Self-report Tool Research Articles

Implementation of organizational health literacy depending on school characteristics in Germany

Abstract Background Children and adolescents are important target groups for health promotion measures to sustain a healthy upbringing. Organizational health literacy in schools is a promising environmental intervention to strengthen health literacy in school children. This study examines the relationship between school characteristics and the implementation of organizational health literacy. Methods School principals in Germany were invited to complete a 20-minute online survey between November 2022 and July 2023. An 8-item self-report tool was used to measure organizational health literacy in schools (OHLS-Q-SF) that comprehends eight different areas within schools to become health literate. A hierarchical cluster analysis was carried out to identify groups according to the composition of the socioeconomic status of the student body. Descriptive statistics, Mann-Whitney-U tests, and Kruskal-Wallis tests were performed. Results 598 school principals (73.6% female, Ø 52.3 years old) who worked at primary schools (49.1%), secondary schools (37%), and special education schools (13.9%) completed the survey. Cluster analysis revealed two groups. The first one (36.8%) contains schools with mainly students with lower socioeconomic status, and the second group (63.2%) contains schools with more students from middle or higher socioeconomic status. The socioeconomic status of students within the schools showed no significant results for any area of organizational health literacy, whereas all eight areas are more likely implemented if the schools already participate in a school health promotion program or network (p < 0.001). Conclusions Participating in a school health promotion program was associated with higher levels of implementation in all areas of organizational health literacy in schools. This finding highlights the importance of those programs. Integrating organizational health literacy into those interventions can be a beneficial approach to sustaining health literate schools. Key messages • Participating in a school health promotion program or network might facilitate schools to become health literate organizations. • In Germany, the socioeconomic status of the students within the schools is not associated with the implementation of organizational health literacy.

Health literacy and health-related outcomes among preschool educators: a cross-sectional survey

Abstract Background Given the increasing use of childcare services and the shortage of skilled workers, preschool educators are under particular pressure. Health literacy has previously been shown to be an asset for stress and well-being in school principals. Within the organizational health literacy in preschools project, the Health-Literate Preschools Survey aims to assess educators’ health literacy levels and investigate differences in health-related outcomes based on these levels. Methods Preschool educators from a Bavarian county participated in a cross-sectional online survey in February 2024. Sociodemographic information, health literacy, and health-related outcomes (well-being, exhaustion, psychosomatic complaints) were assessed using established self-report tools. Descriptive statistics and variance analyses were carried out using SPSS. Results The sample consists of N = 114 preschool educators from a Bavarian region (94.6% female, Ø 41.5 years). Of the educators, 23.7% showed adequate, 50.0% problematic, and 26.3% inadequate health literacy levels. Kruskal-Wallis H analyses indicated statistically significant differences in well-being (H(2, n = 113) = 14.200, p < 0.001), exhaustion (H(2, n = 114) = 6.098, p = 0.047), and psychosomatic complaints (H(2, n = 114) = 8.910, p = 0.012) across health literacy levels. Conclusions The survey provides first-time insights into preschool educators’ health literacy and health-related outcomes in Germany. Only one-quarter of preschool educators demonstrated adequate health literacy levels. Further, the findings confirm the link between health literacy and well-being and stress already shown for other samples. Health promotion initiatives for preschool staff should focus on strengthening educators’ health literacy, especially given their role model function for children. Key messages • This survey is the first assessment of health literacy among preschool educators, which is an important target group given their role model for young children. • Preschool educators demonstrated overall low levels of health literacy, which is associated with well-being, exhaustion, and psychosomatic complaints.

Development and validation of the chemotherapy adherence assessment scale (CAAS).

