Making physical activity fun and accessible to adults with intellectual disabilities: A pilot study of a gamification intervention

BACKGROUND

Only about 9% of individuals with intellectual disabilities reach the government's physical activity (PA) recommendations. Combining gamification and technology seems particularly promising in overcoming personal and environmental barriers to PA participation.

METHOD

Eighteen adults with varying levels of intellectual disabilities completed a pilot study to assess the initial effects of a cycling gamification intervention on levels of PA, fitness, psychosocial outcomes, and challenging behaviours. The study comprised three designs: pre-post single group, AB single-case, and qualitative. Social validity, implementation barriers and facilitators were also explored.

RESULTS

Nearly all 18 participants cycled daily. Time and distance cycled daily increase during the intervention while a decrease in stereotyped behaviours was observed. Participants and staff found the intervention enjoyable and socially valid.

CONCLUSIONS

Results of the multiple-design study suggest that gamification interventions may be a suitable, enjoyable, and promising way to contribute to PA participation of adults with intellectual disabilities.

Strategies that nurses working irregular night shifts use to improve sleep quality: A qualitative study among good and poor sleepers

AIMS

To assess the sleep strategies that nurses working irregular night shifts use to improve their sleep quality, and to compare the strategies of good and poor sleepers to determine whether the differences between the two groups could provide insights into possible effective strategies.

DESIGN

A qualitative descriptive study.

METHODS

The study was conducted from September 2019 to January 2020. Thirty-four nurses working irregular night shifts participated; 17 were classified as good sleepers and 17 as poor sleepers based on the Sleep-Wake Experience List, a validated self-report instrument that measures one's sleep quality. Interviews were conducted using open questions to explore strategies around the night-shift set. The interviews were analysed using thematic analysis.

FINDINGS

Both groups described similar and different strategies that help them work and sleep well during and after night shifts. However, good sleepers mentioned a greater number of strategies and seemed to have thought about them more than poor sleepers. The most common strategies were having a clear structure, being organized-especially regarding sleeping time-maintaining a daily routine and adjusting their sleep environment.

CONCLUSION

Healthcare institutions should consider offering education and training programs aimed at empowering nurses who work irregular night shifts. These programs should provide nurses with various sleep strategies to enhance their sleep quality and overall well-being.

IMPLICATIONS FOR THE PROFESSION

Nurses working irregular night shifts can possibly enhance their sleep quality by making personalized plans, for example, including a clear day structure, or an optimized sleep environment.

IMPACT

The study focused on how nurses working night shifts could possibly enhance their sleep quality. The findings highlight the importance of providing nurses with diverse sleep strategies to improve sleep quality, helping them to identify what works best for them and consistently apply these strategies.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research guidelines were followed.

PATIENT OR PUBLIC CONTRIBUTION

Nurses working irregular night shifts at Maastricht University Medical Center in Maastricht, the Netherlands, who agreed to participate in the study, engaged in a discussion to assess the relevance of sleep quality to their work. They were also encouraged to share their perspectives during the interviews.

Features and behaviours for weight loss in the Chilean cohort with obesity from the ACTION study

In Latin America, obesity rates are among the highest in the world. Currently, people with obesity (PWO) receive suboptimal care due to several challenges and barriers. The international ACTION-IO study aimed to identify perceptions, attitudes and behaviours of PWO and healthcare providers (HCP), and to assess potential barriers to effective obesity care. The aim of this subanalysis of the Chilean cohort was to compare their characteristics, perceptions, attitudes and behaviours according to the percentage of weight loss (lower weight loss [LWL; ≤10%] or higher weight loss [HWL; >10%] of basal weight). The ACTION-IO survey was completed by 1000 Chilean PWO and 200 HCPs. Mean age of PWO was 38 years (range 18-75); 62% were female. The majority had class I obesity. HWL subgroup represented 17.2% of all Chilean subset. Specific characteristics of patients with HWL were identified (higher educational level, lower proportion of class III obesity, preference for consulting obesity specialists, considering conversations with HCP as very helpful). HWL patients reported higher rates of favourable outcomes following HCP advice and a higher probability of attending scheduled follow-up visits. Certain demographic and behavioural variables (educational level, consultation to obesity specialists, adherence to HCP advice, follow-up scheduled visits and becoming aware of the obesity state) may identify PWO with a higher probability of a greater weight loss.

Nonpharmacological nursing interventions for behavioural and psychological symptoms of dementia in acute and subacute settings: A systematic review

BACKGROUND

Behavioural and psychological symptoms of dementia are a group of non-cognitive symptoms such as agitation, physical aggression, depression, sexual disinhibition and psychosis. Therapeutic approaches vary because of the multifactorial and complex symptomology. The researchers of this study aimed to systematically review the nonpharmacological interventions for BPSD used by nurses in acute and subacute hospital settings.

DESIGN

The PRISMA guidelines guided this systematic review. The review was registered with PROSPERO (CRD42020184015).

METHOD

The databases Cumulative Index of Nursing and Allied Health Literature (CINAHL) complete, Medline complete, Excerpta Medica (Embase®) and PsycINFO published by the American Psychological Association (APA) were searched for studies published in English to October 2021. Quality appraisal was performed independently by three reviewers using the Critical Appraisal Skills Program tools. Data were synthesized using a narrative approach.

RESULTS

Two studies were identified that focused on interventions used by nurses; findings were positive for the use of nonpharmacological interventions to manage BPSD.

CONCLUSION

Current evidence suggests that nonpharmacological interventions are the best practices to manage BPSD. However, limited, and low-quality evidence suggests that further investigation is required to understand the factors contributing to the lack of use of nonpharmacological interventions by nurses in acute and subacute hospital settings.

Differences in socio-demographics status, risk behaviours, healthcare uptake and HIV/ sexually transmitted infections (STIs) between brothel-based and street-based female sex workers in Yunnan, China

BACKGROUND

Heterosexual contact is the primary mode of HIV transmission in China and commercial sex is thought to play a crucial role in China's epidemic. Female sex workers (FSWs) in China tend to be either brothel-based (BSWs) or street-based (SSWs), but few studies have investigated the differences between these important segments of this difficult-to-reach, high-risk population. Our aim was to explore the differences between SSWs and BSWs in terms of socio-demographic characteristics, sexual and risky practices, HIV/STI-related knowledge, health services, HIV/STI prevalence and other aspects.

METHODS

A cross-sectional survey was conducted in Yunnan Province of China in partnership with a local FSW-friendly non-governmental organization. Face-to-face interviews using a structured questionnaire were conducted to collect data on socio-demographic characteristics, sex work history, sexual behaviours, HIV/STI-related knowledge, HIV testing history, and healthcare services uptake. Blood samples were taken for HIV and syphilis testing, and urine samples for gonorrhea and chlamydia testing. Descriptive statistics were used to evaluate differences between SSWs and BSWs.

RESULTS

A total of 185 BSWs and 129 SSWs were included in the study. SSWs were older and less educated, had more dependents and more clients, lower condom use and accessed fewer healthcare services. Moreover, 37.2% of SSWs and 24.9% of BSWs were found to have HIV/STI infection. Unfortunately, the awareness related to STIs was relatively low in both groups, especially SSWs.

CONCLUSIONS

Our study provides evidence that confirms the disproportionately high vulnerability of SSWs to HIV and other STIs, underscoring the urgent need for the Chinese health and public health sectors to prioritize outreach to SSWs. Awareness and educational programs, condom distribution, testing and health check-ups should be included in a comprehensive strategy for HIV/STI prevention in this high-risk population.

Managing Medications During "Sick Days" in Patients With Diabetes, Kidney, and Cardiovascular Conditions: A Theory-informed Approach to Intervention Design and Implementation

OBJECTIVES

Our aim in this work was to: 1) explore barriers and enablers to patient and health-care provider (HCP) behaviours related to sick-day medication guidance (SDMG), 2) identify theory-informed strategies to advise SDMG intervention design, and 3) obtain perspectives on an eHealth tool for this purpose.

METHODS

A qualitative descriptive study using qualitative conventional content analysis was undertaken. Interviews and focus groups were held with patients and HCPs from January 2021 to April 2022. Data were analyzed using the Behaviour Change Wheel and Theoretical Domains Framework to inform intervention design.

RESULTS

Forty-eight people (20 patients, 13 pharmacists, 12 family physicians, and 3 nurse practitioners) participated in this study. Three interventions were designed to address the identified barriers and enablers: 1) prescriptions provided by a community-based care provider, 2) pharmacists adding a label to at-risk medications, and 3) built-in prompts for prescribing and dispensing software. Most participants accepted the concept of an eHealth tool and identified pharmacists as the ideal point-of-care provider. Challenges for an eHealth tool were raised, including credibility, privacy of data, medical liability, clinician remuneration and workload impact, and equitable access to use of the tool.

