Low Confidence Research Articles

Factors associated with parental intentions to vaccinate 0-4-year-old children against COVID-19 in Canada: a cross-sectional study using the Childhood COVID-19 Immunization Coverage Survey (CCICS)

BackgroundThe objective of this study was to determine the factors associated with low or no parental intention to vaccinate children of 0-4-years in Canada with a COVID-19 vaccine through the 2022 Childhood COVID-19 Immunization Coverage Survey (CCICS). The CCICS was conducted prior to the introduction of a COVID-19 vaccine and a vaccine recommendation for this age group.MethodsSimple and multiple logistic regression models were used to determine associations between sociodemographic factors as well as knowledge, attitudes and beliefs and low/no intentions to vaccinate against COVID-19 among parents of children 0–4 years.ResultsFactors associated with low intentions to vaccinate children against COVID-19 included being male (aOR: 2.0; 95% CI: 2.0‒2.1) compared to female; being 30–39 (aOR 1.1; 95% CI: 1.1‒1.2) compared to 40+; being Black (aOR: 2.3, 95% CI: 2.2‒2.5), East/Southeast Asian (aOR: 3.6, 95% CI: 3.3‒3.8), or having multiple ethnicities (aOR: 1.3, 95% CI: 1.1‒1.6) compared to White European ethnicity; living in a rural (aOR: 2.0, 95% CI: 1.9‒2.1) compared to urban community; having a total 2021 household income of $60,000‒$79,999 CAD (aOR: 1.4, 95% CI: 1.3‒1.5) compared to $150,000 CAD and above; and trusting government bodies (aOR: 2.4; 95% CI: 1.1‒1.2), international bodies (aOR: 2.4; 95% CI: 2.2‒2.5), or media (aOR: 2.0, 95% CI: 1.9‒2.2) for information about COVID-19 vaccines compared to health care providers.ConclusionsThe findings of this study demonstrate that several sociodemographic factors and parental beliefs impact the decision to vaccinate children 0–4 years of age against COVID-19. Future research should focus on sociodemographic barriers to vaccination and how to most appropriately tailor the delivery of vaccination programs to specific groups, in an effort to narrow the gap between intentions and uptake of COVID-19 vaccination in younger children. As well, messaging should specifically be targeted to parents who have lower confidence in the COVID-19 vaccine and the government to provide correct information and build trust.

Collective ambiguous loss after mass hostage-taking in war: exploring public mental health outcomes and resilience

ABSTRACT Objective: Collective ambiguous loss can arise in communities facing the unresolved absence or presence of loved ones, marked by uncertainty and confusion. This study examines the impact of such loss on the general public in Israel after 251 individuals were taken hostage by Hamas on October 7 2023. Method: A diverse sample of 740 participants (ages 18–85, 58.2% women) took part in a comprehensive survey from December 2023 to January 2024. The survey measured boundary ambiguity (BA), separation distress related to disappearance (Ambiguous Loss Inventory Plus – ALI + - SD), general psychological distress (Mini-DASS), and personal resilience factors: ambiguity tolerance (Need for Closure Scale-Revised, NCSR) and psychological flexibility (PF). Results: Public stances indicated that 85% of respondents had moderate to very low confidence in the hostages’ return, coupled with high endorsement of psychological engagement indicators such as emotional pain, intrusive thoughts, and survivor guilt. Those acquainted with a hostage (12%) showed no differences in stances or ALI + -SD and Mini-DASS levels, except for higher BA and greater engagement in demonstrations activities for their return. SEM analysis showed that ALI + -SD mediated the relationship between BA and Mini-DASS (high BA related to high general distress). In this model, BA and ALI + -SD explained over half of the variation in general psychological distress (R2 = 53%). A second model revealed serial mediation by BA and ALI + -SD in the relationship between NCSR and Mini-DASS, with lower ambiguity tolerance related to increased general distress. However, no such mediation was observed in the relationship between PF and Mini-DASS, and overall, the effect of personal resilience on general distress was relatively small. Conclusions: Mass hostage-taking substantially impacts society’s mental health, extending beyond personal acquaintance with a hostage. The findings underscore the need to shift focus from personal resilience to community-based policies and therapeutic approaches to effectively address communal ambiguous loss amid collective trauma.

Hospital pharmacists' perceived competence in providing care to oncology patients - (HoPP-CoP2).

