Previous Negative Experiences Research Articles

Effect of oncology provider conversations on patients’ vaccination decision-making: Patient perspectives at a safety-net system.

266 Background: Low immunization rates among adults are associated with worse outcomes, particularly among immunocompromised individuals, such as those diagnosed with a cancer. To better understand vaccination communication and decision-making experiences among adult cancer patients treated at a safety-net system, we conducted structured interviews to: (1) explore patients’ perceptions of their oncology providers’ role in adult immunization, and (2) understand the potential factors that underlie patients’ hesitancy to receive vaccines. Methods: Parkland Health is the safety-net system for Dallas County, providing care for a primarily minority and un-/under-insured population. Cancer patients who had previously deferred or declined immunization participated in either in-person or telephone interviews in their preferred language (English/Spanish), using a structured 8-question interview guide. Questions centered on oncology providers’ role, vaccine hesitancy, and vaccine decision-making. Interviews averaged 12 minutes and were recorded for transcription. Aggregated interview responses were coded by question and interpreted through content analysis which noted frequency (i.e., times concept stated) and extensiveness (i.e., repetition across questions). Results: Thirteen patients were interviewed – 7 in English, 6 in Spanish. Patient’s perceived their oncology providers as highly important to their vaccination decision-making as they were: (1) more likely to get a vaccine if it is recommended by their provider (P2: Well, if the doctor hadn’t told me I wouldn’t have gotten vaccinated ; P3: If they didn’t recommend it, I would not get it ; P12: If they recommend it, it's worth looking into or thinking about ), and (2) identified their oncology provider as a preferred means for learning about vaccines (P8: Asking the doctor or the doctor communicating with us patients about a vaccine... in my personal opinion, I would say, go ahead and vaccinate me ). Patient-identified reasons for hesitancy included concerns about side effects (P2: “several people told me that is why we got cancer” ), fear of needles, previous negative experiences, and preference for alternative medicine approaches. Conclusions: Results from this preliminary study suggest that while patients may not initiate vaccination conversations with their oncology providers, they do identify their providers as influential in their decision-making. Oncology providers may not consider immunization as their primary responsibility but can be a primary source for effective vaccine communication in conjunction with the oncology care team. Findings from our patient interviews informed interventions in a quality improvement project to increase immunization uptake among cancer patients at our safety-net system.

Transgender People in Emergency And Rescue Services

The treatment of transgender individuals presents a multifaceted challenge for those involved in emergency and rescue services, encompassing not only medical but also social aspects. Despite the increasing importance of healthcare for transgender individuals in Germany over recent years, there remains significant uncertainty among healthcare professionals in addressing the needs of this population. This uncertainty can result in transgender individuals delaying access to the healthcare system due to previous negative experiences, thereby increasing the risk of receiving suboptimal medical care.Ambiguities exist regarding gender-specific health issues and the appropriate use of pronouns and names. Surveyed participants have expressed a desire for more training opportunities in this area. Enhanced training of emergency services personnel is essential for fostering a better understanding of gender-specific health concerns. Additionally, there is a notable lack of specific guidelines for the treatment of transgender individuals within both emergency services and emergency rooms. Establishing specific treatment guidelines can enhance the safety of healthcare workers and consequently improve the medical care provided to transgender individuals.The objective of this CME article is to outline the key aspects of emergency medical care for transgender individuals, aiming to reduce uncertainties among emergency service personnel and enhance the quality of medical care for this group.

Indigenous, Black, and Latine Adolescents Disproportionately Experience Barriers to Pediatric Gender-Affirming Care

Although prior studies have explored the barriers that transgender and nonbinary (TNB) adolescents experience in receiving gender-affirming medical care (GAMC), few have sought to understand how these barriers may differ among racial and ethnic minority groups. Accordingly, this study used data from a survey of TNB young adults (ages 18–20 years) to explore how barriers to GAMC during adolescence varied by race and ethnicity. Differences in the impact of 11 potential barriers when comparing the members of each racial and ethnic group with those who did not identify with that racial or ethnic group were evaluated usingttests. The results showed that Indigenous respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit and not being able to find a clinic contributed significantly more compared with those who did not identify as Indigenous. Black respondents indicated that not knowing it was possible to receive GAMC during adolescence and previous negative experiences in healthcare related to race or ethnicity contributed significantly more to their inability to receive GAMC during adolescence compared with those who did not identify as Black. Latine respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit, worries about cost, and previous negative experiences in healthcare due to race or ethnicity contributed significantly more compared with those who did not identify as Latine. Overall, the results suggest disproportionate barriers in access to GAMC during adolescence among Indigenous, Black, and Latine TNB individuals and illustrate a need for additional resources and interventions to promote more equitable access.