CONCLUSIONS

Patients and HCPs endorsed non-technology and eHealth innovations as strategies to aid in the delivery of SDMG. These findings can guide the design of future theory-informed SDMG interventions.

Do Animal Welfare Education Campaigns Really Work? An Evaluation of the RSPCA's #DogKind Campaign in Raising Awareness of Separation-Related Behaviours in UK Dog Owners

One of the main aims of companion animal welfare charities is to educate the public about the needs of animals. This is frequently performed through campaigns focusing on specific aspects of welfare. The Royal Society for the Prevention of Cruelty to Animals (RSPCA), Britain's biggest animal welfare charity, launched the nationwide #DogKind campaign in March 2019. Targeted mainly at 25-34-year-olds, the campaign aimed to increase awareness of separation-related behaviour (SRB) among dog owners and encourage them to seek help for SRB from reliable sources. This research involved a quasi-experimental, non-equivalent control group design evaluating the campaign's effectiveness. It was conducted through a series of online surveys at three different time points: before the launch of the campaign (n = 2002), six months after (n = 2423), and, again, two months later (n = 269), during which we asked the same questions regarding knowledge of SRB. An experimental trial of 269 participants tested whether accessing a video alongside the campaign web pages increased the effectiveness of the campaign objectives. Overall, the campaign appeared to be effective in reaching its target audience but not at raising awareness of SRB or increasing the number of owners intending to seek help. The inclusion of a video in the campaign made no difference to its effectiveness. This study shows that this campaign had limited success in achieving its targets and highlights the importance of thorough evaluations of education interventions that aim to improve the welfare of companion animals.

An Electronic Teen Questionnaire, the eTeenQ, for Risk Behavior Screening During Adolescent Well Visits in an Integrated Health System: Development and Pilot Implementation

Background

Screening for risk behaviors is a routine and essential component of adolescent preventive health visits. Early identification of risks can inform targeted counseling and care. If stored in discrete fields in the electronic health record (EHR), adolescent screening data can also be used to understand risk behaviors across a clinic or health system or to support quality improvement projects.

Objective

Goals of this pilot study were to adapt and implement an existing paper adolescent risk behavior screening tool for use as an electronic data capture tool (the eTeenQ), to evaluate acceptance of the eTeenQ, and to describe the prevalence of the selected risk behaviors reported through the eTeenQ.

Methods

The multidisciplinary project team applied an iterative process to develop the 29-item eTeenQ. Two unique data entry forms were created with attention to (1) user interface and user experience, (2) the need to maintain patient privacy, and (3) the potential to transmit and store data for future use in clinical care and research. Three primary care clinics within a large health system piloted the eTeenQ from August 17, 2020, to August 27, 2021. During preventive health visits for adolescents aged 12 to 18 years, the eTeenQ was completed on tablets and responses were converted to a provider display for teens and providers to review together. Responses to the eTeenQ were stored in a REDCap (Research Electronic Data Capture; Vanderbilt University) database, and for patients who agreed, responses were transferred to an EHR flowsheet. Responses to selected eTeenQ questions are reported for those consenting to research. At the conclusion of the pilot, the study team conducted semistructured interviews with providers and staff regarding their experience using the eTeenQ.

Results

Among 2816 adolescents with well visits, 2098 (74.5%) completed the eTeenQ. Of these, 1811 (86.3%) agreed to store responses in the EHR. Of 1632 adolescents (77.8% of those completing the eTeenQ) who consented for research and remained eligible, 1472 (90.2%) reported having an adult they can really talk to and 1510 (92.5%) reported feeling safe in their community, yet 401 (24.6%) reported someone they lived with had a gun and 172 (10.5%) reported having had a stressful or scary event that still bothered them. In addition, 157 (9.6%) adolescents reported they were or wondered if they were gay, lesbian, bisexual, pansexual, asexual, or other, and 43 (2.6%) reported they were or wondered if they were transgender or gender diverse. Of 11 staff and 7 providers completing interviews, all felt that the eTeenQ improved confidentiality and willingness among adolescents to answer sensitive questions. All 7 providers preferred the eTeenQ over the paper screening tool.

Conclusions

Electronic capture of adolescent risk behaviors is feasible in a busy clinic setting and well accepted among staff and clinicians. Most adolescents agreed for their responses to risk behavior screening to be stored in the EHR.

Understanding Factors Contributing to Vaccine Hesitancy in a Large Metropolitan Area

Vaccine hesitancy has become a major global concern, leading to a significant decrease in the vaccination rate, with the World Health Organization recognizing it as one of the top ten threats to public health. Moreover, the health cost generated is evaluated to be 27 billion dollars per year in the US alone. To investigate the association between demographic variables and knowledge, attitudes, and behaviours related to vaccination, a survey-based cross-sectional study was conducted with 1163 individuals. Three models were used to perform a multiple linear regression analysis. In Model I, knowledge about vaccinations was found to be associated with smoking habits, education, and marital status. In Model II, attitudes towards vaccinations were significantly associated with sex, smoking habits, education, marital status, and knowledge. In Model III, behaviours related to vaccination were associated with sex, smoking habits, having children, knowledge, and attitudes. One potential solution to improve behaviours related to vaccinations in the general population is to implement specific public health programs, which can be a cost-effective intervention. This study provides valuable insights into the determinants of knowledge, attitudes, and behaviours related to vaccinations in the general population.

Acquisition behaviours for nutrition-related information based on a health promotion model for older adults in a long-term care facility

AIM

To explore the acquisition behaviours for nutrition-related information of older adults in a long-term care facility.

DESIGN

A qualitative descriptive design was used in this study.

METHODS

Sixteen older adults in a long-term care facility were recruited using purposive sampling between March and May 2021. Data were collected via face-to-face semi-structured interviews, based on open questions regarding acquisition behaviours for nutrition-related information and flexible question formulation, and the data were analysed using an inductive-deductive method. A health promotion model was used as a conceptual framework to regulate the refinement of themes.

RESULTS

Three themes were identified in this study. The first theme discussed the individual characteristics and experiences of older adults that contributed to their acquisition behaviours for nutrition-related information. The second theme described behaviour-specific cognitions of and the effects on the participants regarding the influencing factors involving various internal individual elements and external physical environment. The third theme explored the positive behavioural outcomes of the participants resulting from these acquisition behaviours.

CONCLUSION

Acquisition behaviours for nutrition-related information of older adults in long-term care facilities were affected by both individual characteristics and external physical environment factors. Access to nutritional information can help older adults cultivate a healthy diet. Although they exhibited a significant interest in nutrition, the participants still encountered several difficulties. Based on the actual care needs of the older people, appropriate nutritional information interventions should be provided by healthcare providers working in long-term care facilities so as to improve the ability of the older people to acquire information independently.

PATIENT OR PUBLIC CONTRIBUTION

All 16 participants actively participated in the interview process and the preliminary preparation of the article.

Knowledge, risk assessment, practices, self-efficacy, attitudes, and behaviour's towards venous thromboembolism among nurses: A systematic review

AIM

This study reviewed the literature on nurses' knowledge, risk assessment practices, self-efficacy, attitudes, and behaviours towards venous thromboembolism (VTE).

DESIGN

A systematic review following PRISMA guidelines.

METHODS

CINAHL (via EBSCO), MEDLINE (via PubMed), and Web of Science were electronic databases used to find studies published from 2010 to November 2020 in English language. A Hoy critical appraisal checklist was used to assess the risk of bias and methodologic quality.

RESULTS

This study included fourteen studies conducted on 8628 Registered Nurses. Nine of the fourteen studies examined nurses' general knowledge level regarding VTE, and five showed that most nurses had a good knowledge of VTE. Of the 14 studies, six assessed nurses' risk assessment knowledge regarding VTE, and three showed that nurses had low knowledge of VTE risk assessment. Eleven studies assessed nurses' practices concerning VTE prophylaxis; 5 of the 11 studies reported that nurses had poor and unsatisfactory levels of VTE practice. Three of the 14 studies showed that nurses had low self-efficacy and varied beliefs. The most frequent recommendations were to create continuous educational programs and in-service training programs (n = 11), followed by creating institutional protocols standardizing VTE (n = 6).

CONCLUSIONS

Comprehensive educational programs and campaigns based on well-established and standardized tools should be provided to nurses to improve their VTE knowledge.

The Role of Human and Organizational Factors in the Pursuit of One Digital Health

OBJECTIVE

This paper surveys a subset of the 2022 human and organizational factor (HOF) literature to provide guidance on building a One Digital Health ecosystem.

METHODS

We searched a subset of journals in PubMed/Medline for studies with "human factors" or "organization" in the title or abstract. Papers published in 2022 were eligible for inclusion in the survey. Selected papers were categorized into structural and behavioural aspects to understand digital health enabled interactions across micro, meso, and macro systems.

