Open Text Boxes Research Articles

An Interprofessional Faculty Development Program for Workplace-Based Learning.

Most faculty development programs in health professions education, pivotal in cultivating competent and effective teachers, focus on systematic, planned and formal learning opportunities. A large part of clinical teaching however, encompasses ad-hoc, informal and interprofessional workplace-based learning whereby individuals learn as part of everyday work activities. To fully harness the educational potential embedded in daily healthcare practices, prioritizing interprofessional faculty development for workplace-based learning is crucial. Utilizing the 'ADDIE' instructional design framework we developed, implemented and evaluated an interprofessional faculty development program for workplace-based learning. This program, encompassing seven formal training sessions each with a different theme and five individual workplace-based assignments, aimed to support clinical teachers in recognizing and optimizing informal learning. The pilot program (n = 10) and first two regular courses (n = 13 each) were evaluated using questionnaires containing Likert scale items and open textboxes for narrative comments. The quality and relevance of the program to the clinical work-place were highly appreciated. Additional valued elements included practical knowledge provided and tools for informal workplace-based teaching, the interprofessional aspect of the program and the workplace-based assignments. Since its development, the program has undergone minor revisions twice and has now become a successful interprofessional workplace-based alternative to existing faculty development programs. This faculty development program addresses the specific needs of healthcare professionals teaching in clinical settings. It stands out by prioritizing informal learning, fostering collaboration, and supporting integration of formal training into daily practice, ensuring practical application of learned knowledge and skills. Furthermore, it emphasizes interprofessional teaching and learning, enhancing workplace environments.

Helpful and meaningful aspects of a psychoeducational programme to treat complex dissociative disorders: a qualitative approach

ABSTRACT Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs. Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses. Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure. Conclusion: Clients and therapists in the TOP DD Network programme described the programme’s components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs.

Agroforestry in the UK: exploring consumer knowledge and interest

PurposeThis paper's purpose is to explore the current interest and knowledge that UK consumers hold around agroforestry. Despite the many reported benefits of agroforestry systems, uptake in the UK, as well as other temperate nations, has been low. As the consumer has a role to play in the transition of agriculture to methods that are more environmentally friendly it is vital to have an understanding of their perceptions. Yet to date no work has looked at agroforestry from the perspective of the UK consumer.Design/methodology/approachAn online survey was conducted using a convenience sample accessed by floating a link through social media and messaging apps. The survey was also shared to the members of a private Facebook group associated with an organic vegetable box service. A mix of multiple choice and open text boxes were used. The survey received 139 responses.FindingsNon-parametric tests indicate that this sample of UK consumers would be mostly likely to buy, and willing to pay more for, agroforestry produce; and the sample showed a split group regarding familiarity. Inductive thematic analysis of the qualitative data highlighted some important barriers to the purchase as well as capturing a snapshot of this sample's perceptions.Originality/valueThis paper presents, to the authors knowledge, the first set of data regarding a sample of UK consumers' perspective of agroforestry produce. The findings could bolster producers' confidence in adopting agroforestry practices, but also highlight the need for policymakers to bolster consumer support through parallel means.

Surveying the landscape: First Nations, Métis, and Inuit cancer resources in radiation therapy

Introduction/BackgroundAlberta Health Services (AHS) is Canada's largest provincial integrated health care authority. AHS services over four million people with over 100,000 employees. In 2018, AHS introduced Indigenous training modules which were mandatory for all staff. These eight modules included topics detailing residential schools, Indian hospitals, The Indian Act, The 60′s Scoop, Alberta's Indigenous populations, present day realities, including customs, practices and traditional medicines. Limited research exists in general in the field of radiation therapy with Canadian Indigenous populations. No formal research exists on the effectiveness of these AHS training modules. MethodsA mixed methods survey was developed and distributed by the radiation therapy managers to practicing radiation therapists in the four cancer centers in Alberta. The survey contained both drop down and open text boxes. ResultsSurvey respondents indicated that 90 % of radiation therapists completed the AHS Indigeneous training modules. However, 50 % of the respondents did not know what resources are available for their Indigenous patients. Furthermore, only 67 % felt that the information provided in the modules created enough comfort for them to have a conversation with Indigenous patients with cancer and their families. DiscussionRespondents indicated that although they felt knowledgeable and educated from the training modules, this did not necessarily translate into daily clinical practice. This included a lack of confidence to lead a conversation, knowing what resources are available and how to document if patient education material was given. ConclusionCreation of an Indigenous specific oncology module highlighting both resource availability and cultural customs that may be part of a person's cancer journey, may be of benefit to health care providers providing radiation treatment. Having Elders and Knowledge Keepers be part of the development of an oncology module may help create mutual understanding for both the cancer patient and their families and health care providers. This research suggests that the current cultural competency training for radiation therapists at AHS may not be enough for radiation therapists to feel comfortable with translating learnings from Indigenous online modules into their practice.