Adherence to chemotherapy regimens is crucial for achieving optimal treatment outcomes in cancer patients. However, measuring adherence remains a significant challenge. This study aimed to develop and validate a comprehensive self-report tool for assessing chemotherapy adherence. The Chemotherapy Adherence Assessment Scale (CAAS) was developed through a multi-stage process involving literature review, expert input, and pilot testing. Face validation was conducted with 23 subject experts, and content validity was assessed using the Content Validity Index (CVI). The CAAS was pilot-tested on 28 cancer patients undergoing chemotherapy. Psychometric properties were evaluated through internal consistency analysis (Cronbach's alpha) and Exploratory Factor Analysis (EFA). Face validation revealed 85% agreement among experts regarding grammar, clarity, and content. The CVI was 0.81 for individual items and 0.83 for the overall scale, indicating good content validity. Cronbach's alpha was 0.789, demonstrating strong internal consistency. The EFA yielded a robust five-factor structure, explaining 94.63% of the total variance. Most items exhibited strong factor loadings (>0.7) and high communalities (>0.7), supporting the construct validity of the CAAS. The CAAS demonstrated robust psychometric properties, including good content validity, high internal consistency, and a well-defined factor structure capturing key dimensions of chemotherapy adherence. The CAAS represents a valuable contribution to adherence assessment in oncology settings, with potential applications in clinical practice and adherence interventions.

Experiencing Cerebrovascular Diseases like Stroke and Fear of Falling: Longitudinal Results from the Survey of Health, Ageing and Retirement in Europe.

Objective: The aim of this study was to clarify the link between experiencing cerebrovascular diseases (strokes as an explicit example) and fear of falling (FOF) among middle-aged and older adults in Europe. Methods: Longitudinal data were used from wave 5 to wave 7 of the representative Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported tools were used to quantify the key variables. Fear of falling was similarly assessed using a dichotomous yes or no question, "For the past six months at least, have you been bothered by any of the health conditions on this card", with fear of falling being one of the options. It was adjusted for various sociodemographic and health-related factors. In particular, to account for unobserved heterogeneity, conditional fixed effect regressions (FE) were used. Accordingly, change in an individual's FOF status over the included waves was analysed and correlated with the reported change of all the included time-varying independent variables within the same individual, including experiencing stroke or other cerebrovascular diseases. The final analytical sample equalled n = 22.071 observations. Results: Conditional logistic FE regressions showed that the onset of a stroke or other forms of cerebrovascular disease was not associated with an increased likelihood of experiencing fear of falling (OR = 1.25, p = 0.095). However, stratified by sex, such an association was present in men (OR = 1.79, p = 0.006), though not in women (OR = 0.94, p = 0.732). Conclusions: The onset of a stroke or other cerebrovascular diseases was associated with an increased likelihood of experiencing FOF in men but not women. Efforts are required to assist older men in avoiding FOF after the onset of stroke or other cerebrovascular pathologies.

The Persian version of the fear of pain questionnaire mong Iranian post-surgery patients: a translation and psychometrics

IntroductionThe Fear of Pain Questionnaire (FOPQ) is a self-report tool designed to measure an individual’s fear of pain (FOP). While the Persian version of the FOPQ (FOPQ-P) has been developed, its validity and reliability have not yet been assessed in the Iranian context. This study aims to evaluate the psychometric properties of the FOPQ-P among Iranian patients after surgery.MethodsA methodological study was conducted in 2023 involving 400 post-surgery patients selected with a convenience sampling. The FOPQ was translated into Persian, and its psychometric properties were analyzed using network analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), as well as assessments of convergent and discriminant validity. Internal consistency was measured using Cronbach’s alpha, McDonald’s Omega, average inter-item correlation coefficient, Composite Reliability, and Maximal Reliability.ResultsThe EFA results with Promax and Kaiser Normalization rotation identified two factors that explained 54.32% of the variance, comprising seven items. The CFA confirmed the model’s validity. Both convergent and discriminant validity were established. The reliability analyses showed that Cronbach’s alpha, McDonald’s omega, composite reliability, and MaxR for all constructs were above 0.7. Additionally, the average inter-item correlation coefficient was greater than 0.5, indicating strong internal consistency and construct reliability.ConclusionThe findings suggest that the FOPQ-P possesses a valid structure and was acceptable reliability in patients cultural context of Iran post-surgery, making it a suitable instrument for measuring fear of pain in this population.

