A Cross-Sectional Study Assessing the Functional Status in Children With Juvenile Idiopathic Arthritis and Its Correlation With Their Quality of Life and Burden on Caregivers.

Background Juvenile idiopathic arthritis (JIA) is a common rheumatic disease in children, significantly impacting their functional status and quality of life (QoL), as well as imposing a burden on caregivers. This study aims to assess the functional status of children with JIA, their QoL, and the associated caregiver burden while exploring the correlations between these factors. Methodology A prospective, cross-sectional, observational study was conducted over 18 months. A total of 33 children diagnosed with JIA were evaluated using the Childhood Health Assessment Questionnaire (CHAQ), and Euro Quality of Life-5 Dimension-Youth (EQ-5D-Y). Caregiver burden was assessed using the Family Burden Interview Schedule (FBIS). Data were analyzed using descriptive statistics, regression analysis, and Spearman's rank correlation. Results A total of 33 consecutive children with JIA were prospectively enrolled. The mean age was 10.1 ± 3.7 years, with a male predominance (63.6%, n = 21). Enthesitis-related arthritis was the most common subtype (42%, n = 14). The CHAQ scores indicated moderate disability, with profound impacts on walking and arising. Most children reported "some problems" in all EQ-5D-Y domains, with a mean health status visual analog scale score of 60.97 ± 23.43. The mean FBIS score was 9.64 ± 5.78, indicating a moderate caregiver burden. The majority of caregivers reported moderate financial, family routine, and family leisure disruptions. Significant correlations were found between CHAQ and EQ-5D-Y scores in several domains (p ≤ 0.040), as well as between specific CHAQ domains and FBIS scores (p ≤ 0.037). Conclusions Children with JIA experience significant functional limitations and reduced QoL, which also impacts their caregivers. Early rehabilitation and comprehensive care strategies are crucial for improving functional outcomes and QoL, as well as alleviating caregiver burden.

Using qualitative exit interviews to explore schizophrenia burden and treatment experience in clinical trial patients.

Introduction: Qualitative research methods can be used to obtain a deeper understanding of patient experience by collecting information in the patients' own words about their encounters, perspectives, and feelings. In this study, patients with schizophrenia were interviewed to capture their voice and to complement the quantitative data typically obtained in clinical trials. Methods: Semi-structured exit interviews were conducted with 41 patients who completed or prematurely discontinued from a phase 3, open-label trial (NCT02873208). The interview guide included open-ended questions on current and prior disease burden, symptoms, quality of life, and treatment experiences. Steps taken to reduce interview stress and secure the validity of data included interviewer sensitivity training specific to mental health conditions and schizophrenia, use of in-person interviews whenever possible and use of videoconferencing for remote interviews to promote trust and comfort, and working closely with clinical site staff to identify patient eligibility and willingness to participate. Transcripts based on audio recordings were content coded and analyzed using thematic analysis; a post-hoc quantitative content analysis was conducted. Results: Patients reported that the symptoms of schizophrenia negatively impacted their work, relationships, self-esteem, emotional health, and daily activities. Most patients had positive experiences with medications that alleviated hallucinations, depression, and anxiety. However, side effects of medications were associated with negative impacts on physical, emotional, behavioral, and cognitive health. Lack of energy/drowsiness, weight gain, mood changes, and involuntary movements were the most common side effects reported with the use of antipsychotic medications. Patients reported unmet treatment needs related to better symptom control and to improved social and physical functioning. Conclusion: Collection of qualitative information within a schizophrenia clinical development process provides value and insights into patients' views on burden of illness, experiences with previous medications, and experiences following participation in a clinical trial and can inform design for future studies.

Strategies to foster stakeholder engagement in residency coaching: a CFIR-Informed qualitative study across diverse stakeholder groups.

