Prior Negative Experiences Research Articles

Patient expectations of and experiences with a suicide risk identification algorithm in clinical practice

BackgroundSuicide risk prediction models derived from electronic health records (EHR) and insurance claims are a novel innovation in suicide prevention but patient perspectives on their use have been understudied.MethodsIn this qualitative study, between March and November 2020, 62 patients were interviewed from three health systems: one anticipating implementation of an EHR-derived suicide risk prediction model and two others piloting different implementation approaches. Site-tailored interview guides focused on patients’ perceptions of this technology, concerns, and preferences for and experiences with suicide risk prediction model implementation in clinical practice. A constant comparative analytic approach was used to derive themes.ResultsInterview participants were generally supportive of suicide risk prediction models derived from EHR data. Concerns included apprehension about inducing anxiety and suicidal thoughts, or triggering coercive treatment, particularly among those who reported prior negative experiences seeking mental health care. Participants who were engaged in mental health care or case management expected to be asked about their suicide risk and largely appreciated suicide risk conversations, particularly by clinicians comfortable discussing suicidality.ConclusionMost patients approved of suicide risk models that use EHR data to identify patients at-risk for suicide. As health systems proceed to implement such models, patient-centered care would involve dialogue initiated by clinicians experienced with assessing suicide risk during virtual or in person care encounters. Health systems should proactively monitor for negative consequences that result from risk model implementation to protect patient trust.

Examining the Intention of Authorization via Apps: Personality Traits and Expanded Privacy Calculus Perspectives.

By integrating the extended privacy calculus theory with the Big Five personality theory, this research proposes and validates a conceptual model in the context of mobile application (App) information authorization. It investigates the implications of each component of privacy costs, privacy advantages, and trust on users’ willingness to authorize their information, and explores how the five personality traits affect App users’ perceived benefits, privacy concern, and trust. Simultaneously, the links between prior negative experience and privacy concern as well as the final authorizing willingness were uncovered. We employed a questionnaire to collect 455 users’ data, and the partial least squares structural equation model (PLS-SEM) was used to test the hypotheses. The findings demonstrate that App users’ perceived benefits and trust have a positive impact on their privacy authorization intention, whereas privacy concerns negatively affect their disclosure willingness. Just as Extraversion and Agreeableness would make someone pay a heightened attention to the benefits, agreeable, neurotic, and conscientious users are more easily stimulated by privacy concern. Respectively, Agreeableness and Neuroticism affect users’ trust positively and negatively. Additionally, prior negative experience will trigger an individual’s privacy concern, which in turn hinders their willingness to authorize his/her information. All of the aforementioned can serve as a guide for App providers as they optimize the features of their products and services, implement the necessary privacy protections to alleviate users’ privacy concern, and boost users’ trust belief. More importantly, these results effectively demonstrate the significance of personal traits in the formation of users’ privacy perceptions.

A qualitative study of factors resulting in care delays for adults with meningitis in Zambia.

Meningitis causes significant mortality in regions with high comorbid HIV and TB. Improved outcomes are hindered by limited understanding of factors that delay adequate care. In-depth interviews of patients admitted to the University Teaching Hospital with suspected meningitis, their caregivers, doctors and nurses were conducted. Patient/caregiver interviews explored meningitis understanding, treatment prior to admission and experiences since admission. Provider interviews addressed current and prior experiences with meningitis patients and hospital barriers to care. A conceptual framework based on the Three Delays Model identified factors that delayed care. Twenty-six patient/caregiver, eight doctor and eight nurse interviews occurred. Four delays were identified: in-home care; transportation to a health facility; clinic/first-level hospital care; and third-level hospital. Overcrowding and costly diagnostic testing delayed outpatient care; 23% of patients began with treatment inside the home due to prior negative experiences with biomedical care. Admission occurred after multiple clinic visits, where subsequent delays occurred during testing and treatment. Delays in care from home to hospital impair quality meningitis care in Zambia. Interventions to improve outcomes must address patient, community and health systems factors. Patient/caregiver education regarding signs of meningitis and indications for care-seeking are warranted to reduce treatment delays.