Standardised and Objective Dietary Intake Assessment Tool (SODIAT): Protocol of a dual-site dietary intervention study to integrate dietary assessment methods

Introduction Current dietary assessment methods face challenges in accurately capturing individuals’ dietary habits, undermining the efficacy of public health strategies. The ‘Standardised and Objective Dietary Intake Assessment Tool’ (SODIAT)-1 study aims to assess the effectiveness of three emerging technologies (urine and capillary blood biomarkers, and wearable camera technology) and two online self-reporting dietary assessment tools to monitor dietary intake. Methods This randomised controlled crossover trial will recruit 30 participants (aged 18-70 years and BMI of 20-30 kg/m2) from Imperial College London and the University of Reading. Exclusion criteria include recent weight change, food allergies/intolerances, following restrictive diets, certain health conditions and medication use. Interested volunteers will be directed to an online screening questionnaire via REDCap and eligible participants will attend a pre-study visit. Volunteers will consume, in a random order, two highly-controlled diets (compliant and non-compliant with UK guidelines) for four days each. Each study arm will be separated by at least one-week. During each test period, dietary intake will be monitored continuously using wearable cameras and self-recorded using eNutri (food frequency questionnaire) and Intake24 (24-hour dietary recall). Urine and capillary blood samples will be collected for biomarker analysis. Data analysis will assess the accuracy of dietary reporting across these methods using Lin’s concordance correlation coefficient. Discussion and ethical considerations This study introduces a novel approach to dietary assessment, addressing the limitations of traditional methods by reducing misreporting and enhancing inclusivity, particularly for underrepresented populations with literacy or language barriers. However, challenges persist, such as variability in biomarker data due to failure to adhere to sample storage requirements and the practicalities of continuously wearing cameras. To protect privacy, participants will be instructed to remove cameras at inappropriate times, and artificial intelligence will be used to blur all images captured apart from food.

Effectiveness of a digital single-session cognitive behavioral psychoeducational intervention in reducing public stigma associated with psychosis: A randomized controlled trial

Psychosis is a severe mental health condition that is highly stigmatized, significantly increasing the costs of mental healthcare and reducing the productivity of those affected. Due to public stigma, individuals with psychosis often delay seeking professional help, exacerbating the socioeconomic burden of their ill-health. Psychoeducation, delivered in a structured and systematic manner, has been a key part of evidence-based psychological treatments and has been gradually adopted in stigma reduction efforts. This study evaluated the effectiveness of a digital single-session cognitive behavioral psychoeducation intervention in reducing public stigma toward people with psychosis in a collectivist society through a randomized controlled trial. Stigma was assessed using standardized self-report tools at pre-intervention, post-intervention, and 1-month follow-up. A significant reduction was observed in stereotyping, prejudice, and discrimination on seven out of 10 public stigma components post-intervention. However, the desired effects were maintained for only two components at the 1-month follow-up. No significant changes were found in negative emotions, tolerance, and support from pre-intervention to post-intervention. Attribution of responsibility significantly increased after the intervention, contrary to predictions. The findings of this study provide empirical support for the short-term effectiveness of a brief cognitive behavioral psychoeducation intervention in reducing public stigma toward individuals with psychosis while highlighting the potential benefits of delivering this intervention digitally. At the same time, the limitations of individual-level interventions in sustaining long-term effects are discussed from a sociocultural perspective. This study also examined the relevance of these findings in the context of health economics.

