Negative Outcomes Research Articles

The clinical pathway in ADMiRE, Ireland's first public specialist service for children and adolescents with attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder occurring in approximately one in twenty young people in Ireland, and in one-third of those attending Irish Child and Adolescent Mental Health Services (CAMHS). It is important to treat ADHD, as un/poorly treated ADHD is associated with a raft of negative health and socio-economic outcomes. Effective interventions for ADHD are available, and the use of standardised, evidence-based pathways for assessment and management of ADHD optimises outcomes. Despite this, there is no national standardised clinical pathway for assessment and treatment of ADHD in Ireland. ADMiRE, the first public healthcare specialist service for children and adolescents in Ireland, has developed a strongly evidence-based, efficient, effective and safe clinical pathway for assessment and management of ADHD. This paper describes the ADMiRE Clinical Pathway and references ADMiRE resources that are available to other services.

Ductus arteriosus diameters in fetuses with early- and late-onset fetal growth restriction.

Fetal growth restriction (FGR) is a common pregnancy complication that can be associated with several adverse perinatal outcomes. One of these negative outcomes is ductus arteriosus, especially in preterm babies. In this study, intrauterine heart function and ductus diameter were evaluated in babies with FGR. Thirty-seven fetuses with FGR were compared with 37 normal-weight fetuses at the same gestational week. In our study, ventricular diameters, aorta, pulmonary artery, ductus arteriosus (DA), aortic arch diameter, and flow traces were examined. In addition, the aorta and aortic isthmus diameters were proportioned to the ductus diameter, and the left ventricular myocardial performance index (MPI) [(ICT + IRT)/ET] was evaluated. There was no difference in DA diameters between the patient and control groups. The intragroup comparison of the cases with early- and late-onset FGR revealed no statistically significant difference between DA diameters. However, the ratios of the aortic annulus diameter/ductus diameter (AOD/DAD) and aortic isthmus diameter/ductus diameter (AID/DAD) were significantly lower in early-onset FGR because the diameter of the DA was greater. In addition, the mod-MPI values were higher in the patient group. In our study, although the ductal diameters did not change significantly in the patient group, the ductal diameter was greater in the early-onset intrauterine growth restriction (FGR) group compared with other cardiac measurements. The mod-MPI value, a cardiac function indicator, was higher in fetuses with FGR. These findings may be useful for evaluating postnatal cardiac functions in FGR.

Depression, Contraception, and Ambivalence Concerning Fertility.

Individuals suffering from depression exhibit a higher rate of unintended pregnancies, which are associated with negative outcomes for both parents and children. Often, unintended pregnancies result from contraceptive mistakes. Here, we examine the relationship between depression and the consistency of contraceptive behavior, testing ambivalence as a possible mediator. The analyses were based on cross-sectional data from the second and third waves of the German Relationship and Family Panel Pairfam. A German-speaking sample without children (N = 190; 117 female, 73 male), who reported not attempting to conceive or become pregnant during the last 12months, was analyzed in comparison with a propensity score matched sample. Ambivalence was operationalized as the difference between the ideal and realistic number of children in wave 2. Data from wave 3 were used to assess contraceptive behavior. Depressed mood in wave 2 and consistency of contraceptive behavior in wave 3 were negatively correlated. After including ambivalence in wave 2 as a mediator in the model, the direct path between depressed mood and consistency of contraceptive behavior remained significant, with no significant mediation found. For men only, we observed a significant negative association of ambivalence with the consistency of contraceptive behavior in the last 3months. No significant relationship was found between depressed mood and ambivalence. We conclude that future research aiming to better understand the consistency of contraceptive behavior should incorporate measures of ambivalence.

