Session Participants Research Articles

Augmenting project ECHO for opioid use disorder with data-informed quality improvement

BackgroundNational opioid-related overdose fatalities totaled 650,000 from 1999 to 2021. Some of the highest rates occurred in New Hampshire, where 40% of the population lives rurally. Medications for opioid use disorder (MOUD; methadone, buprenorphine, and naltrexone) have demonstrated effectiveness in reducing opioid overdose and mortality. Methadone access barriers disproportionally impact rural areas and naltrexone uptake has been limited. Buprenorphine availability has increased and relaxed regulations reduces barriers in general medical settings common in rural areas. Barriers to prescribing buprenorphine include lack of confidence, inadequate training, and lack of access to experts. To address these barriers, learning collaboratives have trained clinics on best-practice performance data collection to inform quality improvement (QI). This project sought to explore the feasibility of training clinics to collect performance data and initiate QI alongside clinics’ participation in a Project ECHO virtual collaborative for buprenorphine providers.MethodsEighteen New Hampshire clinics participating in a Project ECHO were offered a supplemental project exploring the feasibility of performance data collection to inform QI targeting increased alignment with best practice. Feasibility was assessed descriptively, through each clinic’s participation in training sessions, data collection, and QI initiatives. An end-of-project survey was conducted to understand clinic staff perceptions of how useful and acceptable they found the program.ResultsFive of the eighteen health care clinics that participated in the Project ECHO joined the training project, four of which served rural communities in New Hampshire. All five clinics met the criteria for engagement, as each clinic attended at least one training session, submitted at least one month of performance data, and completed at least one QI initiative. Survey results showed that while clinic staff perceived the training and data collection to be useful, there were several barriers to collecting the data, including lack of staff time, and difficulty standardizing documentation within the clinic electronic health record.ConclusionsResults suggest that training clinics to monitor their performance and base QI initiatives on data has potential to impact clinical best practice. While data collection was inconsistent, clinics completed several data-informed QI initiatives, indicating that smaller scale data collection might be more attainable.

Temporal dynamics of electroencephalographic microstates during sustained pain.

Brain dynamics can be modeled by a sequence of transient, nonoverlapping patterns of quasi-stable electrical potentials named "microstates." While electroencephalographic (EEG) microstates among patients with chronic pain remained inconsistent in the literature, this study characterizes the temporal dynamics of EEG microstates among healthy individuals during experimental sustained pain. We applied capsaicin (pain condition) or control (no-pain condition) cream to 58 healthy participants in different sessions and recorded resting-state EEG 15min after application. We identified 4 canonical microstates (A-D) that are related to auditory, visual, salience, and attentional networks. Microstate C had less occurrence, as were bidirectional transitions between microstate C and microstates A and B during sustained pain. In contrast, sustained pain was associated with more frequent and longer duration of microsite D, as well as more bidirectional transitions between microstate D and microstates A and B. Microstate D duration positively correlated with intensity of ongoing pain. Sustained pain improved global integration within microstate C functional network, but weakened global integration and efficiency within microstate D functional network. These results suggest that sustained pain leads to an imbalance between processes that load on saliency (microstate C) and processes related to switching and reorientation of attention (microstate D).

The remote exercise SWEDEHEART study–Rationale and design of a multicenter registry-based cluster randomized crossover clinical trial (RRCT)

Despite proven benefits of exercise-based cardiac rehabilitation (EBCR), few patients with myocardial infarction (MI) participate in and complete these programs. The Remote Exercise SWEDEHEART study is a large multicenter registry-based cluster randomized crossover clinical trial with a planned enrollment of 1500 patients with a recent MI. Patients at intervention centers will be offered supervised EBCR, either delivered remotely, center-based or as a combination of both modes, as self-preferred choice. At control centers, patients will be offered supervised center-based EBCR, only. The duration of each time period (intervention/control) for each center will be 15 months and then cross-over occurs. The primary aim is to evaluate if remotely delivered EBCR, offered as an alternative to center-based EBCR, can increase participation in EBCR sessions. The proportion completers in each group will be presented in a supportive responder analysis. The key secondary aim is to investigate if remote EBCR is as least as effective as center-based EBCR, in terms of physical fitness and patient-reported outcome measures. Follow-up of major adverse cardiovascular events (cardiovascular- and all-cause mortality, recurrent hospitalization for acute coronary syndrome, heart failure hospitalization, stroke, and coronary revascularization) will be performed at 1 and 3 years. Safety monitoring of serious adverse events will be registered, and a cost-effectiveness analysis will be conducted to estimate the cost per quality-adjusted life-year (QALY) associated with the intervention compared with control. The cluster randomized crossover clinical trial Remote Exercise SWEDEHEART study is evaluating if participation in EBCR sessions can be increased, which may contribute to health benefits both on a group level and for individual patients including a more equal access to health care. The study is registered at ClinicalTrials.gov (Identifier: NCT04260958).