Patient interest in exploring nonsurgical treatment approaches for early-stage breast cancer: A qualitative study.

578 Background: Advances in radiotherapy allow the ability to deliver ablative treatments without compromising outcomes, but there has been limited application of these treatments to early-stage breast cancers. The purpose of this study was to explore patients’ interest in pursuing nonsurgical treatment approaches for their early-stage breast cancer. Methods: Investigators conducted a qualitative descriptive study involving semi-structured interviews with 21 early-stage breast cancer patients eligible for participation in a phase 2 trial offering omission of surgery. Interviews were transcribed, and three independent reviewers performed an inductive, thematic analysis to generate themes and subthemes. Results: Data analysis revealed the following factors that impacted patients’ willingness and desire to explore nonsurgical treatment options: Perceptions and feelings about their cancer; Current quality of life and the level of support available in their daily life; External conversations focusing on family members’ and friends’ experiences with cancer and/or cancer treatments; Personal healthcare experiences, including with their current breast cancer diagnosis; Perceptions and feelings about their physicians; Conversations with their physicians about their treatment options; and Self-identified desire to direct care decisions. Specifically, patients described fearing surgery and surgical recovery and wanting to avoid negative surgery-related events previously experienced by friends, family, and themselves. Participants also expressed a desire to preserve their breast(s), receive treatment per the latest research, match the level of treatment with the severity of their cancer, and avoid other comorbidities as reasons for omitting surgery. Patient reasons for pursuing surgery included the desire to remove their cancer immediately, prior positive experiences of friends, family, and themselves with surgery, lack of concern about preserving their breast(s), and prior negative experiences of friends, family, and themselves with radiation. Conclusions: The results of this study highlight that there is patient interest in nonsurgical options for biologically favorable early stage breast cancers. A key factor hindering patient education and awareness of nonsurgical options is how the physician frames the discussion and presents treatment options. In addition, patients’ self-identity and the prior experiences of friends, family, and self with cancer treatment and surgery in general appear to be key factors in their decision-making. The findings from this study demonstrate an unmet need to explore nonsurgical options for early-stage breast cancer. Study results can help shape conversations around shared decision making and clinical trial design and result in more personalized treatment options for women with early-stage breast cancer.

Fisheries governance and associated health implications: Current perspectives from US commercial fishermen

Developing useful regulations that lead to intended effects from originating legislation can be a challenge for those entities that are implementing and responding to those regulations. In the commercial fishing industry, fisheries management regulations are fundamentally designed to conserve and sustain marine resources. Numerous studies have underscored the importance of engaging commercial fishermen in discussions of how to best preserve these resources. By ensuring numerous, diverse perspectives, policies and associated implementing regulations can thus address a broad spectrum of concerns and utilize input from a wide spectrum of knowledgeable informants to make regulations more effective and easier to enforce. The purpose of this manuscript is to share our findings on fishermen’s perceptions of the fisheries governance process and to describe how these perceptions impact their emotional health and willingness to engage in future fisheries management discussions. In sharing these perspectives, we hope to underscore the need for further research on fishermen’s governance experiences and to highlight how prior negative experiences could adversely impact future engagement with the process. The data highlighted in this study was gathered from interviews originally conducted to explore fishermen’s sleep patterns and general health in the Alaska salmon, Oregon Dungeness crab, Northeast scallop and Massachusetts lobster fisheries. However, a primary theme that emerged from these interviews was the impact that fisheries management decisions had on work-related stress. Stressors were largely related to increasing regulatory complexity and the economic impact of management decisions that add to an already challenging commercial enterprise. The governance process was also seen as yet another factor outside of fishermen’s direct control, which when combined with unpredictable weather, access to reliable crew and rapid shifts in market prices, has severe consequences to their overall sense of wellbeing. While increased engagement has been highlighted in the literature as a means for addressing fishermen’s regulatory concerns, our informants believe their input is neither valued nor prioritized, which appears to threaten future engagement in fisheries management discussions.

