Communication About Negative and Uncertain Results: Interactional Dilemmas During a Genetic Telehealth Consult.

This case study focuses on a video telehealth consult to discuss genetic testing results. Participants include a Genetic Counselor (GC) and a Patient (P) previously diagnosed with ovarian cancer who is currently undergoing chemotherapy treatments. Utilizing conversation analysis (CA), attention is first given to a series of interactional dilemmas as GC delivers and P responds to negative, uncertain, and complex test results. Specific findings address practices employed by GC to structure the encounter and establish authority, impacts on P's participation and understandings, recurring and at times problematic orientations to "negative" findings, and inherent ambiguities faced by GC and P when attempting to discern good and bad news. Close examination of these moments provides a unique opportunity to identify, describe, and explain genetic counseling as a co-produced, interactional achievement. These findings are then integrated with patient's post-counseling survey (susceptibility, anxiety, uncertainty, fear, and hope), including reported experiences which broaden understandings of the interactional environment. Specific recommendations are raised for improving counseling skills, enhancing patients' understandings, and building therapeutic alliances addressing both patients' emotional circumstances and the complexities of genetic test results.

A qualitative systematic review and thematic synthesis exploring the impacts of clinical academic activity by healthcare professionals outside medicine.

BACKGROUND: There are increasing opportunities for healthcare professionals outside medicine to be involved in and lead clinical research. However, there are few roles within these professions that include time for research. In order to develop such roles, and evaluate effective use of this time, the range of impacts of this clinical academic activity need to be valued and understood by healthcare leaders and managers. To date, these impacts have not been comprehensively explored, but are suggested to extend beyond traditional quantitative impact metrics, such as publications, citations and funding awards. METHODS: Ten databases, four grey literature repositories and a naïve web search engine were systematically searched for articles reporting impacts of clinical academic activity by healthcare professionals outside medicine. Specifically, this did not include the direct impacts of the research findings, rather the impacts of the research activity. All stages of the review were performed by a minimum of two reviewers and reported impacts were categorised qualitatively according to a modified VICTOR (making Visible the ImpaCT Of Research) framework. RESULTS: Of the initial 2704 identified articles, 20 were eligible for inclusion. Identified impacts were mapped to seven themes: impacts for patients; impacts for the service provision and workforce; impacts to research profile, culture and capacity; economic impacts; impacts on staff recruitment and retention; impacts to knowledge exchange; and impacts to the clinical academic. CONCLUSIONS: Several overlapping sub-themes were identified across the main themes. These included the challenges and benefits of balancing clinical and academic roles, the creation and implementation of new evidence, and the development of collaborations and networks. These may be key areas for organisations to explore when looking to support and increase academic activity among healthcare professionals outside medicine. The modified VICTOR tool is a useful starting point for individuals and organisations to record the impact of their research activity. Further work is needed to explore standardised methods of capturing research impact that address the full range of impacts identified in this systematic review and are specific to the context of clinical academics outside medicine.

Promoting Oral Health in Appalachia: Effects of Threat Label and Source Accent on Message Acceptance.

This study examined the effects of threat label (i.e., the name assigned to a health threat) and source accent (i.e., the source's manner of pronunciation) on Appalachian residents' acceptance of oral health promotion messages. Participants (N = 348) listened to an audiotaped oral health promotion message about tooth decay or Mountain Dew Mouth; the message was delivered either in a standard American English or a Southern accent. Compared to the label Mountain Dew Mouth, the label tooth decay elevated perceptions of threat susceptibility, threat severity, and response-efficacy and resulted in higher message acceptance. The effect of threat label on message acceptance was mediated by severity perceptions. Participants attributed more status to the source and agreed more with her message when she spoke in a standard than a Southern accent. The effect of source accent on message acceptance was mediated by status perceptions. These findings suggest that the success of persuasive health messages depends not only on message content (i.e., what is said), but also on how that content is linguistically framed and delivered (i.e., how it is said).

When Do Friends Prevent Friends from Hooking Up Intoxicated? An Examination of Sex Differences and Hypothetical Intoxication in Peer Interventions.

