Conceptualising the experiences of continuing professional development of young private sector audiologists as an attribute of andragogy.

Background: Continuing professional development (CPD) is an ongoing learning process that builds on initial training and education to improve competency. Low compliance rates of audiologists adhering to CPD have been reported by the Health Professions Council of South Africa. However, there is an absence of research on the uptake of CPD from the perspective of young audiologists working in the private sector. Aim: This study aimed to explore the experiences and views of young audiologists working in the private sector on continuing professional development. Setting: The study was conducted in KwaZulu-Natal province, South Africa. Methods: The descriptive, qualitative approach entailed conducting 11 online, semi-structured interviews with audiologists working in the private sector. Semi-structured interviews consisted of open-ended questions, and the qualitative data were thematically analysed. The adult learning theory, andragogy, was used as both the conceptual and analytical framework. Results: Five andragogy concepts were used to analyse the data, with eight sub-themes emerging related to: self-concept, adult learning experiences, readiness to learn, orientation to learning and internal motivation. Conclusion: The experiences of audiologists in the private sector on CPD aligned with the concepts of andragogy. Audiologists' experiences need to be taken into consideration during the planning and implementation of CPD for it to be relevant, effective and purposeful. Contribution: This study highlighted the experiences of audiologists on CPD working in the private sector with continuing professional development.

Community service rehabilitation therapists' understanding of social accountability.

BACKGROUND:  Social accountability is the obligation of health care providers to address the priority health concerns of the community they serve and of universities to ensure that graduates understand these social responsibilities. Although social accountability can combat systemic health inefficiencies, it is not well-understood or practised. AIM:  The study aimed to explore community service rehabilitation therapists' understanding of social accountability. SETTING:  The study was conducted in KwaZulu-Natal, South Africa. METHODS:  This study used an interpretive exploratory design and purposively recruited 27 community service rehabilitation therapists namely, audiologists, speech-language therapists, occupational therapists, and physiotherapists working in public sector health facilities in rural and peri-urban areas. Four focus group discussions and four free attitude interviews were conducted, the results being thematically analysed. RESULTS:  Despite most of the participants not being instructed in social accountability as part of their formal training or institutional induction, three themes emerged based on their experiences. These themes include describing social accountability, values of social accountability, and values of community-based rehabilitation applicable to social accountability. CONCLUSION:  Inclusion of instruction on social accountability as part of their formal training and health facility induction would contribute to rehabilitation therapists' understanding of social accountability.Contribution: The study contributes to data on rehabilitation education and community service training regarding social accountability within a South African context and has captured how experiences gained during community service contribute to the rehabilitation therapists' understanding of social accountability.

Social accountability challenges and recommendations by community service rehabilitation therapists.

BACKGROUND:  Social accountability entails providing equitable and accessible services that are tailor-made for the community's healthcare needs and enable rehabilitation therapists to improve the efficiency and efficacy of healthcare delivery and their response. Enabling them to provide optimal care during their community service year requires understanding the gaps in their knowledge, experience and the support they provide to the communities they service. METHODS:  Four in-depth individual interviews and four focus group discussions were conducted via Zoom. The qualitative responses to the questions related to the challenges and recommendations associated with social accountability in clinical settings were analysed using an inductive thematic approach via NVIVO. RESULTS:  Four sub-themes emerged for each of the two areas of interest: the challenges relating to (1) budget and equipment constraints, (2) staff shortages, (3) cultural and language barriers and (4) scope of practice limitations. The recommendations related to (5) collaboration with community caregivers, (6) service inclusion in primary health care clinics, (7) improved executive management support and (8) continuing professional development. CONCLUSION:  Equipping graduates with the knowledge, skills and support needed to work in an under-resourced setting is essential for community service rehabilitation therapists to ensure social accountability, given that they often work alone, specifically in rural settings.Contribution: Being aware of the challenges that face community service rehabilitation therapists, having the necessary tools and health facility management support will enable ongoing improvements in their ability to provide socially accountable services.

Health budget cuts will be paid for by the most vulnerable.

No abstract available.

