Peer Communication Research Articles

Systemic inequities and sources of resilience: challenges faced by Indigenous women living with HIV during COVID-19 in the Canadian prairies

ABSTRACT This study explored the challenges faced by, and resilience of First Nations, Métis, and Inuit women living with HIV in Manitoba and Saskatchewan during the COVID-19 pandemic. Through a decolonizing, community-based research approach, guided by a Community Guiding Circle (CGC), interviews were conducted with 45 Indigenous women living with HIV. Participants were recruited via community outreach, peer networks, and social media. Data collection and analysis utilized Indigenous storywork and inductive thematic analysis. The study revealed significant barriers related to housing instability, childcare, and access to healthcare, all exacerbated by systemic inequities rooted in colonialism, patriarchy, and capitalism. Despite these challenges, Indigenous cultural practices, ceremonies, community support, and family ties emerged as crucial sources of resilience, though often disrupted during the pandemic. The findings underscore the urgent need for culturally safe, women-centered care models that integrate Indigenous knowledge and practices. For health and social care practitioners, this research emphasizes the importance of advocating for systemic change to address the unique needs of Indigenous women living with HIV and calls for the development and implementation of culturally safe health and social care tailored to their unique needs and resilience.

Navigating barriers and embracing facilitators of connection: insights from peer recovery specialists working with individuals with substance use disorder and criminal justice involvement: a qualitative analysis

BackgroundSubstance use disorder affects over half of incarcerated individuals, with 23% experiencing opioid use disorder specifically. Addressing opioid use disorder in jails is crucial due to its association with increased recidivism and overdose. This study investigates the experiences of peer recovery specialists working with individuals with opioid use disorder and criminal justice involvement, focusing on barriers and facilitators to client connections. Qualitative interviews were conducted and thematically analyzed using a hybrid inductive and deductive coding approach. The sample involved five peer recovery specialists, who were interviewed multiple times, across three sites in Virginia between August 2022 to December 2023.ResultsThis analysis categorized findings into two main domains: barriers to connection and facilitators of connection. Within the barriers to connection, six themes emerged: jail specific restrictions, client in withdrawal, social determinants of health insecurities, lack of client engagement, disconnection, and adverse peer recovery experience. Jail-specific restrictions was the most common barrier to connection with 91.30% of transcripts referencing at least one code for jail-specific restrictions; 73.91% of all transcripts indicated social determinants of health insecurities; 56.52% of all peer recovery specialist transcripts experienced clients in withdrawal; 52.17% of all transcripts identified lack of client engagement; 43.48% of all transcripts identified disconnection as a barrier; and 34.78% of all transcripts indicated adverse peer recovery specialist experiences. Three themes were identified as facilitators of connection: peer communication skills, connection to services, and positive peer recovery specialist experience. Peer communication skills were by far the most prominent, with 100% of all transcripts indicating a code related to peer communication skills; 60.87% of all transcripts indicated positive peer recovery specialist experience; and 56.52% of all transcripts identified connection to services as a facilitator. Notable discrepancies in code frequency were observed across different sites, suggesting site specific challenges.ConclusionThis study offers valuable insights into enhancing peer-based support programs within the justice system for individuals with opioid use disorder. Barriers such as jail specific restrictions, client withdrawal, and social determinants of health insecurities pose significant challenges, while effective communication emerges as a critical facilitator. Findings emphasize the need for collaborative efforts between justice and recovery partners to optimize the impact of peer-based support services.