INTRODUCTION: Coaching interventions in graduate medical education have proven successful in increasing technical and communication skills, reducing errors, and improving patient care. Effective stakeholder engagement enhances the relevance, value, and long-term sustainability of interventions, yet specific strategies for stakeholder engagement remain uncertain. The purpose of this article is to identify strategies to foster engagement of diverse stakeholder groups in coaching interventions. MATERIAL AND METHODS: We conducted 35 semi-structured interviews between November 2021 and April 2022 with purposively sampled key stakeholders that captured participants' perspectives on physicians' communication training needs, roles, and involvement in, as well as contextual factors, facilitators, barriers, and improvement strategies of the multi-departmental Communication Coaching Program at our institution. We utilized the Consolidated Framework of Implementation Research to guide data collection and analysis. An analytic approach relied on team-based thematic analysis with high inter-coder agreement between three raters (Cohen's kappa coefficient 0.83). Several validation techniques were used to enhance the credibility and trustworthiness of the study. RESULTS: Analysis of transcribed interviews with stakeholders directly involved in the Communication Coaching Program, including 10 residents, 10 faculty coaches, 9 medical education leaders, and 8 programmatic sponsors, revealed five key engagement strategies: (1) embrace collaborative design, (2) enable flexible adjustments and modifications, (3) secure funding, (4) identify champions, and (5) demonstrate outcomes. Additionally, a patient-centered approach to delivering the best possible patient care emerged as a primary objective that linked all stakeholder groups. DISCUSSION: Evaluating the experiences of key stakeholders in the Communication Coaching Program helped identify targetable strategies to facilitate participant engagement across all organizational levels. The analysis also revealed universal alignment around the importance of providing high-quality patient care. Insights from this work provide guidance for clinical training programs moving toward the implementation of coaching interventions.

Seeking simplicity, navigating complexity: How veterinarians select an antimicrobial drug, dose, and duration for companion animals.

BACKGROUND: Minimizing harm from antimicrobials requires use of the narrowest spectrum drug, at an effective dose for the minimum effective duration. Many prescribers are not currently following these guidelines. To address suboptimal antimicrobial use, the underlying reasons must be understood. OBJECTIVES: To identify factors influencing choices of antimicrobial drug, dose, and duration for companion animals. SUBJECTS: Twenty-two veterinarians treating companion animals in Australia. Diversity of participants was deliberately sought. METHODS: Semistructured interviews were conducted online. Two case studies were discussed, and then a range of broader questions was posed. Transcripts were analyzed thematically, using an inductive approach. RESULTS: Few participants chose guideline-concordant management for the case studies. Prescribing choices were influenced by a complex array of factors associated with the clinical case, pet owner, drug, veterinarian, veterinary colleagues, and external factors. Key factors driving broad-spectrum antimicrobial use included a sense of safety, habit, ease of administering the drug (especially in cats), pharmaceutical marketing, and the self-perpetuating dispensary cycle. Many participants were concerned about antimicrobial resistance, but insufficiently informed about how to minimize this risk. Several participants believed that longer duration of treatment and ensuring patients finish a predetermined course would decrease the risk of antimicrobial resistance and improve clinical outcomes. CONCLUSIONS AND CLINICAL IMPORTANCE: Veterinarians are engaged with the concept of antimicrobial stewardship, but face numerous practical barriers and require more information. In particular, improved education is needed on enhancing patient safety by minimizing both spectrum of activity and duration of treatment, and dispelling myths about "finishing the course."

Longitudinal Changes in Preschoolers' Self-reported Psychological and Social Problems: Feasibility, Reliability, and Cross-informant Agreement.

For decades, parental report was used to assess children's psychological symptoms and social problems. The Berkeley Puppet Interview (BPI) utilizes hand puppets to collect questionnaire-style data from children, allowing consideration of children's own perspective. The current longitudinal study compared the feasibility and reliability of preschoolers' self-report with BPI at age 4 (M = 4.03, SD =0.16; 52% boy, 82% White American) and 5 (M = 5.22, SD = 0.36; 51% boy, 85% White American) as well as cross-informant agreement among children, mothers (74% above college education), alternate caregivers (>90% biological fathers), and coders. Children completed symptomatology, social, and parenting scales of BPI and their parents completed surveys assessing similar constructs. Our findings revealed both similarities and changes across ages. Specifically, the reliability and cross-informant agreement of the broad symptomatology and parenting scales were promising at both timepoints; however, 4-year-olds showed lower internal consistency in social scales.