Interpersonal Mechanisms Between Child Maltreatment Timing and Young Adult Internalizing and Externalizing Symptomatology.

OBJECTIVE: Children who experience maltreatment are prone to exhibit interpersonal deficits and lack secure attachment, which can lead to internalizing and externalizing symptomatology. This study investigated timing and chronicity of maltreatment and its impacts on psychopathology outcomes in young adulthood. Two interpersonal mediators were examined: problems with peers and childhood attachment security. METHOD: Children with and without maltreatment exposure were recruited to take part in a 1-week research summer camp (N = 697; mean [SD] age = 11.29 [0.97] years; 71.3% Black or African American; 50.5% male). Participants were recontacted in young adulthood to complete a second wave of assessments (n = 427; mean [SD] age = 19.67 [1.16] years; 78.0% Black or African American; 48.9% male). Structural equation modeling was used to estimate indirect effects from child maltreatment timing to young adult internalizing and externalizing symptomatology via childhood attachment security and peer problems. RESULTS: Findings highlighted the detrimental impact of chronic maltreatment, which was associated with higher levels of peer problems (ß = .24, p < .001) and less secure attachment (ß = -.13, p < .01) in childhood. Also, lower attachment quality in childhood mediated the association between chronic maltreatment and self-reported internalizing (a × b = 0.02, p < .05) and externalizing symptomatology (a × b = 0.02, p < .05). Additionally, childhood peer problems mediated the association between chronic maltreatment and caregiver-reported internalizing problems (a × b = 0.04, p < .05). CONCLUSION: Chronic maltreatment is particularly harmful for interpersonal outcomes of children. Mediation findings differed by who reported on psychopathology, showing the importance of considering multireporter measures of psychopathology. PLAIN LANGUAGE SUMMARY: Child maltreatment is an interpersonal stressor that may impact developmental outcomes throughout a youth's life. In this study of 697 children who participated in a 1-week research summer camp and were contacted in young adulthood, the authors found that chronic maltreatment significantly increased the risk of difficulties in forming secure attachments as well as having problems with peers during childhood. In turn, these challenges were linked to emotional and behavioral symptomology in young adulthood. These findings emphasize the need to support children facing chronic maltreatment to improve their long-term mental health.

The relative effects of parental alcohol use disorder and maltreatment on offspring alcohol use: Unique pathways of risk.

Childhood adversity represents a robust risk factor for the development of harmful substance use. Although a range of empirical studies have examined the consequences of multiple forms of adversity (i.e., childhood maltreatment, parental alcohol use disorder [AUD]), there is a dearth of information on the relative effects of each form of adversity when considered simultaneously. The current study utilizes structural equation modeling to investigate three unique and amplifying pathways from parental AUD and maltreatment exposure to offspring alcohol use as emerging adults: (1) childhood externalizing symptomatology, (2) internalizing symptomatology, and (3) affiliation with substance-using peers and siblings. Participants (N = 422) were drawn from a longitudinal follow-up study of emerging adults who participated in a research summer camp program as children. Wave 1 of the study included 674 school-aged children with and without maltreatment histories. Results indicated that chronic maltreatment, over and above the effect of parent AUD, was uniquely associated with greater childhood conduct problems and depressive symptomatology. Mother alcohol dependence was uniquely associated with greater affiliation with substance-using peers and siblings, which in turn predicted greater alcohol use as emerging adults. Results support peer and sibling affiliation as a key mechanism in the intergenerational transmission of substance use between mothers and offspring.

Negative Perceptions of Peer Relationships as Mechanisms in the Association Between Maltreatment Timing and the Development of Psychopathology.

Despite findings that developmental timing of maltreatment is a critical factor in predicting subsequent outcomes, children's developmental stage is understudied in maltreatment research. Moreover, childhood maltreatment is associated with the development of maladaptive peer relationships and psychopathology, with social cognition identified as a process underlying this risk. The current study utilizes structural equation modeling to examine the impact of developmental timing of maltreatment (i.e., infancy through preschool versus elementary and middle school years) on psychopathology via negative perceptions of peer relationships. Multi-informant methods were used to assess 680 socioeconomically disadvantaged children. Results did not support differential effects of early versus later maltreatment on children's internalizing symptomatology or disruptive behavior, but indicated that chronic maltreatment, relative to episodic maltreatment, has more severe consequences for children's internalizing symptomatology. Results further support the mediating role of children's perceptions of relationships in the effect of maltreatment on negative developmental outcomes.

