Determining the Impact of an Educational Intervention on Family Medicine Residents' Social Cognitions and Behavior for Discussing Physical Activity.

Problem: Primary care providers are recognized as important advocates for physical activity (PA); yet, clinical PA discussions remain infrequent. Educational approaches promoting the uptake of strategies that are proven to increase patient PA levels are effective for improving primary care providers' social cognitions and behavior for discussing PA with patients. However, research on the effectiveness of such educational interventions among family medicine residents is limited. Intervention: Using the Theory of Planned Behavior (TPB), an interactive, educational intervention was developed to increase PA discussion between first year family medicine residents and their patients. This study aimed to determine the impact of the intervention on residents' social cognitions and behavior for discussing PA with all adult (18-64 years) patients. Context: The intervention condition was comprised of 15 first year residents (2017/2018) who: (1) received the full intervention, and (2) completed both the pre- and post-intervention TPB questionnaires assessing changes in PA discussion social cognitions, and (3) had their medical charts reviewed for PA discussion behavior. The nonintervention condition was comprised of 15 first-year residents (2016/2017) who were randomly selected to have their medical charts reviewed for PA discussion behavior. Impact: Although no significant differences in social cognitions were observed pre- vs. post-intervention, intervention condition residents' perceptions of feeling adequately trained to discuss PA increased post-intervention (p = 0.005). A difference in residents' PA discussion behavior was observed between conditions at post (p = 0.01), where PA was discussed at more patient visits among intervention condition residents. Lessons Learned: Findings suggest that the observed effect of resident PA discussion behavior being greater in the intervention condition at post may be attributed to the intervention condition residents having received the theory-based, educational workshops. This study highlights the importance of educating and training residents on strategies for PA discussion; however, future interventions should address both the reflective and automatic processing aspects of behavior and strive to influence organizational factors that impact resident behavior for discussing PA.Supplemental data for this article is available online at at 10.1080/10401334.2021.1891542.

Urinary incontinence among competitive rope-skipping athletes: a cross-sectional study.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to determine the prevalence, impact and management of stress urinary incontinence (SUI) among rope-skipping (RS) athletes. METHODS: A cross-sectional observational study was employed. Survey #1 (current athletes): RS athletes aged ≥13 years attending a national RS competition (183) were invited to participate. The primary outcome was the prevalence of SUI during RS (yes/no question). Secondary outcomes included SUI interference with RS (Likert scale, 0-10), quality of life (ICIQ-SF), and the prevalence and bothersomeness of SUI for each RS event (un-validated sport-specific questionnaire inspired by the IIQ-7). Survey #2 (retired athletes): retired RS athletes were invited to complete an online questionnaire to identify whether SUI contributed to their retirement from RS. RESULTS: Survey #1: 56% (103 out of 183) of athletes responded. Athletes were predominantly girls of adolescent age, normal weight, menarchal, and nulliparous. Seventy-five percent of the girls (67 out of 89) and 7% of boys (1 out of 14) reported SUI during RS, mostly when competing "double-unders" and "triple-unders." Twenty-one percent (14 out of 67) of affected girls indicated a moderate or greater interference of SUI with RS, although the median impact of SUI on their overall quality of life was slight. Female athletes managed SUI with containment products, fluid limitation, and timed voiding. Survey #2: one of the 77 respondents (74 females, 3 males) indicated that SUI contributed to their retirement from RS. CONCLUSIONS: Similar to other high-impact sports, female RS athletes experience a relatively high rate of SUI while participating in RS, which may lead to decreased quality of life.

Evaluating the Implementation and Impact of a Motivational Interviewing Workshop on Medical Student Knowledge and Social Cognitions Towards Counseling Patients on Lifestyle Behaviors.