HIV Treatment and Mental Health Outcomes Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV in a Pilot Multicomponent Intervention in Guatemala City.

Globally, gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by HIV, but few interventions address mental health and HIV outcomes among GBMSM living with HIV. The purpose of this study was to pilot a multicomponent intervention, integrating emotional well-being (EW) and health navigation for GBMSM living with HIV in Guatemala City. We implemented a 12-month intervention, including a four-session EW component and a health navigation component among newly diagnosed and reengaged GBMSM with HIV (n = 112). We conducted socio-behavioral surveys at baseline and endline to measure patient characteristics and HIV, and mental health outcomes as well as viral load testing. We documented participation in EW sessions and used a smartphone application to track navigation mode, frequency, and content. Using first-difference estimation modeling, we assessed associations between participation in EW and navigation and mental health (depression and anxiety symptoms) and HIV outcomes (HIV treatment adherence, viral suppression). Acceptability was high for EW (86%) and navigation (99%). During the intervention, viral suppression increased significantly and anxiety and depression decreased significantly. Participation in EW sessions and greater navigation frequency and duration were associated with being suppressed, whereas higher emotional navigator support was associated with being unsuppressed. Participation in EW sessions was associated with reduced anxiety. Findings suggest that multicomponent interventions integrating individual counseling and navigation may promote EW and sustained viral suppression. Future intervention research is needed to confirm whether HIV and mental health outcomes are attributable to the intervention and to assess mechanisms of influence.

Implementing case-based collaborative learning curriculum via webinar in internal medicine residency training: A single-center experience.

This study aimed to investigate the effects of the Case-based collaborative learning (CBCL) curriculum in webinar format on internal medicine residents' knowledge covering cardiologic topics and their attitudes toward the CBCL teaching module. CBCL is a novel small-group approach, that incorporates elements of problem-based learning and case-based learning, and it has shown to improve medical students' knowledge mastery. However, few studies have explored its applicability for internal medicine residents, especially in the webinar format. This prospective cohort study included internal medicine residents in a residency program in Beijing, China. Eight CBCL sessions in webinar format covering cardiologic topics were delivered to them from February to April 2020. Pre-session reading materials included textbook and guidelines published by the academic societies. Multiple-choice questions were delivered to assess participants' knowledge before and after the sessions. Changes in participants' knowledge were determined using the paired t test to compare mean values. In addition, surveys based on 5-point Likert scale scores assessed satisfaction at the end of the second and eighth sessions. The Wilcoxon signed-rank test was used to identify any potential satisfaction improvement. In total, 9 internal medicine residents participated in the study, of whom 33.3% were male, and the overall rate of participation in CBCL sessions in webinar format was 94.4%. The mean scores of 50 multiple-choice questions were 68.0 ± 12.3 and 75.1 ± 9.9 in the pre- and post-curriculum assessments (P = .029). In the first survey performed at the second week, 5 (55.6%) residents chose "like" or "extremely like" in overall satisfaction, "neutral" by 3 (33.3%) residents and "dislike" by 1 (11.1%) resident. In the second survey, only 1 (11.1%) resident selected a neutral reply in satisfactory assessment, and the other 8 (88.9%) residents selected either "like" or "extremely like" choices. Compared with the results of the first survey, the overall satisfaction rate significantly improved (P = .031). Implementing the CBCL sessions in webinar format for cardiology residents was resulted in the improved knowledge mastery and a high acceptance rate.

Knowledge transmission in the second part of careers: does formal training matter?

