Closing the equity deficit: Sustainability justice in municipal climate action planning in Waterloo region.

There is growing recognition that often well-intended climate action solutions perpetuate and exacerbate manifestations of colonialism and racism due to the lack of equity and justice considerations in designing and implementing these solutions. There is limited research exploring why the integration of these considerations are lacking in municipal climate action planning. This exploratory descriptive qualitative study explored how municipal actors perceive and understand equity and justice in municipal climate action planning as a step toward addressing this issue. Semistructured interviews were conducted with seven members of the core management group from ClimateAction Waterloo region, and a template analysis of the interview data resulted in six themes. Findings suggested that those involved in municipal climate action planning understand and perceive justice and equity considerations as important to their work, however, translating this understanding to practice is a challenge due to structural (governmental and societal) and capacity (limited time, funding, resources, and knowledge) barriers. By better understanding how key actors consider justice and equity, we identify shifting colonial mental models as a potential pathway for transformative change given the central role of these actors.

Contributions, missed opportunities, and future directions: A critical reflection on global climate change and environmental sustainability in AJCP over five decades.

In this contribution to the 50th Anniversary Special Issue, the authors consider how global climate change and environmental sustainability have been addressed in the American Journal of Community Psychology (AJCP) over the last five decades. As we are increasingly exceeding critical planetary boundaries (global climate change, biodiversity loss, land degradation, etc.) with disastrous impacts on human well-being-especially for peoples already marginalized-it is timely to consider the treatment of environmental issues in the history of the AJCP and in community psychology more broadly. This review of relevant articles is clustered into three topics derived from our critical understanding of the articles themselves: (a) public participation and power; (b) community-level responses to environmental change, including its disproportionate impacts on marginalized groups; and (c) frameworks and worldviews that integrate the natural world as necessary context for research and action. The commentary on the featured articles is framed in terms of their key contributions, missed opportunities up to this point, and future directions for the field. While looking back at the past 50 years, the authors also have an eye to the years ahead and what work can be done to mitigate the harms of climate change, adapt to the emerging new environmental reality, and promote just and inclusive sustainabilities worldwide.

Antibiotics for the treatment of COVID-19.