Despite the risks involved when mixing alcohol with casual sexual activity, the majority of college students engage in hookups, and the majority of those hookups involve alcohol. This study focused on the protective role college students' peers can play and the situational factors that might influence their willingness to intervene when a close friend is about to hook up intoxicated. Drawing on the theory of planned behavior (TPB), this study investigated differences in students' (N = 1270) attitudes, norms, perceived behavioral control, and intentions to persuade a close friend not to engage in a hypothetical drunken hookup using a 2 (friend sex) × 2 (participant sex) × 2 (sober/intoxicated) factorial design. Results indicated significant differences in the TPB variables. Participants intended to intervene with female friends, but not male friends, and women were more likely to intervene than men. Participants in the sober condition had stronger intentions to intervene than those in the intoxicated condition, but this effect was driven by increases in men's intentions when sober. Implications for theory and prevention programming are discussed.

Theory-Based Formative Research on an Anti-Cyberbullying Victimization Intervention Message.

Cyberbullying is a common byproduct of the digital revolution with serious consequences to victims. Unfortunately, there is a dearth of empirically based methods to confront it. This study used social cognitive theory to design and test an intervention message aimed at persuading college students to abstain from retaliation, seek social support, save evidence, and notify authorities-important victim responses identified and recommended in previous research. Using a posttest-only control group design, this study tested the effectiveness of an intervention message in changing college students' perceived susceptibility to and perceived severity of cyberbullying as well as their self-efficacy, response efficacy, attitudes, and behavioral intentions toward each recommended response in future episodes of cyberbullying. Results indicated that the intervention message caused participants in the experimental condition to report significantly higher susceptibility, but not perceived severity, to cyberbullying than those in the control condition. The intervention message also caused expected changes in all outcomes except self-efficacy for not retaliating and in all outcomes for seeking social support, saving evidence, and notifying an authority. Implications for message design and future research supporting evidence-based anti-cyberbullying health communication campaigns are discussed.

News Stories of Intimate Partner Violence: An Experimental Examination of Participant Sex, Perpetrator Sex, and Violence Severity on Seriousness, Sympathy, and Punishment Preferences.

This study experimentally examines the effects of participant sex, perpetrator sex, and severity of violence on perceptions of intimate partner violence (IPV) seriousness, sympathy toward the victim, and punishment preferences for the perpetrator. Participants (N = 449) were randomly assigned to a condition, exposed to a composite news story, and then completed a survey. Ratings of seriousness of IPV for stories with male perpetrators were significantly higher than ratings of seriousness for stories with female perpetrators. Men had significantly higher sympathy for female victims in any condition than for male victims in the weak or strong severity of violence conditions. Men's sympathy for male victims in the fatal severity of violence condition did not differ from their sympathy for female victims. Women had the least sympathy for female victims in the weak severity condition and men in the weak or strong severity conditions. Women reported significantly higher sympathy for female victims in the strong and fatal severity of violence conditions. Women's ratings of sympathy for male victims in the fatal severity of violence condition were statistically indistinguishable from any other group. Participants reported stronger punishment preferences for male perpetrators and this effect was magnified among men. Theoretical implications are presented with attention provided to practical considerations about support for public health services.

A Mixed Method Study of Intimate Partner Violence: How Sex and Severity Impact Perpetrator Prior Involvement, Abnormality, and Responsibility.

This study employed a mixed method approach to examine the effects of participant sex, perpetrator sex, and severity of violence on perceptions of intimate partner violence (IPV) perpetrators. Quantitative participants (n = 449) completed a survey and qualitative participants (n = 31) participated in a focus group or an interview. Participants believed that it was more likely male perpetrators had prior involvement in IPV. Participants rated stories of female perpetrators as more abnormal than stories of male perpetrators. Participants in the weak severity of violence condition had lower evaluations of responsibility than the strong or fatal severity of violence conditions and only women were discerning about perpetrator sex in their ratings of responsibility. Theoretical implications extend intimate terrorism and defensive attribution theory.

Perceptions of oral health in Appalachian Kentucky: implications for message design.

