The hidden therapist: evidence for a central role of music in psychedelic therapy

RATIONALE

Recent studies have supported the safety and efficacy of psychedelic therapy for mood disorders and addiction. Music is considered an important component in the treatment model, but little empirical research has been done to examine the magnitude and nature of its therapeutic role.

OBJECTIVES

The present study assessed the influence of music on the acute experience and clinical outcomes of psychedelic therapy.

METHODS

Semi-structured interviews inquired about the different ways in which music influenced the experience of 19 patients undergoing psychedelic therapy with psilocybin for treatment-resistant depression. Interpretative phenomenological analysis was applied to the interview data to identify salient themes. In addition, ratings were given for each patient for the extent to which they expressed "liking," "resonance" (the music being experienced as "harmonious" with the emotional state of the listener), and "openness" (acceptance of the music-evoked experience).

RESULTS

Analyses of the interviews revealed that the music had both "welcome" and "unwelcome" influences on patients' subjective experiences. Welcome influences included the evocation of personally meaningful and therapeutically useful emotion and mental imagery, a sense of guidance, openness, and the promotion of calm and a sense of safety. Conversely, unwelcome influences included the evocation of unpleasant emotion and imagery, a sense of being misguided and resistance. Correlation analyses showed that patients' experience of the music was associated with the occurrence of "mystical experiences" and "insightfulness." Crucially, the nature of the music experience was significantly predictive of reductions in depression 1 week after psilocybin, whereas general drug intensity was not.

CONCLUSIONS

This study indicates that music plays a central therapeutic function in psychedelic therapy.

SPIRIT trial: A phase III pragmatic trial of an advance care planning intervention in ESRD

Advance care planning (ACP) is a central tenet of dialysis care, but the vast majority of dialysis patients report never engaging in ACP discussions with their care providers. Over the last decade, we have developed and iteratively tested SPIRIT (Sharing Patient's Illness Representation to Increase Trust), a theory-based, patient- and family-centered advance care planning intervention. SPIRIT is a six-step, two-session, face-to-face intervention to promote cognitive and emotional preparation for end-of-life decision making for patients with ESRD and their surrogates. In these explanatory trials, SPIRIT was delivered by trained research nurses. Findings consistently revealed that patients and surrogates in SPIRIT showed significant improvement in preparedness for end-of-life decision making, and surrogates in SPIRIT reported significantly improved post-bereavement psychological outcomes after the patient's death compared to a no treatment comparison condition. As a critical next step, we are conducting an effectiveness-implementation study. This study is a multicenter, clinic-level cluster randomized pragmatic trial to evaluate the effectiveness of SPIRIT delivered by dialysis care providers as part of routine care in free-standing outpatient dialysis clinics, compared to usual care plus delayed SPIRIT implementation. Simultaneously, we will evaluate the implementation of SPIRIT, including sustainability. We will recruit 400 dyads of patients at high risk of death in the next year and their surrogates from 30 dialysis clinics in four states. This trial of SPIRIT will generate novel, meaningful insights about improving ACP in dialysis care.

TRIAL REGISTRATION

ClinicalTrials.govNCT03138564, registered 05/01/2017.

Clinical and management skills for hospital nurses: perspective of nursing university students

ABSTRACT Objective: to analyze nursing university students’ perception of the professional skills to act in the hospital setting developed during their academic training, and what strategies are being created for the development of these skills during their performance. Method: an exploratory, qualitative study in which 40 nursing university students participated. The data were collected from September to December 2016 and conducted thematic inductive analysis. Results: clinical skills were identified that could be learned and previously developed at the undergraduate level; and management skills learned during undergraduate education and developed only in the hospital environment. Strategies for the development of skills were identified, such as individual study and Permanent Education, by the employing institution. Final considerations: it was evidenced that college contributed in significant proportions for learning and development of some clinical and management skills in the hospital. Still, despite the identified strategies, managers and training centers need to continuously implement strategies for the development of new skills in nurses.

A Qualitative Study on Midwives' Perceptions of Physiologic Birth in Singapore

Midwives are advocates for parturients, and their actions and attitudes can influence a woman's experience during childbirth. Hence, it is valuable to examine midwives' perceptions of physiologic birth in an obstetric-led environment. A descriptive, qualitative study design was utilized. Semistructured face-to-face interviews were conducted with 10 registered midwives from the birthing suite of a public hospital in Singapore. Data were analyzed using thematic analysis. Three major themes were (1) perceptions of physiologic birth, (2) perceived facilitators of physiologic birth, and (3) perceived barriers to physiologic birth. Interestingly, senior midwives in this study experienced more negative outcomes with physiologic birth, resulting in apprehension and reduced confidence levels. This study contributed to the understanding of midwives' perceptions regarding facilitators and barriers to physiologic birth. Factors such as supporting birthing team and antepartum education could be useful in supporting physiologic birth. However, advanced age of some of the midwives was found in this study to be a barrier to physiologic birth.

Stakeholder perspectives about general practice pharmacists in the Australian Capital Territory: a qualitative pilot study

Previous studies have found that integrating non-dispensing pharmacists in general practice may improve patient safety, improve patient outcomes, deliver health system efficiencies and generate savings. However, the employment of pharmacists in general practice is not common in Australia. A naturalistic study was conducted in the Australian Capital Territory with three general practices, each employing a part-time pharmacist for 12 months. This study reports on stakeholder perspectives of the benefits, barriers and enablers for integrating pharmacists into general practice. Patients, practice staff and community pharmacists that had interacted with a practice pharmacist were asked to complete a self-administered questionnaire. Patient questionnaire respondents (n=44) reported that a practice pharmacist was beneficial and wanted to see this continue. Practice pharmacists were also perceived beneficial by primary healthcare employees surveyed (n=42). Opinions were further explored by individual semi-structured interviews (n=20). The qualitative data explored five themes: perception of the practice pharmacist, collaboration with doctors, pharmacist roles, sustainability and community pharmacy aspects. Patients welcomed improved understanding about their medication, whereas general practice staff appreciated pharmaceutical advice about patients with chronic conditions. Participants discussed options to fund practice pharmacists longer term, which was identified as the main barrier to widespread roll out.

The experience and understanding of pain management in recently discharged adult trauma patients: A qualitative study

INTRODUCTION

Pain following injury is often intense, prolonged and debilitating. If poorly managed, this acute pain has the potential to delay rehabilitation and lead to chronic pain. Recent quantitative Australian research recommends implementing further information and interventions to improve trauma patient outcomes, however, to ensure effectiveness, exploration of the patient perspective is imperative to ensure the success of future pain management strategies. This study aimed to gain understanding about the experience of pain management using prescribed analgesic regimens of recently discharged adult trauma patients.

METHOD

Semi-structured interviews were used to explore the experiences and understandings of trauma patients in managing pain using prescribed analgesic regimens during the initial post-hospital discharge period. Twelve participants were purposively selected over a 6-month period at a level one trauma outpatient clinic based on questionnaire responses indicating pain related concerns. Qualitative data were thematically analysed.

