Perceptions, expectations, and recommendations of trans adults on gender-affirming care in France: a qualitative study.

Trans people have diverse life experiences which may include gender-affirming care (GAC). GAC positively impacts the quality of life of trans adults. However, they are often met with barriers to care and are particularly vulnerable within the healthcare system. The needs and expectations surrounding GAC may vary between individual patients. This article aims to analyze trans adults' perceptions, expectations, and recommendations on GAC. Twenty-seven semi-structured interviews were conducted by a team of academic and peer researchers; transcribed interviews were then analyzed using a codebook and thematic analysis. Three main themes were identified; the liberating experience of GAC; the uneven distribution of knowledge and power between patients and providers; and the recommended practices in GAC. Additional training and research are necessary to facilitate high-quality care for trans adults accessing GAC.

The role expectations of young women as wives after breast cancer treatment: A qualitative study.

Objectives: Through the reflection of young breast cancer women on their selves and identities, we explored expectations of the wife role that they need to fulfill to return to their families, aimed to provide a reference basis for medical professionals to develop interventions related to cancer family rehabilitation. Methods: Descriptive phenomenological methods and purposive sampling were used. Young breast cancer patients and their spouses were selected for semi-structured face-to-face interviews in the study from March to April 2023 at the department of breast surgery and oncology center of a Class A tertiary hospital in Xuzhou City, China. The interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological approach. Results: Twenty patients and six spouses were interviewed. The mean patient age was (35.95 ± 3.36) years, and the mean spouse was (37.67 ± 5.28) years. Young breast cancer patients were concerned about three main wife expectations during their treatment and rehabilitation: preserving self-love and self-esteem (paying attention to physical health, embracing the disease, and regaining confidence in female characters); adjustment of conjugal relationships (harmonious and effective couple communication, providing support for marriage and love, and creating a beautiful married life together); assisting in family recovery (relieving stress on spouses from caregiving and finances, and management of daily household chores). Conclusions: The wife role expectations of young breast cancer women and their spouses encompass three core aspects: self, couple, and family. Self-esteem and self-love are the most fundamental expectations of the wife role, while adjusting the couple's relationship and assistance in family rehabilitation represent higher expectations. This study can help healthcare professionals and cancer families gain a more comprehensive understanding of the wife role expectations for young cancer women, thereby enabling the development of couple-centered interventions to promote patient recovery and enhance the resilience of marriages and families.

A single-item Expectancy Measure's Validity, Reliability, and Responsiveness to Detect Changes in Clinical Efficacy Studies of Integrative Cancer Therapies: A Methodology Study.

BACKGROUND: Expectations may modify outcomes. However, studies often fail to measure expectations. This raises the need for a brief valid and reliable expectancy measure. OBJECTIVES: To study treatment expectations in individuals entering acupuncture or rest, validity and test re-test reliability of a single-item expectancy measure graded on a category scale, a Numeric Rating Scale (NRS) and a Visual Analog Scale (VAS), and to identify psychometric differences between the scales. METHOD: In this methodology study, treatment expectations were measured in 363 participants before they received acupuncture (genuine traditional penetrating or non-penetrating telescopic sham acupuncture, n = 239, 98%, responded) or a control treatment involving just rest (n = 120, 100%, responded), aimed to improve level of relaxation. A treatment expectancy measure, graded on a five-grade category scale, an eight-grade NRS and a 100 mm VAS, was tested for test re-test reliability. Level of expectation and relaxation was measured at baseline, pre- and post-therapy (n = 729 expectancy measurements). RESULTS: The participants scheduled for acupuncture or rest believed moderately (Inter Quartile Range, IQR, moderately-much) and much (IQR moderately-much) the treatment to be effective. The Intra-Class Correlation coefficient versus Kappa coefficient between test and re-test was .868/.868 for the category scale, .820/.820 for the NRS, and .856/.854 for the VAS. The middle step "Believe moderately the treatment to be effective" was equivalent with median 4 (IQR, 3-4) on NRS and median 52 mm (IQR 42-52) on VAS. The response rates were 708 (97%) on the category scale, 707 (97%) on the NRS, and 703 (96%) on the VAS. All three scales discriminated that pre-therapy expectations were more positive in the individuals who reported an improvement in relaxation level (P < .001-.003). The VAS presented higher responsiveness to detect expectancy changes over time (71% increased expectation), compared to the NRS (52% increased) and the category scale (12% increased), P < .001. CONCLUSIONS: Individuals entering acupuncture, or a control intervention, presented positive treatment expectations, and the expectancy measure presented satisfactory reliability, validity, high response rates, sensitiveness, and responsiveness. Integrative cancer therapy researchers who want to control for expectancy-related bias in clinical trials should consider measuring expectation using the single-item expectancy measure.

