Supplemental Interviews Research Articles

Food Shopping Strategies Among a Diverse Sample of East Harlem Residents: A Qualitative Study.

To inform food retail interventions, this study explored food shopping strategies employed by people constrained by limited budgets but residing in an urban environment offering numerous retail options. Qualitative study incorporating semi-structured interviews and shop-alongs. East Harlem, New York City. 37 East Harlem residents participated in interviews, of whom 15 participated in shop-alongs. Interviews and shop-alongs were conducted in English, Spanish, and Mandarin Chinese. Interview transcripts were analyzed using a grounded theory approach. Data from shop-alongs were used to supplement interview findings. Participants shopped 1-2 times at an average of 4 retail locations per week. Two key themes emerged: (1) planning trips and choosing venues; and (2) shopping experiences and perceptions of stores. Price was the primary driver of store choice, followed by product quality and variety. Substantial time was invested in shopping. Most English- and Spanish-speaking participants shopped in East Harlem. Chinese American participants shopped in Chinatown due to language concordance, availability of culturally-preferred foods, and proximity to other services. East Harlem residents invested substantial planning, time and effort in food shopping to acquire sufficient food for their households on limited budgets. These findings offer insight into how residents interact with food environments and key drivers of decision-making about food shopping that affect decisions about where to shop and what to purchase.

The influence of media scrutiny on firms' strategic eschewal of lobbying

AbstractResearch SummaryLobbying allows firms to influence the government to potentially limit firms' costs during product recall crises. However, such lobbying can elicit scrutiny from the media if the lobbying gives the impression that firms wish to save costs at the expense of safety, thereby appearing hypocritical. We theorize that when faced with negative media coverage of product recalls or recall‐related lobbying, firms strategically eschew lobbying to limit further media scrutiny and its associated negative consequences. We test our hypotheses using the US auto industry's lobbying from 2008 to 2022. We provide further depth to our examination of strategic eschewal through 15 supplemental interviews of lobbyists about how the media influences firms' lobbying decisions.Managerial SummaryCompanies may resort to lobbying in efforts to reduce costs related to product recall crises, but such controversial lobbying may also tarnish their image. When confronted with negative media coverage of product recalls, or recall‐related lobbying, companies are more likely to strategically refrain from lobbying to minimize additional, unwanted media spotlight and its associated negative repercussions. Managers should be mindful that even if lobbying may help limit the costs of recalls, it could also cause potential reputational harm. Thus, it is vitally important that managers pay attention to the reputational cues from the media, which can help them determine when lobbying may be problematic and allow them to preemptively refrain from such lobbying.

Getting to the bottom of why children with spina bifida use the emergency department: A qualitative analysis of parent and stakeholder perspectives

Children with Spina Bifida (SB) have considerable healthcare utilization, including Emergency Department use (EDU). We aimed to elicit reasons for EDU using qualitative analysis of interviews with both patient-caregiver dyads and stakeholders. A cohort of children with SB followed at our institution between 2016 and 2020 was identified and patient and clinical characteristics abstracted. Purposeful sampling by age and degree of past EDU was performed. Semi-structured interviews of dyads were performed using iteratively revised interview guides. Spanish-language interviews were conducted by a native Spanish speaker and transcripts professionally translated. Supplemental interviews with stakeholders, namely knowledgeable healthcare professionals, were also conducted. A qualitative framework approach was used for analysis, including open followed by closed independent coding with calculation of inter-rater reliability. A final interpretation of coding reports assessing convergence, divergence, and variation in themes across participant characteristics. 116 families (4 Spanish-speaking) and 7 stakeholders were interviewed. Sampling yielded a heterogenous cohort for EDU (56% with 0-10, 44% with >10 visits) and age (25% 0-4, 44% 5-11, 31%>11 years). IRR was optimal (κ=0.9). Themes in perceived reasons for EDU were 1) desire for "one-stop-shop" care, 2) an emergent medical problem, 3) providers' instructions, 4) negative past healthcare experience, 5) intrinsic caregiver moderators, and 6) temporospatial influences. Themes 1, 2, and 5 predominated in dyads, whereas themes 6, 3, and 5 were most common in stakeholders. Stakeholders focused largely on negative institutional and patient characteristics. Among dyads only, theme #1 was disproportionately emphasized by Spanish-speaking patients. Families desired access to coordinated expert care, testing and imaging. The ED offers this for children with SB, regardless of clinical acuity. This may be especially valued by families with inherent challenges to navigating the healthcare system. Negative experiences in community clinical settings, healthcare provider recommendations and intrinsic parental factors were themes that seemed to contribute to seeking this "one-stop-shop" type of care. Care coordination may reduce ED reliance, but themes for the interviews suggest a systems-based efforts should weave in the community care setting. For both stakeholders and caregivers, the ED represented a valued form of immediate access to multispecialty, expert care and testing in the context of perceived lack of timely, coordinated outpatient care. This may be moderated by intrinsic caregiver factors and negative past experiences. Although stakeholders discussed ideas that fit into patient-caregiver themes, the also uniquely focused on systems-based and patient-caregiver limitations.