RESULTS

The overarching finding was that injuries and inadequate pain management incapacitate the patient at home. Four main themes were developed: injury pain is unique and debilitating; patients are uninformed at hospital discharge; patients have low confidence with pain management at home; and patients make independent decisions about pain management. Patients felt they were not given adequate information at hospital discharge to support them to make effective decisions about their pain management practices at home.

CONCLUSION

There is a need for more inclusive and improved hospital discharge processes that includes patient and family education around pain management following injury. To achieve this, clinician education, support and training is essential.

A qualitative evaluation of the role of simulation in policy development for service improvement

Objective

To evaluate the efficacy of simulation-based techniques to prospectively assess developing polices prior to implementation.

Methods

A self-selected sample of nursing staff from a local, acute hospital reviewed a draft intravenous drug administration policy before simulating drug administration of either an infusion or direct injection. The participants completed a postsimulation questionnaire regarding the new policy and simulation, took part in a semistructured interview and were observed during the simulation with their consent.

Results

10 staff attended the simulation. The emergent themes identified a wide range of factors relating to the everyday usability and practicalities of the policy. There were issues surrounding inconsistent language between different clinical teams and training requirements for the new policy.

Conclusion

Simulation, using simple scenarios, allows the safe evaluation of new policies before publication to ensure they are appropriate for front-line use. It engages staff in user-centred design in their own healthcare system.

Sex work and three dimensions of self-esteem: self-worth, authenticity and self-efficacy

Sex work is assumed to have a negative effect on self-esteem, nearly exclusively expressed as low self-worth, due to its social unacceptability and despite the diversity of persons, positions and roles within the sex industry. In this study, we asked a heterogeneous sample of 218 Canadian sex workers delivering services in various venues about how their work affected their sense of self. Using thematic analysis based on a three-dimensional conception of self-esteem - self-worth (viewing oneself in a favourable light), authenticity (being one's true self) and self-efficacy (competency) - we shed light on the relationship between involvement in sex work and self-esteem. Findings demonstrate that the relationship between sex work and self-esteem is complex: the majority of participants discussed multiple dimensions of self-esteem and often spoke of how sex work had both positive and negative effects on their sense of self. Social background factors, work location and life events and experiences also had an effect on self-esteem. Future research should take a more complex approach to understanding these issues by considering elements beyond self-worth, such as authenticity and self-efficacy, and examining how sex workers' backgrounds and individual motivations intersect with these three dimensions.

Senior Services that Support Housing First in Metro Vancouver

Housing First is a model and philosophy for housing homeless people in immediate and permanent housing. In order to implement and deliver Housing First, research is essential to understand the system of support services as they currently exist. Guided by principles of community-based participatory research, this paper presents the findings from a senior-focused deliberative dialogue workshop in Metro Vancouver, Canada. Participants (16 service providers and 1 service recipient) identified services and resources available to support seniors in maintaining housing and barriers and facilitators for accessing services. Broadly, data were organized into seven themes: (1) Housing; (2) Home support; (3) Transportation; (4) Information availability, accessibility, and navigation; (5) Cultural diversity; (6) Discrimination; and (7) Funding and financial support. Results found that affordable housing that adapts to changing health conditions, income supports, health services, homecare, transportation, and culturally appropriate and nondiscriminatory informational resources are among the supports most needed for persons as young as 50 years old to succeed under the Housing First model in Metro Vancouver. Barriers to Housing First service provision, including rigid eligibility criteria for chronically and episodically homeless, should be revised to better support the growing number of older adults who are newly entering homelessness in Metro Vancouver.

The views of carers about support for their family member with an intellectual disability: With a focus on positive behavioural approaches

This qualitative study explored the views of family carers about the support that their adult children with an intellectual disability had received in relation to their behaviour that challenged. There was a particular focus on positive behavioural support (PBS), although some participants spoke more generally in terms of positive approaches. Semi-structured interviews with eight family carers were analysed using inductive thematic analysis. Four key themes were identified. Good support, of which PBS was an example, was seen as both having reduced behaviours that challenged and having a wider positive impact on the quality of life of the individual and their families. Key features highlighted were: technical knowledge and skill; a strong value base of warmth, acceptance and respect; a collaborative, consistent approach; open communication; and the extension of support to the family carer when needed. It was recognised that there is a need for broad systemic change and for the application of a workforce development model that takes account of the needs of staff, carers and those working in wider systems that have contact with people with an intellectual disability.

Facilitators and barriers of participation in a longitudinal research on migrant families in Badalona (Spain): A qualitative approach

Migrant populations are under-represented in health research. We conducted a community-based qualitative study with the aim to examine the willingness, barriers, facilitators and reasons for participating in longitudinal health research among migrants. In Badalona and Santa Coloma de Gramanet (Barcelona) from May to November 2014, 26 individual interviews and 8 discussion groups were conducted with a convenience sample of 76 migrants born in Colombia, Peru, Ecuador, Bolivia, Morocco, Pakistan and China; and 9 key informants. Grounded Theory methods and thematic analysis was used to analyse the data. Atlas-ti(R) software was used. Participants were willing to participate in health surveys and biological samples testing, and agreed to be re-contacted after 12 months. Participants agreed to the same participation for their children. Participants reported that undertaking biological samples and knowledge of the health status of their children were the greatest benefits of participation in health research. Barriers to participation reported by participants were language difficulties, time constraints and mobility issues. Facilitators of participation included offering complete and understandable information about the study objectives and procedures; offering interviewers with the same migrant background, gender, country of origin and socioeconomic status as participants; building trust through ensuring proximity, privacy and confidentiality; respecting cultural relationships; and receiving monetary compensation and test results. Focusing on migrant families instead of individuals may facilitate participation in the study. Despite being beneficial in general, receipt of monetary compensation, inclusion of questions related to sexual and reproductive health, and blood sample testing resulted in distrust for a small number of participants. The simultaneous use of several Internet tools was the most recommended tool for re-contact. Those with higher risk of mobility, greater language barriers and less Internet use were more difficult to re-contact. Study findings will help to improve participation and retention of migrants in longitudinal research.

A qualitative feasibility study to inform a randomised controlled trial of fluid bolus therapy in septic shock

OBJECTIVE

The Fluids in Shock (FiSh) Trial proposes to evaluate whether restrictive fluid bolus therapy (10 mL/kg) is more beneficial than current recommended practice (20 mL/kg) in the resuscitation of children with septic shock in the UK. This qualitative feasibility study aimed to explore acceptability of the FiSh Trial, including research without prior consent (RWPC), potential barriers to recruitment and participant information for a pilot trial.

DESIGN

Qualitative interview study involving parents of children who had presented to a UK emergency department or been admitted to a paediatric intensive care unit with severe infection in the previous 3 years.

PARTICIPANTS

Twenty-one parents (seven bereaved) were interviewed 16 (median) months since their child's hospital admission (range: 1-41).