Previous research has shown community pharmacists do not have high perceived competence or confidence providing care to patients on oral anti-cancer medications. There is a paucity of evidence when it comes to hospital pharmacists providing care to oncology patients admitted to the hospital for a reason other than cancer. To assess the perceived competence of hospital pharmacists not working in oncology in managing patients taking anticancer drugs. Additionally, identify factors impacting, potential interventions increasing, and any factors that improve perceived competence. An anonymous cross-sectional survey distributed to hospital pharmacists throughout Canada. Mean perceived competence results ranged from 2.52 to 3.97 out of 7.00 with respondents reporting most perceived competence managing electrolyte disturbances and least competence managing drug-disease interactions and intervening on hepatic dysfunction. Low confidence in knowledge received from previous oncology training was reported with a mean of 2.82 on the 7-point Likert Scale. Continuing education sessions were perceived as the intervention which would most improve perceived competence with a mean value of 5.92 to 5.94 on a 7-point Likert Scale. The number of CE hours completed in the last five years was the only factor shown to have a statistically significant correlation with perceived competence. Hospital pharmacists do not perceive themselves as competent in providing care to oncology patients. The implementation of a continuing education program related to oncology may improve perceived and actual competence.

Effects of Tai Chi and Qigong in Depressive and Anxiety Symptoms in Cancer Patients: An Overview of Systematic Reviews

Abstract Depressive and anxiety symptoms are prevalent among cancer patients, significantly impacting their quality of life and treatment adherence, which can lower survival rates. Addressing these symptoms with evidence-based interventions is crucial. Tai Chi and Qigong (TCQ) are popular complementary therapies that have shown potential in improving mental health in various populations, including cancer patients. However, systematic reviews (SRs) and meta-analyses have reported inconsistent findings regarding TCQ’s effectiveness in alleviating depressive and anxiety symptoms in cancer patients. An overview of these reviews can help synthesize outcomes, evaluate methodological quality, and clarify these discrepancies. The objective of this study was to identify and summarize the existing evidence regarding the effectiveness of TCQ in improving depressive and anxiety symptoms in cancer patients. Six electronic databases were searched from inception to July 2024. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Assessing the Methodological Quality of Systematic Reviews 2 was used to assess the methodological quality of the included SRs. In total, 894 studies were retrieved and assessed. Of these, 10 SRs were included, of which 9 SRs reported depressive symptoms and 8 SRs anxiety symptoms. Of these SRs, 5 out of 9 (56%) demonstrated significant improvement in depressive symptoms for TCQ with standardized mean differences (SMDs) ranging from −0.27 to −0.70, while 6 out of 8 (75%) demonstrated significant improvement in anxiety symptoms with SMDs ranging from −0.29 to −0.71. For quality appraisal, 1 SR was rated as high confidence, 3 SRs as moderate confidence, 2 SRs low confidence, and 4 SRs critically low confidence. After excluding 4 SRs with critically low confidence, 4 out of 5 (80%) of SRs demonstrated a significant effect of TCQ in improving depressive symptoms with SMDs ranging from −0.32 to −0.70, and all 6 SRs demonstrated significant improvement in anxiety symptoms with SMDs ranging from −0.29 to −0.71. TCQ can be effective in alleviating depressive and anxiety symptoms in cancer patients. Healthcare providers should consider incorporating TCQ into cancer care. More randomized controlled trials on various cancer sites (e.g., female genitals, lungs, brain, skin, and pancreas), cancer stages (e.g., Stage IV), and non-Chinese populations with longer follow-ups should be conducted.

Effectiveness and Acceptability of Asynchronous Digital Health in Asthma Care: Mixed Methods Systematic Review.