Problem: Although motivational interviewing is an effective patient-centered counseling method that healthcare providers can adopt to promote positive behavior change among patients, motivational interviewing is not routinely taught in medical schools. Intervention: A 3.5-hour motivational interviewing workshop was delivered to second year students at a Canadian medical school. Students were first introduced to the concept of motivational interviewing, and then given an opportunity to apply this knowledge in smaller seminar groups to increase their competency within the context of lifestyle behaviors. Context: Using the Theory of Planned Behavior, this study sought to evaluate the impact of the workshop on medical students' motivational interviewing knowledge and social cognitions. Questionnaires were distributed to students pre- and immediately post-workshop to gather student demographics, previous motivational interviewing experience, current motivational interviewing knowledge and Theory of Planned Behavior social cognitions for using motivational interviewing. Repeated-measures ANOVAs assessed changes in motivational interviewing knowledge and social cognitions. During the workshop, a process evaluation assessing fidelity to and quality of motivational interviewing instruction was conducted. Outcome: The process evaluation indicated high fidelity and high quality of delivery of the workshop by all facilitators. Students (N = 27; Mage = 24 ± 2 years) reported significant increases in motivational interviewing knowledge from pre- to post-workshop (p = 0.001). Although not significant, small-to-moderate effect sizes in changes in social cognitions were reported from pre- to post-workshop. Lesson Learned: Medical students hold motivational interviewing in a high regard, as evidenced by the relatively high social cognitions observed prior to the commencement of the workshop. We learned that while a shorter, workshop-style approach is successful in increasing motivational interviewing knowledge, future workshops should allocate more time to skill acquisition to ensure proficiency in clinical use. Practice PointsMotivational interviewing (MI), an effective patient-centred counseling method that promotes positive patient behavior change, is not routinely taught in medical schools.The theory-based evaluation of the implementation and impact of an MI workshop for second year medical students revealed high quality of delivery and significant improvements in self-reported MI knowledge.While the workshop was implemented as intended and based on the Theory of Planned Behavior, no significant changes in students' social cognitions for using MI with future patients was seen from pre- to post-workshop.The fulsome workshop description and suggestions for future workshop modifications may be adopted by others interested in incorporating MI-specific training into the medical school curriculum.

Pyrroles as antioxidants: solvent effects and the nature of the attacking radical on antioxidant activities and mechanisms of pyrroles, dipyrrinones, and bile pigments.

The absolute rate constants, k(inh), and stoichiometric factors, n, of pyrroles, 2-methyl-3-ethylcarboxy-4,5-di-p-methoxyphenylpyrrole, 6, 2,3,4,5-tetraphenylpyrrole, 7, and 2,3,4,5-tetra-p-methoxyphenylpyrrole, 8, compared to the phenolic antioxidant, di-tert-butylhydroxyanisole, DBHA, during inhibited oxidation of cumene initiated by AIBN at 30 degrees C gave the relative antioxidant activities (k(inh)) DBHA > 8 > 7 > 6 and n = 2, whereas in styrene, 8 > DBHA. These results are explained by hydrogen atom transfer, HAT, from the N-H of pyrroles to ROO(*) radicals. The k(inh) values in styrene of dimethyl esters of the bile pigments of bilirubin ester (BRDE), of biliverdin ester (BVDE), and of a model compound (dipyrrinone, 1) gave k(inh) in the order pentamethylhydroxychroman (PMHC) >> BRDE > 1 > BVDE. These antioxidant activities for BVDE and the model compound, 1, and PMHC dropped dramatically in the presence of methanol due to hydrogen bonding at the pyrrolic N-H group. In contrast the k(inh) of BRDE increased in methanol. We now show that pyrrolic compounds may react by HAT, proton-coupled electron transfer, PCET, or single electron transfer, SET, depending on their structure, the nature of the solvent, and the attacking radical. Compounds BVDE and 1 react by the HAT or PCET pathway (HAT/PCET) in styrene/chlorobenzene with ROO(*) and with the DPPH(*) radical in chlorobenzene according to N-H/N-D kH/kD of 1.6, whereas the DKIE with BRDE was only 1.2 with ROO(*). The antioxidant properties of polypyrroles of the BVDE class and model compounds (e.g., 1) are controlled by intramolecular H bonding which stabilizes an intermediate pyrrolic radical in HAT/PCET. According to kinetic polar solvent effects on the monopyrrole, 8, and BRDE, which gave increased rates in methanol, some pyrrolic structures are also susceptible to SET reactions. This conclusion is supported by some calculated ionization potentials. The antioxidant mechanism for BRDE with peroxyl radicals is described by the PCET reaction. Experiments using the 2,6-di-tert-butyl-4-(4'-methoxyphenyl)phenoxyl radical (DBMP(*)) showed this to be a better radical to monitor HAT activities in stopped-flow kinetics compared to the use of the more popular DPPH(*) radical.