Personal Preferences Research Articles

Comparison of distance versus in-person laparoscopy training using a low-cost laparoscopy simulator—a randomized controlled multi-center trial

IntroductionSimulation training programs are essential for novice surgeons to acquire basic experience to master laparoscopic skills. However, current state-of-the-art laparoscopy simulators are still expensive, limiting the accessibility to practical training lessons. Furthermore, training is time intensive and requires extensive spatial capacity, limiting its availability to surgeons. New laparoscopic simulators offer a cost-effective alternative, which can be used to train in a digital environment, allowing flexible, digital and personalized laparoscopic training. This study investigates if training on low-cost simulators in a digital environment is comparable to in-person training formats.Materials and methodsFrom June 2023 to December 2023, 40 laparoscopic novices participated in this multi-center, prospective randomized controlled trial. All participants were randomized to either the ‟distance” (intervention) or the “in-person” (control) group. They were trained in a standardized laparoscopic training curriculum to reach a predefined level of proficiency. After completing the curriculum, participants performed four different laparoscopic tasks on the ForceSense system. Primary endpoints were overall task errors, the overall time for completion of the tasks, and force parameters.ResultsIn total, 40 laparoscopic novices completed digital or in-person training. Digital training showed no significant differences in developing basic laparoscopic skills compared to in-person training. There were no significant differences in median overall errors between both training groups for all exercises combined (intervention 3 vs. control 4; p value = 0.74). In contrast, the overall task completion time was significantly lower for the group trained digitally (intervention 827.92 s vs. control 993.42; p value = 0.015). The applied forces during the final assessment showed no significant differences between both groups for all exercises. Overall, over 90% of the participants rated the training as good or very good.ConclusionOur study shows that students that underwent digital laparoscopic training completed tasks with a similar number of errors but in a shorter time than students that underwent in-person training. Nevertheless, the best strategies to implement such digital training options need to be evaluated further to support surgeons’ personal preferences and expectations.

Historical narratives: how Portuguese students aged 10 and 15 make use of national history

The main purpose of this study is to demonstrate how students make use of their knowledge about national history, while considering relevant perspectives in history education about the development of historical consciousness. A total of 103 students attending the sixth or the ninth grade in Portuguese schools were asked to ‘spontaneously’ write about the history of Portugal. This allowed the understanding of their historical literacy and the identification of the development of their historical consciousness. The data analysis was mainly based on a qualitative approach inspired by the grounded theory, carried out through a process of coding of the narrative elements in order to find meanings on conceptual trends. Generally, the results suggest the prevalence of similar schematic templates in the students’ narratives. At the same time, the research process highlighted two main categories: the assumption of a certain national identity and the understanding of intertemporal relations for personal orientation. Within the former, students either appear tied to fixed conceptions of the past, more often in the sixth grade, or to present a more historically balanced pattern, although still somewhat ethnocentric. In the latter, the idea of connecting the past and the present appears to be the overall trend, particularly in the ninth grade.

Digital Stories Created by Children With Advanced Cancer.

Background: Legacy building is a priority for pediatric oncology. Storytelling is one strategy to help children document their legacies. Understanding story content would advance knowledge of how children want to be remembered but this has yet to be explored. This study explored content of digital stories created by children with advanced cancer. Method: Facebook advertisements were used to recruit families of children (7-17) with relapsed/refractory cancer to participate in a randomized controlled trial testing a legacy intervention through storytelling. Parent-child dyads (N = 150) were randomly assigned to an intervention or usual care group. A web program guided children to answer legacy questions and upload photographs, movies, and music. Families received the final digital stories. Experienced qualitative coders developed a hierarchical coding system to identify major categories/subcategories within 78 stories. Results: Stories included 1,516 unique story entries, including text, photographs, and movies. Two major categories emerged from the data: (a) story entry medium and (b) story content. Photographs frequently reflected people, objects, pets, and places while text often described personal preferences, goals, dreams, and other people. The story content overall included references to (a) people, (b) setting/location, (c) cancer, (d) objects/activities, and (e) expression of emotions/beliefs. Exemplar quotes, counts, and frequencies for each category are reported. Discussion: Children documented their legacies through stories that emphasized the value of family relationships and children's desires to be known for personal traits/preferences. Children chose to include cancer in their stories, indicating that cancer is a part of how children perceive their legacies. Registration Number: ClinicalTrials.gov NCT04059393.