Speech-language pathologists’ experience with nursing initiated texture modified diets in health care settings

BACKGROUND: Texture modified diets (TMDs) are among the most widely used compensatory measures for managing dysphagia. TMDs are associated with significant risks involving nutrition, hydration, and quality of life. Speech-language pathologists (SLPs) are trained to evaluate and treat people with dysphagia and to assess client-specific appropriateness of TMDs. However, patients are regularly placed on TMDs by nursing staff without formal training in dysphagia and without SLP consult (Gurevich et al., 2021). OBJECTIVE: This study explores the experience of SLPs in health care with respect to such nursing initiated TMDs with the goal of assessing the prevalence of this practice. METHOD: SLP students, clinical fellows, and practicing clinicians (N = 503) were surveyed regarding their exposure to the nursing initiated TMD practice. RESULTS: Overall, 78.9% of respondents have directly encountered the nursing initiated TMD practice, with an additional 10% having heard of it. The group most susceptible to this practice, the certified clinicians who work with dysphagia alongside nurses (n = 461), had a higher rate of directly encountering this practice (82.2%). Among these, the early career clinicians (n = 104) had an even higher direct encounter rate at 87.5%. CONCLUSIONS: Findings show that nursing initiated TMDs are pervasive in United States (U.S.) health care, and SLPs are shown to regularly face this issue in their work settings as soon as they enter the workforce. Given negative outcomes associated with TMDs, patient care would be best served if decisions to implement TMDs were made by personnel with training in dysphagia.

What did you hear and what did you see? Understanding the transparency of facial recognition and speech recognition systems during human–robot interaction

As social robots begin to assume various social roles in society, the demand for understanding how social robots work and communicate grows rapidly. While literature on explainable artificial intelligence suggests that transparency about a social robot’s working mechanism can evoke users’ positive attitudes, transparency may also have negative outcomes. This study investigates the paradoxical effects of the transparency of facial recognition technology and speech recognition technology in human–robot interactions. Based on a lab experiment and combined analyses of users’ quantitative and qualitative responses, this study suggests that the transparency of facial recognition technology in human–robot interaction increases users’ social presence, reduces privacy concerns, and enhances users’ acceptance of robots. However, exposure to both facial and speech recognition technologies revives users’ privacy worries. This study further parses users’ open-ended evaluation of the prospective application of social robots’ tracking technologies and discusses the theoretical, practical, and ethical value of the findings.

Pregaming potentiates risk between UPPS-P impulsivity and day-level drinking behavior: A test of person-environment transactions theory.

Pregaming represents a uniquely high-risk drinking event for young adults, and subfacets of impulsivity are robust predictors of alcohol use and related negative outcomes. Further, it is likely that pregame events contain social and physical stimuli that are particularly appealing for impulsive individuals, thus exacerbating risk for negative outcomes. However, no prior studies have investigated the extent to which impulsive personality traits interact with pregame events to confer alcohol-related risk. Thus, the present study examined the extent to which UPPS-P (urgency-perseverance-premeditation-sensation seeking-positive urgency) subfacets of impulsivity interact with the occurrence of pregaming to predict relations between pregaming, drinking quantity, and negative alcohol-related outcomes. College students (N = 737) completed a modified, online version of the 30-day Timeline Followback in which they reported drinking quantity, negative consequences, and whether they engaged in pregaming on a given day. Results indicated that sensation seeking and a lack of premeditation moderated relations between pregaming and drinking quantity such that those who are higher in sensation seeking and lower in their ability to plan ahead drank more on pregaming days. Sensation seeking and positive urgency moderated relations between pregaming and negative consequences such that those who are higher in positive urgency experience more consequences on pregaming days whereas those who are higher in sensation seeking experience less consequences. Future studies may benefit from more granular assessments of pregame-related risk as subfacets of impulsivity may confer momentary risk. Prevention efforts targeting the reduction of pregaming frequency, particularly among impulsive individuals, may lower overall risk for heavy drinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The effect of social support and resource support on emotional exhaustion, insomnia, and suicidal ideation among allied health trainees and post-graduate year doctors in Taiwan

