 to June 2019) in 17 LTCFs across the west of the Netherlands. Inclusion criteria were age ≥ 65 years, (advanced) dementia and a moderate to low QoL, independent of the presence of pain (QUALIDEM ≤ 70). Exclusion criteria were the use of regular pain treatment, allergies to the study medication, severe liver disease, use of > 4 units of alcohol/day, weight < 50 kg and/or concomitant use of flucloxacillin. Participants received study medication (paracetamol/placebo) in two periods of 6 weeks each (1 week in between as a wash-out period). Randomisation decided in which order participants received paracetamol and placebo. Primary outcomes included QoL (QUALIDEM) and discomfort (DS-DAT), secondary outcomes included pain (MOBID-2) and neuropsychiatric symptoms (NPI-NH).ResultsNinety-five LTCF residents (mean age 83.9 years [SD 7.6], 57.9% females) were included. Repeated linear mixed models showed no difference in mean differences of QUALIDEM (paracetamol +1.3 [95% CI -1.0–3.5], placebo +1.5 [95% CI -0.7–3.8]), DS-DAT (paracetamol -0.1 [95% CI -1.4–1.2], placebo 0.6 [95 CI -0.7–1.8]), MOBID-2 (paracetamol 0.0 [95% CI -0.5–0.5], placebo -0.2 [95% CI -0.7–0.3]) and NPI-NH (paracetamol +1.5 [95% CI -2.3–5.4], placebo -2.1 [95% CI -6.0–1.7]) in favour of either paracetamol or placebo.ConclusionsCompared to placebo, paracetamol showed no positive effect on QoL, discomfort, pain and neuropsychiatric symptoms in persons with advanced dementia with low QoL. It is important to find out more specifically which individual persons with advanced dementia could benefit from pain treatment with paracetamol, and for clinicians to acknowledge that a good assessment, monitoring and multidomain approach is vital for improving QoL in this vulnerable group.Trial registrationNetherlands Trial Register NTR6766. Trial registration date: 20 October 2017

Everyone’s ‘uncomfortable’ but only some people report: privacy management, threshold levels, and reporting decisions stemming from coworker online sexual harassment

ABSTRACT Online sexual harassment is important for scholars to consider because employees who are harassed by coworkers online can experience distinct consequences that may differ from face-to-face sexual harassment. Through a qualitative analysis of more than 200 survey responses, this study examines why employees who are harassed by a coworker on social media report their experiences or not. We use the lens of communication privacy management theory to argue that people report due to interpersonal awkwardness, personal discomfort, and factors influence them to link supervisors as co-owners. Participants who reported disclosed to protect others from harassment, because they felt fed up, and because they perceived they would receive effective social support. Participants who did not report wanted to preserve personal relationships at work, downplayed the severity, and also framed social media as a private space. Theoretical implications suggest that discernible differences in reporting correspond to personal thresholds for tolerating harassment.

Systematic Review of Clinician-Reported Barriers to Provision of Brief Advice for Alcohol Intake in Hospital Inpatient and Emergency Settings.

Hospital inpatient and emergency care settings provide frequent opportunities for clinicians to screen and provide brief interventions to patients who engage in the harmful use of alcohol. However, these services are not always provided, with several reasons given in different studies. We aimed to systematically review clinician-reported barriers in the provision of brief alcohol screening, brief advice, and intervention specific to hospital inpatient and emergency department (ED) settings. A systematic literature review was conducted in MEDLINE, PsycINFO, and CINAHL to identify the barriers perceived by healthcare workers in the provision of alcohol screening and brief intervention. These barriers were then categorized according to the capability, opportunity, and motivation (COM-B) model of behavior change theory. Twenty-five articles were included in this study, which involved questionnaires, surveys, interviews, and conference call discussions. The most commonly cited barriers (i.e., greater than half of the studies) were related to capability (lack of knowledge cited in 60% of studies); opportunity (lack of time and resources, 76 and 52% of studies, respectively); and motivation (personal discomfort in 60% of studies). Twenty-two other barriers were reported but with lower frequency. Clinicians cite a multitude of factors that impede their delivery of alcohol screening and brief interventions in the hospital inpatient and ED settings. These barriers were explored further under the framework of the COM-B model, which allows for intervention design. As such, changes can be made at the policy, managerial, and educational levels to address these barriers and help improve the self-efficacy and knowledge of clinicians who counsel patients on alcohol use.

