Promoting teachers' wellbeing through a serious game intervention: a qualitative exploration of teachers' experiences.

Introduction: Teachers' wellbeing plays a critical role in their overall job satisfaction, motivation, and effectiveness in building supporting learning environments. In today's dynamic educational settings, where teachers often face numerous challenges and stressors, their wellbeing becomes increasingly vital. Consequently, there is an urgent need to innovate and develop targeted training interventions that can support specifically the wellbeing of educators. Methods: This study sought to provide an overview of the "Online Wellbeing Course - OWC," a serious game developed to enhance teachers' wellbeing, and to investigate the participants' feedback after being engaged in the OWC, utilizing a qualitative approach through focus group discussions. A total of 189 in-service teachers took part in the study. To qualitatively explore their experiences with the OWC, participants were involved in focus groups and asked to provide feedback about how and to what extent the course was beneficial for their wellbeing. Results: Teachers reported enhancements in areas such as emotional competence, self-care strategies, social awareness, relationship skills, decision-making, and school climate. Discussion: These outcomes suggested the potential of serious games as an innovative training approach for supporting teachers' wellbeing, offering valuable insights for researchers, policymakers, and educators.

The role of teachers' socio-emotional competence in reducing burnout through increased work engagement.

Introduction: Research has highlighted the relevance of socio-emotional competence in buffering the harmful impacts of perceived stress on the psychological facets of the teaching profession. The purpose of this paper is to innovatively investigate the relationships between perceived stress, work engagement, and burnout in a single comprehensive model, when considering the potential role that socio-emotional competence plays in mitigating the adverse impact of perceived stress on burnout. Methods: A total of 276 Italian in-service teachers (mean age = 46.6 ± 9.9 years) completed quantitative self-report measures of perceived stress, socio-emotional competence, work engagement, and burnout. Data were analyzed by using a structural equation modeling (SEM) approach. Results: All fit indexes supported the model's full acceptance and suggested that teachers' socio-emotional competence reduced the effect of perceived stress on the risk of burnout by increasing their level of work engagement. Discussion: The implications of the findings are discussed in terms of promoting interventions that target not only stress reduction but also foster teachers' socio-emotional competence in order to maintain a good level of work engagement and reduce the effect of stress on burnout.

Validation of Italian students' self-ratings on the SSIS SEL brief scales.

Introduction: Despite increasing interest in measuring social and emotional learning (SEL), there is a lack of European-validated tools for assessing the efficacy of SEL programs. The aim of this study was to validate an Italian version of the social skills improvement system (SSIS) SEL brief scales-student form. Methods: Participants were 1,175 students (mean age: 11.02 years; SD: 2.42; range: 8-16 years; males: 46.8%) recruited at schools in Northern Italy. Statistical analyses and results: Initial confirmatory factor analysis encountered a series of challenges, implying non-convergence of the original five-factor measurement model (self-awareness, self-management, social awareness, relationship skills, and responsible decision-making) based on the Collaborative on Academic Social Emotional Learning (CASEL) competency framework established with students in the United States. Further exploratory and confirmatory analyses supported a four-factor model that remained partially invariant across gender groups. The Italian version of the SSIS SEL brief scales was thus shown to be an efficient measurement tool for estimating social and emotional learning in students. Discussion: We discuss the implications of findings in relation to selecting valid and reliable instruments for assessing children's and adolescents' SEL competencies, while considering the culturally-situated nature of the constructs under study.

Supporting Preschoolers' Mental Health and Academic Learning through the PROMEHS Program: A Training Study.

There is compelling evidence that early school intervention programs enhance children's development of life skills, with a positive knock-on effect on their behaviors and academic outcomes. To date, most universal interventions have displayed gains in children's social-emotional competencies with a limited reduction in problem behaviors. This may depend on programs' curricula focused to a greater extent on preschoolers' social-emotional competencies rather than problem behaviors. Promoting Mental Health at Schools (PROMEHS) is a European, school-based, universal mental health program explicitly focused on both promoting students' mental health and preventing negative conduct by adopting a whole-school approach. In this study, we set out to evaluate the effectiveness of the program for Italian and Portuguese preschoolers. We recruited 784 children (age range = 4-5 years), assigning them to either an experimental group (six months' participation in the PROMEHS program under the guidance of their teachers, who had received ad hoc training) or a waiting list group (no intervention). We found that PROMEHS improved preschoolers' social-emotional learning (SEL) competencies, prosocial behavior, and academic outcomes. The more practical activities were carried out at school, the more children's SEL competencies increased, and the more their internalizing and externalizing behaviors decreased. Furthermore, marginalized and disadvantaged children were those who benefited most from the program, displaying both greater improvements in SEL and more marked decreases in internalizing problems compared to the rest of the sample.