Exploring black women's experiences of mental health services: a literature review.

The prevalence of mental health issues among black women is high, but they are underrepresented among mental health service users. This article details a systematised review of the literature that explored black women's perceptions and experiences of, and barriers to, engaging with mental health services. A total of 16 articles from the UK and North America were included in the review. Four main themes were identified as presenting barriers to black women's engagement with services: mistrust; sociocultural factors; lack of awareness; and practical barriers. The intersection of gender and race was evident in the 'strong black woman' ideal, which may have hindered their recognition and disclosure of mental health conditions, as well as in practical barriers such as costs and caring responsibilities. Historical and cultural perceptions of mental health issues and healthcare services, alongside their previous negative experiences of services, may prevent many black women from accessing essential support. Nurses and other healthcare professionals have an important role in engendering trust, challenging racism and promoting positive mental health.

Learning Outcomes and Training Satisfaction: A Case Study of Blended Customization in Professional Training

AbstractIn the case of training programs for workplace settings, design customization can help trainers to better address trainees’ needs and, at the same time, it can help them build a sense of competence and autonomy. This is particularly difficult when trainees are skeptical because of former failing training experiences. The case study presented here, is about a training program featuring customization design from the pre-training phase throughout the training process, aimed precisely at trainees with previous negative experiences. Eighteen participants (M: 10; F: 8; age average: 55,7) were involved in training senior professionals in the information communication technology (ICT) field, all of them with a history of failed training attempts and a long period of workplace inactivity. In preparation for the training, the trainers gathered information about trainees’ attitude towards training, training preferences, and baseline skills, which determined the training design. During training, feedback and intermediate learning results were considered for fine tuning. Results attested the change of attitude towards training, perceived enhancement of self-awareness, feelings of being part of a community, and successful learning outcomes.

The effect of maternal concerns about childbirth and postpartum period on obsessive and compulsive behaviors related to baby care

Postpartum anxiety after childbirth is a common condition among pregnant women due to reasons such as the uncertainty of experiencing pregnancy and childbirth for the first time, or previous negative experiences. Fear of childbirth can affect the mother's baby care process. This study was conducted analytically with a single-subject design to determine the effects of maternal concerns about childbirth and the postpartum period on obsessive and compulsive behaviors related to baby care. The study was conducted with 260 mothers. Data were collected using a descriptive information form, and the scales 'Fear of Childbirth and Postpartum Period', and 'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care'. The data were analyzed using the SPSS™ software to calculate percentages, mean values, t tests, ANOVA, Pearson's correlation, and simple linear regression analysis. A statistically significant and positive correlation was found between participant scores of the 'Fear of Childbirth and Postpartum Period' and the 'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care' scales (p < 0.01). The regression model showed that 18.0% of the total variance in the obsessive and compulsive behaviors of mothers in the postpartum was explained by the fear of childbirth and the postpartum period (corrected R2 = 0.180). Fear of childbirth and the postpartum period were moderate. However, as the fear of women regarding childbirth and the postpartum period increased, their postpartum obsessive and compulsive behaviors about baby care also increased.

A stakeholder co-design approach to designing a dental service for adults experiencing homelessness.