Value-Semantic Approach in Training Future Teachers to Implement the Main Directions of the Federal Work Program of Education

Introduction. The article is devoted to the problem of using a value-semantic approach in the process of preparing future teachers for the implementation of the main directions of the Federal Work program of education. The purpose of the study is to analyze the degree of understanding by future primary school teachers of the essence of education as a process of value-semantic interaction with children, to identify their knowledge about the methods and forms of such interaction and to determine the necessary adjustments to the content of pedagogical education. Methodology. To achieve the purpose of the study, the following methods were chosen: ranking, questioning, the method of unfinished sentences, which allowed us to assess the readiness of students of the Faculty of primary school teacher training to implement the main directions of the Federal Work program of education. Results. The personal value orientations of future teachers are family and family traditions, care and help, life and the meaning of life; the value orientations for students are care and help, patriotism, family values. Future teachers see the essence of the education process in creating conditions for personal development, and not in organizing value-semantic interaction with students. Most future teachers are aware of the goals and objectives of the Federal Educational Work Program, but do not know how to organize the educational process at school. Conclusions. The article concludes that it is necessary to prepare future teachers for the implementation of the main directions of the Federal Work program of education based on a value-semantic approach and provides recommendations for its implementation in the educational practice of the university.

Burnout and moral injuries after foreign deployment among medical personnel of the German armed forces: a pre-post study.

Given a high amount of workplace stressors, burnout syndrome, as a depression-related syndrome, is highly relevant for medical service soldiers. This study aims to examine their effects with regard to moral injuries and personal values following foreign deployment. This longitudinal study included 91 soldiers of the German Armed Forces Medical Service. Participants completed the Maslach Burnout Inventory (MBI) and the Portrait-Value-Questionnaire (PVQ) before and after a foreign deployment as well as the Moral Injury Scale (SMBE) after deployment. Analysis has been conducted using t-tests to assess potential changes in MBI and PVQ scales between pre-test - t1 (2-4 weeks before deployment) and post-test - t2 (up to 6 months after deployment). In addition, correlations were examined between moral injuries (MI) after deployment and MBI scores at t1 and t2 as well as between personal values (PVQ t1) and MBI scores at t1 and t2. The MBI subscales showed mild to moderate burnout symptoms at both pre- and post-tests, with a slight deterioration during the study period, albeit not significant. There were no significant mean differences in PVQ between measurement points. Nevertheless, PVQ self-direction and tradition at t1 correlated negatively with MBI INV at t2 (PVQ SD r = -.21, p = .043) and MBI PA at t2 (PVQ TR r = -.23, p = .027). Furthermore, the subscale PVQ power at t1 correlated positively with MBI PA at t2 (PVQ PO r = .28, p = .006), meanwhile PVQ universalism at t1 correlated positively with MBI INV at t1 (PVQ UN r = .25, p = .018). Furthermore, positive correlations were found between moral injuries at t2 (SMBE total score, SMBE_Sub1, SMBE_Sub2) and MBI subscales Emotional Exhaustion (EE; r = -.54, p = .001), Depersonalization (DP; r = .38, p = .001), and Involvement (INV; r = .30, p = .004) before and after the deployment period. No correlation was found between MI and MBI subscale Personal Accomplishment (PA). The results indicate that medical service soldiers exhibit mild to moderate burnout symptoms even before deployment. Significant associations between moral injuries and burnout were found in 3 out of 4 MBI subscales (EE, DP, INV). There was a significant association with a stronger moral injury and higher burnout levels, persisting both before and after the study period. Furthermore, our results suggest that personal value orientations might be meaningful predictors of burnout. Hence, causal questions regarding general work stress among medical service soldiers should be further explored in more detailed studies. Further research could lay the foundation for future approaches in psychotherapy as well as primary and secondary prevention in this field.

