Cost of Acute and Sequelae Care for Japanese Encephalitis Patients, Bangladesh, 2011-2021.

Japanese encephalitis (JE) is associated with an immense social and economic burden. Published cost-of-illness data come primarily from decades-old studies. To determine the cost of care for patients with acute JE and initial and long-term sequelae from the societal perspective, we recruited patients with laboratory-confirmed JE from the past 10 years of JE surveillance in Bangladesh and categorized them as acute care, initial sequalae, and long-term sequelae patients. Among 157 patients, we categorized 55 as acute, 65 as initial sequelae (53 as both categories), and 90 as long-term sequelae. The average (median) societal cost of an acute JE episode was US $929 ($909), of initial sequelae US $75 ($33), and of long-term sequelae US $47 ($14). Most families perceived the effect of JE on their well-being to be extreme and had sustained debt for JE expenses. Our data about the high cost of JE can be used by decision makers in Bangladesh.

Implementation research on kangaroo mother care, Bangladesh.

OBJECTIVE: To describe the implementation, coverage and performance of the national kangaroo mother care programme in Bangladesh. METHODS: Kangaroo mother care services for clinically stable babies with birth weight under 2000 g were set up in government-run health-care facilities in rural and urban areas of Bangladesh. Each facility provided counselling on kangaroo mother care, ensured adequate nutrition, and followed up mothers and babies. We studied implementation of the programme from January 2016 to March 2020 using data from the national database. We tracked the number of eligible babies enrolled and their outcomes, mortality and post-discharge follow-up. FINDINGS: The numbers of kangaroo mother care facilities increased from 16 in 2016 to 108 in 2020. Over the 4-year period 64 426 babies weighing under 2000 g were born in these facilities, 6410 of whom received kangaroo mother care. The quarterly percentage of eligible babies receiving kangaroo mother care increased from 4.7% (37/792) during the first quarter to 21.7% (917/4226) during the last five quarters of the programme. Deaths of babies receiving kangaroo mother care showed a downward trend over the study period. The overall mortality was 1.2% (77/6410), with large quarterly fluctuations in mortality. Post-discharge follow-up was low and only 15-20% of babies received four follow-up visits. CONCLUSION: Implementation of kangaroo mother care interventions is feasible in low-resource settings. Such care has the potential to reduce mortality among low-birth-weight and premature babies. Challenges include low coverage, expanding the programme to the community and strengthening the monitoring system.

Living-in-history effect in the dating of important autobiographical memories.

The tendency of a person to frequently use public (i.e., historical) events as temporal landmarks when dating personal memories is termed the living-in-history (LiH) effect. We investigated the LiH effect in autobiographical memories of Bangladeshi older adults who lived through the 1960s Bengali nationalist movement and the 1971 Bangladesh War of Independence. 476 participants (mean age = 67.16 years; SD = 5.96 years), including 62 independence war veterans, retrieved and dated three important memories from their life and completed two scales: (a) a transitional impact-of-war scale and (b) a generational identity scale. Results showed that nearly one-third of the total memories (32%) were dated using public event references, demonstrating a LiH effect. However, this effect was twice as strong among veterans (58%) than among nonveterans (28%). The memory content analysis revealed that public event references were mostly used to date public memories (e.g., war and political struggle) and the memories with negative valence. Multivariate analyses showed that veteran identity, material changes due to war and participants' age significantly predicted the use of public event references to date one, two or three memories relative to no use of those references. The public memories that were personally significant and the extent participants experienced the material changes due to war mainly caused the LiH effect. We discuss the results considering current theories of autobiographical memory.

Assessing predictors of self-management intentions in people with type 2 diabetes.