Social and Emotional Learning and Internalizing Problems among Adolescents: The Mediating Role of Resilience.

(1) Background: The high rates of mental disorders in adolescence presented in the literature often exclude internalizing problems. Although there is extensive data on the effectiveness of SEL skills in improving resilience, few studies included evidence in their reports on the relationship between SEL skills and internalizing problems. The present study aims to deepen the understanding of the relationship between SEL, resilience, and internalizing problems, by investigating the mediating effect of resilience between SEL components and internalizing problems. (2) Methods: Adolescents (N = 968 adolescents, aged between 11 and 18 years old; M = 13.30; SD = 1.92) from 30 schools from the NE region of Romania were invited to fill out questionnaires on social and emotional learning, internalizing problems, and resilience. (3) Results: The results show that resilience mediates the link between self-awareness and internalizing problems, between self-management and internalizing problems, between relationship skills and internalizing problems, and between responsible decision-making and internalizing problems. (4) Conclusions: These findings revealed the need for social and emotional learning interventions that include resilience-oriented approaches in order to decrease internalizing problems in adolescents. Moreover, we suggest that more culturally appropriate interventions are required to better investigate the interaction between SEL components, resilience, and internalizing problems.

Multi-informant validity evidence for the SSIS SEL Brief Scales across six European countries.

The SSIS SEL Brief Scales (SSIS SELb) are multi-informant (teacher, parent, and student) measures that were developed to efficiently assess the SEL competencies of school-age youth in the United States. Recently, the SSIS SELb was translated into multiple languages for use in a multi-site study across six European countries (Croatia, Greece, Italy, Latvia, Portugal, and Romania). The purpose of the current study was to examine concurrent and predictive evidence for the SEL Composite scores from the translated versions of the SSIS SELb Scales. Results indicated that SSIS SELb Composite scores demonstrated expected positive concurrent and predictive relationships with scores from the Connor-Davidson Resilience Scale (CD-RISC) and negative relationships with scores from the problem behavior scales of the Strengths and Difficulties Questionnaire (SDQ). Although there were a few exceptions, these patterns generally were consistent across informants (parents, teachers, and students) and samples providing initial validity evidence for the Composite score from the translated versions of the SSIS SELb Scales. Limitations and future research directions are discussed.

The effectiveness of a school-based, universal mental health programme in six European countries.

As children and young people today face ever increasing social, emotional and mental health challenges, schools, as one of the primary systems in children's lives, are called to broaden their agenda and help to address these challenges. This paper discusses the evaluation of a school-based, universal mental health promotion programme developed recently for the European context. The programme provides a universal curriculum from early years to high school, aiming to promote social and emotional learning and resilience and prevent social, emotional, and behavioural problems in children and adolescents. A total of 7,789 students (and their teachers and parents) from kindergarten to high school across 6 countries in Europe were recruited from 434 classrooms in 124 schools, making use of cluster sampling. A quasi-experimental longitudinal design was used to evaluate the effectiveness of the programme on students' outcomes by comparing the groups' outcomes within times (pre-test vs. post-test) and between groups (experimental vs. control group). A total of 779 classroom teachers completed pre-and-post scales measuring students' social and emotional learning, mental health and academic achievement. Results indicate that the experimental group had significantly larger increase in social and emotional competence and prosocial behaviour, and a decrease in mental health issues (externalising and internalising problems). No significant impact was found for academic outcomes. The findings are discussed in view of the limitations of the study and areas for further research.

Adolescent social emotional skills, resilience and behavioral problems during the COVID-19 pandemic: A longitudinal study in three European countries.