BACKGROUND: The effect of antibiotics with potential antiviral and anti-inflammatory properties are being investigated in clinical trials as treatment for COVID-19. The use of antibiotics follows the intention-to-treat the viral disease and not primarily to treat bacterial co-infections of individuals with COVID-19. A thorough understanding of the current evidence regarding effectiveness and safety of antibiotics as anti-viral treatments for COVID-19 based on randomised controlled trials (RCTs) is required. OBJECTIVES: To assess the efficacy and safety of antibiotics compared to each other, no treatment, standard of care alone, placebo, or any other active intervention with proven efficacy for treatment of COVID-19 outpatients and inpatients.  SEARCH METHODS: We searched the Cochrane COVID-19 Study Register (including MEDLINE, Embase, ClinicalTrials.gov, WHO ICTRP, medRxiv, CENTRAL), Web of Science and WHO COVID-19 Global literature on coronavirus disease to identify completed and ongoing studies to 14 June 2021. SELECTION CRITERIA: RCTs were included that compared antibiotics with each other, no treatment, standard of care alone, placebo, or another proven intervention, for treatment of people with confirmed COVID-19, irrespective of disease severity, treated in the in- or outpatient settings. Co-interventions had to be the same in both study arms. We excluded studies comparing antibiotics to other pharmacological interventions with unproven efficacy. DATA COLLECTION AND ANALYSIS: We assessed risk of bias of primary outcomes using the Cochrane risk of bias tool (ROB 2) for RCTs. We used GRADE to rate the certainty of evidence for the following primary outcomes: 1. to treat inpatients with moderate to severe COVID-19: mortality, clinical worsening defined as new need for intubation or death, clinical improvement defined as being discharged alive, quality of life, adverse and serious adverse events, and cardiac arrhythmias; 2. to treat outpatients with asymptomatic or mild COVID-19: mortality, clinical worsening defined as hospital admission or death, clinical improvement defined as symptom resolution, quality of life, adverse and serious adverse events, and cardiac arrhythmias. MAIN RESULTS: We included 11 studies with 11,281 participants with an average age of 54 years investigating antibiotics compared to placebo, standard of care alone or another antibiotic. No study was found comparing antibiotics to an intervention with proven efficacy. All studies investigated azithromycin, two studies investigated other antibiotics compared to azithromycin. Seven studies investigated inpatients with moderate to severe COVID-19 and four investigated mild COVID-19 cases in outpatient settings. Eight studies had an open-label design, two were blinded with a placebo control, and one did not report on blinding. We identified 19 ongoing and 15 studies awaiting classification pending publication of results or clarification of inconsistencies. Of the 30 study results contributing to primary outcomes by included studies, 17 were assessed as overall low risk and 13 as some concerns of bias. Only studies investigating azithromycin reported data eligible for the prioritised primary outcomes. Azithromycin doses and treatment duration varied among included studies.  Azithromycin for the treatment of COVID-19 compared to placebo or standard of care alone in inpatients We are very certain that azithromycin has little or no effect on all-cause mortality at day 28 compared to standard of care alone (risk ratio (RR) 0.98; 95% confidence interval (CI) 0.90 to 1.06; 8600 participants; 4 studies; high-certainty evidence). Azithromycin probably has little or no effect on clinical worsening or death at day 28 (RR 0.95; 95% CI 0.87 to 1.03; 7311 participants; 1 study; moderate-certainty evidence), on clinical improvement at day 28 (RR 0.96; 95% CI 0.84 to 1.11; 8172 participants; 3 studies; moderate-certainty evidence), on serious adverse events during the study period (RR 1.11; 95% CI 0.89 to 1.40; 794 participants; 4 studies; moderate-certainty evidence), and cardiac arrhythmias during the study period (RR 0.92; 95% CI 0.73 to 1.15; 7865 participants; 4 studies; moderate-certainty evidence) compared to placebo or standard of care alone. Azithromycin may increase any adverse events slightly during the study period (RR 1.20; 95% CI 0.92 to 1.57; 355 participants; 3 studies; low-certainty evidence) compared to standard of care alone. No study reported quality of life up to 28 days. Azithromycin for the treatment of COVID-19 compared to placebo or standard of care alone in outpatients Azithromycin may have little or no effect compared to placebo or standard of care alone on all-cause mortality at day 28 (RR 1.00 ; 95% CI 0.06 to 15.69; 876 participants; 3 studies; low-certainty evidence), on admission to hospital or death within 28 days (RR 0.94 ; 95% CI 0.57 to 1.56; 876 participants; 3 studies; low-certainty evidence), and on symptom resolution at day 14 (RR 1.03; 95% CI 0.95 to 1.12; 138 participants; 1 study; low-certainty evidence). We are uncertain whether azithromycin increases or reduces serious adverse events compared to placebo or standard of care alone (0 participants experienced serious adverse events; 454 participants; 2 studies; very low-certainty evidence). No study reported on adverse events, cardiac arrhythmias during the study period or quality of life up to 28 days. Azithromycin for the treatment of COVID-19 compared to any other antibiotics in inpatients and outpatients One study compared azithromycin to lincomycin in inpatients, but did not report any primary outcome. Another study compared azithromycin to clarithromycin in outpatients, but did not report any relevant outcome for this review. AUTHORS' CONCLUSIONS: We are certain that risk of death in hospitalised COVID-19 patients is not reduced by treatment with azithromycin after 28 days. Further, based on moderate-certainty evidence, patients in the inpatient setting with moderate and severe disease probably do not benefit from azithromycin used as potential antiviral and anti-inflammatory treatment for COVID-19 regarding clinical worsening or improvement. For the outpatient setting, there is currently low-certainty evidence that azithromycin may have no beneficial effect for COVID-19 individuals. There is no evidence from RCTs available for other antibiotics as antiviral and anti-inflammatory treatment of COVID-19. With accordance to the living approach of this review, we will continually update our search and include eligible trials to fill this evidence gap. However, in relation to the evidence for azithromycin and in the context of antimicrobial resistance, antibiotics should not be used for treatment of COVID-19 outside well-designed RCTs.

Trial registration and selective outcome reporting in 585 clinical trials investigating drugs for prevention of postoperative nausea and vomiting.

