Longitudinal Research Study Research Articles

Supporting and Enabling the Process of Innovation in Public Health: The Framework for Public Health Innovation.

This manuscript introduces a new framework for creating innovations in public health—the Framework for Public Health Innovation. The framework was developed through a longitudinal qualitative research study that investigated the process of creating innovative adolescent health programs. Interviews were conducted with a national sample of 26 organizations over two time points. Data collection focused on the process of innovative program development; organizational capacity; training; and technical assistance needs, successes, and barriers. The framework was developed and modified based on interview findings and expert advice; then, the final framework was validated with content experts. The framework illustrates a dynamic process of innovation that begins with dissatisfaction with the status quo, and then, illustrates three necessary components for innovation—space, process, and partnerships. Four categories of innovation, which range in complexity, are proposed: (1) creating a new component to an existing program, (2) adapting an existing program to meet new needs, (3) taking an alternative approach to addressing an existing program, and (4) reframing a health problem from a new perspective. As illustrated by a feedback loop, the resulting innovations disrupt the status quo. This model can be applied to any content area in public health and is useful for both research and practitioners.

COVID-19 and the gendered impacts on adolescent wellbeing: Evidence from a cross-sectional study of locally adapted measures in Ethiopia, Jordan, and Palestine.

SummaryBackgroundThe COVID-19 pandemic and associated policy responses have interrupted services, increased financial stress, and driven social isolation, with acute impacts for adolescents. This study explores relationships between gender, COVID-19 vulnerability, social protection, and adolescent wellbeing in three diverse contexts: Ethiopia, Jordan, and Palestine.MethodsThis study presents findings from a quantitative phone survey with adolescents in Ethiopia, Jordan, and Palestine (n = 5752) on household-level vulnerability to COVID-19-related shocks, household-level social protection (cash transfers or food aid), and locally adapted outcome measures designed to capture the gendered impacts of COVID-19 (collected between November 22, 2020 and February 25, 2021). We examine the relationship between each outcome and household-level COVID-19 vulnerability and social protection (and their interaction) using multivariate regressions, adjusting for adolescent and household characteristics.FindingsFor all adolescents, increased vulnerability to COVID-19-related shocks is associated with worse outcomes for resilient coping and time spent on domestic tasks and care work. Across samples, girls spent over two additional hours on domestic and care work compared to boys. Girls in more vulnerable households experienced greater gendered constraints on behaviour. We find no association between receipt of social protection and adolescent wellbeing, and find that it only moderates the effect of COVID-19 vulnerability for less vulnerable households. Disability status, being out of school, and experiencing child marriage are also associated with adverse outcomes.InterpretationOur study highlights that the pandemic has exacerbated underlying gender inequalities across adolescents in three very different settings, and that existing social safety nets are not adequate to fully address these impacts, particularly for the most vulnerable.FundingThis work was supported by UK aid through a grant from the Foreign, Commonwealth & Development Office to the Gender and Adolescence: Global Evidence (GAGE) longitudinal research study; the EMERGE project (Bill & Melinda Gates Foundation grants: OPP1163682 and INV018007; PI Anita Raj) and the World Health Organization (WHO) Regional Office for the Eastern Mediterranean.

Addressing Moral Distress: lessons Learnt from a Non-Interventional Longitudinal Study on Moral Distress

Background Moral distress is prevalent within the neonatal intensive care unit (NICU) and can negatively affect clinicians. Studies have evaluated the causes of moral distress and interventions to mitigate its harmful effects. However, the effects of participating in moral distress studies have not been evaluated. Objective To evaluate the impact of participation in a longitudinal, non-intervention research project on moral distress in the NICU. Design Clinicians who previously participated in an 18-month longitudinal research study on moral distress at two NICUs were invited to complete a questionnaire on the impact of participation. The original study required regular completion of surveys that sought predictions of death, disability and the intensity/nature of moral distress experienced by clinicians caring for extremely preterm babies. Individual and unit-wide effects were explored. Free-text responses to open-ended questions were analyzed using inductive content analysis. Results A total of 249/463 (53%) eligible clinicians participated. Participation in the original 18-month study was perceived as having a positive impact by 58% of respondents. Clinicians found articulating their views therapeutic (76%) and useful in clarifying personal opinions about the babies (85%). Free-text responses revealed the research stimulated increased reflection, validated feelings and increased dialogue amongst clinicians. Respondents generally did not find participation distressing (70%). However, a small number of physicians felt the focus of discussion shifted from the baby to the clinicians. Intensity and prevalence of moral distress did not significantly change over the 18-month period. Conclusions Participating in moral distress research prompted regular reflection regarding attitudes toward fragile patients, improving ethical awareness. This is useful in clarifying personal views that may influence patient care. Participation also enhanced communication around difficult clinical scenarios and improved provider satisfaction. These factors are insufficient to significantly reduce moral distress in isolation.