Objectives: The consequences of long-lasting restrictions related to the COVID-19 pandemic have become a topical question in the latest research. The present study aims to analyze longitudinal changes in adolescents' social emotional skills, resilience, and behavioral problems. Moreover, the study addresses the impact of adolescents' social emotional learning on changes in their resilience and behavioral problems over the course of seven months of the pandemic. Methods: The Time 1 (T1) and Time 2 (T2) measuring points were in October 2020 and May 2021, characterized by high mortality rates and strict restrictions in Europe. For all three countries combined, 512 questionnaires were answered by both adolescents (aged 11-13 and 14-16 years) and their parents. The SSIS-SEL and SDQ student self-report and parent forms were used to evaluate adolescents' social emotional skills and behavioral problems. The CD-RISC-10 scale was administered to adolescents to measure their self-reported resilience. Several multilevel models were fitted to investigate the changes in adolescents' social emotional skills, resilience, and behavioral problems, controlling for age and gender. Correlation analysis was carried out to investigate how changes in the adolescents' social emotional skills were associated with changes in their resilience and mental health adjustment. Results: Comparing T1 and T2 evaluations, adolescents claim they have more behavioral problems, have less social emotional skills, and are less prosocial than perceived by their parents, and this result applies across all countries and age groups. Both informants agree that COVID-19 had a negative impact, reporting an increment in the mean internalizing and externalizing difficulties scores and reductions in social emotional skills, prosocial behavior, and resilience scores. However, these changes are not very conspicuous, and most of them are not significant. Correlation analysis shows that changes in adolescents' social emotional skills are negatively and significantly related to changes in internalized and externalized problems and positively and significantly related to changes in prosocial behavior and resilience. This implies that adolescents who experienced larger development in social emotional learning also experienced more increase in resilience and prosocial behavior and a decrease in difficulties. Conclusion: Due to its longitudinal design, sample size, and multi-informant approach, this study adds to a deeper understanding of the pandemic's consequences on adolescents' mental health.

Digital single-operator cholangioscopy in diagnostic and therapeutic bilio-pancreatic diseases: A prospective, multicenter study.

BACKGROUND AND AIM: Digital single-operator cholangioscopy (D-SOC) is an endoscopic procedure that is increasingly used for the management of bilio-pancreatic diseases. We aimed to investigate the efficacy and safety of D-SOC for diagnostic and therapeutic indications. METHODS: This is a multicenter, prospective study(January 2016-June 2019) across eighteen tertiary centers. The primary outcome was procedural success of D-SOC. Secondary outcomes were: D-SOC visual assessment and diagnostic yield of SpyBite biopsy in cases of biliary strictures, stone clearance rate in cases of difficult biliary stones, rate of adverse events(AEs) for all indications. RESULTS: D-SOC was performed in 369 patients (201(54,5%) diagnostic and 168(45,5%)therapeutic). Overall, procedural success rate was achieved in 360(97,6%) patients. The sensitivity, specificity, PPV, NPV and accuracy in biliary strictures were: 88,5%, 77,3%, 83,3%, 84,1% and 83,6% for D-SOC visual impression; 80,2%, 92,6%, 95,1%, 72,5% and 84,7% for the SpyBite biopsy, respectively. For difficult biliary stones, complete duct clearance was obtained in 92,1% patients (82,1% in a single session). Overall, AEs occurred in 37(10%) cases.The grade of AEs was mild or moderate for all cases, except one which was fatal. CONCLUSION: D-SOC is effective for diagnostic and therapeutic indications.Most of the AEs were minor and managed conservatively, even though a fatal event has happened that is not negligible and should be considered before using D-SOC.

Adolescents' Resilience During COVID-19 Pandemic and Its Mediating Role in the Association Between SEL Skills and Mental Health.