BackgroundCOVID-19-related stigmatization refers to COVID-19-related judgements by others that devalue the individual. Such stigmatization towards healthcare workers may cause psychological burden and negative consequences. Such stigmatization may have particularly overwhelmed allied health trainees (AHTs) and post-graduate year doctors (PGYDs) because they just started their medical career. Social support and resource support have been reported to benefit psychological health and reduce stigmatization. Therefore, the present study used a cross-sectional study design to investigate the association between perceived stigma, self-stigma, psychological distress, and negative outcomes (including emotional exhaustion, insomnia and suicidal ideation) among AHTs and PGYDs in Taiwan.MethodsAn online survey distributed between July and December, 2022 received 522 responses. Variables were assessed using the 21-item Depression, Anxiety and Stress Scale, Insomnia Severity Index and a series of self-designed questions to assess social support, resource support, perceived stigma, self-stigma, emotional exhaustion, and suicidal ideation.ResultsStructural equation modeling showed that perceived stigma was associated with self-stigma (standardized coefficient [β] = 0.428, p < 0.001), and self-stigma was associated with psychological distress (β = 0.197, p < 0.001), as well as being associated with emotional exhaustion, insomnia, and suicidal ideation (β = 0.349, 0.556 and 0.212, all p-values < 0.001). While social support and resource support were negatively associated with perceived stigma (β= − 0.175 and − 0.152, p < 0.01), additional associations were found between social support and emotional exhaustion (β= − 0.093, p < 0.001), as well as between resource support and insomnia (β= − 0.120, p < 0.001).ConclusionsThe results showed that COVID-19 related stigmatization was correlated to the detrimental consequences of emotional exhaustion, insomnia and suicidal ideation. Clear paths regarding the associations of social support and resource support with the three negative associations were found as the possible solutions. Strategies to reduce the stigmatization and these negative outcomes, or improve the psychological health will benefit AHTs and PGYDs in maintaining a healthy mental status.

The impact of compassion-focused therapy on positive and negative mental health outcomes: Results of a series of meta-analyses.

The impact of compassion-focused therapy on positive and negative mental health outcomes: Results of a series of meta-analyses.

The companion dog as a model for inflammaging: a cross-sectional pilot study.

Inflammaging, the chronic, progressive proinflammatory state associated with aging, has been associated with multiple negative health outcomes in humans. The pathophysiology of inflammaging is complex; however, it is often characterized by high serum concentrations of inflammatory mediators such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, and C-reactive protein (CRP). Few studies have evaluated the effects of age on inflammatory cytokines in companion dogs, and most of these studies included dogs of a single breed. In this cross-sectional study, we measured multiple circulating inflammatory markers and hematological parameters in banked serum samples from 47 healthy companion dogs of various breeds enrolled in the Dog Aging Project. Using univariate linear models, we investigated the association of each of these markers with age, sex, body weight, and body condition score (BCS), a measure of obesity in the dog. Serum IL-6, IL-8, and TNF-α concentrations were all positively associated with age. Lymphocyte count was negatively associated with age. Platelet count had a negative association with body weight. IL-2, albumin, cholesterol, triglyceride, bilirubin, S100A12, and NMH concentrations were not associated with age, weight, BCS, or sex after adjustment for multiple comparisons. Our findings replicate previous findings in humans, including increases in IL-6 and TNF-α with age, giving more evidence to the strength of the companion dog as a model for human aging.

Evaluating the feasibility of a Mobile Audio Companion (Elly) to reduce anxiety and to improve patient-reported outcomes among patients with cancer.