The homeless population faces a "cliff edge of inequality" when trying to access essential dental services. There are several additional barriers to accessing dental care in comparison to the general population and the heterogeneous nature of patients presents a significant challenge when designing dental services to meet their needs. Following the Smile4Life report in 2009, there is limited up-to-date and population-specific evidence available for the optimal model of service delivery. This study aimed to co-design principles for a prospective dental service for adults experiencing homelessness. A qualitative methodology was used to incorporate experts-by-experience into elements of co-designing a dental service for adults experiencing homelessness. The study combined elements of an experienced-based co-design framework for healthcare innovation with community-based participatory research. Focus groups with people experiencing homelessness and healthcare practitioners were conducted to identify principles for any prospective dental service, as well as several barriers and enablers to establishing a homeless dental service. The findings were transcribed and analysed using thematic analysis on Nvivo software. From the qualitative analysis five key themes emerged: (1) Impact and expectations of oral health while experiencing homelessness, (2) Barriers to accessing dental care; (3) Practitioner's views about homelessness and access to care; (4) Barriers to designing a homeless service and (5) Enablers for co-designing a new model of dental care delivery for the homeless population.Five key principles for a new model of homeless dental service were identified: (i) Services designed to address the needs of patients; (ii) Services delivered in a safe and welcoming environment (iii) Training and consistency of staff; (iv) Focus on dental education (v) Developing peer mentoring and peer support. While the barriers to accessing dental care while homeless are well established and understood by healthcare practitioners, more work is required to gain consensus on the most effective way to deliver an innovative a sustainable dental service for patients experiencing homelessness. Previous negative experiences, lack of readily available information on services and barriers to access in the current system could be addressed by developing peer mentors within the homeless community, empowering individuals to share their knowledge and skills to support others in improving their oral health.

Patient-related predictors of post-operative pain following root canal treatment: A structural model analysis.

The pathways to post-operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient-related predictors of post-operative pain following root canal treatment. A total of 154 patients received a single-visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post-operative pain was assessed using the Numeric Rating Scale at multiple time-points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient-related predictors on a theoretical model of post-operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%). Dental anxiety (coefficient 0.028; p < .01), dental fear (coefficient 0.007; p = .02) and irrigant solution (coefficient 0.004; p = .03) exerted a direct effect on post-operative pain. SOC exerted an indirect effect on post-operative (coefficient 0.006; p = .01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p = .04) exerted an indirect effect on post-operative pain through dental anxiety. Dental anxiety, dental fear, previous negative experiences and SOC are patient-related predictors of post-operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post-operative pain.

The prevalence of pain catastrophising in nulliparous women in Nepal; the importance for childbirth.

In Lower-Middle-Income-Countries women are encouraged to present at a birthing facility for skilled care, but attending early can be associated with additional harm. Women admitted in latent labour are more likely to receive a cascade of unnecessary interventions compared with those attending a birthing facility during active labour. One reason that women present early is pain, with higher rates of admission among those who pain catastrophise. The aim of this study was to explore the prevalence of pain catastrophising in nulliparous women in Nepal and to identify predictors for pain catastrophising. A cross sectional study was conducted using a semi-structured survey. The survey was completed by 170 women (18-32 years) in one higher education institution in Kathmandu. The survey included the pain catastrophising scale (PCS), current and previous pain and information about period pain, sociodemographic variables of age, ethnicity, and religion. The prevalence of pain catastrophising reported at a cut off score of PCS≥20 was 55.9% and at a cut off score of PCS≥30 was 17.1%. All women with a PCS ≥30 reported having painful periods. Those with a PCS≥20 were four times [95%CI 1.93-8.42] more likely to report painful periods affecting their daily activities (p<0.001) and those with PCS≥30 three times [95%CI1.10-10.53] more likely (p<0.05). In both cases ethnicity and age were not associated. Women with higher PCS were less likely to take pain medication. A high prevalence of pain catastrophising was reported. It is important to understand how women's previous negative experiences of pain and pain catastrophising are perceived and if they are contributing to the rise in obstetric intervention, particularly caesarean births, in Nepal. We recommend repeating this study with a larger sample representing a more diverse population.

Perceived barriers to help-seeking for people who use crystal methamphetamine: Perspectives of people with lived experience, family members and health workers.