Older adults make sense of their suicidal behavior: a Swedish interview study.

Introduction: The aim of this study was to explore how individuals aged 70 or older living in Sweden understood a recent suicidal act, and what changed in them and around them in the aftermath. Method: Four women and five men (age range 71-91 years) receiving care at a geriatric psychiatric outpatient clinic in a large Swedish city took part in two interviews about their most recent suicidal act. Most of the women and none of the men had engaged in prior suicidal acts. Interpretative phenomenological analysis was employed. Results: The suicidal act was explained as a response to losses (in physical and cognitive functions, social roles and relationships) that rendered previous coping strategies unviable. The participants reported being dependent on a healthcare system that they experienced as indifferent and even dismissive of their suffering. The suicidal act was described as an unplanned act of despair. Positive changes followed for participants who reported having had suicidal ideation prior to the suicidal act and had insights into its triggers. Some gained access to needed medical care; others developed greater awareness of their psychological needs and became more effective at coping. Individuals who said that they had not had suicidal thoughts prior to the suicidal act and could not explain it reported no positive change in the aftermath. The respondents' narratives indicated gendered themes. Discussion: Participants' age-related losses were in many cases exacerbated by negative interactions with health care providers, indicating that continued attention needs to be given to implicit ageism in medical professionals. The suicidal acts were described as impulsive, which was unexpected because a dominant belief is that older adult suicidal behavior is planned. One reason for the discrepancy may be that this study focused on nonfatal acts, and planned acts may be more likely to be fatal. Another reason could be shame due to suicide stigma. Alternatively, these acts were truly unplanned. The older adult suicide planning question should be addressed in larger studies across geographical and cultural settings. Future studies should also include questions about gender norms of suicidality and separately examine women's and men's data.

Enhancing Medical Interview Skills Through AI-Simulated Patient Interactions: Nonrandomized Controlled Trial.

BACKGROUND: Medical interviewing is a critical skill in clinical practice, yet opportunities for practical training are limited in Japanese medical schools, necessitating urgent measures. Given advancements in artificial intelligence (AI) technology, its application in the medical field is expanding. However, reports on its application in medical interviews in medical education are scarce. OBJECTIVE: This study aimed to investigate whether medical students' interview skills could be improved by engaging with AI-simulated patients using large language models, including the provision of feedback. METHODS: This nonrandomized controlled trial was conducted with fourth-year medical students in Japan. A simulation program using large language models was provided to 35 students in the intervention group in 2023, while 110 students from 2022 who did not participate in the intervention were selected as the control group. The primary outcome was the score on the Pre-Clinical Clerkship Objective Structured Clinical Examination (pre-CC OSCE), a national standardized clinical skills examination, in medical interviewing. Secondary outcomes included surveys such as the Simulation-Based Training Quality Assurance Tool (SBT-QA10), administered at the start and end of the study. RESULTS: The AI intervention group showed significantly higher scores on medical interviews than the control group (AI group vs control group: mean 28.1, SD 1.6 vs 27.1, SD 2.2; P=.01). There was a trend of inverse correlation between the SBT-QA10 and pre-CC OSCE scores (regression coefficient -2.0 to -2.1). No significant safety concerns were observed. CONCLUSIONS: Education through medical interviews using AI-simulated patients has demonstrated safety and a certain level of educational effectiveness. However, at present, the educational effects of this platform on nonverbal communication skills are limited, suggesting that it should be used as a supplementary tool to traditional simulation education.

Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience.

Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents' values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family's experience. Conclusions: Parents' use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app.

General Surgery Residency Applicant Perspectives on Alternative Residency Interview Models with Implementation of an Optional Second Look Day.