RESULTS

All parents said they would have provided consent for the use of their child's data in the FiSh Trial. The majority were unfamiliar with RWPC, yet supported its use. Parents were initially concerned about the change from currently recommended treatment, yet were reassured by explanations of the current evidence base, fluid bolus therapy and monitoring procedures. Parents made recommendations about the timing of the research discussion and content of participant information. Bereaved parents stated that recruiters should not discuss research immediately after a child's death, but supported a personalised postal 'opt-out' approach to consent.

CONCLUSIONS

Findings show that parents whose child has experienced severe infection supported the proposed FiSh Trial, including the use of RWPC. Parents' views informed the development of the pilot trial protocol and site staff training.

TRIAL REGISTRATION NUMBER

ISRCTN15244462-results.

Gay Men's Health and Identity: Social Change and the Life Course

Due to significant historical change in the late 20th and early 21st century related to both health and cultural attitudes toward homosexuality, gay men of distinct birth cohorts may diverge considerably in their health and identity development. We argue that research on gay men's health has not adequately considered the significance of membership in distinct generation-cohorts, and we present a life course paradigm to address this problem. Focusing on the U.S. as an exemplar that can be adapted to other cultural contexts, we identify five generations of gay men alive today and review unique issues related to health and identity development for each. Implications for research, practice, and advocacy on gay men's health and development are discussed.

Contradictions in digital health engagement: An activity tracker's ambiguous influence on vulnerable young adults' engagement in own health

OBJECTIVE

Activity trackers are designed to support individuals in monitoring and increasing their physical activity. The use of activity trackers among individuals diagnosed with depression and anxiety has not yet been examined. This pilot study investigates how this target group engages with an activity tracker during a 10-week health intervention aimed to increase their physical activity level and improve their physical and mental health.

METHODS

Two groups of 11 young adults (aged 18-29 years) diagnosed with depression or anxiety participated in the digital health intervention. The study used mixed methods to investigate the research question. Quantitative health data were used to assess the intervention's influence on the participants' health and qualitative data provided insights into the participants' digital health experience.

RESULTS

The study demonstrated an ambiguous influence from the use of an activity tracker with positive physical and mental health results, but a fading and even negative digital health engagement and counterproductive competition.

CONCLUSIONS

The ambiguous results identify a need for (1) developing strategies for health professionals to provide supervised use of activity trackers and support the target groups' abilities to convert health information about physical activity into positive health strategies, and (2) designing alternatives for health promoting IT targeted users who face challenges and need motivation beyond self-tracking and competition.

The Rationale and Design of the Reducing Pathology in Alzheimer's Disease through Angiotensin TaRgeting (RADAR) Trial

BACKGROUND

Anti-hypertensives that modify the renin angiotensin system may reduce Alzheimer's disease (AD) pathology and reduce the rate of disease progression.

OBJECTIVE

To conduct a phase II, two arm, double-blind, placebo-controlled, randomized trial of losartan to test the efficacy of Reducing pathology in Alzheimer's Disease through Angiotensin TaRgeting (RADAR).

METHODS

Men and women aged at least 55 years with mild-to-moderate AD will be randomly allocated 100 mg encapsulated generic losartan or placebo once daily for 12 months after successful completion of a 2-week open-label phase and 2-week placebo washout to establish drug tolerability. 228 participants will provide at least 182 subjects with final assessments to provide 84% power to detect a 25% difference in atrophy rate (therapeutic benefit) change over 12 months at an alpha level of 0.05. We will use intention-to-treat analysis, estimating between-group differences in outcomes derived from appropriate (linear or logistic) multivariable regression models adjusting for minimization variables.

RESULTS

The primary outcome will be rate of whole brain atrophy as a surrogate measure of disease progression. Secondary outcomes will include changes to 1) white matter hyperintensity volume and cerebral blood flow; 2) performance on a standard series of assessments of memory, cognitive function, activities of daily living, and quality of life. Major assessments (for all outcomes) and relevant safety monitoring of blood pressure and bloods will be at baseline and 12 months. Additional cognitive assessment will also be conducted at 6 months along with safety blood pressure and blood monitoring. Monitoring of blood pressure, bloods, and self-reported side effects will occur during the open-label phase and during the majority of the post-randomization dispensing visits.

CONCLUSION

This study will identify whether losartan is efficacious in the treatment of AD and whether definitive Phase III trials are warranted.

Strengthening community mental health competence-A realist informed case study from Dehradun, North India

Few accounts exist of programmes in low- and middle-income countries seeking to strengthen community knowledge and skills in mental health. This case study uses a realist lens to explore how a mental health project in a context with few mental health services, strengthened community mental health competence by increasing community knowledge, creating safer social spaces and engaging partnerships for action. We used predominantly qualitative methods to explore relationships between context, interventions, mechanisms and outcomes in the "natural setting" of a community-based mental health project in Dehradun district, Uttarakhand, North India. Qualitative data came from focus group discussions, participant observation and document reviews of community teams' monthly reports on changes in behaviour, attitudes and relationships among stakeholder groups. Data analysis initially involved thematic analysis of three domains: knowledge, safe social spaces and partnerships for action. By exploring patterns within the identified themes for each domain, we were able to infer the mechanisms and contextual elements contributing to observed outcomes. Community knowledge was effectively increased by allowing communities to absorb new understanding into pre-existing social and cultural constructs. Non-hierarchical informal community conversations allowed "organic" integration of unfamiliar biomedical knowledge into local explanatory frameworks. People with psycho-social disability and caregivers found increased social support and inclusion by participating in groups. Building skills in respectful communication through role plays and reflexive discussion increased the receptivity of social environments to people with psycho-social disabilities participation, thereby creating safe social spaces. Facilitating social networks through groups increases women's capacity for collective action to promote mental health. In summary, locally appropriate methods contribute most to learning, stigma reduction and help-seeking. The complex social change progress was patchy and often slow. This study demonstrates a participatory, iterative, reflexive project design which is generating evidence indicating substantial improvements in community mental health competence.

Investigating the Relationship Between Perceived Community Safety and the Public's Attitudes Towards the Treatment of Youth Offenders in New Zealand

While opinions on what should be done with youth offenders vary from person to person, perceived levels of safety and fear of crime have been linked to more punitive attitudes towards crime and punishment. Qualitative methods were employed to explore the attitudes and opinions of members of the New Zealand public with varying levels of community safety in respect to the treatment of youth offenders. Results indicate those who identified as lowest in levels of safety were more punitive in their opinions, though they also expressed a firm desire for progressive treatment options such as rehabilitation and taking preventative action. Those who felt the safest in their community were less likely to be punitive in their opinions towards youth offenders.