Supporting nutrition and dietetics students' relationships with food and body image: Adopting a co-created curricula approach.

The aims of this study were to: (1) explore perspectives of university students' and academics' regarding disordered eating, eating disorders and body image in relation to pedagogy and curricula and (2) to evaluate a co-designed student seminar and an academic workshop on these topics. A participatory action research approach was employed whereby an educational intervention was co-created by academics and students. An online seminar was presented to students and a 1-h workshop was presented to academic staff. Evaluation was conducted via a post-seminar anonymous survey for students and a pre- and post-anonymous workshop survey for academics with a mix of Likert-scale questions and open text boxes. Qualitative data were open coded, both deductively and inductively, and quantitative data were analysed descriptively. One hundred and seventeen students attended the voluntary education seminar. Six themes were identified from student qualitative data which included feeling safe, empowered, inspired, connected, emotional and reflective. Problematic aspects of pedagogy and curricula were identified by students and included: using personal data for teaching, demonising language to describe food/bodies and not always feeling safe or supported to discuss disordered eating. Twenty academics shared divergent perspectives-some reported feeling concerned and challenged by the content (exploring disordered eating with students), others noted the complexity of the area, and others reported low/moderate confidence or indifference in the space and felt this content outside of their scope as educators. Curricula interventions that reduce triggering and shaming and increase space and support for strengthening students' relationships with food and their bodies are valued by nutrition and dietetics students. We encourage academics to consider pedagogical approaches and expand discourse in this space.

Understanding the attitudes towards breastfeeding amongst staff and students in a UK higher institutional setting – a mixed-method cross-sectional study

ABSTRACT Breastfeeding is recognised as a human right and in the UK, it is a legal requirement for employers to provide a space where breastfeeding mothers can rest. Despite this, breastfeeding rates in the UK are amongst the lowest in the world and breastfeeding mothers suffer prolonged loss of earnings compared to those who do not. In response, this study aimed to measure the attitudes to infant feeding among staff and students in a UK higher education institution and understand the experiences of those who have breastfed and/or expressed on campus. A convenience sampling technique was used to recruit 72 staff members and 99 students at the same UK university. Respondents completed an online questionnaire which first presented the Iowa Infant Feeding Attitude Scale and then provided an open text box where people who had experience of feeding on campus could share their experiences. Female respondents were more likely to prefer breastfeeding than men. Students were more likely to prefer breastfeeding than staff. However, raising breastfeeding awareness among both staff and students is required. A realist thematic analysis of the comments made by 17 staff members about their feeding experiences on campus identified a lack of consistency in terms of management and access to suitable facilities to either express milk or breastfeed. It is argued that a combination of education around breastfeeding, visual cues that breastfeeding is welcome, provision of suitable facilities and a clear breastfeeding policy that is consistently implemented is required to support breastfeeding on campus.

Differences Between Highly Rated vs Poorly Rated Patient Ratings of Radiology Reports