BACKGROUND: Type 2 diabetes mellitus (T2D) is slowly turning into an international health emergency, evidenced by accelerated growth in prevalence rates worldwide. Experts have now called for greater integration of self-management interventions in clinical practice in light of these worrisome trends, supplanting the prevailing notion of a "glucocentric" approach. In this pilot study designed to complement a novel assessment program currently in development, we describe a concise screening tool designed to stratify the intention to follow through on self-management practices in people with T2D. METHODS: A cross-sectional survey was conducted at 3 regional primary care clinics. Individuals with T2D having the following characteristics were recruited into the study: (i) individuals with T2D between 18 and 65 years, (ii) fluent in English and, and iii) having been diagnosed with T2D for at least 2 years. We assessed the relevance of components in the Theory of Planned Behaviour (TPB) within the context of self-management behaviour in T2D. Participants were requested to complete a questionnaire containing questions related to intention, attitudes subjective norm and perceived behavioural control. Based on their responses, the psychometric properties of the scale were then evaluated using both reliability and validity analysis. RESULTS: The Cronbach α value for all direct measures of TPB was excellent: intention to adhere to self-management practices (0.98), attitude towards self-management behaviour (0.87), subjective norm (0.83), and perceived behaviour control (0.66). The correlation between intentions and all 3 constructs of TPB was excellent (p < 0.01). Structural equation modeling helped determine attitudes and subjective norms as important predictors of intentions to follow through self-management practices. CONCLUSIONS: By first understanding the dimensions that influence intentions associated with self-management behaviour, clinicians have the opportunity to "triage" individuals with T2D who require greater involvement to bring about better self-care practices. Thus, our research attempts to bridge this gap by devising a psychometric tool suited to a regional setting which allows for an improved person-centered communication between clinicians and patients.

Trauma, mental health, and everyday functioning among Rohingya refugee people living in short- and long-term resettlements.

PURPOSE: This study investigated if Rohingya refugee people resettled in camps in rural Bangladesh and urban locations in Malaysia had different levels of trauma, mental health and everyday functioning. The study also examined if direct and indirect exposure to traumatic events could predict PTSD, depression, generalized anxiety, and everyday functioning in the two groups separately. An attempt was also made to see if the relations between trauma and mental health were different across the two settings. METHODS: This was a cross-sectional study, for which we conveniently recruited 100 adult Rohingyas, 50 from each country; the majority was males. Rohingyas in Bangladesh fled Myanmar's Rakhine State following a major military crackdown in 2017, whereas Rohingyas in Malaysia fled Rakhine gradually over the last three decades because of recurrent violence and military operations. We assessed trauma (cumulative trauma, direct trauma, and indirect trauma), PTSD, depression, generalized anxiety, and everyday functioning of the participants using traumatic event questionnaire, PTSD-8, PHQ-9, GAD-7, and WHODAS-2.0. RESULTS: The Bangladeshi cohort experienced more types of traumatic events (i.e., cumulative trauma) than did the Malaysian cohort (d = 0.58). Although the two cohorts did not differ in terms of indirect exposure to traumatic incidents (i.e., indirect trauma), the Malaysian cohort had direct exposure to traumatic events (i.e., direct trauma) more frequently than did the Bangladeshi cohort (d = 1.22). The Bangladeshi cohort showed higher PTSD (d = 1.67), depression (d = 0.81), generalized anxiety (d = 1.49), and functional impairment (d = 2.51) than those in Malaysia. Hierarchical linear regression analyses showed that after controlling for demographic variables, both direct and indirect trauma significantly predicted PTSD, depression, and functional impairment among Rohingyas in Bangladesh, with direct trauma being the stronger predictor. However, similar analyses showed that only indirect trauma predicted PTSD among Rohingyas in Malaysia, while all other effects were nonsignificant. The results also showed that the predictive relationship between direct trauma and PTSD was different across the two countries. With the same level of direct trauma, a participant from Malaysia would score 0.256 points lower in PTSD than a participant from Bangladesh. CONCLUSION: The recently experienced direct and indirect trauma have impaired mental health and everyday functioning among the Bangladeshi cohort. However, only indirect trauma was active to cause PTSD in the Malaysian cohort as direct trauma was weakening due to the time elapsed since migration. We discuss the results in the context of the current theories of trauma and mental health and suggest therapeutic interventions for the refugee population.

Probing the self-defining period in memories of the Bangladesh independence war generation.

This study investigated the self-defining periods (SPs) in private and public memories of Bangladeshi older adults (N = 476; mean age = 67.16 years) who, during adolescence and early adulthood, witnessed the 1960s Bengali nationalist movement and the 1971 Bangladesh War of Independence. Each participant retrieved three private and three public memories they considered to be highly significant. The lifespan distributions for private and public memories were identical; in both cases, participants recalled more than half of their memories from 10 to 29 years of age. The calendar-year distributions revealed that nearly one-fourth of private and one-third of public memories were recalled from the year of the War of Independence. The memory content analysis showed that participants sampled more negative than positive memories: 55% versus 45% for private memory and 66% versus 34% for public memory. The enhanced recollection of private and public memories from 10 to 29 years of age was predominantly shaped by memories of the independence struggle-a period that was self-defining for the entire Bangladeshi society.