ANALISIS HUBUNGAN MARKETING MIX TERHADAP LOYALITAS KONSUMEN PADA KOFFIELOTS COFFEE & EATERY

Marketing mix is one of the marketing strategies to convey information widely, introduce a product of goods and services, stimulate consumers to give and even create personal preferences for the image of a product. It can be seen that Koffielots Coffee & Eatery experienced a significant decline in sales from January to December. In January, sales were recorded at Rp 17,134,500 with a sales percentage reaching 12%. However, in December, sales dropped drastically to Rp 7,814,500 with a sales percentage of only 5%. The type of research data uses a quantitative approach. The data analysis method uses multiple linear regression. The study shows that the variables Product (X1), Price (X2), Promotion (X3), and Location (X4) have a significant positive effect on Consumer Loyalty (Y). This is evidenced by the positive and significant regression coefficient, as well as the high Adjusted R Square value (80.9%). The high correlation value (ranging from 0.804 to 0.868) indicates that an increase in each variable will tend to increase consumer loyalty in one direction

Edukacja wspierająca zdrowe i bezpieczne relacje intymne młodzieży z niepełnosprawnością intelektualną

Introduction: By treating a person with a disability in a subjective manner, we consent to the development of his autonomy and support his personal choices, privacy and preferences. In the case of a young person with intellectual disabilities, this issue does not seem so simple, and especially when it concerns the sphere of romantic and sexual experiences. Research Aim: The article identifies possible solutions for improving this important area of adolescents' lives, including, in particular, the importance of implementing educational programs and preparing professionals and parents to engage in meaningful conversations about sexuality and intimate relationships. Evidence-based Facts: There is a growing body of research showing that many young people with intellectual disabilities experience problems in realizing their sexuality and restrictions on their right to intimate relationships. Also, they are more vulnerable to abuse and risky sexual behavior because they do not understand social rules and signals from others, do not distinguish socially appropriate sexual behavior, and have difficulty negotiating equal relationships, setting boundaries, and reporting abuse. Summary: Addressing the intimacy needs, sexual expression, and romantic activities of teens with intellectual disabilities can occur in a healthier, safer, and more intimate manner. Education provides an alternative to ignoring, suppressing, interfering or treating this sphere of activity and experience as non-normative and forbidden.

The choice of optimal therapy for ER+ HER2-metastatic breast cancer (PROMETHEUS): all-Russian analysis of physicians’ preferences – updated survey results

Cyclin-dependent kinase 4/6 inhibitors (iCDK4/6) are the generally accepted standard of care for the treatment of luminal HER2-negative metastatic breast cancer (ER+HER2- mBC). Data from randomized and observational studies have proven the high effectiveness of the combination of iCDK4/6 and endocrine therapy (ET) both in the 1st and in subsequent lines. The use of new drugs in real clinical practice is determined by a number of factors, including the awareness of doctors, their personal experience and subjective preferences, as well as financial support and availability in a particular region. To assess the frequency of prescription of CDK4/6, as well as other types of treatment in the 1st‑2nd line of therapy for ER+ HER2- mBC in real clinical practice in Russia, as well as to determine the factors and preferences of doctors influencing their choice, the National Association of Oncomammologists (NAOM) conducted a survey “Prometheus” of oncology specialists. From February 15 to August 30, 2023, a web survey of healthcare professionals who treat patients with mBC was conducted on the website anketolog.ru. An invitation to survey was sent out through the NAOM database, 112 questionnaires were received and processed. Earlier, in 2020, the “Prometheus” survey was conducted on the territory of the Russian Federation for a similar purpose. In this paper, we present the results of an updated and expanded survey and evaluate changes that have occurred over the past 3 years in actual clinical practice. The results of a 2023 survey conducted in the Russian Federation on the choice of early-line therapy for ER+HER2- mBC showed that, compared with the 2020 survey, the level of “trust” in iCDK4/6 has increased among practicing physicians, and the indications for their use have expanded, including visceral metastases (and even pending visceral crisis), the indications for prescribing chemotherapy in the 1st line have narrowed. When using monoET in the 1st line, the majority of respondents prescribe iCDK4/6 in the 2nd line. Obviously, the wider use of iCDK4/6 is associated not only with the accumulation of clinical knowledge and experience in the use of drugs, but also with improved drug supply. However, the main limitations to the use of iCDK4/6 are still insufficient funding and organizational difficulties. However, it should be noted that 1/5 of the respondents do not face any restrictions and widely prescribe combination therapy.