Decoding pain: prediction under different emotional contexts through physiological signals

AbstractPain recognition is a challenging yet crucial problem. Common methods used to measure pain are based on self-reported tools; however, not every person can communicate it. Therefore, automatic pain detection methods have emerged. Since pain is related to the emotional state of an individual, this variable must be considered. Thus, this work proposes pain prediction under different emotional contexts. For this purpose, data were collected during a protocol designed for pain induction with previous emotional elicitation. Emotions were elicited through videos composed of excerpts of documentaries, horror and comedy films, while the pain was induced through a Cold Pressor Test. Physiological signals, such as electrocardiogram, electrodermal activity and surface electromyogram, were collected during the protocol. Furthermore, several questionnaires were answered and pain reports were also registered. Two problems were addressed: pain classification and estimation of the Pain Tolerance score. The algorithm with the best performance for each problem was found using only data from the neutral session and nested cross-validation strategy. Using only physiological data from the neutral session, a F1-score of 99.32% was obtained for pain recognition and a mean absolute error (MAE) of 0.29 was obtained for Pain Tolerance estimation. When considering all the emotional sessions, the physiological data were merged with scores of the Visual Analogue Scale questionnaire, achieving a F1-score of 98.60% and a MAE of 0.41, for the first and second problems, respectively. These results are promising and stress out the key role that the emotional context of the individuals plays in pain prediction.

Psychometric Properties of the Serbian Version of the Arm, Shoulder, and Hand Disability Self-Assessment Questionnaire: Criterion Validity, Construct Validity, and Internal Consistency.

Background/Objectives: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a widely employed self-report tool for assessing upper extremity function. The aim of this study was to assess the psychometric properties of the Serbian version of the DASH by determining its criterion and construct validity, as well as internal consistency. Methods: This cross-sectional study was conducted among patients with hand and wrist disabilities at the Institute for Orthopedics "Banjica", Serbia. The psychometric properties of the Serbian version of the DASH were analyzed through an examination of its factorial structure and internal consistency. The DASH consists of 30 items, 24 of which assess function, 21 of which focus on physical function and three on social/role function. The remaining six items evaluate symptoms related to pain, tingling/numbness, weakness, and stiffness. Results: A total of 297 patients were included in the study. The mean age was 47.4 ± 16.8 years, with 50.5% males. Three models were assessed to determine the reliability and validity of the questionnaire across different domains. Model 1 examined a single-factor structure. In Model 2, the items were divided into two domains: Physical Function and Psychosocial/Symptoms. In Model 3, items were subdivided into three domains: Physical Function, Symptoms, and Psychosocial. All models demonstrated an excellent internal consistency with a Cronbach's alpha > 0.9 for most domains. The values for the fit indices Tucker-Lewis index (TLI) and Comparative-Fit Index (CFI) were above their cut-off criteria of 0.9, while the Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) were below the suggested value of 0.06, indicating an excellent level of models fit. Standardized factor loadings were statistically significant (p < 0.05). Conclusions: The present study provided the evidence for the appropriate metric properties of the Serbian version of the DASH. Results support both the unidimensional and multidimensional structures of the DASH.

To Be in Pain: Pain Multidimensional Questionnaire as Reliable Tool to Evaluate Multifaceted Aspects of Pain

Background/Objectives: Pain is a multidimensional experience influenced by sensory, emotional, and cognitive factors. Traditional pain assessments often fail to capture this complexity. This study aimed to develop and validate the Pain Multidimensional Questionnaire (Pa-M-QU), a new self-report tool designed to assess pain catastrophizing, sensitivity, and coping strategies. Methods: Two independent samples of Italian-speaking participants, aged 18 and above, were recruited online. The first sample (n = 392; mean age = 29.36) was used for exploratory factor analysis (EFA), and the second sample (n = 123; mean age = 28.0) for confirmatory factor analysis (CFA). Pearson’s correlations and convergent validity analyses were conducted. Results: From an initial pool of 59 items identified through focus group discussions, 35 items were removed based on reliability analysis. The final 24-item Pa-M-QU features a three-factor structure: catastrophizing, pain sensitivity, and coping with pain. Conclusions: The Pa-M-QU offers a rapid, non-invasive assessment that captures the multidimensional nature of pain. It is a starting point to develop tools for both clinical and research settings, aiding in evaluating pain in healthy individuals and predicting acute and chronic pain disorders. Future research should focus on refining the Pa-M-QU for broader clinical applications and exploring its potential to complement or replace traditional pain assessments, thereby advancing pain management and research.