Autobiographical memory impairment among Rohingya refugee people: roles of direct and indirect trauma exposures and PTSD symptom severity.

Literature indicates that trauma exposure leads to autobiographical memory (AM) impairment, but the differential effects of direct and indirect trauma on memory remain unclear. We investigated AMs of 100 Rohingya refugees (Meanage = 35.79; SDage = 15.36) recruited from camps in Bangladesh and communities in Malaysia. Each participant retrieved ten memories to word cues and rated to what extent those memories were self-defining on a 5-point scale. They also completed the PTSD-8 scale and a trauma checklist reporting the types of traumatic events they experienced. Results showed that participants with frequent exposure to direct and indirect trauma recalled more traumatic memories. Surprisingly, more direct-trauma memories appeared to be specific than indirect trauma and non-trauma memories. As expected, individuals who scored higher on the PTSD-8 scale recalled more non-specific AMs. Rohingyas in Bangladesh who migrated months before data collection, thus retaining recent trauma experiences , retrieved more non-specific memories than those in Malaysia who migrated years ago. The direct trauma memories of the Malaysian cohort were more self-defining than their counterparts. The participant's ability to recall more direct trauma memories with specificity could be attributed to the repeated recall of those memories to the relevant authorities of the host countries to justify their refugee status.

A review of autobiographical memory studies on patients with schizophrenia spectrum disorders.

BACKGROUND: Patients suffering from schizophrenia spectrum disorders demonstrate various cognitive deficiencies, the most pertinent one being impairment in autobiographical memory. This paper reviews quantitative research investigating deficits in the content, and characteristics, of autobiographical memories in individuals with schizophrenia. It also examines if the method used to activate autobiographical memories influenced the results and which theoretical accounts were proposed to explain the defective recall of autobiographical memories in patients with schizophrenia. METHODS: PsycINFO, Web of Science, and PubMed databases were searched for articles published between January 1998 and December 2018. Fifty-seven studies met the inclusion criteria. All studies implemented the generative retrieval strategy by inducing memories through cue words or pictures, the life-stage method, or open-ended retrieval method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines were followed for this review. RESULTS: Most studies reported that patients with schizophrenia retrieve less specific autobiographical memories when compared to a healthy control group, while only three studies indicated that both groups performed similarly on memory specificity. Patients with schizophrenia also exhibited earlier reminiscence bumps than those for healthy controls. The relationship between comorbid depression and autobiographical memory specificity appeared to be independent because patients' memory specificity improved through intervention, but their level of depression remained unchanged. The U-shaped retrieval pattern for memory specificity was not consistent. Both the connection between the history of attempted suicide and autobiographical memory specificity, and the relationship between psychotic symptoms and autobiographical memory specificity, remain inconclusive. Patients' memory specificity and coherence improved through cognitive training. CONCLUSIONS: The overgeneral recall of autobiographical memory by patients with schizophrenia could be attributed to working memory, the disturbing concept of self, and the cuing method implemented. The earlier reminiscence bump for patients with schizophrenia may be explained by the premature closure of the identity formation process due to the emergence of psychotic symptoms during early adulthood. Protocol developed for this review was registered in PROSPERO (registration no: CRD42017062643).

The development of an integrated behavioural model of patient compliance with diabetes medication: a mixed-method study protocol.