"I Was Grabbed by My Pussy and Its #NotOkay": A Twitter Backlash Against Donald Trump's Degrading Commentary

The present study assessed how individuals used the #NotOkay hashtag on Twitter to respond to Donald Trump's comments about grabbing women by their genitals. We analyzed 652 tweets which included commentary about the hashtag. Three main themes emerged: (a) users' acknowledgment and condemnation of rape culture, (b) Donald Trump and the national state of sexual assault, and (c) engaging men and boys to end violence against women. Our findings emphasize that powerful political leaders can be salient symbols of rape culture, and Twitter is used as a public platform to organize and challenge problematic social discourse and call for action/change.

Moving Between Dialogic Reflexive Processes In Systemic Family Therapy Training: An Interpretative Phenomenological Study of Trainees' Experience

In this article, we present a qualitative research study concerning the ways that systemic family therapy trainees experience reflexivity while in training. There is inadequate theorizing and limited research concerning reflexivity in family therapy, particularly from trainees' perspective. In our study, we used Interpretative Phenomenological Analysis to analyse transcripts of semistructured interviews with 10 systemic family therapy trainees. Here, we present one of the four superordinate analytic themes, entitled "Moving between reflexive processes". Our analysis suggests that trainees seem to experience reflexivity as a multifaceted, dialogic process, which occurs both at an inner and at an outer space and both synchronically but also subsequently to the therapeutic/training process. We conclude by raising implications for family therapy training. Video abstract accessible by clicking here.

Human factors considerations in designing for infection prevention and control in neonatal care - findings from a pre-design inquiry

Qualitative data collection methods drawn from the early stages of human-centred design frameworks combined with thematic analysis were used to develop an understanding of infection prevention practice within an existing neonatal intensive care unit. Findings were used to generate a framework of understanding which in turn helped inform a baseline approach for future research and design development. The study revealed that a lack of clarity between infection transmission zones and a lack of design attributes needed to uphold infection prevention measures may be undermining healthcare workers' understanding and application of good practice. The issue may be further complicated by well-intentioned behavioural attitudes to meeting work objectives; undue influences from spatial constraints; the influence of inadvertent and excessive touch-based interactions; physical and/or cognitive exertion to maintain transmission barriers; and the impact of expanding job design and increased workload to supplement for lack of effective barriers. Practitioner Summary: Despite high hand hygiene compliance within a neonatal intensive care unit, healthcare workers expressed concerns about the unit design and infection prevention practice. Early inquiry methods from human-centred design and thematic analysis helped develop a framework to understand how design can be used to aid infection prevention.

Male-Partnered Bisexual Women's Perceptions of Disclosing Sexual Orientation to Family Across the Transition to Parenthood: Intensifying Heteronormativity or Queering Family?

Drawing from queer and communication privacy management frameworks, this study examines the narratives of 22 bisexual, male-partnered women who were interviewed during the perinatal period and one year postnatally about their disclosures of sexual identity to family of origin. Most women rarely discussed their sexual identity with family; participants who had disclosed described such disclosures as provoking discomfort. Some women stated that their parental status seemed to invalidate the need to talk about their sexual history or identity with family, due its declining salience and increased concerns about judgment. This study reveals how partnership and parenthood statuses contribute to the intensification of heteronormative pressures in relation to family. Therapists should attend to the role of heteronormative values regarding partnering, family-building, and parenting.

Service user engagement in healthcare education as a mechanism for value based recruitment: An evaluation study

AIM

Within the United Kingdom (UK) there is an increasing focus on Values Based Recruitment (VBR) of staff working in the National Health Service (NHS) in response to public inquiries criticising the lack of person-centred care. All NHS employees are recruited on the basis of a prescribed set of values. This is extended to the recruitment of student healthcare professionals, yet there is little research of how to implement this. Involving Service Users in healthcare educational practice is gaining momentum internationally, yet involvement of service users in VBR of 'would be' healthcare professionals remains at an embryonic phase. Adult nurses represent the largest healthcare workforce in the UK, yet involvement of service users in their recruitment has received scant attention. This paper is an evaluation of the inclusion of service users in a VBR of 640 adult student nurses.

BACKGROUND DESIGN

This study used a participatory mixed methods approach, with service users as co-researchers in the study.

METHODS

The study consisted of mixed methods design. Quantitative data via an online questionnaire to ascertain candidates' perspectives (n=269 response rate of 42%), and academic/clinical nurses (n=35 response rate 34.65%). Qualitative data were gathered using focus groups and one to one interviews with service users (n=9). Data analysis included descriptive statistics and thematic analysis.

FINDINGS

4 overarching themes were identified; increasing sense of humanness, substantiating care values; impact of involvement; working together and making it work, a work in progress.

CONCLUSION

The findings from the study highlight that involving service users in VBR of student healthcare professionals has benefits to candidates, service users and local health services. Appreciating the perceptions of healthcare professionals is fundamental in the UK and internationally to implementing service users' engagement in service enhancement and delivery. Findings from this study identify there may be a dissonance between the policy, the nurses' thoughts and their practice.

"I feel that life is meaningless": Vietnamese adolescents' experiences of and reflections about interpersonal violence

BACKGROUND

The experiences of and reflections on interpersonal violence and victimisation among adolescents living in low- and middle-income countries are poorly understood. The aim was to describe Vietnamese adolescents' reflections on their experiences of victimisation.

METHOD

A self-completed, cross-sectional survey investigating exposure to violence among high school students in Hanoi, Vietnam was conducted during 2013-2014. The last section invited participants to write about any of the matters covered in the questionnaire. Thematic analysis was conducted on these free-text comments.

RESULTS

A total of 73/76 eligible students participated in the pilot and 1616/1745 in the main survey. Of these, a total of 239 records with free-text comments were analysed. Students described experiences of violence occurring at home, at school and in the community. Experiences of violence led to sadness, loneliness, having extremely negative thoughts about the value of life, and suicidal ideas. Adolescents' experiences occurred in the context of poor parent-adolescent and teacher-student relationships, particularly concerning dissatisfaction with academic performance. Adolescents wanted to be trusted, to be given more autonomy, and to improve their relationships with parents and teachers.

CONCLUSIONS

Vietnamese adolescents experience various forms of victimisation, which are detrimental to their health and wellbeing. Understanding of their experiences of and perceptions of violence and its impact on their health and wellbeing is important in the prevention of violence against young people in Vietnam.

How Do People Experience Early Intervention Services for Psychosis? A Meta-Synthesis

We conducted a study to explore how people diagnosed with first-episode psychosis experienced their contact with early intervention services for psychosis and the way these experiences relate to their recovery processes. Our aim was to integrate and describe the service users' experiences in a rigorous and comprehensive way. A broad literature search was performed in June and July 2016. After screening, 17 qualitative studies were included. We analyzed the findings in two main steps: (a) translating studies into one another and (b) synthesizing the findings from the studies. Through these interpretative processes, we found five new and overarching themes: (a) something is wrong, (b) do for myself, (c) it's about people, (d) a price to pay, and (e) ongoing vulnerability. We describe these themes as a process that service users' maneuver through in their contact with the services. Our findings are discussed in light of relevant research.