ObjectiveTo evaluate differences in quantitative features between poorly versus highly rated patient ratings of radiology reports. MethodsA HIPAA-compliant, IRB-waived study was performed from October 2019 to June 2021. Patients completed an optional 2-question survey (“How helpful was the report?” with a 5-star scale and an open text box) embedded into the patient portal, and reports were assessed for readability and brevity. Quantitative analyses were performed between poorly (≤3 stars) and highly rated (>3 stars) CT and MRI reports, including the use of structured reporting, number of words, words per sentence, Flesch Reading Ease, and Flesh-Kincaid Grade level within the findings and impression sections of the radiology reports. A two-tailed nonparametric Mann U Whitney test was performed for continuous variables and Chi2 for categorical variables. ResultsOf the 490 responses, all 135 evaluating CT or MR were included (27%). 106/135 (78%) of the patients gave high ratings (score of 4 or 5). 46/135 (34%), the radiology reports were in a structured format. The proportion of highly rated reports were significantly higher for structured than freeform reports (93.5 vs. 70.8%, p = 0.002). In the findings section, highly rated reports had a lower Flesch Reading Ease score than poorly rated reports (19.6 vs. 28.9, p <0.01). No significant differences were observed between number of words (p=0.27), words per sentence (p=0.94), and Flesh-Kincaid Grade level (p=0.09) in the findings section. In the impression section, no differences were observed between highly vs. poorly rated reports among the measured parameters. ConclusionPatients preferred highly rated reports that were structured and had lower Flesch Reading Ease scores in the findings section.

“I would not want the mechanic to direct me to an engine repair manual”: a qualitative analysis of provider perspectives on low-intensity treatments for patients on waiting lists

BackgroundLow-intensity treatments (LITs), such as bibliotherapy or online self-help, have the potential to reach more individuals than traditional face-to-face care by circumventing many of the common barriers to mental health treatment. Despite substantial research evidence supporting their usability and efficacy across several clinical presentations, prior work suggests that mental health providers rarely recommend LITs for patients waiting for treatment.MethodsThe present study analyzed provider open responses to a prompt asking about perceived barriers, thoughts, and comments related to additional treatment resources for patients on treatment waiting lists. We surveyed 141 practicing mental health providers, 65 of whom responded to an open text box with additional thoughts on using LITs for patients on treatment waiting lists. Responses were qualitatively coded using a thematic coding process.ResultsQualitative outcomes yielded 11 codes: patient appropriateness, research evidence, feasibility, patient barriers, liability, patient personal contact, additional resources, positive attitudes, trust in programs, systemic problems, and downplaying distress.ConclusionsResults suggest providers are predominantly concerned about the potential of suggesting a LIT that would be ultimately inappropriate for their patient due to a lack of assessment of the patient’s needs. Furthermore, providers noted ambiguity around the legal and ethical liability of recommending a LIT to someone who may not yet be a patient. Guidelines and standards for recommending LITs to patients on treatment waiting lists may help address ambiguity regarding their use in routine care.

Qualitative analysis of the cognitive triad in a sample of the general population in response to the COVID-19 pandemic

This paper explored cognitive responses to the COVID-19 pandemic in those selfreporting depressive symptoms during a period of realistic health, economic and social threat. Negative cognitions are a key therapy target for evidence-based psychological interventions. A cross-sectional survey was conducted with a convenience sample from the general population between December 2020 and February 2021. Adult respondents (n = 555) completed open text-box questions which provided prompts of the cognitive triad: "I am…/I am not…"; "Other people are…/Other people are not…"; "The world is…". These qualitative data were analysed using reflexive thematic analysis. Thematic responses were compared between people who self-reported moderate depressive symptoms (n = 223) and those who did not (n = 332). Fourteen independent themes were identified. Those self-reporting depressive symptoms described significantly fewer positive cognitions across all three aspects of the cognitive triad, X2 = 60.40 p < 0.01; X2 = 10.51 p < 0.05; X2 = 12.22 p < 0.01. Those self-reporting depressive symptoms also reported more self-referent negative cognitions. These data highlighted that an absence of positive cognitions differentiated the two groups more greatly than negative cognitions. These data have implications for the cognitive targets in psychological therapies in realistic high-stress situations. This paper explored cognitive responses to the COVID-19 pandemic in those selfreporting depressive symptoms during a period of realistic health, economic and social threat. Negative cognitions are a key therapy target for evidence-based psychological interventions. A cross-sectional survey was conducted with a convenience sample from the general population between December 2020 and February 2021. Adult respondents (n = 555) completed open text-box questions which provided prompts of the cognitive triad: "I am…/I am not…"; "Other people are…/Other people are not…"; "The world is…". These qualitative data were analysed using reflexive thematic analysis. Thematic responses were compared between people who self-reported moderate depressive symptoms (n = 223) and those who did not (n = 332). Fourteen independent themes were identified. Those self-reporting depressive symptoms described significantly fewer positive cognitions across all three aspects of the cognitive triad, X2 = 60.40 p < 0.01; X2 = 10.51 p < 0.05; X2 = 12.22 p < 0.01. Those self-reporting depressive symptoms also reported more self-referent negative cognitions. These data highlighted that an absence of positive cognitions differentiated the two groups more greatly than negative cognitions. These data have implications for the cognitive targets in psychological therapies in realistic high-stress situations.

