Seeking consensus on a play-based intervention framework for promoting play of children with HIV/Aids in a low-resourced setting: A Delphi study.

INTRODUCTION: Implementing occupation-based practice in low-resourced settings can be challenging especially when working with children with HIV/Aids whose daily occupation of play is often affected by their health condition and other contextual factors such as poverty or stigma. AIM: The aim of this paper is to obtain consensus from experts on the content and application of a play-based intervention for children with HIV/Aids living in a low-resourced setting. METHODS: A Delphi study involving two rounds using an online survey format was conducted with experts from the field of child development, play and/or HIV/Aids. Consensus agreement was reached when at least 70% of Delphi experts rated each item at 3 or higher on a 5-point Likert scale. CONSUMER AND COMMUNITY INVOLVEMENT: This paper is part of a multi-stage study that involved input and feedback from families of children who were born HIV/Aids, occupational therapists working with families of children with HIV/Aids, and input from local and international experts working with people with HIV/Aids. RESULTS: Thirty-seven experts completed the first round, and 35 completed the second round of the study. Consensus was achieved on the application of the Cooper's Model of Children's Play, techniques to be used and the structure of the intervention. Experts also agreed on the inclusion of a pre-intervention workshop as part of the play-based intervention. DISCUSSION AND CONCLUSION: The consensus on the content and application of a play-based intervention framework through a process of gaining expert perspectives provides confidence that the intervention planned to promote play for children with HIV/Aids living in low-resourced settings is likely to be effective.

Understanding evidence and provision of services around social isolation and loneliness of military widow/ers: A scoping review.

BACKGROUND: Whilst the uniqueness of loneliness and social isolation is now recognised for members of the Armed Forces Community, there is currently a lack of evidence examining these experiences within the Military Widow/er population. Therefore, this scoping review aimed to search and synthesise the current evidence base exploring experiences of loneliness and social isolation in this community. METHOD: Six databases were searched; ASSIA; CINAHL; ProQuest Dissertation & Theses Global; PsycArticles; Medline; Web of Science. Any article type was included if they focused on UK or international Military Widows and loneliness and social isolation. In the absence of loneliness and social isolation, related aspects were included, for example, social support. RESULTS: A thematic synthesis was completed on the nine eligible papers, where key findings were coded and generated into four themes; Experiences of Loneliness and Social Isolation, The Uniqueness of the Military, Access to Social Support, and The Importance of Peer Support. CONCLUSIONS: Evidence supports the need for military-specific support services with peers who recognise the individuals' unique experiences of loneliness and social isolation. None of the available evidence focused specifically on social isolation, however this was often prevalent in the results. All of the studies were carried out in the USA and Israel, with none including the views of widowers. Further evidence is required, particularly relating to a UK-context.

A qualitative exploration of internet forum discussions surrounding female sexual function for individuals with Sjögren's syndrome.

Sexual dysfunction is a common experience for women with the autoimmune rheumatic disease, Sjögren's syndrome (SS); however, the lived experience of how the disease affects sexual functioning and the sexual environment remains unexplored. This qualitative study explores the conversations pertaining to female sexual function and the sexual environment that individuals with SS have on an internet forum. Qualitative data posted on one publicly accessible, worldwide, internet forum was extracted using an automated web scraping tool. A total of 247,694 posts across 23,382 threads were scraped from the forum in July 2019 and June 2022 (from the United Kingdom). A predetermined and theoretically informed keyword search strategy was used to screen the captured data for content relevant to the study aim. The dataset was cleaned to remove duplication and identifying information and screened for topic relevance. The Computer-Assisted Qualitative Data Analysis software tool, ATLAS.ti, was used to facilitate the data analysis process. Thematic analysis was conducted on 1443 female-oriented posts, and four key themes were identified: the symptoms of SS and their impact on the sexual environment; the emotional responses that are commonly evoked in response to sexual difficulties; the strategies that users have implemented to manage sexual problems; and the impact that a partner's behavior may have on the sexual environment. Together these themes provide an insight into the nature of sexual difficulties for females with SS. Our findings provide novel insights to inform clinical discussions between practitioners and patients whilst further outlining the importance of undertaking qualitative research with this population.

Coping strategies, illness perceptions, and relationship dynamics contribute to female sexual function and sexual distress in Sjögren's syndrome.