PurposeThis paper examines to what extent formal training targeted to workers aged 45 and over could enhance their knowledge transmission activities specifically in changing work environments. This is a key issue for human resources practitioners. Allowing older workers to keep on interacting with their colleagues and transmitting their knowledge acquired through experience reduces the risk for firms of losing critical knowledge assets.Design/methodology/approachThe authors use French-matched employer–employee data to estimate the effect of participation in training sessions intended to support change on the probability for workers aged 45–59 of frequently showing work practices to their co-workers. To account for selection bias in training, the authors reduce the group of untrained workers to those who wanted to attend a training session but had to cancel their participation for exogenous reasons. Leuven and Oosterbeek (2008) show that this is a valid approximation of a random assignment to training.FindingsTraining with the intention to support change for workers aged 45 and more significantly increases knowledge transmission for training participants. This effect is not strictly related to a supervising role as it is significant for workers without subordinates; it holds when the authors address the selection bias in training by narrowing down the comparison group. When training comes as a response to mitigate the potential negative effects of technological or organizational changes in the work environment, it helps workers aged 45–59 maintain their contribution to the knowledge base of the production.Research limitations/implicationsOur findings suggest that two main aspects have to be borne in mind when assessing the effectiveness of training for older workers. First, the reasons for training must be carefully considered, especially if it occurs in response to technological or organizational change in the workplace. Second, the continuation of interactions between older workers and their co-workers must be factored. If the public debate acknowledges that employee learning and development is critical in times of structural change and crisis, the outcomes of knowledge transmission within workplaces in terms of job satisfaction, turnover intentions, productivity or innovation, which the authors do not cover in this paper, deserve further investigations. In particular, the authors believe that studying how the training that supports technological and organizational change influences the relationship between age diversity and firm productivity is a promising avenue for future research.Practical implicationsThe implication of this article for human resource managers is that there may be a substantial cost to not updating the skills of older workers after technological or organizational change. Indeed, it is likely that a large proportion of jobs will only be partially automated, which implies that while some tasks will disappear, rendering the corresponding skills obsolete, others will persist and the skills associated with them will remain useful to organizations. If older workers are excluded from their work collectives after these changes, because their skills have not been updated through training, the knowledge from their accumulated experience that remains valuable will be irrevocably lost when they retire.Originality/valueThis study sheds a new light on the effectiveness of older workers’ training. Some contributions argue that training for older workers is not very effective because it has no significant effect on employment duration, earnings or relative productivity. The authors show that specific types of training to update skills after a technological or organizational change allow older workers to keep interacting with their co-workers and pass on their knowledge gained through experience, thereby reducing the risk for firms of losing critical knowledge assets.

Integrating motivated goal achievement in maritime simulator training

The application of cloud-based simulators has increasing momentum in maritime education and training as a virtual platform for supplementing professional training with task-specific simulation-based learning. Congruent with traditional simulator technology and training methods, this new condition allows for asynchronous and unlimited simulator access where participation in training sessions is at the discretion of the trainee. Furthermore, this provides a learning environment that can have adaptive features to the trainee characteristics with selectable complexity levels, automated feedback, and automated performance assessment. With the advent of this emerging training technology, the organization of how training is deployed, the new roles and expectations for trainees and instructors, and the application of new data-driven analytics are not yet well understood. This paper employs a quasi-experimental study to investigate trainee motivation, personality traits, and task performance using a novel training design. The study was administered remotely to a sample (N = 18) of first-year maritime students who first completed a knowledge acquisition phase before conducting a skill acquisition phase with repeated simulator training of a procedural task, and finally a performance assessment of the simulator scenario. Data was collected from (1) a multiple-choice knowledge test, (2) a short-scaled Big Five Inventory, (3) the Motivated Strategies for Learning Questionnaire, and (4) programmed simulator metrics. Results indicate that Extraversion correlates with motivation and self-efficacy predicts training performance. No significant relationship between prior knowledge and the training performance was found. The results can provide knowledge for implementation and delivery of remote simulator training in maritime education and training, as well as other fields.

Effectiveness of family-centred sexual health education and HPV self-sampling in promoting cervical cancer screening among hard-to-reach indian women in rural and tribal areas: a community-based pilot study