Cognitive frailty and 5-year adverse health-related outcomes for the Malaysian elders longitudinal research (MELoR) study.

To determine the risk of adverse outcomes among prefrail and frail individuals with and without cognitive impairment as well as those with isolated cognitive impairment compared to robust individuals without cognitive impairment. Data from the Malaysian elders longitudinal research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted interviews and hospital-based health-checks from 2013 to 2015. Protocol of MELoR study has been described in previous study (Lim in PLoS One 12(3):e0173466, 2017). Follow-up interviews were conducted in 2019 during which data on the adverse outcomes of falls, sarcopenia, hospitalization, and memory worsening were obtained. Sarcopenia at follow-up was determined using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire. Follow-up data was available for 776 participants, mean (SD) age 68.1 (7.1) years and 57.1% women. At baseline, 37.1% were robust, 12.8% had isolated cognitive impairment, 24.1% were prefrail, 1.0% were frail, 20.2% were prefrail with cognitive impairment, and 4.8% had CF. Differences in age, ethnicity, quality of life, psychological status, function and comorbidities were observed across groups. The association between CF with hospitalisation and falls compared to robust individuals was attenuated by ethnic differences. Pre-frail individuals were at increased risk of memory worsening compared robust individuals [aOR(95%CI) = 1.69 (1.09-2.60)]. Frail [7.70 (1.55-38.20)], prefrail with cognitive impairment [3.35 (1.76-6.39)] and CF [6.15 (2.35-16.11)] were significantly more likely to be sarcopenic at 5-year follow-up compared to the robust group. Cognitive frailty was an independently predictor of sarcopenia at 5-year follow-up. The relationship between CF with falls and hospitalization, however, appeared to be accounted for by ethnic disparities. Future studies should seek to unravel the potential genetic and lifestyle variations between ethnic groups to identify potential interventions to reduce the adverse outcomes associated with CF.

Understanding Health Care Graduates' Conceptualizations of Transitions: A Longitudinal Qualitative Research Study.

Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners' conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa. The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally. The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2). This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders' transition conceptualizations over lengthier durations beyond the new graduate transition.

Enterprise social media platforms for coping with an accelerated digital transformation

PurposeThe purpose of this paper is to investigate how to support small organizations to navigate the context of an accelerated Digital Transformation using Enterprise Social Media platforms, in response to external contingencies, such as the COVID-19 pandemic.Design/methodology/approachA longitudinal action research study, supported by an exploratory analysis that follows a hybrid approach of deductive and inductive reasoning, has been conducted in the context of a small organization. Several data collection techniques were used for context understanding and problem-solving.FindingsFindings suggest that value creation related to the use of Enterprise Social Media platforms supports small organizations in this accelerated context of Digital Transformation. Value perception is central in overcoming adoption barriers and achieving sustainable use of these platforms in daily basis activities, especially in remote working. External pressures, like those imposed by the COVID-19 pandemic, play an important role in catalyzing digital initiatives.Research limitations/implicationsAs the main limitations to this paper, we highlight the study of a single organization in a specific context and the number of actors involved; hence, there is room to extend the study to other industries, organization sizes and contexts.Practical implicationsThis paper provides managers with insights into how to conduct their Enterprise Social Media initiatives in a turbulent environment, highlighting their key success elements, and their potential to create value for their organizations and stakeholders. Furthermore, managers could explore the potential of Enterprise Social Media platforms to support organizations in the Digital Transformation journey.Social implicationsSmall organizations play an important role in generating wealth for nations around the world. However, governments encounter difficulties in supporting the Digital Transformation of this type of organization. This paper provides insights into how to use an affordable and intuitive technology to include this type of organization in the Digital Transformation journey.Originality/valueA long-term study of Enterprise Social Media is recommended, but quite rare in the Information Systems literature. This study adopts a longitudinal investigation to analyze the use of Enterprise Social Media to support a small organization to adapt, in balance with their internal and external contingencies, providing a further contribution to the contingency theory. This research also adds contributions to the sociotechnical system perspective, analyzing the deep imbrication between social and technical subsystems in the required organizational change, supporting a small organization for coping with the effects of the COVID-19 pandemic.