Introducing technologies into national large-scale testing: Are we ready?

In recent decades, the potential benefits of introducing technologies into large-scale tests have been much discussed. Yet the path to effective technology use on large-scale testing has fallen short of expectations, especially when these tests have medium or high stakes for students. After a temporary cancelation of external assessment of learning due to the COVID-19 pandemic, the Portuguese government is taking a step forward. With a gradual implementation until 2025, the reintroduction of external assessment of learning in the Portuguese education system foresees all national assessment tests and all national examinations in digital format with the implementation of the External Assessment Dematerialization Project (DAVE). However, assessment reforms, such as DAVE, raise concerns within school communities. To identify and analyze these concerns, we conducted 32 semi-structured interviews with head teachers from mainland Portugal. To understand to what extent these concerns were considered and covered in DAVE’s design and implementation, a supplementary interview was conducted with the president of the Portuguese institute responsible for DAVE. In addition, a survey with 2 673 teachers was carried out to find out their degree of agreement with the implementation of DAVE. Results show that DAVE raises many concerns among head teachers, and it is not fully accepted by the teachers.

Value of Knowing: Health-Related Behavior Changes following Amyloid PET Results Disclosure in Mild Cognitive Impairment.

Growing evidence supports the clinical utility of amyloid PET, however, whether patients at risk for dementia use knowledge of their brain amyloid status to alter their health behaviors remains unclear. To explore the effect of amyloid PET results disclosure on self-reported health behaviors in patients with mild cognitive impairment. Self-reported health behaviors were a secondary outcome of the Return of Amyloid Imaging Scan Results (RAISR) randomized clinical trial of amyloid PET results disclosure for individuals with mild cognitive impairment. Academic medical center. RAISR study participants included 82 patients with mild cognitive impairment who were 92% non-Hispanic white, 59% male, and, on average, 73 ± 8.61 years old with 16.25 ± 2.49 years of education. Participants were assigned to a scan group with the opportunity to have an amyloid PET scan and learn their results or to a control group consisting only of a mild cognitive impairment education session and no opportunity for an amyloid PET scan. A 14-item health behavior questionnaire supplemented with qualitative data from the open-ended text entries to describe "other" health behaviors and follow-up semi-structured interviews. Baseline assessments were conducted prior to group assignment. For the present analysis, 71 participants had available data and scan group participants were divided by amyloid status, creating three groups for comparison: amyloid positive, amyloid negative, and control (no scan). Over 12 months of follow-up, no significant differences were observed in lifestyle, vitamin/supplement use, stress reduction activities, cognitive stimulation, or advance directive completion. Amyloid-negative participants were less likely than controls to consider long-term care insurance (63.6% vs. 89.2%; P = .025), and to endorse behaviors classified as "other" (36.4% vs. 64.9%; P = 0.037). After adjusting for education level, gender, and Mini-Mental State Exam score, logistic regression showed that amyloid-negative patients were 74% less likely than controls to report "other" behaviors (OR = 0.26, 95% CI [0.08, 0.85], P = 0.025), and 78% less likely to consider long-term care insurance (OR= 0.22, 95% CI [0.06, 0.86], P = 0.03). Qualitative analysis of open-ended questionnaire data and supplemental interviews with scan group participants revealed "other" activities to include changes in areas like employment, driving, and residential status, and engagement in other non-medical activities (e.g., pursuing bucket lists). This exploratory analysis of health-related behavior changes following amyloid PET disclosure suggests that the value of knowing one's brain amyloid status may differ by scan result and encompass actions that focus more on maximizing quality of life than promoting cognitive health.