'Was it worth it?' Intrathecal analgesia for cancer pain: A qualitative study exploring the views of family carers

BACKGROUND

Intrathecal drug delivery is known to reduce pain in patients where conventional systemic analgesia has been ineffective or intolerable. However, there is little information regarding the effects of intrathecal drug delivery on quality of life and function in those with advanced, incurable cancer.

AIM

Retrospective exploration of the views of bereaved carers regarding the physical and psychosocial effects of external tunnelled intrathecal drug delivery in patients with advanced incurable cancer.

DESIGN

Thematic analysis of qualitative interviews with carers of deceased individuals who received percutaneous external tunnelled intrathecal drug delivery as part of their pain management, within two UK centres.

SETTING

A total of 11 carers were recruited from two UK Palliative Care centres. Family carers of adult patients who had received external tunnelled intrathecal drug delivery analgesia for cancer pain and had died between 6 and 48 months prior to contact were included. Carer relatives who were considered likely to be too vulnerable or who had lodged a complaint about treatment within the recruiting department or who had been treated directly by the interviewer were excluded.

RESULTS

In total, 11 interviews took place. The emerging themes were (1) making the decision to have the intrathecal - relatives described desperate situations with severe pain and/or sedation, meaning that the individual would try anything; (2) timing and knowing they were having the best - an increased access to pain and palliative care services, meant carers felt everything possible was being done, making the situation more bearable; (3) was it worth it? - the success of the external tunnelled intrathecal drug delivery was judged on its ability to enable the individual to be themselves through their final illness. Side effects were often considered acceptable, if the external tunnelled intrathecal drug delivery enabled improvements in quality of life.

CONCLUSION

Carers perceived external tunnelled intrathecal drug delivery as most valuable when it improved quality of life towards the end of life, by reducing pain and side effects of conventional systemic analgesia to enable individuals 'to be themselves'. Under these circumstances, the carers judged significant side effects to be acceptable.

Betrayals in Emerging Adulthood: A Developmental Perspective of Infidelity

Infidelity is associated with considerable distress and discord in dating relationships. The current mixed methods study examined both the written narratives and survey responses of 104 (59.6% women) emerging adults to investigate reasons for engaging in infidelity (i.e., sexual and emotional infidelity). Emerging adults' reasons for engaging in infidelity were attributed primarily to their primary relationships and/or their romantic partners not fulfilling their needs for interdependence and thus feeling motivated to fulfill these needs elsewhere. Although the majority of participants provided independence and/or interdependence reasons for their infidelity, a large proportion of responses (40%) referenced alternative reasons. These responses included (a) the opportunity to become intimate with an infidelity partner while under the influence of alcohol, (b) attraction to an infidelity partner, and (c) the excitement and novelty that the infidelity experience provided. Those who reported engaging in infidelity because of unmet interdependence needs, and intimacy needs in particular, were more avoidantly attached than those who did not reference unmet interdependence needs. Those who reported engaging in infidelity because of unmet independence needs were more anxiously attached than those who did not reference unmet independence needs. Implications for the developmental importance of infidelity in terms of research and applied work are discussed.

Social Difficulties As Risk and Maintaining Factors in Anorexia Nervosa: A Mixed-Method Investigation

Anorexia nervosa (AN) is a serious psychiatric disorder characterized by severe restriction of energy intake and dangerously low body weight. Other domains of functioning are affected, including social functioning. Although difficulties within this domain have started to be acknowledged by the literature, some important gaps remain to be filled. Do social difficulties predate the onset of the illness? What difficulties in particular are relevant for the development and maintenance of the illness? The aim of this study is to combine the use of quantitative and qualitative methods to answer these questions. Ninety participants with lifetime AN (88 women and 2 men) completed an online survey assessing memories of involuntary submissiveness within the family, fear of negative evaluation from others, perceived lack of social competence, feelings of social belonging, eating disorder symptoms, and work and social adjustment. Participants also answered three open questions regarding their experience of social relationships before and after the illness onset. The findings provided support for the hypothesized relationships between the study variables. Involuntary submissiveness and fear of negative evaluation predicted eating disorder symptoms and these associations were partially mediated by perceived lack of social competence. Two-thirds of the sample recalled early social difficulties before illness onset and recognized that these had played a role in the development of the illness. A larger proportion of participants stated that the eating disorder had affected their social relationships in a negative way. This study sheds some light on patients' perspective on the predisposing and maintaining role that social difficulties play in AN and identifies key psychological variables that could be targeted in treatment.

How do caregivers understand and respond to unsettled infant behaviour in Vietnam? A qualitative study

BACKGROUND

Unsettled infant behaviours are a common source of concern for new parents and have been associated with perinatal common mental disorders amongst women in high-income settings. There is little evidence about how unsettled infant behaviours are understood and managed in low and lower-middle income countries. This study aimed to describe caregivers' understandings of, and responses to, unsettled infant behaviours in Vietnam and their family caregiving contexts.

METHODS

Women who were mothers of infants aged 0-6 months were purposively recruited from two sites in Thua Thien Hue Province, Vietnam (one urban and one rural). An additional group of women who were grandmothers were recruited by snowball sampling. Data were collected in semi-structured interviews about demographic information, infant feeding practices, descriptions of infant crying episodes, beliefs about why infants cry, settling strategies, infant sleeping arrangements and sources of advice on infant care. Translated interview transcripts were analysed thematically.

RESULTS

Twenty-four interviews were undertaken (21 with mothers and 3 with grandmothers). Five major themes emerged from the data after analysis: infant settling techniques, sources of information on unsettled infant behaviour, understandings of the causes of infant crying, the emotional responses of caregivers and the intergenerational household context. Infants were commonly cared for by people from multiple generations, particularly during the day. Infant settling was characterized by attending to infants immediately, breastfeeding and bed-sharing with parents during the night. Most mothers received advice on caregiving from family members. Infant crying was attributed to hunger and loneliness, as well as traditional beliefs that the infant was being upset by 'ghosts' or becoming 'hot'. Women described feeling anxious, frustrated and helpless in relation to unsettled behaviours amongst their infants.

CONCLUSIONS

Educational interventions on interpreting infant cues, infant sleep requirements and bed sharing may be appropriate in Vietnam if multiple generations are included and traditional beliefs about infant crying are addressed.

Decolonizing Scoping Review Methodologies for Literature With, for, and by Indigenous Peoples and the African Diaspora: Dialoguing With the Tensions

This article summarizes our deepened understanding of decolonizing research with, for, and by Indigenous peoples and peoples of African descent that emerged from conducting a scoping review of the methodological literature and reflecting on our review process. Although our review identified decolonizing methodologies as a promising approach, we questioned if our scoping review process engaged in decolonizing knowing. To unpack the epistemological tensions between decolonizing knowing and Western ways of doing scoping reviews, we engaged in individual and collective reflective processes- dialoguing with the tensions-moving from individual immersion in the literature to transformative dialogues among the team. In reflecting upon our tensions with the scoping review process, themes that emerged included (a) ontological/epistemological disjunctures, (b) tensions with concepts and language, and (c) relationships with the literature and beyond. This reflexive process provides valuable insight into ways in which review methods might be made a decolonizing research experience.