RESULTS

Our survey of the 2022 HOF literature showed that while we continue to make meaningful progress at digital health enabled interactions across systems levels, there are still challenges that must be overcome. For example, we must continue to grow the breadth of HOF research beyond individual users and systems to assist with the scale up of digital health systems across and beyond organizations. We summarize the findings by providing five HOF considerations to help build a One Digital Health ecosystem.

CONCLUSION

One Digital Health challenges us to improve coordination, communication, and collaboration between the health, environmental and veterinary sectors. Doing so requires us to develop both the structural and behavioural capacity of digital health systems at the organizational level and beyond so that we can develop more robust and integrated systems across health, environmental and veterinary sectors. The HOF community has much to offer and must play a leading role in designing a One Digital Health ecosystem.

Knowledge, attitudes and behaviours towards vitamin D and sun exposure of parents of infants and young children and health professionals in New Zealand

BACKGROUND

Vitamin D deficiency may result in adverse long-term health consequences in adulthood if it occurs during fetal development, infancy and childhood. To effectively improve vitamin D status of infants/toddlers, there needs to be knowledge and awareness of vitamin D among parents and health professionals.

AIMS

The aim of this study was to investigate parents' and health professionals' knowledge, attitudes and behaviours towards vitamin D and sun exposure over two timepoints.

METHODS

The study was an ecological study over two timepoints (Parents 2009 and 2021; Health professionals 2010 and 2019) and used an online questionnaire.

RESULTS

The analysis included 9834 parents (2009 n = 8032; 2021 n = 1802) and 283 health professionals (2010 n = 193; 2019 n = 90). Parents and health professionals had good knowledge of vitamin D sources, roles and risk factors for deficiency over two timepoints. There were however some confusions regarding the vitamin D content of breast milk, exclusive breastfeeding as a risk factor for deficiency, and ineffectiveness of sun exposure through glass windows in relation to vitamin D synthesis. In 2019, only 37% of health professionals indicated giving advice on supplements for infants/toddlers. Most parents and health professionals believed there was not enough information available to parents regarding vitamin D (>90%) and that skin cancer prevention messages make it difficult to get information about vitamin D across (>70%).

CONCLUSION

Although parents and health professionals had good knowledge in most areas, knowledge of some specific sources and risk factors for vitamin D deficiency was poor.

Are childhood oral health behaviours and experiences associated with dental anxiety in adolescence?

BACKGROUND

Dental anxiety is associated with untreated dental caries. Understanding which childhood behaviours or experiences have the strongest association with later dental anxiety may help focus preventive strategies, subsequently limiting the burden of dental caries and anxiety.

AIM

The aim of this study was to explore whether behaviours and experiences during childhood were associated with adolescent dental anxiety.

DESIGN

Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC). Multivariable logistic regression was used to explore associations between adolescent dental anxiety and childhood behaviours and experiences. 1791 participants answered questions about oral health behaviours and experiences at 8 years of age and dental anxiety questions aged 17 years.

RESULTS

Children with experience of invasive dental treatment were more likely to have dental anxiety at 17 years of age than those who had not experienced dental treatment (OR 1.63; 95% CI: 1.12, 2.37; p = .011). Irregular dental attenders in childhood had over three times the odds of dental anxiety by adolescence, compared with regular attenders (OR 3.67 95% CI: 1.52, 8.88; p = .004).

CONCLUSIONS

Adolescent dental anxiety is associated with invasive treatment and irregular dental attendance in childhood. A history of irregular attendance or invasive treatment may serve as a useful predictor when considering dental anxiety in young adult patients. Early preventive care supports good attendance and oral health. These actions may have secondary effects of reducing future dental anxiety.

Measuring behaviour in hens using an ethogram to assess analgesia during further refinement of a high welfare, on-hen, poultry red mite feeding device

Background: To refine an on-hen mite feeding device, an ethogram was employed to measure the reactions of hens during a routine experimental procedure (feather plucking) and to assess effects of analgesic cream on those reactions. Methods: Three experimental groups were used; one treated with EMLA 5% before plucking ("EMLA group"); one with aqueous cream ("placebo group") and a "no treatment" group. Behaviours were measured and compared on three days: 'dummy handling day' i.e. no plucking; 'plucking day', plucking the left thigh; and 'treatment day' i.e with right thighs plucked post-treatment. Poultry red mite feeding assays were performed to examine effect of creams on mite feeding rates, mortality and fecundity. All data were analysed using generalised linear (mixed) modelling approaches. Results: Use of the ethogram demonstrated no significant difference in hen behaviours in the EMLA group between dummy handling day and treatment day (p = 0.949) alongside a significant reduction in measured behaviours between plucking day and treatment day in the same group (p = 0.028). There was a statistically significant increase in measured behaviours from the dummy handling day to the plucking day in both placebo (p = 0.011) and no treatment group (p < 0.001). Effect sizes and directions were similar between dummy handling and treatment days in the 'placebo' and 'no treatment' groups, though not statistically significant (placebo, p = 0.064; no treatment p = 0.069). Mite feeding in the EMLA group was significantly lower than in the no treatment group in feeding assay 1 (p = 0.029) only. Mite mortality and fertility were unaffected. Conclusions: The ethogram successfully measured changes in observed behaviours between the dummy handling session and procedures. No adverse effects of EMLA cream on hens were demonstrated at 3mg/kg in hens. Use of analgesia for this routine procedure improves hens' experiences during experimental trials.

Attitudes to COVID-19 Vaccines Among Australians During the Delta Variant Wave: A Qualitative Interview Study

Since the outbreak of COVID-19 globally, a range of vaccines has been developed and delivered to reduce viral transmission and prevent COVID cases. This article reports findings from a qualitative research project involving telephone interviews with a diverse group of 40 adult Australians about their experiences of the COVID crisis. Interviews were conducted in late 2021 when Australians were dealing with the Delta variant outbreak and following a major effort on the part of government authorities to improve COVID-19 vaccination supplies and take-up. Responses to a question about COVID vaccines revealed that attitudes to and acceptance of COVID vaccines among this group were overwhelmingly positive. All participants had received at least one vaccine dose and the majority expressed views in support of mass vaccination against COVID. People who were hesitant or cautious about accepting COVID vaccination referred to the vaccines' novelty and potential side effects. While many people were aware of debates about vaccine safety in the news media, trust in science and medical advice about COVID vaccines was strong. Participants wanted to protect themselves and others by accepting the recommended doses. Participants' locale was a major factor in shaping experiences and stances on vaccines. The setting of government targets and mandates for vaccination was a key motivating factor. The goal of 'getting back to normal' was expressed as another reason for accepting vaccination, particularly for those living in areas that had been badly affected by high COVID cases and prolonged lockdowns.

Defining the Characteristics of Successful Biosecurity Scent Detection Dogs

To perform their role effectively, scent detection dogs require certain characteristics. Identifying these characteristics will inform the selection of prospective dogs and preferred approaches to their training. The current study drew upon the perspectives of industry stakeholders to identify the behavioural traits considered relevant for detection dogs in biosecurity screening roles. Dog handlers, trainers, and supervisors (n = 25) in Australian biosecurity operations participated in focus group interviews to determine the perceived characteristics that, in their experience, influence detection performance. Their descriptions were used to create a questionnaire which was then administered to handlers to assess the working behaviours of current biosecurity dogs. Responses were collected for 88% of the operational dogs (n = 36). An exploratory factor analysis revealed seven tentative dimensions: search motivation, emotional stability, search arousal, food motivation, play motivation, search independence, and search focus. Search motivation and search arousal were both positively associated with handler ratings of detection performance (p ≤ 0.006). In general, biosecurity dogs were scored consistently high in ratings of search motivation, emotional stability, and food motivation. Our approach has advanced our understanding of the working behaviours and characteristic profile of biosecurity detector dogs and will be used to inform candidate selection processes.

Perceived risk and risk reduction behaviours of female first-degree relatives of breast cancer patients attending care at Uganda cancer institute

OBJECTIVE

The objective of this study was to assess the perceived risk of breast cancer (BC) and adoption of risk reduction behaviours among female first-degree relatives (FDRs) of BC patients attending care at the Uganda Cancer Institute (UCI).

METHODS

A cross-sectional study was performed using a questionnaire to collect data between March to October 2019. Adult female FDRs of patients attending care at UCI were recruited consecutively. Breast cancer perceived risk was assessed using a verbal measure; 'My chances of getting BC are great' on a Likert scale with 5 response alternatives. Chi square tests and modified Poisson regression using generalised estimating equations model were used to determine associations and examine factors associated with perceived risk of BC.

RESULTS

We enrolled 296 FDRs from 186 female BC patients. Few participants 118/296 (40%) had high perceived risk of BC. Majority 165/296 (56%), had ever practiced breast self-examination. At the multivariable modified Poisson GEE model, women aged 36-45 years were more likely to perceive themselves to be at high risk of developing BC compared to women aged 18-25 years (adjusted prevalence ratio: 1.174; 95% confidence interval [95%CI] = 1.05-2.88; p value = 0.030) after adjusting for age, religion, educational level and residence.