EFFECT OF AMYLOID PET RESULTS DISCLOSURE ON HEALTH-RELATED BEHAVIORS IN PERSONS WITH MILD COGNITIVE IMPAIRMENT

Abstract Mounting evidence supports the clinical utility of amyloid PET. However, whether patients use knowledge of their amyloid status to alter health behaviors remains unclear. We describe health-related actions taken by Mild Cognitive Impairment patients following amyloid PET disclosure (n=34) vs. a comparison group (n=37). Patients were 92% non-Hispanic white, 59% male, 73±8.61 years old with 16.25±2.49 years of education. Over 12 months of follow-up, all participants reported at least one behavior change from baseline on a 14-item health behavior questionnaire. Amyloid positive patients reported the most behavior changes (mean=4.67±1.83) while amyloid negative patients reported the fewest (mean=3.72±1.58). Across groups, no significant differences were observed in: lifestyle, vitamin/supplement use, stress reduction activities, cognitive stimulation, or advance directive completion. Amyloid negative participants were significantly less likely than controls to consider long-term care insurance (63.6% vs. 89.2%; P=.025), and to endorse changes classified as “other” (36.4% vs. 64.9%; P=0.037). After adjusting for education level, gender, and MMSE, logistic regression showed that amyloid negative patients were 74% less likely than controls to report “other” changes (OR=0.26, 95% CI [0.08, 0.85], P=0.025), and 78% less likely to consider long-term care insurance (OR=0.22, 95% CI [0.06, 0.86], P=0.03). Qualitative analysis of supplemental interviews with scan group participants revealed “other” activities to include changes in employment, driving, and residential status, and engagement in other non-medical activities (pursuing bucket lists and mending strained relationships). Health-related behavior changes following amyloid PET disclosure may differ by scan result and encompass actions to enhance not only cognition but quality of life.

The impacts of relational organizing for health system and community collaboration: Early evidence from a rapid multisite qualitative study.

To understand the ways relational organizing practices impacted collaborations between independent or health system-affiliated community health clinics, public health offices, and community groups during the early COVID-19 pandemic. Between November 2020 and June 2021, we interviewed clinical and public health workers, clinic-based community organizers, and staff and volunteers at community organizations who participated in three COVID-19 response collaborations in the Northwestern United States. This was a qualitative study employing participatory and rapid data collection and analysis methods. Research team members invited key participants in organizing efforts to a semi-structured virtual interview conducted by an independent health services researcher. A sensemaking team that included project participants analyzed interview data using an iterative, thematic approach and conducted a ripple effect mapping exercise to supplement interview data. A total of 19 people contributed data for analysis. Analysis was guided by the underlying research questions: whether and how relational organizing practices contributed to successful collaboration, and what challenges were encountered. Relational organizing was perceived to contribute to multiple positive project outcomes, including greater self-efficacy in a time of crisis and enhanced sense of connection; these outcomes contributed to a sense of successful collaboration. Four mechanisms were identified that explained relational organizing's collaborative efficacy: (1) mobilizing existing relationships for rapid community engagement; (2) bringing concrete skills for enhancing trust among cross-sector partners; (3) recognizing and addressing power dynamics; and (4) creating vehicles for exercising collective community power. Lack of trust and unsurfaced power dynamics were perceived as common challenges to sustained collaboration, which relational organizing could sometimes mitigate. Our findings suggest relational organizing practices can be protective against common "pain points" faced by cross-sectoral partnerships, especially in times of crisis. Further piloting of clinic-based relational organizing is recommended, as is research on longer-term impacts.

Task type matters: The impact of virtual reality training on training performance

AbstractBackgroundVirtual reality (VR) is becoming increasingly accessible and being utilized in various organizations to meet education and training needs. Despite its potential, research regarding VR applications has focused on measuring the effectiveness of VR programs relative to non‐VR programs; consequently, the ways in which VR programs are effective remain unclear.ObjectivesRecognizing this research gap, this study examined whether task type‐dependent differences in training outcomes exist between VR training and non‐VR training groups.MethodsTo examine the effects of VR technology for training purposes in a military setting, we conducted a quasi‐experiment focusing on how the effects vary based on task characteristics. A total of 90 military personnel were randomly assigned to either an experimental group (VR) or a control group (non‐VR). After completing their respective training, the two groups participated in four tasks simulating real battle scenarios and designed to evaluate the effectiveness of the VR‐based training. We analysed primary data collected through survey instruments and performance evaluation using a one‐way between‐group analysis of covariance (ANCOVA) and supplementary interview data using thematic analysis.Results and ConclusionsThe quantitative analysis showed that the VR group performed better than the control group on three tasks in which communication, interaction and immediate situational judgements were critical. No difference was found between the two groups in the other task, which involved the routine operation of physical objects. Additional interview data revealed the extent to which trainees perceived the VR training as effective in understanding in‐situ conditions, preparing and practising their own and their team's reactions to emergent situations and in manipulating virtual objects.ImplicationsOur findings provide insight into VR technology's potential to enhance human performance in various training contexts. VR is specifically effective in training that aim to improve immediate judgement and group coordination. Our findings provide useful information for those seeking to design and develop training environments that maximize the effects of VR.