Factors Associated With Comfort Using Telemedicine for Upper Limb Specialty Care

There is a growing interest in diagnosis and treatment through telemedicine because of its convenience, accessibility, and lower costs. There are clinician and patient barriers to wider adoption of telemedicine. To support the effective and equitable use of telemedicine, we investigated the patient, illness, and surgeon factors associated with the specialist level of comfort in providing upper limb care via telemedicine. Seventy-five upper-extremity musculoskeletal specialists completed an online survey-based experiment in which they viewed 12 patient scenarios with randomized patient age, gender, diagnosis, pain intensity, and patient preference for surgical treatment (yes or no) and rated their comfort with telemedicine from 0, no comfort, to 10, complete comfort. The participants were able to provide a rationale for their stance in open text boxes. We recorded the following specialist factors: gender, location of practice, years in practice, subspecialty, the supervision of trainees, and surgeon-rated importance of a physical examination. In a multivariable analysis, greater surgeon comfort using telemedicine was associated with nontrauma conditions, four specific diagnoses, and patients who did not have severe pain. Lower surgeon comfort with telemedicine was associated with the higher clinician-rated importance of a hands-on physical examination and supervising trainees. Text-based reasons provided for relative comfort with telemedicine included nonsurgical treatment and facility of diagnosis based on interviews alone. Text-based reasons for relative discomfort with telemedicine included a perceived need for a hands-on physical examination and a preference for an in-person conversation for specific discussions, including scheduling surgery. Greater specialist enthusiasm for telemedicine is associated with personal preferences regarding the upper-extremity condition, patients with less severe pain, and a willingness to forego a hands-on examination. Utilization of telemedicine for upper-extremity specialty care may be facilitated by diagnosis-specific care strategies and strategies for video examination, with a focus on tactics that are effective for people with more intense symptoms.

Nursing during the COVID-19 pandemic: A reflective thematic analysis of how the hamster wheel shifted personal and professional control.

The aim of this national study was to examine the experience of nurses 9-12 months after the onset of the pandemic. This article reports the reflective thematic analysis of the qualitative portion of a mixed methods study of the experiences of 1319 Canadian nurses between February to May 2021. Data gathering occurred through open-text box questions in an online survey. Three overarching themes were found: (1) the hamster wheel, (2) the shifting sense of control, and (3) the inability to leave the pandemic at work. This research presents a national perspective of nurses which contributes to the wider global narrative. The experience of redeployment, nurses as decision-makers, communication and leadership challenges were all factors impacting mental health and intraprofessional collaboration. The findings revealed the immense pressure, mental health concerns, and professional implications for nurses in all domains. No public or patient contributions.

Sustainment of diverse evidence-informed practices disseminated in the Veterans Health Administration (VHA): initial development and piloting of a pragmatic survey tool

BackgroundThere are challenges associated with measuring sustainment of evidence-informed practices (EIPs). First, the terms sustainability and sustainment are often falsely conflated: sustainability assesses the likelihood of an EIP being in use in the future while sustainment assesses the extent to which an EIP is (or is not) in use. Second, grant funding often ends before sustainment can be assessed.The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program is one of few large-scale models of diffusion; it seeks to identify and disseminate practices across the VHA system. The DoE sponsors “Shark Tank” competitions, in which leaders bid on the opportunity to implement a practice with approximately 6 months of implementation support. As part of an ongoing evaluation of the DoE, we sought to develop and pilot a pragmatic survey tool to assess sustainment of DoE practices.MethodsIn June 2020, surveys were sent to 64 facilities that were part of the DoE evaluation. We began analysis by comparing alignment of quantitative and qualitative responses; some facility representatives reported in the open-text box of the survey that their practice was on a temporary hold due to COVID-19 but answered the primary outcome question differently. As a result, the team reclassified the primary outcome of these facilities to Sustained: Temporary COVID-Hold. Following this reclassification, the number and percent of facilities in each category was calculated. We used directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), to analyze open-text box responses.ResultsA representative from forty-one facilities (64%) completed the survey. Among responding facilities, 29/41 sustained their practice, 1/41 partially sustained their practice, 8/41 had not sustained their practice, and 3/41 had never implemented their practice. Sustainment rates increased between Cohorts 1–4.ConclusionsThe initial development and piloting of our pragmatic survey allowed us to assess sustainment of DoE practices. Planned updates to the survey will enable flexibility in assessing sustainment and its determinants at any phase after adoption. This assessment approach can flex with the longitudinal and dynamic nature of sustainment, including capturing nuances in outcomes when practices are on a temporary hold. If additional piloting illustrates the survey is useful, we plan to assess the reliability and validity of this measure for broader use in the field.