Barriers to help-seeking for illicit drug use cross psychosocial (e.g., knowledge of where to seek help, attitudinal beliefs like being afraid of what people will think) and structural (e.g., service availability) domains. Along with people who use illicit drugs, it is important to consider the perspectives of other key groups who are often involved in the help-seeking and recovery process. This study aimed to examine the perceived barriers to help-seeking for people who use crystal methamphetamine ('ice') among key groups (people who use crystal methamphetamine, families and friends, health workers) as well as the general community. A cross-sectional online survey open to all Australian residents (aged ≥18 years) was conducted November 2018-March 2019. Four key groups of interest were recruited to examine and compare perceived barriers to help-seeking for crystal methamphetamine use. Participants (n = 2108) included: people who use/have used crystal methamphetamine (n = 564, 39%), health workers (n = 288, 26.8%), affected family/friends (n = 434, 13.7%) and general community (n = 822, 20.6%). People who used crystal methamphetamine demonstrated increased odds of reporting attitudinal (OR 1.35; 1.02-1.80) or structural (OR 1.89; 1.09-3.27) barriers, or a previous negative help-seeking experience (OR 2.27; 1.41-3.66) compared to knowledge barriers. Health workers demonstrated decreased odds of reporting attitudinal compared to knowledge barriers (OR 0.69; 0.50-0.95). Perceived barriers to seeking help for crystal methamphetamine use differed among key groups involved in treatment and recovery. Acknowledging and addressing the mismatches between key groups, through targeted interventions may better support people to seek help for crystal methamphetamine use.

Preferences of support and barriers and facilitators to help-seeking in pregnant women with severe fear of childbirth in Sweden: a mixed-method study

BackgroundThere are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women’s experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women’s parity.MethodsPregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately.ResultsIn total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category “A twisting road to walk towards receiving support for fear of childbirth” was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home.ConclusionsMost pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.

#2121 The Kidney-specific Psychosocial ASSessment and support (Kidney PASSPORT) feasibility trial

Abstract Background and Aims Psychosocial interventions for depressive and anxiety symptoms are effective in CKD, but studies mainly focus on people on dialysis. Little is known about the role of screening and prevention of common mental health difficulties in early CKD. This trial assessed the research feasibility of an intervention to screen for psychological distress in CKD and deliver prevention approaches for sub-threshold symptoms. The intervention was facilitated by an Assistant Wellbeing Practitioner (AWP), a Band 3 healthcare assistant familiar with renal services and upskilled with specific competency-based training. Method We conducted a mixed-methods, one-year, single-centre, prospective, single-blind, wait-list, randomised controlled feasibility trial. We anticipated screening 250 individuals to identify 100 eligible, with a 40% screening positivity rate, a 45% participation rate and 20% attrition rate, to give 36 participants in the feasibility study. Primary outcomes are shown in Table 1. Potential participants were screened using an online self-completion questionnaire. Participants were randomised to 6 months of immediate or wait-list intervention. Data was collected using online self-report surveys, clinical research forms and semi-structured qualitative interviews. The trial was overseen by a steering committee and received the relevant ethics approvals. Funders included Kidney Care UK, the British Renal Society, the Royal Devon and Exeter Research Capacity Awards and the Exeter Kidney Unit development fund. Results We approached n = 233 people. Feasibility outcomes are shown in Table 2. Due to logistical issues an extension was obtained and in total n = 24 participants were recruited, agreed by the steering committee. All clinical research forms were completed. The most common intervention components were self-management and liaison with the clinical team. The median (interquartile range) difference in baseline and post intervention PHQ-9 score was −5 (−7, 0), n = 19, p = 0.003) and GAD-7 score was −7 (−8, −2), n = 19, p = 0.0002). Qualitative findings showed the AWP was seen as filling in the gaps left by other parts of the service. Key themes were accessibility, time availability, empathy, patient empowerment, and ability to empower the individual. Balance—especially family, work and health—was noted to be a challenge for participants. Importantly, the AWP was able to help participants overcome previous negative experiences. The trial provided valuable learning regarding role implementation, including recruitment, training, work patterns, everyday practicalities, and supervision arrangements. Conclusion We propose a novel intervention for screening and addressing early mental health problems in people with CKD. A single-centre feasibility design was appropriate. The screening positivity rate was lower than anticipated, informing samples for future trials. Outcome data collection via self-report surveys was not feasible. The intervention was well received, with the AWP being valued and self-help and clinical liaison being core elements. Significant reductions in depression and anxiety screening scores were observed. Despite the rigorous design, limitations included slow initial recruitment impacting the sample size and AWP role vulnerability. Future work includes adapting the AWP training and role based on trial learning and considering suitability for other long-term conditions. In conclusion, the AWP role shows promise in routine screening for and prevention of common mental health difficulties in CKD.

Why do women choose home births.