What can I do for my low back pain? The Work In Progress questionnaire!

There is growing evidence on Commitment Therapy for people with low back pain (LBP). A self-reported questionnaire is lacking which evaluates commitment by relying on the most recommended actions, the most important core outcome domains, and the most evidenced treatment options. To describe the development and psychometric validation of the Work In Progress (WIP) questionnaire. Development and psychometric validation of the WIP questionnaire in the context of people with LBP, as a means to evaluate Commitment. Outpatient facilities. People with LBP. The new instrument was created by item generation and selection. Face validity, appropriateness, acceptability and feasibility were investigated. Psychometric testing was carried out in a cross-sectional study and included: 1) exploratory factor analysis; 2) reliability by internal consistency (Cronbach's alpha) and test-retest measurement (Intra-class Correlation Coefficient, ICC<inf>2.1</inf>); and 3) construct validity by hypothesis testing the correlation of the WIP questionnaire with the Pain Catastrophizing Scale (PCS), the Oswestry Disability Index (ODI), and a pain intensity Numerical Rating Scale (NRS) (Pearson's r correlations). The WIP questionnaire was successfully developed based on international guidelines and the testing of face validity, appropriateness, acceptability and feasibility were satisfactory. The instrument was administered to 102 people with LBP (39 females, mean age of 49.7±14.6 years [range 20-80], pain median duration of 42.1 weeks [range 3-360]). Factor analysis revealed a two-factor 10-item solution (57% of explained variance). The internal consistency was good (α=0.70-85) and test-retest assessment was excellent (ICC<inf>2.1</inf>=0.91-94). Construct validity was good, as ≥75% of hypotheses were confirmed. The WIP questionnaire is a self-reported tool to evaluate commitment in persons with LBP showing satisfactory psychometric properties. It can be recommended for clinical and research purposes. This study adds original new data to the existing knowledge in the field of Commitment within the bio-psychosocial paradigm for disabled people. It is expected to contribute to the evaluative, clinical and rehabilitative approach of individuals with low back pain.

Tracking COVID-19 Infections Using Survey Data on Rapid At-Home Tests

Identifying and tracking new infections during an emerging pandemic is crucial to design and deploy interventions to protect populations and mitigate the pandemic's effects, yet it remains a challenging task. To characterize the ability of nonprobability online surveys to longitudinally estimate the number of COVID-19 infections in the population both in the presence and absence of institutionalized testing. Internet-based online nonprobability surveys were conducted among residents aged 18 years or older across 50 US states and the District of Columbia, using the PureSpectrum survey vendor, approximately every 6 weeks between June 1, 2020, and January 31, 2023, for a multiuniversity consortium-the COVID States Project. Surveys collected information on COVID-19 infections with representative state-level quotas applied to balance age, sex, race and ethnicity, and geographic distribution. The main outcomes were (1) survey-weighted estimates of new monthly confirmed COVID-19 cases in the US from January 2020 to January 2023 and (2) estimates of uncounted test-confirmed cases from February 1, 2022, to January 1, 2023. These estimates were compared with institutionally reported COVID-19 infections collected by Johns Hopkins University and wastewater viral concentrations for SARS-CoV-2 from Biobot Analytics. The survey spanned 17 waves deployed from June 1, 2020, to January 31, 2023, with a total of 408 515 responses from 306 799 respondents (mean [SD] age, 42.8 [13.0] years; 202 416 women [66.0%]). Overall, 64 946 respondents (15.9%) self-reported a test-confirmed COVID-19 infection. National survey-weighted test-confirmed COVID-19 estimates were strongly correlated with institutionally reported COVID-19 infections (Pearson correlation, r = 0.96; P < .001) from April 2020 to January 2022 (50-state correlation mean [SD] value, r = 0.88 [0.07]). This was before the government-led mass distribution of at-home rapid tests. After January 2022, correlation was diminished and no longer statistically significant (r = 0.55; P = .08; 50-state correlation mean [SD] value, r = 0.48 [0.23]). In contrast, survey COVID-19 estimates correlated highly with SARS-CoV-2 viral concentrations in wastewater both before (r = 0.92; P < .001) and after (r = 0.89; P < .001) January 2022. Institutionally reported COVID-19 cases correlated (r = 0.79; P < .001) with wastewater viral concentrations before January 2022, but poorly (r = 0.31; P = .35) after, suggesting that both survey and wastewater estimates may have better captured test-confirmed COVID-19 infections after January 2022. Consistent correlation patterns were observed at the state level. Based on national-level survey estimates, approximately 54 million COVID-19 cases were likely unaccounted for in official records between January 2022 and January 2023. This study suggests that nonprobability survey data can be used to estimate the temporal evolution of test-confirmed infections during an emerging disease outbreak. Self-reporting tools may enable government and health care officials to implement accessible and affordable at-home testing for efficient infection monitoring in the future.