38 Burn Prevention and Education for Newcomers to North America

Abstract Introduction The experience of a city’s fire department suggested regions typically home to immigrant and multigenerational families show increased occurrence of fire calls. This study explored the incidence of fire calls in our city stratified by geographic ward and identified opportunities for fire and thermal injury prevention in immigrants. Methods This study was approved by our university’s research ethics board. Fire call data from 2016-2021 was used to characterize adjusted fire totals, civilian injuries, incident descriptions, sources of fire ignition, type of material, area of origin, and contribution to ignition of these fires by ward. ANOVAs were performed to reveal differences in fire characteristics between wards. High fire occurrence wards were classed as at greater risk and probable targets for prevention. To follow, an open ended interview was conducted with a newcomer organization in the city to elucidate factors that contribute to thermal injury risk in immigrants. Interview content was informed by a literature search around the factors and impact of burn injury in immigrants to North America, Europe, and Australia. Interview responses were thematically analyzed. Results The city is stratified into 14 wards, within which there are several communities described by income, education, immigration diversity and more. Between wards, total adjusted fire incidents were not significantly different (p = 0.119). Though, fire characteristics did differ regionally. Common fire incident descriptions included vehicle/structure, trash and cooking fires with less variability by ward in the number of cooking fires compared to the two former. Contributions to ignition were frequently human related. The supplementary interview highlighted individual burn risk as multifactorial. Cultural norms (notably cooking practices and equipment such as pressure cookers), inexperience (related to weather and frostbite risk), and participation in entry level jobs (including cooking) may impart increased burn risk to immigrants. Senior immigrants were noted to be specifically at risk for burns given their propensity to retain cultural cooking norms. Conclusions Newcomers may face increased fire and thermal injury risk that can be attributed to occupational hazards not specific to immigrants and adjustment to a new way of life. Given that many fires and injuries are connected to cooking, kitchen safety and environmental education becomes important to enable safer engagement in cultural practices. Follow up to this work includes matching high fire incidence wards to their resident immigrant groups for targeted prevention. Applicability of Research to Practice Inclusion of race and ethnicity in burn registries may assist in recognizing at risk groups for burn prevention and serve as a retrospective comparator to assess the impact of population specific burn prevention efforts.

Faith or path? Profiling the motivations of multilingual Chinese as a foreign language teachers using Q methodology

As a topic of rising interest, language teacher motivation has been studied through various lenses and across different contexts over recent years. Yet, relatively scant attention has been paid to Chinese language teachers teaching overseas. Using Q methodology and supplementary interview data, this study investigated the motivational profiles of multilingual Chinese as a foreign language (CFL) teachers who teach abroad. An analysis informed by the Factors Influencing Teaching Choice (FIT-Choice) model identified four types of career choice motivation: ‘self-devotion and social contribution’, ‘personal utility’, ‘personal interest+’, and ‘personal pursuit and immigration path’. The results show that teachers with a strong sense of national pride and social responsibility chose the career mainly for social contribution. They shared with teachers driven by personal interest, a positive attitude and a strong commitment to the career. Teachers driven by personal utility and teachers pursuing diverse life experiences or permanent residence were more likely to choose to teach Chinese as a last resort, which potentially inhibited their determination and commitment to the job. The study further explores the complexity of teachers’ career choice motivation by investigating the interaction between the identified types. The discussion of these findings contributes to a better understanding of the subjectivity of multilingual CFL teachers and provides insights into Chinese teachers’ professional development and the sustainability of international Chinese education.

From distress to detachment: exploring how providing care for stigmatized patients influences the moral development of medical trainees.

