Increasing food insecurity severity is associated with lower diet quality.

OBJECTIVE: Food insecurity may reduce diet quality, but the relationship between food insecurity severity and diet quality is under-researched. This study aimed to examine the relationship between diet quality and severity of household food insecurity. DESIGN: A cross-sectional, online survey used the United States Department of Agriculture Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately or severely food insecure. The Australian Recommended Food Score (ARFS; scored 0­73) determined diet quality (ARFS total and sub-scale scores). Survey-weighted linear regression (adjusted for age, sex, income, education, location and household composition) was conducted. SETTING: Tasmania, Australia. PARTICIPANTS: Community-dwelling adults (aged 18 years and over). RESULTS: The mean ARFS total for the sample (n 804, 53 % female, 29 % aged > 65 years) was 32·4 (sd = 9·8). As the severity of household food insecurity increased, ARFS total decreased. Marginally food-insecure respondents reported a mean ARFS score three points lower than food-secure adults (B = ­2·7; 95 % CI (­5·11, ­0·34); P = 0·03) and reduced by six points for moderately (B = ­5·6; 95 % CI (­7·26, ­3·90); P < 0·001) and twelve points for severely food-insecure respondents (B = ­11·5; 95 % CI (­13·21, ­9·78); P < 0·001). Marginally food-insecure respondents had significantly lower vegetable sub-scale scores, moderately food-insecure respondents had significantly lower sub-scale scores for all food groups except dairy and severely food-insecure respondents had significantly lower scores for all sub-scale scores. CONCLUSIONS: Poorer diet quality is evident in marginally, moderately and severely food-insecure adults. Interventions to reduce food insecurity and increase diet quality are required to prevent poorer nutrition-related health outcomes in food-insecure populations in Australia.

The grammaticality judgement of inflectional morphology in children with and without Developmental Language Disorder.

To explore the clinical potential of grammaticality judgement tasks, this study investigated whether a Grammaticality Judgment Task (GJT) of inflectional morphology could differentiate between a clinically selected sample of children with DLD and children in mainstream (i.e. regular education) schools. We also explored the relationship between grammaticality judgement and measures of receptive vocabulary, receptive grammar, and nonword repetition. Children with DLD (n = 30; age range = 69-80 months) and mainstream children in Pre-primary, Year 1, and Year 2 (n = 89, age range = 61-96 months) were assessed on a GJT of regular past tense, third person singular, and possessive 's. The GJT was sensitive to developmental differences in mainstream children and differentiated children with DLD from Year 1 and 2 mainstream children, with DLD results consistent with a one-year delay in performance compared to controls. The GJT was the strongest discriminator of membership to a clinically selected sample of children with DLD (ROC curve analysis, area under the curve = 88%). Receptive grammar, receptive vocabulary, and nonword repetition were related to performance on the GJT. The grammaticality judgement of inflectional morphology shows promise as a reliable indicator of DLD and a measure sensitive to developmental differences in mainstream children. GJTs should continue to be explored for clinical application as a potential tool for both assessment and intervention.

The new normal for food insecurity? A repeated cross-sectional survey over 1 year during the COVID-19 pandemic in Australia.

BACKGROUND: Food insecurity during the COVID-19 pandemic has been impacted by necessary public health restrictions. Tasmania, an island state south of the Australian mainland, recorded no community transmission of COVID-19 between May 2020 to November 2021 due to strong border restrictions. This study aimed to determine the changes in prevalence and sociodemographic predictors of food insecurity throughout the COVID-19 pandemic in Tasmania, Australia. METHODS: In May 2020 (survey 1: during lockdown), September 2020 (survey 2: eased restrictions) and May 2021 (survey 3: 1-year post-lockdown), cross-sectional, online surveys using convenience sampling methods determined food insecurity in Tasmanian adults using the USDA Household Food Security Survey Module: Six-Item Short Form, in addition to key sociodemographic questions. Crude and age-adjusted prevalence of food insecurity was calculated, and binary logistic regression determined at-risk groups and changes in prevalence over time. RESULTS: The age-adjusted prevalence of food insecurity was 27.9% during lockdown (n = 1168), 19.5% when restrictions had eased (n = 1097) and 22.6% 1-year post-lockdown (n = 1100). Young adults, Aboriginal and/or Torres Strait Islander people, individuals with disabilities, families with dependents and temporary residents were at highest risk across all time points. CONCLUSIONS: The prevalence of food insecurity was higher than pre-pandemic levels across all three time points. Our results indicate the potential long-term impacts of the COVID-19 pandemic on food security in Australia, where despite easing social distancing restrictions and a lack of COVID-19 transmission, the prevalence of food insecurity reduced, but did not recover to pre-pandemic levels 1-year following a lockdown.