Asynchronous digital health (eg, web-based portal, text, and email communication) can overcome practical barriers associated with in-person and remote synchronous (real-time) consultations. However, little is known about the effectiveness and acceptability of asynchronous digital health to support care for individuals with asthma (eg, asthma reviews). We aimed to systematically review the qualitative and quantitative evidence on the role of asynchronous digital health for asthma care. Following Cochrane methodology, we searched 6 databases (January 2001-July 2022; search update: September 2023) for quantitative, qualitative, or mixed methods studies supporting asthma care using asynchronous digital health. Screening and data extraction were duplicated. We assessed the risk of bias in the clinical outcomes of randomized controlled trials included in the meta-analysis using the revised Cochrane risk of bias tool. For the remaining studies, we evaluated the methodological quality using the Downs and Black checklist, critical appraisal skills program, and mixed methods appraisal tool for quantitative, qualitative, and mixed methods studies, respectively. We determined the confidence in the evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. We conducted a meta-analysis of trial data and a thematic analysis of qualitative data. We included 30 studies (20 quantitative, 6 qualitative, and 4 mixed methods) conducted in 9 countries involving individuals with asthma, their caregivers, and health care professionals. Asynchronous digital consultations linked with other functionalities, compared to usual care, improved asthma control (standardized mean difference 0.32, 95% CI 0.02-0.63; P=.04) and reduced hospitalizations (risk ratio 0.36; 95% CI 0.14-0.94; P=.04). However, there were no significant differences in quality of life (standardized mean difference 0.16; 95% CI -0.12 to 0.43; P=.26) or emergency department visits (risk ratio 0.83; 95% CI 0.33-2.09; P=.69). Patients appreciated the convenience of asynchronous digital health, though health care professionals expressed concerns. Successful implementation necessitated an organizational approach. Integrative synthesis underscored the ease of asking questions, monitoring logs, and medication reminders as key digital functionalities. Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for nonemergency asthma care. This type of consultation, well accepted by individuals with asthma and their caregivers, offers opportunities for those facing challenges with traditional synchronous consultations due to lifestyle or geographic constraints. However, efficient organizational strategies are needed to manage the associated workload. PROSPERO CRD42022344224; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344224. RR2-10.1371/journal.pone.0281538.

Exploring the Challenges and Opportunities of Employing Persons with Disabilities

Background To supplement the extant literature on the economics of employing persons of disability, the present study explores the challenges and opportunities companies face with the employment of people with disabilities. Despite legal frameworks and growing awareness, individuals with disabilities often face significant barriers to securing meaningful employment. Misconceptions about their capabilities and concerns over potential costs persist, overshadowing evidence of economic and social benefits. This study explores these dynamics, emphasizing the potential advantages of inclusive hiring practices for organizations. Methods Semi-structured expert interviews were conducted with HR managers from five South Tyrolean companies across diverse industries. Participants were selected based on criteria such as company size (minimum 35 employees) and HR management experience (at least 3 years). Interviews focused on exploring workplace adjustments, employment motivations, challenges, and barriers, generating qualitative insights into inclusion practices. Results The study identified several advantages of employing individuals with disabilities, including low turnover rates, increased employee motivation, and a positive workplace atmosphere. Most companies incurred minimal costs for workplace adjustments. Challenges included insufficient understanding among staff, difficulty matching job roles with capabilities, and bureaucratic obstacles. The experts also noted a lack of job applications from individuals with disabilities, potentially due to low confidence or family overprotection. Conclusions Employing people with disabilities can be economically profitable and is not limited to social aspects alone. Existing barriers can often be dismantled without significant financial or time investment, with obstacles being readily overcome. This article contributes to a better understanding of challenges and opportunities of employing staff with disabilities and demonstrates the conditions under which economic benefits emerge for companies. The findings are discussed from an economical and social/cultural perspective with practical implications for human resource practice and operation management.

A national perspective of ambulance clinicians’ perceptions, experiences and decision-making processes when assessing older adults with a head injury: a mixed-methods study

Introduction: UK ambulance services employ diverse models of care, resulting in 40‐60% emergency department (ED) conveyance rates. Head injury conveyance rates for older adults (60 years and over) remain high (60‐70%), despite most being mild. This research aimed to explore ambulance clinicians’ perceptions, experiences and decision-making processes when assessing older adults with head injuries, considering the various factors influencing their clinical decisions.Methods: This study used a mixed-methods sequential explanatory design comprising an online survey and one-to-one interviews with patient-facing ambulance clinicians in the UK. The survey, distributed through nine ambulance services and via social media, gathered data about clinicians’ experiences, confidence levels and perceptions when assessing older adults with head injuries. It focused on exposure frequency, confidence in assessing asymptomatic patients, perceived risks of medications and confidence in available decision tools. The subsequent interviews delved deeper into the survey responses.Results: A total of 385 participants were recruited, predominantly male paramedics (61%), with a median age of 35 years and a median of eight years of ambulance service experience. Participants reported frequent encounters with older adults with head injuries, and expressed high confidence in assessing visible injuries but lower confidence in conducting neurological examinations. Participants found NICE and JRCALC guidelines satisfactory, and reported confidence in conveying patients to the ED but less confidence in alternative referrals or discharges. The interviews revealed two overarching themes: guideline-based care and patient-centred care, with sub-themes emphasising the importance of shared decision making, collaboration with other healthcare professionals and safety-netting strategies.Conclusion: Although clinicians express confidence in using clinical guidelines for ED conveyances, they often find such guidance overly prescriptive and struggle to translate them for individual cases. There is a need for more patient-centred, holistic decision making, especially considering the unique aspects of head injuries in older adults. Challenges include fear of poor outcomes, limited feedback on patient outcomes and low confidence in making referral or discharge decisions. Specific guidelines tailored to this demographic, as well as improved support services, may aid in reducing unnecessary ED conveyances.