Patient perspective on the participation of ophthalmology residents in their cataract surgery

ObjectifDéterminer la proportion de patients qui acceptent que des résidents prennent part à leur chirurgie de la cataracte et découvrir les facteurs permettant de prédire le consentement. NatureÉtude transversale prospective. ParticipantsLes 330 patients consécutifs adressés à 3 chirurgiens dans un centre de soins tertiaires de London, en Ontario, en vue de l’évaluation de leurs cataractes entre février et avril 2021. MéthodesOn a demandé aux patients – en utilisant un outil de dialogue standardisé – ce qu'ils pensaient de la participation de résidents à leur chirurgie de la cataracte. Les données cliniques et démographiques ont été obtenues par téléphone et tirées des dossiers médicaux. Les facteurs de prédiction du consentement ont été évalués au moyen d'un modèle de régression logistique. RésultatsOn a obtenu des réponses de la part de 279 sujets (taux de réponse de 85 %), dont l’âge moyen était de 71,7 ± 8,6 ans et dont 113 étaient des femmes. Le taux de consentement s'est élevé à 71 %. Une expérience antérieure négative lors d'interactions avec des étudiants en médecine constituait un facteur de prédiction indépendant du refus de laisser participer des résidents (rapport de cotes [RC] = 3,10; intervalle de confiance [IC] à 95 %: 1,32–7,28; p = 0,009). Les sujets qui ont refusé de donner leur consentement avaient également eu plus d'expériences négatives dans leurs interactions avec d'autres médecins (35 % vs 23 %; p = 0,031) et connaissaient quelqu'un qui avait eu des problèmes après une chirurgie oculaire (36 % vs 22 %; p = 0,016). Les sujets dont la profession comprend un stage (RC = 2,87; IC à 95 % : 1,08–7,67; p = 0,035) et ceux dont l'acuité visuelle préopératoire était de 20/200 ou pire (RC = 2,78; IC à 95 % : 1,03–7,14; p = 0,043) étaient plus susceptibles de donner leur consentement. ConclusionsOn doit demander explicitement aux patients s'ils consentent à ce que des résidents prennent part à leur chirurgie. La personne qui a vécu des expériences antérieures négatives peut se montrer réticente à la participation d'un étudiant à ses soins de santé. La sensibilisation des patients envers le mode d'apprentissage par stages des étudiants en médecine pourrait encourager l'octroi du consentement.

Transgender and Gender Nonbinary Patient Experiences in the Emergency Department: A Regional Study.

Transgender people experience discrimination in health care, including reports of avoiding or delaying emergency department (ED) care due to prior negative experiences, fear of discrimination, poor accommodations, and inappropriate staff behavior. Emergency physicians receive minimal training on transgender care. This study sought to understand the experience of transgender patients when visiting EDs in the Portland metro area, and the knowledge and training experience of Oregon Health & Science University (OHSU) ED staff. Two populations were examined via survey: (1) Transgender people who accessed, or felt they should access, ED care in Portland, Oregon, in the past 5 years; and (2) OHSU ED patient-facing staff. Data were analyzed to identify trends in ED experiences, and predictors of positive experiences. Potential relationships between self-reported proficiency in transgender care and formal training experience, professional role, and duration of practice were also assessed. Of the predictors assessed, only the opportunity to provide pronouns at check-in was associated with better perceived experiences (p<0.01). The differences between reported best and worst ED experiences were significant in all domains of perceived experiences but one (p<0.01). ED providers who had formal training were more likely to rate themselves as proficient (p<0.01). There was no relationship found between self-reported proficiency and length of practice. This study demonstrated that there are significant differences between reported best and worst ED experiences by transgender patients, and thus areas for ED improvement. It is our recommendation that EDs provide the opportunity for patients to supply their pronouns, and offer trainings in transgender health care for employees.