Gait speed, handgrip strength, and their combination, and risk of depression in later life: Evidence from a prospective study of community-dwelling older adults

ObjectiveThis study investigated the association between gait speed, handgrip strength, and their combination, and the risk for developing clinically relevant depressive symptoms in community-dwelling older adults. MethodsA secondary analysis was conducted using data from the ASPirin in Reducing Events in the Elderly study. Participants were community-dwelling older adults in Australia and the United States of America followed for a median (interquartile range) of 3.97 (2.26) years. Baseline handgrip strength and gait speed were used as exposure variables, and their combination categories were also explored. Depression was measured using the modified Center for Epidemiological Studies Depression 10-item scale (CES-D 10). Cox regression was used to estimate Adjusted Hazard Ratios (AHR) with 95 % Confidence Intervals (CI) after adjusting for a range of potential confounders. ResultA total of 17,231 participants (55.3 % women) were included in the analysis. Slow gait and weak grip at baseline were associated with the risk of depression (AHR: 1.20; CI: 1.11–1.29 and 1.14; 1.06–1.23, respectively). The combination of the two physical performance measures was associated with a 31 % increase in the risk of depression (1.31; 1.16–1.47) and a significant dose-response association was observed for quintiles of gait and grip with depression. LimitationsAlthough the CES-D 10 is a validated scale, it is a self-reported tool rather than a clinical diagnosis of depression. ConclusionLow physical function may be a risk factor for depression in older adults. This highlights the inextricable link between the physical and mental health of older adults, which can inform potential clinical and public health prevention strategies for depression in later life.

Analysis of the Counseling Competency Scale-Revised Using Trainees’ Self-Assessment Data

Objective The Counseling Competencies Scale – Revised (CCS-R) measures counselor trainees’ therapeutic skills and dispositions and is a tool for counseling outcome research and evaluation. Prior research on the CCS-R has focused on supervisors’ ratings of counselors’ competencies. Our study evaluated the factor structure of CCS-R scores based on the counselors’ self-reports. Method The present study utilized confirmatory factor analysis to test if the factor structure of the CCS-R fits using self-reported scores on the measure. Results The data (N = 998) produced a good fit with the factor structure of the CCS-R. Conclusions The results demonstrated that the CCS-R model from prior research is consistent when the scale is used as a self-report measure. The results demonstrated evidence of construct validity when applying CCS-R as a supervisee self-report tool. Future research can look for additional ways to demonstrate the construct validity of the CCS-R across different supervisee groups.

Limitations of Self-Report Tools in Pain Evaluation of Patients With Vertebral Fractures.

Few studies have evaluated the usefulness and limitations of pain assessment using verbal communication tools for acute orthopedic diseases in older patients. The purpose of this study was to assess the rate of usage of the numerical rating scale (NRS), a verbal communication tool, and to identify the characteristics of patients in whom continuous assessment was impossible. We retrospectively examined electronic medical records of patients with acute vertebral fractures who had been admitted to our hospital between April 2018 and March 2020. Continuous pain assessment using the NRS was possible in 43.2% of hospitalized patients with the fractures. The factors preventing continuous pain assessment using the NRS were an advanced age and low Mini-Mental State Examination (MMSE) scores. Based on the receiver-operating characteristic curves, the cutoff age and MMSE score were >85.3 years and <22, respectively. Continuous NRS-based pain assessment is difficult in older adult patients or those with cognitive decline with acute vertebral fractures. In future, a simple observational assessment tool for patients with dementia should be introduced in acute medical care settings.