11120 Background: Anxiety is one of the most commonly reported symptoms among cancer patients, and is a known risk factor for reduced health-related quality of life and other negative patient-reported outcomes (PROs). Mobile health applications (apps) are tools that can be used flexibly in patients’ preferred environments with the potential to reduce anxiety and improve quality of life. The current study sought to examine the feasibility and preliminary efficacy of a mobile audio companion app, Elly, to improve anxiety and other critical PROs among cancer patients. Methods: This was a single-site, single-arm pilot study conducted over 6-months. Adults 18 years or older with a diagnosis of cancer of any type, received treatment within 6 months of consent, and had access to an iPhone were eligible. The primary outcome was change in mean anxiety t-scores (NIH PROMIS anxiety short form (8a)) administered electronically via REDCap at baseline, 1 (primary timepoint), 3, and 6 months. Secondary outcomes included changes in NIH PROMIS depression, loneliness, social support, and perceived stress scores from baseline to 6 months. Changes in NIH PROMIS T-scores at each time point were calculated and analyzed using paired t-tests. Results: Of 53 patients who consented for the study, 38 patients (72%) were included in the analysis ( Mage: 52.8 years, SD: 11.7, 84.2% female). Most participants reported a history of breast cancer (50%), followed by ovarian (16%), hematologic (11%), and other cancer types (24%) Phone incompatibility and technological challenges were the most common reasons for screen-fails (n=15). All participants downloaded and used the app at least once, with an average of 154 app usage events across participants recorded over the study period (median: 64, range 11-1186 times). The mean baseline anxiety T-score was 63.5 (SD: 2.1). Anxiety levels decreased among participants over time, with a mean difference in anxiety T-scores of -1.9 at 30 days, -3.3 at 90 days, and -3.0 at 6 months from baseline, which was statistically (p&lt;0.05) and clinically significant. Participants also reported improvements in perceived stress, depression symptomatology, social support, and loneliness, although statistical significance was not reached. Conclusions: Mobile apps, such as Elly, may feasibly be used to support patient-reported anxiety as well as other PROs, especially among those who present with high levels of anxiety at baseline. Efforts to increase access to mobile health apps and provide technical support for patients should be made increase equity across the cancer survivor population. Larger, multi-center randomized controlled trials are needed to build on these findings.

Support and services available to at-risk mothers and their children in maternity residences: a scoping review protocol.

The objective of this scoping review is to identify, categorize, and map the types of support and services available to at-risk mothers and their children in maternity residences. A secondary objective is to identify and map the measures used to evaluate the efficacy of these types of support and services. Pregnant and parenting women and their children experiencing complex challenges related to the social determinants of health, including unstable housing and poverty, are at high risk of long-term negative health and socioeconomic outcomes. Maternity residences may provide support and services that improve this population's outcomes; however, there is little understanding of what services are offered and how efficacious they may be. Therefore, it is necessary to provide a comprehensive overview of support and services in maternity residences, and to identify the measures used to evaluate the efficacy of the support and services. This will provide the foundation to evaluate these services and outcomes and inform the development of future maternity residential programs. Studies including pregnant and parenting women and gender-diverse individuals who are housed in, or accessing the services of, maternity residences in politically stable high-income countries due to challenges rooted in the social determinants of health will be considered for inclusion. We define maternity residences as any agency with a residential component offering support/services to this population. This review will be conducted in accordance with JBI methodology for scoping reviews. The data will be analyzed using a quantitative descriptive analysis approach. The data analysis and discussion will be informed by the Social Determinants of Health, Reproductive Justice, Harm Reduction, and Health in All Policies frameworks.

How Student and Faculty Perceptions Differ on the Stressors that Medical Students Face.

Medical education is notorious for the stress that students face as they strive to succeed both academically and clinically. This stress has been linked to declining academic performance and worsening mental health. To combat these negative outcomes, it is essential for medical school faculty and administration to address common stressors among medical students. No studies have addressed whether medical school faculty and students perceive stressors similarly, however. In this two-part study, data collected from medical students in 2021 to 2022 to identify their most significant sources of stress were used to create a survey that queries the frequency and intensity of these stressors. This survey was distributed to medical students and faculty at the same institution. The responses between students and faculty were compared and student data also were analyzed by academic year to observe changes in perception that accompany progression through the medical curriculum. The results showed that faculty overestimated the impact of certain stressors on medical students (eg, in-house examinations, US Medical Licensing Examination Steps 1 and 2 examinations, and patient interactions). In addition, preclinical students were more concerned with finding extracurricular activities, missing opportunities, and performing research compared with clinical students. This study demonstrated that although faculty anticipated most medical student stressors, there are significant gaps that still need to be addressed to better reduce and respond to the stress experienced by medical students.

Missed Opportunities: Characteristics of People Who Received a Concurrent HIV/AIDS Diagnosis in New York State From 2016 to 2021.