OBJECTIVE: In response to Covid-19, the Association of American Medical Colleges (AAMC) recommended for residency interviews to take place virtually. Benefits of virtual interviews include substantial cost saving and scheduling flexibility. However, it is more difficult to understand program culture and there is concern that more emphasis will be placed on board examination scores and class rank. Programs are split in their decision to keep virtual interviews in the future. This study aims to provide more clarification on students' perspectives and explore the role of an optional second look day to bridge the gap left by the lack of in-person interaction. DESIGN: This cross-sectional study surveyed applicants at our general surgery residency program during the 2022 to 2023 cycle. An optional second look day event was held after submission of the program's rank list. The first survey was sent to all applicants who interviewed with the residency program and asked to pick an interview style that they favored (in person vs virtual) and then asked to rate factors that impacted their decision. It also asked if an optional second look day event was made available, what factors would applicants consider to be important in their decision to attend. The second survey was sent to applicants who attended second look day and asked applicants to state importance of factors that led to their decision to attend. RESULTS: About 50/110 completed the first survey. Applicants preferred virtual over in-person interviews (52% vs 28%). Those who chose virtual selected factors of time commitment and financial burden to be very important compared to those who chose in-person. Applicants who preferred in-person interviews placed most importance on avoiding technical issues and having personal interactions such as: with attending surgeons, with residents, assessment of program culture, visiting facilities, and visiting the town. Applicants were asked to pick important factors if they were to attend an optional second look day after their virtual interview. The following factors were chosen as very important: time commitment, financial burden, interaction with program leadership, interaction with attending surgeons, interaction with residents, visiting facilities, and visiting the town. We then held a second look event after the submission of our rank list. 34/110 attended and 17 complete the survey. Cost and time commitment were not as important to this group who actually attended; they chose in-person interactions with leadership and residents and assessing the program culture to be most important. CONCLUSION: This study aimed to determine the best interview method based on student perceptions. We also piloted an optional second look day to determine whether or not it fills the gaps left by the suspension of in-person interviews. We recommend continuing with virtual interviews as this is what applicants prefer. It alleviates the financial burden of travel and allows for better time management. However, the significance of in-person interactions cannot be ignored. We propose that second look days should be incorporated after submission of the program's rank list to allow applicants the opportunity for in-person interactions, exploration of the town, and enhance their overall interviewing experience.

[Investigation on cognition for insomnia and preference for acupuncture in breast cancer survivors: a in-depth interview study].

OBJECTIVE: To understand the cognition for insomnia and preference for acupuncture in breast cancer survivors based on the in-depth interview. METHODS: Thirty breast cancer survivors with insomnia symptoms were collected for in-depth interview. The interview questions included three aspects, i.e. sleep expectation, cognition for insomnia (discomfort caused by insomnia, and underlying inducing factors of insomnia) and the preference for acupuncture (treatment methods used in the past, the reasons for not choosing acupuncture, and the tendency of acupuncture treatment). Using Colaizzi content analysis method, the data was analyzed. RESULTS: Regarding sleep expectation, most breast cancer survivors with insomnia symptoms were able to maintain normal activity in daytime. Insomnia symptoms often led to fatigue, and the inducing factors of insomnia referred to the treatment with endocrine therapy, anticipatory anxiety and inadequate sleep hygiene. All of the patients had received pharmacotherapy. The use proportion of non-pharmacological therapies was relatively low, and acupuncture was not chosen due to "not familiar with" and "fear of pain". Concerning to the preference for acupuncture, patients preferred the therapeutic methods of acupuncture with mild pain sensation and gentle stimulation; and the treatment should be more acceptable if delivered 2 or 3 times a week. CONCLUSION: Breast cancer survivors have the expectations for sleep, and are willing to receive the treatment with medication for their sleep disorders. Because of lack of the knowledge for acupuncture effect on insomnia and fear of strong needling sensation, a part of patients are unwilling to be treated with acupuncture therapy, but they are expected to receive the treatment with acupuncture while feeling more comfortable.

"Veterinary medicine is not finished when I have diagnosed an incurable disease, that's when it starts for me." A qualitative interview study with small animal veterinarians on hospice and palliative care.