Impact of COVID-19 and Mpox on Sexual Practices and Disease Mitigation Strategies Over Time Among Men Who Have Sex With Men Affiliated With Collective Sex Venues.

The COVID-19 pandemic and subsequent multinational mpox outbreak significantly disrupted sexual health care delivery, particularly impacting men who have sex with men (MSM). This study investigated these public health emergencies in relation to perceptions, attitudes, and sexual practices among MSM affiliated with a collective sex venue (CSV). Electronic surveys were sent to clientele of a high-volume CSV between June 2021 and November 2022 across 3 time periods defined as pre-Omicron, post-Omicron, and mpox. Data collection encompassed sociodemographics, health care access, sexually transmitted infection/HIV status, COVID-19 testing, and sexual behaviors. Multivariable regression analyses identified factors associated with self-reported COVID-19 testing and positivity, and mpox exposure. Among 1135 responses, demographics were largely cisgender MSM and predominantly White. Increased self-reported COVID-19 positivity was associated with having more sex partners and frequenting bathhouses for meeting sex partners. Confidence in COVID-19 mitigation strategies decreased post-Omicron. Factors linked to mpox exposure included younger age, increased sex partners, sexually transmitted infection positivity, and lower confidence in mitigation strategies. These findings underscore the intersectionality between sexual behaviors and public health responses to COVID-19 and mpox among MSM communities affiliated with a CSV. Decreased confidence in mitigation strategies and changes in sexual behaviors during public health emergencies underscore the need for targeted interventions and messaging. Collaboration between health departments and CSVs can facilitate responses to current and future public health threats and interventions.

The empathy project: Staff confidence and training needs in psychosocial patient care

IntroductionRadiation Therapists (RT) must balance highly technical procedures and psychosocial patient care during their daily work practices. While RTs are in a unique position to form rapport with patients and provide support and information, many RTs lack confidence in the psychosocial care of patients, and struggle to identify and address emotional cues. This study aimed to assess the confidence, competence, and training needs of RTs regarding psychosocial patient care. MethodsAll RTs at the Radiation Oncology Princess Alexandra Hospital Deparmtents were invited to participate in an electronic survey in May 2021, and May 2023 via email. The survey was distributed using SurveyMonkey and utilised a series of Likert-scale and open-ended questions. ResultsStaff reported high confidence in addressing technical treatment issues (98 % of respondents) and communicating with anxious (78 %) and distressed (78 %) patients. However, lower confidence was indicated with managing patient conflict (58 %) and communicating with patients who were depressed (53 %) or suffering mental health conditions (74 %). Staff were concerned about saying the wrong thing and experienced stress when they couldn't adequately communicate with patients requiring psychosocial support.The most significant barriers to providing adequate psychosocial care included time, staff numbers, and workload. Staff requested training in emotional cues, communication, anxiety and depression, and understanding psychosocial and mental health conditions. ConclusionWhile staff perceptions and motivations of psychosocial care were overwhelmingly positive, further training is required to improve patient psychosocial care. Future steps include implementing psychosocial training resources in the departments, and reassessing staff confidence post training.

The impact of methylome analysis on the diagnosis and treatment of CNS tumours in children and adolescents: a population-based study in Greece.