Longitudinal effects of peer victimization on adolescents' future educational and work expectations: Depressive symptoms as a mechanism.

Leveraging six waves of data, this study examined the effects of ninth-grade peer victimization on adolescents' future work and education expectations 2 years later, testing depressive symptoms as a mechanism. Participants (N = 388, Mage = 14.05; 61% female, 35% male, 3% non-binary, trans, or other gender; 46% White, 19% Black, 17% Asian, 6% AMENA, 6% Multiracial, 6% other race) completed surveys from ninth through 11th grade. Results indicated that adolescents who experienced more frequent relational, but not overt, peer victimization in ninth grade were subsequently more pessimistic about their educational and occupational prospects beyond high school; depressive symptoms mediated this link. The findings suggest that relational victimization and its psychological harm may undermine adolescents' confidence in achieving postsecondary success.

rTMS as a Next Step in Antidepressant Nonresponders: A Randomized Comparison With Current Antidepressant Treatment Approaches.

OBJECTIVE: Although repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, little is known about the comparative effectiveness of rTMS and other treatment options, such as antidepressants. In this multicenter randomized controlled trial, rTMS was compared with the next pharmacological treatment step in patients with treatment-resistant depression. METHODS: Patients with unipolar nonpsychotic depression (N=89) with an inadequate response to at least two treatment trials were randomized to treatment with rTMS or to a switch of antidepressants, both in combination with psychotherapy. Treatment duration was 8 weeks and consisted of either 25 high-frequency rTMS sessions to the left dorsolateral prefrontal cortex or a switch of antidepressant medication following the Dutch treatment algorithm. The primary outcome was change in depression severity based on the Hamilton Depression Rating Scale (HAM-D). Secondary outcomes were response and remission rates as well as change in symptom dimensions (anhedonia, anxiety, sleep, rumination, and cognitive reactivity). Finally, expectations regarding treatment were assessed. RESULTS: rTMS resulted in a significantly larger reduction in depressive symptoms than medication, which was also reflected in higher response (37.5% vs. 14.6%) and remission (27.1% vs. 4.9%) rates. A larger decrease in symptoms of anxiety and anhedonia was observed after rTMS compared with a switch in antidepressants, and no difference from the medication group was seen for symptom reductions in rumination, cognitive reactivity, and sleep disorders. Expectations regarding treatment correlated with changes in HAM-D scores. CONCLUSIONS: In a sample of patients with moderately treatment-resistant depression, rTMS was more effective in reducing depressive symptoms than a switch of antidepressant medication. In addition, the findings suggest that the choice of treatment may be guided by specific symptom dimensions.

Leveraging Doctor of Nursing Practice Scholarship to Meet Organizational Leaders' Expectations.