BACKGROUND: There has been a shift in worldwide disease burden from infections to non-communicable diseases, especially type 2 diabetes (T2D). Behavioural change and self-management are key to optimal T2D control. Several universal models of diabetic care have been proposed to help explain the dimensions of T2D self-care such as medication adherence, physical activity, diet and patient-doctor interaction. These models do not allow an objective and quantifiable measurement of the problems faced by patients in terms of medication compliance. OBJECTIVE: To create a comprehensive conceptual model of behavioural change related to T2D medication compliance. METHODS: A cross-sectional study will be conducted at a regional primary care clinic using a mixed-method technique. First, a Grounded Theory qualitative inquiry will be used to investigate predictors of medication adherence in T2D patients. Consequently, the elements derived from the interview will be incorporated into the Theory of Planned Behaviour framework to generate an integrated behavioural model. This model will then be used to quantify the factors related to compliance with medication amongst T2D patients. DISCUSSION: The framework developed here could help in the design of policies to optimize T2D control by identifying lapses in patients' intake of diabetic medications. This can be done by exploring the patients' fundamental and unarticulated belief system via a naturalistic approach adopted in this study. The properties of the framework can be replicated in other settings to serve as a benchmark for quality improvement in T2D patient care.

Investigating the mediating role of self-construal on the relationship between cultural group (Malay and Australian) and the characteristics and functional use of autobiographical memory.

Cultural differences in autobiographical memory characteristics and function have often been presumed to be associated with different cultural beliefs related to the self. The current research aimed to investigate whether self-construal mediated the relationship between cultural group and the characteristics and functional use of autobiographical memory. Caucasian Australians (n = 71) and Malay Malaysians (n = 50) completed an online questionnaire that included the Self-Defining Memory task, the Thinking About Life Experiences Revised Questionnaire and the Self Construal Scale. As expected, the Australian group provided longer, more autonomously oriented, specific memories than the Malay group. However, contrary to our predictions, self-construal did not mediate the relationships between cultural group and memory characteristics. The Malay group reported more frequently using autobiographical memories for self-continuity than the Australian group. Finally, there was support for an indirect pathway between cultural group and use of autobiographical memories for self-continuity and social-bonding through self-construal (i.e. independent self relative to interdependent self). The findings highlight the importance of explicitly examining values assumed to be associated with autobiographical remembering, and relating these values to memory characteristics and function.

The transmission and stability of cultural life scripts: a cross-cultural study.

Cultural life scripts are shared knowledge about the timing of important life events. In the present study, we examined whether cultural life scripts are transmitted through traditions and whether there are additional ways through which they can be attained by asking Australian and Malaysian participants which information sources they had used to generate the life script of their culture. Participants hardly reported that they had used cultural and religious traditions. They more often reported that they had used their own experiences and experiences of relatives and friends. They also reported the use of comments of relatives and friends and the use of newspapers, books, movies and television programmes. Furthermore, we examined the stability of life scripts and similarities and differences across cultures. We found that life scripts are stable cognitive structures and that there are, besides cross-cultural differences in the content, small cross-cultural differences in the valence and distribution of life script events, with the Australian life script containing more positive events and more events expected to occur before the age of 16.

Autobiographical memory and hierarchical search strategies in depressed and non-depressed participants.

BACKGROUND: There is a growing body of literature showing individuals with depression and other trauma-related disorders (e.g., posttraumatic stress disorder) recall more overgeneral and less specific autobiographical memories compared to normal participants. Although the mechanisms underlying overgeneral memory are quite clear, the search strategy operated within the autobiographical knowledge base, at time of recollection, requires further exploration. The current study aimed to examine the hierarchical search sequence used to recall autobiographical memories in depressed and non-depressed participants, with a view to determining whether depressed participants exhibited truncated search strategies. METHODS: Thirteen depressed and an equal number of non-depressed participants retrieved 15 memories each, in response to 15 commonly used cue words. Participants reported the first memory that entered in their mind. All memory descriptions were recorded and later transcribed verbatim for content analysis. RESULTS: Depressed participants retrieved autobiographical memories faster, produced shorter memory descriptions and were less likely to recall positive memories than non-depressed participants. Non-depressed participants were more likely to commence retrieval by accessing lifetime period knowledge followed by general event and event specific knowledge, whereas depressed participants showed a tendency to terminate retrieval at the general event level. CONCLUSIONS: It is concluded that depressed participants do adhere to the same hierarchical search strategy as non-depressed participants when retrieving specific autobiographical memories, but that they terminate their search early, resulting in overgeneral memories.

Light exposure behaviors predict mood, memory and sleep quality.