Food insecure households faced greater challenges putting healthy food on the table during the COVID-19 pandemic in Australia.

The COVID-19 pandemic negatively affected the Australian food supply. However, it has remained unclear how food access, food availability and consumption were impacted, especially for households experiencing food insecurity. This study aimed to determine the association between food security and cooking and eating habits, food access and availability, self-sufficiency and perceptions of the food supply at the beginning of the COVID-19 pandemic in Tasmania, Australia. Throughout May-June 2020 during strict social distancing restrictions, a cross-sectional survey was conducted including the U.S. Household Food Security Survey Module Six-Item Short Form, twenty Likert scale questions on cooking and eating habits, food access, self-sufficiency and perceptions of the food supply (responses from 1 = strongly agree to 5 = strongly disagree), two questions on food availability and eleven socio-demographic questions. Survey data (n = 1067) were analysed using multivariate linear regression, and binary logistic regression. Food insecure households were significantly more likely to agree they were consuming less fresh food compared with food secure households (Mean difference between scale responses (MD) = 0.66; 95%CI:0.36-0.66; p < 0.001), and significantly more food insecure households agreed it was more difficult to get to the shops (MD = 0.49; 95%CI:0.34-0.64; p < 0.001) and they had less money available for food than prior to the COVID-19 pandemic (MD = 0.95; 95%CI:0.79-1.10; p < 0.001). Compared to food secure households, food insecure households were at significantly greater risk of foods being unavailable to them (OR:1.75; 95%CI:1.33-2.35; p < 0.001) and were less likely to have sufficient food stored in their homes (OR:0.48; 95%CI: 0.33-0.687; p < 0.001). This study indicates there was a disproportionate impact of the COVID-19 pandemic on food insecure households, related to food availability and access, with effects on cooking and eating habits.

Development of a scale to measure the psychological resources of grit in adults.

Grit, a personality trait characterized by  having passion and perseverance for long-term goals, has been linked to increased performance, retention, and well-being in various fields. In the 15 years since the original grit scale was published, many studies have investigated factors that promote grit. However, a scale has not yet been developed measuring characteristics that can contribute to higher levels of grit. This study aimed to develop a novel scale to measure the psychological resources of grit. The Delphi technique was used to obtain consensus from a national and international panel of academics and practitioners who are experts in grit and related constructs. A total of 30 participants rated 100 scale items over three rounds of online surveys. Experts agreed that items selected for the final scale (n = 20) were essential, with 85% rating them as important or very important. The scale, called the Grit Psychological Resources Scale, has promise as a helpful tool for practitioners involved in staff development and building capabilities that contribute to goal achievement.

Grit: A Concept Analysis.

The concept of grit, defined as having passion and perseverance for long-term goals, has gained significant recognition in recent years. The idea that being gritty is ultimately more important than innate talent to achieve goals has widespread appeal. This review examined the concept of grit to clarify relationships between constructs and identify future opportunities for research. A systematic search across five databases including CINAHL, PsycINFO, PubMed, Scopus and Web of Science yielded 422 records. After screening and assessment for eligibility, 42 articles were retained and reviewed using the Walker and Avant method for concept analysis. Results provided support for passion, perseverance and long-term goals as defining attributes of grit, along with an extensive nomological network of antecedents, consequences, and mediating and moderating variables. Positive thoughts, behaviours and habits appear to play a key preparatory role in achieving long-term goals. Grit was associated with reduced burnout and depression, improved performance and well-being. Further research is needed to understand the best practice approaches for developing grit at both an individual and collective level.

