Co-designing planning interventions to facilitate participation in mail-out bowel cancer screening.

BACKGROUND: Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Many non-participants are "intenders"; that is, they intend to screen but fail to do so, often forgetting or procrastinating. This study aimed to co-design interventions to increase screening participation among intenders in the Australian National Bowel Cancer Screening Program. METHODS: Three semi-structured interviews, and one online cross-sectional survey, were conducted between August 2021 and December 2022. Interviews with people who had completed and returned their latest screening kit ("completers") were first conducted to identify the planning strategies they had used. Using survey data, logistic regressions were conducted to analyse strategies predictive of participants having returned their latest bowel cancer screening kit. Then, intenders were interviewed to explore their opinions of these strategies and worked with researchers to adapt these strategies into prototype interventions to facilitate screening participation. All interviews were analysed using the framework approach of codebook thematic analysis. RESULTS: Interview participants who returned their kit shared their effective planning strategies, such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit compared to those who did not. Prototype interventions developed and endorsed by intenders included providing a prompt to place the kit or a sticker near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, and a bag to store the sample in the fridge. CONCLUSIONS: These novel, consumer-led interventions that are built upon the needs and experience of screening invitees provide potential solutions to improve participation in population bowel cancer screening.

Consumer versus expert opinions on bowel cancer screening videos: Findings from a co-design study.

OBJECTIVE: To describe compare and assess expert and consumer evaluations of videos the National Bowel Cancer Screening Program in Australia to inform the future development of effective promotional materials. METHODS: From July to November, 2022 consumers (n = 487) were randomly assigned to see 3 of 15 videos and 34 "experts" (i.e., researchers, clinicians, and health promotion specialists) viewed all 15 videos. Participants completed 22 items reflecting positive and negative perceptions and perceived efficacy in encouraging screening participation. Multiple analyses of covariance assessed mean differences in expert and consumer ratings controlling for age and gender differences. RESULTS: Experts and consumers reported similar perceptions about videos, with no difference in the degree to which each would encourage kit completion. However, compared to those containing personal stories, experts rated instructional and informational videos significantly lower than consumers in terms of encouraging actions that facilitate kit completion. CONCLUSIONS: Experts may underestimate the degree to which information and personal narratives resonate with consumers viewing bowel cancer screening videos. PRACTICAL IMPLICATIONS: It is valuable to consult consumers when designing bowel cancer screening promotion and education videos as opposed to relying solely on expert opinion especially in the context of encouraging actions that lead to kit completion.

Decisions and prompts to screen for cervical, bowel, and breast cancer.

OBJECTIVES: To investigate what makes Australians decide to screen and follow through for breast, cervical, and bowel cancer population screening programs. METHODS: A convenience sample (N = 962) answered open-text questions about their decision to screen and what prompted them to act in an online survey. Open text responses were coded based on shared meaning using content analysis. Frequencies of each code were calculated. RESULTS: For breast and cervical screening, decisions were commonly based on screening being routine (32.58%breast and 35.19%cervical) or receiving a reminder (20.53% breast 13.07% cervical), and similarly, common prompts were receiving a reminder (40.68% breast and 29.13% cervical), screening being routine (22.05% breast and 18.65% cervical). Participants reported deciding to screen for bowel cancer due to arrival of home screening test kit (40.50%) or the experience of loved one's cancer (13.57%) and were prompted by arrival of home test kit (23.58%), and convenience (15.72%). CONCLUSIONS: Findings can inform the development of interventions targeting non-participants of cancer screening programs. PRACTICE IMPLICATIONS: Messages to encourage breast and cervical cancer screening should frame screening as part of regular healthcare routine. Messages to encourage bowel cancer screening should encourage immediate use of the screening kit upon arrival.

Psychological distress and bowel cancer screening participation.