Background: The Doctor of Nursing Practice (DNP) degree prepares nurses for engagement in practice scholarship to improve health outcomes at multiple system levels. Organizational leaders' and employers' perceptions and expectations of DNP-prepared nurses require further study. Objective: To explore the perception of organizational leaders regarding expectations and engagement of DNP-prepared nurses in practice scholarship activities. Methods: Guided by the Actualized DNP Model, a cross-sectional design was used to survey organizational leaders (N = 87) regarding DNP-prepared nurses' engagement in practice scholarship. Results: Findings indicate that 92% (n = 80) of participants believed practice scholarship should be an expectation of DNP-prepared nurses serving in a variety of roles. Of the 77 respondents to the scholarship engagement questions, 97.4% (n = 75) reported that DNP-prepared nurses engaged in one or more practice scholarship activities over the past year. Conclusions: Aligning DNP practice scholarship competencies, as outlined in the American Association of Colleges of Nursing 2021 Essentials, with organizational needs, expectations, and provision of sufficient time to support these scholarship activities is needed. Implications for Nursing: Opportunities exist for DNP-prepared nurses to articulate and demonstrate their value by conducting practice scholarship through innovative advanced nursing roles to realize organizational goals. Organizational support is necessary for practice scholarship activities to transform DNP education.

Predictors of academic engagement of high school students: academic socialization and motivational beliefs.

The potential of academic engagement to enhance academic outcomes and well-being has been empirically supported, yet studies addressing its predictors are too limited. Hence, the current study collected self-report cross-sectional data from randomly selected 614 (male = 323) high school students in Ethiopia and examined the relations of academic socialization (parental and peer), self-efficacy, and outcome expectations in explaining variance in academic engagement, guided by an integrative model of engagement. Structural equation modeling with the maximum likelihood method indicated that (a) the hypothesized model fit the data well, (b) direct paths from parental and peer academic socialization to self-efficacy, outcome expectations, and academic engagement were positive and significant, (c) the relationships of the constructs in the model explained a significant portion of the variance in academic engagement, and (d) self-efficacy and outcome expectations significantly and positively but partially mediated the pathway from academic socialization to academic engagement. The findings' implications for boosting student academic engagement were forwarded.

[Return to activity and return to sports after total knee replacement]. / "Return-to-activity" und "return-to-sport" nach endoprothetischer Versorgung des Kniegelenks.

BACKGROUND: Total knee arthroplasty (TKA) is one of the most common and successful operations in the field of orthopaedics, with a steadily increasing number of patients. However, as the patient population becomes younger, expectations regarding the outcome of the surgery are also changing. In addition to pain reduction and improved mobility, the longevity of the implant and the recovery of (everyday) activity in general (return-to-activity, RtA) and sporting activity in particular (return-to-sports, RtS) are becoming increasingly important. STATE OF THE STUDY: RtS with a tendency towards low-impact sports seems generally possible but is highly dependent on the individual characteristics of the patient. Despite comprehensive studies on treatment with TKA, there are no systematic studies and reliable conclusions on the key factors that enable patients to return to sports after TKA. Any recommendation by the responsible surgeons remains dependent on their subjective experience due to the lack of standardized implementation of an RtA/RtS assessment and the necessary long-term follow-up observation under control of patient-related confounding factors.

The effect of dysmenorrhea severity and interference on reactions to experimentally-induced pain.