BACKGROUND: Sexual dysfunction and sexual distress are common complaints for women with the autoimmune rheumatic disease Sjögren's syndrome (SS); however, the role of psychosocial and interpersonal factors has not previously been explored in SS. AIM: This study investigated whether psychosocial variables, such as coping strategies, illness perceptions, and relationship dynamics, contributed to sexual function and sexual distress for women with SS. METHODS: Participants with SS completed an online cross-sectional survey that included prevalidated questionnaires assessing sexual function, sexual distress, disease-related symptom experiences, cognitive coping strategies, illness perceptions, relationship satisfaction, and partners' behavioral responses. Multiple linear regression was used to identify factors significantly associated with sexual function (total Female Sexual Function Index [FSFI] score) and sexual distress (total Female Sexual Distress Scale score) for women with SS. OUTCOMES: Study outcome measures were the FSFI, Female Sexual Distress Scale, EULAR SjÓ§gren's Syndrome Patient Reported Index, numeric rating scale for vaginal dryness (0-10), Profile of Fatigue and Discomfort, Cognitive Emotion Regulation Questionnaire (CERQ), Brief Illness Perceptions Questionnaire (B-IPQ), West Haven-Yale Multidimensional Pain Inventory (WHYMPI), and Maudsley Marital Questionnaire. RESULTS: A total of 98 cisgender women with SS participated in the study (mean age = 48.13 years, SD = 13.26). Vaginal dryness was reported by 92.9% of participants, and clinical levels of sexual dysfunction (total FSFI score <26.55) were observed in 85.2% (n = 69/81) of cases. More vaginal dryness, lower CERQ positive reappraisal, and higher CERQ catastrophizing were significantly associated with poorer self-rated sexual function (R2 = 0.420, F3,72 = 17.394, P < .001). Higher CERQ rumination, lower CERQ perspective, lower WHYMPI distracting responses, and higher B-IPQ identity were significantly associated with higher sexual distress (R2 = 0.631, F5,83 = 28.376, P < .001). CLINICAL IMPLICATIONS: This study suggests that interpersonal and psychosocial factors are important contributors to sexual function and distress in women with SS and that the development of psychosocial interventions for this population is warranted. STRENGTHS AND LIMITATIONS: This study is one of the first to explore the impacts of coping strategies, illness perceptions, and relationship dynamics on sexual function and sexual distress for women with SS. Limitations of our study include its cross-sectional nature and narrow sample demographic, which limit the generalizability of our results to other population groups. CONCLUSION: Women with SS who utilized adaptive coping strategies had better sexual function and lower levels of sexual distress than women who utilized maladaptive coping strategies.

The experiences of older adult members of a combined lunch club and assisted shopping group and the perceived value in their occupational lives: A qualitative study.

Background and Aims: Health and social care policies are increasingly focusing on community interventions for older adults with service providers diversifying services to widen their reach. As a result, new concepts are under-researched, and it can be challenging to draw parallels with existing interventions. Evidence of the value of community interventions is often limited and conflicting and few researchers have considered the service-user perspective. This qualitative research explores the experiences of members of a combined lunch club and assisted shopping group based in North-East England to understand the perceived value in their lives from an occupational perspective. Methods: Six older adult members were recruited through convenience sampling to participate in individual semistructured interviews January-March 2020. Interview data was subject to thematic analysis using an inductive approach and three key themes were constructed to represent the data. Results: Themes identified were: "Togetherness: promoting social belonging"; "Meaningful engagement for older adults" and "Independence and staying active in later life." Findings indicated largely positive experiences with themes depicting influences that motivate engagement and perceived benefits. Conclusion: Participants particularly valued the opportunity for social engagement, as well as independence through supporting continued engagement with shopping in later life. In conclusion, successful community interventions for older adults need to be meaningful and purposeful.

Frequent callers to UK ambulance services in the COVID-19 pandemic: managing mental health, social isolation and loneliness.

OBJECTIVES: Patients who frequently call ambulance services are a vulnerable yet heterogeneous population with unmet multiple and complex physical health, mental health and/or social care needs. In this article, we report the challenges that the COVID-19 pandemic has introduced for ambulance services across the UK when managing frequent callers, and reflect on how existing systems and practices are adapting to support changing patient needs. METHODS: Data reported in this article comprise reflections from the frequent caller leads in each ambulance service in the UK. All data were provided between 23 April 2020 and 1 May 2020, shortly after the peak of the outbreak in the UK. A single anonymised case study is also reported to illustrate how the pandemic is affecting people's circumstances and contributing to frequent caller behaviour. RESULTS: Ambulance services are observing changes to the frequent caller population, with many new frequent callers due to health anxiety caused or exacerbated by the pandemic. Management of frequent callers is also changing, with multidisciplinary and multi-agency working becoming more challenging due to decreased access to external services, whether in social care or the community and voluntary sector, and the redeployment of ambulance service staff. There is also decreased face-to-face contact with frequent callers, meaning that opportunities to deliver person-centred care are reduced. However, the introduction or increased use of tele/video conferencing with other organisations has mitigated some of these challenges, and in some cases has improved engagement among external organisations. CONCLUSIONS: Health anxieties, lack of access to other health, social and community and voluntary sector services and exacerbations of social isolation and/or loneliness have reportedly contributed to changing behaviour among frequent callers. The COVID-19 pandemic has also affected how ambulance services have been able to manage frequent callers. Ambulance services should continue to engage with external organisations to aid the delivery of person-centred care, particularly organisations with experience in multiple complex needs such as mental health, social isolation and/or loneliness. Future research should examine the consequences of the pandemic for frequent users of ambulance services, and how these impact on the wider health and care community.