The Unbreakable Bond: The Mental Health Benefits and Challenges of Pet Ownership for People Experiencing Homelessness.

Pet ownership provides a unique relationship that is beneficial to many aspects of the pet owner's life, including mental health and companionship. Mental health and social isolation are negatively impacted by homelessness, increasing the importance of the owner-pet bond during this time. However, this relationship is complicated by the need for pet owners to urgently find accommodation for themselves while still caring for their pets. This paper explores two firsthand narratives of the relationship between a person and their pets during a period of homelessness and subsequent search for accommodation. Both narratives highlight important aspects of the emotional bond between owner and pet: the concept of choosing pet over place; improved mental health and changed behaviours; and stressors or negative emotions of parental concern, separation anxiety and grief. These narratives emphasise the importance of supporting, expanding and creating new pet-friendly crisis and permanent accommodation options for pet owners experiencing homelessness.

Prevalence and factors associated with depression, anxiety, and stress symptoms among older adults: A cross-sectional population-based study.

Despite population aging and the increase in mental health problems, studies on the mental health of older people in developing countries are lacking. This population-based cross-sectional study estimated the prevalence and associated factors for depression, anxiety and stress symptoms among older adults in Nepal. Community-dwelling older adults (N = 794) were interviewed using a questionnaire which consisted of the 21-item Depression Anxiety Stress Scales; and a wide range of sociodemographic, health-related, and lifestyle characteristics; functional ability, social support, participation in social activities, and adverse life events. The prevalence of symptoms was 15.4% for depression, 18.1% for anxiety, and 12.1% for stress. Risk factors for symptoms included female gender, working in agriculture, lower household wealth, perceived poor health, smoking, chronic conditions, migration of adult children, and exposure to adverse life events. Receiving an allowance, physical exercise, functional ability, social support, and participation in social activities were found to have protective effects. The findings indicate the need for community-based interventions, including appropriate diagnosis and treatment of mental health conditions, and mental health promotion programs targeting the risk and protective factors.

Mental Health Considerations for International Students.

Collectively, universities and other tertiary education providers globally, attract significant numbers of international students each year. However, the extent and significance of the benefits derived by the host society from this international mobility is often misunderstood, or at best, underestimated. International students commonly provide multiple benefits to the financial and cultural health of the host institution and country but the economic benefit (for the host) is typically the primary consideration. A potential challenge or circuit-breaker for host institutions is the failure to acknowledge the particular differences between the needs of international students and their domestic counterparts. For some international students, the adjustment to studying offshore and experiencing an array of academic and personal development possibilities not otherwise available to them in their home country, may be overwhelming and contribute to unforeseen and unfortunate consequences for their mental health. All students in new settings, irrespective of background, require strong guidance, advice and support. However, the challenges of acculturation and adjustment to the stressors of academic study and everyday life in another country is accentuated for many international students rendering them a vulnerable student population. Irrespective of the number of international students in an educational setting, and given the steady growth in the number of students seeking educational opportunities overseas, there is an urgent need to ensure that adequate resources are provided for the support of all international students across all aspects of academic life. The importance of maximising the benefits and minimising the risks associated with international study for overseas students cannot be overstated. A quality experience for all, underpinned by an evidence-based and resourced safety net of support with specific training for mental health professionals, should be considered a global industry standard.

Emotional regulation training for intensive and critical care nurses.

Professional quality of life is related to psychological well-being for nurses with implications for quality patient care. This study evaluated the effectiveness of emotional regulation training on depression, anxiety and stress, and professional quality of life for intensive and critical care nurses. In this experimental comparison trial, 60 intensive and critical care nurses were randomly assigned to treatment and wait-list control groups. The treatment group received six sessions of emotional regulation training, while the wait-list control group received no treatment. Outcome measures were: the Cognitive Emotion Regulation Questionnaire; the Depression, Anxiety and Stress Scale; and the Professional Quality of Life Scale in a pre-post design. The treatment group demonstrated greater improvements in burnout and compassion satisfaction compared with the wait-list control group. No significant reduction in compassion fatigue was found compared with controls. Some cognitive coping strategies improved in the treatment group compared with controls, with greater reductions in depression, anxiety, and stress. This study indicates the benefits of implementing emotional regulation training programs to improve psychological well-being and professional quality of life for intensive and critical care nurses.