CONCLUSION

Few FDRs of BC patients perceived themselves to be at high risk of developing BC and do not seek risk reduction measures including screening and early diagnosis approaches. Breast cancer health education especially targeting younger women should emphasize the increased risk of BC in FDRs.

The effectiveness and usability of a novel mobile phone-based self-care intervention for patients with heart failure: A mixed-methods pilot study

AIM

To evaluate the preliminary effectiveness and usability of a novel mobile phone-based self-care intervention (named WithUs) for patients with heart failure (HF).

METHODS AND RESULTS

We conducted a mixed-methods pilot study with group pretest-posttest design and usability testing. Participants were 26 Korean HF patients (20 men; median age 62 years) who took part in this study after hospital discharge. Data were collected at baseline and after the 24-week intervention, using questionnaires and interviews. The outcome variables were eHealth literacy, disease knowledge, and self-care behaviours. The Wilcoxon signed-rank test was used to compare the pre- and post-intervention results. Thematic analysis was used for analysing qualitative data. The WithUs programme improved the eHealth literacy (p = .005), disease knowledge (p < .001), and self-care behaviours (p < .001) of patients with HF. The median score of total app usability was 4.1 out of 5 (interquartile range = 4.0-5.0). Four themes were identified which complemented the quantitative results. These were increased awareness of the importance of routine self-care behaviours, enhanced motivation toward self-care behaviours, challenges adapting to the new app, and suggestions for improving app adoption.

CONCLUSION

The app was effective in improving adherence to self-care behaviours, eHealth literacy, and disease knowledge in patients with HF. The usability evaluation results showed that the app is usable and has the potential to support HF patients in self-care. However, the app needs to be modified to improve its adoption.

A critical review of household recycling barriers in the United Kingdom

The UK recycling rate fluctuates between 45% and 47% and has consistently failed to meet the 65% target set by the post-Brexit Resource and Waste Strategy. Understanding the issues surrounding the low recycling rate in metropolitan cities in the United Kingdom will help to overcome these recycling challenges. The review examines the current situation with regard to the recycling rate and tonnage of waste produced in the United Kingdom based on available secondary waste flow data and explores different barriers related to household recycling. Many areas giving rise to the recycling challenges have been identified, including waste policy constraints, lack of effective communication, public engagement, physical barriers, service constraints, human factors and socio-economic barriers. The literature review reveals that factors such as waste policy, communication and physical factors were the most important aspects in influencing recycling rate or output. It is concluded that a multi-dimension intervention is required, which includes a thorough review of waste policy, a more stringent enforcement, an improved communication strategy and a more integrated planning development policy to mitigate issues affecting the United Kingdom's low recycling rate or output. This approach will propel the local authorities to launch or initiate effective recycling management and to put in place the required infrastructure to facilitate effective recycling activities.

Hand hygiene practices in Caribbean and Latin American countries: An integrative review

AIM AND OBJECTIVE

To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low- and middle-income Caribbean and Latin American countries.

BACKGROUND

With the emergence of infectious diseases such as the recent COVID-19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low-income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions.

METHODS

Following PRISMA 2020 Checklist, an integrative review of studies published from 2008-2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal.

RESULTS

The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak.

CONCLUSION

Future post-disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation.

RELEVANCE TO CLINICAL PRACTICE

Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices.

Investigating oral and systemic pathways between unhealthy and healthy dietary patterns to periodontitis in adolescents: A population-based study

AIM

To investigate pathways between unhealthy and healthy dietary patterns and periodontitis in adolescents (18-19 years of age).

MATERIALS AND METHODS

This population-based study (n = 2515) modelled direct and mediated pathways (via biofilm and obesity) from patterns of healthy diet (fruits, fibre, vegetables, and dairy) and unhealthy diet (sugars, snacks, and salty/fast foods) with initial periodontitis (bleeding on probing [BoP], probing depth [PD] ≥ 4 mm, clinical attachment loss [CAL] ≥ 4 mm), moderate periodontitis (BoP, PD ≥ 5 mm, and CAL ≥ 5 mm), and European Federation of Periodontology and the American Academy of Periodontology (EFP-AAP) periodontitis definitions, adjusting for sex, socio-economic status, smoking, and alcohol, through structural equation modelling (α = 5%).

RESULTS

Higher values of healthy diet were associated with lower values of initial periodontitis (standardized coefficient [SC] = -0.160; p < .001), moderate periodontitis (SC = -0.202; p < .001), and EFP-AAP periodontitis (p < .05). A higher value of unhealthy diet was associated with higher values of initial periodontitis (SC = 0.134; p = .005) and moderate periodontitis (SC = 0.180; p < .001). Biofilm mediated the association between higher values of unhealthy diet and all periodontal outcomes (p < .05).

CONCLUSIONS

Our findings suggest that both healthy and unhealthy dietary patterns may contribute to reduced or increased extent and severity of periodontitis by local and systemic mechanisms, preceding the effect of other established causes such as smoking and obesity, in younger population.

Intervening factors in health care professionals' attitudes and behaviours towards comprehensive abortion care in the workplace: a comparative case study of Tanzania and Ethiopia

PURPOSE

Health care professionals' attitudes and behaviours play a fundamental role in the provision of timely comprehensive abortion care as a maternal health intervention and save hundreds of thousands of women's lives, annually. This study explores underlying factors influencing Tanzanian and Ethiopian health care professionals' attitudes and behaviours towards comprehensive abortion care between 2015 and 2020.

MATERIALS AND METHODS

The study inductively explored Ethiopian and Tanzanian health care professionals' behaviours using a comparative case study design and a textual analytical approach. Published and unpublished literature, documents and newspapers were used as data sources. The two cases were selected because of their different approaches towards the governance of abortion care, one gradually legalising while the other persistently restricting.

RESULTS

Results demonstrated that there are both subjective (beliefs, attitudes, images, pre-dispositions) and objective (institutional incapacity) factors that impact the actions of health care professionals in the work environment.

CONCLUSIONS

The study concluded that the intervention of subjective factors results from the institutional failure to effectively bridge the divide between governance and accessibility of safe abortion care.

Systematic review: Perceptions of type 2 diabetes of people of African descent living in high-income countries

AIMS

To describe how people of African descent perceive and understand type 2 diabetes, and to examine the impact of their perceptions and beliefs on the uptake of diet, exercise, weight control and adherence to medication recommendations.

DESIGN

Systematic literature review of quantitative and qualitative studies.

DATA SOURCES

We searched MEDLINE, CINAHL Complete, Psych INFO, Academic Search Premier, Education Research Complete, Web of Science and Scopus, World Health Organization (WHO), Diabetes UK and American Diabetes Association for articles published from January 1999 to December 2019.

REVIEW METHODS

Informed by the PRISMA guidelines, we independently reviewed titles and abstracts, identified articles for full-text review that met inclusion criteria, conducted a quality assessment and extracted data. Findings were synthesized using a thematic approach.

RESULTS

Twenty-six studies met the inclusion criteria. Knowledge and understanding of diabetes were poor. Beliefs and behaviours about diet, exercise, weight and health care were erroneous. Most diabetic participants could not recognize diabetes symptoms, failed to take their diagnosis seriously and did not adhere to medication recommendations. The resultant effect was an increased risk of complications with undesirable outcomes.

CONCLUSION

Poor diabetes perceptions are linked to negative consequences and may be responsible for poorer outcomes among people of African descent. This review highlights the need to consider this population's beliefs and practices in structuring culturally sensitive programmes for diabetes management.

IMPACT

This systematic literature review is the first to exclusively explore perceptions of people of African descent in relation to diabetes. It is important to consider people of African descents' diabetes perceptions and practices before formulating interventions for their diabetes management.

Perceptions Underlying Addictive Technology Use Patterns: Insights for Cognitive-Behavioural Therapy

Cognitive-Behavioural Therapy (CBT) is considered the 'gold standard' in the treatment of addictive disorders related to excessive technology use. However, the cognitive components of problematic internet use are not yet well-known. The aim of the present study was to explore the cognitive components, that according to problematic users, can lead to potential internet addiction. A total of 854 European adults completed an online survey using a mixed-methods design. Internet problems and attachment styles were assessed, prevalence rates estimated, correlations, chi-squared automatic interaction detection, and content analysis were performed. Self-reported addictions to social networking, internet, and gaming had a prevalence between 1.2% (gaming) to 2.7% (social networking). Self-perception of the addiction problem and preoccupied attachment style were discriminative factors for internet addiction. In an analysis of qualitative responses from self-identified compulsive internet users, a sense of not belonging and feeling of disconnection during life events were perceived as causes for internet addiction. The development depended on a cycle of mixed feelings associated with negative thoughts, compensated by a positive online identity. The severity of this behaviour pattern produced significant impairment in various areas of the participants' functioning, suggesting a possible addiction problem. It is suggested that health professionals administering CBT should target unhealthy preoccupations and monitor mixed feelings and thoughts related to internet use to support coping with cognitive distortions.