Experiences of Living with Severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a rare disease with no known etiology. It affects 0.4% of the population, 25% of which experience the severe and very severe categories; these are defined as being wheelchair-, house-, and bed-bound. Currently, the absence of biomarkers necessitates a diagnosis by exclusion, which can create stigma around the illness. Very little research has been conducted with the partly defined severe and very severe categories of CFS/ME. This is in part because the significant health burdens experienced by these people create difficulties engaging in research and healthcare provision as it is currently delivered. This qualitative study explores the experiences of five individuals living with CFS/ME in its most severe form through semi-structured interviews. A six-phase themed analysis was performed using interview transcripts, which included identifying, analysing, and reporting patterns amongst the interviews. Inductive analysis was performed, coding the data without trying to fit it into a pre-existing framework or pre-conception, allowing the personal experiences of the five individuals to be expressed freely. Overarching themes of 'Lived Experience', 'Challenges to daily life', and 'Management of the condition' were identified. These themes highlight factors that place people at greater risk of experiencing the more severe presentation of CFS/ME. It is hoped that these insights will allow research and clinical communities to engage more effectively with the severely affected CFS/ME population.

Using Peer Discussion to Create a SOAP Note in Graduate Clinical Nursing Education.

ABSTRACT: Faculty in graduate nursing education have been challenged when teaching first-year family nurse practitioner students to accurately assess a patient and build a subjective, objective, assessment, and plan note (SOAP note) through history taking and patient interviews. Students' familiarity with peer discussion can assist with learning the SOAP note process. Using peer discussion, faculty were able to make the learning process student friendly and useful in future clinical settings.

An occupational perspective of the lived experience of familial dementia caregivers: A thematic review of qualitative literature.

Dementia caregiving is thought to have a negative impact on health and wellbeing. This critical review of qualitative literature explored the lived experience of familial dementia caregivers from an occupational therapy perspective. The method was informed by systematic review and qualitative research methodologies and was structured within the occupational dimensions framework of doing-being-becoming-belonging. A comprehensive search of major databases was undertaken which identified 484 studies on the topic; 14 met the inclusion criteria and were included in the review. Ten themes emerged within the doing-being-becoming-belonging framework from the analysis of the studies. The occupational participation of caregivers is conveyed within the 'doing' domain. Ways in which caregiving impacts upon opportunities for self-nurture are presented within the 'being' domain. The 'becoming' domain elucidates ways in which caregivers redefine themselves, their values and their priorities through their caregiving role. The 'belonging' domain depicts ways in which caregivers' connections with their care recipient and others are shaped over time. Practice implications for health and social care practitioners who work with familial dementia caregivers are presented in light of the findings.

The personal communities of men experiencing later life widowhood.

Increasingly men are becoming widowed in later life due in part to a longer life expectancy. Social networks and social support are thought to help buffer the negative consequences of such later life transitions. This paper explores the personal communities of a group of older men experiencing widowhood. Qualitative in-depth interviews were conducted, September 2013-February 2014, with seven older widowers, 71-89 years of age, in North Staffordshire, UK. Interviews included personal community diagrams to identify the structure of the older men's social relationships. Data analysis comprised thematic analysis of interview transcripts and content analysis of personal community diagrams. Three overarching themes were identified from the interview data: "Personal identity and resilience assist transition," "Continuity in personal communities provides stability" and "Changes in social relationships and practices facilitate adaptation." The study identified three types of personal community among the older widowers, comprising different combinations of family, friends and others. The findings illustrate that some older widowers have very restricted personal communities which puts them at greater risk of loneliness and social isolation. The social needs of long-term carers should be addressed as isolation and loneliness can begin long before the death of a spouse. It is important to consider gender differences and preferences when designing interventions for older people in order to promote engagement, social inclusion and well-being.

'It pushed me back into the human race': evaluative findings from a community Christmas event.