"Down in the Sewers": Perceptions of Depression and Depression Care Among African American Men

Depression is one of the most common, costly, and debilitating psychiatric disorders in the United States. One of the most persistent mental health disparities is the underutilization of treatment services among African American men with depression. Little is known about appropriateness or acceptability of depression care among African American men. The purpose of this study was to examine perceptions of depression and determine barriers to depression treatment among African American men. A series of four focus groups were conducted with 26 African American men. The average age of the sample was 41 years and most participants reported that they had completed high school. Nearly half of the participants reported that they are currently unemployed and most had never been married. The most common descriptions of depression in this study were defining depression as feeling down, stressed, and isolated. A small group of participants expressed disbelief of depression. The majority of participants recognized the need to identify depression and were supportive of depression treatment. Nonetheless, most men in this sample had never sought treatment for depression and discussed a number of barriers to depression care including norms of masculinity, mistrust of the health care system, and affordability of treatment. Men also voiced their desire to discuss stress in nonjudgmental support groups. Research findings highlight the need to increase the awareness of symptoms some African American men display and the need to provide appropriate depression treatment options to African American men.

The Burden Experience of Formal and Informal Caregivers of Older Adults With Hip Fracture in Nigeria

INTRODUCTION

The incidence of hip fracture among older adults in Nigeria is on the rise. As a result, there is increased frequency of hospitalization, patient suffering, family burden, and societal cost. One dimension that has not been sufficiently explored is the burden of care experienced by informal and formal caregivers.

OBJECTIVES

To describe the care burden experience of informal and formal caregivers for older adults with hip fractures in a specialized orthopedic center in Nigeria and to explore in detail how their experience differs in caregiving roles.

METHOD

This study was conducted in the phenomenological approach of qualitative methods. Face-to-face interviews and focus group interaction with 12 family caregivers and 5 health-care professionals were carried out until data saturation was achieved. Data were analyzed using thematic analysis.

RESULTS

The physical, emotional, and general health of elderly hip fracture patients are issues that affect caregiving. Factors that contribute to increased caregivers' burden include system factors (lack of personnel and health-care facilities) and patient factors: comorbidity, patient's cognitive status, and challenges completing activities of daily living (ADL). Social and financial barriers to care contribute to the type of burden experienced by the participants.

CONCLUSIONS

Caregivers experience difficulty in helping patients complete their ADL because patients with hip fracture have mobility issues that are often complicated by comorbid physical and cognitive problems. Strategies to reduce caregivers' burden for older adults with hip fracture in Nigeria are needed. Greater access to health-care services and ADL aids, and training of caregivers on how to deal with cognitive and multimorbid health problems are potential solutions.

TAXA DE INCIDÊNCIA E O USO DO FLUSHING NA PREVENÇÃO DAS OBSTRUÇÕES DE CATETER VENOSO PERIFÉRICO

RESUMO Objetivo: avaliar a incidência cumulativa de obstrução do cateter venoso periférico e identificar o uso do flushing para prevenção das obstruções. Método: método misto, com estudo de coorte descritivo com seguimento de 110 pacientes de uma clínica médica de Portugal. A coleta de dados envolveu entrevistas com 22 enfermeiros, análise documental e observação participante. Realizada análise temática dos achados qualitativos e análise descritiva para os dados quantitativos. Resultados: a incidência cumulativa de obstrução foi 50%. As categorias temáticas desvelaram que o flushing era um cuidado para prevenção da obstrução do cateter venoso e realizado antes e/ou após a administração dos medicamentos. O volume de solução fisiológica utilizado no flushing variou entre 3 e 10 ml. Verificaram-se, também, situações de não adesão ao flushing e fatores que influenciavam nesta adesão, a saber: o tempo para realizar os cuidados, a complexidade e o grau de dependência dos pacientes, o volume de trabalho e o número de enfermeiros para prestar os cuidados. Conclusão: o flushing é um cuidado de enfermagem para a prevenção da obstrução do cateter venoso periférico, no entanto, as práticas de enfermagem para implementação não são uniformes quanto a frequência e volume de solução fisiológica. A ausência de um protocolo de enfermagem, a complexidade e o grau de dependência dos pacientes, o volume de trabalho e o número de enfermeiros são fatores capazes de influenciar na adesão à prática do flushing e consequentemente na incidência de obstrução do cateter venoso periférico e na segurança do paciente e qualidade dos cuidados.

Improving gout education from patients’ perspectives: a focus group study of Māori and Pākehā people with gout

ABSTRACT INTRODUCTION Gout is a common form of arthritis that is typically managed in primary care. Gout management guidelines emphasise patient education for successful treatment outcomes, but there is limited literature about the educational experiences of people living with gout in New Zealand, particularly for Māori, who have higher gout prevalence and worse gout outcomes than Pākehā. AIM To explore gout patient education in primary care from the perspectives of Māori and Pākehā people with gout. METHODS In total, 69 people with gout were recruited through primary care providers in three locations across New Zealand. Nine semi-structured focus groups were run with Māori and Pākehā participants in separate groups. RESULTS Thematic analysis yielded two themes in relation to gout education: (i) ‘Multiple sources of gout education’; and (ii) ‘Gaps in gout knowledge’. Participants received education from general practitioners, educational resources, family and friends, and their own experiences. Māori participants preferred information to be kanohi-ki-te-kanohi (face-to-face) and with significant others present where necessary. Participants disclosed gaps in gout’s epidemiology and management. Pākehā and Māori participants reported limited understanding of the genetic basis of gout or the biological underpinnings of the condition and its treatments, but learned treatment adherence through experience. DISCUSSION Despite improved gout patient education, knowledge gaps remain and may contribute to poor medication adherence. Gout patient education interventions need to be tailored to culture and incorporate suitable methods of disseminating information about gout management.

Implementation of a Quit Smoking Programme in Community Adult Mental Health Services-A Qualitative Study

Little is known about the experiences of people with severe mental health difficulties in smoking cessation interventions. This study aimed to review the implementation of a smoking cessation programme across 16 community mental health day services. The aim was to establish the experience from both service user and facilitator perspectives and refine implementation for future groups. In-depth interviews were conducted with 20 service users and four focus groups held with 17 facilitators. Thematic analysis was used to analyse the data for emergent themes in relation to key enablers and barriers to implementation. Data from service users and facilitators revealed that implementation was enabled by an open and engaged recruitment approach; the resourcefulness of facilitators; programme materials and group-based format; combining the cessation programme with other and broader health initiatives; and participants' motivations, including health and money. Barriers included the structure of the service; the lack of a joined-up approach across the health services; literacy issues and the serial/logical process assumed by the programme. Barriers perceived as more specific to those with mental health difficulties included the use of smoking as a coping mechanism, lack of alternative activities/structure and lack of consistent determination. The tobacco free policy, implemented shortly before the programme, interestingly emerged as both a barrier and an enabler. In conclusion, although this group-based cessation programme in community mental health settings was well-received overall, a number of key barriers persist. A joined-up approach which addresses the culture of smoking in mental health settings, inconsistencies in smoking policies, and provides consistent cessation support, is needed. Care needs to be taken with the timing as overall it may not be helpful to introduce a new smoking cessation programme at the same time as a tobacco free policy.