Who Volunteers? Results From an Internet-Based Cognitive Monitoring Study of Community-Based Older Adults.

Objectives. Volunteering promotes well-being and may provide added purpose to life after retirement. Limited evidence exists regarding the characteristics and study adherence among those who participate in longitudinal studies while also volunteering outside the study. We assessed characteristics and adherence of older adults who volunteered outside of participation in a regular monthly cognitive monitoring study. Method. All 124 participants with complete data were included. Participants were from a regular cognitive monitoring study that required completion of a 15-min monthly online cognitive assessment. Analysis of covariance and logistic regression analysis were performed to examine differences between volunteers and nonvolunteers. Results. Those who volunteered outside the study were significantly less likely to be college-educated (although all participants were highly educated) but the two groups were cognitively similar. Volunteers had significantly lower scores for neuroticism. Those who volunteered also were significantly less likely to drop out but had poorer study adherence. The most frequent type of volunteering was religious activities. Volunteers were motivated mainly by altruism, although most reported multiple reasons. Conclusion. Older adults who enroll in a longitudinal research study and volunteer outside the study have similar personal characteristics as those who opt out of additional volunteering, with somewhat less education and more favorable personality traits. However, they may be more likely to drop out and need more reminders. Therefore, those who volunteer outside a study may need more attention from study administrators and potentially a more individualized schedule that works around their volunteer obligations.

Changes in children's wellbeing in Bradford during COVID-19: The Born in Bradford COVID-19 longitudinal research study.

Background: Concerns have been raised about the potential impact of COVID-19 and associated lockdown measures on child mental wellbeing, but emerging evidence suggests mixed results and there is a dearth of information from ethnically diverse samples. The current study aims to explore the impact of the pandemic on wellbeing using longitudinal data collected from the multi-ethnic Born in Bradford family cohort study. Methods: Within-child changes in wellbeing were explored using data collected pre-pandemic and again during the first UK lockdown for 500 children aged 7-13 from a range of ethnic and socioeconomic backgrounds, using self-reported feelings of happiness and sadness. Associations between changes in wellbeing, demographic factors, quality of social relationships and physical activity levels were explored using multinomial logistic regression models. Results: In this sample, 55% of children reported no change in their wellbeing from pre-pandemic to during the first lockdown (n=264). Children of Pakistani heritage were more than twice as likely to report feeling sad less often than White British children (RRR: 2.61, 95% CI: 1.23, 5.51) during the first lockdown. Those who reported being left out by other children before the pandemic were over three times as likely than those who did not (RRR: 3.72: 1.51, 9.20) to report feeling sad less often during the pandemic. Around a third of children reported feeling happier (n=152, 31.6%), but these changes did not relate to any of the explanatory variables included in this analysis. Conclusion: Many children in this study reported no changes in their wellbeing during the first UK lockdown compared to before the pandemic and some described improved wellbeing. These findings suggest that children have coped well with the significant changes over the past year, though targeted support, particularly for those children who felt excluded before the pandemic, would be beneficial.

0161 Strategies for Enhancing Recruitment of Adults for Randomized Controlled Trial Among Heterogenous Sample of Cancer Survivors with Insomnia Amid the Covid Pandemic