Matters of Life and Death: An Experimental Study Investigating Psychological Interventions to Encourage the Readiness for End-of-Life Conversations

Introduction: Talking about death and dying is evoking discomfort in many persons, resulting in avoidance of this topic. However, end-of-life discussions can alleviate distress and uncertainties in both old and young adults, but only a minority uses this option in palliative care. Even in healthy populations, talking about death is often seen as alleviative and worthwhile, but rarely initiated. Objective: To investigate different psychological interventions (a) encouraging the readiness for end-of-life discussions and (b) changing death attitudes in healthy adults of different ages. Methods: 168 participants were randomized to four different interventions (IG1: value-based intervention with end-of-life perspective, IG2: motivation-based intervention with end-of-life perspective, IG3: combination of IG1 and IG2, CG: control group). Primary outcome was the readiness to engage in end-of-life topics. Secondary outcomes were fear of death, fear of dying and death acceptance. Assessments took place before, directly after the intervention and at 2 weeks of follow up. Results: IG2 and IG3 reported significantly more changes in the readiness to engage in end-of-life discussions than the CG (F[5.61, 307] = 4.83, p < 0.001, ηp² = 0.081) directly after the intervention. The effect of IG3 remained stable at the follow-up. There were no significant effects of the interventions on end-of-life fears or death acceptance. Acceptability of the interventions was very high. Conclusions: Short interventions can be useful to encourage end-of-life discussions and could be integrated in health care programs. The efficacy and effectiveness of these short interventions in palliative patients are currently examined.

Electronic health nudges to improve reproductive health care for women with cystic fibrosis

As health and survival of patients with cystic fibrosis (CF) continue to dramatically improve, women with CF increasingly require gynecologic and obstetrical care. However, too often reproductive health care is forgotten amidst more pressing pulmonary and other concerns. Women with CF underutilize sexual and reproductive health (SRH) services such as Pap tests, sexually transmitted infection screening, and contraceptive counseling compared to the general United States population [ [1] Kazmerski TM Sawicki GS Miller E Jones KA Abebe KZ Tuchman LK Ladores S Rubenstein RC Sagel SD Weiner DJ Pilewski JM Orenstein DM Borrero S Sexual and reproductive health care utilization and preferences reported by young women with cystic fibrosis. J Cyst Fibros. 2018; 17: 64-70https://doi.org/10.1016/j.jcf.2017.08.009 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ] and may face CF-related gynecologic concerns, such as urinary incontinence and yeast infections. Streamlined referral to gynecologists with familiarity with CF has been shown to significantly improve cervical cancer screening and contraceptive uptake. [ [2] Rousset-Jablonski C Reynaud Q Perceval M Nove-Josserand R Durupt S Ray-Coquard I Golfier F Durieu I Improvement in contraceptive coverage and gynecological care of adult women with cystic fibrosis following the implementation of an on-site gynecological consultation. Contraception. 2020; 101: 183-188https://doi.org/10.1016/j.contraception.2019.10.014 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar ] Despite patient and provider desire to incorporate SRH into the CF care model, providers cite barriers such as time, knowledge, and personal discomfort that prevent discussion of SRH issues during routine practice. [ [3] Kazmerski TM Tuchman LK Borrero S Weiner D Pilewski JM Orenstein DM Miller E Cystic fibrosis program directors’ attitudes toward sexual and reproductive health in young women with CF. Pediatric Pulmonology. 2014; 51: 22-27https://doi.org/10.1002/ppul.23321 Crossref Scopus (20) Google Scholar ]

Italian primary school teachers’ comfort and training needs regarding same-sex parenting

ABSTRACT School teachers today are increasingly coming into contact with lesbian and gay parents. Given the lack of research in the field, this study investigated the role of homonegativity and beliefs about the well-being of children raised by same-sex parents in how comfortable teachers feel when interacting with same-sex parents. Additionally, possible predictors of teachers’ training needs regarding sexual orientation and same-sex parenting were explored. The sample consisted of 244 primary-school teachers. The results showed that ‘personal discomfort’ and ‘beliefs about the welfare of children of lesbian and gay parents’ were predictive of ‘comfort in interacting with lesbian and gay families’. Seniority, having a high number of lesbian and gay friends and having positive ‘beliefs about the welfare of children with lesbian and gay parents’ are linked to recognising the need for training on lesbian, gay and same-sex parenting issues. Suggestions and implications are discussed.