"I've Had Bad Experiences With Team Sport": Sport Participation, Peer Need-Thwarting, and Need-Supporting Behaviors Among Youth Identifying With Physical Disability

This study was guided by self-determination theory to explore the sport experiences of youth with a physical disability and the role of peers within this context. Interviews were conducted with eight youths using a relational mapping technique and analyzed using a deductive thematic approach. Sport peers were broadly defined by the youth as individuals from a large age range and of all abilities. Youth perceived their sport peers to have dynamic roles throughout their participation in sport. The perceived roles of these sport peers included supporting and thwarting basic psychological needs, and influencing the youths' processing of sport internalization. Findings focus on the complexity of peer need-thwarting and need-supporting interactions in sport for youth with physical disabilities. Overall, peers have a multifaceted role in the sport experiences of youth identifying with a physical disability and may, in some cases, thwart youths' basic psychological needs.

Why do older people refuse resuscitation? A qualitative study examining retirement village residents' resuscitation decisions

BACKGROUND

There is a dearth of qualitative research on resuscitation preferences of older New Zealanders. The aim of this study was to investigate the resuscitation preferences of older New Zealanders in a retirement village or residential care setting, as well as the reasons for these preferences.

METHODS

This study had 37 participants from two retirement villages in Auckland, New Zealand. Participants were interviewed about a hypothetical case vignette about cardiopulmonary resuscitation, and then they completed a semi-structured interview. Interviews were subsequently transcribed and analyzed by two independent researchers using thematic qualitative methodology.

RESULTS

The majority of the participants (n = 25, 67.6%) decided against resuscitation, 10 (27.0%) wanted resuscitation, and 2 (5.4%) were ambivalent about their resuscitation preferences. Three main themes emerged during the data analysis regarding participants' reasons for deciding against resuscitation: (i) the wish for a natural death; (ii) advanced age; and (iii) a realistic awareness about the consequences of resuscitation. Responses related to the third these had three subthemes: (i) reduced quality of life; (ii) loss of personal integrity and sense of existence; and (iii) concern that resuscitation could result in unnecessary costs or a burden on others. Among participants who preferred resuscitation, two main themes emerged regarding their reasons for wanting resuscitation: (i) the wish to prolong a good quality of life; and (ii) unrealistic expectations of resuscitation.

CONCLUSIONS

Older people in this study were able to make reasoned decisions about resuscitation based on balancing their subjective estimations of quality of life and the presumed consequences of resuscitation. It is important therefore to educate older adults about the potential outcomes of resuscitation and explore (and document) their reasoning when discussing resuscitation preferences so their wishes can be respected.

Is early integration of palliative care feasible and acceptable for advanced respiratory and gastrointestinal cancer patients? A phase 2 mixed-methods study

BACKGROUND

There is evidence that early integration of palliative care improves quality of life, lowers spending and helps clarify preferences and goals for advanced cancer patients. Little is known about the feasibility and acceptability of early integration.

AIM

Assessing feasibility of early integration of palliative care, and exploring concerns perceived and problems encountered by patients, relatives and oncologists.

DESIGN

A phase 2 mixed-methods study ( ClinicalTrials.Gov :NCT02078700).

METHODS

Oncologists of two outpatient clinics offered a specialised palliative care intervention integrated with standard oncological care to all consecutive newly diagnosed metastatic respiratory/gastrointestinal cancer patients. We interviewed samples of patients, relatives and oncologists to explore strengths and weaknesses of the intervention.

RESULTS

The intervention was proposed to 44/54 eligible patients (81.5%), 40 (90.1%) accepted, 38 (95.0%) attended the first palliative care visit. The intervention was completed for 32 patients (80.0%). It did not start for three (7.5%) and was interrupted for three patients who refused (7.5%). The Palliative Care Unit performed 274 visits in 38 patients (median per patient 4.5), and 24 family meetings with relatives of 16 patients. All patients and most relatives referred to the usefulness of the intervention, specifically for symptoms management, information and support to strategies for coping. Oncologists highlighted their difficulties in informing patients on palliative intervention, sharing information and coordinating patient's care with the palliative care team.

CONCLUSION

Early integration of palliative care in oncological setting seems feasible and well accepted by patients, relatives and, to a lesser extent, oncologists. Some difficulties emerged concerning patient information and inter-professional communication.

Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions

Promoting timely and continuous care for people experiencing homelessness has been a challenge in many jurisdictions, plagued by access barriers and service fragmentation. As part of a larger programme evaluation, this study used qualitative methods to examine the role of a brief interdisciplinary intervention in supporting continuity of care for this population in a large Canadian urban centre. The intervention provides time-limited case management, primary and psychiatric care, and peer accompaniment to homeless adults with unmet health needs discharged from hospital. Data were collected from 52 study participants between July 2013 and December 2014. Three focus groups were conducted with service providers and people with lived experience of homelessness, and 29 individual, semi-structured interviews were conducted with service users and other key informants. Transcripts were analysed using thematic analysis. Analysis was informed by existing frameworks for continuity of care, while remaining open to additional or unexpected findings. Findings suggest that brief interdisciplinary interventions can promote continuity of care by offering low-barrier access, timely and responsive service provision, including timely connection to long-term services and supports, appropriate individualised services and effective co-ordination of services. Although brief interdisciplinary interventions were perceived to promote access, timeliness and co-ordination of care for this population with complex health and social needs, gaps in the local service delivery context can present persisting barriers to care comprehensiveness and continuity.

"Being a Therapist Doesn't Exclude You From Real Life": Family Therapists' Beliefs and Barriers to Political Action

A crucial and overlooked facet of social justice in family therapy is political and policy advocacy. Family therapists have unique insight into how social policies and political discourse shapes clients' lives and the life of our profession. Such knowledge can inform policymakers and political debate, yet few family therapists are trained to engage in political action. In this randomized, national survey of licensed family therapists' (N = 174), we explore beliefs about and barriers to engagement in political and policy processes. The findings suggest that there are significant barriers and uncertainties surrounding family therapists' engagement, including time, feelings of efficacy, and interest. Given these barriers we discuss practical suggestions for clinicians and family therapy training programs.