Beyond household income: the role of commercial vegetable farming in moderating socio-cultural barriers for women in rural Nepal

BackgroundPromoting rural women’s agricultural entrepreneurship in the Global South has become a major policy and program priority for governments and development partners. Women’s income earning is viewed as a pathway to their empowerment and gender equality. The research goal was to understand how patriarchal socio-cultural norms and practices influence women’s participation in commercial vegetable farming (CVF) in the mid-hills of Sudurpashchim Pradesh, Nepal, and identify the specific and evolving strategies that women use to negotiate these changes.MethodologyData for the study were generated through in-depth interviews with 16 smallholder couples, eight each in Dadeldhura and Achham districts. Additionally, 17 key informants who were government agency and development organization agriculture support officials at the district and national level were interviewed. Besides in-depth interviews, focus group discussions (FGDs) with women’s groups, women leaders, development actors, and government officials at district, regional, and national level were also conducted. Interview data analysis using NVivo was complemented with field notes, observations and government agency and development organization reports.ResultsCVF possibilities initially motivated a few women to discuss with their husbands, organize self-help groups, and seek development program subsidies. With strong support from husbands and parents-in-law, they actively engage in CVF, generate income, form cooperatives for savings and credit, and improve household food security and their own economic status. CVF-associated groups, cooperatives, meetings, exposure visits, skill development training, knowledge sharing, counseling, and advocacy are vital tools. Through them, women build self-confidence, contest and transform entrenched socio-cultural barriers, and negotiate new socio-cultural norms and practices within and outside the household. Dissolving gender stereotypes regarding the division of labor in CVF plays a significant role in encouraging more women to join CVF and increases gender parity. However, a diminishing minority of women still struggle to overcome the legacy of prior negative experiences and subconsciously fear community backlash, especially regarding extended travel outside their village.ConclusionSocio-cultural practices restricting women’s income-generating roles can be transformed through investment in women’s group initiatives, enhancing husbands’ and wives’ communication and livelihood planning, and community members increased appreciation for women’s role in contributing household income and food security.

"The SUMMIT Team is All I Got": perspectives of medically and socially complex patients seen in intensive primary care.

Context: There is great interest in intensive primary care (IPC) interventions to address the needs of medically and socially complex patients, however it is unknown how these interventions impact patient experience. Objective: Describe the experience of patients on the Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT), an IPC for patients with complex needs at a federally qualified health center serving patients with high rates of homelessness. Study Design: Qualitative study using semi-structured interviews with 25 patients enrolled in the SUMMIT intervention. We conducted a thematic analysis using a hybrid inductive/deductive approach. Results: Prior to SUMMIT, patients often felt it was difficult to engage with the healthcare system, in part due to their complex medical conditions, but also factors including prior trauma, poverty, substance use, and providers' stigma. We identified four themes related to how and why patients felt SUMMIT improved their care: 1) Investment: Patients perceived the team as truly invested in them and expressed how the team walked side by side in their care journeys to overcome stigma, low-self efficacy, and prior negative experiences with the healthcare system 2) Family: Patients reported feeling a strong sense of family with SUMMIT team members and believed that the team had genuine duty and obligation toward them, interacting with them in a non-judgmental, culturally competent manner. 3) Feeling valued: Patients expressed that the team's flexible design, continuity of team membership, care coordination and addressing unmet needs and social determinants led them to feel valued and hope. 4) Evolution of self-efficacy: Patients experienced improved self-efficacy, and were able to engage with health care proactively, instead of avoiding care. Conclusion: Medically and socially complex patients experience trauma and stigma that shape perceptions of care. Patients appreciated humanizing interactions with team members along with the additional support SUMMIT provided to overcome barriers to care. They spoke of the team as family members who valued them and they recognized how the program had helped them take a more active role in improving their own health. Our findings suggest that effectiveness of IPC interventions may lie, in part, on the use of team members who have the skills and commitment to deliver non-judgemental, culturally competent, longitudinal relationship-focused care.