Abstract Introduction Challenges associated with recruiting participants in a longitudinal research study have been recognized yet remain a major barrier for researchers. The current study details strategies used in recruiting a heterogenous sample of cancer survivors with insomnia from multiple clinical sites, referral sources and outreach. Methods Enrollment goals were 158 participants over 3 years (June 2019 to May 2022). Recruitment strategies included 1) face-to-face (FTF) recruitment at hospital clinics; 2) posting recruitment flyers in clinical settings; 3) completion of insomnia screening instrument at community clinic sites; 4) research registries; 5) institutional social media outreach; 6) community events; 7) PI interview and request for study volunteers in local newspaper; and 8) ongoing engagement and communication with recruited participants. Results 108 of 158 participants have been recruited and completed baseline surveys; 9 participants dropped out. To date, 42 of 49 (85.7%) participants have completed the 12-month study. June 2019 through December 2019 FTF recruitment occurred, where 104 were eligible and 32 (30.76%) were enrolled. Due to changes in study personnel and the COVID pandemic restricting access to in-person recruitment and enrollment, the study pivoted to develop protocols for electronic consent and enrollment using video conferencing. In addition, research databases, institutional social media, community events and local newspaper were utilized, where 76 of 239 (31.79%) interested participants enrolled. The most effective recruitment strategies included on-site FTF recruitment (57.9%) and local newspaper interview (13.88%). The local newspaper interview was the most cost-effective considering personnel costs associated with FTF recruitment. Conclusion Despite the onset of the COVID pandemic during the recruitment phase, we were able to pivot and employ innovative techniques to meet our targeted enrollment goal for the projected study deadline. FTF recruitment, perceived value by clinic staff in benefitting cancer survivors, and participants’ acceptance of video-conferencing were significant contributors. The importance of building and maintaining relationships with providers and nurses in local clinical sites cannot be underestimated. Support (If Any) This research was funded by R01 NR018215 (Dean) by the National Institute of Nursing Research.

Care structure of patients with mycosis fungoides and Sézary syndrome in Germany - Care research based on SHI claims data.

Cutaneous T-cell lymphomas (CTCLs) are rare forms of non-Hodgkin's lymphoma of T-cell origin that occur mainly in the skin. The most common form is mycosis fungoides (MF), but Sézary syndrome (SS), a more aggressive form of CTCL, is another relevant subgroup. Due to the rare nature of the disease, population-based studies of the epidemiology and disease burden and insights into care delivery are limited. Based on an anonymized, age and sex-adjusted routine dataset comprising approximately five million people with statutory health insurance, a retrospective, longitudinal healthcare research study was conducted over a six-year period (2012-2017). In 55% of patients with MF and SS, the initial diagnosis was documented in an outpatient setting; in 59% of cases by a dermatologist. Immunophenotyping by flow cytometry is considered an important investigative tool for the detection and follow-up surveillance of blood involvement of cutaneous lymphomas, as the disease stage is the most important prognostic factor in MF and SS; this was performed in only 10% of patients. The first-line treatment was topical (76%), in particular with corticosteroids (66%). The findings from this healthcare research point to the need for increased guideline-based care.

Moving our care home: A qualitative study of the views and experiences of residents, relatives and staff.

Involuntary relocation when care homes close can be detrimental to residents' health and well-being and is associated with increased mortality. There is little formal evidence to support whether planning can mitigate the impact of such moves. This study aimed to understand the experiences of a whole care home relocation where staff and residents relocated together using existing published guidance. A longitudinal qualitative research study using individual face-to-face semi-structured interviews was conducted between August 2018 and August 2019. Baseline interviews were conducted 6-8weeks after relocation with follow-up interviews 10-12months later. Interviews were recorded, transcribed and analysed using framework analysis. 27 interviews were conducted; 19 baseline interviews (4 residents, 7 family members, 8staff) and 8 follow-up interviews (2 residents, 2 family members, 4staff). Participants' feelings about the relocation were mixed: some reported apprehension before the move but others excitement. Residents and families felt variably involved in planning the move, whereas staff expressed lack of involvement. Time, family support and continuity of care helped participants settle in. The new environment shaped participants' experiences and abilities to adjust, especially the lack of a homely feeling with the new home, the larger size and changes in staff organisation and management. Despite implementation of existing guidance, relocation was still challenging for residents, staff and family members. Future relocations should increase involvement of staff in the planning and design of the home; offer continuous support to those involved; and ensure continuity of care and management style.