In the wake of recent medical developments in small animal practice, curing animals of their illnesses and restoring their health can be realized better than ever before. However, the growing medical possibilities are also leading to an increase in demand for better care for patients suffering from terminal illnesses. Consequently, the field of animal hospice and palliative care has become increasingly available, enabling veterinarians to optimize the quality of life of patients, such as dogs and cats, who no longer have a prospect of full recovery. Using qualitative, semi-structured interviews with 20 small animal veterinarians involved in hospice and palliative care, we investigated the factors that motivate veterinarians to become involved in hospice and palliative care and explored the importance of relationships, communication, time and infrastructure in this area. Findings show that personal experiences with their own pets or during training or work life motivated veterinarians to provide this service. Although veterinarians highlighted the importance of empathetic-driven relationships, they were aware that keeping an emotional distance from the patient and caregiver is significant to provide successful care. Further, veterinarians emphasized their high investment of time that resulted primarily from the increased frequency and provided opportunities to communicate with caregivers. The overall conclusion is that having time for patients and the patients' caregivers is one of the most important aspects of work in this field. However, as it will be also shown, veterinarians must consider aspects of self-care management by reflecting on their own time and energy resources while caring for animals and their caregivers.

A Qualitative Study on the Impact and Feasibility of a Simulation-Based Program for Shared Decision-Making in Non-Small Cell Lung Cancer Care.

BACKGROUND: In the pursuit of improved clinical outcomes and patient experience in health care, shared decision-making (SDM) stands as a pivotal concept garnering increasing attention, but SDM utilization varies widely, often leading to confusion regarding team members' roles. This study explores knowledge, skills, and attitudes of oncology clinicians engaged in a pioneering educational initiative at a comprehensive cancer care center, aimed at enhancing frontline SDM capabilities. METHODS: Utilizing a prospective cohort qualitative approach, the team conducted interviews with 6 clinicians in a multidisciplinary oncology program who were engaged in an SDM continuing education program. In the program, participants were immersed in experiential learning activities including standardized didactic sessions and simulation-based SDM case role-play activities. RESULTS: Thematic analysis of interview data revealed 5 major categories: 1) perceptions of SDM; 2) training; 3) patient-centered care; 4) challenges and constraints; and 5) leadership buy-in. Participants perceived benefits, including adopting a better approach to integrate SDM into their practice, heightened engagement, emphasizing team collaboration, and embracing a patient-centric care model. CONCLUSIONS: This study underscores the transformative impact of education and training on enhancing SDM capabilities among oncology clinicians and is not intended for generalizability. By promoting a basic understanding and application of SDM principles, practicing clinicians can be better empowered to improve health care outcomes and experience. Our findings contribute to the broader endeavor of embedding practical SDM principles within clinical practice, thereby fostering a more patient-centered and effective health care environment.

How do experts determine where to intervene on test ordering? An interview study.

OBJECTIVES: Lab testing is a high-volume activity that is often overused, leading to wasted resources and inappropriate care. Improving test ordering practices in tertiary care involves deciding where to focus scarce intervention resources, but clear guidance on how to optimize these resources is lacking. We aimed to explore context-sensitive factors and processes that inform individual decisions about laboratory stewardship interventions by speaking to key interest holders in this area. METHODS: We conducted semi-structured interviews with test-ordering intervention development experts and authors of test-ordering guidance documents to explore five broad topics: 1) processes used to prioritize tests for intervention; 2) factors considered when deciding which tests to target; 3) measurement of these factors; 4) interventions selected; 5) suggestions for a framework to support these decisions. Transcripts were double coded using directed-content and thematic analysis. RESULTS: We interviewed 14 intervention development experts. Experts noted they frequently consider test volume, test value, and patient care when deciding on a test to target. Experts indicated that quantifying many relevant factors was challenging. Processes to support these decisions often involved examining local data, obtaining buy-in, and relying on an existing guideline. Suggestions for building a framework emphasized the importance of collaboration, consideration of context and resources, and starting with "easy wins" to gain support and experience. CONCLUSIONS: Our study provides insight into the factors and processes experts consider when deciding which tests to target for intervention and can inform the development of a framework to guide the selection of tests for intervention and guideline development.