Assessing the deliverables of beyond-the-classroom engagement of management students: an outcome-oriented model approach

PurposeStudent engagement is a multifaceted concept that encompasses various dimensions that significantly influence students and their learning journey. This study aims to explore the extent of engagement among management students outside the confines of the classroom, specifically focusing on their engagement with the campus and community and assessing the outcomes resulting from this engagement.Design/methodology/approachThe literature review provided the basis for developing a student engagement framework, focusing on campus and community engagement and their outcomes. Established scales measured these variables through surveys administered to 386 UG and PG management students. In-depth analysis using PLS-SEM technique revealed the interplay of variables, beyond demographic and descriptive examinations.FindingsThe study found that campus and community engagement fosters a sense of responsibility. Campus engagement also cultivates long-term loyalty to the institution, while community engagement enhances social consciousness. Additionally, no significant differences in engagement levels were observed based on gender or educational level among management students.Research limitations/implicationsThe study faces limitations that need addressing for balanced understanding and future research guidance. Firstly, varying definitions across studies lead to inconsistent outcomes and comparability challenges. Secondly, accurate measurement is difficult due to reliance on self-reporting tools, which are prone to biases. Cultural and contextual differences also limit generalizability, and quantitative data alone may not capture the full picture. In India, identifying specific skills and competencies as engagement outcomes in outcome-based education is challenging, requiring precise variable identification.Practical implicationsThe study would contribute to improving the efficacy of efforts beyond the classroom engagement activities as it tests, validates, and projects them as outcome-driven by showcasing learning both as generic competencies in a broad sense and higher-order competencies in particular.Originality/valueThe literature indicates higher education institutes' activities beyond classroom teaching enhance students' campus and community relationships. This study measures these engagements' outcomes and suggests new research dimensions in student engagement.

Beyond adverse events in anesthesiology: 'unanticipated events' and strategies for improved reporting.

Patient safety in anesthesiology has advanced significantly over the past several decades. The current process of improving care is often based on studying adverse events (AEs) and near misses. However, there is a wealth of information not captured by focusing solely on these events, potentially resulting in missed opportunities for care improvements. We review terms such as AEs and nonroutine events (NREs), and introduce the concept of unanticipated events (UEs), defined as events that deviate from intended care that may/may not have been caused by error, may/may not be preventable, and may/may not have caused injury to a patient. UEs incorporate AEs in addition to many other anesthetic events not routinely tracked, allowing for trend analysis over time and the identification of additional opportunities for quality improvement. We review both automated and self-reporting tools that currently exist to capture this often-neglected wealth of data. Finally, we discuss the responsibility of quality/safety leaders for data monitoring. Consistent reporting and monitoring for trends related to UEs could allow departments to identify risks and mitigate harm before it occurs. We review various proposed methods to expand data collection, and recommend anesthesia practices pursue UE tracking through department-specific reporting interfaces.

Relationship of adaptive expertise of health professions educators with age, experience, academic rank, and their work performance during an altered academic environment