Cross-sectional and Longitudinal Associations of Anxiety and Irritability With Adolescents’ Neural Responses to Cognitive Conflict

BackgroundPsychiatric symptoms are commonly comorbid in childhood. The ability to disentangle unique and shared correlates of comorbid symptoms facilitates personalized medicine. Cognitive control is implicated broadly in psychopathology, including in pediatric disorders characterized by anxiety and irritability. To disentangle cognitive control correlates of anxiety versus irritability, the current study leveraged both cross-sectional and longitudinal data from early childhood into adolescence. MethodsFor this study, 89 participants were recruited from a large longitudinal research study on early-life temperament to investigate associations of developmental trajectories of anxiety and irritability symptoms (from ages 2 to 15) as well as associations of anxiety and irritability symptoms measured cross-sectionally at age 15 with neural substrates of conflict and error processing assessed at age 15 using the flanker task. ResultsResults of whole-brain multivariate linear models revealed that anxiety at age 15 was uniquely associated with decreased neural response to conflict across multiple regions implicated in attentional control and conflict adaptation. Conversely, irritability at age 15 was uniquely associated with increased neural response to conflict in regions implicated in response inhibition. Developmental trajectories of anxiety and irritability interacted in relation to neural responses to both error and conflict. ConclusionsOur findings suggest that neural correlates of conflict processing may relate uniquely to anxiety and irritability. Continued cross-symptom research on the neural correlates of cognitive control could stimulate advances in individualized treatment for anxiety and irritability during child and adolescent development.

Changes in children's wellbeing in Bradford during COVID-19: The Born in Bradford COVID-19 longitudinal research study.

Background: Concerns have been raised about the potential impact of COVID-19 and associated lockdown measures on child mental wellbeing, but emerging evidence suggests mixed results and there is a dearth of information from ethnically diverse samples. The current study aims to explore the impact of the pandemic on wellbeing using longitudinal data collected from the multi-ethnic Born in Bradford family cohort study. Methods: Within-child changes in wellbeing were explored using data collected pre-pandemic and again during the first UK lockdown for 500 children aged 7-13 from a range of ethnic and socioeconomic backgrounds, using self-reported feelings of happiness and sadness. Associations between changes in wellbeing, demographic factors, quality of social relationships and physical activity levels were explored using multinomial logistic regression models. Results: In this sample, 55% of children reported no change in their wellbeing from pre-pandemic to during the first lockdown (n=264). Children of Pakistani heritage were more than twice as likely to report feeling sad less often than White British children (RRR: 2.61, 95% CI: 1.23, 5.51) during the first lockdown, and those who reported being left out by other children before the pandemic were over three times as likely than those who did not (RRR: 3.72: 1.51, 9.20) to report feeling sad less often during the pandemic. Around a third of children reported feeling happier (n=152, 31.6%), but these changes did not relate to any of the explanatory variables included in this analysis. Conclusion: Many children in this study reported no changes in their wellbeing during the first UK lockdown compared to before the pandemic and some described improved wellbeing. These findings suggest that children have coped well with the significant changes over the past year, though targeted support, particularly for those children who felt excluded before the pandemic, would be beneficial.

From "Invented here" to "Use it everywhere!": A Learning health system from bottom and/or top?

IntroductionDeparting from a practical problem of how to use digitalization to improve care quality and efficiency, this paper investigates how the concept of Learning Health Systems (LHSs) can be applied to an existing organization. LHSs offer a vision for how healthcare can accelerate both scale‐up of innovations and quality improvements at all levels. However, aligning stakeholders at different levels to convergent development is challenging and translation and adaptation of the LHS concept to fit with the existing organization is essential.MethodsA one‐year longitudinal action research (AR) study was conducted within five psychiatric departments at the Sahlgrenska University Hospital in Gothenburg, Sweden. Translation of the LHS concept to the local circumstances within the organization was set as the aim, to both improve practice and further scientific understanding. An AR group led the practical and scholarly work and holistic data were collected, including field notes, documents, recordings, and workshops. Data were analyzed by an insider‐outsider approach.ResultsThe one‐year study is described to provide insights into the process of designing a locally adapted LHS using an AR approach. Practical needs were identified and iteratively matched with theory to form a local LHS model. A conflict between top‐down and bottom‐up views on development emerged, where higher‐level management tended to prioritize uniform solutions and developers local learning. An adapted solution to balance these approaches was negotiated, consisting of a technical and an organizational part.ConclusionsThe conflict between top‐down and bottom‐up approaches for how to implement LHSs needs to be considered both in practical work to transform care organizations and in scientific studies of LHSs. The approach to translate, rather than instrumentally implement, LHSs to real‐world settings is suggested as advantageous. Furthermore, designing such endeavors as AR projects can provide excellent conditions to create LHSs that work in practice.