We conducted three studies to investigate Appalachian college students' perceptions and behavior concerning oral health for the purpose of identifying salient factors to consider in designing persuasive messages to promote oral health. In Study 1, we conducted seven focus groups with 67 college students at a state university in Appalachian Kentucky. Using thematic analysis, we found that students based their oral health behavior on the perception that people living in Appalachia have poor oral health and that students denied, confirmed, reframed, or fulfilled this "misconception." In Study 2, quantitative results from a representative survey of students (N = 587) at the same university indicated that the barriers to enacting good oral health behavior were primarily logistical in nature, whereas the facilitators of good oral health behavior were largely social. In Study 3, results from dental screenings (N = 364) of students at the university demonstrated that about one in five students presented with active, visible decay. We discuss how these results inform our understanding of oral health behavior in Appalachia and the implications of these results for designing messages to promote oral health in the region.

Outcome evaluation results of school-based cybersafety promotion and cyberbullying prevention intervention for middle school students.

Guided largely by the Extended Parallel Process Model, the Arizona Attorney General's Social Networking Safety Promotion and Cyberbullying Prevention presentation attempts to shape, change, and reinforce middle school students' perceptions, attitudes, and intentions related to these important social issues. This study evaluated the short-term effects of this presentation in a field experiment using a posttest-only control-group design with random assignment to conditions. A total of 425 sixth, seventh, and eighth graders at a public middle school in a large Southwestern city participated in this study. Results reveal several interesting trends across grade levels regarding cyberbullying perpetration and victimization, and concerning access to various communication technologies. The intervention had the hypothesized main effect on eight of the dependent variables under investigation. Examination of condition by grade interaction effects offered further support for an additional four hypotheses (i.e., the intervention positively affected or reversed a negative trend on four dependent variables in at least one grade). Ideas and implications for future social networking safety promotion and cyberbullying prevention interventions are discussed.

Determining factors of physical activity and sedentary behaviour in university students during the COVID-19 pandemic: A longitudinal study.

INTRODUCTION: Historically, university students demonstrate poor movement behaviours that could negatively impact current and future health. Recent literature has focused on identifying determinants of physical activity (PA) and sedentary behaviour (SB) in this population to inform the development of intervention strategies. However, the COVID-19 pandemic substantially restricted movement behaviours in this population, meaning findings of previous research may no longer be applicable within the current societal context. The present study explored the longitudinal relationships between pre-pandemic psychological, behavioural and anthropometric factors, and the movement behaviours of UK university students nine months following the outbreak of COVID-19. METHODS: Mental wellbeing (MWB), perceived stress (PS), body mass index (BMI), SB, and PA were assessed using an online self-report survey in 255 students prior to (October 2019) and nine months following (October 2020) the first confirmed case of COVID-19 in the UK. Path analysis was utilised to test relationships between pre-COVID mental wellbeing, perceived stress and BMI, and movement behaviours during the pandemic. RESULTS: The fit of the path analysis model was good (χ2 = 0.01; CMIN = 0.10, CFI = 1.00, RMSEA = 0.00). Pre-covid MWB and PS positively influenced PA (ß = 0.29; ß = 0.24; P < 0.01) but not SB (ß = -0.10; ß = 0.00; P = 0.79) during the pandemic. Additionally, pre-pandemic SB and PA positively influenced SB and PA during the pandemic respectively (SB: ß = 0.26; P < 0.01) (PA: ß = 0.55; P < 0.01). Pre-pandemic BMI did not influence any measured variable during the pandemic (PA: ß = 0.03 and P = 0.29; SB: ß = 0.06 and P = 0.56), and there was no mediating effect of PA on SB during the pandemic (ß = -0.26; P = 0.14). CONCLUSION: These findings indicate that pre-covid mental health and movement behaviours had a direct positive influence on PA during the pandemic, but not SB. This longitudinal study demonstrates the influence that prior psychological and behavioural factors have in determining university students' response to periods of elevated stress and uncertainty, furthering our understanding of determinants of health-related behaviours in students.

Acquired Hemophilia: A Rare Complication of Pediatric Idiopathic Multicentric Castleman Disease.

Acquired hemophilia is caused by acquired autoantibodies to 1 of the factors of the coagulation cascade, usually factor VIII or IX, and is an exceedingly rare phenomenon in children. The finding of an acquired factor VIII inhibitor in a pediatric patient with idiopathic multicentric Castleman disease has never been reported. Patients with acquired hemophilia can have life-threatening bleeds that are refractory to blood product support, requiring bypassing agents to manage bleeding symptoms. We present the novel finding of acquired hemophilia resulting from an autoantibody to factor VIII in a pediatric patient with idiopathic multicentric Castleman disease and discuss the optimal management of bleeding in a patient with acquired hemophilia.