The prevalence and associated factors of fear of childbirth among Turkish pregnant women

ABSTRACT Objective This study was conducted to determine the prevalence of fear of childbirth and affecting factors in pregnant women in Turkey. Materials and methods This was a cross-sectional study and included a total of 2025. Pregnant Women Assessment, some variables related to previous and current perinatal processes and Wijma Delivery Expectancy/Experience Questionnaire (version A) were used for data collection. Findings In this sample, 42.4% of the women reported fear of childbirth. What the women were afraid of most was the development of unwanted conditions at childbirth, obscurity/uncertainty, and negative attitudes of health professionals. The factors causing fear of childbirth were the low education level, unemployment status, low financial status, stillbirth, unplanned pregnancy, indecisiveness about the type of delivery, not attending prenatal education programs, negative effects of other people, insufficient social support, confiding in the healthcare centre and health professional, negative, and indecisive birth perceptions, prior negative birth experiences and not feeling ready for childbirth (p < 0.001). Conclusions The prevalence of fear of childbirth in this Turkish sample, especially in the multipara is higher than in Western countries. Causes of fear of childbirth can vary with countries and even with each region of a country.

Social commerce advertising avoidance and shopping cart abandonment: A fs/QCA analysis of German consumers

In recent years, due to the extensive use of social media advertisement and the development of social commerce tools, scholars and practitioners pay more attention to interaction with the digital channel, shopping intention, satisfaction, and retention. The objective of this study is to understand the shopping cart abandonment behavior as an outcome condition of ad avoidance on social media platforms. This research takes into consideration of cognitive, affective, and behavioral ad avoidance; alongside its antecedent conditions of perceived goal impediment, perceived add clutter, and prior negative experiences on social media. The research is conducted in Germany and Fuzzy sets/Qualitative Comparative Analysis (fs/QCA) is applied to understand the outcome condition of shopping cart abandonment. The findings imply that ad avoidance can create a learning mechanism for consumers about shopping cart abandonment of a brand or product if interrupted by a futile message or content. Theoretical and practical implications are discussed.

Divergent perspectives: autistic adults' perceptions of the police

PurposeMuch of the current criminological research regarding police and the autistic community focuses on police training for interacting with autistic individuals or the experiences, fears and perceptions of parents or caregivers. Largely absent from the criminological research are the opinions and perceptions of autistic adults. The purpose of the paper is to examine perceptions of the police and police-led initiatives among these individuals.Design/methodology/approachThe authors analyze data from 121 autistic adults regarding their perceptions of the police and police-led autism awareness efforts using ordinary least squares (OLS) regression. Variables of interest include perceptions of procedural justice, police treatment of autistic individuals, fear of interacting with police and perceptions of police autism awareness campaigns.FindingsFindings indicate that autistic respondents vary in perceptions of the police. Prior negative experiences with police have a stronger influence on perceptions than do positive experiences. Support for awareness campaigns is also varied.Originality/valueDespite high-profile police incidents involving autistic individuals, there have been no empirical examinations of autistic adults' global perceptions of the police or police-led autism awareness campaigns. The current study addresses that oversight by directly examining autistic adults' perceptions. The approach is particularly salient given the ongoing police public scrutiny surrounding officer interactions with individuals from special populations, which is largely uninformed by research centering the voices of impacted individuals.