BACKGROUND: Selective outcome reporting in clinical trials introduces bias in the body of evidence distorting clinical decision making. Trial registration aims to prevent this bias and is suggested by the International Committee of Medical Journal Editors (ICMJE) since 2004. METHODS: The 585 randomized controlled trials (RCTs) published between 1965 and 2017 that were included in a recently published Cochrane review on antiemetic drugs for prevention of postoperative nausea and vomiting were selected. In a retrospective study, we assessed trial registration and selective outcome reporting by comparing study publications with their registered protocols according to the 'Cochrane Risk of bias' assessment tool 1.0. RESULTS: In the Cochrane review, the first study which referred to a registered trial protocol was published in 2004. Of all 585 trials included in the Cochrane review, 334 RCTs were published in 2004 or later, of which only 22% (75/334) were registered. Among the registered trials, 36% (27/75) were pro- and 64% (48/75) were retrospectively registered. 41% (11/27) of the prospectively registered trials were free of selective outcome reporting bias, 22% (6/27) were incompletely registered and assessed as unclear risk, and 37% (10/27) were assessed as high risk. Major outcome discrepancies between registered and published high risk trials were a change from the registered primary to a published secondary outcome (32%), a new primary outcome (26%), and different outcome assessment times (26%). Among trials with high risk of selective outcome reporting 80% favoured at least one statistically significant result. Registered trials were assessed more often as 'overall low risk of bias' compared to non-registered trials (64% vs 28%). CONCLUSIONS: In 2017, 13 years after the ICMJE declared prospective protocol registration a necessity for reliable clinical studies, the frequency and quality of trial registration in the field of PONV is very poor. Selective outcome reporting reduces trustworthiness in findings of clinical trials. Investigators and clinicians should be aware that only following a properly registered protocol and transparently reporting of predefined outcomes, regardless of the direction and significance of the result, will ultimately strengthen the body of evidence in the field of PONV research in the future.

Fostering Cultures of Sustainability in a Multi-Unit Office Building: A Theory of Change.

Psychological approaches to fostering sustainability are heavily focused on individual behaviors and often insufficiently address the physical and social contexts individuals are embedded in. This limits the ability to create meaningful, long-lasting change, as many of day-to-day behaviors are social practices embedded in broader cultural norms and systems. This is particularly true in the work context, where organizational cultures heavily condition both the actions of individual employees and the collective actions of organizations. Thus, we argue cultures, not behaviors, must become the focus of sustainability change efforts. In this paper, we present a theory of change aimed at fostering strong organizational cultures of sustainability (COS) within a high-performance multi-tenant office building. Our theory takes a systems perspective that incorporates the social and physical aspects of the work environment, and views culture change as a co-creative exercise involving engagement of multiple stakeholders. The paper concludes with implications for practice and research.

Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common adverse effect of anaesthesia and surgery. Up to 80% of patients may be affected. These outcomes are a major cause of patient dissatisfaction and may lead to prolonged hospital stay and higher costs of care along with more severe complications. Many antiemetic drugs are available for prophylaxis. They have various mechanisms of action and side effects, but there is still uncertainty about which drugs are most effective with the fewest side effects. OBJECTIVES: • To compare the efficacy and safety of different prophylactic pharmacologic interventions (antiemetic drugs) against no treatment, against placebo, or against each other (as monotherapy or combination prophylaxis) for prevention of postoperative nausea and vomiting in adults undergoing any type of surgery under general anaesthesia • To generate a clinically useful ranking of antiemetic drugs (monotherapy and combination prophylaxis) based on efficacy and safety • To identify the best dose or dose range of antiemetic drugs in terms of efficacy and safety SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and reference lists of relevant systematic reviews. The first search was performed in November 2017 and was updated in April 2020. In the update of the search, 39 eligible studies were found that were not included in the analysis (listed as awaiting classification). SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing effectiveness or side effects of single antiemetic drugs in any dose or combination against each other or against an inactive control in adults undergoing any type of surgery under general anaesthesia. All antiemetic drugs belonged to one of the following substance classes: 5-HT3 receptor antagonists, D2 receptor antagonists, NK1 receptor antagonists, corticosteroids, antihistamines, and anticholinergics. No language restrictions were applied. Abstract publications were excluded. DATA COLLECTION AND ANALYSIS: A review team of 11 authors independently assessed trials for inclusion and risk of bias and subsequently extracted data. We performed pair-wise meta-analyses for drugs of direct interest (amisulpride, aprepitant, casopitant, dexamethasone, dimenhydrinate, dolasetron, droperidol, fosaprepitant, granisetron, haloperidol, meclizine, methylprednisolone, metoclopramide, ondansetron, palonosetron, perphenazine, promethazine, ramosetron, rolapitant, scopolamine, and tropisetron) compared to placebo (inactive control). We performed network meta-analyses (NMAs) to estimate the relative effects and ranking (with placebo as reference) of all available single drugs and combinations. Primary outcomes were vomiting within 24 hours postoperatively, serious adverse events (SAEs), and any adverse event (AE). Secondary outcomes were drug class-specific side effects (e.g. headache), mortality, early and late vomiting, nausea, and complete response. We performed subgroup network meta-analysis with dose of drugs as a moderator variable using dose ranges based on previous consensus recommendations. We assessed certainty of evidence of NMA treatment effects for all primary outcomes and drug class-specific side effects according to GRADE (CINeMA, Confidence in Network Meta-Analysis). We restricted GRADE assessment to single drugs of direct interest compared to placebo. MAIN RESULTS: We included 585 studies (97,516 randomized participants). Most of these studies were small (median sample size of 100); they were published between 1965 and 2017 and were primarily conducted in Asia (51%), Europe (25%), and North America (16%). Mean age of the overall population was 42 years. Most participants were women (83%), had American Society of Anesthesiologists (ASA) physical status I and II (70%), received perioperative opioids (88%), and underwent gynaecologic (32%) or gastrointestinal surgery (19%) under general anaesthesia using volatile anaesthetics (88%). In this review, 44 single drugs and 51 drug combinations were compared. Most studies investigated only single drugs (72%) and included an inactive control arm (66%). The three most investigated single drugs in this review were ondansetron (246 studies), dexamethasone (120 studies), and droperidol (97 studies). Almost all studies (89%) reported at least one efficacy outcome relevant for this review. However, only 56% reported at least one relevant safety outcome. Altogether, 157 studies (27%) were assessed as having overall low risk of bias, 101 studies (17%) overall high risk of bias, and 327 studies (56%) overall unclear risk of bias. Vomiting within 24 hours postoperatively Relative effects from NMA for vomiting within 24 hours (282 RCTs, 50,812 participants, 28 single drugs, and 36 drug combinations) suggest that 29 out of 36 drug combinations and 10 out of 28 single drugs showed a clinically important benefit (defined as the upper end of the 95% confidence interval (CI) below a risk ratio (RR) of 0.8) compared to placebo. Combinations of drugs were generally more effective than single drugs in preventing vomiting. However, single NK1 receptor antagonists showed treatment effects similar to most of the drug combinations. High-certainty evidence suggests that the following single drugs reduce vomiting (ordered by decreasing efficacy): aprepitant (RR 0.26, 95% CI 0.18 to 0.38, high certainty, rank 3/28 of single drugs); ramosetron (RR 0.44, 95% CI 0.32 to 0.59, high certainty, rank 5/28); granisetron (RR 0.45, 95% CI 0.38 to 0.54, high certainty, rank 6/28); dexamethasone (RR 0.51, 95% CI 0.44 to 0.57, high certainty, rank 8/28); and ondansetron (RR 0.55, 95% CI 0.51 to 0.60, high certainty, rank 13/28). Moderate-certainty evidence suggests that the following single drugs probably reduce vomiting: fosaprepitant (RR 0.06, 95% CI 0.02 to 0.21, moderate certainty, rank 1/28) and droperidol (RR 0.61, 95% CI 0.54 to 0.69, moderate certainty, rank 20/28). Recommended and high doses of granisetron, dexamethasone, ondansetron, and droperidol showed clinically important benefit, but low doses showed no clinically important benefit. Aprepitant was used mainly at high doses, ramosetron at recommended doses, and fosaprepitant at doses of 150 mg (with no dose recommendation available). Frequency of SAEs Twenty-eight RCTs were included in the NMA for SAEs (10,766 participants, 13 single drugs, and eight drug combinations). The certainty of evidence for SAEs when using one of the best and most reliable anti-vomiting drugs (aprepitant, ramosetron, granisetron, dexamethasone, ondansetron, and droperidol compared to placebo) ranged from very low to low. Droperidol (RR 0.88, 95% CI 0.08 to 9.71, low certainty, rank 6/13) may reduce SAEs. We are uncertain about the effects of aprepitant (RR 1.39, 95% CI 0.26 to 7.36, very low certainty, rank 11/13), ramosetron (RR 0.89, 95% CI 0.05 to 15.74, very low certainty, rank 7/13), granisetron (RR 1.21, 95% CI 0.11 to 13.15, very low certainty, rank 10/13), dexamethasone (RR 1.16, 95% CI 0.28 to 4.85, very low certainty, rank 9/13), and ondansetron (RR 1.62, 95% CI 0.32 to 8.10, very low certainty, rank 12/13). No studies reporting SAEs were available for fosaprepitant. Frequency of any AE Sixty-one RCTs were included in the NMA for any AE (19,423 participants, 15 single drugs, and 11 drug combinations). The certainty of evidence for any AE when using one of the best and most reliable anti-vomiting drugs (aprepitant, ramosetron, granisetron, dexamethasone, ondansetron, and droperidol compared to placebo) ranged from very low to moderate. Granisetron (RR 0.92, 95% CI 0.80 to 1.05, moderate certainty, rank 7/15) probably has no or little effect on any AE. Dexamethasone (RR 0.77, 95% CI 0.55 to 1.08, low certainty, rank 2/15) and droperidol (RR 0.89, 95% CI 0.81 to 0.98, low certainty, rank 6/15) may reduce any AE. Ondansetron (RR 0.95, 95% CI 0.88 to 1.01, low certainty, rank 9/15) may have little or no effect on any AE. We are uncertain about the effects of aprepitant (RR 0.87, 95% CI 0.78 to 0.97, very low certainty, rank 3/15) and ramosetron (RR 1.00, 95% CI 0.65 to 1.54, very low certainty, rank 11/15) on any AE. No studies reporting any AE were available for fosaprepitant. Class-specific side effects For class-specific side effects (headache, constipation, wound infection, extrapyramidal symptoms, sedation, arrhythmia, and QT prolongation) of relevant substances, the certainty of evidence for the best and most reliable anti-vomiting drugs mostly ranged from very low to low. Exceptions were that ondansetron probably increases headache (RR 1.16, 95% CI 1.06 to 1.28, moderate certainty, rank 18/23) and probably reduces sedation (RR 0.87, 95% CI 0.79 to 0.96, moderate certainty, rank 5/24) compared to placebo. The latter effect is limited to recommended and high doses of ondansetron. Droperidol probably reduces headache (RR 0.76, 95% CI 0.67 to 0.86, moderate certainty, rank 5/23) compared to placebo. We have high-certainty evidence that dexamethasone (RR 1.00, 95% CI 0.91 to 1.09, high certainty, rank 16/24) has no effect on sedation compared to placebo. No studies assessed substance class-specific side effects for fosaprepitant. Direction and magnitude of network effect estimates together with level of evidence certainty are graphically summarized for all pre-defined GRADE-relevant outcomes and all drugs of direct interest compared to placebo in http://doi.org/10.5281/zenodo.4066353. AUTHORS' CONCLUSIONS: We found high-certainty evidence that five single drugs (aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron) reduce vomiting, and moderate-certainty evidence that two other single drugs (fosaprepitant and droperidol) probably reducevomiting, compared to placebo. Four of the six substance classes (5-HT3 receptor antagonists, D2 receptor antagonists, NK1 receptor antagonists, and corticosteroids) were thus represented by at least one drug with important benefit for prevention of vomiting. Combinations of drugs were generally more effective than the corresponding single drugs in preventing vomiting. NK1 receptor antagonists were the most effective drug class and had comparable efficacy to most of the drug combinations. 5-HT3 receptor antagonists were the best studied substance class. For most of the single drugs of direct interest, we found only very low to low certainty evidence for safety outcomes such as occurrence of SAEs, any AE, and substance class-specific side effects. Recommended and high doses of granisetron, dexamethasone, ondansetron, and droperidol were more effective than low doses for prevention of vomiting. Dose dependency of side effects was rarely found due to the limited number of studies, except for the less sedating effect of recommended and high doses of ondansetron. The results of the review are transferable mainly to patients at higher risk of nausea and vomiting (i.e. healthy women undergoing inhalational anaesthesia and receiving perioperative opioids). Overall study quality was limited, but certainty assessments of effect estimates consider this limitation. No further efficacy studies are needed as there is evidence of moderate to high certainty for seven single drugs with relevant benefit for prevention of vomiting. However, additional studies are needed to investigate potential side effects of these drugs and to examine higher-risk patient populations (e.g. individuals with diabetes and heart disease).