BackgroundWhile cervical cancer deaths have declined steeply in high-income countries due to the widespread use of the Papanicolaou test (Pap test), the same trend has not emerged in low or middle-income countries (LMICs). Access to screening in LMICs like India is limited due to barriers such as limited healthcare infrastructures, lack of sexual health education, and stigma demarcating sexually transmitted infections (STIs). HPV self-sampling (HPV-SS), a woman–centered and at-home method for screening, can be utilized as a unique screening tool to overcome some of these barriers. Our study examined the effectiveness of HPV-SS, supported by family-centred arts-based sexual health literacy on the uptake of cervical cancer screening among hard-to-reach women in rural and remote areas in India.MethodsOur community-based mixed methods pilot study recruited 240 participants (120 women and 120 male partners or family members) through female Accredited Social Health Activists (ASHA) across 3 Indian villages of Shirgoan, Khodala, and Jamsar in Palghar district. Inclusion criteria included women ages 30–69 who were under or never screened (UNS) and their male partners/family members aged 18 or over. Knowledge and attitudes about cervical cancer and screening and their perceived stigma surrounding STI were assessed using validated scales prior to and after attending a 2-hour arts-based sexual health education (SHE). In addition, participants’ uptake of cervical cancer screening was assessed after attendance in SHE.FindingsResults revealed significant improvement in knowledge and attitudes about cervical cancer and screening, and a reduction in the STI stigma after participation in SHE sessions (overall mean difference in Knowledge: z = 6.1 ± 2.4, P < 0.001; attitudes about Pap-test and VIA: z = 2.2 ± 8.4, P < 0.001 and z = 2.9 ± 8.2, P < 0.001; STI stigma: z = 2.8 ± 12.4, P < 0.001). 118 out of 120 female participants chose to be screened and 115 opted for HPV-SS.ConclusionsThe implementation of HPV-SS coupled with family-centered arts-based and culturally appropriate SHE is highly promising in promoting cervical cancer screening among hard-to-reach women. Evidence from our study can be used to advance public health policies and inform the scale-up of similar initiatives in other villages and states across rural India and other LMICs.

Editor's notes: FAIR BOT. As metadata is data is metadata is data ...

Editor's notes: FAIR BOT. As metadata is data is metadata is data ...

Motivational Interviewing Counseling to Increase Endocrine Therapy Adherence in Diverse Patients

Oral endocrine therapy (ET) is an inexpensive and effective therapy for hormone receptor-positive (HR+) breast cancer that prevents recurrence but relies upon long-term adherence for up to ten years. More than 80% of breast cancer patients have an HR+ phenotype and are candidates for ET, but approximately half discontinue or become non-adherent by five years. ET underuse is more prevalent in Black and young (<50 yrs) women, which may contribute to outcome disparities in these groups. The objective of this study was to evaluate the feasibility, acceptability, and utility of a patient-centered counseling intervention to enhance ET adherence, with a focus on the needs of Black and younger women. We conducted a single-arm pilot study of a twelve-month motivational interviewing (MI) intervention consisting of five MI counseling sessions, an interactive workbook, a resource guide, and an educational video developed and revised with iterative patient and clinician input. The eligible participants were >18 years old, English speaking, and with stage I-III HR+ breast cancer. Participants were recruited across a large academic medical center and four community sites. Feasibility and acceptability were assessed by measures of participant recruitment, retention, session participation, and patient-reported satisfaction. ET adherence at 12 months was assessed by self-report and medication event monitoring system (MEMS) caps using a continuous measure of the proportion of days covered (PDC) as well as a dichotomous measure of the optimal adherence, defined as >80% PDC. Forty-two women initiated the intervention, of whom thirty-five participants (83%) completed outcome assessments at 12 months, including thirteen Black and twenty-two non-Black participants. The average participant age was 54.8 years (range: 25-73). Overall, 97% completed at least three MI sessions and 83% completed at least four sessions. Participant retention and satisfaction were high, particularly among Black women. Self-reported adherence at 12 months was 88% overall (100% in Black women and 81% in non-Black women). The majority of women also achieved 80% of days adherent using MEMS caps, with a greater adherence in Black women. This study demonstrates the feasibility, acceptability, and early promise of the effectiveness of an MI counseling-based intervention to promote ET adherence and prevent breast cancer recurrence in diverse populations.

Moral Elevation Online Intervention for Veterans Experiencing Distress Related to Posttraumatic Stress Disorder and Moral Injury (MOVED): Pilot Trial of a 4-Week Positive Psychology Web-Based Intervention