The Role of Peer- and Self-Appraisals in the Association Between Maltreatment and Symptomatology.

Recent research highlights the use of artificial boundaries between distinct types of adverse experiences, including forms of maltreatment. Commonly-utilized methods that isolate the impact of one maltreatment subtype over others and fail to consider the often co-occurring nature of maltreatment may not adequately capture the complex heterogeneous nature of maltreatment and may obscure understanding of developmental pathways. Moreover, childhood maltreatment is associated with the development of maladaptive peer relationships and psychopathology, with negative conceptions of relationships identified as a risk pathway. The current study utilizes structural equation modeling to examine the impact of an adapted threat versus deprivation framework for conceptualizing maltreatment via children's negative conceptions of relationships, which have not been previously tested as mechanisms in the context of this conceptual framework. Participants included 680 socioeconomically disadvantaged children who attended a week-long summer camp. Multi-informant methods were used to assess children's symptomatology and interpersonal functioning. Results did not support differences between threatening versus depriving maltreatment experiences, but indicated that all groups of children who experienced maltreatment, including those enduring both threatening and depriving experiences, showed more maladaptive functioning and more negative conceptions of relationships relative to non-maltreated peers. Results of the current study support the mediating role of children's appraisals of the self and peers in the effect of maltreatment on children's internalizing and externalizing symptomatology.

A person-centered data analytic approach to dopaminergic polygenic moderation of child maltreatment exposure.

The present study illustrates the utility of latent class analysis, a person-centered data analytic approach, as an innovative method for identifying naturally occurring patterns of polygenic risk, specifically within the dopaminergic system. Moreover, this study tests whether latent classes of polygenic variation moderate the effect of child maltreatment exposure on internalizing symptoms among African ancestry youth. African ancestry youth were selected for this study because youth of color are overrepresented in the child welfare system and because African ancestry individuals are significantly underrepresented in genomics research. Results identified three latent classes of dopaminergic gene variation. Class 1 was marked predominately by homozygous minor alleles, Class 2 was characterized by homozygous major and heterozygous presentations, and Class 3 was marked by heterozygous alleles on the DAT-1 single-nucleotide polymorphisms (SNPs) and a combination of homozygous major and minor alleles on the other SNPs. Results indicated that a greater number of maltreatment subtypes experienced were associated with higher internalizing symptoms only for children with the latent polygenic Class 2 pattern. This latent class was distinctly characterized by more homozygous major or heterozygous allelic presentations along all three DAT-1 SNPs. This significant latent polygenic class by environment interaction was replicated in an independent replication sample. Together, findings suggest that African ancestry children with a pattern of dopaminergic variation characterized by this specific combination of polygenic variation are more vulnerable to developing internalizing symptoms following maltreatment exposure, relative to their peers with other dopamine-related polygenic patterns.

An integrated review of social information processing as a mechanism in the association between maltreatment and depression among youth of color.

BACKGROUND: Child maltreatment is a potent risk factor for depression across the life course, with maltreatment and depression demonstrated to disproportionately impact youth of color. Despite evidence for mechanisms (e.g., social information processing; SIP) accounting for the effects of maltreatment on youth broadly, pathways of risk for depression among maltreated youth of color specifically remain largely under-investigated. OBJECTIVE: In an effort to address this gap in the literature, the present review synthesizes available research regarding SIP as a mechanism underlying the impact of maltreatment on the development of depression in general, and among youth of color specifically. PARTICIPANTS & SETTING: A review of literature was conducted on English language articles published between 1989 and 2022 involving maltreatment, depression, social information processing, and/or youth of color. METHODS: An electronic database search using terms "Maltreatment," "Depression," "Social Information Processing," "Social Cognition," and "Youth of Color" identified relevant literature. RESULTS: Synthesis of literature supports SIP as a salient mechanism in the effect of maltreatment on depressive symptomatology for youth broadly, identifying the need for additional empirical work explicitly assessing this pathway among youth of color. CONCLUSION: In addition to support for SIP as a risk pathway for youth broadly, this review highlights associated processes that can lend support to SIP as a meaningful mechanism of risk for youth of color. Additionally, this review addresses the deficit-based approach through which research and intervention tools evaluate youth of color experiencing maltreatment and depression, proposing alternative approaches towards prevention and intervention efforts with this marginalized population.