BackgroundThe recently published WHO classification of central nervous system (CNS) tumours recognizes DNA methylation profiling as a desirable and, for some diagnoses, essential diagnostic tool adjunctive to conventional histopathology. DNA methylation profiling is not routinely available in many countries, including Greece. MethodsIn this collaborative study, we report the DNA methylation results in a series of children and adolescents with CNS tumours in Greece (2018-2023). In total, 130 tumour samples were analyzed using the latest applicable version of the Heidelberg brain tumour classifier. ResultsUpon initial analysis, 80% (104/130) achieved calibrated scores (Cs) ≥0.9 and matched an established methylation class family/subclass. Among them, methylation results confirmed (90/104, 86.5%), refined (50/104, 48%) or changed (10/104, 9.6%) the histological diagnosis. Only four results were regarded as non-contributing (4/104, 3.9%). Twenty-six tumour samples received Cs <0.9. Despite low scores, methylation results supported the initial diagnosis with lower confidence in 38.5% (10/26) and established the diagnosis in two tumours with non-conclusive histopathology. Additional t-distributed stochastic neighbour embedding (t-SNE) analysis allowed the possible classification of twelve tumours. Nine more samples reached high Cs using the newer brain tumour classifiers, since available. Samples co-tested in Greece demonstrated excellent test reproducibility, supporting the analysis' local implementation. Methylome profiling impacted the clinical management of 40% of patients, modifying stratification, prognosis, or treatment approach. ConclusionsThis study supports the need to integrate methylome analysis into routine diagnostics in our country and highlights the importance of collaboration between European pediatric oncology centres.

Exposure and Sensitivity of Terrestrial Vertebrates to Biological Invasions Worldwide.

While biological invasions continue to threaten biodiversity, most of current assessments focus on the sole exposure to invasive alien species (IAS), without considering native species' response to the threat. Here, we address this gap by assessing vertebrates' vulnerability to biological invasions, combining measures of both (i) exposure to 304 identified IAS and (ii) realized sensitivity of 1600 native vertebrates to this threat. We used the IUCN Red List of Threatened Species to identify species threatened by IAS, their distribution, and the species' range characteristics of their associated IAS. We found that 38% of worldwide terrestrial lands are exposed to biological invasions, but exposure alone was insufficient to assess vulnerability since we further found that most of the world hosted native species sensitive to biological invasions. We delineated areas highly vulnerable to biological invasions, that is, combining areas of high exposure and high sensitivity to IAS, located in Australia and coastal states of North America with a high confidence level, but also-depending on the group-in Pacific islands, Southern America, Western Europe, Southern Africa, Eastern Asia, and New-Zealand with a medium confidence level. Assessing the completeness in exposure data, we revealed strong biases in the global description of the well-known invasion hotspots, with limited areas being assessed with a medium to high confidence level. The completeness of sensitivity was overall very high, for the three studied taxonomic groups. We also demonstrated that coldspots of vulnerability to biological invasions were areas of low confidence in terms of data completeness, which coincided with biodiversity hotspots. There is thus a critical need to address these knowledge shortfalls which jeopardize efficient conservation initiatives, regarding the threats to well-known vertebrate taxa.

Winners and Losers From Climate Change: An Analysis of Climate Thresholds for Tree Growth and Survival for Roughly 150 Species Across the Contiguous United States.

Changes in temperature and precipitation are already influencing US forests and that will continue in the future even as we mitigate climate change. Using spatiotemporally matched data for mean annual temperature (MAT) and mean annual precipitation (MAP), we used simulated annealing to estimate critical thresholds for changes in the growth and survival of roughly 150 tree species (153 spp. for growth, 159 spp. for survival) across the conterminous United States (CONUS). We found that growth of nearly one-third of tree species assessed (44 spp.) decreased with any increase in MAT (42-49 species), whereas fewer responded negatively to projected regional trends in MAP (< 20 species each in the east and west). Hypothetical increases in temperature (+1°C, +2°C) increased average annual growth in the Central East and Pacific Northwest and decreased growth over large areas of the Rockies and Southeast, while decadal survival generally decreased with temperature. Average annual growth and decadal survival had unfavorable associations with projected precipitation, generally decreasing with wetter conditions (+25%) in the east and decreasing with drier conditions (-25%) in the west. Beyond these averages, there were species that positively and negatively responded nearly everywhere across the CONUS, suggesting changes in forest composition are underway. We identified only eight species out of ~150 assessed that were tolerant to increases in temperature, and 24 species in the east and seven in the west were tolerant to regionally specific trends in precipitation (increases in the east and decreases in the west). We assessed confidence on a 5-point scale (1-5) for five aspects of uncertainty. Average confidence scores were generally high, though some species and metrics had low confidence scores especially for survival. These findings have significant implications for the future national forest carbon sink and for conservation efforts in the face of climate change.