Hurricane adaptation behaviors in Texas and Florida: exploring the roles of negative personal experience and subjective attribution to climate change

Understanding the motivation to adopt personal household adaptation behaviors in the face of climate change-related hazards is essential for developing and implementing behaviorally realistic interventions that promote well-being and health. Escalating extreme weather events increase the number of those directly exposed and adversely impacted by climate change. But do people attribute these negative events to climate change? Such subjective attribution may be a cognitive process whereby the experience of negative climate-change-related events may increase risk perceptions and motivate people to act. Here we surveyed a representative sample of 1846 residents of Florida and Texas, many of whom had been repeatedly exposed to hurricanes on the Gulf Coast, facing the 2020 Atlantic hurricane season. We assessed prior hurricane negative personal experiences, climate-change-related subjective attribution (for hurricanes), risk appraisal (perceived probability and severity of a hurricane threat), hurricane adaptation appraisal (perceived efficacy of adaptation measures and self-efficacy to address the threat of hurricanes), and self-reported hurricane personal household adaptation. Our findings suggest that prior hurricane negative personal experiences and subjective attribution are associated with greater hurricane risk appraisal. Hurricane subjective attribution moderated the relationship between hurricane negative personal experiences and risk appraisal; in turn, negative hurricane personal experiences, hurricane risk appraisal, and adaptation appraisal were positively associated with self-reported hurricane personal adaptation behaviors. Subjective attribution may be associated with elevated perceived risk for specific climate hazards. Communications that help people understand the link between their negative personal experiences (e.g. hurricanes) and climate change may help guide risk perceptions and motivate protective actions, particularly in areas with repeated exposure to threats.

Factors influencing primary care provider referral for bariatric surgery: Systematic review.

To identify barriers to and facilitators of primary care provider (PCP) referral for bariatric surgery in patients with obesity. MEDLINE, EMBASE, and PsycINFO databases were searched and reference lists of included articles were screened to identify additional relevant articles. Two reviewers independently reviewed citations and full-text articles, and appraised the quality of the included articles using the Critical Appraisal Skills Programme Tool Qualitative Checklist and the Appraisal Tool for Cross-Sectional Studies. They extracted data on the study characteristics and the barriers to and facilitators of PCP referral for bariatric surgery. Appraisal discrepancies were resolved through consensus among authors. Overall, 882 citations were identified and 18 articles were then selected for this review. Barriers included fear of surgery complications and side effects, cost, lack of availability, perception that surgery is a quick fix or a last resort, and prior negative experiences. Facilitators included direct requests from patients, patient motivation, previously failed weight-loss interventions, and obesity-related comorbidities. Those PCPs who were knowledgeable about the risks and benefits of bariatric surgery were more likely to refer their patients. Education and continuing professional development programs regarding bariatric surgery are needed to improve PCP knowledge and capacity to manage patients with obesity. Also, educating the general public on obesity, weight management, and available treatment options can empower patients and families to manage their weight and pursue evidence-informed treatments.

Making quality improvement data more accessible and understandable: Analyst, designer, and storyteller.

Making data more accessible and understandable in quality improvement requires a diversity of approaches beyond formal teaching in technical skills of measurement. Improvement practitioners might co-opt the wider skillset of analyst, designer, and storyteller in tailoring the team strategy needed to make best use of the data used to inform decision-making at the point of care. Data literacy levels, negative prior experiences, or limited access to technology might influence the ability of teams to engage in measurement. Co-designing the experience ensures that the data are meaningful, that it is framed in inclusive language, and that the process is manageable. Being mindful about intrinsic motivators when designing measurement strategies can improve the collective approach to data analysis and the sustainability of the project. Thoughtful data visualization takes account of the inherent perceptual challenges of comprehending data and complex images. Establishing a routine of simplification-removing redundant elements and distractions-and amplifying aspects that aid understanding can bring clarity to the important concepts within a chart. Story-telling techniques can help wider audiences engage with data by carefully shaping analytical and emotional content around a central narrative-always mindful of the limitations of working memory, and the emotional momentum needed to inspire change.