In recent years, the US has seen a significant rise in the rate of planned home births, with a 60 % increase from 2016 to 2023, reaching a total of 46,918. This trend positions the US as the leading developed country in terms of home birth prevalence. The American College of Obstetricians and Gynecologists (ACOG) suggests stringent criteria for selecting candidates for home births, but these guidelines have not been adopted by home birth midwives leading to poor outcomes including increased rates of neonatal morbidity and mortality. This paper explores the motivations behind choosing home births in the US despite the known risks. Studies highlight factors such as the desire for a more natural birth experience, previous negative hospital experiences, and the influence of the COVID-19 pandemic on perceptions of hospital safety. We provide new insights into why women choose home births by incorporating insights from Nobel laureate Daniel Kahneman's theories on decision-making, suggesting that cognitive biases may significantly influence these decisions. Kahneman's work provides a framework for understanding how biases and heuristics can lead to the underestimation of risks and overemphasis on personal birth experiences. We also provide recommendations ("nudges according to Richard Thaler") to help ensure women have access to clear, balanced information about home births. The development of this publication was assisted by OpenAI's ChatGPT-4, which facilitated the synthesis of literature, interpretation of data, and manuscript drafting. This collaboration underscores the potential of integrating advanced computational tools in academic research, enhancing the efficiency and depth of our analyses.

Health Technology Access and Peer Support Among Digitally Engaged People Experiencing Homelessness: Qualitative Study.

Although the effects of digital health are receiving wide scientific attention, very little is known about the characteristics of digitally engaged people experiencing homelessness, especially in Central and Eastern Europe. Our previous research revealed a considerable level of internet use in the homeless population of Budapest, Hungary, for general purposes (350/662, 52.9%) and medical purposes (229/664, 34.6%). Moreover, a digitally engaged subgroup was identified (129/662, 19.5%). The aim of this exploratory study was to map out the resources, attitudes, and behaviors of digitally engaged homeless individuals in relation to digital technology to set the basis for potential health policy interventions, which will enable better access to health services through strengthening of the digital components of the existing health care system. Between August 18, 2022, and October 27, 2022, a total of 12 in-depth semistructured interviews were conducted in 4 homeless shelters in Budapest, Hungary. Upon analysis by 3 independent evaluators, 2 interviews were excluded. The interviewees were chosen based on purposive sampling with predefined inclusion criteria. Thematic analysis of the transcripts was conducted. In the thematic analysis, 4 main themes (attitude, access, usage patterns, and solutions for usage problems) emerged. Health-related technology use mostly appeared in health information-seeking behavior. Online search for prescribed medications (5 interviews), active ingredients of medications (4 interviews), medicinal herbs believed to replace certain pills (2 interviews) or foods, and natural materials (1 interview) were mentioned. Moreover, mobile health app use (3 interviews) was reported. The intention to circumvent or check on mainstream health care solutions was mainly associated with previous negative experiences in the health care system. Several gaps in the daily use of technology were identified by the interviewees; however, more than half of the interviewees (6/10) turned out to be contact points for their peers for digital problem-solving or basic digital literacy skill enhancement in the homeless shelters. Furthermore, a lack of institutional support or special programs targeting senior clients was noted. Digitally engaged homeless individuals might become mediators between their peers and comprehensive digital health programs. They have the trust of their peers, can recognize and harness the benefits of digital technology, and are able to provide meaningful help in technology- and usage-related issues through experience. Digital health services have great promise in community shelters for managing and preventing health issues, and digitally engaged individuals might be important for the success of such services.

Preference and Associated Factors for Cesarean Delivery Among Pregnant Women: A Cross-Sectional Study.

