Students' and tutors' experiences of remote 'student-patient' consultations.

BACKGROUND: Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. AIM: To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. METHOD: A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. RESULTS: Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student-patient interaction, and student-doctor interaction. DISCUSSION: Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students' psychological safety. Frequent debriefs could ameliorate this risk and positively impact student-doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients.[Box: see text].

"When we were allowed to go back the freedom, the vista, the delight It was just magic": Disruption and adaptation among people ageing-in-place in Ireland during COVID-19.

COVID-19 person-place disruptions may dislocate enabling resources and affect the short- and long-term wellbeing of individuals ageing-in-place. However, outcomes may vary according to individuals' personal experiences and capabilities to put in place adaptive strategies. Underpinned by the Conservation of Resources (COR) Theory, this study aimed to identify shifts in older people's relationships to place during the pandemic and to gain a deeper understanding of their adaptive strategies. We analysed data collected between April-May and October-November 2021 from the [Details omitted for double-blind reviewing], a qualitative investigation of community-dwellers based in Ireland and aged 65 years or over. Participants (n = 57) completed written submissions, narrative interviews and/or go-along interviews detailing their experiences during the pandemic. The mean age of participants was 74.9 years, 53% were female, 46% lived alone, and 86% lived in areas with high urban influence. Our framework analysis identified three thematic categories: 1) Characterization of individuals experiencing flow or disruption of place-resources; 2) Effects of place-resource disruptions; and 3) Adaptive strategies to manage disruption. Findings suggest that during the pandemic individuals ageing-in-place experienced trajectories of resistant flow, resilient flow, chronic disruption, or delayed disruption of place-resources, Participants' health and wellbeing was influenced in diverse ways by the threat of- and actual loss of material, social and affective resources. To compensate for disruptions, participants developed multiple adaptive strategies that highlight older people's potential to transform themselves, others, and their environments during times of adversity. These findings showcase the processes by which health enabling places may be maintained and generated, and present areas of opportunity for public health interventions seeking to support ageing populations during public health emergencies and beyond.

Depression, stress and body fat are associated with binge eating in a community sample of African American and Hispanic women.

OBJECTIVE: The purpose of this study was to examine the relationships among depressive symptoms, stress and severity of binge eating symptoms in a community sample of African American and Hispanic or Latina women. METHOD: Women (African American, n = 127; Hispanic or Latina, n = 44) completed measures of body composition, stress, depression, and binge eating. RESULTS: Scores on a depressive symptom scale indicated that 24.0 % of participants exhibited clinically significant levels of depressive symptoms. Mean binge eating scores were below the threshold for clinically diagnosed binge eating (12.99 ± 7.90). Mean stressful event scores were 25.86 ± 14.26 and the average stress impact score was 78.36 ± 55.43. Linear regression models found that body composition, stress impact score, and being classified as having clinically significant levels of depression were associated with severity of binge eating symptoms. CONCLUSION: Higher levels of percent body fat, a CES-D score ≥16 and higher WSI-Impact scores were associated with greater severity of binge eating symptoms.

Socio-ecological determinants of older people's mental health and well-being during COVID-19: A qualitative analysis within the Irish context.

Background: Evidence indicates that older people with biological and social vulnerabilities are at high risk of short- and long-term consequences related to the COVID-19 pandemic. However, studies have also highlighted that the crisis may present opportunities for personal growth if older individuals are met with appropriate resources and support. Objective: The aim of this study was to explore the perceptions of older people regarding how individual, social, and environmental factors have supported or hindered their well-being and health during COVID-19. Methods: We analyzed data collected between April-May and October-November 2021 from the Well-being, Interventions and Support during Epidemics (WISE) study, a qualitative investigation of community-dwellers based in Ireland and aged 65 years or over. Participants (n = 57) completed written submissions, narrative interviews and/or go-along interviews detailing their experiences during the pandemic. Framework analysis was carried out in NVivo 12 to identify determinants, linkages, and explanations within Bronfenbrenner's socio-ecological model. Results: The mean age of participants was 74.9 years, 53% were female, 45% lived alone, and 86% lived in areas with high urban influence. Our findings highlight the heterogeneous effect of COVID-19 across diverse older individuals who held distinct concerns, capabilities, and roles in society before and during the pandemic. Multi-scalar contextual characteristics such as individual's living arrangements, neighborhood social and built environments, as well as social expectations about aging and help seeking, had an influential role in participants' well-being and available supports. We identified mixed views regarding public health restrictions, but a consensus emerged questioning the suitability of one-size-fits-all approaches based on chronological age. Conclusions: Our results suggest that some negative pandemic consequences could have been avoided by increasing collaboration with older people and with the provision of clearer communications. The interdependencies identified between individual characteristics and socio-ecological factors that influenced participants' availability of supports and development of adaptive strategies represent areas of opportunity for the development of age-friendly interventions during and beyond public health crises.

Developing a continence care centre using an urban/academic model of continence care.