In acute hospital settings, medical trainees are often confronted with moral challenges and negative emotions when caring for complex and structurally vulnerable patients. These challenges may influence the long term moral development of medical trainees and have significant implications for future clinical practice. Despite the importance of moral development to medical education, the topic is still relatively under-explored. To gain a deeper understanding of moral development in trainees, we conducted a qualitative exploration of how caring for a stigmatized population influences their moral development. Data were collected from 48 medical trainees, including observational field notes, supplemental interviews, and medical documentation from inpatient units of two urban teaching hospitals in a Canadian context. Utilizing a practice-based approach which draws on constructivist grounded theory, we conducted constant comparative coding and analysis. We found that caring for stigmatized populations appeared to trigger frustration in medical trainees, which often perpetuated feelings of futility as well as avoidance behaviours. Additionally, hospital policies, the physical learning environment, variability in supervisory practices, and perceptions of judgment and mistrust all negatively influenced moral development and contributed to apathy and moral detachment which has implications for the future. Recognizing the dynamic and uncertain nature of care for stigmatized patients, and addressing the influence of structural and material factors provide an opportunity to support moral experiences within clinical training, and to improve inequities.

Fostering Assistive Technology (at) Education and Training of Academic Library Professionals in Zimbabwe

The study examines the forms of structured Assistive Technology (AT) education and training available to library professionals in Zimbabwe, focusing on in-service training delivered within organizations, pre-service training offered in colleges/universities and technology-based training delivered by AT vendors/suppliers. The study employs a qualitative research design. Data were collected using interviews conducted with a sample of 13 academic library staff drawn from selected universities in Zimbabwe. The websites of institutions of interest also provided vital data to supplement interview data. The study draws attention to key intervention areas in the fostering of AT education and training of library professionals in Zimbabwe. It contributes to ongoing discussion on the improvement of AT provision in developing countries’ academic libraries.

MEASURING SPECIFIC TRADITIONAL CHINESE VALUES IN RELATION TO SATISFACTION OF THE FIVE MASLOW NEEDS

To determine whether living according to specific traditional Chinese cultural values was associated with satisfaction of the five needs in Maslow’s motivational hierarchy and overall life satisfaction, a mixed-method approach was employed, with an empirical questionnaire and supplemental interviews. The questionnaire assessed the hypothesized relationships that traditional Chinese values had with personal life outcomes, including health, employment, satisfaction of the five needs from Maslow’s hierarchy, and life satisfaction. The interviews examined the relationships that several demographic variables had with living by traditional Chinese values. The results of the empirical data revealed that most Chinese people today are still living according to the traditional Chinese cultural values, and that living by those traditional values are strongly associated with satisfaction of all five of the human needs in the Maslow hierarchy, as well as with overall life satisfaction. Additionally, the results of the qualitative interviews readily supported the empirical findings, and also revealed that the time during which inter-generational transmission of the Chinese cultural values occurs is when parents teach those values to their children at a very early age, that is, between 3 and 8 years old, before the children start primary school.

An International Professional Development Collaboration: Supporting Teachers in the Kingdom of Saudi Arabia through an Immersion Program in the United States

The Kingdom of Saudi Arabia (KSA) recently initiated multiple, one-year, school immersion programs to help 25,000 KSA teachers better support KSA students and the KSA education system after spending time abroad in teacher education programs throughout the United States (US). This study explored the effects of one such program, aimed at helping KSA teachers become agents of change. The authors examined how the 46 KSA teachers involved in this program changed. Survey-research and English language tests were used to show that the immersion program yielded its desired effects: the program increased teachers’ sense of efficacy; improved teachers’ pedagogical, content, technical, and English language skills; and enhanced teachers’ understandings of education across nations and cultures, with emphasis on the transfer of features of the US educational system back to the KSA (although teachers were uncertain about the extent to which the transference desired might actually occur). Via supplemental interviews, the authors also identified self-reported influential sources of change. The article examines how these sources of change impacted KSA teachers’ mindsets regarding their teaching. The study confirms that the program influenced participants through their school immersion experiences, given that the program offered KSA teachers chances to learn more about student-centered learning approaches and more customized and individualized care for students.

Augmentative and Alternative Communication in an Elementary School Setting: A Case Study.