"Treat people with human dignity": the perspective of older adults on the quality of geriatric rehabilitation.

PURPOSE: The aim of this study was to gain insight into the perspectives of older adults on the quality of geriatric rehabilitation (GR) during the trajectory of GR from admission until six weeks after discharge. METHODS: We conducted a longitudinal qualitative study. Participants were interviewed three times: at the start of rehabilitation, at discharge, and six weeks after discharge. The data were analysed using a thematic analysis. RESULTS: In total, 50 interviews were conducted, with 18 participants being interviewed multiple times. The following themes emerged: 1. A bond of trust with health care professionals (HCPs), 2. Being prepared and informed at all stages of GR, 3. Participants emphasise physical and occupational therapy rather than other aspects of care as comprising GR 4. Changing needs regarding (the extent of) involvement in decision-making, 5. Contact with family and peers. CONCLUSION: For older adults, preparation for and good organisation of rehabilitation and social interaction with HCPs and other older adults were found to be important for the perceived quality of GR. Social interaction is influenced by how HCPs engage with older adults in all the phases of the rehabilitation process. Older adults have varying preferences about involvement in decision-making during GR. These perspectives should be acknowledged and acted upon in clinical practice to further improve the quality of care in GR.

Health Professionals' Views on the Use of Conversational Agents for Health Care: Qualitative Descriptive Study.

BACKGROUND: In recent years, there has been an increase in the use of conversational agents for health promotion and service delivery. To date, health professionals' views on the use of this technology have received limited attention in the literature. OBJECTIVE: The purpose of this study was to gain a better understanding of how health professionals view the use of conversational agents for health care. METHODS: Physicians, nurses, and regulated mental health professionals were recruited using various web-based methods. Participants were interviewed individually using the Zoom (Zoom Video Communications, Inc) videoconferencing platform. Interview questions focused on the potential benefits and risks of using conversational agents for health care, as well as the best way to integrate conversational agents into the health care system. Interviews were transcribed verbatim and uploaded to NVivo (version 12; QSR International, Inc) for thematic analysis. RESULTS: A total of 24 health professionals participated in the study (19 women, 5 men; mean age 42.75, SD 10.71 years). Participants said that the use of conversational agents for health care could have certain benefits, such as greater access to care for patients or clients and workload support for health professionals. They also discussed potential drawbacks, such as an added burden on health professionals (eg, program familiarization) and the limited capabilities of these programs. Participants said that conversational agents could be used for routine or basic tasks, such as screening and assessment, providing information and education, and supporting individuals between appointments. They also said that health professionals should have some oversight in terms of the development and implementation of these programs. CONCLUSIONS: The results of this study provide insight into health professionals' views on the use of conversational agents for health care, particularly in terms of the benefits and drawbacks of these programs and how they should be integrated into the health care system. These collective findings offer useful information and guidance to stakeholders who have an interest in the development and implementation of this technology.

Emotion word repertoire in the adult attachment interview is linked to reduced suicide attempts in patients with borderline personality disorder.

Background: This study explored the association between emotion word repertoire (EWR), attachment, reflective functioning and personality organization (PO) and suicidal behavior in borderline personality disorder (BPD) patients. Methods: The current study performed a secondary data analysis from a randomized control trial for BPD patients (all female; n = 87; age: m = 27; SD = 7.42). EWR was assessed via machine-scoring transcripts of Adult Attachment Interviews (AAI) for affective words using the VETA electronic scoring software for the Levels of Emotional Awareness Scale (LEAS). Generated scores were related to impairments in PO (Structured Interview for Personality Organization; STIPO), attachment organization (AAI) and mentalization (Reflective Functioning Scale), general symptom severity (Brief Symptom Inventory; BSI-53), self-harm and suicidal behavior. Independent effects of the investigated predictors were studied using Bayesian path analysis. Results: Corrected for education, findings in Bayesian path analysis suggest an independent negative association between EWR and suicide attempts (BE = -.32; 95 % CI [-.51, -.12]) and positive associations of deficits in PO with psychiatric symptoms (BE = .23; 95 % CI [.01, .44]) as well as suicide attempts (BE = .30; 95 % CI [.08, .49]). Discussion: The findings underscore the potential role of high EWR and PO as a protective factor for suicidal behavior in individuals with BPD.

