Predictors of Literacy and Attitudes Toward Reading Among Syrian Refugee Children in Jordan.

Refugee children often face disruptions to their education before and during displacement. However, little is known about either levels or predictors of refugee children's literacy or about their attitudes toward reading in low- or middle-income countries. To address this, we conducted in-home literacy assessments using the Holistic Assessment of Learning and Development Outcomes with 322 Syrian refugee mother-child dyads who lived in Jordan (child age range 4-8 years, M = 6.32 years, 50% female). Overall, the children had quite low levels of literacy, although they indicated a strong enthusiasm for reading. Child age, maternal education, and maternal ability to read all predicted child literacy, although maternal literacy predicted it only among children enrolled in school. Among those enrolled in school (64.9% of the total sample, 88.7% of those aged ≥ 6), students attending hybrid classes had better literacy than those attending either solely in-person or solely online, although the frequency of school attendance did not predict literacy. A less consistent pattern emerged for predicting children's attitudes toward reading. Our results suggest an urgent need to improve literacy skills among refugee children in Jordan, as well as a need for validated measures of attitudes toward reading for use with Arabic-speaking youth. Supplementary Information: The online version contains supplementary material available at 10.1007/s13158-022-00334-x.

Testing the impact of interpersonal regulatory fit on empathy, helping intentions, and prosocial behaviour.

Similarity with others in need regarding various attributes [e.g., social group membership] has been shown to increase individuals' empathic responses, willingness to help and prosocial behaviour. We tested whether a subtle similarity, namely of observers' and targets' self-regulatory orientation in terms of a promotion or prevention regulatory focus [i.e., interpersonal regulatory fit], would entail similar effects. Interpersonal regulatory [mis]fit was conveyed through focus-congruent or -incongruent emotional reactions which targets, facing distressing situations, expressed. We predicted that when observer participants' regulatory focus fits with targets' negative emotional reaction [i.e., promotion focus-dejection or prevention focus-agitation], they would be more likely to express empathy, willingness to help, and to engage in prosocial behaviour towards this target compared to conditions of misfit. Five studies relied on observers' chronic regulatory focus [Study 1, 3, & 4] and situationally induced regulatory focus [Study 2 & 5] and presented different distressing scenarios with targets conveying focus [in]congruent negative emotions. Inconsistent results emerged across the studies, which indicated misfit, fit and no effects. Study characteristics did not suggest a moderator explaining these inconsistent findings. An internal meta-analysis across all studies indicated that overall there was no evidence of either a fit or a misfit effect. This work sheds light on the technical challenges of exploring relations between subtle interpersonal regulatory [mis]fit and prosocial reactions. Implications for future research are discussed, including the importance of creating stronger interpersonal [mis]fit experiences by means of incorporating descriptions of distressed targets' hindered goal pursuits as well as negative reactions.

Public knowledge of emergency medicine in Beirut, Lebanon.

INTRODUCTION: To examine the public's level of knowledge and expectations of Emergency Medicine (EM) in Beirut, Lebanon. METHODS: A nested cross-sectional study was conducted exploring participants' knowledge and expectations of EM; the skillset, role and scope of practice of the emergency physician, and the dynamics of the Emergency Department (ED). RESULTS: A majority understand EM physicians perform minor procedures (83%), have specialized training (79%) and that they should be treated by a specialized EM physician (74%). However, they also believed they should visit the ED for faster service (81%) or whenever they cannot be seen by their doctor (71%); most also expected to see their personal doctors in the ED (88%). There were significant misconceptions that ED physician could be a general doctor (84%), a specialist (81%) or a family doctor (70%). Half believe patients have the right to order blood tests (46%) or X-rays (50%) and to be admitted to the hospital at their preference (51%). Most (90%) expected patients with a possibly life-threatening problem to be treated immediately, and 48% a wait of less than thirty minutes for a non-life threatening problem. Half (54%) expected test results returned within thirty minutes, and 62% expected to spend less than sixty minutes in the ED. CONCLUSION: There is poor recognition of the role of the EM physician and the dynamics of the ED among the Lebanese population. Awareness campaigns targeted to improve understanding may help align expectations with the reality of the practice of EM.

Neurocognitive Predictors of Clinical Improvement in Selective Serotonin Reuptake Inhibitor-Treated Adolescents with Major Depressive Disorder.

OBJECTIVES: Numerous studies have suggested cognitive deficits as consistently associated with adolescent depression. No study to date, however, has assessed neurocognitive predictors of selective serotonin reuptake inhibitor (SSRI) treatment response in adolescents with depression. This study examined neurocognitive tasks at baseline as predictors of clinical improvement with SSRI treatment (fluoxetine) at week 6 and 12 in an adolescent population. METHODS: Adolescents with depression were recruited from a child and adolescent psychiatry outpatient clinic at a university medical center. Twenty-four adolescents (mean age 14.8 years) with Major Depressive Disorder completed tasks of the Cambridge Neuropsychological Test Automated Battery, including visual memory, executive functioning, sustained attention, and impulsivity. Depression severity, measured by the Children's Depression Rating Scale-Revised (CDRS-R), was assessed at week 6 and 12 and clinical improvement was defined as percentage (%) change in CDRS-R from baseline. RESULTS: Clinical improvement is noted at both week 6 (mean % change in CDRS-R [M] = 46.8, standard deviation [SD] = 51.9) and week 12 (M = 87.9, SD = 57.2). Results reveal that less difficulty in sustained attention (p = 0.02), lower impulsivity (p = 0.00), and better planning (p = 0.04) at baseline were predictors of greater clinical improvement at week 6. Lower impulsivity at baseline remained significantly predictive of clinical improvement at week 12 (p = 0.01). CONCLUSION: Neurocognitive assessments could potentially help identify a subset of depressed adolescents who may not respond to conventional SSRI treatment and who may be better candidates for alternative or augmentation treatments.