Individual and classroom-level associations of within classroom friendships, friendship quality and a sense of peer community on bullying victimization

For most students, attending school entails daily intense social interactions with classmates in a classroom context. While many of these interactions are positive and lead to the development of friendships and a shared classroom community, some students instead suffer peer harassment and bullying. According to the social-ecological theory these disparate social phenomena may be linked. The aim of this study was to examine how number of friends, perceived friendship quality, and a sense of peer community were associated with bullying victimization at both the individual and classroom level. Additionally, to thoroughly investigate the nuances of different types of friendship qualities the concept was analyzed both as one unified construct and as five distinct dimensions (companionship, conflict, help, security, and closeness). Survey data from 587 Swedish upper elementary school students (56.22% girls; Mage = 11.72, SD = 0.96) across 54 classrooms was collected and analyzed using multilevel regression. Results showed that having at least one friend was negatively associated with victimization and that victimization was less prevalent in classrooms where students experienced a shared sense of community. Furthermore, while high-quality friendships were associated with less victimization at both the individual and classroom level, when the five dimensions where considered, only conflictual and helpful friendships were significantly associated with victimization (on both levels of analysis for conflictual friendships and only on the individual level for helpful friendships). Together these results highlights the importance of schools helping students cultivate high-quality friendships, teaching constructive conflict management and promoting a more prosocial classroom community.

Multi-level Factors to Build Confidence and Support in Active Surveillance for Low-Risk Prostate Cancer: A Qualitative Study.

Active surveillance (AS) is the guideline-recommended treatment for low-risk prostate cancer and involves routine provider visits, lab tests, imaging, and prostate biopsies. Despite good uptake, adherence to AS, in terms of receiving recommended follow-up testing and remaining on AS in the absence of evidence of cancer progression, remains challenging. We sought to better understand urologist, primary care providers (PCPs), and patient experiences with AS care delivery to identify opportunities to improve adherence. A qualitative study involving patients, PCPs, and urologists with experience of AS. PCPs (19), urologists (15), and patients (15) in Michigan. Participants were recruited through a statewide quality improvement collaborative. Semi-structured interviews were conducted virtually from June 2020 to April 2021. The Theoretical Domains Framework and the Behavior Change Wheel's Capability, Opportunity, and Motivation model guided interviews and coding. Thematic analysis was used to identify shared perspectives on AS care delivery. Three main themes emerged from the PCP, urologist, and patient data collected related to AS care delivery that were needed to improve AS adherence: (1) building patient confidence in AS by leveraging provider roles and expertise and creating connection through communication across the care team and with patients; (2) building confidence in AS through psychosocial support by involving families and peers, and addressing anxiety and uncertainty; (3) building AS support within healthcare processes and electronic health record systems. These themes reflect opportunities for interventions at the care team, community (family and peers), and health system levels that could better support individualized care and overcome challenges to AS adherence through team-based approaches.

A Cross-Sectional Study Exploring the Role of Social Isolation in the Relationship Between Food Insecurity, Depressive Symptoms, and Resource Use Among Midwestern Rural Veterans in the U.S.

The study's objective was to determine whether social isolation serves as a mediator in the cross-sectional relationship between food insecurity, both as a short-term and longer-term situation, with resource use and depressive symptoms as outcomes. This cross-sectional design study utilized secondary survey data, including 30-day and 12-month food security measured by the U.S. Household Food Security Survey Module. The Baron-Kenny mediation approach was used to determine whether social isolation mediated the relationship between food security, depressive symptoms, and resource use (p ≤ 0.05). Social isolation mediates the association between both 30-day and 12-month food security with depressive symptoms but not resource use. Acknowledging and targeting social isolation, policies, and interventions that integrate peer support and community outreach to promote food security could support rural veterans food security and mental health.

Exploring the Influence of Mood Triggers on Information Encountering Among Chinese Youth on Mobile Social Media

Noticing is an important stage in information encountering when the user becomes aware of the information. Despite the large amount of research confirming that different information behaviors affect users' moods, there is still a dearth of research on the noticing of information encountered in different moods. This study surveyed 252 Chinese youth using fsQCA to explore how communication processes on mobile social media platforms trigger young users to notice information encountering different moods. This study finds that there are significant differences among moods: In a positive mood, users are more receptive to communication cues such as the perceived usefulness and ease-of-use of the transmitted information, indicating that positive moods may enhance information processing. In a neutral mood, the focus shifts towards the information interesting, suggesting that the user’s mood moderates the reception of communicative content on mobile social platforms. In a negative mood, users’ attention to information is more heavily influenced by social cues and peer communication, suggesting that social influence plays a vital role. Negative moods may prompt users to rely more on the opinions and behaviors of their social network, reinforcing the role of social dynamics in mobile communication. This study offers valuable insights into the relationship between mood and information encountering on mobile social media, providing communication practitioners with actionable strategies for tailoring content based on users' moods. By understanding how mood influences information reception and processing, communicators can enhance message delivery and audience engagement.