Veterans with posttraumatic stress disorder (PTSD) and moral injury can encounter several barriers to treatment, including limited access to care and low engagement with therapy. Furthermore, most treatment approaches focus on alleviating distress rather than cultivating positive experiences that could facilitate trauma recovery. A potential way to address these issues is through moral elevation: feeling uplifted and inspired by others' virtuous actions. This study aimed to examine the feasibility and acceptability of a novel, web-based moral elevation intervention for veterans with PTSD symptoms and moral injury distress (Moral Elevation Online Intervention for Veterans Experiencing Distress Related to PTSD and Moral Injury [MOVED]). This mixed methods study also examined potential changes in PTSD symptoms, moral injury distress, quality of life, and prosocial behavior. In this pilot trial, 48 participants were randomized to a MOVED or control condition (24 participants per condition). Both conditions included 8 sessions and lasted 1 month. The MOVED intervention and all survey components across both conditions were administered online. Participants completed self-report measures that assessed PTSD symptoms, moral injury distress, quality of life, and prosocial behavior at baseline and follow-up. Veterans in the MOVED condition also completed individual qualitative interviews at follow-up. We coded qualitative responses to interviews and identified emergent themes. Findings suggest the MOVED intervention was largely feasible, with evidence for moderate-to-high levels of participation, engagement, and retention in MOVED sessions. Both quantitative and qualitative results suggest veterans found MOVED to be acceptable and satisfactory at the overall treatment level. Furthermore, participants reported high scores for helpfulness and engagement at the session level. Veterans who completed MOVED reported large within-person decreases in PTSD symptoms (Cohen d=1.44), approximately twice that of veterans in the control condition (Cohen d=0.78). Those in MOVED also reported medium-sized increases in physical (Cohen d=0.71) and psychological domains of quality of life (Cohen d=0.74), compared with no meaningful changes in the control condition. Unexpectedly, MOVED veterans reported no decrease in moral injury distress, whereas veterans in the control condition endorsed a medium-sized decrease in the total score. There were no changes in prosociality for either condition. Qualitative feedback further supported high levels of perceived acceptability and satisfaction and positive treatment outcomes across a range of domains, including behaviors, cognitions, emotions, and social functioning. Veterans also recommended adaptations to enhance engagement and maximize the impact of intervention content. Overall, findings indicate that veterans with PTSD and moral injury distress were interested in an intervention based on exposure to and engagement with experiences of moral elevation. After further research and refinement guided by future trials, veterans may benefit from this novel approach, which may enhance treatment outcomes and increase treatment accessibility for those in need of additional trauma-focused care.

Effects of the ECHO tele-mentoring program on HIV/TB service delivery in health facilities in Zambia: a mixed-methods, retrospective program evaluation

BackgroundIn the quest to ensure that quality healthcare is provided to all citizens through building healthcare worker capacity and extending reach for expert services, Zambia’s Ministry of Health (MoH) in collaboration with its partners PEPFAR through the CDC and HRSA, began to implement the Extension for Community Healthcare Outcomes (ECHO) tele-mentoring program across the country through the Health Workers for the 21st Century (HW21) Project and University Teaching Hospital HIV/AIDS Project (UTH-HAP). This ECHO tele-mentoring approach was deemed pivotal in helping to improve the human immunodeficiency virus (HIV) service delivery capacity of health care workers.MethodThe study used a mixed method, retrospective program evaluation to examine ECHO participants’ performance in the management of HIV/AIDS patients in all the 10 provinces of Zambia.Case presentationA phenomenological design was applied in order to elicit common experiences of ECHO users through focus group discussions using semi-structured facilitation guides in four provinces (Eastern, Lusaka, Southern and Western) implementing ECHO tele-mentoring approach. These provinces were purposively selected for this study. From which, only participants that had a monthly frequency of ECHO attendance of ten (10) and above were selected. The participants were purposively selected based on the type of cadre as well as facility type so that the final sample consisted of Doctors, Nurses, Midwives, Clinical Officers, Medical Licentiates, Pharmacy and Laboratory Personnel. All sessions were audio recorded and transcribed by the data collectors. A thematic content analysis approach was adopted for analyzing content of the interview's transcripts.ResultsEnhanced knowledge and skills of participants on HIV/TB improved by 46/70 (65.7%) in all provinces, while 47/70 (67.1%) of the participants reported that ECHO improved their clinical practice. Further, 12/70 (17.1%) of participants in all provinces reported that presenter/presentation characteristics facilitated ECHO implementation and participation. While, 15/70(21.4%) of the participants reported that ownership of the program had contributed to ECHO implementation and participation. Coordination, another enabler accounted for 14/70 (20%). Inclusiveness was reported as a barrier by 16/70 (22.8%) of the participants while 6/70 (8.6%) of them reported attitudes as a barrier (8.6%) to ECHO participation. In addition, 34/70 (48.6%) reported poor connectivity as a barrier to ECHO implementation and participation while 8/70 (11.5%) of the participants reported that the lack of ownership of the ECHO program was a barrier. 22/70 (31.4%) reported that increased workload was also a barrier to the program’s implementation.ConclusionConsistent with its logical pathway model, healthcare providers’ participation in ECHO sessions and onsite mentorship contributed to improved knowledge on HIV/TB among health care providers and patient health outcomes. In addition, barriers to ECHO implementation were intrinsic to the program its self, such as coordination, presenter and presentation characteristics other barriers were extrinsic to the program such as poor connectivity, poor infrastructure in health facilities and negative attitudes towards ECHO. Improving on intrinsic factors and mitigating extrinsic factors may help improve ECHO outcomes and scale-up plans.