Reducing the risks of extreme heat for seniors: communicating risks and building resilience. / Réduire les risques de chaleur extrême pour les personnes âgées : communiquer les risques et renforcer la résilience.

INTRODUCTION: As the global climate changes, heat waves are having a disproportionate impact on seniors and other socially vulnerable groups. In order to mitigate the threats of extreme heat, it is critical to develop and promote resources for coping during these events. A better understanding of the role of risk perceptions and the factors that influence them is needed in order to improve public responses to threatening events, particularly among seniors. METHODS: This mixed-methods study examined risk perceptions and coping practices in seniors using qualitative interviews (n = 15) and a survey (n = 244) of seniors across Waterloo Region, Ontario. RESULTS: Seniors showed relatively accurate risk tracking as indicated by the link between measures of actual risk and perception of personal risk. While vulnerability to heat is often believed to be associated with inaccurate perceptions of risk, within our sample, vulnerability appears more strongly related to social location and access to resources. Participants described social connections as important resources for resilience, but the stigma surrounding vulnerability, and other social norms, as barriers to seeking support. CONCLUSION: The positive relationship between participants' risk perceptions and actual risk for negative consequences of extreme heat was an important finding, given that problems of emergency preparedness and risk reduction are often framed as issues of awareness of risk, rather than social location and inequality. Along with increased public resources for coping with extreme heat, communicating about resources, fostering social connections and reducing stigma may be important leverage points for increasing the resiliency of seniors to heat waves.