OBJECTIVE: To better understand barriers to participation in mail-out bowel cancer screening programs, two survey studies tested the relationship between psychological distress and self-reported bowel cancer screening. METHODS: First, a nationally representative sample of Australians N = 5421 completed measures of bowel cancer screening and psychological distress (using the Kessler Psychological Distress Scale; K10). Second, N = 479 completed a survey measuring participation in the National Bowel Cancer Screening Program (NBCSP) and psychological distress using the Depression, Anxiety and Stress Scale. In both studies, logistic regressions were conducted to test relationships between psychological distress and self-reported screening participation. RESULTS: Study one found that psychological distress had a significant quadratic effect on having ever screened for bowel cancer, where screening rates were similar for those with low, moderate, or high levels of distress, but were lower for those with very high levels of distress. In study two, depression scores had a negative linear relationship with NBCSP participation (higher depression levels were associated with lower screening participation), and anxiety had a quadratic effect whereby NBCSP participation rates were higher with increasing levels of anxiety except in the severe category, where participation was significantly lower. CONCLUSIONS: Findings indicate that psychological distress has a complex relationship with screening, and those with extreme levels of distress consistently show lower participation rates. Special efforts to encourage screening may be required for those experiencing extreme psychological distress and mental health disorders.

Increasing the duration of an intervening distractor word can increase repetition blindness: Evidence for interitem competition in rapid visual sequences.

In rapid serial visual presentation (RSVP), accurate report of a critical item (C2) declines when an earlier critical item (C1) is identical rather than unrelated. The most prominent theories of this phenomenon of repetition blindness (RB) concern the effects of processing C1 on later processing of C2. However, characteristics of distractor items between C1 and C2 strongly moderate RB, suggesting that items may compete for registration as separate events. We investigated interitem competition by manipulating the word frequency of distractors and C2s, and introducing novel manipulations of C1 and distractor duration. The frequency manipulations affected overall performance but not the size of RB; C2 reporting accuracy improved when distractors were of higher frequency and, contrary to typical results in lexical tasks, when C2s were of lower frequency. These results align with a competition model in which lower frequency words have an advantage. C1 duration had no significant effects on performance. A new finding was that increasing distractor duration had no main effect on performance but did increase the size of RB. The difficulty of registering a repeated C2 in memory under time pressure is exacerbated by the competitive effects of a temporally adjacent word of longer duration. The findings add to other evidence that interitem competition is important in RB and in processing of rapid visual sequences more generally. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Testing a psychosocial model of sexual communication and sexual risk-taking: A cross-sectional, online survey study of Australian University students.

OBJECTIVE: Sexually transmitted infection rates are higher among young people relative to other age groups. Despite much investigation, there is not enough research about in-the-moment factors associated with risky sexual behaviour, such as relational and situational variables. The present study sought to test a comprehensive psychosocial model of sexual risk-taking that included a range of factors: individual (emotion dysregulation, impulsivity), relational (attachment, communication), societal (norms, gender), and situational (dating application use, alcohol use). METHODS: 1244 young people aged 18 to 25 years (82.9 % women; 59.2 % single, 36.0 % in a monogamous relationship) participated in an online survey. The cross-sectional model was tested using Structural Equation Modelling. RESULTS: Sexual communication mediated the relationship between attachment anxiety and sexual risk. However, contrary to predictions, greater sexual communication was related to higher risk. Post-hoc analysis showed that this unexpected relationship may be due to the way sexual risk was measured, as an alternative model specifying casual unprotected sex as the outcome showed no positive relationship between sexual communication and risk. CONCLUSION: Findings indicate that young people with anxious attachment are less confident communicating about sexual health. Measures of sexual risk focusing on specific risk activities in context yield different findings to those assessing general sexual behaviours. Findings support interventions focusing on addressing perceived sexual risk norms and the dating application context to reduce risk.

The role of need for control and self-reliance in gender and age differences in bowel cancer screening participation.