Testosterone administration enhances the expectation and perception of painful and non-painful somatosensory stimuli

The influence of testosterone on pain perception remains inconsistent in the literature. This randomized, placebo-controlled, double-blind, crossover study investigated the effect of testosterone administration on perception and expectation of electrocutaneous stimulus. Thirty healthy male participants received a single dose of testosterone in one session and a placebo in the other session. For each session, they completed a pain-rating task in which a predictability cue was inserted before a painful or non-painful electocutaneous stimulus delivery, while neural activity was simultaneously recorded by a 64-channel electroencephalographic (EEG) system. Expected and perceived pain ratings, as well as event-related potentials (ERPs) to electocutaneous stimuli and prestimulus EEG oscillatory activities while expecting upcoming electocutaneous stimuli were comprehensively compared between testosterone and placebo sessions. Compared with the placebo session, participants in the testosterone session reported greater pain rating and exhibited greater amplitude of N1 component on ERPs when perceiving both painful and non-painful electrocutaneous stimuli. Mediation analysis revealed that testosterone enhanced the pain-intensity ratings via the N1 response to the electrocutaneous stimulus. Upon viewing the predictability cues after testosterone administration, expected pain intensity increased and spontaneous low-frequency α-oscillation power in the frontal region decreased. These results provide evidence that testosterone enhanced perception and expectation of somatosensory events, and that this was a general effect rather than pain-specific. A plausible explanation for these findings is that testosterone acts to increase vigilance and sustained attention levels, as evidenced by the decreased α-oscillation power. Thus, our findings support a causal role for testosterone in heightening the biological salience of incoming somatosensory information.

Development of a Medicare plan dashboard to promote health equity.

To describe a multistage process of designing and evaluating a dashboard that presents data on how equitably health plans provide care for their members. We designed a dashboard for presenting summative and finer-grained data to health plans for characterizing how well plans are serving individuals who belong to racial/ethnic minority groups and individuals with low income. The data presented in the dashboard were based on CMS' Health Equity Summary Score (HESS) for Medicare Advantage plans. Interviews and listening sessions were conducted with health plan representatives and other stakeholders to assess understanding, perceived usefulness, and interpretability of HESS data. Usability testing was conducted with individuals familiar with quality measurement and reporting to evaluate dashboard design efficiency. Listening session participants understood the purpose of the HESS and expressed a desire for this type of information. Usability testing revealed a need to improve dashboard navigability and to streamline content. The HESS dashboard is a potentially useful tool for presenting data on health equity to health plans. The multistage process of continual testing and improvement used to develop the dashboard could be a model for targeting and deciding upon quality improvement efforts in the domain of health equity.

The impact of an organizational-level mindfulness-based intervention on workplace social capital and psychological safety: A qualitative content analysis.