BackgroundHealth professionals and health professions educators (HPEs) worldwide were confronted by the COVID-19 pandemic, which disrupted standard practice and forced HPEs to develop creative, alternative modes of training and education. The ability of people to work successfully and efficiently in non-standard situations can be called adaptive expertise in which people quickly overcome changes in work requirements using their expert knowledge in novel ways. The objectives of the current study were to investigate how the adaptive expertise of a group of HPEs influenced perceived work performance in a non-standard situation and to see whether there were relationships between the level of adaptive expertise and academic ranking and work experience of HPEs.MethodsA descriptive, cross-sectional, single-site study was conducted using a self-reported study tool about adaptive expertise developed by Carbonell et al. (2016), and three questions were asked about participants’ perceptions of work performance, amount of work done, and teaching quality. The sample consisted of HPEs from the University of Twente, Netherlands.ResultsAmong 123 eligible participants, 40 individuals completed the survey. Kaiser-Meyer-Olkin and Bartlett’s Test of Sphericity indicated the adequacy of the sample size (KMO = 0.633, P < 0.0001). Participants were lecturers, senior lecturers, assistant professors, associate professors and full professors. The average adaptive expertise score of the sample was 4.18 ± 0.57 on a scale from 1 (low) to 5 (high). The domain and innovative skills are the principal distinct dimensions of adaptive expertise among HPEs. Professors showed higher adaptive expertise scores than the other ranks. Statistically significant correlations were found between scores of adaptive expertise and perceived work performance (r = 0.41, p < 0.05 and academic ranking (r = 0.42, p < 0.05). Adaptive expertise scores were not associated with work experience or HPEs’ age.ConclusionsOur finding of a lack of relationships between self-reported level of adaptive expertise and experience and age but significant relationships with work performance and academic ranking of HPEs suggests that adaptive expertise is not auto-generated or acquired with seniority and experience but is a ‘mastery’ that should be developed deliberately.

Childhood trauma and suicide risk: Investigating the role of adult attachment

BackgroundSuicide is a leading cause of death globally and a serious public health concern. Childhood trauma has been found to be associated with adult suicide vulnerability. Recent research has turned attention to investigating the role of attachment in the context of the childhood trauma-adult suicide relationship. The current study investigated for the first time whether attachment influences and moderates the childhood trauma-suicidality relationship, using a daily diary design, in the general population. Methods481 participants completed questionnaires assessing experiences of childhood trauma, attachment patterns, and history of suicidality. 243 participants continued to a daily diary phase where measures of daily stress, defeat and entrapment were completed for 7 consecutive days. ResultsHigher levels of childhood trauma were associated with a history of suicide ideation and attempt and also higher levels of daily defeat, entrapment and stress during the 7 day study. Similarly, higher levels of attachment anxiety and avoidance were associated with a history of suicide ideation and attempt together with higher levels of daily defeat, entrapment and stress. However, the effects of childhood trauma on suicide history and on daily suicide vulnerability factors were not moderated by attachment anxiety or avoidance. LimitationsThe measure of childhood trauma was a retrospective self-report tool that may be influenced by memory biases. ConclusionsChildhood trauma and insecure attachment are implicated in adult suicide risk. Interventions aimed at mitigating the negative effects of childhood trauma and insecure attachment should also incorporate components that target modifiable risk factors such as defeat, entrapment and stress.

The Relevance of Hypersexuality and Impulsivity in Different Groups of Treatment-Seekers With and Without (Exclusive) Pedophilia.

Hypersexuality and impulsivity are regarded as risk factors for sexual offending against children. Studies exploring these factors in undetected men who offended or are at risk of offending are rare. This study aims to investigate hypersexuality and impulsivity in treatment-seeking men with and without a diagnosis of (exclusive) pedophilia who committed child sexual abuse (CSA), consumed child sexual abuse images (CSAI), or feel at risk of offending sexually. Data were obtained from three child abuse prevention projects in Bamberg, Germany. We employed self-report (BIS-11, HBI), objective measures (TSO), and risk assessment tools (STABLE-2007). We computed Bayesian ordinal logit and binomial generalized linear models to explore differences between groups and to predict lifetime CSA and CSAI. Hypersexuality scores were particularly pronounced in patients with exclusive and non-exclusive pedophilia. Patients without pedophilia scored similarly to nonclinical samples. Impulsivity measures did not consistently differ between groups. We could not predict lifetime CSA and CSAI using impulsivity and hypersexuality measures. Sexual rather than general impulsivity seems to be an issue in men with pedophilia. The motivation to offend in patients without pedophilia is discussed.