“It Is My Responsibility to Escort My Child to School …” Factors Influencing Parental Involvement in Educating Children with Disabilities in Malawi

This study aimed to explore the factors that influence parental involvement in supporting the education of children with disabilities in Malawi, thereby generating insights into the barriers and facilitators they face. We conducted focus groups and in-depth interviews with 25 participants from Nkhata Bay District: teachers, parents, and children with disabilities. We used the COM-B model to analyse how parents’ capabilities, opportunities, and behaviours influence their involvement in their children’s education. This study revealed that parents of children with disabilities showed willingness, optimism regarding their children’s future, and a strong sense of responsibility for their education. However, factors such as the limited knowledge of children’s learning needs, time, low confidence, and financial challenges have constrained their involvement. Schools and communities frequently limit participation opportunities by not consistently practising or championing parental involvement in policies and actions. This study sheds light on the complex interplay between knowledge, practical constraints, and external support systems that shape parental involvement in the education of children with disabilities. Further research aimed at creating tailored and context-relevant interventions to improve parental involvement in the education of children with disabilities in low-income settings is required.

Manual physical therapy for neck disorders: an umbrella review

ABSTRACT Introduction Neck pain is a common musculoskeletal disorder, with a prevalence rate (age-standardized) of 27.0 per 1000 in 2019. Approximately 50–85% of individuals with acute neck pain do not experience complete resolution of symptoms, experiencing chronic pain. Manual therapy is a widely employed treatment approach for nonspecific neck pain (NSNP), cervical radiculopathy (CR) and cervicogenic headaches (CGH). This umbrella review synthesized systematic reviews examining manual physical therapy for individuals with cervical disorders. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed with Prospero registration (CRD42022327434). Four databases were searched from January 2016 to May 2023 for systematic reviews with or without meta-analysis examining manual therapy for individuals with neck pain of any stage. Interventions included any manual physical therapy of the cervical or thoracic spine as well as neuromobilization of the upper quarter. Primary outcomes included pain and disability. Two reviewers screened for eligibility and completed data extraction. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool. Results A total of 35 SRs were included: 15 NSNP, 7 cervical radiculopathy, 9 CGH and 4 samples with combined diagnoses. AMSTAR 2 ratings of the SRs support high confidence in results for 10 reviews, moderate confidence in 12 reviews and low to critically low confidence in 13 reviews. For NSNP, there was high confidence in the results showing manual therapy combined with exercise was superior to either treatment in isolation. In cervical radiculopathy, neural mobilization, distraction, soft tissue treatment and mobilization/manipulation to cervical and thoracic spine were supported with moderate confidence in results. For CGH, there was high confidence in the results supporting the use of cervical spine mobilization/manipulation, soft tissue mobilization, and manual therapy combined with exercise. Original authors of SRs reported varying quality of primary studies with lack of consistent high quality/low risk of bias designs. Conclusion Manual therapy plus exercise, cervical or thoracic mobilization and manipulation, neuromobilization, and other types of manual therapy were supported as effective interventions in the management of pain and disability for individuals with NSNP, CGH, or CR in the short-term.

Comparing spiritual wellbeing and illness perceptions between cancer patients from culturally and linguistically diverse and those from mainstream backgrounds in Australia.

Cancer presents a significant health challenge, particularly within culturally and linguistically diverse (CALD) populations. Religious, spiritual, and personal beliefs regarding illness may mitigate its psychological and physical impacts, varying with CALD status. This study aims to assess illness perceptions in Australian cancer patients from both CALD and Anglo-Australian backgrounds and to explore the associations between spiritual wellbeing and illness perceptions within these groups. Cross-sectional study, involving 119 cancer patients from CALD backgrounds (Arabic, Chinese, and Greek) and 50 Anglo-Australians. Spiritual wellbeing and cancer perception were assessed using the World Health Organization Quality of Life-Spirituality, Religiousness, and Personal Beliefs questionnaire and the revised Illness Perception Questionnaire, respectively. Linear regression models analyzed associations. CALD patients perceived their cancer as less enduring (β - 4.74, 95%CI - 6.16, - 3.31) and symptoms as less predictable (- 4.96, 95%CI - 6.12, - 3.86) compared to Anglo-Australians. They had lower confidence in medical interventions (- 2.96, 95%CI - 3.36, - 1.22) and poorer illness understanding (- 4.66, 95%CI - 5.83, - 3.49). In Greek-speaking patients, an increase in spiritual wellbeing was associated with less favourable perceptions of treatment controllability (β - 2.25, 95%CI - 4.39, - 0.09). Conversely, for Chinese-speaking patients, an increase in spiritual wellbeing was associated with improved illness perception across all domains except for consequences and emotional representation. However, no significant association was observed for Arabic patients. Differences in illness perceptions exist among CALD and Anglo-Australians. Spiritual wellbeing appears linked to more favourable perceptions; however, differential effects emerged among groups, emphasizing the need for culturally tailored interventions to improve outcomes.