Identifying barriers and facilitators to follow-up after endovascular aortic repair (EVAR): Qualitative study design and protocol.

Endovascular aortic repair (EVAR) is now first line therapy for most patients with abdominal aortic aneurysms (AAA) as it reduces perioperative morbidity and mortality compared to open surgery. However, up to 40 % of patients do not undergo recommended follow-up, increasing risk of subsequent rupture. Risk factors for loss to follow-up have been studied retrospectively, however, qualitative studies assessing perceived barriers and facilitators to follow-up have not been performed and there are few qualitative protocols within the vascular surgery literature. This article presents a qualitative descriptive study protocol aimed at understanding and improving post-operative follow-up adherence after EVAR developed through an iterative process based on the Theoretical Domains Framework of behavior change. Steps include:•Selection of target behavior and study design•Development of study materials, sampling/recruitment strategy, and data collection•Qualitative data analysis and reporting findingsWe demonstrate the feasibility of this study by pilot testing of the semi-structured interview guides on a small group of patients, healthcare providers, and key personnel. This protocol aims to describe key stakeholder experiences within the healthcare system that will ultimately serve as the basis for future multi-institutional research piloting intervention strategies to improve EVAR follow-up.

Mary Main: portrait and tribute.

Brett Kahr has referred to the death of Mary Main as the loss of "the queen of attachment research." However, how well is Main's work actually known? In this portrait and tribute, I argue that Main's transformative contributions have become a taken-for-granted part of the basic environment of attachment research, but that readers have faced obstacles in understanding and responding to their strengths and limitations. Drawing from interviews with Main, in this paper I describe some of her early life experiences and mental and physical health challenges, which she felt had influenced what was possible for her in her research. I then highlight less well-known aspects of her ideas regarding the role of attention within attachment strategies, the nature of disorganised attachment, the implications of alarming caregiving behaviours, and what is ultimately measured by the Adult Attachment Interview. My goal throughout is to help reader see both how much Main's rich and exciting works still have to teach, and identify their many loose threads still to follow.

Posttraumatic stress disorder (PTSD) prevalence: an umbrella review.

Posttraumatic stress disorder (PTSD) is one of the most serious and incapacitating mental diseases that can result from trauma exposure. The exact prevalence of this disorder is not known as the literature provides very different results, ranging from 2.5% to 74%. The aim of this umbrella review is to provide an estimation of PTSD prevalence and to clarify whether the prevalence depends on the assessment methods applied (structured interview v. self-report questionnaire) and on the nature of the traumatic event (interpersonal v. not-interpersonal). A systematic search of major databases and additional sources (Google Scholar, EBSCO, Web of Science, PubMed, Galileo Discovery) was conducted. Fifty-nine reviews met the criteria of this umbrella review. Overall PTSD prevalence was 23.95% (95% confidence interval 95% CI 20.74-27.15), with no publication bias or significant small-study effects, but a high level of heterogeneity between meta-analyses. Sensitivities analyses revealed that these results do not change after removing meta-analysis also including data from underage participants (23.03%, 95% CI 18.58-27.48), nor after excluding meta-analysis of low quality (24.26%, 95% CI 20.46-28.06). Regarding the impact of diagnostic instruments on PTSD prevalence, the results revealed a lack of significant differences in PTSD prevalence when structured v. self-report instruments were applied (p = 0.0835). Finally, PTSD prevalence did not differ following event of intentional (25.42%, 95% CI 19.76-31.09) or not intentional (22.48%, 95% CI 17.22-27.73) nature (p = 0.4598). The present umbrella review establishes a robust foundation for future research and provides valuable insights on PTSD prevalence.