Nursing Approaches to Autism Stigma, Bullying, and Inclusion, Alkharj- Saudi Arabia

Introduction: Autism spectrum disorder (ASD) presents challenges such as social stigma, bullying, and difficulties in fostering inclusive environments. Addressing these barriers requires exploring healthcare utilization, parental advocacy, and social experiences within a cultural context. The objective of this study was to explore and analyze the factors influencing understanding, stigma, and bullying towards individuals with autism, and to identify effective strategies for fostering inclusive environments.Methods: A cross-sectional study was conducted at King Khalid Hospital's outpatient clinic in Saudi Arabia. A total of 200 families were selected through convenience sampling. Data were collected using the Autism Quotient (AQ), Social Responsiveness Scale (SRS), Community Attitudes Toward Disability Scale (CATD), Bullying and Peer Relations Questionnaire, Cultural Competence Assessment Tool (CCAT), and Parent Advocacy Scale. Data analysis involved descriptive and inferential statistics to explore correlations.Results: The sample consisted of 55% females, with 80% being Saudi nationals. Moderate autistic traits were noted (AQ mean score: 126.7), and significant social challenges were identified (SRS mean score: 159.1). Community attitudes were generally positive (CATD mean score: 94.2), but bullying was prevalent (mean score: 54.5). Cultural competence was moderate (CCAT mean score: 103.2), and parental advocacy was identified as a key factor in improving outcomes (Parent Advocacy Scale mean score: 116.2).Conclusion: The study highlights the need for increased support, reduced bullying, and improved cultural competence to foster inclusive environments for individuals with autism. Parental advocacy emerged as critical for better outcomes.

A study on the factors influencing sustainable social media consumption among Generation Z through sustainability, ease of use, trust, social influence, and subscription convenience concerning YouTube Streaming

Introduction: The increase in Software as a Service (SaaS) revolutionized streaming services and changed how people consume digitally. Most of these facilities use massive amounts of energy, which raises concerns about the environment and social impact of the technology. The study examines how awareness of sustainability, ease of use, social influence, trust, and subscription convenience drive sustainable streaming behavior among Generation Z, reducing environmental strain.Methods: A quantitative research approach was used to investigate the factors influencing responsible streaming behavior among Generation Z. Participants were recruited using a non-probability convenience sampling method. The 206 responses were collected from students aged 18 to 25 studying in Higher Educational Institutions from different academic departments in India. Results: The findings reveal that streaming platforms must increase sustainability awareness through campaigns to promote sustainable streaming behavior. Ease of use is essential, suggesting that user-friendly features encourage responsible actions like reducing video quality or downloading videos. Social influence is a strong predictor, emphasizing the role of peer norms and societal expectations in promoting sustainable, responsible streaming behaviors. Conclusions: Streaming services can use peer recommendations and community engagement to promote responsible, sustainable streaming behavior among Generation Z. Streaming services have a social impact by offering access to diverse content and contribute to issues like excessive screen time and algorithm-driven information that limit exposure to different opinions. To mitigate these social impacts, platforms should introduce screen time reminders and enhance algorithms to promote balanced, inclusive content, ensuring that streaming continues as a positive and developing societal factor

Consumer Engagement with Retail Businesses: A Systematic Literature Review and Future Agendas