A grounded theory analysis of care-coordinators’ perceptions of family growth associated with an experience of first episode psychosis

ABSTRACT Background Growth associated with a first episode of psychosis (FEP) is taken from post-traumatic growth literature, where positive changes are perceived following adverse circumstances. FEP is a critical period in which care-coordinators play a key role in working with families. Care-coordinators’ perceptions influence the way in which they work with families. Methods Eleven care-coordinators described their perceptions of growth within families with FEP through semi-structured interviews. Transcripts were analysed using social constructivist grounded theory. Results Care-coordinators perceived the existence of family growth in the form of enhanced communication, as well as less explicit forms of growth including distancing from unhelpful relationships and a re-establishment of norms and boundaries. Growth was inhibited by the construct of the “perfect family” model, a mis-trust in services due to suspiciousness or prior negative experiences of services. Conclusions These inhibitors limit engagement with interventions and prevent open exploration of difficulties. Future work may consider how these findings align with the views of families.

Review From Multiple Perspectives for the State of the Practice on the Use of Recycled Asphalt Materials and Recycling Agents in Asphalt Concrete Surface Mixtures

The objective of this paper is to provide information from multiple perspectives on the current state of the practice with regard to using recycled materials and recycling agents (RAs) in asphalt concrete mixtures. This information was collected through a survey of U.S. transportation agencies and RA suppliers combined with a search of RA-related specifications and pilot projects previously constructed. Moreover, a case study describing the Virginia Department of Transportation’s experience with RAs provides a tangible example of how at least one agency is approaching the potential implementation of these technologies. This practice review was achieved by documenting the experience, lessons learned, and best practices of multiple asphalt experienced contractors and asphalt binder suppliers in the Virginia area. This paper follows a similar survey conducted in 2014 as part of NCHRP 09-58 and provides a second look at the use of RAs across North America. Not all state departments of transportation have experience with using RAs. Factors preventing the use of RAs included specification limitations, lack of expertise in processing recycled materials, supporting data, and negative prior experiences. Developing a performance-based testing framework is mandatory for the successful use of RAs. In general, good and frequent communication with the RA supplier is critical and necessary during the planning stages, the production of mixtures, and the continuous quality control by the supplier to resolve issues when they arise. Finally, a strong quality control and quality assurance-testing program should be implemented to ensure that materials meet the properties needed to produce a good-performing mixture.

The influence of prior experience on food preference by sheep exposed to unfamiliar feeds and flavors

We explored the influence of dietary experiences on ensuing ingestive responses to novel feeds and flavors by lambs. Twenty lambs housed in individual pens were assigned to two groups (10 lambs/group). In four different periods, all animals were offered four different nutritive novel feeds (oats, wheat bran, corn, beep pulp), followed by intra-ruminal infusions of lithium chloride-LiCl (150 mg/kg BW), a toxicant that causes food aversions (Group NE; negative experiences with novel foods), or just or water (Group PE; Control). After exposure, all lambs were tested for their acceptance of single novel feeds (sorghum grain, rice bran, Calf manna® pellets and soybean meal) presented separately and simultaneously in 5-way preference tests with alfalfa (a familiar feed) at familiar and unfamiliar locations. Lambs were also tested for their acceptance and preference for novel flavors (onion, oregano, cinnamon, garlic) added to alfalfa at the unfamiliar location. During exposure, the PE group ate more of the novel feeds than the NE group (P < 0.05). During testing at both familiar and unfamiliar locations, PE lambs ate more (P < 0.05) of the novel feeds than NE lambs, displaying greater preferences for novel feeds and a greater Shannon’s diversity index (P < 0.05). No differences between groups regarding ingestive behavior were observed when lambs were offered novel flavors at the unfamiliar location (P > 0.05), likely due to generalization of familiar cues in flavored alfalfa. Thus, prior negative experiences with novel foods increased neophobia and constrained dietary diversity during exposure to novel feeds, an outcome that could impact the composition and structure of plant communities, as well as the nutrition and welfare of grazing animals. Finally, nutritious and safe cues from familiar feeds may be important at attenuating the influence of such negative experiences in novel feeding environments.