Although there is a strong evidence base supporting the use of augmentative and alternative communication (AAC) in school settings, the research-to-practice gap in this area remains a concern. Few studies have examined how AAC systems are implemented in school settings and whether these systems adequately promote communicative competence for students with complex communication needs. The aim of this case study was to better understand the ways in which elementary-age students with complex communication needs used AAC throughout daily routines. Observations of five students, four receiving services under the category of autism and one under intellectual disability, in school settings were conducted to document the communication function, type of AAC systems used, and the times and activities during which AAC systems were accessible. In addition, supplemental interviews were conducted to understand the rationale for AAC implementation from the perspective of the special education teacher and speech-language pathologist. Overall, findings from the observations and interviews indicated that a variety of AAC modes were utilized. Interactions represented a range of communicative functions, with the exception of social closeness, and were primarily observed during academic activities. However, there were some discrepancies between observations and interview data. Although these findings provide insight into how students with complex communication needs may use AAC in elementary school settings, more research is needed to explore AAC use across a range of students, classrooms, and schools. We present specific future research directions, along with implications and recommendations for AAC teams and researchers.

Factors affecting access to administrative health data for research in Canada: a study protocol.

IntroductionIn Canada, most provinces have established administrative health data repositories to facilitate access to these data for research. Anecdotally, researchers have described delays and substantial inter-provincial variations in the timeliness of data access approvals and receipt of data. Currently, the reasons for these delays and variations in timeliness are not well understood. This paper provides a study protocol for (1) identifying the factors affecting access to administrative health data for research within select Canadian provinces, and (2) comparing factors across provinces to assess whether and how they contribute to inter-provincial variations in access to administrative health data for research.MethodsA qualitative, multiple-case study research design will be used. Three cases will be included, representing three different provinces. For each case, data will be collected from documents and interviews. Specifically, interviews will be carried out with (1) research stakeholders, and (2) regulatory stakeholders (10 individuals/group * 2 groups/province * 3 provinces = 60). During within-case analysis, interview data for each stakeholder group will be analyzed separately using constant comparative analysis. Document analysis will occur iteratively, and will inform interview guide adaptation, and supplement interview data. Cross-case analysis will involve systematic comparison of findings across cases.DiscussionThis study represents the first in-depth examination of access to administrative health data in Canada. The main outcome will be an overarching mid-range theory explaining inter-provincial variations in access to administrative health data in Canada. This theory will be strengthened by the inclusion of the perspectives of both researchers and those involved in the regulation of data access. The findings from this study may be used to improve equitable and timely access to administrative health data across provinces, and may be transferable to other jurisdictions where barriers to access to administrative health data have been reported.

The Contribution of Mobile Pastoral Herds to Soil Fertility Maintenance in Sedentary Mixed Crop-Livestock Systems at Farm and Territory Scales—Part of Mutually Reinforcing Social and Ecological Relationships Supporting Sustainability

Agricultural development through settlement schemes on desert lands has always raised acute debates, especially over environmental issues due to cultivation based on intensive additions of water and fertilizers. However, nutrient cycling approaches at the farm level are generally based on apparent N flows, i.e., purchased inputs and sold products, without considering nutrient flows driven by mobile herds crossing the arable lands of sedentary farmers. Through a territory level approach, the present study aimed to assess the contribution of mobile pastoral herds located in the newly reclaimed land on the western desert edge of the Nile Delta on the supply of the manure for local sedentary farms. Based on a survey of 175 farmers, we calculated the partial farm nitrogen balances. Supplemental interviews were conducted with the pastoral community to assess the additional manure coming from grazing practices in the research area. The results show that the sedentary mixed crop-livestock systems based on the planting ofTrifolium alexandrinumand a manure supply make a useful contribution toward converting poor, marginal soil into fertile soil. Moreover, grazing of crop residue by pastoral herds on the reclaimed land contributes to social sustainability by maintaining social links between the first occupants, the Bedouins, and the new settlers. Grazing accounts for 9% to 34% of farm-level N input and 25% to 64% of farm-level N output depending on the village and the cropping system. This contribution calls for different rural policies that consider the complementarity between pastoral herders and sedentary farmers that supports both systems' social and environmental sustainability.