Introduction: Dysmenorrhea is associated with increased risk of chronic pain and hyperalgesia. Menstruating individuals with dysmenorrhea are more likely to have elevated pain reactivity when experiencing experimental pain, than those without. However, no study has examined intragroup differences in reactions to experimentally induced pain for individuals with dysmenorrhea. The main aim of this study was to examine the relative roles of dysmenorrhea severity and interference in the experience of experimentally-induced pain. Methods: Participants were 120 menstruating individuals involved in a larger research study examining the influence of expectations on experimentally-induced pain. As part of the study, participants completed an online questionnaire regarding demographic and menstrual information and participated in a cold pressor task. Participants were randomized into four groups based on the manipulation of two independent variables: (1) high vs. low expectations about pain severity (pain-expectations); (2) and high vs. low expectations about one's pain tolerance (self-expectations). Participants verbally rated their pain severity throughout the cold pressor task using a 0-10 scale. Regression analyses were conducted examining the relationships between dysmenorrhea experience (i.e., average severity and interference) and cold pressor data [pain severity ratings and pain tolerance (i.e., total time in the cold pressor)], controlling for the manipulated expectations and age. Then, moderation analyses were conducted examining expectation group differences. Results: When controlling for manipulated expectations and age, dysmenorrhea severity significantly predicted initial pain severity rating (p = 0.022) but did not predict final pain severity rating (p = 0.263) or pain tolerance (p = 0.120). Dysmenorrhea interference did not predict initial pain severity rating (p = 0.106), final pain severity rating (p = 0.134), or pain tolerance (p = 0.360). A moderation analysis indicated that the relationship between dysmenorrhea severity and initial pain severity rating was not moderated by pain-expectations, χ 2(1) = 0.412, p = 0.521. Discussion: During an experimentally-induced pain task, dysmenorrhea severity but not interference predicted initial pain severity rating, such that higher levels of dysmenorrhea severity predicted greater initial pain severity rating. This suggests individuals with more severe dysmenorrhea pain may experience greater initial sensitivity to pain and be at risk for increased sensitivity to acute pain and potentially the development of chronic pain.

Turkish cross-cultural adaptation, construct validity, and reliability of the treatment expectations in chronic pain scale.

BACKGROUND: Measuring treatment expectations using the Treatment Expectations in Chronic Pain (TEC) scale has the potential to help clinicians and researchers better understand the role that treatment expectations play within the framework of multimodal pain management settings. OBJECTIVE: The purpose of this study is to determine the cross-cultural adaptation, construct validity and reliability of the TEC Scale in the Turkish language. METHODS: The study included 191 volunteers aged 22-65 with chronic musculoskeletal diseases. This study composed of a six-stage cross-cultural adaptation process, which included translation, translation synthesis, back-translation, expert committee review, pre-testing and documentation submission. The Positivity Scale and Illness Cognition Questionnaire were used to measure convergent validity while the Hospital Anxiety and Depression Scale was used to test divergent validity. The psychometric properties of the Turkish version of the TEC scale was examined by confirmatory factor analysis (CFA). Scale's internal consistency was examined using Cronbach's alpha. Pearson correlation coefficients were utilized to evaluate both convergent and divergent validity. The significance level was set at p < .05. RESULTS: The results of the CFA showed that factor structure of predicted subscale fitted well the data (x2/df = 3,07;CFI = 0,91,IFI = 0,91 TLI = 0,87,RMSEA = 0,10). The results of the CFA indicated that factor structure of ideal subscale fitted well with the data (x2/df = 2,38;CFI = 0,92,IFI = 0,93,TLI = 0,90,RMSEA = 0,08). Both subscales of the TEC were strongly correlated. The predicted subscale had moderate relationships to depression, anxiety, and positivity (r = -0.37 to r = 0.55) but poor correlations with measures of acceptance, perceived benefits and helplessness (r = -0.24 to 0.35). The ideal subscale had moderate correlations with measures of positivity (r = 0.36) and depression (r = -0.38) but poor correlations with measures of acceptance, perceived benefits helplessness and anxiety (r = 0.14). CONCLUSIONS: The Turkish version of the TEC scale is acceptable, valid, and reliable for use in Turkish patients with chronic musculoskeletal pain in physiotherapy outpatient practice.

The Cultural Evolution and Social Pressures of Liposuction Among Iraqi Women: Navigating Modern Beauty Standards Amidst Conservative Traditions.

This editorial explores the impact of societal transformation on Iraqi women's lives, particularly concerning beauty standards and cosmetic procedures like liposuction. It examines the influences of modernization, social media, and social pressures juxtaposed with traditional conservative values. The transition from repressive regimes to more open, albeit unstable, political landscapes has led to significant shifts in women's roles, with increased conservatism contrasting with emerging modernist influences. The role of social media in amplifying modern beauty ideals creates internal conflicts for women striving to balance these with traditional expectations. The growing acceptance of cosmetic procedures indicates a shift toward integrating modern beauty standards within Iraqi society.