Challenges in measuring ACGME competencies: considerations for milestones.

BACKGROUND: Measuring milestones, competencies, and sub-competencies as residents progress through a training program is an essential strategy in Accreditation Council for Graduate Medical Education (ACGME)'s attempts to ensure graduates meet expected professional standards. Previous studies have found, however, that physicians make global ratings often by using a single criterion. METHODS: We use advanced statistical analysis to extend these studies by examining the validity of ACGME International competency measures for an international setting, across emergency medicine (EM) and neurology, and across evaluators. Confirmatory factor analysis (CFA) models were fitted to both EM and neurology data. A single-factor CFA was hypothesized to fit each dataset. This model was modified based on model fit indices. Differences in how different EM physicians perceived the core competencies were tested using a series of measurement invariance tests. RESULTS: Extremely high alpha reliability coefficients, factor coefficients (> .93), and item correlations indicated multicollinearity, that is, most items being evaluated could essentially replace the underlying construct itself. This was true for both EM and neurology data, as well as all six EM faculty. CONCLUSIONS: Evaluation forms measuring the six core ACGME competencies did not possess adequate validity. Severe multicollinearity exists for the six competencies in this study. ACGME is introducing milestones with 24 sub-competencies. Attempting to measure these as discrete elements, without recognizing the inherent weaknesses in the tools used will likely serve to exacerbate an already flawed strategy. Physicians likely use their "gut feelings" to judge a resident's overall performance. A better process could be conceived in which this subjectivity is acknowledged, contributing to more meaningful evaluation and feedback.

Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department.

INTRODUCTION: Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions. METHODS: We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period. RESULTS: Overall, E-prescriptions included fewer prescription errors as compared to HW-prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p <0.0001), missing frequency (3.5% to 2.2%, p=0.04), missing strength errors (32.4% to 10.2%, p <0.0001) and legibility (0.7% to 0.2%, p=0.005). E-prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02). CONCLUSION: A basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

The effect of patient death on medical students in the emergency department.

BACKGROUND: The emotional consequences of patient deaths on physicians have been studied in a variety of medical settings. Reactions to patient death include distress, guilt, and grief. Comparatively, there are few studies on the effects of patient death on physicians and residents in the Emergency Department (ED). The ED setting is considered unique for having more sudden deaths that likely include the young and previously healthy and expectations for the clinician to return to a dynamic work environment. To date, no studies have looked at the effects of patient deaths on the more vulnerable population of medical students in the ED. This study examined aspects of patient deaths in the ED that most strongly influence students' reactions while comparing it to those of an inpatient setting. METHODS: Semi-structured qualitative interviews were carried out with a total of 16 medical students from the American University of Beirut, Medical Center in Lebanon who had recently encountered a patient death in the ED. Questions included their reaction to the death, interaction with patients and their family members, the response of the medical team, and coping mechanisms adopted. RESULTS: The analysis revealed the following as determinant factors of student reaction to patient death: context of death; including age of patient, expectation of death, first death experience, relating patient death to personal deaths, and extent of interaction with patient and family members. Importantly, deaths in an inpatient setting were judged as more impactful than ED deaths. ED deaths, however, were especially powerful when a trauma case was deemed physically disturbing and cases in which family reactions were emotionally moving. CONCLUSION: The study demonstrates that students' emotional reactions differ as a function of the setting (surprise and shock in the ED versus sadness and grief in an inpatient setting). Debriefing and counseling sessions on ED deaths may benefit from this distinction.

Testing Cognitive and Emotion-Focused Models of Worry in Black and White Samples.

Several models have been proposed to conceptualize worry. Broadly, the models can be classified as cognitive (including the Avoidance Model, the Intolerance of Uncertainty Model, and the Metacognitive Model) and emotion-focused (including Emotion Dysregulation and Acceptance-Based models). Although these models have received strong empirical investigation in primarily non-Hispanic White samples, no known study has examined the applicability to racial and ethnic minority groups. The current study compared the proportion of variance explained by cognitive and emotion-focused models of worry in White and Black samples. Results indicated that cognitive and emotion-focused models significantly predicted worry in both Black and White samples. However, the overall amount of variance in worry explained by the models was less for Black samples. Specifically, controlling for gender, the cognitive models explained 53% of the variance in worry in the White sample compared with 19% in the Black sample. Similarly, the emotion-focused models explained 34% of the variance in worry in the White sample but only 13% in the Black sample. These findings suggest that well-established conceptual frameworks for worry failed to explain the bulk of the variance in worry in Black samples, leaving much unknown. Additional research is needed to identify key variables that may further explain worry in ethnic minority samples.