Comparison of the effectiveness of a 12 step substance use recovery program on quality of life.

Substance-related disorders can adversely impact quality of life. This study assessed a 12 step program on health-related quality of life for Iranian individuals seeking to recover from substance use. The study used a quasi-experimental, two group, three stage, pre- and post-test design and collected data at baseline, and at 1 and 3 months' post-intervention. The treatment group comprised 35 participants in a 12 step program with a non-equivalent comparison group of individuals admitted to addiction treatment centers. Physical and mental health quality-of-life domains were assessed using the Short Form 36 Health Survey Questionnaire. The treatment group improved in all aspects of health-related quality of life. The treatment group improved compared to the comparison group for two of eight quality of life dimensions - physical functioning and role limitations due to emotional problems - at 1 month post-intervention. There were additional improvements at 3 months' follow up in six of eight quality-of-life subscales compared to the comparison group. The benefits to quality of life related to mental health recovery extended beyond the treatment program, indicating that the program principles were effectively implemented in daily life.

The Homeless and Their Animal Companions: An Integrative Review.

Research indicates a strong bond between those who are homeless and their companion animals. This relationship provides a number of benefits to the homeless person as well as to the animal, including safety, responsibility and improved emotional and mental health. However, the relationship can also add challenges, including decreased access to accommodation, decreased effort to find shelter as a consequence, and emotional vulnerability relating to fear of losing their companion pet. This integrative review examined the benefits and challenges of companion animals for the homeless to determine the consistency of findings to aid better service delivery to the homeless population.

A systematic review of Calendula officinalis extract for wound healing.

Use of complementary and alternative medicine for wound healing is influencing mainstream medical practice. This systematic review evaluates the role of Calendula officinalis flower extract as monotherapy compared to control for wound healing in vivo. Searches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus (up to April 2018) with 14 studies meeting the inclusion criteria, comprising 7 animal experiments and 7 clinical trials. Findings from the review on acute wound healing showed faster resolution of the inflammation phase with increased production of granulation tissue in the test groups treated with extract. These findings were consistent in five animal studies and one randomized clinical trial. Chronic wound healing studies were varied. Two clinical control studies on venous ulcers demonstrated decreased ulcer surface area compared to controls. Another randomized clinical trial demonstrated no improvement for the calendula group in diabetic leg ulcer healing. Burn healing similarly showed mixed results. Two animal studies demonstrated a prophylactic effect for the administration of calendula extract prior to burn injury. A randomized clinical trial of patients suffering from partial to full thickness burns demonstrated no benefit for topical application of calendula extract compared to controls. Two randomized clinical trials assessed the potential for extract to prevent acute post radiation dermatitis, with one study showing improvements compared to trolamine, while the other found no improvement compared to aqua gel cream. Animal studies provide moderate evidence for improved recovery from the inflammation phase and increased production of granulation tissue in calendula extract treatment groups. This review identified some evidence for the beneficial effects of C. officinalis extract for wound healing, consistent with its role in traditional medicine. There is a need for larger, well-designed randomized control trials to assess the effect of calendula on wound healing including complications.

Subcutaneous Injection of Tranexamic Acid to Reduce Bleeding During Dermatologic Surgery: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial.