Exploring Differences in Caregiver Communication in Serious Illness.

Background: Demographic factors, such as disease context and family relationships, are communication mediators and moderators; however, little is known about how understanding these factors can improve caregiver communication with providers. Recognition of communication differences among caregivers may aid the development of approaches to improve serious illness communication. Objective: To explore whether caregiver communication differs by disease context (cancer vs. dementia) and caregiver communication type (Manager, Carrier, Partner, and Lone). Caregiver communication type is based on communication patterns between the care recipient and caregiver. Design and Measurements: Caregivers of persons with cancer and/or dementia were surveyed from a U.S. national research registry website. Measures of caregiver communication included information needs, communication confidence, perception of provider understanding of the caregiver, perceived frequency of caregiver assessment, and caregiver stress. Analysis of variance (ANOVA) determined significant differences between caregiver communication (p < 0.05) based on disease context and caregiver communication type. Results: Cancer caregivers reported higher unrecognized-demanded information states (i.e., not recognizing information was needed), more communication confidence, and more frequent caregiver assessment compared to dementia caregivers. Among caregiver communication types, Manager caregiver types were more confident communicating than other caregiver types and perceived greater understanding by providers than the Lone caregiver type. Manager caregivers reported significantly less stress than other caregiver communication types. Conclusions: Understanding disease context and caregiver communication type may help improve caregiver communication with health care providers.

What follow-up interventions, programmes and pathways exist for minor stroke survivors after discharge from the acute setting? A scoping review.

OBJECTIVE: To identify the breadth and range of follow-up interventions currently provided to people after minor stroke with a focus on the definitions used for minor stroke, intervention components, intervention theory and outcomes used. These findings will inform the development and feasibility testing of a pathway of care. DESIGN: Scoping review. SEARCH STRATEGY: The final search was run in January 2022. Five databases were searched-EMBASE, MEDLINE, CINAHL, British Nursing Index and PsycINFO. Grey literature was also searched. Title and abstract screening and full-text reviews were conducted by two researchers and a third was involved when differences of opinion existed. A bespoke data extraction template was created, refined and then completed. The Template for Intervention Description and Replication (TIDieR) checklist was used to describe interventions. RESULTS: Twenty-five studies, using a range of research methodologies were included in the review. A range of definitions were used for minor stroke. Interventions focused largely on secondary prevention and management of increased risk of further stroke. Fewer focused on the management of hidden impairments experienced after minor stroke. Limited family involvement was reported and collaboration between secondary and primary care was seldom described. The intervention components, content, duration and delivery were varied as were the outcome measures used. CONCLUSION: There is an increasing volume of research exploring how best to provide follow-up care to people after minor stroke. Personalised, holistic and theory-informed interdisciplinary follow-up is needed that balances education and support needs with adjustment to life after stroke.

Pandemic coping and COVID-19 preventive behaviors among cancer survivors.

BACKGROUND: Cancer survivors are at greater risk for COVID-19 complications, emphasizing the importance of adherence to COVID-19 prevention. Active coping mechanisms can help manage pandemic stress but disengaged coping practices can have adverse effects. OBJECTIVES: 1) Identify differences in COVID-19 coping styles and COVID-19 preventive behaviors among cancer survivors in active treatment, survivors not in treatment, and a comparison group without a cancer history. 2) Exploring variables that may predict adherence to COVID-19 preventative behaviors. PATIENT INVOLVEMENT & METHODS: This study used an online survey among two categories of cancer survivors - one group in active treatment and one group no longer in treatment - and one group without a cancer history (N = 897 total). RESULTS AND DISCUSSION: Cancer survivors in treatment were more likely to utilize both active and disengaged coping (p < .001). This could indicate that the additional COVID-19 strain is making survivors more likely to engage in coping in any way possible. Cancer survivors not in treatment were less likely to report intent to carry out COVID- 19 preventative behaviors compared to the comparison group (p = .009). Providers should understand how survivors may use both coping mechanism types because these coping strategies predict both depression and adherence to COVID-19 preventive behaviors.

