LINKS Training and Unit Support for Mental Health: a Group-randomized Effectiveness Trial.

The LINKS curriculum, adapted from Britt et al. (2018a), was designed to improve unit climate, knowledge, and attitudes about mental health treatment seeking in military personnel. The present study extends this research by examining implementation options, comparing the effectiveness of LINKS to an active control condition with training delivered by non-experts and comparing modules that varied in training length. Eight Army platoons were randomly assigned to one of four conditions: (1) 1-h Active Control, (2) 2-h Active Control, (3) 1-h LINKS, or (4) 2-h LINKS. Two platoons were assigned to each condition. Surveys were administered at pre-training (T1), post-training (T2), and 3 months later (T3). Eighty-four participants completed all study phases. Regardless of training content, participants receiving the 2-h modules reported greater training acceptability than those receiving the 1-h modules. At T3, participants in the LINKS conditions reported more mental health knowledge than participants in the Active Control conditions. Sustained effects were also observed on a number of treatment barriers and facilitators, with the LINKS conditions generally leading to better outcomes. At T3, 2-h LINKS condition participants reported receiving more mental health treatment relative to the other conditions. Findings suggest that LINKS can be effectively delivered by non-expert trainers, is a viable intervention for targeting mental health treatment-seeking, and is optimally packaged in a 2-h module. The training might benefit from additional leadership training efforts.

Primary care providers' experiences treating low back pain.

CONTEXT: Our original work addresses the biological sex impact on low back pain (LBP) management and prognosis in primary care settings. To our knowledge, our study is the first in the United States to evaluate the differences in clinicians' approaches to LBP in the ambulatory setting specifically based on patient gender. Our findings suggest that there is a knowledge gap among primary care providers (PCPs) toward the potential impact of biological sex on LBP and a bias toward gender roles when counseling patients for home chores or occupational tasks. Further evaluation of this knowledge gap and its impact on LBP management and prognosis is recommended in US healthcare settings. OBJECTIVES: This study aims to explore PCP experiences and practice patterns regarding LBP in females compared to males in US healthcare settings. METHODS: We utilized a cross-sectional study design and convenience sampling. Data were collected anonymously utilizing a 27-item online survey sent periodically via email to PCPs working in Ohio. We had 58 responses for analysis; data were analyzed utilizing bivariate and multivariate analyses. RESULTS: On average, approximately 9 out of 10 responding clinicians reported experiencing LBP. PCPs were not in agreement that LBP is different in women than men. Clinicians with a women's health, osteopathic, or sport's medicine background were more likely to agree that LBP is different in women than in men. PCPs were more likely to counsel female patients about pelvic floor exercises; however, their intake of present pelvic symptoms in LBP female patients is suboptimal. PCPs were more likely to counsel females for home chores than males, which is aligned with the perceived traditional gender roles among PCPs. CONCLUSIONS: There may be a knowledge gap among PCPs toward the potential impact of biological sex on LBP and a bias toward gender roles when counseling patients for home chores or occupational tasks. Further investigation of this knowledge gap and counseling approaches is recommended to better bridge the gender disparity.

The Feasibility and Effectiveness of an Online Curriculum for Virtual Onboarding/Orientation of Graduate Medical Education Learners During the COVID-19 Pandemic.

Background: Graduate medical education (GME) orientation/onboarding is conventionally an in-person activity, but the COVID-19 pandemic prompted virtual approaches to learner onboarding. However, online GME onboarding strategies have not been disseminated in the literature. Objective: To determine the usefulness of an online curriculum for GME learner orientation at a large sponsoring institution using an electronic survey. The primary outcome was to discover the usefulness of our online curriculum for GME onboarding, and secondary outcomes included identifying barriers to implementation and weaknesses associated with online GME orientation. Methods: We created an online GME orientation curriculum to onboard incoming learners (from June 1 to August 31, 2020) and electronically surveyed our learners to determine the usefulness of this novel approach. We conducted orientation sessions and electronically recorded questionnaire responses using CarmenCanvas, our institutional learning management system. Linear regression analysis was performed to identify factors predicting satisfaction with virtual GME orientation using IBM SPSS Statistics, Version 26.0 (Armonk, NY, USA). Results: Of 353 trainees, 272 completed the survey for a 77% response rate. 97% of respondents reported that the curriculum supported performance of learner duties. 79% of trainees perceived the overall quality as "very good" or "good", 91% responded that the curriculum provided "effective learning", 94% reported "accessing the course content easily", 92% reported "easily navigating the curriculum", 91% described the curriculum as "well-organized", and 87% reported that the lectures "supported their learning". Conclusion: Online delivery of a comprehensive GME orientation curriculum is useful and facilitates learner education, training, and integration into a large GME institution in the COVID-19 era.

How Are Residents Trained in Neuropathology? A Survey of Neurology Program Directors in the United States.

To understand the current state of neurology residents training in neuropathology, we electronically distributed a 16-item survey to 150 adult and 70 child neurology program directors (PDs). The survey inquired about their program characteristics, neuropathology curriculum and assessment methods, trainee performance, and attitudes. Descriptive analysis was used to summarize categorical variables as frequencies and percentages and continuous as means and standard deviations. We conducted a series of Mann-Whitney U and Fisher's exact tests to evaluate differences between various program characteristics. Sixty-four (29%) PDs responded to the survey, including 45 (30%) adult and 19 (27%) child neurology PDs. Thirty-one programs required a dedicated neuropathology rotation. The majority (92%) used the Residency In-Service Training Examination (RITE) to assess trainee's knowledge. Approximately 86% of the PDs agreed that neuropathology is essential and a defined curriculum is necessary during residency training. There was no difference in the RITE scores between programs. We conclude that a neuropathology rotation was felt to be essential even though the RITE scores did not differ between programs with and without a dedicated rotation. Alternative evaluation and training methods may need consideration. A future survey of all the stakeholders may be required to thoroughly understand and disseminate the neuropathology education well.