BACKGROUND: Topical application, oral, and IV injection of tranexamic acid (TXA) have been used to reduce surgical bleeding. OBJECTIVE: To evaluate the safety and efficacy of TXA injected subcutaneously to reduce bleeding during dermatologic surgery. METHODS: In this double-blinded, placebo-controlled, randomized prospective study, 131 patients were randomized to subcutaneous injection of lidocaine 2% diluted 1:1 with either saline (placebo) or TXA 100 mg/1 mL before surgery. Before the second stage or closure, size measurements of bloodstain impregnation on Telfa and surgical wound size were recorded and analyzed using mixed-effects linear regression. Subjective evaluation of hemostasis was performed using 4-point scale grading and analyzed using Fischer's exact test. RESULTS: One hundred twenty-seven patients completed the study. The bloodstain to surgical wound size ratio was smaller in the TXA group (1.77) compared with the placebo group (2.49) (p < .001). An improved effect of TXA on bleeding was observed in the subgroup of patients receiving anticoagulants (mean difference; 95% confidence interval; -0.83; -1.20 to -0.46 p < .001). The subjective hemostasis assessment was significantly better in the TXA group overall (p = .043) and anticoagulant subgroup (p = .001) compared with the placebo group. CONCLUSION: Subcutaneous injection of TXA was safe, reduced bleeding during dermatologic surgery, and particularly effective for patients receiving anticoagulation treatment.

A systematic review of the use of music interventions to improve outcomes for patients undergoing hip or knee surgery.

AIM: To examine the effectiveness of music as an adjunct treatment for pain, anxiety, and/or postoperative delirium, for patients undergoing hip or knee surgery. BACKGROUND: Patients undergoing hip or knee surgery are known to experience pain and anxiety before and after surgery and be prone to postoperative delirium. DESIGN: Quantitative systematic review. DATA SOURCES: CENTRAL, Embase, Ovid MEDLINE, CINAHL, and PsycINFO databases were systematically searched without time limits (to June 2018). REVIEW METHODS: A systematic search yielded 10 randomized controlled trials and quasi-experimental designs. Studies were appraised using the Cochrane Risk of Bias Tool. Data were extracted using the Effective Practice and Organization of Care data extraction tool. RESULTS: Mixed results were found for the effect of music on anxiety, pain, and postoperative delirium in patients undergoing hip or knee surgery. Six of 10 included studies provided evidence that music can improve anxiety, pain, or postoperative delirium outcomes for patients undergoing hip or knee surgery. Music effectively reduced anxiety in one of three studies. Three of seven studies reported benefits of music for reducing postoperative pain. Positive effects of music on postoperative delirium were reported in all three studies that evaluated this outcome. Within group improvements were observed in many of the studies. CONCLUSION: Music has the potential to improve outcomes of anxiety, pain, and postoperative delirium, for patients undergoing hip or knee surgery. The low number of studies found indicates results should be treated with caution. Further studies are required to provide strong evidence generalizable to a broader population.

Occupational stress and cognitive failure of nurses and associations with self-reported adverse events: A national cross-sectional survey.

AIM: To determine correlations for nurse self-reported occupational stress, prevalence of cognitive failure (CF), and adverse events. DESIGN: Cross-sectional nationwide survey. METHODS: Tertiary-level public hospitals (N = 115) from 13 provinces in Iran were recruited and 2,895 nurses surveyed (August 2016-December 2017). Participants' self-reported demographic information, occupational stress, CF, and frequency of adverse events were analysed using chi-square, t tests, and binary logistic regression. RESULTS: This study showed that 29.1% of nurses had experienced adverse events in the past six months. Significant predictors for reported adverse events from logistic regression were 'Role stressors', 'Interpersonal relations stressors', and 'Action', while 'Working environment stressors' was protective for reported adverse events. Demographic predictors of adverse events were longer work hours and male gender, while those working in critical care units, general wards, and other wards had higher reported adverse events than for emergency wards. CONCLUSIONS: Occupational stress and CF are associated with the reporting of adverse events. Further research is needed to assess interventions to address occupational stress and CF to reduce adverse events. IMPACT: Adverse events compromise patient safety, lead to increased healthcare costs, and impact nursing staff. Higher self-reported adverse events were associated with higher reported stressors and CF. Understanding the factors that influence occupational stress, CF, and adverse events will support quality patient care and safety.

Prevalence of Trauma in an Australian Inner City Mental Health Service Consumer Population.