Depressive Cognitions Impact On A Latent Growth Curve Model Of Depressive Symptoms In Caregiving Grandmothers

Grandmothers caring for grandchildren have elevated levels of depressive symptoms compared to grandmothers who do not provide care. While the CES-D measures the somatic, positive and negative affect, and interpersonal strain symptoms experienced with depression, the Depressive CognitionScale © captures the change in cognitive thinking that often precedes depression. Depressive symptoms, on the other hand, are state like in nature and describe depressive symptoms that have happened recently. While depressive cognitions, according to Beck’s theory of depression, are the first negative thought processes to appear, these typically lead to other, more serious symptoms of depression. Specifically, depressive cognitions reflect negative thinking patterns and not depression. Data were collected on 343 participants in a longitudinal nationwide online research study of caregiving grandmothers. A latent growth curve model was used to track the trajectory of depressive symptoms at four time points (baseline, 2 weeks, 12 weeks, and 24 weeks). As depressive cognitions are the precursor to the development of depressive symptoms, a latent growth curve model was tested to gain an understanding of how depressive cognitions impacts the trajectory of depressive symptoms over time. The model fit the data well (Chi Square=21.025; df=9; p=.013; TLI=.976; CFI=.985; RMSEA=.063). Baseline depressive cognitions had a strong impact on the intercept (Standardized Beta=.76, p<.001) and the slope of depressive symptoms (Standardized Beta=-.67, p<.001). The continued impact of depressive cognitions over 24 weeks indicates the need for potential interventions to further address depressive cognitions as a way to decrease depressive symptoms in grandmother caregivers.

Mental Disorders and Emotional Competence Among Chinese Adolescents Before and During COVID-19 Pandemic: A Longitudinal Mediation Model.

Background: The outbreak of the COVID-19 pandemic has had a profound influence on the mental health and well-being of individuals across the globe. Emotional competence, defined as one's ability to recognize, understand, and manage their emotions, has been found linked with mental health problems (e.g., depression and anxiety) in previous studies. However, there is limited knowledge about the direction of the association between these factors among populations exposed to COVID-19. This study examined the possible mediation relationships between depression, anxiety, emotional competence, and COVID-19 exposure among Chinese adolescents.Methods: Responses from 7,958 Chinese adolescents who had previously taken part in a two-wave study before (December 23, 2019–January 13, 2020) and during COVID-19 (June 16, 2020–July 8, 2020) were analyzed (51.67% males, mean age = 11.74, SD = 2.15). Structural equation modeling with three covariates (i.e., age, gender, and ethnicity) was used to test the longitudinal mediation relationships between COVID-19 exposure and depression, anxiety via emotional competence.Results: Results indicated that the prevalence of depression (38.67 to 36.74%) and anxiety (13.02 to 12.77%) decreased from Time 1 to Time 2. The T2 emotional competence significantly mediated the relationship between T2 COVID-19 exposure and T2 anxiety (indirect effect [95% CI] = 0.011 [0.004–0.019], p < 0.05). T2 emotional competence also significantly mediated the relationship between T2 COVID-19 exposure and T2 depression (indirect effect [95% CI] = 0.013 [0.005–0.022], p < 0.05). The results indicated that T2 emotional competence had a significant and negative influence on T2 anxiety (β = −0.266, SE = 0.005, p < 0.001), and T2 depression (β = −0.326, SE = 0.029, p < 0.001).Conclusions: This longitudinal research study demonstrated the crucial role of emotional competence in influencing the severity of long-term mental health problems, and suggested that emotional competence interventions can be conducted to improve mental well-being among Chinese adolescents exposed to COVID-19.

Institutional procedural discrimination, institutional racism, and other institutional discrimination: A nursing research example.