"Every child that is a foster child is marked from the beginning": The home-school communication experiences of foster parents of children with disabilities

This study investigated the perceptions of foster parents of children with disabilities concerning their interactions with school personnel. We conducted semi-structured interviews with 7 foster parents of 6 children with disabilities (age range=5-16). A qualitative analysis of the interviews resulted in the identification of five thematic areas, including foster parent perceptions of: (a) the role of the foster parent, (b) the efficacy of the foster parent in helping the child learn, (c) invitations to involvement from the school (d) invitations to involvement from the child, and (e) foster child experiences in the school system. Marked differences were found in the perceptions of the perceptions in foster parents of elementary and secondary age students. It is clear that foster parents who take on an active role in their child's education experienced positive relationships with their child's school. Foster parents who take a passive role in their partnerships with the schools experienced increased difficulty maintaining motivation to continue in their efforts to increase collaboration and involvement with the schools. They indicated a sense of anger, distrust, and even hostility towards the schools. Based on the findings, recommendations are provided for improving home-school relationships, and addressing obstacles to successful school partnerships with foster families.

'And when a certain health issue happen, they try to cover it': Stakeholder perspectives on the health of temporary foreign workers and their families

This study examines stakeholders' perspectives on the health and well-being of temporary foreign workers (TFWs) and their families in Alberta, Canada. We used a critically informed qualitative methodology. We interviewed 13 stakeholders, including service providers and policy makers. Stakeholders involved in providing services to TFWs perceived that the workers experience (1) barriers in accessing mental health services, (2) mental health challenges, (3) family health challenges, (4) occupational health challenges, and (5) income and social status as a social determinant of health. Immigration and class status intersect to influence the health of this vulnerable population in Canada.

"Shared Destiny": The Dynamics of Relationships in Families of Patients With Brain Injury

This qualitative research focused on the relationships between family members of patients with acquired brain injury (ABI). The aim was to explore the dynamics between caregivers of the family member with a brain injury during rehabilitation hospitalization, and the relationships between them and the rest of the extended family. Twenty semistructured interviews were conducted with family members. In each family, the spouse of the patient and another family member involved in caregiving were interviewed. The importance of the relationships between family members during rehabilitation hospitalization justifies the examination undertaken in this research. Findings point at the change that took place in the relationships between family members because of the need to cope with a relative's injury. It is possible that direct intervention in the dynamics of the relationship, especially between the family of origin and the nuclear family of the injured person, can benefit extended families in coping with the crisis.

"Keeping it on your radar"-assessing the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood: A qualitative study from the early detection of type 1 diabetes in youth study

AIMS

The aim of this study was to explore from the perspectives of key stakeholders involved in the pathway to diagnosis, the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood.

METHODS

Qualitative interviews and free-text analyses were undertaken in 21 parents with a child diagnosed with type 1 diabetes, 60 parents without a child diagnosed with type 1 diabetes, 9 primary healthcare professionals, 9 teachers and 3 community diabetes liaison nurses. Data were analysed thematically and 30% double coded.

RESULTS

Two key themes were identified, namely the importance of widespread awareness and knowledge and seeking healthcare professional help. Parents with a child diagnosed with type 1 diabetes described seeking opinions from a number of individuals prior to seeking health professional help. Healthcare professionals recognized the rarity of the condition and the need for it to be kept on their "radar", to ensure they considered it when examining an unwell child. The process of obtaining a primary healthcare appointment was identified as potentially playing a crucial role in the diagnostic process. However, most parents with a child diagnosed with type 1 diabetes described receiving an appointment on the day they sought it.

CONCLUSIONS

Knowledge and awareness of type 1 diabetes in childhood remain limited in the general population and misconceptions persist relating to how children present with this serious condition. An effective community-based intervention to raise awareness amongst key stakeholders is required to ensure children receive a timely diagnosis once symptomatic.

Students' Perceptions of Trigger Warnings in Medical Education

Phenomenon: Trigger warnings are verbal statements or written warnings that alert students in advance to potentially distressing material. Medical education includes numerous subjects frequently identified as triggers, such as abuse, rape, self-injurious behaviors, eating disorders, drug and alcohol addiction, and suicide. Thus, exploring medical students' perceptions of trigger warnings may provide a valuable perspective on the use of these warnings in higher education.

APPROACH

As part of a larger descriptive, cross-sectional survey study on medical education, we assessed 1st- and 2nd-year medical students' perceptions of trigger warnings in the preclinical curriculum. Five questions specific to trigger warnings explored students' knowledge, prior experience, and perceptions of trigger warnings in medical education. Frequencies of individual question responses were calculated, and qualitative data were analyzed via content and thematic analyses.

FINDINGS

Of the 424 medical students invited to participate, 259 completed the survey (M = 24.8 years, SD + 3.4, 51.4% female, 76.1% White, 53.7% 1st-year students). Few students (11.2%) were aware of the term trigger warning and its definition. However, after being presented with a formal definition on the online survey, 38.6% reported having had a professor use one. When asked whether they supported the use of trigger warnings in medical education, respondents were distributed fairly equally by response (yes = 31.0%, maybe = 39.2%, no = 29.7%). Qualitative analysis revealed three themes: (a) Trigger Warnings Allow Students to Know What is Coming and Prepare Themselves: Respondents believed that trigger warnings would benefit students with a history of trauma by providing them additional time to prepare for the material and, if appropriate, seek professional help; (b) Students Need to Learn How to Handle Distressing Information: Respondents agreed that they needed to learn and cope with highly sensitive material because they would be confronted with difficult and unexpected situations in clinical practice; and (c) Trigger Warnings Help Students Understand the Severity of the Material: Respondents felt that trigger warnings may help students understand the severity of the material being covered and increase awareness about trauma and its effects on health and well-being. Insights: Findings did not reach consensus for or against the use of trigger warnings in medical school; however, students emphasized the importance of learning how to cope with distressing material. Trigger warnings may represent a teaching tool to facilitate classroom discussions about the severity of trauma-related material and problem-focused coping strategies.

Emotional eating and weight regulation: a qualitative study of compensatory behaviors and concerns

BACKGROUND

Emotional eating, or overeating in response to negative emotions, is a behavior endorsed by both normal weight and people with overweight/obesity. For some individuals, emotional eating contributes to weight gain and difficulties losing weight. However, there are also many who engage in emotional eating who maintain a normal weight. Little is known about the mechanisms by which these individuals are able to regulate their weight.

METHODS

The present study seeks to gain insight into the behaviors of individuals of normal weight who engage in emotional eating through a series of one-on-one, 1-h long, qualitative interviews. Interviews were semi-structured and guided by questions pertaining to participants' compensatory behaviors used to regulate weight and concerns regarding their emotional eating. All interviews were transcribed and then objected to a thematic analysis of their content.

RESULTS

The results of this analysis showed that participants endorsed using physical activity, controlling their eating behaviors, and engaging in alternative stress reduction and coping strategies to mitigate the effects of their emotional eating. They reported concern over the effects of emotional eating on their weight, body image, and health and saw this behavior as an unhealthy coping mechanism that was difficult to control.

CONCLUSIONS

These results suggest that programs promoting exercise, mindful eating, emotion regulation, and positive body image could have a positive effect on emotional eaters who struggle to maintain a healthy weight.