Late HIV diagnosis is associated with a wide range of negative outcomes. The aim of this study was to identify the characteristics of individuals who received a concurrent diagnosis (CDX) in New York State (NYS) so that more effective interventions can be developed to encourage earlier testing among these populations. The NYS HIV registry was used to identify people who received a CDX from 2016 to 2021. A CDX was a diagnosis that met the criteria for a stage 3 HIV infection within 30 days of the initial HIV diagnosis. Sex at birth, race/ethnicity, transmission risk group, age at diagnosis, region of residence at diagnosis, urbanicity of zip code of diagnosis, and type of diagnosing facility were used as covariates. Bivariate and multivariate risk ratios were calculated to quantify associations between CDX and covariates. There were 14,866 people newly diagnosed with HIV in NYS from 2016 to 2021, of which 19.0% had a CDX. Those with female sex at birth, history of injection drug use, or history of male-to-male sexual contact/history of injection drug use risk were less likely to have a CDX. Increased age, Asian race/ethnicity, residence outside of New York City, and diagnosis at inpatient facilities or emergency rooms were associated with an increased likelihood of a CDX. Populations with the highest proportions of CDX were ones that made up a small percentage of all new HIV diagnoses and may not be benefiting as much from current HIV prevention efforts. There are complex interactions between many factors including geographic and social characteristics that may lead to delayed diagnostic testing.

Load Shedding and Its Crippling Effect on The South African Economy: An Entrepreneurial Perspective

The country has experienced industry shutdowns, decreased productivity, educational setbacks, increased unemployment rates, and negative healthcare outcomes. Load-shedding in South Africa is primarily caused by inadequate maintenance, internal mismanagement, corruption, and a lack of skills. This issue has had a significant impact on small businesses, as they often lack the necessary resources to handle power surges, equipment damage, and the costs associated with replacing stock. This paper explores how load-shedding has impacted the South African economy from an entrepreneurial perspective. The research is qualitative and exploratory in nature, and it was found that load-shedding has had a significant impact on businesses' finances, resources, and performance. Load-shedding in South Africa has had a severe impact on the daily lives of people, causing disruptions in businesses, households, and the overall economy. Eskom, the primary supplier of energy in South Africa, has been facing significant challenges in meeting the growing demand for electrical energy, leading to job losses, decreased productivity, and a loss of billions of rands. Small businesses have been particularly affected, with an estimated 75% of them failing after being operational for less than three years due to load-shedding. To ensure small businesses have electricity to operate during load-shedding it is recommended that small businesses adopt alternative energy sources like solar power to increase the businesses’ independence and mitigate the effects of load-shedding. The South African government should also encourage and support small businesses to collaborate with successful renewable energy companies.

Direct Comparison of the Effectiveness and Safety Among Direct Oral Anticoagulants and Warfarin in Japanese Patients: Nationwide Cohort Study in Japan.

Direct oral anticoagulant drugs (DOACs) are available in addition to warfarin for the treatment of patients with non-valvular atrial fibrillation (NVAF). Anticoagulants are useful for practical pharmacotherapy in Asian populations, but their responses are different from those in Caucasian populations. Therefore, we aimed to identify the most useful anticoagulant using a nationwide insurance claims database in Japan. We extracted information on patients with NVAF treated with DOACs or warfarin for the first time between September 2015 and February 2018 to conduct a retrospective observational cohort study using the claims database of Japan. We calculated hazard ratios (HR) of effectiveness and safety endpoints among DOACs or warfarin after adjusting for backgrounds by propensity scores (inverse probability weighting). Using negative control outcomes, we considered renal function as an unmeasured confounding factor. After adjusting for their backgrounds, patients treated with DOACs showed higher effectiveness endpoints (stroke or systemic embolism) than those treated with warfarin (HR; 0.72-0.81) and higher safety in terms of safety end points (clinically significant bleeding) (HR; 0.80-0.88). The net clinical benefit, which reflects the actual clinical usefulness, indicates the advantages of DOACs over warfarin (HR; 0.75-0.82). Dabigatran had lower usefulness than edoxaban and rivaroxaban in Japanese patients treated with NVAF, even after considering the unmeasured confounding factor of kidney function. Based on practical clinical data, edoxaban and rivaroxaban were the most useful anticoagulants in Japanese patients with NVAF.