Assessment of knowledge, perceptions, and readiness of healthcare professionals towards clinical pharmacogenomics implementation in Qatar: a mixed-method study.

Pharmacogenomics implementation in clinical practice is anticipated to improve our understanding of individual variations in drug response and optimise the safety and efficacy of drug therapy. We aimed to assess the knowledge, perceptions, and readiness of physicians, pharmacists, and nurses in Qatar regarding the implementation of clinical pharmacogenomics. A mixed-method study with an explanatory sequential design was conducted. Phase I was the quantitative phase which involved sending an online survey to physicians, pharmacists, and nurses. Phase II was the qualitative phase which involved conducting focus group discussions. A total of 802 responses were collected, with a response rate of 20%. Only 15.4% of participants had previous pharmacogenomics-related training. The median knowledge score for healthcare professionals was 4 out of 10 denoting low level of knowledge. However, compared to other professions, pharmacists had a higher knowledge score (p-value <0.001) and Doctor of Pharmacy (PharmD) holders scored higher than BSc holders (p-value <0.001). Despite the low level of knowledge, perceptions of healthcare professionals were positive. In addition, the majority believed knowledge of pharmacogenomics is necessary and that counselling patients on pharmacogenomics requires specialised training pharmacogenomic principles in practice. The main themes extracted from the focus group discussions were knowledge, outcome expectations, preparedness, facilitators, barriers, public education, and implementation planning. Regarding readiness, most healthcare professionals reported that they are not currently confident in applying. Healthcare providers have a low level of knowledge of pharmacogenomics. Despite this, the majority have positive perceptions towards its implementation in practice. Compared to other professionals, pharmacists with a PharmD degree scored higher in the knowledge assessment. Most healthcare providers report low confidence regarding the readiness for the implementation of pharmacogenomics and report a lack of knowledge, specialised training, and clinical guidelines as barriers.

The moderating role of COMT gene rs4680 polymorphism between maladaptive metacognitive beliefs and negative symptoms in patients with schizophrenia

BackgroundAlthough the positive association between impairments in metacognitive capacity and negative symptoms in people with schizophrenia spectrum disorders is widely evidenced in the literature, the explaining mechanisms of this association are still less known and poorly understood. This study aims to bridge this knowledge gap by testing the hypothesis that COMT rs4680 variants will act as moderators in the relationship between certain metacognitive domains and negative symptoms’ severity.MethodA cross-sectional study was carried-out during the period between February and March 2024. A total of 115 biologically unrelated Arab (Lebanese) patients with schizophrenia were included.ResultsAfter controlling for sex and duration of illness as a potential confounder, moderation analyses showed that the AG genotype of the COMT rs4680 served as a significant moderator between maladaptive metacognitive beliefs about cognitive confidence (i.e. lack of confidence in memory) and negative symptoms. In non-carriers of the COMT rs4680 AG genotype, lower cognitive confidence (i.e., more “lack of cognitive confidence”) is significantly associated with greater negative symptoms.ConclusionFindings suggest that metacognition may be a relevant treatment target in the management of negative symptoms particularly in non-carriers of the COMT rs4680 AG genotype. Therefore, genetic testing could potentially be used to match patients with metacognitive interventions that are more likely to be effective in supporting recovery from negative symptoms.

Registered Nurses' Knowledge and Attitudes Towards Psychedelics in Healthcare: Statewide Survey Results.

Psychedelic science is re-emerging to address mental health conditions, of which certain populations in the United States experience disparities. However, the perspectives of registered nurses (RNs), who have important roles within mental health care, towards psychedelics are largely unknown. To assess attitudes, knowledge, and beliefs of a large, state-wide sample of RNs towards psychedelics in healthcare settings. RNs were randomly selected from a statewide directory to participate in a cross-sectional, multi-method online survey. 793 RNs completed all items, with generally positive attitudes towards psychedelics but mixed opinions regarding the legal landscape, including decriminalisation. Few (12.7%) reported psychedelic content in their training, and most expressed low confidence in their knowledge. Findings generally align with previous research regarding provider attitudes towards psychedelics. Participants in this study had slightly more favourable attitudes and higher knowledge scores. The study has potential selection bias, lacks a priori power analysis, and is limited to one state. As psychedelic science emerges as a potential treatment option for several mental health conditions, RNs must be prepared to support individuals and communities. Additional education in this emerging area of mental health nursing is warranted to ensure RN competence and confidence.