What Did We Learn About Fracture Pain from Animal Models?

Progress in bone fracture repair research has been made possible due to the development of reproducible models of fracture in rodents with more clinically relevant fracture fixation, where there is considerably better assessment of the factors that affect fracture healing and/or novel therapeutics. However, chronic or persistent pain is one of the worst, longest-lasting and most difficult symptoms to manage after fracture repair, and an ongoing challenge remains for animal welfare as limited information exists regarding pain scoring and management in these rodent fracture models. This failure of adequate pre-clinical pain assessment following osteotomy in the rodent population may not only subject the animal to severe pain states but may also affect the outcome of the bone healing study. Animal models to study pain were also mainly developed in rodents, and there is increasing validation of fracture and pain models to quantitatively evaluate fracture pain and to study the factors that generate and maintain fracture pain and develop new therapies for treating fracture pain. This review aims to discuss the different animal models for fracture pain research and characterize what can be learned from using animal models of fracture regarding behavioral pain states and new molecular targets for future management of these behaviors.

COVID-19 Pandemic-Knowledge, Attitudes, Behaviours, and Actions among Faculty of Health Sciences Students

The aim of the study was to assess the level of knowledge about COVID-19 disease and preventive behaviour of undergraduate students of nursing, midwifery, and emergency medicine. Material and Methods: An electronic survey was conducted among students of nursing, midwifery, and emergency medicine during the COVID-19 pandemic, from 8 April 2021 to 6 June 2021 in the Pomeranian Voivodeship. Results: A total of 37 men and 238 women participated in the study. A moderate level of knowledge was found in 88% and high in 11% of students Midwifery students had a higher level than nursing students (p = 0.002) and students of emergency medicine (p = 0.003). The female gender is much more afraid of SARS-CoV-2 virus infection (p = 0.021). The most common preventive measure was to avoid people who coughed or had a cold (93%). Only 84% of students were vaccinated. Students who had a high level of knowledge more often avoided people who coughed or had a cold (p = 0.03) and gave up on meeting with friends (p = 0.02). Conclusions: Constant education of students on the principles of dealing with the risk of infection with SARS-CoV-2 is necessary. It is important to continually motivate students to adhere to the principles of prevention. In the face of the existing epidemiological threat, there is a need to change the curricula for the fields of health sciences by adding the subject infectious diseases—clinic and nursing, with special attention to practical aspects.

Comprehensive knowledge and HIV prevalence in two migrant mineworkers' communities of origin in Gaza Province in Southern Mozambique: evidence from a cross-sectional survey

Introduction

migrant mine workers are susceptible to engage in risky sexual behaviour due to their high mobility, putting at risk their families and home communities. Because comprehensive knowledge about HIV/AIDS is a key factor in reducing HIV infections, this study aims to understand the current state of knowledge about HIV in these communities, estimate HIV prevalence and evaluate the risk behaviour associated with comprehensive knowledge.

Methods

secondary data analysis of a cross-sectional survey conducted in two communities of origin of mine workers in Gaza Province, targeting current and former mine workers of the South African mines and their relatives. Households were selected using simple random sampling methodology. Chi-squared tests and logistic regression analysis were used to assess statistical differences between comprehensive knowledge and categorical variables.

Results

from a total of 1,012 participants, only 22.0% of the respondents had comprehensive knowledge about HIV. The overall HIV prevalence in these communities was 24.2% and the HIV prevalence in individuals with comprehensive knowledge was 18.6%. Among the respondents with comprehensive knowledge, 33.1% were male, 22.0% have worked in a South African mine and the median age was 34 years old. Individuals from Muzingane were almost twice as likely (AOR 1.7; 95% IC 1.21-7.44, p=0.014) to have less comprehensive knowledge about HIV than their counterparts in Patrice Lumumba.

Conclusion

the results demonstrate a low level of comprehensive knowledge about HIV amongst this population and reveal an association between comprehensive knowledge about HIV and prevalence. Therefore, it is important to improve knowledge about HIV, its transmission and prevention amongst this population.

The Role of Controlled Motivation in the Self-Esteem of Adolescent Students in Physical Education Classes

The aim of this cross-sectional study was to analyse the relationships between the satisfaction of psychological basic needs, physical education, academic controlling motivation, and self-esteem, and to propose a prediction model in line with the postulates from the hierarchical model found in the self-determination theory. The participants were 618 physical education students from primary and secondary school (317 girls and 301 boys) aged between 10 and 14 years old (M = 11.62; SD = 0.94). The questionnaires basic psychological needs in exercise measurement scale (BPNES), perceived locus of causality scale (PLOC), the academic motivation scale (EME), and physical self-perception profile (PSPP) were used to measure the studied variables. The results showed that autonomy and relatedness significantly and negatively predicted physical education controlling motivation, which predicted a positive and significant academic controlling motivation. This, in turn, negatively and significantly predicted self-esteem. It is concluded that it is essential to avoid controlling motivation to promote the development of a positive self-perception in students.

Towards the Idea of Molecular Brains

How can single cells without nervous systems perform complex behaviours such as habituation, associative learning and decision making, which are considered the hallmark of animals with a brain? Are there molecular systems that underlie cognitive properties equivalent to those of the brain? This review follows the development of the idea of molecular brains from Darwin’s “root brain hypothesis”, through bacterial chemotaxis, to the recent discovery of neuron-like r-protein networks in the ribosome. By combining a structural biology view with a Bayesian brain approach, this review explores the evolutionary labyrinth of information processing systems across scales. Ribosomal protein networks open a window into what were probably the earliest signalling systems to emerge before the radiation of the three kingdoms. While ribosomal networks are characterised by long-lasting interactions between their protein nodes, cell signalling networks are essentially based on transient interactions. As a corollary, while signals propagated in persistent networks may be ephemeral, networks whose interactions are transient constrain signals diffusing into the cytoplasm to be durable in time, such as post-translational modifications of proteins or second messenger synthesis. The duration and nature of the signals, in turn, implies different mechanisms for the integration of multiple signals and decision making. Evolution then reinvented networks with persistent interactions with the development of nervous systems in metazoans. Ribosomal protein networks and simple nervous systems display architectural and functional analogies whose comparison could suggest scale invariance in information processing. At the molecular level, the significant complexification of eukaryotic ribosomal protein networks is associated with a burst in the acquisition of new conserved aromatic amino acids. Knowing that aromatic residues play a critical role in allosteric receptors and channels, this observation suggests a general role of π systems and their interactions with charged amino acids in multiple signal integration and information processing. We think that these findings may provide the molecular basis for designing future computers with organic processors.

Attitudes and beliefs of older adults with acute low back pain: 12-month results from the Brazilian cohort back complaints in the elders

BACKGROUND

Psychosocial factors have been identified as important predictors of onset, course and persistence of low back pain (LBP) in the general population.

OBJECTIVE

To identify factors associated with attitudes/beliefs in older adults with LBP throughout a 12-month follow-up.

METHODS

A longitudinal investigation was conducted with 500 participants aged ≥60 years reporting a new (acute) episode of nonspecific LBP. Data were obtained at baseline, 6-week, 3-, 6-, 9-, and 12-month interviews. The study variables were: [dependent] LBP-related attitudes/beliefs that were assessed by the Back Beliefs Questionnaire (BBQ); [independent] age; sex; LBP intensity 'at-the-present-time' of interview and 'over-the-past-week' before interview; LBP frequency; LBP-related treatments; disability; mobility; depressive symptoms; self-perceived recovery; expectation of pain improvement; and expectation for returning to activities. Data were analysed by multiple linear regression analysis.

RESULTS

At baseline, 85.7% of the participants were female, had mean age of 69.0 (6.3) years, mean BBQ score of 24.5 (6.5), and 79.6% reported pain complaints after an acute episode of LBP. After 12 months, participants maintained a mean BBQ score of 24.6 (6.6) and 63.3% still reported pain complaints after an acute episode of LBP at baseline. Multivariate analysis showed that disability, advancing age, poor expectation of pain improvement in 3 months, and mobility decline were significantly associated with worse BBQ scores during all follow-ups.

CONCLUSION

Ageing, hopelessness, and physical and functional impairment impact pain-related behaviours among older patients seeking healthcare due to acute LBP complaints. Their screening may assist in strategies to manage symptoms and prevent the persistence of pain.