Eco-green mirage: investigating turnover intention as organizational turbulence through perceived greenwashing, cynicism and alienation

Purpose Using social and moral identity theory, this study aims to investigate the influence of perceived greenwashing on employee work attitudes by using social and moral identity theory. By examining the relationships between perceived greenwashing, employee cynicism, work alienation and turnover intention, this study unveils essential mechanisms that shed light on the complex relationship between these variables. Design/methodology/approach The study gathered data from a sample of 267 employees in the service industry and used variance-based structuring equation modeling to test the hypothesized associations. The results of the study indicated a positive relationship between perceived greenwashing and turnover intention. Findings Employee cynicism and work alienation emerged as crucial mediating factors, revealing the underlying psychological dynamics linking perceived greenwashing to turnover intention. Moreover, the study identified organizational pride as a powerful moderator that mitigates the adverse effects of greenwashing on employee attitudes. Practical implications Genuine and transparent environmental practices are crucial in the service industry to avoid misleading claims, safeguard reputation and establish trust. Leaders should exemplify genuine commitment to environmental practices, serving as role models. Regular and honest feedback mechanisms should be established to gauge employee perceptions of the organization’s environmental initiatives. Educating employees about the signs of deceptive practices can empower them to make informed judgments, reducing the likelihood of falling victim to misrepresentations and mitigating associated negative outcomes. Originality/value The current research seeks to shed light on the profound impact of greenwashing on employees, an area that has been surprisingly overlooked. The study responds to the call of the antecedents that influence employees’ intentions to leave their organizations. The study explored the vital relationship between perceived greenwashing and employee attitudes, thereby contributing valuable insights to the existing literature on the sustainable practices of organizations, particularly those in the service industry.

Developing conceptions of forgiveness across the lifespan.

Understanding how to respond to transgressions is central to cooperation, yet little is known about how individuals understand the consequences of these responses. Accordingly, the current study explored children's (ages 5-9), adolescents' (ages 11-14), and adults' (N = 544, predominantly White, ~50% female, tested in 2021) understandings of three such responses-forgiveness, punishment, and doing nothing. At all ages, participants differentiated between the consequences of these three responses. Forgiveness was associated with more positive and fewer negative outcomes, while the opposite was true for punishment and doing nothing. With age, participants were less likely to expect positive outcomes, and this effect was strongest for punishment and doing nothing. The results of this study allow novel insights into reasoning about three important response strategies.

4-h mean lactate clearance as a good predictor of adverse outcome in acute cardiogenic pulmonary edema: a pilot study

Abstract Objectives This pilot study aimed to evaluate the efficacy of the 4-h mean lactate clearance (LACclr) level as a predictive factor for in-hospital outcomes, 30-day mortality, and treatment success in patients with acute cardiogenic pulmonary edema (ACPE), a significant clinical form of acute heart failure (AHF). Methods A total of 44 patients diagnosed with acute pulmonary edema were included in the study. The patients were divided into two groups based on lactate levels and negative outcomes, and lactate and LACclr levels and negative outcomes were analyzed using statistical tests such as Fisher’s exact test, Student’s t-test, Mann-Whitney U test, and Receiver operating characteristic (ROC) analysis. Results The results indicated a statistically significant difference in the total hospitalization length of stay according to whether the patients had a negative outcome (intubation and in-hospital mortality) (p=0.033). Additionally, the area under the curve (AUC) value for 4-h mean LACclr was 0.795 in all patients, which was statistically significant in predicting 30-day mortality (p=0.033). The optimal cut-off value for the 4-h mean LACclr in predicting 30-day mortality was found to be 5.57 %, with 80 % sensitivity and 66.7 % specificity. The threshold to rule out 30-day mortality for all patients was 18.85 with 100 % sensitivity and 30.2 % specificity (AUC, 0.795 95 % CI [0.546–1.000], p=0.033). Conclusions These findings suggest that the 4-h LACclr level, calculated within 4 h of emergency department (ED) presentation, can be used as a predictive indicator for needing intubation, in-hospital mortality, and 30-day mortality and to identify patients at higher risk for adverse outcomes.