Through the past decades, the mental health of the European population has been continuously declining. Social relations in various spheres of life, including workplace settings, have been shown to impact mental health. Mindfulness-based stress reduction (MBSR) has been found effective in enhancing well-being, and reducing perceived stress, and symptoms of depression and anxiety. Research into mindfulness-based interventions (MBIs) in workplace settings has shown that these interventions may positively affect workplace outcomes, such as interpersonal relations. However, research regarding the organizational impacts of MBIs is still nascent. The objective of this study was to investigate how an organizational-level mindfulness-based intervention (MBI) including a workplace-adapted MBSR programme may impact workplace social capital and psychological safety. Four small and medium-sized private companies were included in this study, representing 368 employees and managers. The intervention consisted of three steps: 1. Mandatory participation in introductory sessions on mental health and mindfulness, 2. Voluntary participation in a 10-week workplace-adapted MBSR programme, and 3. A workshop for selected employee representatives and managers on further implementation of mindfulness. Data was collected using pre and post-intervention focus group interviews. In total, 27 interviews including 76 respondents were conducted. Verbatim transcription was performed. Data was analyzed using deductive content analysis with theoretical frameworks for social capital and psychological safety. The analysis resulted in three main categories: 1. Social capital (1.1. bonding social capital, 1.2. bridging social capital, 1.3. linking social capital), 2. Psychological safety, and 3. Emergent theme: The role of lockdown on the perceived organizational impact of a workplace MBI. The greatest impact was found relating to the bridging social capital, i.e., social capital between departments, and psychological safety among colleagues at the same level of employment. The results indicate that company participation in this organizational-level MBI including a workplace-adapted MBSR programme may positively impact social relations at work, especially the bridging social capital and psychological safety between colleagues at the same level of employment. These results may have been influenced by lockdowns due to the COVID-19 pandemic.

Acceptability, feasibility, and effectiveness of internet-based emotion-focused cognitive behavior therapy with husband participation for Iranian pregnant women with anxiety disorder

ABSTRACT Background Anxiety disorders during pregnancy are associated with poor pregnancy outcomes. Internet-based emotion-focused cognitive behavior therapy (IECBT) with husband participation approach is an alternative treatment for treatment of mental disorders in pregnant women. The study aimed to compare the acceptability, feasibility, and effectiveness of IECBT with husband participation. Method In a quasi-experimental study 68 pregnant women diagnosed with anxiety disorders were divided into IECBT with husband participation (n = 34) and IECBT alone (n = 34) and completed the Brief Symptom Inventory (BSI-18) Client Satisfaction Questionnaire (CSQ-8) and System usability scale (SUS) at baseline and eight weeks after the trial. Findings Results showed that acceptability and feasibility of CO-IECBT among women and their spouses were positive. Acceptability with indices, namely women’s satisfaction and average participation in sessions, was greater among IECBT with husband participation participants than among participants in IECBT alone. Feasibility was high for both therapy methods, and no significant difference was observed between the two groups. Conclusion This study suggests that both IECBT with husband participation and IECBT alone are effective treatments for mitigating psychological distress in anxious pregnant women.

Skin temperature changes in response to body ownership modulation vary according to the side of stimulation

A growing body of research has shown that a unilateral alteration in the sense of limb ownership is associated with the cooling of a limb's temperature. However, the recent emergence of contradictory results calls into question the existence of a relationship between this physiological reaction and the sense of body ownership. In the light of evidence that the malleability of the sense of hand ownership differs based on the preferential motor use of the hand to which the illusion is applied, one might observe the same lateralised pattern in the skin temperature cooling. In particular, if skin temperature change is a signature of body ownership, we expected a stronger illusion and reduction in skin temperature when altering ownership alteration of the left hand compared to the right hand in dextral individuals. To test this hypothesis, we selectively perturbated body ownership of the left or right hand in 24 healthy participants in different experimental sessions using the Mirror-Box Illusion (MBI) paradigm. Participants were asked to tap synchronously or asynchronously at a constant rhythm with their left and right index fingers against two parallel mirrors while looking at their reflected right/left hand. Skin temperature was measured before and after each MBI application, and explicit judgments of ownership and proprioceptive drift were collected. The results showed a consistent cooling of the hand's temperature only when the illusion was performed on the left hand. Proprioceptive drift exhibited the same pattern. In contrast, the explicit judgment of ownership of the reflected hand was similar across the two hands. These data provide evidence in favor of a specific laterality effect of the physiological response to an induced alteration of body part ownership. Moreover, they highlight the possibility of a direct link between proprioception and skin temperature.

Effect of Strength and Flexibility Training Combined with Skill Practice on Performance Related Variables of Female Badminton Players

The purpose of the study was to determine the effect of strength and flexibility training combined with skill practice on performance related variables of female Badminton players. The subjects of the study were fifty female Badminton players who were regularly training at the S. N Badminton Academy, Rohini, Sector 24, Perch Sports Academy, Rohini, Sector 7 and Gurgaon Sports Badminton Academy, Rohini, 9 for a period of six weeks. The subjects were classified into two groups i.e. experimental group (N=25) and control group (N=25). The experimental group trained with strength and flexibility exercises combined with regular participation in the Badminton skill training sessions whereas the control group regularly participated in only Badminton skill training sessions. Application of analysis of variance followed by LSD post hoc test reveals that the Experimental group which trained with strength and flexibility exercises combined with regular skill training sessions attained significantly superior performance as compared to control group which regularly practiced skills of Badminton.