This literature review aims (1) to systematically lay out and analyze the literature on consumer engagement and consumer engagement with retail businesses, (2) to identify the possible antecedents of consumer engagement, and (3) to analyze the context of studies, trends in methodologies, and conceptual frameworks and thus provide the future agendas for consumer engagement with retail businesses. This review uses a systematic literature review (SLR) method. The research articles published in Scopus-indexed journals between 2008 and 2022 were downloaded from the Google Scholar database using a systematic search strategy. The key antecedents of consumer engagement included attitudes towards brands, brand interactivity, brand intimacy, consumer involvement, customer participation, customer perceived value, peer communication, personality traits of consumers, self-brand image congruity, perceived service quality, social media marketing efforts of retail brands, and subjective norms. Though only a few reviewed articles had explicit conceptual frameworks, researchers performed an in-depth analysis of conceptual frameworks underpinning the research. This framework-based review uniquely analyzes the antecedents (Independent Variables) and mediating variables of consumer engagement (Dependent Variable) with retail businesses.

Cadê o Kauê? Co-design and acceptability testing of a chat-story aimed at enhancing youth participation in the promotion of mental health in Brazil.

Adolescent mental health is vital for public health, yet many interventions fail to recognise adolescents as proactive community contributors. This paper discusses the co-design and acceptability testing of a chat-story intervention to enhance Brazilian adolescents' participation in the promotion of mental health in their peer communities. We specifically highlight the iterative process of co-creating this intervention with community stakeholders. The co-design was led by researchers, a youth collaborative group, and health-tech experts. Part 1 included quantitative (n = 1,768) and qualitative (n = 46) studies with Brazilian adolescents aged 15-18 for priority-setting. Part 2 involved co-creation and technical production, with input from youth advisors (n = 24), school staff (n = 11), and policy experts (n = 3). In Part 3, the chat-story was user tested (n = 32). Parts 4 and 5 assessed acceptability through a qualitative study in schools (n = 138) and initial efficacy during an online campaign (n = 795). Participants aspired to support their peers' mental health in schools, both one-to-one and collectively, but felt unprepared. This informed the chat-story's goal of enhancing peer support and collective action skills. Themes identified during Part 1, such as prejudice and academic pressure, were woven into the narrative to raise awareness of the social determinants of mental health, drawing from real-life stories. In the final story, players search for their missing best friend at school, uncovering his anxiety struggles and practicing skills such as empathic listening and partnership building. A manual for teachers was collaboratively designed for use within school settings, supplementing direct-to-user online applications. Acceptability testing showed participants found the tool authentic and user-friendly. Online users perceived the tool as preparing and motivating them to offer peer support and engage in collective action. The immersive co-creation model, enriched by input from key stakeholders, yielded a relevant and well-received intervention for Brazilian adolescents. Co-designed creative tools like chat-stories hold promise as digital mental health tools, fostering awareness, critical reflection, and inspiring adolescents to drive positive social change.

Breaking Barriers: Empowering Cervical Cancer Screening with HPV Self-Sampling for Sex Workers and Formerly Incarcerated Women in Toronto.

Although cervical cancer (CC) is highly preventable through appropriate screening methods like the Papanicolaou (Pap) test, which enables early detection of malignant and precancerous lesions, access to such screening has not been equitable across social groups. Sex workers and people with records of incarceration are among the most under-screened populations in Ontario. Little is known about the acceptability and feasibility of HPV self-sampling (HPV-SS) as an alternative cervical cancer screening method for these groups. This online, community-based mixed-methods pilot study aimed to address this knowledge gap. Eighty-four under- and never-screened sex workers and ex-prisoners aged 25-69 years and residing in the Greater Toronto Area, were recruited by community peer associates. Participants completed an online survey and viewed short videos about CC and screening with Pap and HPV-SS. Those who opted for HPV-SS conducted the test at one of two collaborating organizations. The median age of participants was 36.5 years. Most had limited knowledge about CC and screening. Approximately 13% identified as non-binary, and 5% as two-spirit or trans men, with the majority having completed secondary education. Of the participants, 88% chose HPV-SS, and one-third tested positive for high-risk HPV types. The ability to self-sample without judgment from healthcare providers was noted as a key advantage. However, there was a need for training on proper HPV-SS techniques. To improve cervical cancer screening among sex workers, increasing awareness through participatory community co-creation of sexual health education is essential. Additionally, offering HPV-SS as a screening option is crucial, given its demonstrated acceptability and feasibility within this population, many of whom lack a primary care provider and face discriminatory attitudes in healthcare settings.