Barriers and outcomes of therapeutic communication between nurses and patients in Africa: a scoping review

BackgroundTherapeutic communication (TC) promotes effective patient care, emotional wellbeing, and improves patient outcomes. The purpose of this review was to synthesise evidence on barriers and outcomes of TC between nurses and patients in Africa and to inform future studies and systematic reviews.MethodsSearch for the records was done in four major databases including PubMed, Science Direct, PubMed CENTRAL, and JSTOR. Additional searches were done in Google Scholar and Google. Results and findings from published studies and grey literature were included. A total of 16 articles met the eligibility criteria and were included in the review. This scoping review followed the guidelines by Askey and O’Malley.ResultsBarriers associated with TC were grouped under five main themes: sociodemographic factors, patient-related factors, nurse-related factors, environmental and health service-related. Age, and religious beliefs were the main sociodemographic factors that hindered TC while stress and inadequate knowledge and skills were identified among the nurse-related barriers to TC. Extreme weather conditions and mosquito infestation were environmental factors while lack of access to TC educational programmes on TC was a health service-related factor that interfered with TC. Both positive and negative outcomes of TC were also identified.ConclusionContinuous professional development on TC is necessary to improve nurses’ attitudes and update their skills to enable them to render culturally competent nursing care to patients.

Centennium of collegiate real estate education: a prospection on “the search for a discipline” in the American school of business

PurposeThis study reviews the teaching of real estate in the USA for the first 100 years after the foundational curriculum was laid down in 1923 by three key institutions: the National Association of Real Estate Boards (NAREB), the Institute for Research in Land Economics and Public Utilities (The Institute) and the American Assembly of Collegiate Schools of Business (AACSB). Its line of investigative pursuit is the persistent lamentation by American real estate scholars that real estate is not getting the respect it deserves as an academic discipline compared to its peers in the school of business such as accounting, finance and marketing. The study addresses a fundamental question: What is the cause of this endless “search for a discipline”? This is motivated by the belief that identification of the root cause of this “search for a discipline” will lead to the requisite solution: the intellectual foundation of the real estate discipline.Design/methodology/approachThe study used qualitative document analysis to review two primary documents published in 1959 as reports on business education in the USA: (1) Higher Education for Business, financed and sponsored by the Ford Foundation, and (2) The Education of American Businessmen – financed and sponsored by the Carnegie Corporation of New York. The impacts of the publications on the teaching of real estate to date have been reviewed in the context of scholarly actions and literature that has been generated in relation to the two documents.FindingsThe two primary documents impacted negatively on the teaching of real estate. The committee members who produced the two reports had indicated that real estate did not fit into the business curriculum hence should not be taught in business school. This conclusion led to unintended negative outcomes for real estate education. The negative impact of the reports arose principally because the teachers of real estate misinterpreted the outcome to mean that they should tweak the real estate curriculum to fit in the pedagogical framework of the business school. This reaction is responsible for perpetuating the identity crisis that has plagued real estate as an academic discipline since its inception as a subject of study in 1923. Secondly, at the inception of the real estate education in 1923, while the AACSB accepted real estate as a discipline in the school of business, Richard T. Ely wrote the curriculum under land economics which has led to the persistent collegiate dilemma regarding the teaching of the discipline.Social implicationsThe study sheds light on the situation of business education in the USA and AACSB-accredited colleges internationally. It draws attention to the incoherent body of knowledge of business education and will help schools of business to redesign their curricula to include course contents that rightly reflects the business oriented academic disciplines.Originality/valueThe study is timely as it has been done 100 years since the development of the first standard collegiate real estate curriculum following the 1923 conference at Madison. The study has reviewed the first 100 years in terms of the persistent quest: “in search of a discipline”. In so doing, it has uncovered the root cause of this search during the first centennium; and to end the search, it proposes that real estate should not be taught as a business discipline.