Acute Oxidative Stress Can Paradoxically Suppress Human NRF2 Protein Synthesis by Inhibiting Global Protein Translation.

The NRF2 transcription factor is a master regulator of the cellular oxidant/electrophile response and a drug target for the prevention/treatment of chronic diseases. A major mechanism of NRF2 activation is its escape from rapid degradation, and newly synthesized NRF2 induces cytoprotective protein expression through its cognate antioxidant response elements (AREs). However, oxidative stress can also inhibit global protein translation, thereby potentially inhibiting NRF2 protein accumulation. H2O2 has been shown to be a relatively weak inducer of NRF2 in comparison with electrophiles. In the current study, we evaluated whether levels of H2O2 that activate the NRF2/ARE pathway inhibit NRF2 protein synthesis in HaCaT keratinocytes. A weak maximum induction was observed for H2O2 in comparison with electrophiles, both for NRF2 protein accumulation and ARE reporter activation (~10-fold compared to ≥100-fold activation). At similar H2O2 concentrations, both NRF2 protein synthesis and global protein synthesis were inhibited. The manganese porphyrin antioxidant MnTMPyP rescued both global protein synthesis and NRF2 protein synthesis from H2O2 inhibition and increased ARE reporter activation. Similar results were observed for the diphenol di-tert-butylhydroquinone (dtBHQ). In conclusion, induction of the NRF2/ARE pathway by H2O2 and dtBHQ-derived oxidative species can be limited by inhibition of NRF2 protein synthesis, likely by arrest of global protein synthesis.

News Stories of Intimate Partner Violence: An Experimental Examination of Media Framing and Perpetrator Sex in LGBTQ Versus Heterosexual Relationships.

This study experimentally examines the effects of perpetrator sex (male or female), relationship context (heterosexual or homosexual), and the type of media framing (episodic or thematic) on endorsement for public health perspectives about intimate partner violence (IPV) and punishment preferences for IPV perpetrators. Participants (N = 750) were randomly assigned to a condition, exposed to a composite news story, and then completed a survey. Manipulation check responses demonstrated a pattern suggesting that participants had difficulty attending to details of IPV in stories where the perpetrator was a woman, or where the violence occurred in a homosexual relationship. Results revealed significant interaction effects for the endorsement of public health perspectives and for perpetrator punishment preferences. Results for the endorsement of public health perspectives showed that thematic framing caused stronger support only when the perpetrator was a heterosexual man. Results for perpetrator punishment preferences revealed a pattern where participants preferred stronger punishments for heterosexual male perpetrators over any other group. Participants did not distinguish in their punishment preferences for male or female homosexual perpetrators, but these were still stronger than their punishment preferences for heterosexual female perpetrators. Theoretical implications are presented with attention to extending research about media portrayals of IPV, and discussion is offered concerning practical considerations for public health support services that address IPV.

Examining Vaccine Sentiment on Twitter and Local Vaccine Deployment during the COVID-19 Pandemic.

Understanding local public attitudes toward receiving vaccines is vital to successful vaccine campaigns. Social media platforms may help uncover vaccine sentiments during infectious disease outbreaks at the local level, and whether offline local events support vaccine-promotion efforts. Communication Infrastructure Theory (CIT) served as a guiding framework for this case study of the San Diego region examining local public sentiment toward vaccines expressed on Twitter during the COVID-19 pandemic. We performed a sentiment analysis (including positivity and subjectivity) of 187,349 tweets gathered from May 2020 to March 2021, and examined how sentiment corresponded with local vaccine deployment. The months of November and December (52.9%) 2020 saw a majority of tweets expressing positive sentiment and coincided with announcements of offline local events signaling San Diego's imminent deployment of COVID-19 vaccines. Across all months, tweets remained mostly objective (never falling below 63%). In terms of CIT, considering multiple levels of the Story Telling Network in online spaces, and examining sentiment about vaccines on Twitter may help scholars to explore the Communication Action Context, as well as cultivate positive community attitudes to improve the Field of Health Action regarding vaccines. Real-time analysis of local tweets during development and deployment of new vaccines may help monitor local public responses and guide promotion of immunizations in communities.