BACKGROUND: This paper describes the process of adopting the Canadian Continence Foundation's urban/academic model of continence care in the development of British Columbia's Bladder Care Centre, using a process that can serve as a model for other jurisdictions across Canada and internationally. METHOD: A multidisciplinary Working Group assessed the existing system, analyzed local and national statistics, and reviewed the literature on urinary incontinence and models of health care. Following approval from university and hospital authorities, continence services were reorganized including changing infrastructure, altering the location of multidisciplinary services and restructuring of funding and resource allocation. The process was overseen by a steering committee. RESULTS: The plan for the Bladder Care Centre involves diagnostic services and tertiary care coordinated with translational research in voiding dysfunction. Affiliations to university programs and teaching hospitals enable comprehensive interdisciplinary health professional education, training and research, which are distinguishing features of the Canadian Continence Foundation urban academic model. CONCLUSION: From the planning perspective, the Canadian Continence Foundation's urban/academic model of continence care was feasible to implement but required significant changes to hospital budgets and infrastructure related to the existing health care system. Program evaluation markers built into the plan will allow future reporting on whether actual improvements can be achieved, and the degree to which the plan can deliver cost savings.

The relationship between television advertising, children's viewing and their requests to Father Christmas.

OBJECTIVE: Children's letters to Father Christmas provide an opportunity to use naturalistic methods to investigate the influence of television advertising. METHODS: This study investigates the number of toy requests in the letters of children aged between 6 and 8 (n = 98) in relation to their television viewing and the frequency of product advertisements prior to Christmas. Seventy-six hours of children's television were sampled, containing over 2,500 advertisements for toys. RESULTS: Children's viewing frequency, and a preference for viewing commercial channels, were both related to their requests for advertised goods. Gender effects were also found, with girls requesting more advertised products than boys. CONCLUSION: Exploring the children's explicit understanding of advertising showed that children in this age group are not wholly aware of the advertisers' intent and that, together with their good recall of advertising, this may account for their vulnerability to its persuasive messages.

Physical therapy for urinary incontinence in postmenopausal women with osteoporosis or low bone density: a randomized controlled trial.

OBJECTIVE: To assess the effectiveness of 12 weekly physical therapy sessions for urinary incontinence (UI) compared with a control intervention, for reducing the number of UI episodes measured with the 7-day bladder diary, at 3 months and 1 year postrandomization. METHODS: A single parallel-group randomized controlled trial was conducted at one outpatient public health center, in postmenopausal women aged 55 years and over with osteoporosis or low bone density and UI. Women were randomized to physical therapy (PT) for UI or osteoporosis education. The primary outcome measure was number of leakage episodes on the 7-day bladder diary, assessed at baseline, after treatment and at 1 year. The secondary outcome measures included the pad test and disease-specific quality of life and self-efficacy questionnaires assessed at the same timepoints. RESULTS: Forty-eight women participated (24 per group). Two participants dropped out of each group and one participant was deceased before 3-month follow-up. Intention-to-treat analysis was undertaken. At 3 months and 1 year, there was a statistically significant difference in the number of leakage episodes on the 7-day bladder diary (3 mo: P = 0.04; 1 y: P = 0.01) in favor of the PT group. The effect size was 0.34 at 1 year. There were no harms reported. CONCLUSIONS: After a 12-week course of PT once per week for UI, PT group participants had a 75% reduction in weekly median number of leakage episodes, whereas the control group's condition had no improvement. At 1 year, the PT group participants maintained this improvement, whereas the control group's incontinence worsened.

Relationship of fruit, vegetable, and fat consumption to binge eating symptoms in African American and Hispanic or Latina women.

African American (AA) and Hispanic or Latina (HL) women have the highest rates of overweight and obesity of any gender and ethnic groups. Binge eating disorder (BED) is the most common eating disorder in the United States and is linked to overweight and obesity. Traditional treatments for BED may not be appropriate or viable for AA and HL women, because they are less likely than whites to seek treatment for psychological conditions and may have less access to healthcare. Improving dietary habits in those with BED or subthreshold BED may reduce binge eating symptoms. The current study investigated the association of fruit, vegetable, and fat consumption to binge eating symptoms in AA and HL women. AA and HL women in the Health Is Power (HIP) study (N=283) reported fruit and vegetable intake, fat intake, and binge eating symptoms. Women were middle aged (M=45.8 years, SD=9.2) and obese (M BMI=34.5 kg/m(2), SD=7.5). Greater fat consumption was correlated with lower fruit and vegetable consumption (r(s)=-0.159, p<0.01). Higher BMI (r(s)=0.209, p<0.01), and greater fat consumption (r(s)=0.227, p<0.05) were correlated with increased binge eating symptoms. Multiple regression analysis demonstrated that for HL women (ß=0.130, p=0.024), higher BMI (ß=0.148, p=0.012), and greater fat consumption (ß=0.196, p=0.001) were associated with increased binge eating symptoms (R(2)=0.086, F(3,278)=8.715, p<0.001). Findings suggest there may be a relationship between fat consumption and binge eating symptoms, warranting further study to determine whether improving dietary habits may serve as a treatment for BED in AA and HL women.