Ample research has shown that light influences our emotions, cognition, and sleep quality. However, little work has examined whether different light exposure-related behaviors, such as daytime exposure to electric light and nighttime usage of gadgets, especially before sleep, influence sleep quality and cognition. Three-hundred-and-one Malaysian adults (MeanAge±SD = 28 ± 9) completed the Light Exposure Behavior Assessment tool that measured five light exposure behaviors. They also completed the Morningness-Eveningness Questionnaire, Positive and Negative Affect Schedule, Pittsburgh Sleep Quality Index, and single items assessing trouble in memory and concentration. A partial least square structural equation model, showing 72.72% predictive power, revealed that less use of wearable blue filters outdoors during the day and more within one hour before sleep predicted early peak time (direct effect = -0.25). Increased time spent outdoors predicted a positive affect (direct effect = 0.33) and a circadian phase advancement (direct effect: rising time = 0.14, peak time = 0.20, retiring time = 0.17). Increased use of mobile phone before sleep predicted a circadian phase delay (direct effect: retiring time = -0.25; rising time = -0.23; peak time = -0.22; morning affect = -0.12), reduced sleep quality (direct effect = 0.13), and increased trouble in memory and concentration (total effect = 0.20 and 0.23, respectively). Increased use of tunable, LED, or dawn-simulating electric light in the morning and daytime predicted a circadian phase advancement (direct effect: peak time = 0.15, morning affect = 0.14, retiring time = 0.15) and good sleep quality (direct effect = -0.16). The results provide valuable insights into developing a healthy light diet to promote health and wellness.

Modifiable and nonmodifiable factors associated with anxiety, depression, and stress after one year of the COVID-19 pandemic.

BACKGROUND: People worldwide have experienced various mental health issues during the COVID-19 pandemic. This study investigates the modifiable and nonmodifiable predictors of anxiety, depression, and stress among Bangladeshi participants after one year of the pandemic. METHOD: A large group of adult participants (N = 1897), recruited from eight administrative divisions in Bangladesh, completed an online survey in May and June 2021 when the Movement Control Order was in place. We used the Beck Anxiety Inventory, Patient Health Questionnaire-9, and Perceived Stress Scale-4 to assess the participants' anxiety, depression, and stress. We also gave the Mindful Attention Awareness Scale and Life-Orientation Test-Revised to assess mindfulness and optimism. RESULTS: The results revealed that the prevalence rates for anxiety and depression were 62.5% and 45.3%, respectively. Multivariate analyses showed that several nonmodifiable factors, such as those who were students, unmarried and females, and those living in the Northern region (Rajshahi and Mymensingh division) and dwelling in the rural areas, suffered from worse mental health (accounted for 5%-23% of the variances in the mental health outcome scores). Modifiable factors accounted for an additional 10%-25% of the variances in the same outcome variables. Adults with higher mindfulness and optimism, living in the country's Southern region (Chattogram division) and those who took both vaccine doses and had no history of mental illness reported better mental health. CONCLUSION: Anxiety, depression, and stress remained high in Bangladeshi adults after one year of the pandemic. The community-based interventions should aim to increase the mindfulness and optimism levels among the sufferers. More accelerated vaccination programs across the country could protect people from suffering from overall mental distress.

Mental health and suicide risk among homosexual males in Bangladesh.

BACKGROUND: Homosexual individuals are at high risk of suicide, but there is a shortage of data from developing countries to confirm this. Estimates on mental health and suicide risk among male homosexuals in Bangladesh are needed to generate awareness and to plan services accordingly. METHOD: We assessed mental health and suicidal behavior of 102 self-identified homosexual males from a community-based organization that works with the sexual minority population. RESULTS: One-third of the participants (32.4%) had experienced attempted suicide, and almost half (47.1%) had a history of suicidal ideation and self-harm (40.2%). Compared to a heterosexual sample, homosexual males had poorer mental health as they scored higher on Beck Hopelessness Scale (Cohen's d = 0.29) and General Health Questionnaire (GHQ) (Cohen's d = 0.57). The results revealed positive correlations between self-harm, suicidal ideation and suicide attempt scores. Participants with history of suicide attempt, suicide ideation and self-harm reported worse general health, more social dysfunction, and severe depression than those without such history. CONCLUSION: Suicidality and mental health conditions among homosexual males in Bangladesh have appeared to be alarming. Given the concerns, we offer some recommendations for practitioners and social workers who are serving this population in Bangladesh.