Measuring Self-Efficacy for Concussion Recovery: Psychometric Characteristics of the Progressive Activities of Controlled Exertion-Self-Efficacy Scale.

Control over symptoms postconcussion is central to an active self-directed recovery process. Therefore, assessing a patient's confidence in controlling their symptoms and facilitating their concussion recovery is an important component of treatment. Previously, no measures existed to assess symptom-specific self-efficacy (SE) in pediatric concussion recovery. SE is an individual's belief or confidence in their capabilities to execute action plans necessary to perform certain behaviors. Based on this definition, we developed the Progressive Activities of Controlled Exertion-Self-Efficacy (PACE-SE) scale to measure a patient's SE related to pediatric concussion recovery-specific activities. The aim of this article is to present the psychometric characteristics (evidence of reliability, validity) of the PACE-SE scale. The 17-item PACE-SE was administered to children and adolescents, 10-18 years of age, recovering from a diagnosed concussion as part of a standard clinical evaluation. Results revealed a four-factor structure producing the following scales: Managing My Stress, Managing My Activity, Seeking Adult Assistance, and Maintaining Positive Outlook. The PACE-SE scores indicated excellent internal consistency reliability with reasonable test-retest reliability over time. Evidence for the association between recovery status and greater confidence and control over recovery-related activities as measured by the PACE-SE was supported by: (1) an inverse association with symptom status reflecting lower confidence for managing recovery with higher symptom load, (2) greater reported problems with school performance associated with lower SE, (3) positive change in SE ratings across two clinic visits associated with symptom improvement, and (4) a significant difference in SE ratings evident between recovered and nonrecovered patients. The psychometric evidence supporting the PACE-SE scale provides the clinician with a measure to understand the child/adolescent patient's self-confidence in facilitating their concussion recovery.

Quantification Supports Amyloid PET Visual Assessment of Challenging Cases: Results from the AMYPAD Diagnostic and Patient Management Study.

Several studies have demonstrated strong agreement between routine clinical visual assessment and quantification, suggesting that quantification approaches could support assessment by less experienced readers or in challenging cases. However, all studies to date have implemented a retrospective case collection, and challenging cases were generally underrepresented. Methods: We included all participants (n = 741) from the AMYPAD diagnostic and patient management study with available baseline amyloid PET quantification. Quantification was done with the PET-only AmyPype pipeline, providing global Centiloid and regional z scores. Visual assessment was performed by local readers for the entire cohort. From the total cohort, we selected a subsample of 85 cases for which the amyloid status based on the local reader's visual assessment and the Centiloid classification (cutoff = 21) was discordant or that were assessed with low confidence (i.e., ≤3 on a 5-point scale) by the local reader. In addition, concordant negative (n = 8) and positive (n = 8) scans across tracers were selected. In this sample (n = 101 cases; [18F]flutemetamol, n = 48; [18F]florbetaben, n = 53), the visual assessments and corresponding confidence by 5 certified independent central readers were captured before and after disclosure of the quantification results. Results: For the whole AMYPAD diagnostic and patient management study cohort, overall assessment by local readers highly agreed with Centiloid status (κ = 0.85, 92.3% agreement). This was consistently observed within disease stages (subjective cognitive decline-plus, κ = 0.82, 92.3% agreement; mild cognitive impairment, κ = 0.80, 89.8% agreement; dementia, κ = 0.87, 94.6% agreement). Across all central reader assessments in the challenging subsample, quantification of global Centiloid and regional z scores was considered supportive of visual reads in 70.3% and 49.3% of assessments, respectively. After disclosure of the quantitative results, we observed improvement in concordance across the 5 readers (baseline κ = 0.65, 65.3% agreement; κ after disclosure = 0.74, 73.3% agreement) and a significant increase in reader confidence (baseline mean (M) = 4.0 vs. M after disclosure = 4.34, Wilcoxon statistic (W) = 101,056, P < 0.001). Conclusion: In this clinical study enriched for challenging amyloid PET cases, we demonstrate the value of quantification to support visual assessment. After disclosure, both interreader agreement and confidence showed significant improvement. These results are important considering the arrival of antiamyloid therapies, which used the Centiloid metric for trial inclusion and target engagement. Moreover, quantification could support determination of amyloid-β status with high certainty, an important factor for treatment initiation.