This study examined the rates and types of trauma reported by consumers utilising an inner city mental health service in Sydney, Australia. The study also explored whether consumers felt that it had been helpful to be asked about their experience of trauma, whether they thought that these questions should be asked routinely and if they wanted to talk about these experiences. Ninety-one consumers from an inner city mental health service were assessed. Eighty-eight percent of the consumers assessed reported that they had experienced at least one traumatic event, while 79% reported having experienced two or more events. A majority of consumers identified that they thought it was helpful to be asked about trauma and that it should be part of an assessment. However, less than one-third of these consumers surveyed wanted to talk about the trauma at the time of assessment. Concerns that clinicians may have in regards to addressing trauma in mental health assessment are not matched by consumers' expressed beliefs on the issue.

Perceptions of illness as predictive factors for perceived stress in patients participating in a cardiac rehabilitation program.

Psychosocial risk factors, such as perceived stress, not only increase the risk of cardiovascular disease, but also act as barriers for treatment adherence and cardiac rehabilitation. In this study, we examined the predictive role of perceptions for illness to perceived stress in Iranian patients participating in a cardiac rehabilitation program. A cross-sectional study was conducted in 2017 to determine correlations of demographic variables and domains of illness perception with perceived stress, and to develop a predictive model for perceived stress. In total, 150 patients with cardiovascular disease, who were admitted to a cardiac rehabilitation center, completed the questionnaires. (i) demographic and health-related characteristics; (ii) the Perceived Stress Scale-14; and (iii) the Brief Illness Perception Questionnaire. The mean perceived stress was 16.2 (8.4), and five illness perception subscales - timeline, personal control, treatment control, understanding and emotional response - were associated with increased perceived stress. Variables in the multi-variate predictive model accounted for 48% of the total variance in perceived stress. The results demonstrated the value of assessing and managing the patients' perceptions of illness to reduce their perceived stress, which could support adherence to cardiac rehabilitation programs.

A Cognitive Load Theory Simulation Design to Assess and Manage Deteriorating Patients.

Background Cognitive load theory (CLT) uses an understanding of brain architecture for educational design, with implications for simulation. Since working memory is limited, minimising extraneous cognitive load improves learning of new tasks (intrinsic load) and use of existing knowledge (germane load). This study evaluates the effectiveness of low-fidelity simulation (LFS) utilising CLT principles in the assessment and management of the deteriorating patient (AMDP). Method CLT design principles informed the choice of LFS and simulation design. The self-rated ability of 13 undergraduate nurses across seven aspects of AMDP was measured in a pre-post design. Results Self-rated ability increased from 2.98 (SD = 0.19) to 4.47 (SD = 0.12) (p < 0.001), with improvements across all AMDP aspects. Conclusion This study indicates that CLT informed design has benefits for simulation. LFS may be preferred to high fidelity simulation for AMDP teaching and medical simulation for novice learners.

Introducing a Conversational Model Therapy Approach as a Team Model of Care: The Clinician Experience in a Sexual Assault Service.

This article examines clinician experience in adopting a contemporary psychodynamic model of care by exploring the experiences and perspectives of staff at an Australian hospital-based sexual assault service (SAS), reflecting then on implications for how to best engage clinicians in a model of care change and training. The Conversational Model of Therapy (CMT) is a contemporary psychodynamic approach integrating evidence from developmental psychology, neuroscience and trauma. Training was provided in the CMT approach to Short-Term Intensive Psychodynamic Psychotherapy seeking to enable the service to better provide for the needs of adult clients with less recent sexual assault experiences and/or those able to receive a short-term psychotherapy. Five semi-structured individual interviews and one focus group (with four participants) were undertaken to identify SAS staff perceptions of their experiences after initial training of up to 13 sessions with CMT. Thematic analysis was performed to identify, analyse and report patterns in the responses with the following themes emerging: the challenges staff face in providing a service to clients; coping mechanisms staff utilise in their work; the current service structure and how this compares with their experiences of CMT, and; feelings and thoughts on SAS staff being evaluated. Findings provide evidence that the majority of staff understood the need for change and were able to undertake training towards this due to effective coping mechanisms within their work and good support from within their team. The research also highlights the need to ensure effective training to evaluate participants' understanding of the model being taught. In the context of training experience elsewhere, learning and synthesis of all of the knowledge relevant to a psychodynamic model of care may require experiential learning through supervision of audio-recorded sessions, although this has challenges in the SAS context.