Health promotion expectations and perceptions of sport club participants.

To develop health promotion (HP) in sports clubs (SCs), stakeholders need to know the HP expectations of sports participants. However, the literature does not provide information on these aspects, which exacerbates the difficulty for SCs to provide an environment, activities and organization that promote health and to play the role entrusted to them in the integration of vulnerable populations. To fill this gap, this study explores the HP expectations and perceptions of sports participants, with a particular focus on ethnocultural characteristics, and documents participants' understanding of HP. A descriptive qualitative study comprising semi-structured interviews was carried out with 22 French and Quebec sports participants. Because they have little experience with HP in their SC, participants do not seem to have many expectations of their SC in terms of HP. Nevertheless, they felt that SCs can play an important role in health and suggested several themes and types of action, such as seminars on nutrition, activities outside the SC to develop cohesion or health monitoring. Sports participants from ethnocultural minorities seem to appreciate the programs designed to integrate them. There is a predominantly physical conception of health and the contribution of SCs to health, and the relationship between the types of health determinants (economic, environmental, organizational and social) and health is not clear. This study shows that the idea of a health-promoting SC appeals to SC participants, but this approach has not yet taken root in this setting or in society as a whole.

Mitigating the Impact of Religiously Based Family Expectations on Depression Among Sexual and Gender Minorities: The Role of Authenticity.

Although it is clear that religious beliefs can motivate family rejection among sexual and gender minorities (SGMs), ultimately harming their mental health, researchers have not examined the direct link between religiously based family expectations and mental health. In the present study, we first developed the Religiously Based Family Expectations Scale. The scale demonstrated good reliability and factor structure. It evidenced convergent and divergent validity with other measures of religiousness and sexual identity, as well as incremental validity in predicting mental health outcomes above and beyond these measures. Next, we examined how religiously based family expectations related to depression in a sample of 534 SGMs with a conservative religious background (raised as part of the Church of Jesus Christ of Latter-day Saints). We found that religiously based family expectations were positively related to depression but that this relationship was moderated by authenticity such that religiously based family expectations exerted a much stronger relationship with depression among SGMs who evidenced less authenticity.

The employment expectations of adolescents: Examining the role of social origin, parental support, and personality traits.

Early life course conditions and the social origin of families frequently influence the inequalities people experience in adulthood. The transition from education to work is a challenging period during which adolescents make their first employment-related choices and establish the course of their careers. Future expectations guide adolescents' employment-related choices and are assumed to influence future employment outcomes. Therefore, this paper investigates whether family (dis)advantages affect adolescents' employment expectations. We assess various underlying mechanisms that may influence the relationship between social origin and adolescents' employment expectations by using cross-sectional data from the German Socio-Economic Panel (SOEP: 2006-2018), specifically a youth questionnaire administered at age 17. Three key findings emerge. First, family disadvantages, particularly an insecure parental labor market participation, influence the employment expectations of adolescents negatively. Second, supportive parenting does not mediate the relationship between social origin and the employment expectations of adolescents; instead, it functions as an additional positive factor. Third, supportive parenting creates more optimistic employment expectations because it fosters specific "beneficial" personality traits, such as extraversion, conscientiousness, openness, agreeableness, and internal control beliefs.

Are we informing our patients correctly? Evaluation of perioperative counselling for paediatric intestinal stoma formation: a national study.