OBJECTIVE: To examine the relationships between need for control and self-reliance and barriers to bowel cancer screening to better understand the reasons for lower bowel cancer screening adherence in males and younger individuals. METHODS: Participants (n = 506) aged between 54 and 75 years old completed an online survey measuring demographic information, the four-factor Barriers to Home Bowel Cancer Screening Scale (BB-CanS) and a measure of Need for Control and Self-Reliance (NCSR). Model fit statistics were compared for seven path models testing the relationships between NCSR and BB-CanS factors and the moderating and mediating effects of age and gender. RESULTS: Models where age and gender were included as moderators showed the best fit. When compared to females and those under 60 years of age, stronger positive associations between NCSR and BB-CanS factors were evident among males (ßavoidance  = 0.539, p < 0.001); ßdisgust  = 0.558, p < 0.001; ßdifficulty  = 0.489, p < 0.001; ßautonomy  = 0.619, p = 0.002) and those over 60 years of age (ßavoidance  = 0.400, p < 0.001); ßdisgust  = 0.462, p < 0.001; ßdifficulty  = 0.447, p < 0.001; ßautonomy  = 0.378, p < 0.001. CONCLUSIONS: When encouraging males and people aged 60 years and over to participate in bowel cancer screening, public health messages may benefit from conveying preventative health behaviour and cancer screening participation as actions that reflect self-control and self-reliance.

Drug and alcohol practitioners' attitudes toward the use of standardized assessment.

Despite their importance to evidence-based assessment, standardized assessments remain underutilized by mental health practitioners in practice. The underutilization has been attributed to a lack of appreciation of the importance of standardized assessments, lack of knowledge of standardized assessments, and practical barriers to implementation. This study sought to gather the first descriptive data on alcohol and other drug (AOD) practitioners' attitudes toward, and knowledge and self-reported use of, standardized assessments. Practical barriers to implementation in initial assessment and progress monitoring were also assessed. Ninety-nine Australian AOD practitioners recruited via newsletters of national representative bodies and practitioner networks completed an online survey. While practitioners' attitudes towards using standardized assessments for initial assessment and progress monitoring were generally positive and consistent with other populations of health practitioners, assessments remained underutilized in practice. Most AOD practitioners did not consider standardized assessments to be feasible to implement. The current findings highlight the importance of practical barriers, particularly organization-level barriers, in the underutilization of standardized assessments in AOD practice. Findings support an extension of dialogue surrounding evidence-based practice beyond treatment selection to include assessment practices at a more general level. The present study offers a starting point from which efforts to improve practitioner compliance with evidence-based best practices can be conceived, designed, and implemented.

A qualitative assessment of factors affecting nursing home caregiving staff experiences during the COVID-19 pandemic.

BACKGROUND: A large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes. METHODS: Based on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel. RESULTS: Throughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups. CONCLUSIONS: Addressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning.

Young adults' sexual health in the digital age: Perspectives of care providers.

OBJECTIVES: This study examined care providers' views on young people's sexual health in the digital age. Young people have high rates of sexually transmitted infections (STIs), indicating sexual risk-taking behaviours. Adolescents transitioning to adulthood may be particularly at risk due to increased sexual behaviour and exposure to risk factors for unsafe sex, such as less parental monitoring. These risks may be accentuated in the digital age, where the availability of dating apps and pornography have potentially influenced young people's sexual behaviours. Care providers give a unique insight into sexual health in the digital age as they are able to identify changes over time. STUDY DESIGN: Qualitative semi-structured interviews were conducted with general practitioners, nurses, counsellors and university residential college staff (N = 15, six female) who work with young people aged 17 and 18. Interviews took 20-40 min, and were recorded and transcribed verbatim. Transcripts were coded by the primary researcher and an independent coder using thematic analysis. RESULTS: We identified four themes depicting predictors for sexual risk-taking among young people: media influence on norms (influence on sexual behaviours, relationships and appearance), transition to adulthood (independence, social opportunity), communication difficulties (gender and sexuality differences, greater fear of pregnancy than STIs), and impulsive behaviour (disinhibition, substance use). CONCLUSION: Findings highlight targets for prevention of sexual risk-taking among adolescents, such as addressing changing norms depicted in media. Further, the complex interplay of contextual and individual factors highlights the need for more comprehensive theory and holistic approaches to STI prevention.