Exploring the associations between social support and symptoms of posttraumatic stress disorder among Malaysian and Australian trauma survivors.

Background: Social support is an important feature in understanding posttraumatic stress disorder (PTSD) and its treatment. Non-clinical research has identified distinct profiles of culturally appropriate social support. Despite this, little research has examined cultural influences on social support in the context of PTSD.Objective: This study examined cultural differences in the associations between social support and symptoms of PTSD.Method: The study employed a cross-sectional design. Australian (n = 91) and Malaysian (n = 91) trauma survivors completed an online survey assessing PTSD symptomatology and social support (explicit and implicit social support, perceived helpfulness of support provider, attitudes towards professional help-seeking). A quasi-experimental paradigm assessed the influence of mutual (i.e. the sharing of support between relationship partners) and non-mutual support (i.e. where one person constantly receives support, while the other person constantly provides support) on negative emotion and subjective distress.Results: First, explicit social support was negatively associated with PTSD symptoms for the Australian group but not the Malaysian group. Second, perceived helpfulness of support from family was negatively associated with PTSD symptoms for the Malaysian group but not the Australian group. Third, the Malaysian group reported significantly greater distress for non-mutual support and significantly fewer negative emotions and distress for mutual support than the Australian group. Fourth, the Malaysian group reported that they were significantly more open to acknowledging psychological problems and the possibility of seeking professional help for these problems than the Australian group.Conclusions: As the PTSD social support literature continues to evolve, it is essential that cultural influences are considered given the important theoretical and clinical implications.

Social support is an important feature in understanding posttraumatic stress disorder (PTSD). While non-clinical research has identified distinct profiles of culturally appropriate social support, little research has examined cultural influences on social support in the context of posttraumatic stress disorder.Disclosing the trauma to others and explicating requesting assistance was negatively associated with PTSD symptoms for the Australian group but not the Malaysian group. Support from family was negatively associated with PTSD symptoms for the Malaysian group but not the Australian group. The Malaysian group reported significantly greater distress for non-mutual support and significantly less negative affect and distress for mutual support than the Australian group.As the psychotraumatology literature continues to evolve, it is essential that cultural influences on social support are considered given the important theoretical and clinical implications.

Examining the associations between control (primary and secondary) appraisals and posttraumatic stress disorder symptoms in Malaysian and Australian trauma survivors.

Background: Little research has considered the influence of culture on control appraisals in the context of posttraumatic stress disorder (PTSD). Objectives: This study aimed to investigate whether cultural group moderated the relationship between control (primary and secondary) appraisals and PTSD symptoms in trauma survivors from Western (Australian) and Asian (Malaysian) cultural contexts. Methods: Trauma survivors (107 Australian with European cultural heritage; 121 Malaysian with Malay, Indian or Chinese cultural heritage) completed an online survey assessing PTSD symptoms and appraisals of control. Results: Cultural group moderated the association between primary control and PTSD symptoms; the positive association was significant for the Australian group but not the Malaysian group. While cultural group did not moderate the association between secondary control and PTSD symptoms, there was an indirect pathway between secondary control appraisals and PTSD symptoms through interdependent self-construal for both cultural groups. Conclusion: The findings indicate that cultural group and self-construal influence the associations between different types of control appraisals and PTSD. Further research exploring the role of culture and different appraisal types in PTSD is needed.

An inventory of human light exposure behaviour.