A cesarean delivery is regarded as a comparatively favourable and secure approach to childbirth when contrasted with vaginal delivery. Over the past decade, its frequency has risen in both industrialized and developing nations. Maternal request for cesarean delivery has been explained for the escalating rate along with other factors like anxiety, fear of childbirth, previous cesarean delivery, previous negative vaginal birth experience, maternal age, maternal education, and socioeconomic factors. Hence, this study was undertaken to assess pregnant women's tendency to have a cesarean birth and to investigate the factors associated with the inclination for cesarean delivery. A hospital-based cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of a tertiary care hospital, a systematic sampling procedure was utilized, and 368 antenatal mothers after 36 weeks of gestation, who do not have any specific medical reasons against vaginal delivery were included in the study. Data collection was done by questionnaire. The information regarding socio-demographic factors, preexisting comorbidities, current obstetric risk factors, emotional factors, previous delivery experience, and their information preference toward the mode of delivery were collected. Univariate and multivariate analysis were performed to identify the independent variables associated with preference for cesarean delivery. The preference for cesarean delivery and non-preference for cesarean delivery was 114 (30.9%) and 201 (54.6%), respectively whereas 53 (14.4%) participants remained neutral. The Chi-square analysis revealed a notable connection between the inclination towards a preference for cesarean delivery and factors such as obstetric score, parity, comorbidities, and among obstetric risk factors such as pregnancy after in-vitro fertilization (IVF), with a history of abortion, and having a prior history of cesarean delivery. Nevertheless, no meaningful association was observed between the preference for cesarean delivery and the remaining variables. On multivariate logistic analysis, independent variables like preexisting anxiety or depression, pregnancy through IVF, and having a history of previous cesarean delivery have increased the odds of preferring cesarean delivery. The independent variables like increasing gestational age, graduates, and unemployed have decreased the odds of preferring a cesarean delivery. In conclusion, the prevalence of cesarean delivery is influenced by a complex interplay of medical, cultural, socioeconomic, and healthcare system factors. While cesarean delivery is essential in cases of medical necessity, efforts should be made to avoid unnecessary cesarean delivery that does not provide clear benefits over vaginal delivery. Balancing the risks and benefits of cesarean delivery and promoting evidence-based obstetric practices are crucial for ensuring optimal maternal and infant outcomes.

Predictors of Academic Self-Efficacy of University Students: Grades, Learning Disabilities and ADHD

Academic self-efficacy (ASE) is a key concept for academic success as individuals with high ASE are, among other things, ambitious, see problems as challenges, focus on solving tasks, therefore have higher class participation and persevere in difficult tasks. Learning disabilities (LD) and ADHD have been found to be related to academic success, specifically the aspect of taking tests and demonstrating knowledge. Studies of ASE in LD and ADHD students have shown it to be lower in those populations. Most research has focused on ASE as a precursor to academic success. Therefore, we wanted to investigate the opposite, namely how prior academic experiences predict ASE. 287 Croatian students, fifty-three of whom had LD and/or ADHD, participated in the online study. ASE in the learning process and in achieving the desired learning outcomes was lower in the LD/ADHD group. Regression analysis showed that failing an exam, university and middle school grades were significant predictors for both ASE facets, with LD/ADHD diagnosis being a significant predictor only for ASE in achieving the desired learning outcome. Previous negative experiences with testing in the LD/ADHD group and overall relatively recent academic experience have a significant role in students’ ASE. Given the importance of academic self-efficacy, the practical implications of these findings point to the importance of supporting students with LD and ADHD during their education.

Perspectives of potentially eligible Indigenous Māori on a lung cancer screening programme: a qualitative study

aims: Lung cancer causes more deaths than any other cancer, globally and in Aotearoa New Zealand, where it disproportionately affects Māori. We aimed to understand Māori perspectives on lung cancer screening in Aotearoa New Zealand to guide its equity focussed implementation, including identifying enablers and barriers. methods: We took a Kaupapa Māori based co-design approach to inform future screening, recruiting Māori current/ex-smokers and members of their whānau (family) for three focus group phases held in Auckland, Aotearoa New Zealand in August 2019. Participants responded to a proposed lung cancer screening pathway and shared their attitudes and beliefs about lung cancer and screening. Results were thematically analysed. results: The 21 Māori participants supported future lung cancer screening in Aotearoa New Zealand. Perceived benefits included being more informed about lung cancer and screening and enabling healthier future generations. Barriers to screening were previous negative health service experiences; fear; stigma; and access, including time, cost and transport. Enablers included providers’ cultural competence; clear communication; a one-stop shop; and support with transport. A range of factors could potentially influence a decision to participate in screening. conclusions: Participants favoured future lung cancer screening and identified key barriers and facilitators of screening.

Associations Between Religiosity and Medical Mistrust: An Age-Stratified Analysis of Survey Data from Black Adults in Chicago.