Many older people in Britain spend Christmas day alone. The Christmas period may be especially difficult for older people who are socially isolated, living with dementia or who have physical impairments, and may feel particularly marginalised at this time of year. This paper draws on evaluative research findings from a community Christmas event held in December 2014 at the University of Salford for older people and their carers who would be on their own on Christmas day. A multi-method approach was employed, seven guests took part in semi-structured interviews to explore their experiences and perceptions of the event, seven staff and student volunteers participated in a group interview to explore and discuss their participation in the event. Data collection took place during April and May 2015. Interview transcripts were subjected to thematic analysis. Three overarching themes were identified from the interviews: 'reasons for participants attending the event', 'a different Christmas day: the impact on guests and volunteers', and 'learning, planning and moving forwards'. The findings illustrate that a range of people participated in the Christmas day event for a variety of reasons. The event itself had a positive impact, including the shared experience of social belonging, for all involved. There are tangible longer term benefits as a result of the event, such as ongoing contact between participants and the development of supportive networks in the local community.

Conducting longitudinal research with older widows: Exploring personal communities through multiple methods.

This article reports on the process of undertaking a longitudinal multiple methods study with older women experiencing the transition of later-life widowhood. Three qualitative in-depth interviews were conducted with 26 older widows in North Staffordshire, United Kingdom. Interviews included the use of personal community diagrams to identify the structure of personal communities and Christmas and Christmas cards to further explore social relationships and practices during transition. Examples of cases are given to illustrate the findings derived from the methods employed. The cases demonstrate the diverse and often paradoxical nature of social relationships within similar networks.

Athletic fashion, "Punch," and the creation of the new woman.

Between 1885-1900 "Punch" satirized the personality of the New Woman. However, virtually single-handedly it also gave a body and emancipated culture to this otherwise socially abstract personality. Using illustrations from "Punch," this essay argues that using sport specific clothing and equipment in its cartoons, "Punch" completely unintentionally created a liberating picture of women while simultaneously using its captions and border texts to make the New Woman's body signify the anxieties patriarchal culture had about her social personality and politics.

The effect of a cationic porphyrin on Pseudomonas aeruginosa biofilms.

Current studies have indicated the utility of photodynamic therapy using porphyrins in the treatment of bacterial infections. Photoactivation of porphyrins results in the production of singlet oxygen ((1)O(2)) that damages biomolecules associated with cells and biofilms, e.g., proteins, polysaccharides, and DNA. The effect of a cationic porphryin on P. aeruginosa PAO1 biofilms was assessed by exposing static biofilms to 5,10,15,20-tetrakis(1-methyl-pyridino)-21H,23H-porphine, tetra-p-tosylate salt (TMP) followed by irradiation. Biofilms were visualized using confocal laser scanning microscopy (CLSM) and cell viability determined using the LIVE/DEAD BacLight viability assay and standard plate counts. At a concentration of 100 µM TMP, there was substantial killing of P. aeruginosa PAO1 wild-type and pqsA mutant biofilms with little disruption of the biofilm matrix or structure. Exposure to 225 µM TMP resulted in almost complete killing as well as the detachment of wild-type PAO1 biofilms. In contrast, pqsA mutant biofilms that contain less extracellular DNA remained intact. Standard plate counts of cells recovered from attached biofilms revealed a 4.1-log(10) and a 3.9-log(10) reduction in viable cells of wild-type PAO1 and pqsA mutant strains, respectively. Our results suggest that the action of photoactivated TMP on P. aeruginosa biofilms is two-fold: direct killing of individual cells within biofilms and detachment of the biofilm from the substratum. There was no evidence of porphyrin toxicity in the absence of light; however, biofilms pretreated with TMP without photoactivation were substantially more sensitive to tobramycin than untreated biofilms.

PilJ localizes to cell poles and is required for type IV pilus extension in Pseudomonas aeruginosa.

Twitching motility allows Pseudomonas aeruginosa to respond to stimuli by extending and retracting its type IV pili (TFP). PilJ is a protein necessary for this surface-associated twitching motility and bears high sequence identity with Escherichia coli methyl-accepting chemotaxis proteins (MCP). Here, we report that whereas wild-type P. aeruginosa PAO1 cells have extended pili at a single pole, pilJ mutant cells have shortened pili often at both poles despite normal levels of pilin accumulation, suggesting that PilJ is required for full TFP assembly/extension. Using yellow fluorescent protein fusions (pilJ-yfp), both plasmid born and in-frame chromosomal constructs, we determined that PilJ localizes to both poles of the cell. Overexpression of pilJ-yfp resulted in the protein accumulating between the poles.