Characterizing How Peer‐to‐Peer Learning Navigates Coopetitive Tensions Within Online Community‐Based Innovation Contest Networks

ABSTRACTOnline Community‐based Innovation Contests (OCICs) are an important form of network‐based innovation. Creativity derives from the interactions between diverse community peers, positioned across the network, who learn from each other. However, learning takes place against the backdrop of simultaneity of cooperation and competition, leading to coopetitive tensions. This research seeks to unravel how peer‐to‐peer learning occurs within this coopetitive environment. It aims to unpack coopetitive tensions and show how they are navigated by peer‐to‐peer learning mechanisms. To achieve this, an in‐depth case study of a global filmmaking OCIC is conducted, comprising three phases; informal interviews and observation; Social Network Analysis (SNA); and a structured interview program. The results identify diversity and opacity tensions derived from the opposing forces of cooperativeness and competitiveness. These tensions are navigated through two overarching learning mechanisms of assessment and concretizing. The study details several learning strategies connected to the mechanisms. A nuanced analysis shows how they are enacted at core and periphery positions, and through various modes of interaction.

The use and effect of cognitive scaffoldings on facilitating collaborative discussion-supported writing

ABSTRACT Collaborative discussion-supported writing (CDSW) provides opportunities for students to develop arguments and counterarguments through peer communications with a goal to promote a high-quality argumentative essay. Cognitive scaffoldings can be used to facilitate students’ collaborative discussions. However, there is a lack of investigation on the utilisation of cognitive scaffoldings to facilitate CDSW, which limits valuable insights for the instructional design of cognitive scaffolding. This research designed collaborative discussions to support argumentative essay writing at a Chinese senior high school, with three cognitive scaffoldings (i.e. minimal, idea-centred and idea-centred, argumentation-oriented scaffoldings). Results revealed the best effect of the idea-centred, argumentation-oriented scaffolding on collaborative learning processes and performances, compared to the minimal and idea-centred scaffoldings. Based on the results, this research proposes that knowledge construction elements, engagement levels and additional supports should be considered in instructional design of cognitive scaffoldings to improve collaborative learning.

Straight From the Source: Doctor of Physical Therapy Students' Perspectives on the Impacts of Program Policies and Procedures on Sense of Belonging.

There is an urgent need to increase access to and inclusion in health professions education programs for individuals with diverse backgrounds and needs. The purpose of this study is to explore student perspectives of the ways in which current Doctor of Physical Therapy (DPT) program policies, procedures, and practices may facilitate or hinder a culture of belonging and the ability to participate across diverse student identities and needs. To date, there are no best practices in promoting and supporting health profession student belonging, and the student voice is absent in the literature. This prompts a need for guidance on where and how academic DPT programs should focus initial efforts as they self-assess their degree of compliance with newly revised accreditation standards. Sixteen DPT student volunteers from 2 institutions across 4 campuses in 4 states. A cross-sectional qualitative study using thematic analysis with semistructured interviews was used to gather student perspectives regarding factors that positively and negatively affect sense of belonging. Three researchers qualitatively analyzed transcriptions using a combination of open and axial coding to identify themes. Final consensus coding yielded 179 coded responses across 95 unique codes categorized in 6 themes: faculty and staff relationships, program policies and procedures, cohort and peer relationships, diverse identities, communication, and program resources. This is the first study known to investigate the use of student voice to better understand, operationalize, and potentially improve belonging within DPT education. Results demonstrate that when given a voice, students are able to articulate both observations of present-state sense of belonging and clear ideas and recommendations for ways in which DPT programs could address sense of belonging. Findings may help frame program policies and procedures from the student lens by offering themes, strategies, and recommendations for promoting a culture of belonging.