CREMATORIUM WORKERS AND THE STRUCTURE OF BURIAL GROUNDS IN THENI DISTRICT, TAMILNADU

Crematorium and the structure of burial grounds works as described in the treaties. The structure of burial grounds, whether traditional cemeteries or newer memorial parks, varies widely but generally includes designated areas for burial plots on niches, pathways landscaping, and sometimes facilities for visitor. It have been analyzed important features of structure of the burial grounds. The aim of the study the create a space that gives the crematorium in the study area. Preparation burial ground workers prepare the deceased for cremation. This may involve removing items such as pacemakers or jewelry that could interface with the process. Objectives of the study focused on maintaining a serene and respectful atmosphere within the cemetery. To study the historical and cultural significance of the cemetery. Result of the study spaces provide not only places for physical interment or memorialization but also serve as environments for contemplation, remembrance, and healing for families and communities. Together, crematorium workers and the design of burial grounds contribute to the meaningful and respectful handling of human remains and the facilitation of mourning and remembrance processes across diverse cultural and societal contexts. Findings of the study an Emotional distress due to exposure to death and grief .Physical demands of the job, including heavy lifting and long hours. Limited resources and support for mental health. High turnover rates due to stressful work environment. The structure of burial grounds can impact the dignity and respect afforded to the deceased, as well as the comfort and safety of mourners. Conclusion of the study crematorium workers and the structure of burial grounds are integral components of how societies manage and honor the deceased. Crematorium workers perform essential duties in the process of cremation, ensuring that it is conducted with care and respect. They play a vital role in handling human remains and supporting families during a difficult time. Meanwhile, the structure of burial grounds, whether traditional cemeteries or modern memorial parks, reflects evolving cultural, environmental, and personal preferences surrounding the final resting places of loved ones. KEYWORDS: structure of burial grounds, whether traditional cemeteries or modern memorial parks, reflects evolving cultural.

Peran Inovasi Teknologi dalam Transformasi Industri Rokok: Dampaknya Terhadap Produksi, Distribusi, dan Penggunaan Produk Rokok

Generation Z, born between 1997 and 2012, exhibits a significant trend in adopting vape or electronic cigarettes as an alternative to conventional tobacco cigarettes. This study aims to investigate the influence of vape use on the tobacco industry in Indonesia, focusing on production, distribution, and consumer behavior. The research employs a qualitative approach through literature review and interviews. Data were collected from scholarly literature, primary data analysis via questionnaires, and direct interviews with cigarette manufacturers and vape users. Findings indicate that Generation Z tends to adopt vape due to its perceived modernity, diverse flavors, and perceived safety compared to traditional cigarettes. However, vape use also faces negative perceptions from some sectors of society regarding potential health impacts. Moreover, despite the rising popularity of vape, traditional tobacco cigarettes remain favored due to habit, tranquility, and personal preferences.

Towards accurate dose assessment for emergency industrial radiography source retrieval operations: A preliminary study of 4D Monte Carlo dose calculations

The exposure devices utilizing high-activity gamma radiation sources for industrial radiography frequently encounter issues such as stuck or disconnected sources, posing a substantial risk of radiation exposure to the workers executing emergency source retrieval operations, emphasizing the importance of accurate dose assessment. In the present study, the radiation dose to the main worker during the process of source retrieval was calculated and compared for five emergency source retrieval procedures to retrieve stuck or disconnected sources, using 4D Monte Carlo dose calculation and a mesh-type reference computational phantom. For a stuck source, the dose values of the two source retrieval procedures (i.e., repair and cut methods) were found to be relatively small, which indicates that the worker might select either method based on personal preference or situational convenience. Conversely, for a disconnected source, the dose values of the three source retrieval procedures (i.e., fishing, connect/push, and hot stick methods) were much larger and show significant differences. Notably, the fishing method was associated with the lowest dose, whereas the hot stick method resulted in significantly higher doses, differences being as large as ∼5 times. These results underscore the fishing method as a preferable option, particularly over the hot stick method.

Variability in perioperative management of pheochromocytoma in Canada.

Despite recent consensus guidelines, there is substantial variability in the management of pheochromocytomas. Our study aimed to characterize the current state of perioperative pheochromocytoma management by Canadian surgeons. A 23-item online survey was sent to Canadian surgeons who perform adrenalectomies for pheochromocytoma. We assessed personal and institutional practices, including preoperative and postoperative management. National response rate was 51.8%. Surgeons from nine provinces responded; the majority were general surgeons (70.4%). Reviewing pheochromocytoma patients at a multidisciplinary tumor board was not routine practice (12%) and only 42.3% consistently referred patients for genetic testing. Preoperative α- and β-blockade at half of the respondent institutions were performed by endocrinology alone (53.8%), with the other half employing a multidisciplinary approach. Half of respondents admitted their pheochromocytoma patients to hospital prior to the day of surgery. Postoperatively, 11.5% of respondents routinely admitted their patients to the intensive care unit (ICU) for monitoring based on personal preference or institutional convention. Multivariate analyses found no significant relationships between demographics or preoperative factors and perioperative management. Perioperative surgical management of patients undergoing adrenalectomy for pheochromocytoma was highly variable across Canada. Less than half of respondents routinely refer patients for genetic testing, despite recent practice guidelines. Surgeon preference and institutional convention are the main drivers behind preoperative admission and routine postoperative ICU admission, despite a lack of evidence to support this practice.