Early palliative care for those who care: A qualitative exploration of cancer caregivers' information needs during hospital stays.

BACKGROUND: The supporting role of caregivers is crucial to cancer patients' care and well-being. Periods of inpatient hospital treatment are common in the cancer trajectory. There is insufficient systematic knowledge of caregivers' experiences and information needs in hospital context. AIM: Aim of this study is to identify information needs and factors contributing to unmet information needs of caregivers in hospital. DESIGN: A qualitative approach was used to identify major themes and specific types of information needs. Interviews with caregivers were conducted and analysed using a qualitative three-step process. SETTING/PARTICIPANTS: The study was conducted in a hospital oncology department. Seventeen caregivers of patients with advanced cancer were interviewed. RESULTS: Caregivers' needs during inpatient treatment vary and are largely unmet. Four major themes emerged from the analysis, revealing information needs of caregivers related to the cancer disease, patient, caregivers themselves and hospital context. The most mentioned issues were appropriate treatment, treatment outcomes and the related consequences for caregivers' life, hospital processes and transition back home. CONCLUSION: Caregivers have a variety of specific information needs which often remain unmet. Based on our findings, we provide recommendations for integrating caregivers into oncology care, which should be implemented in clinical practice, policy decisions and research.

Beyond Exposure to Outdoor Nature: Exploration of the Benefits of a Green Building's Indoor Environment on Wellbeing.

Most research exploring the psychological benefits of the natural environment has focused on direct exposure to the outdoors. However, people spend most of their time indoors, particularly in office buildings. Poor employee mental health has become one the most prevalent and costly occupational health issues. The integration of high quality environmental features (e.g., access to sunlight) in green-certified office buildings offers a superior work environment. These nature-based experiences are anticipated to provide beneficial outcomes to wellbeing. This study is the first to empirically investigate these benefits. Participants in a green (LEED gold certified) office building (N = 213) in Canada completed an assessment of environmental features, measures of hedonic, eudaimonic and negative wellbeing (NWB) and assessments of psycho-environmental potential, environmental behaviors and social belonging. Linear regression analyses confirmed the benefits of indoor environmental features for all aspects of wellbeing. Multiple regression analyses were conducted to assess the effect of specific indoor environmental features on wellbeing. We explored physical features (e.g., air quality, light), and social features (e.g., privacy), as well as windows to the outside. Results suggest that physical features are important in promoting hedonic wellbeing, while social features prevent NWB. Both features equally predicted eudaimonic wellbeing (EWB). A view to the outside was positively correlated to wellbeing, although it did not uniquely predict it after accounting for other environmental features. Path analyses revealed the importance of person-environment fit, pro-environmental behavior and social belonging in mediating the association of indoor environmental features with hedonic and EWB. The results suggests that, by fostering person-environment fit, pro-environmental behaviors and feeling of community in a high quality setting, green buildings may lead to benefits on an array of wellbeing dimensions. The theoretical and practical implications of these findings are discussed.

Early integration of palliative cancer care: patients' and caregivers' challenges, treatment preferences, and knowledge of illness and treatment throughout the cancer trajectory.

PURPOSE: Early integration of palliative care (EIPC) into oncology is beneficial for cancer patients and their caregivers. Best practice models of EIPC throughout the course of cancer treatment aim to support patients and caregivers in meeting their individual needs. So far, we know little about whether EIPC offers should be phase-specific or patient-centered. This study investigated patients' and caregivers' needs considering individual challenges, treatment preferences, and knowledge over the cancer trajectory. METHODS: Semi-structured qualitative interviews and pre-interview questionnaires were conducted with 11 cancer patients and 9 caregivers. A modified grounded theory approach was used to analyze the interview data applying thematic analysis and reflective principles by using MAXQDA. RESULTS: Our data showed no clearly distinct pattern of illness-phase-specific needs of patients and caregivers. Support needs were dependent on the significance and interpretation of events by patients and caregivers. Mastering challenges was highly individual and influenced by personal and contextual factors. Our results showed that subjective theories of illness significantly influenced experience, information requirements, treatment preferences, and the feeling of patients and caregivers "to be in good hands." The physician-patient relationship was of central relevance and has a major gatekeeper function for EIPC. Access to the medical care system, resources, and information appeared to be based on chance. CONCLUSIONS: For optimal EIPC, it is necessary to improve structural conditions such as more structured information about resources and procedures. Subjective theories of illness need to be continuously considered by practitioners in order to recognize the individual need for support.