Happiness Management: A Culture to Explore From Brand Orientation as a Sign of Responsible and Sustainable Production

The overarching call to action represented by the sustainable development goals (SDGs) calls for new sustainable production and management models. Likewise, in periods of crisis, such as the current COVID-19 pandemic, companies are forced to develop competitive and sustainable development strategies to increase their brand value and achieve a good market position. Therefore, this work's main objective is to design a structural equation modelling (SEM) to analyse the main critical dimensions of brand orientation to influence happiness in responsible and sustainable entities. For this purpose, a descriptive cross-sectional study was carried out based on primary data from a survey of a representative sample of 216 managers of small- and medium-sized enterprises in Andalusia (Spain) in the construction, industry and services sectors. The model results reveal significant dimensions of brand orientation and positively direct influence on happiness management. One of the significant managerial implications of this work is that the model allows for more responsible and sustainable management of entities by considering brand orientation about happiness.

Comparison of methods to quantify metabolic rate and its relationship with activity in larval lake sturgeon Acipenser fulvescens

Until recently most studies have focussed on method development for metabolic rate assessment in adult and/or juvenile fish with less focus on measurement of oxygen consumption (ṀO₂ ) during early life history stages, including fast-growing larval fish and even less focus on nonteleostean species. In the present study we evaluated measurement techniques for standard metabolic rate (SMR), maximum metabolic rate (MMR) and aerobic scope in an Acipenseriform, the lake sturgeon Acipenser fulvescens, throughout the first year of life. Standardized forced exercise protocols to assess MMR were conducted for 5 or 15 min before or after measurement of SMR. We used different levels of oxygen decline during the measurement period of MMR post forced exercise to understand the influence these may have on the calculation of MMR. Opercular rate and tail beat frequencies were recorded by video as measures of behaviours and compared to metabolic rate recorded over a 24 h period. Results indicate that calculated values for aerobic scope were lower in younger fish. Neither exercise sequence nor exercise duration influenced metabolic rate measurements in the younger fish, but exercise duration did affect measurement of MMR in older fish. Finally, there was no strong correlation between metabolic rate and the measured behaviours in the lake sturgeon at either age. Based on the results, we recommend that a minimum of 6 h of acclimation to the respirometry chamber should be given prior to measuring SMR, a chasing protocol to elicit MMR should ideally be performed at the end of experiment, a short chasing time should be avoided to minimize variation and assessment of MMR should balance measurement limitations of the probes along with when and for how long oxygen consumption is measured.

Experiences of nurses amidst giving care to COVID-19 patients in clinical settings in Iraqi Kurdistan: A qualitative descriptive study

Aim and objective

We explored the experiences of nurses who cared for coronavirus disease 2019 patients in Iraqi Kurdistan.

Background

Nurses play a major role in response to pandemics and epidemics in delivering patient care. The experiences of nurses who provided care have significant short and long‐term consequences for individuals, communities, and the nursing profession.

Methods

Descriptive qualitative research approach was adopted in this study. We interviewed 12 nurses (22–50 years) who cared for the coronavirus disease 2019 patients in one of the clinical units of two coronavirus disease 2019 hospitals in Iraqi Kurdistan in 2020. Interviews were conducted via phone calls and were analysed using the thematic analysis method. The Consolidated criteria for reporting qualitative research checklist was applied when constructing this paper.

Results

The nurses had to care for a number of situations during the outbreak of coronavirus disease 2019 in Kurdistan. As people in the public did not believe that there was such a virus, nurses often had to deal with this lack of knowledge and aggression from some patients and their family members. Most nurses changed their preventive behaviours since the coronavirus disease 2019 outbreak at hospital or in public. This was mainly to protect not only themselves but their patients, colleagues, family members and friends. They were cautious about the use of a mask at the hospital and in public. Most nurses experienced fear, stress, anxiety and isolation during this period.

Conclusions

The patients had some concerns about their health and staying at hospitals, and some of them had aggressive behaviours towards nurses at corona hospitals. The public, close friends and relatives of the nurses had a fear of getting the infection by the virus through the nurses. However, the nurses attempted to protect themselves, colleagues and family members, and provide the best care to coronavirus disease 2019 patients. The nurses had a high obligation towards care giving at hospitals.

Relevance to clinical practice

The negative experiences of the nurses regarding the care of coronavirus disease 2019 patients must be considered in clinical settings. Sensitive policy programs must be established to protect nurses from the ostracization and stigmatization of the coronavirus disease 2019 pandemic and to allow them to be able to achieve their professional practices safely.

A Review of Registered Randomized Controlled Trials for the Prevention of Obesity in Infancy

Childhood overweight and obesity is a worldwide public health issue. Our objective was to describe planned, ongoing and completed randomized controlled trials (RCTs) designed for the prevention of obesity in early childhood. Two databases (World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov) were searched to identify RCTs with the primary aim of preventing childhood obesity and at least one outcome related to child weight. Interventions needed to start in the first two years of childhood or earlier, continue for at least 6 months postnatally, include a component related to lifestyle or behaviours, and have a follow up time of at least 2 years. We identified 29 unique RCTs, implemented since 2008, with most being undertaken in high income countries. Interventions ranged from advice on diet, activity, sleep, emotion regulation, and parenting education through to individual home visits, clinic-based consultations, or group education sessions. Eleven trials published data on child weight-related outcomes to date, though most were not sufficiently powered to detect significant effects. Many trials detected improvements in practices such as breastfeeding, screen time, and physical activity in the intervention groups compared to the control groups. Further follow-up of ongoing trials is needed to assess longer-term effects.

Nurses' perspectives of recognising and responding to unsafe practice by their peers: A national cross-sectional survey

AIMS

This study aimed to identify behaviours and cues that nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and actions nurses take in response.

DESIGN

Cross-sectional survey.

METHODS

National cross-sectional survey of a random sample of registered nurses (n = 231) in New Zealand, in 2017-2018. The STROBE Checklist was used to report this study.

RESULTS

Nurses reported a high rate of episodes of unsafe practices and recognised a range of behaviours and cues that alerted them to the potential for unsafe practice. Several organisational issues were perceived to contribute to unsafe practice occurring. The reporting of episodes of unsafe practice and perceived organisational support was low for nurses compared with managers.

CONCLUSION

Failure to recognise and respond to unsafe practice may indicate a tolerance for substandard practice by individual nurses, or by the organisation. Nurses who recognise unsafe practice must be supported by the organisation.

Predictors and priority of caring behaviours in intensive care units

BACKGROUND

There is an increasing number of studies addressing nurses' perception of caring behaviours; however, on the issue of quality of care, it is important to understand why nurses focus more on certain elements of caring than others, and this needs to investigate influencing factors on, priorities, and predictors of caring behaviours.

AIMS

The main goal of this study was to determine the predictors and priorities of nurses' caring behaviours in intensive care units to improve the quality of care and patient outcomes.

METHODS

This is a cross-sectional survey of nurses working in adult and pediatric ICUs in Iran. The participants were 470 ICU nurses from eight hospitals in Iran. Data were collected over 6 months in 2018 using the Persian version of "Caring Assessment Report Evaluation Q-Care"; "Determinants of Nurse Caring Behaviors"; and a demographic data form.

RESULTS

By broad descriptive and analytical analysis, thirteen items were recognized as predictors of caring behaviours. The most important individual predictors reported as "interest in the nursing profession," "moral obligation," and "job experience," respectively. The most important perceived nursing behaviours were, respectively, subscales of "accessible," "monitors/follow-through" and "explains/facilitates."

CONCLUSION

The results provide insight into new and context-specific predictors of nurses' caring behaviours. These findings suggest that nursing managers, besides selecting skilful staff for ICUs, may consider employing those of higher "interest in the nursing profession"; "moral obligation"; and "job experience." They, also, need to be aware that organizational culture, climate, and values have a great impact on the caring behaviours of nurses. This could help them to handle the complex issue of improving the quality of care more efficiently.

Use of Artificial Intelligence to understand adults' thoughts and behaviours relating to COVID-19

Aims:

The outbreak of severe acute respiratory syndrome coronavirus 2 (COVID-19) is a global pandemic that has had substantial impact across societies. An attempt to reduce infection and spread of the disease, for most nations, has led to a lockdown period, where people’s movement has been restricted resulting in a consequential impact on employment, lifestyle behaviours and wellbeing. As such, this study aimed to explore adults’ thoughts and behaviours in response to the outbreak and resulting lockdown measures.

Methods:

Using an online survey, 1126 adults responded to invitations to participate in the study. Participants, all aged 18 years or older, were recruited using social media, email distribution lists, website advertisement and word of mouth. Sentiment and personality features extracted from free-text responses using Artificial Intelligence methods were used to cluster participants.

Results:

Findings demonstrated that there was varied knowledge of the symptoms of COVID-19 and high concern about infection, severe illness and death, spread to others, the impact on the health service and on the economy. Higher concerns about infection, illness and death were reported by people identified at high risk of severe illness from COVID-19. Behavioural clusters, identified using Artificial Intelligence methods, differed significantly in sentiment and personality traits, as well as concerns about COVID-19, actions, lifestyle behaviours and wellbeing during the COVID-19 lockdown.