Research on the Investment Portfolio in Technology and Consumer Goods Industries

This research investigates investment portfolios in the U.S. technology and consumer goods sectors, employing Modern Portfolio Theory (MPT) and the Markowitz Model to analyze and compare their risk-return profiles. The study highlights that the technology sector demonstrates a high-risk and high-return profile, making it attractive for risk-seeking investors aiming for significant gains amidst market volatility. In contrast, the consumer goods sector, with lower volatility, appeals to risk-averse investors who prefer stable and predictable returns. Key findings strongly emphasize the importance of aligning investment choices with individual investor preferences, illustrating how specific industry characteristics can influence investment strategies. The research suggests that investment success is considerably enhanced when portfolios are tailored to match individual risk tolerance and investment goals. This strategic approach provides a robust framework for guiding investors to make informed decisions that reflect their personal preferences and financial objectives, thereby helping them navigate market complexities and enhance portfolio performance.

Creating dynamic environments for the hybrid work experience : A case study of repositioning the Cambridge Consultants Boston office

The COVID-19 pandemic accelerated the transition to hybrid work, leading to increased office vacancies globally. However, many companies grappled with the challenge of creating hybrid work models that provide staff-desired flexibility while enabling effective social connection and appropriately using physical space. The employee experience is multifaceted, involving interpersonal, occupational, physical and technological factors. Human-centred design strategies are essential for fostering well-being, satisfaction and organisational performance. Investing in workplace design fosters employee satisfaction, productivity and talent retention; influences client interactions; and strengthens the connection between employees and organisational identity. The case study detailed herein focuses on Cambridge Consultants, a research and development consulting company, navigating this transition. The company underwent a thorough assessment from autumn 2021 to autumn 2022 to develop an ideal space for their new Boston-based North American office, emphasising participatory design to support the evolving demands of the hybrid work model. The relocation process involved an extensive discovery phase, including surveys, focus groups and envisioning sessions to gather insights from staff. The design development phase further engaged staff, seeking feedback on various design concepts, finishes and layouts. The company’s commitment to inclusivity and transparency extended to change management efforts, which included shifting from assigned desks to a hotelling model. The new office design prioritised innovation, connectedness, flexibility and belonging, aiming to fulfil the staff’s vision for a dynamic and inclusive workspace. Features such as an inviting lobby, staff and project showcases, variable furniture and room options and interactive walls contributed to the vision. A post-occupancy survey in autumn 2023 revealed overall positive perceptions of the new office and considered it conducive to cross-collaboration and creativity, but highlighted challenges such as setting up hotelling desks to meet personal preferences and transit-related factors affecting office attendance. The case study emphasises the importance of ongoing staff engagement, usability assessments, and a holistic understanding of real-world context. Future research is suggested to analyse the impact of hybrid work setups on operational performance metrics and the relationships between commuting complexity and perceived value in going to the office.

Factors Influencing Medical Students' Decision in Choosing a Surgical Specialty.

The decision to pursue a career in surgery among medical students is influenced by various factors, including personal preferences, perceptions of the specialty, and educational experiences. Understanding these factors is crucial for addressing challenges and fostering interest in surgical specialties. This study analyzed data from 889 medical students to explore demographic characteristics and factors influencing their decisionregarding pursuing a surgical career. Participants completed surveys regarding their gender, academic year, GPA, and intentions regarding surgical careers. Factors influencing career were assessed using closed-ended questions, with both deterrents and motivators considered. The study found a higher proportion of female participants (63.1%) compared to male participants (36.9%). Factors influencing participants' decisionnot to pursue a surgical career included a preference for other specialties (61.8%), a dislike for the lifestyle of surgeons (51.3%), and perceptions of long training durations (33.7%). Conversely, interest in the specialty (71.0%) and a preference for hands-on work (55.6%) were significant motivators for pursuing a surgical career. Additional factors such as concerns about the competitive environment, dislike for hands-on work, and perceptions regarding salary and work environment also emerged as notable considerations. The findings highlight the importance of addressing misconceptions, providing mentorship, and promoting diversity within surgical specialties to encourage interest and diversify the surgical workforce. The study found a high interest in surgical specialty among Saudi medical students; however, some barriers were identified, particularly work-home relations, gender disparity, and pressure put on surgeries.