Experiences of the International In-Training Examination (I-ITE) by Rwandan pediatric residents – a survey-study describing candidate feedback

Background: The University of Rwanda is the only African residency to have implemented the pediatric International In-Training Examination (I-ITE) as a tool to monitor resident knowledge acquisition. The objective of this study was to better understand the acceptance and relevance of this exam to residents from this setting and their perceptions regarding this assessment tool. Methods: A retrospective, survey-study was undertaken to describe candidate feedback. Immediately on completing the I-ITE residents provided feedback by filling in an electronic questionnaire comprised of four closed Likert questions and an open text box for free-text feedback. Participants were pediatric residents from the University of Rwanda, the only university in Rwanda with a pediatric residency program. Quantitative analysis of the Likert questions was undertaken descriptively using SPSS. Free-text feedback was coded and analysed employing a phenomenological approach, with coding and analysis undertaken by two researchers. Results: Eighty-four residents completed a total of 213 I-ITE sittings during the five exam cycles undertaken during the study period. The survey was completed after 206 of the 213 exam sittings, giving a response rate of 97%. Five themes emerged from the qualitative analysis; 1) undertaking the I-ITE was a positive experience; 2) exam content; 3) formative nature of the assessment; 4) challenges to completing the exam; 5) practicalities to undertaking the exam. Conclusion: Qualitative feedback demonstrates that the I-ITE, a standardized, and independent exam, produced by the American Board of Pediatrics, was valued and well accepted by Rwanda pediatric residents. Its formative nature and the breadth and quality of the questions were reported to positively contribute to the residents' formative development.

PP145 Improving Patient Expert Involvement In The Lifecycle Of Health Technology Assessments To Build Public Confidence In Decision-Making

IntroductionInvolving patients in the health technology assessment (HTA) lifecycle is a core principle at the National Institute for Health and Care Excellence (NICE). We include both patient organizations and patient experts, which helps build public confidence in healthcare decision-making. We continually work with patient experts to improve their experience and ability to participate by seeking patient expert feedback after every committee meeting.MethodsWe sent patient experts an anonymous experience survey containing a five-point Likert scale and open text boxes to capture qualitative data. The survey covered their overall experience, interaction with the committee Chair, and the support they received from both NICE and the Public Involvement Programme (PIP).In the 2019 to 2020 period we sent out 59 questionnaires and received 29 responses (47%), all of which were from medicines HTA committee participants. In the 2020 to 2021 period we sent out 120 questionnaires and received 65 responses (54%), of which 64 were from patient experts who attended medicines HTAs and one was from a medical devices HTA committee participant.ResultsGood or excellent experiences were reported by 90 percent of patient experts. The four main success factors noted were: good support before meetings; being welcomed and respected; well organized meetings; and patient expert input being valued. Areas for further improvement included: providing better briefing before meetings; allowing more time to review documents; providing more technical support; and giving more consideration to the opinions of patient experts.ConclusionsAs a result of the feedback received, the PIP now holds monthly group briefing meetings for patient experts. We also publish the anonymized feedback from the patient experts quarterly in a newsletter for committee members and share the data with internal NICE teams. Additionally, NICE aims to: send committee papers out earlier; have the option of holding a technical engagement call before committee meetings; and develop a feedback mechanism to ascertain the impact of patient input.