Cost-effectiveness analysis of single-session walk-in counselling.

BACKGROUND: An increasing number of family service agencies and community-based mental health service providers are implementing a single-session walk-in counselling (SSWIC) as an alternative to traditional counselling. However, few economic evaluations have been undertaken. AIMS: To conduct a cost-effectiveness analysis of two models of service delivery, SSWIC compared to being waitlisted for traditional counselling. METHODS: A quasi-experimental design was employed. Data were collected from two community-based Family Service Agencies, one using SSWIC and one using traditional counselling. Participants were assessed at baseline and four weeks after the baseline. Cost-effectiveness was estimated from the societal and payer's perspective. RESULTS: The societal and payer's costs for SSWIC were higher than for those waiting for traditional counselling, and health outcomes were better. SSWIC is not cost-effective compared to being on the waitlist for traditional counselling (or, for a few patients, having received counselling, but after a wait of several weeks). CONCLUSIONS: SSWIC has the potential to reduce the pressure on the mental health care system by reducing emergency visits and wait lists for ongoing mental health services and eliminating costly-no shows at counselling appointments. Long-term studies involving multiple walk-in counselling services and comparison services are needed to support the findings of this study.

A comparison of walk-in counselling and the wait list model for delivering counselling services.

BACKGROUND: Walk-in counselling has been used to reduce wait times but there are few controlled studies to compare outcomes between walk-in and the traditional model of service delivery. AIMS: To compare change in psychological distress by clients receiving services from two models of service delivery, a walk-in counselling model and a traditional counselling model involving a wait list. METHOD: Mixed-methods sequential explanatory design including quantitative comparison of groups with one pre-test and two follow-ups, and qualitative analysis of interviews with a sub-sample. Five-hundred and twenty-four participants ≥16 years were recruited from two Family Counselling Agencies; the General Health Questionnaire-12 assessed change in psychological distress. RESULTS: Hierarchical linear modelling revealed clients of the walk-in model improved faster and were less distressed at the four-week follow-up compared to the traditional service delivery model. Ten weeks later, both groups had improved and were similar. Participants receiving instrumental services prior to baseline improved more slowly. The qualitative data confirmed participants highly valued the accessibility of the walk-in model, and were frustrated by the lengthy waits associated with the traditional model. CONCLUSIONS: This study improves methodologically on previous studies of walk-in counselling, an approach to service delivery not conducive to randomized controlled trials.

The Peabody Treatment Progress Battery: history and methods for developing a comprehensive measurement battery for youth mental health.

There is increased need for comprehensive, flexible, and evidence-based approaches to measuring the process and outcomes of youth mental health treatment. This paper introduces a special issue dedicated to the Peabody Treatment Progress Battery (PTPB), a battery of measures created to meet this need. The PTPB is an integrated set of brief, reliable, and valid instruments that can be administered efficiently at low cost and can provide systematic feedback for use in treatment planning. It includes eleven measures completed by youth, caregivers, and/or clinicians that assess clinically-relevant constructs such as symptom severity, therapeutic alliance, life satisfaction, motivation for treatment, hope, treatment expectations, caregiver strain, and service satisfaction. This introductory article describes the rationale for the PTPB and its development and evaluation, detailing the specific analytic approaches utilized by the different papers in the special issue and a description of the study and samples from which the participants were taken.

The symptoms and functioning severity scale (SFSS): psychometric evaluation and discrepancies among youth, caregiver, and clinician ratings over time.

This paper describes the development and psychometric evaluation of the symptoms and functioning severity scale (SFSS), which includes three parallel forms to systematically capture clinician, youth, and caregiver perspectives of youth symptoms on a frequent basis. While there is widespread consensus that different raters of youth psychopathology vary significantly in their assessment, this is the first paper that specifically investigated the discrepancies among clinician, youth, and caregiver ratings throughout the treatment process within a community mental health setting. Results for all three respondent versions indicated the SFSS is a psychometrically sound instrument for use in this population. Significant discrepancies in scores existed at baseline among the three respondents. Longitudinal analyses reveal the youth-clinician and caregiver-clinician score discrepancies decreased significantly over time. Differences by youth gender existed for caregiver-clinician discrepancies. The average youth-caregiver score discrepancy remained consistent throughout treatment. Implications for future research and clinical practice are discussed.