Light exposure is an essential driver of health and well-being, and individual behaviours during rest and activity modulate physiologically relevant aspects of light exposure. Further understanding the behaviours that influence individual photic exposure patterns may provide insight into the volitional contributions to the physiological effects of light and guide behavioural points of intervention. Here, we present a novel, self-reported and psychometrically validated inventory to capture light exposure-related behaviour, the Light Exposure Behaviour Assessment (LEBA). An expert panel prepared the initial 48-item pool spanning different light exposure-related behaviours. Responses, consisting of rating the frequency of engaging in the per-item behaviour on a five-point Likert-type scale, were collected in an online survey yielding responses from a geographically unconstrained sample (690 completed responses, 74 countries, 28 time zones). The exploratory factor analysis (EFA) on an initial subsample (n = 428) rendered a five-factor solution with 25 items (wearing blue light filters, spending time outdoors, using a phone and smartwatch in bed, using light before bedtime, using light in the morning and during daytime). In a confirmatory factor analysis (CFA) performed on an independent subset of participants (n = 262), we removed two additional items to attain the best fit for the five-factor solution (CFI = 0.95, TLI = 0.95, RMSEA = 0.06). The internal consistency reliability coefficient for the total instrument yielded McDonald's Omega = 0.68. Measurement model invariance analysis between native and non-native English speakers showed our model attained the highest level of invariance (residual invariance CFI = 0.95, TLI = 0.95, RMSEA = 0.05). Lastly, a short form of the LEBA (n = 18 items) was developed using Item Response Theory on the complete sample (n = 690). The psychometric properties of the LEBA indicate the usability for measuring light exposure-related behaviours. The instrument may offer a scalable solution to characterise behaviours that influence individual photic exposure patterns in remote samples. The LEBA inventory is available under the open-access CC-BY license. Instrument webpage: https://leba-instrument.org/ GitHub repository containing this manuscript: https://github.com/leba-instrument/leba-manuscript .

Psychometric evaluation of the Bangla-Translated Rotter's Internal-External Scale through classical test theory and item response theory.

There is no psychometric tool to assess locus of control for Bangla-speaking people. Hence, we attempted to translate the 23-item Rotter's Internal-External scale into Bangla and validate it on Bangladeshi adult participants. In Study 1 (N = 300), we translated the items into Bangla and conducted an exploratory factor analysis, which gave a one-factor solution with 12 items. In Study 2, we conducted a validation study (N = 178) to accumulate evidence on the structural and concurrent validity of the 12-item scale. Structural validity assessed by confirmatory factor analysis yielded the best fit for the one-factor model with 11 items (CFI = 0.98, TLI = 0.97, RMSEA = 0.00). The scale's significant correlations with Internal Control Index, which is also a measure of locus of control (r = -0.22, p < 0.01), Neuroticism (r = 0.21, p < 0.01) and Openness to Experience (r = -0.22, p < 0.01) demonstrated its satisfactory concurrent validity. Reliability coefficient of this 11-item scale was satisfactory (McDonald's Omega total = 0.72). The item quality was assessed on the combined samples of Study 1 & 2 (N = 478) using the item response theory (IRT), which showed that the scale covered a sizable range of the underlying locus of control with items varying in difficulty (-1.09-2.79). Item discrimination analysis indicated sufficient discriminating power of the items (0.49-2.21). The test information curve showed the scale's adequate ability to discriminate between external and internal locus of control. IRT analysis also indicated satisfactory marginal reliability for the scale (0.72). These psychometric properties suggest the usability of the Bangla version of Rotter's Internal-External scale.

Culture and understanding the role of feedback for health professions students: realist synthesis protocol.

INTRODUCTION: Clinical education has moved to a 'competency-based' model with an emphasis on workplace-based learning and assessment which, in turn, depends on feedback to be effective. Further, the understanding of feedback has changed from information about a performance directed to the learner performing the task, to a dialogue, which enables the learner to act and develop.In health professional education, feedback is a complex interaction between trainee, supervisor and the healthcare system. Most published research on feedback in health professional education originates in Europe and North America. Our interest is on the impact of Culture on this process, particularly in the context of Asian cultures.The (scientific) realist approach of Pawson and Tilley provides a means to examine complex interventions in social situations, and thus is an appropriate lens to use for this study. This is a protocol for a realist synthesis which asks how, why and in what circumstances do Asian Cultures influence health professional trainees to seek, respond to and use feedback given in the clinical environment, if at all. METHODS AND ANALYSIS: An initial search was performed to help define the scope of the review question and develop our initial programme theory. The formal electronic search was carried out in February 2020 and included: CINAHL, ERIC, Medline and PsycInfo, and repeated in October 2020. Retrieved articles were imported into Covidence for screening and data extraction, after which components of the Context-Mechanisms-Outcomes configurations will be sought to refine the initial programme theory. ETHICS AND DISSEMINATION: As this study is a literature review, ethics approval is not required.The findings will be documented in line with the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) publications standards for Realist syntheses, and we plan to disseminate the findings by means of a peer-reviewed journal article and conference presentation(s).