The main purpose of this paper is to investigate the role of social and emotional learning (SEL) skills and resilience in explaining mental health in male and female adolescents, during the COVID-19 pandemic. Three self-report questionnaires were administered to 778 participants aged between 11 and 16 years (mean age = 12.73 years; SD = 1.73) and recruited from 18 schools in Northern Italy. The SSIS-SELb-S and the CD-RISC 10 assessed SEL and resilience skills respectively, while the Strengths and Difficulties Questionnaire (SDQ) was used to measure mental health in terms of internalizing problems, externalizing problems, and prosocial behavior. We found that SEL and resilience skills were positively and significantly associated with each other, negatively associated with internalizing and externalizing problems, and positively related to prosocial behavior. Three linear regression analyses showed the significant role of resilience, age, and gender in explaining the variance of internalizing problems; the significant role of SEL skills, resilience, age, and gender in explaining the variance of externalizing problems; and the role of SEL skills, age, and gender in explaining prosocial behavior. Importantly, we found that resilience fully mediated the relationship between SEL skills and internalizing problems, partially mediated the relationship between SEL skills and externalizing problems and didn't mediate the relationship between SEL skills and prosocial behavior. The paper concludes with a discussion of the limitations of the study as well as its practical implications.

EUS-guided biliary drainage with LAMS for distal malignant biliary obstruction when ERCP fails: single-center retrospective study and maldeployment management.

BACKGROUND: EUS-guided biliary drainage (EUS-BD) with Lumen Apposing Metal Stent (LAMS) is a mini-invasive approach for jaundice palliation in distal malignant biliary obstruction (D-MBO) not amenable to ERCP, with good efficacy and not exiguous adverse events. AIMS AND METHODS: From January 2015 to December 2019, we retrospectively enrolled all the EUS-BD with electrocautery-enhanced LAMS for biliary decompression in unresectable D-MBO and failed ERCP. Primary study aims were to evaluate technical/clinical success and AEs rate. In case of maldeployment, we estimated the efficacy of an intra-operative rescue therapy. Secondary aims were to assess the jaundice recurrence and gastric outlet obstruction symptoms. RESULTS: Thirty-six EUS-BD were enrolled over a cohort of 738 patients (ERCP cannulation failure rate was 2.6%): 31 choledocho-duodenostomy and 5 cholecystogastrostomy. A pre-loaded guidewire through the LAMS was systematically used in case of common bile duct ≤ 15 mm or scope instability for a safe/preventive biliary entryway in case of intra-procedural complications. Technical success was 80.6% (29/36 patients). Seven cases of LAMS maldeployment during EUS-guided choledocho-duodenostomy were successfully treated with RT by an over-the-wire fully-covered Self-Expandable Metal Stent (FC-SEMS). The FC-SEMS was released through the novel fistula tract in endoscopic fashion in 5/7 cases and transpapillary in percutaneous-transhepatic-endoscopic rendezvous (1/7) and laparoscopic-endoscopic rendezvous (1/7) in the two remaining cases. The total efficacy of rescue therapy was 100%. Same-session duodenal SEMS was placed in 17 patients with optimal gastric outlet obstruction management. Final clinical success was 100% and no other late adverse events or FC-SEMS migration were observed. CONCLUSION: EUS-BD with LAMS is effective for jaundice palliation after ERCP failure but with considerable adverse events. Maldeployment remains a serious complication with fatal evolution if not correctly recognized/managed. Rescue therapy must be promptly applied especially in tertiary-care centers with highly skilled endoscopists, interventional radiologist and dedicated surgeon.

The Development of Teachers' and Their Students' Social and Emotional Learning During the "Learning to Be Project"-Training Course in Five European Countries.

In recent years, the school curricula in many European countries have introduced social and emotional learning (SEL). This calls for the teachers to have SEL competencies. The present study evaluates teachers' and their students' readiness for SEL during an intervention in five European countries. The participants were teachers (n = 402) in five European countries; Italy, Latvia, Lithuania, Slovenia, and Spain. The pre- and post-measuring points for both the intervention and the comparison group were at approximately the same time before and after the intervention. Comparison data consisted of 159 teachers in the same countries. The training for the intervention group lasted 16 h for the teachers and a maximum of 16 h for the principles and headmasters. An additional 9 h of further monitoring took place. There were two student groups participating in the study: the age group of 8-11 years (pre puberty) and the age group of 12-15-years (adolescents). Students, whose teachers had participated in the intervention, formed the intervention group (n = 2,552). Those students, whose teachers did not participate in the intervention, formed the comparison group (n = 1,730). The questionnaire data were collected at the beginning and at the end of the school year for both age groups. The results indicated that there was a favorable development in the intervention group in some of the measured skills among students, but the effects were different for the two age groups. This study adds to both theoretical and practical development of continuing teacher training about SEL and its possible role in reducing problem behavior among the students.