Infrared Fingerprint Engineering: A Molecular-Design Approach to Long-Wave Infrared Transparency with Polymeric Materials.

Optical technologies in the long-wave infrared (LWIR) spectrum (7-14 µm) offer important advantages for high-resolution thermal imaging in near or complete darkness. The use of polymeric transmissive materials for IR imaging offers numerous cost and processing advantages but suffers from inferior optical properties in the LWIR spectrum. A major challenge in the design of LWIR-transparent organic materials is that nearly all organic molecules absorb in this spectral window which lies within the so-called IR-fingerprint region. We report on a new molecular-design approach to prepare high refractive index polymers with enhanced LWIR transparency. Computational methods were used to accelerate the design of novel molecules and polymers. Using this approach, we have prepared chalcogenide hybrid inorganic/organic polymers (CHIPs) with enhanced LWIR transparency and thermomechanical properties via inverse vulcanization of elemental sulfur with new organic co-monomers.

One Dimensional Photonic Crystals Using Ultrahigh Refractive Index Chalcogenide Hybrid Inorganic/Organic Polymers.

We report on the fabrication of wholly polymeric one-dimensional (1-D) photonic crystals (i.e., Bragg reflectors, Bragg mirrors) via solution processing for use in the near (NIR) and the short wave (SWIR) infrared spectrum (1-2 µm) with very high reflectance (R ∼ 90-97%). Facile fabrication of these highly reflective films was enabled by direct access to solution processable, ultrahigh refractive index polymers, termed, Chalcogenide Hybrid Inorganic/Organic Polymers (CHIPs). The high refractive index (n) of CHIPs materials (n = 1.75-2.10) allowed for the production of narrow band IR Bragg reflectors with high refractive index contrast (Δn ∼ 0.5) when fabricated with low n polymers, such as cellulose acetate (n = 1.47). This is the highest refractive index contrast (Δn ∼ 0.5) demonstrated for an all-polymeric Bragg mirror which directly enabled high reflectivity from films with 22 layers or less. Facile access to modular, thin, highly reflective films from inexpensive CHIPs materials offers a new route to IR Bragg reflectors and other reflective coatings with potential applications for IR photonics, commercial sensing, and LIDAR applications.

Chalcogenide Hybrid Inorganic/Organic Polymers: Ultrahigh Refractive Index Polymers for Infrared Imaging.

We report on the preparation of ultrahigh refractive index polymers via the inverse vulcanization of elemental sulfur, selenium, and 1,3-diisopropenylbenzene for use as novel transmissive materials for mid-infrared (IR) imaging applications. Poly(sulfur-random-selenium-random-(1,3-diisopropenylbenzene)) (poly(S-r-Se-r-DIB) terpolymer materials from this process exhibit the highest refractive index of any synthetic polymer (n > 2.0) and excellent IR transparency, which can be directly tuned by terpolymer composition. Sulfur or selenium containing (co)polymers prepared via inverse vulcanization can be described as Chalcogenide Hybrid Inorganic/Organic Polymers (CHIPs) and are polymeric analogues to wholly inorganic Chalcogenide Glasses (ChGs), which are commonly used as transmissive materials in mid-IR imaging. Finally, we demonstrate that CHIPs composed of (poly(S-r-Se-r-DIB) can be melt processed into windows that enabled high quality mid-IR thermal imaging of human subjects and highly resolved imaging of human vasculature.

High Refractive Index Copolymers with Improved Thermomechanical Properties via the Inverse Vulcanization of Sulfur and 1,3,5-Triisopropenylbenzene.