Institutional discrimination matters. The purpose of this longitudinal community‐based participatory research study was to examine institutional procedural discrimination, institutional racism, and other institutional discrimination, and their relationships with participants' health during a maternal and child health program in a municipal initiative. Twenty participants from nine multilingual, multicultural community‐based organizations were included. Overall reported incidences of institutional procedural discrimination decreased from April 2019 (18.6%) to November 2019 (11.8%) although changes were not statistically significant and participants reporting incidences remained high (n = 15 in April and n = 14 in November). Participants reported experiencing significantly less “[when] different cultural ways of doing things were shared, the project did not support my way” from April 2019 (23.5%, n = 4) to November 2019 (0%, n = 0), Wilcoxon signed‐rank test Z = −2.00, p < 0.05. Some participants reported experiencing institutional racism (29.4%, n = 5) and other institutional discrimination (5.9%, n = 1). Participants experiencing institutional racism, compared to those who did not, reported a higher impact of the Initiative's program on their quality of life (t = 3.62, p < 0.01). Participatory survey designs enable nurse researchers to identify hidden pathways of institutional procedural discrimination, describe the impacts experienced, and examine types of institutional discrimination in health systems.

Adequately Equipping Our Children: The Need for Child-centered, Play-based Approaches to Human Trafficking Prevention

ABSTRACT The A21 Primary Prevention Program (PPP) provides child-centered learning opportunities designed to empower children ages 6–12 to protect themselves and others from human trafficking and other risks. This article provides context around the issue of human trafficking and exploitation as a public health issue and outlines the benefits of play-based, interactive approaches for addressing prevention with children. Results of the first phase of a longitudinal research study conducted in Southeast (SE) Asia indicate that program facilitators found experiential, play-based activities beneficial for increasing their knowledge of human trafficking. Based on these results and extant literature the authors recommend the adoption of child-centered, play-based programing by schools and educators outside of SE Asia, to address the growing risks of human trafficking and exploitation to school aged children. This research promotes the empowerment of societies through prevention education, toward a peaceful, just and safe environment, free of exploitation for children and adults (SDGs 8.7 and 16).

Falls in older persons with type 2 diabetes in the Malaysian Elders Longitudinal Research (MELoR) study.

Older persons with diabetes are at an increased risk of falls leading to fractures, head injuries and disability. To evaluate the potential relationship between falls and diabetes in older persons and identify differences in risk factors of falls among older persons with and without diabetes using the first wave dataset of the Malaysian Elders Longitudinal Research (MELoR) study. Community dwelling adults aged 55years were selected through stratified random sampling from three parliamentary constituencies in greater Kuala Lumpur. Baseline data was obtained through computer-assisted, home-based interviews. The presence of falls was established by enquiring about falls in the preceding 12months. Diabetes was defined as self-reported, physician-diagnosed diabetes, diabetes medication use and an HbA1c of 6.3%. Diabetes was present in 44.4% of the overall 1610 participants. The prevalence for fall among older diabetics was 25.6%. Recurrent falls (odds ratio (OR) 1.65; 95% confidence interval (CI) 1.06-2.57) was more common among diabetics. Following adjustment for potential confounders, osteoporosis (OR 2.58; 95% CI 1.31-5.08) and dizziness (OR 1.50; 95% CI 1.01-2.23) were independent risk factors for falls. Better instrumental activities of daily living scores were protective against falls (OR 0.75; 95% CI 0.58-0.97). The presence of osteoporosis and dizziness was associated with an increased risk of falls among older diabetics. These findings will need to be confirmed in future prospective follow-up of this cohort.

The I’m Learning! intervention methodology for quality learning environments in developing country contexts

Within the context of the global learning crisis and calls to focus on the quality of education, one international organisation took a systematic and holistic approach to improve learning, wellbeing, and development in schools. Known as the Quality Learning Environment (QLE) Framework, it conceptualised the quality of the learning environment in schools with four guiding principles: emotional and psychological protection of learners, physical wellbeing of children, active learning processes, and close collaboration between school and parents/community. From 2013 – 2017, the framework was piloted in three countries of Cambodia, Uganda, and Zimbabwe to improve learning environments and outcomes while documenting the process, methods, and results of the QLE pilot in their country. The interventions in the three countries were closely tracked by a longitudinal research study. This paper explores the ambition of global and national research firms to carry out rigorous cross-country research alongside contextualized and evolving school interventions.