Fostering singing agency through emotional differentiation in an inclusive singing environment

The purpose of this phenomenological study was to gain insight into experiences of adults who expressed personal discomfort with singing, either alone or when others might hear them. Singing agency in music learning, one’s belief in one’s own capacity to sing aloud, served as the guiding lens for the study. Narrative analysis of interview data, from 15 adults who self-identified as non-singers, provided understanding of experiences that they believed undermined their capacity for singing agency. Four initial themes emerged as participants described wounding incidents with resultant perceptions of deficit, disability, and shame; personal strategies to enhance or protect singing agency; perceived obstacles to singing agency; and personal definitions of good singing. Findings describe vocal skill development through emotional differentiation, linking singing agency with principles that underlie a social constructivist approach to music learning and teaching and a Universal Design for Learning.

High Academic Self-Efficacy and Dispositional Empathy in Future Teachers

High perceived academic self-efficacy influences both subject performance and emotions of the subject. In turn, dispositional empathy implies a social and emotional adaptability towards the subject itself and those around them. This study aimed to analyze the differences in the mean dispositional empathy factors (i.e., perspective taking, fantasy, empathic concern and personal distress) between future teachers with high and low perceived academic self-efficacy, as well as the predictive capacity of dispositional empathy on high perceived academic self-efficacy, and the correlations between both dimensions. For this, a sample of 805 Spanish students of the Faculties of Education of the Universities of Alicante and Murcia was recruited. The Escala de Autoeficacia Percibida Específica de Situaciones Académicas was used to assess perceived academic self-efficacy and the Interpersonal Reactivity Index was used to analyze the dimensions of dispositional empathy. It was observed that high academic self-efficacy is more likely to present in people with a high level of perspective taking and fantasy (OR = 1.06 and 1.09, respectively) and less for those with personal discomfort (OR = 0.86). The other analyzes provided the same conclusions. In conclusion, it is important to develop perceived academic self-efficacy in undergraduates and future teachers due to the consequences that can lead to their classrooms.

Parental Perspectives on Sexual Abuse Prevention: Barriers and Challenges

This study examined parental perspectives on educating children about child sexual abuse (CSA) and personal safety. Twenty-four focus groups consisting of 144 parents or guardians (89% female) of children between the ages of 3 and 11 years were conducted in four areas of the U.S. (Northeast, Southeast, Mid-West, West). Parents were recruited through schools and community agencies. Participants viewed the family videos from the Second Step Child Protection Unit and then discussed their perspectives on parenting and sexual abuse prevention. The conversations were audio-recorded, transcribed, and analyzed qualitatively using a thematic approach. A major theme was that parents encountered barriers and challenges in their efforts to protect children and educate them about CSA. These included ambiguous safety messages for children; denial that their child could be at risk; personal discomfort with the topic; fear of ruining their child’s innocence; and limitations imposed by gender role stereotypes. Additional challenges emerged from a sub-sample of groups from low-resourced communities. Many of these parents described challenges in overcoming intergenerational abuse and the culture of silence that surrounds it; fear of reporting CSA due to mistrust of authorities; and lack of options for safe child care. Results suggest that prevention programming should be tailored to the communities in which it will be presented, with attention given to reducing ambiguities in messaging and improving access to resources in low-resourced communities. Findings are interpreted within the framework of Protection Motivation Theory.

Staff experience of the implementation of intensive interaction within their places of work with people with learning disabilities and/or autism

Intensive interaction is an approach used to develop the communication and social inclusion of those who are pre-verbal. It is used in a variety of settings by healthcare and educational staff. A systematic search was conducted to identify and review the literature which explores staff experiences of intensive interaction being implemented within their places of work. Thematic synthesis was utilized to synthesize the findings. Nine papers were included. Three higher-order themes were generated: "Personal Doubt, Discordance & Discomfort," "A Turning Point" and "Needing Implementation at All Levels." There were consistent findings across a range of settings. Findings suggest that intensive interaction is rewarding for staff and beneficial to those that they work with. Implementation was sometimes perceived to be challenging and this review attempts to highlight solutions with guidance of the literature. Limitations largely relate to heterogeneity of the papers and methodological limitations are discussed.