Creating and promoting Geriatric Addictions Knowledge in Canada

AbstractIn this session we will discuss three successful programs featuring innovative education for geriatric psychiatry residents including Geriatric Addiction Guidelines, Geriatric Addiction needs assessment for ECHO rounds and curriculum development and evaluation for geriatric psychiatry residents. These the ability increase participants capacity to support Older Adults with Substance Use disorders.The New Canadian Guidelines for Substance Use Disorders in Older adultsIn this session participants will become familiar with the key recommendations for four the newly launched Canadian Guidelines for Substance Use disorders in Older Adults. The guidelines include Alcohol, Benzodiazepine/ BZRA's, Cannabis and Opiate Use Disorders. The guidelines were developed by a panel of Canadian Interdisciplinary experts. We will discuss the development of the guidelines as well as the key recommendations.Creating a comprehensive addictions curriculum in a geriatric psychiatrysubspecialitytraining program BackgroundSubstance use disorders (SUDs) in older adults, arising from both prescription medications and recreational substances, are often underdiagnosed and undertreated. Barriers to detection of SUDs in this age group include non-specific signs, ageism, lack of research and age-appropriate screening tools, and limited education to health care practitioners and trainees. While Canadian treatment guidelines have recently emerged to aid assessment and management of SUDs in older adults, formal training on this subject in residency programs is minimal. MethodsWe created a first-of-its-kind comprehensive geriatric addictions curriculum in a geriatric psychiatry subspeciality training program in Canada. Informed by a needs assessment, and powered by a multidisciplinary expert faculty, we created a curriculum using a combination of didactic and case-based learning. Course content incudes common substances of misuse, concurrent disorders, medical withdrawal, pharmacologic and non-pharmacologic treatments, and capacity and legal issues. We will conduct pre- and post-intervention assessments of knowledge, skills, and confidence. ResultsFeedback from the September 2022 inaugural curriculum will be presentedLearning Needs Assessment for Project ECHO Ontario Mental Health at CAMH for Geriatric Addiction Rounds an interdisciplinary collaborative approach BackgroundGeriatric Addictions rounds is a collaboration 4 agencies throughout Ontario and supported through Behavioral supports Ontario, CAMH, Baycrest, CMHAWW, & St Joseph's Health Care Guelph. The rounds are held monthly via Zoom and cover a variety of topics related to older adults and substance use disorders. The attendance at rounds has become increasingly popular with representation from multiple disciplines with expressions of interest in case-based learning. MethodsAn online survey of participants from the province was conducted. The survey participants identified the need to learn more about this at-risk population. Education sessions with a case-based learning is a need in the province of Ontario was identified as a learning need for all participants. ResultsA community of practice to help inform geriatric addictions with expressed interest in understanding diversity issues with Older Adult Indigenous, 2SLGTBQ+ and Black with Substance Use Disorders; and ways to support caregivers of Older Adults was identified. This information will be used to move forward with an application for ECHO Geriatric Addition Rounds.

Beyond the bean: Analyzing diversified farming, food security, dietary diversity, and gender in Nicaragua’s smallholders coffee cooperatives

ABSTRACT Diversification is key for agroecological transformations, but little is known about how it relates to farmers’ dietary diversity and food sovereignty. Our team and coffee cooperative staff conducted a participatory action research mixed methods study, including 171 surveys and 50 interviews. Over 70% of the farmers reported self-initiated diversification activities. Statistical analysis showed a significant positive correlation between crop diversity and dietary diversity, while controlling for farm size and income. To assess gender relations females responded to 41% of the surveys, and we separated focus groups by sex. Average male-owned farms were 1.8 ha larger than women-owned farms, yet we found no significant differences in household food security or dietary diversity. Additional disparities included male vs. female perceptions about who does additional diversification work and who decides about strategies. Although the co-op has a strong gender equity and technical assistance program, our analysis of extension training documents identified useful content and a smaller percent of female participants in diversification vs. gender sessions. Suggested strategic actions for co-op planning include supporting: (1) female land ownership, (2) diversification focused farmer-led experimentation, and (3) more training for men on gender, women on diversification, and all participants in feminist agroecology.