Conclusions:

This time-sensitive study provides important insights into adults’ perceptions and behaviours in response to the COVID-19 pandemic and associated lockdown. The use of Artificial Intelligence has identified that there are two behavioural clusters that can predict people’s responses during the COVID-19 pandemic, which goes beyond simple demographic groupings. Considering these insights may improve the effectiveness of communication, actions to reduce the direct and indirect impact of the COVID-19 pandemic and to support community recovery.

Severity of nausea and vomiting in pregnancy and early childhood neurobehavioural outcomes: The Growing Up in Singapore Towards Healthy Outcomes study

BACKGROUND

Nausea and vomiting of pregnancy (NVP) affects 50 to 80 per cent of women. The existing literature has examined NVP from the perspective of the mother, and relatively less is known about offspring outcomes.

OBJECTIVES

To study the relationships of NVP with social-emotional, behavioural, and cognitive outcomes of the offspring in a multi-ethnic Asian cohort.

METHODS

In the Growing Up in Singapore Towards Healthy Outcomes prospective mother-offspring cohort study, mothers responded to a structured NVP questionnaire at 26-28 weeks' gestation (n = 1172) and participants with severe NVP were confirmed using medical records. Children underwent multiple neurodevelopmental assessments throughout childhood. We conducted multivariable regressions with post-estimation predictive margins to understand the associations of NVP with offspring neurobehavioural outcomes, which included 1-year Infant-Toddler Social and Emotional Assessment, 1.5-year Quantitative Checklist for Autism in Toddlers, 2-year Bayley Scales of Infant and Toddler Development, 2- and 4-year Child Behavior Checklist, and 4.5-year Kaufman Brief Intelligence Test. Analyses were adjusted for household income, birth variables, maternal mental health, and other relevant medical variables. Cohen's d effect sizes were calculated using standardised mean differences (μ_d ).

RESULTS

Mothers were categorised into no (n = 296, 25.3%), mild-moderate (n = 686, 58.5%), and severe NVP (n = 190, 16.2%), of whom 67 (5.7%) required admission. Compared to children of mothers who had no or mild-moderate NVP, children with exposure to severe NVP exhibited more externalising behaviours (μ_d 2.0, 95% CI 0.3, 3.6; Cohen's d = 0.33) and social communication difficulties before 2 years (μ_d 4.1, 95% Cl 0.1, 8.0; Cohen's d = 0.38), both externalising (μ_d 1.5, 95% CI 0.4, 2.6; Cohen's d = 0.43) and internalising behaviours at 2 years (μ_d 1.2, 95% CI 0.1, 2.2; Cohen's d = 0.35), and only internalising behaviours after 2 years (μ_d 1.1, 95% CI 0.4, 2.0; Cohen's d = 0.37).

CONCLUSIONS

Severe NVP is highly prevalent in this Asian cohort and may be adversely associated with multiple offspring neurobehavioural outcomes.

Cross-sectional analysis to explore the awareness, attitudes and actions of UK adults at high risk of severe illness from COVID-19

OBJECTIVES

This study explored the impact of COVID-19 on people identified as at high risk of severe illness by UK government, and in particular, the impact of lockdown on access to healthcare, medications and use of technological platforms.

DESIGN

Online survey methodology.

SETTING

UK.

PARTICIPANTS

1038 UK adults were recruited who were either identified by UK government as at high risk of severe illness from COVID-19 or self-identified as at high risk with acute or other chronic health conditions not included in the UK government list. Participants were recruited through social media advertisements, health charities and patient organisations.

MAIN OUTCOMES MEASURES

The awareness, attitudes and actions survey which explores the impact of COVID-19, on including access to healthcare, use of technology for health condition management, mental health, depression, well-being and lifestyle behaviours.

RESULTS

Nearly half of the sample (44.5%) reported that their mental health had worsened during the COVID-19 lockdown. Management of health conditions changed including access to medications (28.5%) and delayed surgery (11.9%), with nearly half of the sample using telephone care (45.5%). Artificial Intelligence identified that participants in the negative cluster had higher neuroticism, insecurity and negative sentiment. Participants in this cluster reported more negative impacts on lifestyle behaviours, higher depression and lower well-being, alongside lower satisfaction with platforms to deliver healthcare.

CONCLUSIONS

This study provides novel evidence of the impact of COVID-19 on people identified as at high risk of severe illness. These findings should be considered by policy-makers and healthcare professionals to avoid unintended consequences of continued restrictions and future pandemic responses.

Antibiotic use in pig farming and its associated factors in L County in Yunnan, China

China has a long history of pig rearing, and it currently raises and consumes approximately half of the pigs in the world. Major improvements have been made in pig farming in China in the last four decades with the growing application of new livestock farming technologies. Among the new improvements, the use of antibiotics in pig farming is a common but not well‐documented practise. In order to understand the behaviour of the farmers regarding antibiotic use in pig farming, we conducted a household survey in four townships of L County in Yunnan Province, China, during August 2014 and April 2015. In this survey, 404 farmer households were interviewed using a questionnaire. Among the farmers interviewed, 89% reported easy access to antibiotics, 83.7% reported experience of self‐purchasing antibiotics, and 40.3% reported that they often used antibiotics in pig farming mainly for the prevention and treatment of pig diseases. These farmers identified 20 antibiotics that they had used in pig farming 6 months before the survey. Of these, 11 and 8 antibiotics have been categorised under ‘critically important’ and ‘highly important’ antimicrobial groups, respectively, by the World Health Organization (WHO), and 12 and 8 have been categorised under the ‘Watch’ and ‘Access’ groups, respectively, as per the 2019 WHO AWaRe classification of antibiotics. Factors associated with the behaviour of self‐purchasing antibiotics included types of farms, sources of antibiotics, and previous experiences of pig diseases: those who were smallholders, buying antibiotics from veterinary drugstores and village vets, and whose pigs had suffered diseases previously were more likely to self‐purchase antibiotics for their pigs. Farmers who cleaned their pigsties less frequently and those whose pigs had suffered from diseases used antibiotics more frequently as compared to their peer farmers.

This survey conducted in a county in Yunnan Province of China finds out that 83.7% of the farmers reported ‘self‐purchasing’ antibiotics for their pigs and 40.3% of the farmers expressed that they ‘often’ use antibiotics in pig farming with the major purposes being prevention and treatment of pig diseases.

Current dietary advice and challenges for adolescents

BACKGROUND

The major risk factors driving the global burden of disease are diet related. Adolescence presents a window of opportunity for establishing healthy dietary trajectories. Yet around the world, adolescents experience many barriers that prevent them from consuming diets that would give them the foundation for long, healthy and productive adult lives.

SOURCES OF DATA

A narrative literature search of most relevant original, review and meta-analyses, restricted to English was conducted in Medline, Web of Science and PubMed up to December 2019 together with published papers known to the author concerning the current dietary advice and challenges for adolescent nutrition.

AREAS OF AGREEMENT

Adolescence is a critical period of growth and development and adequate nutrition is essential. Sufficient population data indicate adolescents are not meeting dietary recommendations and are a vulnerable population group for malnutrition in all its forms.

AREAS OF CONTROVERSY

Despite extensive studies on dietary risk factors and the global burden of disease and population data demonstrating inadequate nutritional intake in adolescent populations, few effective interventions and policies have been scaled up to support adolescent nutrition.

GROWING POINTS

Improving the diets of adolescents, especially vulnerable adolescents from low- and middle-income countries and socioeconomically disadvantaged backgrounds, has the potential to impact individuals, societies and economies.

AREAS TIMELY FOR DEVELOPING RESEARCH

Future research should focus on vulnerable adolescent populations by addressing food environments, food insecurity and ensuring effective programmes and strategies are integrated within broader adolescent health strategies and implemented into government policies.

Excitatory transmission from ventral pallidum to lateral habenula mediates depression

Objectives: Lateral habenula (LHb) is a key brain structure for mediating behavioural responses to aversive stimuli. It receives presynaptic inputs from ventral pallidum (VP) which relates to reward, motivation and hedonics. This study investigated the role of glutamatergic VP-LH projection in negative emotions and depression-like behaviour.Methods: The glutamatergic VP-LHb circuits in Vglut2-Cre mice were activated or inhibited using optogenetic manipulation. Real time place aversion test was performed to access aversive behaviour. Mice underwent chronic social defeat stress or subthreshold social defeat stress paradigm. Then social interaction test and tail suspension test were carried out to evaluate the stress-induced depression-like behaviours.Results: Activation of VP-LHb glutamatergic projections induced aversive behaviour in the real time place aversion test. Activation of this circuit induced depressive-like phenotype after social stress, while optogenetic inhibition of this circuit exerted an antidepressant effect in social stress susceptible mice. Local LHb ketamine administration rescued the depression-like phenotype caused by activation of this circuit.Conclusions: Data from our study demonstrated an involvement of the glutamatergic VP-LHb circuit in the stress-induced depression-related behaviours.