"A Major Quality of Life Issue": A Survey-Based Analysis of the Experiences of Adults With Laryngotracheal Stenosis with Mucus and Cough.

OBJECTIVES: To investigate how the symptoms of mucus and cough impact adults living with laryngotracheal stenosis, and to use this information to guide future research and treatment plans. METHODS: A survey was developed with the support of patient advisors and distributed to people suffering with laryngotracheal stenosis. The survey comprised 15 closed and open questions relating to mucus and cough and included the Leicester Cough Questionnaire (LCQ). Descriptive statistics, X2 and thematic analyses were completed. RESULTS: In total, 641 participants completed the survey, with 83.62% (n = 536) reporting problems with mucus; 79% having daily issues of varying severity that led to difficulties with cough (46.18%) and breathing (20.90%). Mucus affected voice and swallowing to a lesser degree. Respondents described a range of triggers; they identified smoky air as the worst environmental trigger. Strategies to manage mucus varied widely with drinking water (72.26%), increasing liquid intake in general (49.35%) and avoiding or reducing dairy (45.32%) the most common approaches to control symptoms. The LCQ showed a median total score of 14 (interquartile range 11-17) indicative of cough negatively affecting quality of life. Thematic analysis of free text responses identified 4 key themes-the Mucus Cycle, Social impact, Psychological impact, and Physical impact. CONCLUSION: This study shows the relevance of research focusing on mucus and cough and its negative impact on quality of life, among adults with laryngotracheal stenosis. It demonstrates the inconsistent advice and management strategies provided by clinicians for this issue. Further research is required to identify clearer treatment options and pathways.

Between Healthcare Practitioners and Clergy: Evangelicals and COVID-19 Vaccine Hesitancy.

Evangelical Christians are among the most hesitant to get the COVID-19 vaccine. This study examined the extent to which COVID-19 vaccination uptake among Evangelicals is explained by demographic characteristics, Health Belief Model constructs, and faith-based support factors. Survey research firm Qualtrics recruited 531 U.S. adults and conducted a survey to explore predictors of COVID-19 vaccine uptake among people who self-identified as Evangelicals in September 2021. A logistic regression showed that those reporting high perceived benefits of the COVID-19 vaccine were more likely to be vaccinated, while those reporting high perceived barriers were less likely to be vaccinated. Those whose healthcare provider asked them about the vaccine were more likely to be vaccinated than those whose healthcare provider did not ask. Finally, while those who reported information seeking from religious leaders were less likely to be vaccinated, those who reported more faith-based support for vaccination were more likely to be vaccinated. In addition to beliefs about benefits and barriers to vaccination, the role of healthcare providers and clergy were important factors influencing vaccination status. Intervention efforts that capitalize on partnerships between health providers and clergy in supportive congregations may be able to reach undecided Evangelicals.

Nine Months into the COVID-19 Pandemic: A Longitudinal Study Showing Mental Health and Movement Behaviours Are Impaired in UK Students.

Initial studies indicated that student mental health was impaired during the early stages of the pandemic and that maintaining/improving physical activity gave some protection from mental illness. However, as the pandemic persists, these data may not reflect current circumstances and may have been confounded by exam stress. METHODS: This study used an online survey to assess the changes in, and associations between, mental health and movement behaviours in 255 UK university students from before the COVID-19 pandemic (October 2019) to 9 months following the UK's first confirmed case (October 2020). Changes in and associations between mental wellbeing, perceived stress, physical activity, and sedentary behaviour were assessed using a mixed model ANOVA; a multiple linear regression model determined the predictive value of variables associated with Δ mental wellbeing. RESULTS: Mental wellbeing and physical activity decreased (45.2 to 42.3 (p < 0.001); 223 to 173 min/week (p < 0.001)), whereas perceived stress and time spent sedentary increased (19.8 to 22.8 (p < 0.001); 66.0 to 71.2 h/week (p = 0.036)). Δ perceived stress, Δ sedentary behaviour and university year accounted for 64.7%, 12.9%, and 10.1% of the variance in Δ mental wellbeing (p < 0.001; p = 0.006; p = 0.035). CONCLUSION: The COVID-19 pandemic is having a sustained negative impact on student mental health and movement behaviour.