OP16 Learning From Engagement With Human Immunodeficiency Virus Community Organizations In The Health Technology Assessment Lifecycle

IntroductionInvolving patients and community organizations in the health technology assessment (HTA) lifecycle is a core principle at the National Institute for Health and Care Excellence (NICE) and helps build public confidence in the healthcare decision-making. From 2019 to2021 NICE assessed a HIV-1 medicine for the first time. This presented new opportunities and challenges for engaging with Human Immunodeficiency Virus (HIV) community organizations who hadn’t participated in a NICE HTA before. To understand their experience, we collected feedback on the impact and experience of community involvement throughout the assessment.MethodsWe used a mixed-method approach using a survey and qualitative feedback from the committee lay member, community experts, and the community organizations. An impact survey was sent to key committee members, the NICE technical team and Associate Director. It included Likert scale questions and open text boxes to capture both quantitative and qualitative data. Additionally, qualitative feedback was gathered throughout the assessment’s lifecycle from the NICE team and the community stakeholders.ResultsResults from the impact survey showed that the community input: had significant impact on the evaluation (100% (n=5)); helped interpret the other evidence and information (80% (n=4)); provided new evidence (60% (n=3)); and, was consistent with the other evidence (40% (n=2)). Examples of impact included highlighting the population heterogeneity, stigma, side effects and the effects of frequent clinic attendance. The key feedback from the qualitative data from the community organizations and experts in terms of their experience were: early support and support throughout from the NICE team; NICE’s flexibility in involving them; and, meaningful inclusion of their evidence in the committee slides.ConclusionsBoth the NICE committee and the community stakeholders recognized that the community input was valued and had an impact on the decision-making. To ensure meaningful community engagement, support and flexibility from NICE were required throughout the assessment. This level of engagement will be adopted in future for community organizations new to medicines HTAs at NICE.

How Do Women and Men Negotiate Sex in Later Life Relationships? A Qualitative Analysis of Data from the English Longitudinal Study of Aging

ABSTRACT Later life relationships and in particular the role of sex within them, have often been neglected in research due to assumptions of decline and sexlessness. We contribute to a growing body of work which counters these stereotypes by examining sexual scripts within the socio-cultural context of later life relationships. We analyzed open-text comments from the English Longitudinal Study of Aging (ELSA) collected as part of a self-completion questionnaire. In Wave 6, 1065 participants (M age 67.5, SD 9.6 years) and in Wave 8, 922 participants (M age 69.1, SD 9.01 years) responded to an open-text box question. Across both waves, 38% of respondents were men and 62% were women. The analysis used a coding template developed from existing literature and adjusted to accommodate emerging topics. A gendered analysis of the interrelated topics of relationships, sex and sexuality resulted in themes which illustrate similarities and differences in how men and women negotiate sex in later life relationships. The findings confirm that sex remains integral to intimacy in later life relationships for many men and women. However, they also demonstrate that norms of age and gender interact to shape sex and relationship practices in later life. These norms limit some people’s experiences, for example, preventing them from seeking new relationships, as well as creating challenges for intimacy in partnerships. These findings extend the theoretical understanding of relationships and sex in later life.

Sit-Stand Desks and Physical Self-care Behaviors in a Family Medicine Residency.

More than 50% of primary care physicians' practice involves sedentary desk work. Growing evidence suggests a link between sedentary workplace behaviors and increased morbidity and mortality. Research on the effects of sit-stand desks in the workplace suggests that sit-stand desks reduce sedentary behaviors. This study examined the use and satisfaction of adjustable desks with a height of sit-stand and their association with physical self-care behaviors among family medicine residents. We conducted a longitudinal cohort survey study at a 9-9-9 family medicine residency after the clinic installed height-adjustable sit-stand desks in January 2020. Standardized questions about the use and satisfaction of adjustable sit-stand desks and physical self-care behaviors were administered in June 2020, December 2020, and December 2021. The survey also included an open text box for feedback. Median time spent standing at the sit-stand desks was 55.0%. The percentage of time standing was similar across June 2020, December 2020, and December 2021. The average satisfaction rate with the desks across all time points was 71.4%. We did not observe significant differences in the proportion of residents' satisfaction with the adjustable desks over time. Residents who reported standing at the adjustable desk reported increased satisfaction with the desks (Kendall's τ=.38, P<.001) and with physical self-care behaviors (Kendall's τ=.25, P<.05). Themes associated with desk dissatisfaction revolved around limited desktop space. Over a nearly 1.5-year period, more than half of family medicine residents reported standing at their adjustable desks and being satisfied with them. Residents who reported standing at adjustable desks also reported increased physical self-care behaviors. Residency programs investing in sit-stand desks may consider options that allow for increased desktop surface space.