PURPOSE: Adequate preoperative information is known to improve patient outcomes. We aimed to evaluate perioperative education for paediatric patients and families undergoing intestinal stoma formation. METHODS: UK paediatric surgery centres were invited to recruit patients aged 6-16 years with a stoma in situ or reversed within the last 2 years. Patient and parent questionnaires were posted for potential participants. RESULTS: Eighty-three patient/parent dyads returned questionnaires. Median age was 11.5 years (range 4.1-17.8), with 48% (n = 40) formed electively. Parents rated how well-informed they felt perioperatively out of 10 (0 poorly, 10 highly informed). Parents were better informed about surgical issues and stoma care than psychological and social impacts (7.45 vs 6.11; p < 0.0001). 54% reported surgical complications but significantly fewer patients listed these amongst the worst things about having a stoma (24.4%) when compared with psychosocial issues: distress from bag leaks (90.8%; p < 0.0001), self-consciousness (54.1%; p = 0.0001), and restricted activity (40.2%; p = 0.03). CONCLUSION: Parents felt well-informed for medical and practical aspects but less well-informed of psychological and lifestyle impacts of having a stoma. Surgical complications were less important to patients than the impact on daily life. Increased psychosocial information would enable families to be better prepared for life with a stoma.

Inpatient's, therapist's and staff's expectations regarding treatment and their effects on placebo response in the psychiatric ward - results from an add-on oxytocin RCT.

OBJECTIVES: Patient's and therapist's expectations are considered an important factor influencing placebo response in experimental and therapeutic settings. Nevertheless, the placebo effects of common neurological facilitators that promote treatment efficacy have not been explored. In the present study we examined the estimations of patients, therapists, and staff members, regarding their treatment type and assessed their influence on the facilitating effects of oxytocin. METHODS: Patients (N = 87) were randomized and double-blindly allocated to receive either oxytocin or placebo, twice daily for a period of four weeks, as part of a larger randomized, double-blind, placebo-controlled trial. Patient's, therapist's and staff's expectations were assessed based on their estimation of treatment type (agent or placebo). Multilevel modeling and univariate and multivariate regression analysis were performed to assess the effects of patient's, therapist's, and staff's estimations on treatment outcome beyond the effects of treatment type. RESULTS: Staff's, therapist's, and patient's estimations were significantly associated with treatment outcomes. Nevertheless, only therapist's and patient's estimations significantly predicted improvement beyond actual administration, with therapist's and patient's estimations associated with improvement in trait anxiety (STAI-T, B=-1.80, p < .05, and B=-2.02, p < .05, respectively); therapist's estimations were associated with improvement in general distress (OQ-45, B=-3.71, p < .05), and patient's estimations were associated with symptom relief (HSCL-11, B=-0.13, p < .05). Overall, patient's estimations had a higher relative contribution to treatment success, with standardized coefficients across scales ranging from - 0.06 to -0.26. CONCLUSIONS: The neurobiological factors that promote treatment success are also influenced by patient's and therapist's expectations. Future studies should consider these effects when examining their impact in inpatient settings.

Assessing the parental SES gradient in young Britons' partnership expectations, attitudes and its potential mediators.

A well-documented trend in family demography is that young adults from disadvantaged backgrounds tend to enter their first partnership earlier and forego marriage more often than their advantaged counterparts. Yet, limited research has explored whether there is also an association between parental background and expectations for partnership formation, which are considered important precursors of behaviours. Further, few studies have explored the potential mechanisms mediating these differences. This paper uses data from the British Household Panel Survey and Understanding Society to analyse the relationships between parental socioeconomic status and young Britons' expectations for marriage, cohabitation, and attitudes towards ideal age at marriage. Using the KHB decomposition as a mediation method, we verify whether these relationships are explained by two mechanisms measured during the young adults' adolescence: family structure socialisation and academic socialisation. We find that marriage expectations are socially stratified in the UK. Those from the least advantaged backgrounds have significantly lower expectations for marriage than the most advantaged, but this difference does not hold for cohabitation. Those from the least advantaged backgrounds are also more uncertain about their ideal age at marriage. Academic socialisation mediates these relationships to a limited extent. Family structure socialisation mediates a greater percentage, especially living with a single parent, rather than married parents, during adolescence.