Endoscopic Ultrasound-guided Fine-needle Biopsy With or Without Rapid On-site Evaluation for Diagnosis of Solid Pancreatic Lesions: A Randomized Controlled Non-Inferiority Trial.

BACKGROUND AND AIMS: The benefit of rapid on-site evaluation (ROSE) on the diagnostic accuracy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has never been evaluated in a randomized study. This trial aimed to test the hypothesis that in solid pancreatic lesions (SPLs), diagnostic accuracy of EUS-FNB without ROSE was not inferior to that of EUS-FNB with ROSE. METHODS: A noninferiority study (noninferiority margin, 5%) was conducted at 14 centers in 8 countries. Patients with SPLs requiring tissue sampling were randomly assigned (1:1) to undergo EUS-FNB with or without ROSE using new-generation FNB needles. The touch-imprint cytology technique was used to perform ROSE. The primary endpoint was diagnostic accuracy, and secondary endpoints were safety, tissue core procurement, specimen quality, and sampling procedural time. RESULTS: Eight hundred patients were randomized over an 18-month period, and 771 were analyzed (385 with ROSE and 386 without). Comparable diagnostic accuracies were obtained in both arms (96.4% with ROSE and 97.4% without ROSE, P = .396). Noninferiority of EUS-FNB without ROSE was confirmed with an absolute risk difference of 1.0% (1-sided 90% confidence interval, -1.1% to 3.1%; noninferiority P < .001). Safety and sample quality of histologic specimens were similar in both groups. A significantly higher tissue core rate was obtained by EUS-FNB without ROSE (70.7% vs. 78.0%, P = .021), with a significantly shorter mean sampling procedural time (17.9 ± 8.8 vs 11.7 ± 6.0 minutes, P < .0001). CONCLUSIONS: EUS-FNB demonstrated high diagnostic accuracy in evaluating SPLs independently on execution of ROSE. When new-generation FNB needles are used, ROSE should not be routinely recommended. (ClinicalTrial.gov number NCT03322592.).

Impact of biliary stents on the diagnostic accuracy of EUS-guided fine-needle biopsy of solid pancreatic head lesions: A multicenter study.

BACKGROUND AND OBJECTIVES: There is no clear evidence of a negative impact of biliary stents on the diagnostic yield of EUS-guided fine-needle biopsy (EUS-FNB) for diagnosing pancreatic head lesions. We aimed to evaluate the association between the presence of biliary stents and the diagnostic accuracy of EUS-FNB. MATERIALS AND METHODS: A multicenter retrospective study including all jaundiced patients secondary to pancreatic head masses was performed. Patients were divided into two groups according to the presence of a biliary stent placed before EUS-FNB. Pathological results were classified according to the Papanicolaou classification and compared against the final diagnosis. Diagnostic measures in the two groups were compared. Multivariate logistic regression analyses including potential factors affecting EUS-FNB accuracy were performed. RESULTS: Overall, 842 patients were included, 495 (58.8%) without and 347 (41.2%) with biliary stent. A plastic or a metal stent was placed in 217 (62.5%) and 130 (37.5%) cases, respectively. Diagnostic sensitivity and accuracy were significantly higher in patients without biliary stent than in those with stent (91.9% and 92.1% vs. 85.9% and 86.4%, P = 0.010 At multivariate analyses, lesion size (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.02-1.09, P = 0.01) and presence of biliary stent (OR: 0.51, 95% CI: 0.32-0.89, P = 0.01) were independently associated with diagnostic accuracy. In the subgroup of patients with biliary stent, the type of stent (plastic vs. metal) did not impact EUS-FNB yield, whereas the use of larger bore needles enhanced diagnostic accuracy (OR: 2.29, 95% CI: 1.28-4.12, P = 0.005). CONCLUSIONS: In this large retrospective study, an indwelling biliary stent negatively impacted the diagnostic accuracy of EUS-FNB. Preferably, EUS-FNB should precede endoscopic retrograde cholangiopancreatography, especially in the case of small tumors.