Psychosocial Effects on US Government Personnel of Exposure to the 1998 Terrorist Attack on the US Embassy in Nairobi

Objective: The mental health effects of major terrorist attacks on diplomatic government personnel have not been well studied. This study examined the psychiatric and psychosocial effects of the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya, on US government personnel exposed to the bombing. Method: At 8–10 months after the bombing, 179 US government employees (53 Americans, 126 Kenyans, 53% male, age mean = 40.6 and SD = 8.4 years ranging 21–65) were assessed with the Diagnostic Interview Schedule for DSM-IV for disaster-related psychiatric diagnoses and the Disaster Supplement Interview and Questionnaire about their immediate disaster experiences, subjective responses, mental health interventions/treatment, safety perceptions, and coping. Results: About one-third (32%) of these US government personnel developed postdisaster psychiatric disorders, mostly bombing-related PTSD (20%), but few received psychiatric treatment. Prevalence rates of all postdisaster psychiatric disorders, including bombing-related PTSD, were similar between subgroups of Americans and Kenyans, despite the Kenyans reporting more direct disaster trauma exposures, subjective postdisaster distress, and posttraumatic stress symptoms. These US government personnel had fewer psychiatric consequences of the Nairobi bombing than their previously studied civilian counterparts. Conclusions: Possible explanatory factors in the lower prevalence of postdisaster psychopathology in these government personnel compared to the civilians are selection for greater personal resilience for government employment and stigma-based underreporting of mental health needs in governmental workplaces. Stigma is a potential barrier to psychiatric treatment that needs to be addressed in government workplaces.

Short- and long-term effects of the patient education strategy-learning and coping-in cardiac rehabilitation: a randomized controlled trial (LC-REHAB).

The objectives were to assess the short- and long-term effect of the patient education strategy 'Learning and Coping' (LC) in cardiac rehabilitation (CR) on health-related quality of life, patient education impact, cardiac risk factors and lifestyle. In total, 825 patients hospitalized with ischaemic heart disease or heart failure were randomized to either LC-CR or standard CR at three Danish hospitals. Teaching approach in LC-CR was situational, inductive and reflective, with experienced patients as co-educators and supplemental interviews. Teaching approach in standard CR was structured and deductive. Outcomes were assessed immediately after CR, and after 3 months (short term), and after 3 years (long term). Between-arm differences in favour of LC-CR were SF-12 'role emotional' (3.7, 95% CI: 0.6-6.8) and MDI depression score (0.9, 0.1-1.8) immediately after CR, exercise capacity (4 W, 1-9) at 3 months and SF-12 'role physical' (4.6, 0.1-9.0) (long term). Between-arm differences in favour of controls were waist circumference (-1.7 cm, -2.3 to -1.0) immediately after CR and HeiQ domain 'Constructive attitudes and approaches' (0.11, 0.04-0.18), triglycerides (-0.12 mmol/l, -0.21 to -0.02), systolic blood pressure (-3.12 mmHg, -5.66 to -0.58) at 3 months. Adding LC strategies to CR provides inconsistent short-term results but improves 'role physical' long term.

Newcomer knowledge, attitudes, and beliefs about human papillomavirus (HPV) vaccination

BackgroundHuman Papillomavirus (HPV) is the most common sexually transmitted infection in Canada and around the world. Vaccination is an effective prevention strategy, but uptake is low, especially among newcomers to Canada. We sought to understand newcomers’ knowledge, attitudes, and beliefs (KAB) on HPV and HPV vaccination and their role in HPV vaccine acceptance.MethodsNewcomers were defined as individuals born outside Canada, (i.e., individuals born in a different country, the majority of whom are immigrants or refugees, but also includes students and undocumented migrants). Eligible participants were newcomers, aged 16 or older and who could read or write in English, French or Arabic. Surveys were administered in two community health centres in Ottawa, Canada that primarily engage with newcomer populations. Follow-up interviews were conducted either at the community health centre or over the phone, depending on participants’ preferences.ResultsFifty participants completed the survey, the majority of whom were women (74%) and spoke Arabic as their first language (54%). Seven participants completed supplemental interviews to complement their survey responses. The majority (70%) of participants had not previously heard of HPV. Less than half (46%) knew that the vaccine is effective in preventing certain types of cancer; nearly 40% incorrectly believed the vaccine could cure HPV. Qualitative interviews supported the survey findings.ConclusionsDespite a lack of HPV knowledge due to cultural and language barriers, there is still a strong desire among newcomers to receive the vaccine, especially when accompanied by a physician recommendation. Cultural and language-appropriate resources are needed to help newcomers make informed vaccination decisions and promote HPV vaccine uptake.