A conceptual model of vulnerability to care delay among women at risk for endometrial cancer

ObjectiveCare delay may allow for cancer progression prior to treatment initiation. However, in endometrial cancer, quantitative data to support this hypothesis is mixed. Factors that cuase delay prior to clinical presentation are present among Black women, however the whether and how they present among White women, and thus how they may drive racial disparity is unknown. MethodsIn this qualitative study, from June 2019 to March 2020, we conducted in-depth semi-structured interviews among 17 White women with EC (34–73 years), living in the Northwest (11), West (2), Midwest (1), Southwest (1), and Northeast (2) U.S. regions, including six with high-risk and/or advanced stage endometrial cancer. An exploratory and descriptive content analysis was performed using iterative rounds of inductive coding, case summaries, and additional interviews to confirm emergent themes, followed by synthetic analysis of themes from a prior qualitative study conducted among Black women, which we analyzed for overlap and distinctions. ResultsThere were critical points of overlap and distinction between Black and White women in four delay factors identified: menopause and endometrial cancer knowledge, prior negative healthcare experiences, prior/concurrent reproductive conditions, and healthcare provider response. Conceptualizing the care journey as a circular path demonstrates the potential for accumulation of delay that is dependent on underlying risk. ConclusionWe have identified four areas of vulnerability that are often unrecognized and difficult to assess in quantitative investigations of overall quality and co-occurring disparities in endometrial cancer care. With the addition of epidemiologic risk, we present a unified model of vulnerability to care delay in endometrial cancer that can be applied to future quantitative studies and ongoing clinical care.

91 Health care needs and missed care among youth in care in British Columbia: A population study

Abstract Primary Subject area Adolescent Medicine Background Youth in care (YIC), including those living in foster care, kinship care, group homes, and youth agreements, are a vulnerable population with many risk factors leading to a high prevalence of mental and physical health needs. YIC are recommended to have more frequent health care encounters than the general adolescent population, though it is unknown how Canadian YIC perceive whether their health care needs are sufficiently met. Objectives To assess YIC's perception of their health care needs and frequency of missed care, defined as not having received needed health care. Design/Methods A representative sample of 38,015 students in Grades 7 to 12 across British Columbia was surveyed in the 2018 BC Adolescent Health Survey (McCreary Centre Society). Questionnaire items on demographics, mental and physical health, and health care access in the past year were examined. Frequencies and cross-tabulations were performed using IBM SPSS® Complex Samples module software. Results In the past year, 1.9% of respondents reported living in government care. YIC had a mean age of 14.76 years and were 50.9% female. YIC reported worse mental health (46.5% vs. 27.6% poor/fair rating, p &amp;lt; 0.01) and physical health (36.4% vs. 19.1% poor/fair rating, p &amp;lt; 0.01) compared to non-YIC, with female and non-binary YIC most severely impacted. YIC were less likely to report not needing health care (15.6% vs. 21.3%, p &amp;lt; 0.01) and more likely to report missed care (11.2% vs. 3.1%, p &amp;lt; 0.01) compared to non-YIC. Although the rate of any health care usage was not significantly different between the groups, nearly one-quarter (23.7%) of YIC accessed health care at 3 or more locations, compared to only 16.4% of non-YIC (p &amp;lt; 0.01), with YIC accessing counsellors/psychologists and youth clinics more frequently. YIC reported more missed mental health care (32.9% vs. 18.4%, p &amp;lt; 0.01) and physical health care (21.6% vs. 7.8%, p &amp;lt; 0.01) than non-YIC, with female YIC reporting more missed care than male YIC. Non-binary YIC also reported more missed mental health care than male YIC. YIC were more likely than non-YIC to have missed mental health care due to reasons such as prior negative experiences and lack of transportation. Conclusion YIC reported worse mental and physical health and greater frequencies of missed care compared to non-YIC, especially female and non-binary YIC. Further attention is needed in addressing systemic and individual barriers to health care in this vulnerable population.