Perspective: Key Considerations When Developing and Publishing Dietary Interventions for Human Clinical Trials

A key guiding principle in the 2020–2025 Dietary Guidelines for Americans emphasizes the need for individuals to choose eating habits that allows for personal, cultural, and traditional preferences while establishing a high-quality diet. This concept becomes a daunting task given the need to reduce the consumption of foods higher in saturated fat, sodium, and/or added sugar—which are typically found in familiar, highly palatable foods most-often liked and consumed in the United States. Similarly, in nutrition intervention studies, adherence to healthier dietary patterns is typically low because of many factors, including reduced taste, flavor, and familiarity to the study foods. Increasing evidence illustrates the promising role of herbs and spices to maintain acceptability of healthier food options for nutrition interventions. This perspective article was informed by a Satellite Session presented at the American Society for Nutrition’s annual meeting, Nutrition 2023, entitled, “Developing Culturally Appropriate Recipes for Human Clinical Trials,” which explored several proposed best practice guidelines when developing nutrition interventions to improve dietary adherence and acceptability within clinical trials. The session also highlighted a need to include sufficient detail concerning the types and amounts of specific foods included within nutrition interventions in combination with preparation methods and study recipes, including herbs and spices, to improve intervention reproducibility and translatability for future research, dietary guidelines, and clinical practice.

Feasibility of Nurse-Facilitated Advance Care Planning Among Older Veterans in a Dialysis Unit and an Oncology Infusion Center.

Many veterans with serious illnesses, such as end-stage kidney disease requiring dialysis and advanced cancer requiring treatment infusions, must make complex decisions about their current and future medical care. Advance care planning (ACP) is a process where individuals identify, express, and communicate their personal values, life goals, and preferences for care. ACP may be feasible in chemotherapy infusion centers or chronic dialysis centers during patient treatment. We assessed the feasibility of a licensed vocational nurse (LVN) facilitator to help veterans review the PREPARE for Your Care program (www.prepareforyourcare.org) and complete an advance directive (AD) in an outpatient hemodialysis unit or a chemotherapy infusion center. PREPARE For Your Care is an evidence-based online program with written pamphlets and ADs that prepares patients to participate with clinicians in making medical decisions. We measured the time to complete a session and the level of assistance required from LVNs via LVN self-report. Self-reported ease-of-use, comfort, and helpfulness were assessed on a 10-point Likert scale from 1 (not at all) to 10 (very). Twenty-eight patients were enrolled (mean age ± SD: 67 ± 11 years); all (100%) completed PREPARE and the AD within 1 session. The mean completion time was 100 (±40) minutes. Most of the patients required considerable assistance from the LVN. The mean scores were 8.0 of 10 for ease-of-use (±2.3), 7.7 of 10 (±2.8) for comfort, and 8.2 of 10 (±2.3) for helpfulness. This pilot study demonstrates that using PREPARE as an ACP tool for veterans may be feasible for patients during hemodialysis and chemotherapy infusion. Patients required considerable assistance from the LVN to complete PREPARE. Hemodialysis and chemotherapy infusion are opportunities when patients have time and space to consider ACP.

Facilitators and barriers in the implementation of a fall prevention program based on physical activity for elderly people living in the community: A qualitative study.

Physical activity is recognized as beneficial for older individuals in preventing falls. Achieving high adherence to exercise programs among the elderly poses challenges for administrations and healthcare systems. This study explored the facilitators and barriers perceived by both the participants and nurse trainers involved in an exercise program aimed at preventing falls in primary healthcare. Sixteen semi-structured interviews with elderly people who had participated in the Otago Exercise Program and a focus group of nurse trainers of this program were conducted between October 2018 and September 2019 in primary health care centers in Lleida, Spain. Interviews were transcribed and analyzed using inductive thematic analysis with Atlas.ti 8 software. Analysis revealed five overarching categories and 17 subcategories. Key facilitators included personal motivation, the perceived benefits of exercise, and the supportive role of nurse trainers. Primary barriers encompassed factors such as the excessive duration of the program, not considering personal preferences for individual or group participation, and differences in physical condition among group participants. To increase participation and adherence to exercise programs, it is necessary to consider the important role of the nursing professionals that recommend program enrolment and the participants' personal motivations. The program with group sessions is a model that is easy to integrate into Primary Healthcare centers, which must always take into account the preferences and physical conditions of the participants.