The synthesis of a novel high sulfur content material possessing improved thermomechanical properties is reported via the inverse vulcanization of elemental sulfur (S8) and 1,3,5-triisopropenylbenzene (TIB). A key feature of this system was the ability to afford highly cross-linked, thermosetting materials, where the use of TIB as a comonomer enabled facile control of the network structure and dramatically improved the glass transition temperature (relative to our earlier sulfur copolymers) of poly(sulfur-random-(1,3,5-triisopropenylbenzene)) (poly(S-r-TIB)) materials over a range from T = 68 to 130 °C. This approach allowed for the incorporation of a high content of sulfur-sulfur (S-S) units in the copolymer that enabled thermomechanical scission of these dynamic covalent bonds and thermal reprocessing of the material, which we confirmed via dynamic rheological characterization. Furthermore, the high sulfur content also imparted high refractive index (n > 1.75) and IR transparency to poly(S-r-TIB) copolymers, which offered a route to enhanced optical transmitting materials for IR thermal imaging applications with improved thermomechanical properties.

Dynamic Covalent Polymers via Inverse Vulcanization of Elemental Sulfur for Healable Infrared Optical Materials.

We report on dynamic covalent polymers derived from elemental sulfur that can be used as thermally healable optical polymers for mid-IR thermal imaging applications. By accessing dynamic S-S bonds in these sulfur copolymers, surface scratches and defects of free-standing films of poly(sulfur-random-1,3-diisopropenylbenzene) (poly(S-r-DIB) can be thermally healed, which enables damaged lenses and windows from these materials to be reprocessed to recover their IR imaging performance. Correlation of the mechanical properties of these sulfur copolymers with different curing methods provided insights to reprocess damaged samples of these materials. Mid-IR thermal imaging experiments with windows before and after healing of surface defects demonstrated successful application of these materials to create a new class of "scratch and heal" optical polymers. The use of dynamic covalent polymers as healable materials for IR applications offers a unique advantage over the current state of the art (e.g., germanium or chalcogenide glasses) due to both the dynamic character and useful optical properties of S-S bonds.

A comparison between whites and blacks with severe multi-organ iron overload identified in 16,152 autopsies.

BACKGROUND & AIMS: Little is known about differences in the prevalence of severe iron overload at death in whites and blacks. We evaluated data and samples from 16,152 autopsies (8484 whites, 7668 blacks) performed at a single university hospital. METHODS: Cases of severe multi-organ iron overload were identified by review of autopsy protocols and Perls-stained tissue specimens, analysis of hepatocyte and Kupffer cell iron levels, and measurement of liver tissue iron concentrations. RESULTS: We analyzed autopsy data from 10,345 adults (age > or =21 years), 1337 children (1-20 years), and 4470 infants (<1 year). Iron overload without reports of excessive exogenous iron was observed in 18 adults; the prevalence in whites and blacks was 0.0019 and 0.0015, respectively (P = .6494). Twenty-nine adults and 2 children had iron overload with reports of excessive exogenous iron. In adults, the prevalences of iron overload with reports of excessive exogenous iron in whites and blacks were 0.0040 and 0.0013, respectively (P = .0107). Among adults, the prevalence of cirrhosis was 6-fold greater in those with iron overload. In adults with severe iron overload, 67% without reports of excessive exogenous iron and 14% with reports of excessive exogenous iron died of hepatic failure or cardiomyopathy caused by siderosis. The overall prevalence of deaths caused by severe iron overload in whites and blacks was 0.0021 and 0.0009, respectively (P = .0842). CONCLUSIONS: The prevalence of severe iron overload without reports of excessive exogenous iron did not differ significantly between whites and blacks. The prevalence of iron overload with reports of excessive exogenous iron was greater in whites. Hepatic failure and cardiomyopathy were common causes of death in severe iron overload cases.