Motivation for youth's treatment scale (MYTS): a new tool for measuring motivation among youths and their caregivers.

Treatment motivation can be important for treatment adherence and outcomes, yet few measures of motivation are available for youths in mental health settings. These authors describe the psychometric properties of the motivation for youth's treatment scale (MYTS), an 8-item measure with forms for youths and caregivers that assesses their problem recognition and treatment readiness. Results indicate that the MYTS offers practitioners and researchers a brief, psychometrically sound tool for assessing treatment motivation of youths and their caregivers. Multivariate analyses of clinical and non-clinical characteristics of youths and caregivers show that youths' symptom severity consistently predicts treatment motivation for both groups. However, the strain of caring for the youth adds significantly to caregivers' recognition of the youth's troubles. While caregiver and youth motivations correlate, their agreement is low. Caregivers are nearly always more treatment motivated than youths. The authors discuss the implications of their findings for measurement, treatment planning, and future research.

Measuring youths' perceptions of counseling impact: description, psychometric evaluation, and longitudinal examination of the Youth Counseling Impact Scale v.2.

The Youth Counseling Impact Scale (YCIS) is an empirically validated treatment progress measure that assesses youths' perceptions of the short term effectiveness of therapy. Since its initial publication, the original 10-item measure has been shortened to ease measurement burden and revised to include a question about a youth's insight into his or her strengths. The current study describes the development of the revised YCIS (v.2) and evaluates its psychometric properties. Additionally, this study examines whether the YCIS (v.2) total score or subscale scores change over time and investigates whether there are gender or age differences for youths' perceptions of the impact of therapy. Results found the revised version obtained comparable information to that of the original measure, and that the revised version retained the factor structure of the original model with one primary general factor of Counseling Impact and two secondary factors (Insight and Change). Results also suggested that while the YCIS (v.2) total score and Change subscale score did not change linearly over the course of treatment, the Insight subscale score showed a small but significant linear increase over time. No significant differences in YCIS scores based on youth age or gender were found. The implication of these findings, the clinical and empirical utility of this measure, and its limitations are discussed.

Developing effective research-practice partnerships for creating a culture of evidence-based decision making.

With growing evidence that treatment as usual may have limited effectiveness in mental health the pressure on service providers to be accountable and produce evidence as to the effectiveness of their services has increased. Measurement Feedback Systems, such as the Contextualized Feedback System (CFS), have the potential to be powerful tools for service providers in assessing their own effectiveness at multiple levels with an organization. These systems represent an amalgamation of the data driven world of science and the experience driven world of clinical practice. However, the synthesis of these two worlds is not without significant challenges as these two very different cultures can easily clash. The key for successful collaboration in developing and implementing Measurement Feedback Systems is a good university-practice partnership that has a strong foundation in common goals and the positive relationships among its members. In addition, the partnership needs to be flexible so that it can adapt to new challenges and continuously grow with each obstacle. These are some of several lessons learned the authors of this article will share as part of their experience with developing and implementing CFS in one of the largest behavioral health service providers in the U.S.

Effects of routine feedback to clinicians on mental health outcomes of youths: results of a randomized trial.

OBJECTIVE: A randomized cluster controlled trial tested the hypothesis that weekly feedback to clinicians would improve the effectiveness of home-based mental health treatment received by youths in community settings. METHODS: Youths, caregivers, and clinicians at 28 sites in ten states completed assessments of the youths' symptoms and functioning every other week. Clinicians at 13 sites were provided with weekly feedback about the assessments, and clinicians at 15 sites received feedback every 90 days. Data were collected from June 1, 2006, through December 31, 2008. Intent-to-treat analyses were conducted with hierarchical linear modeling of data provided by youths, caregivers, and clinicians. RESULTS: Assessments by youths, caregivers, and clinicians indicated that youths (N=173) treated at sites where clinicians could receive weekly feedback improved faster than youths (N=167) treated at sites where clinicians did not receive weekly feedback. A dose-response analysis showed even stronger effects when clinicians viewed more feedback reports. CONCLUSIONS: Routine measurement and feedback can be used to improve outcomes for youths who receive typical home-based services in the community.

Community psychology and global climate change: introduction to the special section.

Global climate change is not just a distant environmental or future problem but a crisis that has a clear human face already causing the suffering of millions around the globe. It is an issue of high relevance for community psychologists and the communities we work with but has received little attention within the field of community psychology. This special section is intended to promote more thinking and dialogue on this important topic. Six articles are presented that feature both theoretical consideration and empirical research related to global climate change and related environmental issues.