The link between Empathy and Forgiveness: Replication and extensions Registered Report of McCullough et al. (1997)'s Study 1

ABSTRACT McCullough et al. [McCullough, M. E., Worthington, E. L., & Rachal, K. C. (1997). Interpersonal Forgiving in Close Relationships. Journal of Personality and Social Psychology, 73(2), 321–336.] demonstrated that in situations of feeling hurt by an offender, empathy towards the offender is positively associated with forgiving the offender, which in turn is positively associated with conciliatory behaviour and negatively associated with avoidance behaviour. In a Replication Registered Report with a Prolific US online sample (N = 794), we conducted a replication of Study 1 from McCullough et al. (1997) with extensions manipulating empathy to determine causality and measuring revenge motivation adopted from McCullough et al. [McCullough, M. E., Rachal, K. C., Sandage, S. J., Worthington, E. L., Brown, S. W., & Hight, T. L. (1998). Interpersonal forgiving in close relationships: II. Theoretical Elaboration and Measurement. Journal of Personality and Social Psychology, 75(6), 1586–1603]. We found that empathy was positively associated with perceived apology (r = 0.45[0.35,0.55]) and forgiveness toward the offender (r = 0.64[0.56,0.70]), and forgiveness was positively associated with conciliatory motivation (r = 0.51[0.41,0.59]) and negatively associated with avoidance motivation (r = −0.51[−0.59,−0.42]) and revenge motivation (r = −0.43[−0.52,−0.33]). Manipulating empathy, we found that participants who recalled situations in which they felt strong empathy towards the offender rated higher forgiveness compared to participants recalling situations with low empathy or compared to control (d = 0.60–0.62). Overall, this was a successful replication of the findings by McCullough et al. (1997; 1998) with the empathy model of forgiveness receiving strong empirical support. Materials, data and code are available on: https://osf.io/fmuv2/. This Registered Report has been endorsed by Peer Community in Registered Reports: https://doi.org/10.24072/pci.rr.100444.

The Causal Factors Affecting the Management of Predictive Student Relationship using Business Intelligence Concept for the Retention of Undergraduate Students

This study aims to analyze causal factors affecting predictive student relationship management for undergraduate student retention using business intelligence. Phase 1 involved identifying key factors influencing retention through document analysis, categorizing them into social, learning, teaching, and student-related factors. Social factors include student community, friendships, communication channels, and organizational culture, which promote engagement, motivation, and perseverance. Learning and teaching factors, such as supportive learning environments, scholarships, instructional design, and structured assignments, impact academic success and retention. Student-related factors, including learning abilities, academic preparedness, goals, and parental support, are essential for persistence. Data was gathered from 1,574 students at Valaya Alongkorn Rajabhat University, with 1,160 usable entries after cleansing. Exploratory Factor Analysis (EFA) grouped these variables into five components: Student Communication Channels, Academic Proficiency, Parental Guidance, Scholarships, and Organizational Culture. Confirmatory Factor Analysis (CFA) validated the model, highlighting well-clustered factors. In Phase 2, a predictive model was developed using stepwise multiple regression, identifying impactful variables, such as note-taking abilities, scholarship counseling, peer communication, and access to advisors. The final model, with an R value of 0.881 and an adjusted R² of 0.777, demonstrated 77.7% predictive accuracy, emphasizing the combined influence of academic support, communication, financial aid, and social integration on student retention. The findings suggest that institutions should prioritize these areas to foster a conducive environment for student success.

Young men's everyday life experiences with contraception and unintended pregnancy in Papua New Guinea.