Young people and adult stakeholders' reflections on how school staff should support students who self-harm: A qualitative study.

Self-harm is a significant public health issue affecting school communities, students, and families. The school is an ideal environment for early intervention and prevention. This study aimed to explore the views of young people and stakeholders on how school staff should support students who self-harm in the context of developing accessible and acceptable guidelines. The study was nested within a larger Delphi study conducted in New Zealand. Two panels were asked to provide reflection in open text boxes in two questionnaires on how school staff can support students who self-harm. The youth panel included 22 participants between 16 and25 years, and 81.8%identified as female and 18.3% as male. The stakeholder panel (e.g., school staff) included 27 participants over 25 years, and 63.0%identified as female, and 37.0%as male. The data were analyzed using thematic analysis to identify key themes. Eight themes were identified; (1) an approach that prioritizes trust, (2) an approach that recognizes students'agency, (3) an individually tailored approach, (4) a whole-school approach, (5) an approach that recognizes role boundaries, (6) an approach that prioritizes safety, (7) a nonpunitive approach, and (8) an appropriately-resourced approach. The eight themes identified highlighted ineffective practices in response to self-harm in schools. The eight themes provide solutions to these practices. Our findings highlighted four recommendations that address ineffective management approaches in response to students who self-harm. These recommendations included using a student-centered approach, a whole-school approach, avoiding punitive approaches, and providing adequate resourcing to schools.

Barriers to accessing and continuing mental health treatment among individuals with dissociative symptoms

ABSTRACT Background Dissociative disorders (DDs) are characterized by interruptions of identity, thought, memory, emotion, perception, and consciousness. Patients with DDs are at high risk for engaging in dangerous behaviours, such as self-harm and suicidal acts; yet, only between 28% and 48% of individuals with DDs receive mental health treatment. Patients that do pursue treatment are often misdiagnosed, repeatedly hospitalized, and experience disbelief from providers about their trauma history and dissociative symptoms. Lack of dissociation-specific treatment can result in poor quality of life, severe symptoms requiring utilization of hospitalization and intensive outpatient treatment, and high rates of disability. Objective Given the extensive and debilitating symptoms experienced by individuals with DDs and the infrequent utilization of treatment, the current study explored barriers to accessing and continuing mental health treatment for individuals with dissociative symptoms and DDs. Method A total of 276 participants with self-reported dissociative symptoms were recruited via online social media platforms. Participants completed a survey which featured 35 possible barriers to accessing treatment and 45 possible reasons for discontinuing treatment, along with open text boxes for adding barriers/reasons that were not listed. Results Results showed 97% of participants experienced one or more barriers to accessing treatment (M = 9 barriers) and 92% stopped treatment with a provider due to at least one of the reasons captured in the survey (e.g. limited insurance coverage, poor therapeutic alliance, disbelief from providers, etc.; M = 7 barriers). Conclusions The most frequently endorsed barriers were structural barriers, such as those related to finances, insurance, and lack of provider availability. It is imperative more service providers are trained to treat dissociation and that insurers and health care systems recognize the need for specialized, dissociation-focused treatment.

Conditionality of COVID-19 vaccine acceptance in European countries

The COVID-19 vaccine rollout has offered a powerful preventive measure to help control SARS-CoV-2 transmission. Nevertheless, long-standing public hesitation around vaccines heightened concerns that vaccine coverage would not achieve desired public health impacts, particularly in light of more contagious variants. This cross-sectional survey was conducted online just before the European vaccine rollout in December 2020 among 7000 respondents (aged 18–65) in Belgium, France, Germany, Italy, Spain, Sweden, and Ukraine. The survey included open text boxes for fuller explanation of responses. Overall, 56.9% of respondents would accept a COVID-19 vaccine, 19.0% would not, and 24.1% did not know or preferred not to say. By country, between 44% (France) and 66% (Italy) of respondents would accept a COVID-19 vaccine. Respondents expressed conditionality in open responses, voicing concerns about vaccine safety and mistrust of authorities. We highlight lessons learned about the dynamism of vaccine conditionality and persistence of safety concerns.