Persistent Frustration-Induced Reconfigurations of Brain Networks Predict Individual Differences in Irritability.

OBJECTIVE: Aberrant responses to frustration are central mechanisms of pediatric irritability, which is a common reason for psychiatric consultation and a risk factor for affective disorders and suicidality. This pilot study aimed to characterize brain network configuration during and after frustration and test whether characteristics of networks formed during or after frustration relate to irritability. METHOD: During functional magnetic resonance imaging, a transdiagnostic sample enriched for irritability (N = 66, mean age = 14.0 years, 50% female participants) completed a frustration-induction task flanked by pretask and posttask resting-state scans. We first tested whether and how the organization of brain regions (ie, nodes) into networks (ie, modules) changes during and after frustration. Then, using a train/test/held-out procedure, we aimed to predict past-week irritability from global efficiency (Eglob) (ie, capacity for parallel information processing) of these modules. RESULTS: Two modules present in the baseline pretask resting-state scan (one encompassing anterior default mode and temporolimbic regions and one consisting of frontoparietal regions) contributed most to brain circuit reorganization during and after frustration. Only Eglob of modules in the posttask resting-state scans (ie, after frustration) predicted irritability symptoms. Self-reported irritability was predicted by Eglob of a frontotemporal-limbic module. Parent-reported irritability was predicted by Eglob of ventral-prefrontal-subcortical and somatomotor-parietal modules. CONCLUSION: These pilot results suggest the importance of the postfrustration recovery period in the pathophysiology of irritability. Eglob in 3 specific posttask modules, involved in emotion processing, reward processing, or motor function, predicted irritability. These findings, if replicated, could represent specific intervention targets for irritability.

Child maltreatment and youth suicide risk: A developmental conceptual model and implications for suicide prevention.

Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.

Perceptions of specialists in the public sector, on the role and value of family medicine.

BACKGROUND: Family medicine (FM) is often perceived to be a 'lesser' speciality compared with other disciplines, despite its importance as a generalist discipline in the healthcare system. Family physicians (FPs) provide comprehensive care at the district level and act as a gatekeeper for patient's upward referral to other specialists. This study aimed to explore the perceptions of healthcare specialists other than FPs involved in registrar training regarding FM at the University of KwaZulu-Natal, South Africa (SA). METHODS: This was a qualitative study, with seven consultants, other than FPs, who worked at three public sector regional hospitals using purposive sampling. Individual semistructured interviews were conducted, audio-recorded and transcribed verbatim and analysed thematically. RESULTS: Four themes emerged (perception of FM as a medical speciality, role of FPs in the healthcare system and proposed National Health Insurance, FM registrars rotating in units and the scope of their training and how to improve the perceptions of FM by other specialities). Family medicine was regarded as a major and relevant specialist field with a significant contribution to make in advancing patients' care. The country's healthcare system is yet to make the best use of the FM specialist's role in improving quality of care. CONCLUSION: The perceptions of FM from other specialists were generally positive and reinforced its importance in facilitating improved healthcare in SA. These specialists have high regard for FM and emphasised the large responsibility of practitioners.

Impact of COVID-19 - Experiences of 5th year medical students at the University of KwaZulu-Natal.