Unintended adolescent pregnancy is a public health priority in Papua New Guinea (PNG), where national policies specify need for easier access to reliable modern contraceptives. To reduce young people's experiences of unintended pregnancy in PNG, improved understandings of use of modern and other forms of contraception within young people's relationships is required to support the development of new sexual and reproductive health (SRH) programs and policies. The aim of this paper is to understand young men's use of modern and other contraceptives. This qualitative study involved semi-structured interviews with 35 sexually active young men aged 15-24 years, who were sampled purposively from the general population within community-based settings. Data were analysed using inductive thematic analysis techniques. Our analysis of young men's everyday experiences of using condoms and other contraceptives highlights clear drivers of unintended adolescent pregnancies. Across three settings, these included non-use of any modern method at first sex or during early sexual experiences; inconsistent use of condoms, often only after first pregnancy experiences; difficulties accessing condoms from health service providers, pharmacies and stores; a lack of understanding of other modern contraceptive strategies; inconsistent use of the withdrawal method; and inconsistent and incorrect use of calendar approaches due to misunderstandings about women's fertile period. Ten young men had never used any form of contraception. These occurred largely because young men's sexual agency is constrained within sexual and peer relationships, and community, school and health service settings, in ways that inhibit pregnancy prevention. It is important to engage meaningfully with young men to build sexual and reproductive health policies and programs that pay honest, respectful attention to young people's everyday sexual and social lives. Young men's everyday stories provide a unique lens through which we can identify mechanisms of change required to address the health and social inequities associated with unintended pregnancy among young men and young women in PNG and beyond.

Young people’s sense of agency and responsibility towards promoting mental health in Brazil: a reflexive thematic analysis

ObjectivesThis study investigated how Brazilian young people perceive their role in promoting and supporting their peer community’s mental health and well-being, and the conditions and contexts influencing their engagement.DesignCo-produced qualitative...

Mental disorder diagnoses and symptoms and functional impairment in school-age children in the care of child protective services

BackgroundAbout 50 % of children in the care of child protective services present at least one mental disorder, but few studies have looked at whether there are differences in mental disorders or symptoms between children placed in out-of-home care (foster care and residential care) and their community peers. ObjectiveThis study documents the mental disorder diagnoses and symptoms among children in out-of-home care and their associations with children functional impairment. It also compares out-of-home care children with those from the community. Participants and settingThe sample was composed of children aged 5 to 12 years in foster care (n = 154), in residential care (n = 111), and from the community (n = 92). MethodsCaregivers reported the children's diagnoses and completed questionnaires on the children's symptoms. Results1) Proportionally more children in out-of-home care presented a mental disorder than did children from the community. Proportions were similar for those in foster care and those in residential care; 2) Children in out-of-home care presented more symptoms than those from the community for all the mental disorders considered and the children in residential care presented more symptoms than did those in foster care for about half of the disorders considered; 3) symptoms were strongly associated with functional impairment; and 4) the symptoms of RAD, ADHD, OCD, CD, and ODD proved significant predictors of functional impairment. ConclusionsThis study provides a picture of the mental disorders and symptoms among samples of school-age children in the care of child protective services and raises questions about the proportions of some of the diagnosis that children receive.

The Primacy of Professionalism: A Selective Review of Medical Education, Practice, and Research.

From the 12th Century, when the word referred to taking religious vows, to its present meaning as a constellation of organized practices requiring special training, legal liability, and covenants with individual patients and society, professionalism has played an important role in the practice of medicine. Until relatively recently, the concepts of professionalism and professional behavior were rooted in timeless ideals that individual physicians were expected to achieve in training and practice. As an ideal type, professionalism was seen as a quality or characteristic residing in the individual physician. By the same measure, the period of rapid technological and social change that marked the early to mid-20th Century made clear that timelessness, as it applied to professionalism, had its limitations. Where once sharing bad or sad news with patients was viewed as harmful, the right to know one's diagnosis is now enshrined in law and taken for granted in education and practice. Moreover, research shows that knowing one's diagnosis is often beneficial, not harmful, to individuals and families. In response to changing norms and technological advances, medical educators have introduced new models of professionalism that stress the role of social context and relationships in training and practice. One innovative approach is based on the concept of professional identity formation, the moment-by-moment process of becoming and being a physician. Identity formation occurs primarily through story-telling and other forms of self-expression in the context of a community of peers who learn to practice medicine with technical proficiency, kindness, and self-awareness together. [Pediatr Ann. 2024;53(12):e440-e445.].