YaHaLOM training in the military: Assessing knowledge, confidence, and stigma.

Under conditions of profound stress, individuals in high-risk occupations may experience an acute stress reaction (ASR). Given that ASRs may interfere with functioning, placing the team in danger, the Israel Defense Forces developed YaHaLOM training to teach service members how to manage ASRs in team members. YaHaLOM is a novel, rapid, peer-based intervention specifically designed for use in the midst of a high-stress event. In all, 904 Israeli combat soldiers participated in the study; 76% reported having received YaHaLOM, and 24% reported that they had not. In addition to measures of knowledge about managing ASRs, confidence in managing ASRs, and stigma-related attitudes toward ASRs, questions also addressed training approach, including the use of a video and instructor type. Participants who reported receiving YaHaLOM also reported more knowledge about managing an ASR, more confidence in managing an ASR, less external stigma, and more normative views of ASRs. Being trained with a video was associated with more confidence and less self-stigma than being trained without a video. Instructor type was not associated with differences in knowledge, confidence, or stigma-related attitudes. The study is limited by cross-sectional self-report data. Nevertheless, results suggest YaHaLOM may prepare soldiers to manage ASRs in team members; future studies are needed to assess intervention efficacy and to expand this research to other high-risk occupational contexts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Rapid response to acute stress reaction: Pilot test of iCOVER training for military units.

OBJECTIVE: The purpose of this study was to pilot the iCOVER curriculum-a training product designed to teach service members how to recognize and respond to acute stress reactions (ASRs) using a simple, 6-step procedure, iCOVER. Three goals guided the pilot: (a) assess training acceptability, (b) assess impact of training on knowledge and performance of the iCOVER procedure, and (c) explore the effects of in-person and computer-simulated practical exercises. METHOD: Six military squads (N = 66) were randomly assigned to 3 conditions: iCOVER Standard (iCOVER instruction with an in-person practical exercise), iCOVER Tech (iCOVER instruction with a computer-simulated practical exercise), or Control (no iCOVER instruction). Squads in the iCOVER conditions received iCOVER instruction, completed a knowledge test and practical exercise to which they were assigned (i.e., Standard or Tech), demonstrated their iCOVER skills in live-action scenarios, and reported their perceptions of the training. RESULTS: iCOVER training was acceptable to most participants and associated with improved knowledge about iCOVER (Mpre = 3.33 vs. Mpost = 5.15; t[42] = -7.61, p < .001, d = 1.41); iCOVER Standard resulted in more iCOVER behaviors during a live-action scenario compared with the other conditions, F(2, 35) = 13.36, p < .001, η2 = 0.43. Compared with iCOVER Tech, iCOVER Standard had greater acceptability and resulted in better performance of iCOVER. CONCLUSIONS: This is the first U.S. demonstration of a training program designed to address ASRs during high-risk operations and offers a potential way ahead for preparing military teams to manage ASRs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Predicting Suicide Ideation in the Military: The Independent Role of Aggression.

The purpose of this study was to examine the longitudinal relationship between aggression and suicide ideation when controlling for other externalizing (i.e., alcohol misuse and risk-taking) and internalizing (i.e., depression and sleep problems) risk factors in an active duty, military sample. Preexisting data from a longitudinal study were analyzed to assess the wellness of service members across the deployment cycle. Participants were 944 active duty service members (95% male, 48% between 18 and 24 years old) who completed surveys upon initial return from deployment and approximately 3 months later. After controlling for other externalizing (alcohol misuse, risk-taking) and internalizing (depression, sleep problems) risk factors, service members reporting aggression were significantly more likely to report suicide ideation than those reporting no aggression (OR = 3.19; OR 95% CI: 1.16-8.80). The independent nature of the relationship between anger and suicidality suggests aggression may be an important indicator of suicidality for service members. Understanding the role of aggression in suicidality may improve the ability to identify at-risk service members and to develop effective interventions to reduce suicide risk.

Self-reported mindfulness and soldier health following a combat deployment.

OBJECTIVE: Combat exposure has been linked to health-related challenges associated with postcombat adjustment, including mental health symptoms, behavior-related problems, physical pain, and functional impairment. Mindfulness, or acceptance of the present moment without reactivity or judgment, may be associated with better mental health following a combat deployment. This study examined whether self-reported mindfulness predicted soldier health outcomes over the course of the postdeployment period. METHOD: U.S. soldiers (n = 627) were surveyed 4 months after a deployment to Afghanistan (T1) and again 3 months later (T2). Mindfulness was assessed using the nonreactivity to inner experience subscale of the Five-Facet Mindfulness Questionnaire. Hierarchical linear regressions examined how mindfulness (T1) moderated the impact of combat exposure (T1) on outcomes at T2. RESULTS: Controlling for rank, the interaction between combat exposure and mindfulness significantly predicted posttraumatic stress disorder (PTSD) symptoms, depression symptoms, risk-taking behaviors, pain symptoms, and functional impairment. The interaction term explained 1% to 2% of the variance in these health outcomes. Simple slopes analyses revealed that combat exposure was associated with more PTSD symptoms, depression symptoms, risk-taking behaviors, pain symptoms, and functional impairment when soldiers reported low levels of mindfulness. There was no effect for alcohol misuse, sleep difficulties, or aggressive behaviors. CONCLUSIONS: Nonreactivity to inner experience may mitigate the detrimental effects of high-levels of combat exposure on both mental and physical health outcomes. These findings indicate that mindfulness strategies such as nonreactivity may be particularly useful for employees facing potentially traumatic stressors in a high-risk occupational context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).