Mortality risk information and health-seeking behavior during an epidemic.

In a context where pessimistic survival perceptions have been widespread as a result of the HIV/AIDS epidemic (Fig. 1 A), we study vaccine uptake and other health behaviors during the recent COVID-19 pandemic. Leveraging a longitudinal cohort study in rural Malawi that has been followed for up to 25 y, we document that a 2017 mortality risk information intervention designed to reduce pessimistic mortality perceptions (Fig. 1 B) resulted in improved health behavior, including COVID-19 vaccine uptake (Fig. 1 C). We also report indirect effects for siblings and household members. This was likely the result of a reinforcing process where the intervention triggered engagement with the healthcare system and stronger beliefs in the efficacy of modern biomedical treatments, which led to the adoption of health risk reduction behavior, including vaccine uptake. Our findings suggest that health information interventions focused on survival perceptions can be useful in promoting health behavior and participation in the formal healthcare system, even during health crises-such as the COVID-19 pandemic-that are unanticipated at the time of the intervention. We also note the importance of the intervention design, where establishing rapport, tailoring the content to the local context, and spending time with respondents to convey the information contributed to the salience of the message.

High-intensity interval training is feasible, credible and clinically effective in the early subacute stroke stage in the low-income country of Benin.

High-intensity interval training (HIIT) has been shown to benefit stroke patients when implemented three months post-stroke. This study examined HIIT's feasibility and clinical effectiveness in the early post-stroke stage in Benin. This was a prospective interventional study comprising an HIIT programme executed on a recumbent bike, three times/week, 20-30 min/session for 6 weeks, added to a conventional physiotherapy. The primary outcomes were feasibility, credibility and expectancy assessed with credibility and expectancy questionnaire. A maximal exercise test, 6-min walking test (6MWT), 10-m walking test (10mWT), Berg balance scale (BBS) and five repetitions sit-to-stand test (5 R-STS) were performed before and after the training programme. Ten outpatients, with a median age [P25-P75]: 63.5[56.7-71.2] years; time since stroke: 15.0[9.7-21.0] days, started and completed all training sessions without serious adverse events. High scores were observed on the Credibility subscale at admission (27.0[25.7-27.0]), which remained so after intervention (26.5[25.7-27.0]). Expectancy subscale scores were high at admission (25.5[24.0-27.0]) and post-training (25.5[24.5-27.0]). Peak workload (p < 0.001), BBS (p < 0.001), 6MWT (p < 0.001), 10mWT (p < 0.001) and 5 R-STS (p = 0.004) were all improved. HIIT is feasible and safe in the early subacute post-stroke stage and is perceived by patients as highly credible, meeting their expectations of recovery.

Assessing the longevity of attribute framing in attenuating the nocebo effect to brand and generic medication.

The perception of taking a generic, relative to brand, medication has been demonstrated to exacerbate the nocebo effect. Conversely, positive attribute framing has been shown to attenuate the nocebo effect. However, little is known about the longevity of positive attribute framing nor how it interacts with generic versus brand treatment cues. Healthy participants (N = 205) were randomised to receive either sham-modafinil capsules with a brand or generic appearance, in conjunction with standard negative side effect framing (brand-negative: N = 42; generic-negative: N = 41) or positive side effect framing (brand-positive: N = 40; generic-positive: N = 40). The remainder were randomised to a no-treatment control (N = 42). Participants were informed that modafinil could enhance alertness and cognitive performance and reduce fatigue. Critically, modafinil was described as having several potential side effects. Treatment-related side effects, alertness, fatigue and cognitive performance were measured at baseline, 30-min post-treatment and 24 h later. Nocebo and placebo effects were observed across modafinil-treated participants relative to control. Positive framing significantly reduced warned side effects for 24 h. Perceived side effect likelihood, severity, and worry mediated the nocebo, but not framing, effect. Results have important implications for the presentation of side effect information, providing a potential route to reduce unwanted negative effects of generic medication.