BACKGROUND: The global pandemic associated with coronavirus disease 2019 (COVID-19) had a considerable effect on higher education in South Africa, with online instruction replacing traditional lectures for many students. Medical students were required to vacate their residences in March 2020 but returned to campus in July 2020 to enable them to continue with clinical teaching and learning. The aim of this study was to understand the learning experiences of 5th year medical students at the University of KwaZulu-Natal (UKZN) during 2020. METHODS: This was a qualitative study conducted via Zoom in December 2020 with 18 students in four focus group discussions and four semi-structured interviews. These were all facilitated by an independent researcher with experience in qualitative research. All the interviews were recorded, transcribed verbatim and analysed qualitatively through the identification of codes, categories and themes. RESULTS: The following major themes emerged: A stressful and at times an overwhelming year, mental health issues, developing strategies to cope, and issues that related to teaching and learning. CONCLUSION: The disruptions caused by COVID-19, the lockdown, a condensed academic programme and uncertainty about their competency resulted in high levels of anxiety and stress among medical students. Participants highlighted strategies that had helped them to cope with the isolation and academic pressures. Given the large volume of work, careful thought needs to be given to what should be taught and how it should be taught to ensure that graduates have the competencies they need to practise.

Continuing professional development in Eswatini: Factors affecting medical practitioners' participation.

BACKGROUND: The availability of continuing professional development (CPD) activities does not necessarily translate into good participation by health practitioners. Reasons for low participation include time constraints, cost of some activities, irrelevant material and lack of access. This study aimed to explore the views of medical practitioners' working in Eswatini regarding the factors that affect their participation in CPD programmes. METHODS: A qualitative study using seven in-depth semi-structured interviews and three focus group discussions (FGDs) of medical officers working in the public heath sectors in Eswatini was conducted between November 2020 and February 2021. Open-ended questions were used to explore factors that both motivate and demotivate medical officers participation in CPD activities. The interviews and FGDs were audio-recorded and transcribed verbatim, the qualitative data were analysed using the thematic approach. RESULTS: The emerging motivating themes described by the participants were: (1) professional responsibility and (2) personal interest and learning need. Whilst the demotivating factors were: (1) non-relevance to clinical practice, (2) cost of participation, (3) lack of reward, and (4) no recognition for staying up-to-date. CONCLUSION: The motivating factors are associated with deep learning and linked well with the principles of adult learning. The demotivating factors found were in keeping with findings from other studies in a variety of countries. It is important for the Medical Council and CPD organisers to be aware of the different motivations and de-motivations for practitioners to engage in CPD to enable them to plan and implement their programmes effectively.

Learning in a time of crises: The learning experiences of 5th year medical students at the University of KwaZulu-Natal during the COVID-19 pandemic in 2020.

BACKGROUND: The coronavirus disease 2019 (COVID-19) global pandemic led to the closure of the University of KwaZulu-Natal (UKZN) in March 2020 and the migration to online teaching for all students, with modules and assessments being modified to accommodate the new form of teaching. AIM: The aim of this research was to assess the 5th year students' experience of emergency on-line learning during the Family Medicine module, which was adapted in response to the pandemic. SETTING: The research was conducted among 5th year medical students at the University of KwaZulu-Natal in December 2020. METHODS: A questionnaire was used to assess the experiences of the 5th year MBChB students of on-line learning. RESULTS: Of the 256 students, 43.8% completed the questionnaire; 43 (38.4%) spent lockdown in an urban area; 30 (26.8%) in semi-urban and 39 (34.8%) in rural area; 34 (30.4%) always had internet connectivity; 41 (36.6%) mostly or often; and 28 (25%) sometimes or occassionally whilst 9 (8%) did not have any connectivity. Despite data bundles being provided by the UKZN, 47 did not have access to sufficient data for their academic needs. Only 35 students felt that their environment during lockdown was conducive to online learning and 71 students were not in a good headspace to engage with online learning. CONCLUSION: Whilst there are undoubted advantages of online teaching and learning in terms of access and reach, this potential is limited by structural and economic factors. These issues had a major impact on the ability of students to engage with this form of instruction.

Clinical utility of smartphone-based audiometry for early hearing loss detection in HIV-positive children: A feasibility study.