Medical mistrust is associated with poor health outcomes, ineffective disease management, lower utilization of preventive care, and lack of engagement in research. Mistrust of healthcare systems, providers, and institutions may be driven by previous negative experiences and discrimination, especially among communities of color, but religiosity may also influence the degree to which individuals develop trust with the healthcare system. The Black community has a particularly deep history of strong religious communities, and has been shown to have a stronger relationship with religion than any other racial or ethnic group. In order to address poor health outcomes in communities of color, it is important to understand the drivers of medical mistrust, which may include one's sense of religiosity. The current study used data from a cross-sectional survey of 537 Black individuals living in Chicago to understand the relationship between religiosity and medical mistrust, and how this differs by age group. Descriptive statistics were used to summarize data for our sample. Adjusted stratified linear regressions, including an interaction variable for age group and religiosity, were used to model the association between religiosity and medical mistrust for younger and older people. The results show a statistically significant relationship for younger individuals. Our findings provide evidence for the central role the faith-based community may play in shaping young peoples' perceptions of medical institutions.

Integration of medical legal services into a hospital-based violence intervention program: A survey and interview-based provider needs assessment.

Violent injury among trauma surgery patients is strongly associated with exposure to harmful social determinants of health and negative long-term health outcomes. Medical-legal partnerships in other settings successfully provide patients with legal services to address similar health-harming legal needs and may offer a promising model for the care of violently injured patients. An electronic survey tool was distributed to clinicians and staff affiliated with the hospital-based violence intervention program at a single urban level one trauma center. Semistructured follow-up interviews were conducted with participants, and interviews were coded using thematic analysis and grounded theory. Participants reported many health-harming legal needs among their violently injured patients. The most commonly identified needs were: health insurance denials (62.5%); difficulty accessing crime victims compensation funds (56.3%); trouble accessing official documents (50%); and problems with non-SSDI public benefits (50%). Participants reported inconsistent methods for learning about and responding to patients' health-harming legal needs. The most common barriers to addressing these needs included the following: lack of awareness that a lawyer could help with the issue (68.8%); prioritization of other needs (68.8%); previous negative legal experiences (62.5%); and cost (62.5%). Identified needs encompass issues traditionally addressed by MLPs as well as more novel challenges faced by violent injury survivors. This survey and interview-based study identifies complex health-harming legal needs present among violently injured trauma surgery patients. Medical-legal partnerships specially designed for the setting of violent injury appear well-suited to meet these needs, potentially reducing risk of violent reinjury, long-term negative health outcomes, and health care system costs. Prognostic and Epidemiological; Level IV.

Topical anaesthesia for invasive procedures in dermatology and cosmetology

Currently, in dermatology and cosmetology, the range of cosmetic procedures and minor invasive interventions, which use local anesthetics, is expanding. They are used alone or as part of an integrated anesthetic approach. Procedures such as mesotherapy, biorevitalization, contour plastic surgery, removal of skin tumors, and laser procedures require anesthesia in the form of local topical anesthesia. Local anesthetics have long been known and well-studied; they have many advantages, significantly increasing patient comfort during invasive procedures, but they also have some disadvantages, including the risk of toxicity. The purpose of using a local anesthetic is to increase the effectiveness of the procedure, convenience and comfort for the patient, minimize negative emotions associated with pain, and the ability to achieve local anesthesia without anatomical distortion of the tissue (i.e., without the use of infiltration anesthesia). Often, the severity of the pain experienced depends on the individual response of the patient. The characteristics of pain are subjective and can vary depending on the “pain threshold”, type of temperament, and previous negative experience. For some patients, sometimes minimal pain becomes a serious obstacle to performing a particular procedure. Some invasive, painful procedures that are performed on pediatric patients require a particularly careful approach to the choice of anesthesia drug and method of administration. In this article, we analyzed the mechanisms of pain pathogenesis, methods of local anesthesia, focused on the role of local anesthetics in cosmetology and dermatology, examined the features of using a cream for local and external use containing a combination of lidocaine 2.5% and prilocaine 2.5%, its therapeutic effectiveness, clinical recommendations for use in various procedures in dermatology and cosmetology. When choosing a drug for local anesthesia, safety is important for the doctor, when used correctly, a low level of side effects, timely pain relief, effectiveness, ease of use and accessibility.