Social Networking Sites and Perceived Content Influence: An Exploratory Analysis from Focus Groups with French Adolescents

Social networking sites (SNSs) are invested in heavily by marketers aiming to reach a growing number of consumers. Concerns regarding the influence of posts displayed on SNSs in relation to behaviour were raised, in particular the promotion of ill-health behaviour directed to adolescents who may be at risk from suggestible practices. Although adolescents tend to be critical towards traditional forms of advertising, little is known about their perception of influencing strategies developed online, especially where sponsor- and user-generated content coexist. This exploratory study aims to gather information directly from adolescents about their use of SNSs their awareness of the influence that SNS content may have, particularly when it comes to tobacco and alcohol messages. Ten focus groups were conducted with 39 adolescents (11-16 years old; 56.4% male). Qualitative analysis documents the differences associated with adolescents' favourite SNSs. The different parameters linked to each SNS and the expectation to find entertaining content and values associated with friendship may decrease adolescents' perception of potential risk for health associated with SNS use. Authors advocate for the development of educational programs based on eHealth literacy and the use of social marketing techniques to facilitate and motivate adolescents to develop their competences.

Great expectations: views and perceptions of professionalism amongst mental health services staff, patients and carers

BACKGROUND

Numerous studies have explored the concept of 'professionalism' in medicine, yet little attention has been paid to the concept in a mental health services context.

AIMS

This study sought to determine how the lived experience of patients, carers and healthcare professionals in mental health services align with medically defined, generic, professionalism standards.

METHOD

Interviews and focus groups were conducted with patients, carers, nurses, occupational therapists, psychiatrists and psychologists. A framework analysis approach was used to analyse the data, based on the 'Improving Selection to the Foundation Programmes' Professional Attributes Framework.

RESULTS

Fifty-six individuals participated. Data aligned to all nine attributes of the Professional Attributes Framework, however the expectations within each attribute varied from that originally cited. A tenth attribute was devised during the process of analysis; Working with Carers. This attribute acknowledges the need to liaise with, and support carers in mental health services. Situational examples included both online and offline behaviours and the topic of 'black humour' emerged.

CONCLUSIONS

Compared to a conventional medical definition of professionalism, additional themes and differing emphases were observed for mental health and learning disability services. These findings should be used to inform the teaching and evaluation of professionalism, especially for staff pursuing mental health service careers.

"There is no fear in me … well, that little fear is there": dualistic views towards HIV testing among South African adolescent girls and young women

In spite of the high HIV burden and high prevalence and incidence of HIV infection among adolescent girls and young women (AGYW) in South Africa, uptake of HIV testing in this population falls short of the UNIADS 90-90-90 targets, leading to late diagnosis, late entry into HIV care and treatment, and poor uptake of prevention services. There is a critical need to update and deepen our understanding of attitudes towards testing in this population, in order to appropriately respond to their specific needs. This article reports on findings from an exploration of perceptions of HIV testing and testing behaviour amongst AGYW in South Africa using a combination of quantitative and qualitative data. Analysis included data on testing behaviour and reasons for never testing from a survey conducted with 4 399 AGYW aged 15-24 years in six provinces. Combined with survey data is qualitative analysis from 63 in-depth interviews and 24 focus group discussions with 237 AGYW from five provinces. Findings revealed complex, dualistic and often contradictory views towards HIV testing in this population, with fear of HIV and the consequences of testing positive existing alongside a lack of concern towards HIV infection because of the availability and accessibility of antiretrovirals. These findings can help to address barriers to HIV testing in this population and ensure appropriateness of future interventions and HIV messaging.

An Empirical Study on the Relationship between Causes of Teacher Examination Anxiety and Dimensions of Coping with Pre-Exam Anxiety: A Structural Equation Modelling Approach

In recent years, examination anxiety among teachers assumes a critical sphere in the global academic environment. The causes of teacher examination anxiety in education have been reviewed by a few scholars. This shows that teacher examination anxiety and its impact on academic development are limited in research. Therefore, this study investigated the linear relationship between two self-report instruments – the causes of teacher examination anxiety and dimensions of coping with pre-exam anxiety. The study adopted a quantitative approach with three-hundred teachers from four secondary schools in Nigeria and twenty teachers from two secondary schools in North Cyprus participated in the survey. Also, a Structural Equation Modeling (SEM) was utilized for the analysis. The results of the study indicate that the two factors (teacher causes of exam anxiety and dimensions of coping with pre-exam anxiety) are interconnected. The results also indicate teachers’ preparation for examinations coupled with various dimensions of anxiety is a complex task that demands educational stakeholders to constantly improving on causes of examination anxiety and factors of pre-exam anxiety among teachers for better academic and ethical development.

Investigating primary preservice teachers' ultraviolet radiation awareness and perceived ability to teach sun safety

Issue addressed

Sun protection practices in Australian primary schools remain inconsistent. Therefore, this study investigates primary PSTs sun protective sun behaviours, ultraviolet (UV) radiation awareness and perceived ability to teach sun safety.

Methods

A convenience sample of undergraduate PSTs (N = 275; mean age = 23.13 years) enrolled at one Western Australian university completed an online survey. Descriptive analyses provided features of the data. Factors associated with sun protection behaviours and perceived knowledge and skill to teach sun safety were explored using multivariable logistic regression models.

Results

Lesser than 10% of participants reported using sun protective measures daily (midday shade use: 6.5%; sunscreen: 7.6%; hat: 4.4%). Only 56.3% reported they understand the UV index, with 68.0% rarely/never using it to aid sun protection. Under half the participants reported they felt they had the knowledge (38.5%) or skills (40%) to effectively teach sun safety in primary schools. Regression analysis revealed gender, undergraduate, year and skin sensitivity were not predictors of UV index use (P > .05) or perceived knowledge of sun safety (P > .05). Skin sensitivity was the strongest predictor for shade usage (P = .02), hat usage (P = .05) and perceived skill to teach sun safety (P = .02).

Conclusions

Survey data indicate UV radiation is inconsistently understood by PSTs. Many felt that they did not have the required knowledge or skill to teach sun safety effectively.

So what?

Improving PSTs UV radiation knowledge while at university is a potential opportunity to improve sun safety delivery in primary schools. A targeted intervention for PSTs is warranted.

Using touchscreen tablets to support social connections and reduce responsive behaviours among people with dementia in care settings: A scoping review

The use of touchscreen tablets, such as the iPad, offers potential to support the person with dementia staying in a care setting, ranging from a long-term care home to an adult day programme. Although electronic devices are used among people with dementia, a comprehensive review of studies focusing on their impact and how they may be used effectively in care settings is lacking. We conducted a scoping review to summarize existing knowledge about the impact of touchscreen tablets in supporting social connections and reducing responsive behaviours of people with dementia in care settings. Our research team consists of patient partners and family partners, physicians, nurses, a medical student and an academic professor. A total of 17 articles were included in the review. Our analysis identified three ways in which touchscreen tablets support dementia care: (1) increased the person’s engagement, (2) decreased responsive behaviours and (3) positive effect on enjoyment/quality of life for people with dementia. Lessons learned and barriers to the use of touchscreen tablets in the care of people with dementia are described. Overall, only a few studies delineated strategies that helped to overcome barriers to technology adoption in care settings. Knowledge translation studies are needed to identify effective processes and practical tips to overcome barriers and realize the potential of assistive technology in dementia care.

Successful weight loss maintenance: A systematic review of weight control registries

Weight loss maintenance is a major challenge for obesity treatment. Weight control registries can be useful in identifying psychological and behavioural factors that could contribute to better long-term success. The objective of this study is to describe the existing weight control registries and their participants and identify correlates of weight loss maintenance. A comprehensive search of peer-reviewed articles published until November 2018 was conducted in PubMed, Web of Science, and Scopus. Studies that reported results from weight control registries were considered. Fifty-two articles, corresponding to five registries (the United States, Portugal, Germany, Finland, and Greece), were included. Registries differed in inclusion criteria and procedures. Of 51 identified weight loss and maintenance strategies, grouped in 14 domains of the Oxford Food and Activity Behaviors taxonomy, the following were the most frequently reported: having healthy foods available at home, regular breakfast intake, increasing vegetable consumption, decreasing sugary and fatty foods, limiting certain foods, and reducing fat in meals. Increased physical activity was the most consistent positive correlate of weight loss maintenance. To our knowledge, this is the first systematic review of information about successful weight loss maintenance obtained from weight control registries. Key common influential characteristics of success were identified, which can inform future prospective studies and weight management initiatives.