Moving an exercise referral scheme to remote delivery during the Covid-19 pandemic: an observational study examining the impact on uptake, adherence, and costs

BackgroundExercise Referral Schemes (ERSs) have been implemented across Western nations to stimulate an increase in adult physical activity but evidence of their effectiveness and cost-effectiveness is equivocal. Poor ERS uptake and adherence can have a negative impact on effectiveness and cost-effectiveness and, if patterned by socio-demographic factors, can also introduce or widen health inequalities. Different modes of ERS delivery have the potential to reduce costs and enhance uptake and adherence. The primary aim of this study was to examine the effect of different programmes of ERS delivery on scheme uptake and adherence. Secondary aims were to examine the effect of socio-demographic factors on scheme uptake and adherence, and the impact of delivery mode on the expected resource and corresponding costs of delivering core parts of the programme.MethodsThis was an observational cohort study with cost analysis. Routine monitoring data covering a three-year period (2019–2021) from one large UK ERS (number of patients = 28,917) were analysed. During this period three different programmes of delivery were operated in succession: standard (all sessions delivered face-to-face at a designated physical location), hybrid (sessions initially delivered face-to-face and then switched to remote delivery in response to the Covid-19 pandemic), and modified (sessions delivered face-to-face, remotely, or a combination of the two, as determined on a case-by-case basis according to Covid-19 risk and personal preferences). Multi-level binary logistic and linear regression were performed to examine the effect of programme of delivery and socio-demographic characteristics on uptake and adherence. Cost data were sourced from regional-level coordinators and through NERS audits supplied by national-level NERS managers and summarised using descriptive statistics.ResultsThere was no effect of programme of delivery on scheme uptake. In comparison to those on the standard programme (who attended a mean of 23.1 exercise sessions) those on the modified programme had higher adherence (mean attendance of 25.7 sessions) while those on the hybrid programme had lower adherence (mean attendance of 19.4 sessions). Being older, or coming from an area of lower deprivation, increased the likelihood of uptake and adherence. Being female increased the chance of uptake but was associated with lower adherence. Patients referred to the programme from secondary care were more likely to take up the programme than those referred from primary care for prevention purposes, however their attendance at exercise sessions was lower. The estimated cost per person for face-to-face delivery of a typical 16-week cycle of the scheme was £65.42. The same cycle of the scheme delivered virtually (outside of a pandemic context) was estimated to cost £201.71 per person.ConclusionsThis study contributes new evidence concerning the effect of programme of delivery on ERS uptake and adherence and strengthens existing evidence concerning the effect of socio-economic factors. The findings direct the attention of ERS providers towards specific patient sub-groups who, if inequalities are to be addressed, require additional intervention to support uptake and adherence. At a time when providers may be considering alternative programmes of delivery, these findings challenge expectations that implementing virtual delivery will necessarily lead to cost savings.

Features of Reference and Bibliographic Services for Students in University Libraries

Students are in a continuous process of communication, using various information environments and electronic resources of the Internet. But at the same time they do not interact with libraries enough, they do not know their capabilities. This paper highlights the issue of effective use of modern technologies to create forms and methods of reference and bibliographic services adapted to the information needs of students. The purpose of the article is to identify the experience of foreign university libraries aimed at attracting students and increasing their awareness of reference services on the basis of publications in English-language periodicals. Readers belonging to the Internet generation are an active segment of the target audience, and specialists of reference and bibliographic services should study their individual information needs and purposefully promote library resources and services oriented to the youth audience. One of the ways to solve these problems is to organize library cooperation programmes, where librarians integrate their knowledge and skills into the educational process, being in constant contact with both students and university lecturers. The article considers the key vectors of development of reference and bibliographic services in the conditions of modern society. It is concluded that students prefer a multi-level hybrid model of reference bibliographic service with the fulfillment of user requests (remotely and face-to-face) in the context of their personal preferences in combination with independent search using information resources of libraries.