BACKGROUND: Paediatric human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) often manifests with hearing loss (HL). Given the impact of HL, early detection is critical to prevent its associated effects. Yet, the majority of children living with HIV/AIDS (CLWHA) cannot access hearing healthcare services because of the scarcity of audiologists and expensive costs of purchasing screening equipment. Alternative solutions for early detection of HL are therefore necessary. AIM: The overall aim of this study was to assess the feasibility of using self-administered smartphone-based audiometry for early HL detection amongst CLWHA. SETTING: This study was conducted at the paediatrics department of a state hospital in the Eastern Cape province, South Africa. METHODS: This was a feasibility study conducted amongst twenty-seven (27) CLWHA who were in the age group of 6-12 years. The participants self-administered hearing screening tests using a smartphone-based audiometric test. The primary end-points of this study were to determine the sensitivity, specificity and test-retest reliability of self-administered hearing screening. RESULTS: The sensitivity and specificity for self-administered screening were 82% and 94%, respectively, with positive and negative predictive values of 90% and 88%, respectively. Moreover, a strong positive test-retest reliability (r = 0.97) was obtained when participants self-administered the screening test. CONCLUSION: Six- to 12-year-old CLWHA were able to accurately self-administer hearing screening tests using smartphone-based audiometry. These findings show that self-administered smartphone audiometry can be used for serial hearing monitoring in at-risk paediatric patients.

Longitudinal Outcomes of Child Parent Psychotherapy: Response to Commentaries.

In response to the commentaries provided by Chu et al. (2020), Harmon et al. (2020), and McMahon & Maxwell (2020) on our longitudinal follow-up of Child-Parent Psychotherapy (CPP) with mothers with depression and their children, we focus on two domains: accessibility and scalability of CPP and identifying empirically supported mechanisms of change in attachment intervention research. In considering the accessibility and scalability of CPP, we discuss issues related to attrition, length of intervention, and implementation with caregivers with depression. Our discussion of mechanisms of change in attachment interventions explores active comparison conditions, theorized mediators, intervention modalities, assessment methods, and longitudinal research designs. This conversation is intended to highlight important areas for future research in the field of attachment interventions, with the goal of informing clinical and systems-level policies and practices.

A preliminary study on functional activation and connectivity during frustration in youths with bipolar disorder.

OBJECTIVES: Frustration is associated with impaired attention, heightened arousal, and greater unhappiness in youths with bipolar disorder (BD) vs healthy volunteers (HV). Little is known about functional activation and connectivity in the brain of BD youths in response to frustration. This exploratory study compared BD youths and HV on attentional abilities, self-reported affect, and functional activation and connectivity during a frustrating attention task. METHODS: Twenty BD (Mage  = 15.86) and 20 HV (Mage  = 15.55) youths completed an fMRI paradigm that differentiated neural responses during processing of frustrating feedback from neural responses during attention orienting following frustrating feedback. We examined group differences in (a) functional connectivity using amygdala, inferior frontal gyrus (IFG), and striatum as seeds and (b) whole-brain and regions of interest (amygdala, IFG, striatum) activation. We explored task performance (accuracy, reaction time), self-reported frustration and unhappiness, and correlations between these variables and irritability, depressive, and manic symptoms. RESULTS: Bipolar disorder youths, relative to HV, exhibited positive IFG-ventromedial prefrontal cortex (vmPFC) connectivity yet failed to show negative striatum-insula connectivity during feedback processing. Irritability symptoms were positively associated with striatum-insula connectivity during feedback processing. Moreover, BD vs HV youths showed positive IFG-parahippocampal gyrus (PHG)/periaqueductal gray (PAG) connectivity and negative amygdala-cerebellum connectivity during attention orienting following frustration. BD was not associated with atypical activation patterns. CONCLUSIONS: Positive IFG-vmPFC connectivity and striatum-insula decoupling in BD during feedback processing may mediate heightened sensitivity to reward-relevant stimuli. Elevated IFG-PAG/PHG connectivity in BD following frustration may suggest greater recruitment of attention network to regulate arousal and maintain goal-directed behavior.