A serial mediation model of physical exercise and loneliness: the role of perceived social support and resilience.

BACKGROUND: Loneliness is a risk factor for numerous negative life outcomes and diseases among older adults. Physical exercise can reduce social isolation among older adults and improve their health status. This study focused on the relationships among physical exercise, perceived social support, resilience and loneliness to provide theoretical support for physical exercise interventions to address loneliness in older adults. METHODS: This study used a structural equation model and bootstrap method to test a serial mediation model of physical exercise and loneliness and the role of perceived social support and resilience. In this descriptive and cross-sectional study, a questionnaire survey was conducted on 516 older adults from 5 January 2024 to 20 January 2024. The data were collected using the physical activity rating scale (PARS-3), UCLA loneliness Scale-8 (ULS-8), perceived social support scale (PSSS) and Connor-Davidson Resilience Scale (CD-RISC). RESULTS: The results showed that physical exercise among older adults had a direct negative relationship with loneliness (Effect = -0.049, 95% CI: -0.072 to -0.027). In addition, perceived social support and resilience mediated the relationship between physical exercise and loneliness both independent and serially, with the independent mediation effect of perceived social support being - 0.041 (95% CI: -0.056 to -0.028), the independent mediation effect of resilience being - 0.018 (95% CI: -0.026 to -0.011), and the serial mediation effect of perceived social support and resilience being - 0.009 (95% CI: -0.015 to -0.005). The total indirect effect of the three mediation paths was 58.47%. CONCLUSIONS: (1) In this study, physical exercise and loneliness in older adults were negatively correlated. Perceived social support and resilience play mediating roles in the relationship between physical exercise and loneliness. (2) This study suggests that participation in group events or team sports is valuable for alleviating loneliness caused by a lack of social interaction.

Living With and Beyond Cancer With Comorbid Conditions: Qualitative Insights to Understand Psychosocial Support Needs.

INTRODUCTION: There is a pressing need to understand and explore the complex experiences and psychosocial support needs of people LWBC-CM and their informal caregivers, to inform survivorship and supportive care interventions. METHODS: In-depth qualitative interviews were conducted with people LWBC-CM and their informal caregivers in Scotland, invited via primary care. One-to-one, face-to-face interviews were conducted with informed consent exploring experiences of symptoms, psychosocial support needs and interactions with health services. Interviews were transcribed and analysed using a thematic approach. RESULTS: Forty-one people LWBC-CM and twenty-three informal caregivers were interviewed. Four themes were identified: the Physical and Psychological Impact of Cancer and Comorbidity, Dominant Storie-Prioritising Conditions and Making Sense of Illness, Navigating Health Services and Treatments and Caring for People with Complex Health Conditions. Type and severity of conditions mediated people's experiences and daily living. Complex fatigue-fatigue arising from a number of health conditions-dominated symptomology. Participants navigated multiple appointments and complex medication regimes. Patients identified the need for acknowledgement of other chronic conditions and for streamlined care provision. Mutual caring and social isolation were also identified as part of the caring relationship. CONCLUSIONS: There is a mandate to address the psychosocial support needs of people LWBC-CM, and their informal carers, given the burden of treatment for cancer survivors with moderate to severe complex conditions as they navigate health services. PATIENT OR PUBLIC CONTRIBUTION: A patient representative has been involved in all stages of the study from development of the application through study design, commenting on documentation, analysis of transcripts and writing the manuscript. They are included as an author on the manuscript.

A Scoping Review of Factors Influencing Smoking Cessation in Patients with Chronic Obstructive Pulmonary Disease.

To provide a scoping review of studies on factors affecting smoking cessation in patients with chronic obstructive pulmonary disease (COPD), so as to provide a basis for healthcare professionals to intervene early in the process of cessation of smoking in patients with COPD, and to formulate personalized interventions for smoking cessation. Arksey and O'Malley's scoping review methodology as a framework, searched databases including CNKI, Wanfang Data, VIP, China Biomedical Database, PubMed, Web of Science, Embase, ProQuest, CINAHL, and Cochrane Library to collect literature on factors influencing smoking cessation among COPD patients. The literature was screened, data extracted, and summarized accordingly. A total of 28 papers were included. The socio-demographic related factors affecting smoking cessation in patients with COPD were age, educational level, residence, marital status, occupational status, economic status, race, and sex; tobacco related factors included smoking index, smoking duration (years), cumulative smoking (packs/year), smoking intensity (packs/day), and tobacco addiction; disease related factors included mMRC score, GOLD level, severity of airflow restrictions, symptom, activity limitation due to lung problems, history of deterioration in outpatient care, receipt of COPD medication, receipt of lung CT, receipt of pulmonary function tests, receipt of surgery, and comorbid comorbidities; psychologically related factors included mental health status, quit smoking health beliefs, smoking cessation self-efficacy, motivation to quit smoking, stress, and adverse emotions; environmental/Interpersonal network related factors-included environmental impacts, social support, family support, tobacco control policies, and satisfaction with cessation care; and behavior related factors included alcohol consumption, coffee consumption, eating, physical activity, and have a hobby. Healthcare professionals should avoid critical education of COPD patients in the process of smoking cessation management, pay attention to the adverse effects of medication side effects on patients, emphasize the improvement of patients' health beliefs and self-efficacy in smoking cessation, and help patients to establish a correct cognition of smoking cessation.

A qualitative study of psychological stress and coping among persons using crack cocaine.

BACKGROUND: Research has identified a strong link between stress and drug use behaviours. Also, it has been established that the prolonged use of crack cocaine stimulates emotional, cognitive, neurological and social changes. This paper explores the psychological stressors that occur from crack cocaine use and the coping mechanisms used to mitigate them. This will provide an understanding of the intricate relationship between substance use and psychological well-being. METHODOLOGY: The study is qualitative and uses a descriptive phenomenological approach. The coping circumplex model is the theoretical model that underpins the study. Data was collected through 26 face-to-face in-depth semi-structured interviews with people who use crack cocaine. Data were analysed using thematic analysis. Participants consisted of 15 males and 11 females between the ages of 24-57 years, guaranteeing multiplicity within the study sample. RESULTS: Cravings, financial burdens, relationship breakdown and emotional /cognitive stimulation were revealed as psychological stressors. Maladaptive coping which includes self-harm, isolation, not speaking about/not dealing with emotions and using substances were adopted by study participants. Also, positive coping such as seeking help and keeping busy were adopted by study participants. Social and environmental factors such as stigma, easy accessibility of crack and flashbacks served as barriers to positive coping. Positive coping was linked to the availability and easy accessibility to social support and strong family bonds, underlining the importance of accessible support systems in managing the challenges linked with crack cocaine use. CONCLUSION: The challenges faced by study participants in coping with the psychological stressors linked to their crack cocaine use highlight the importance of adopting personalised and comprehensive strategies to tackle the intricate dynamics between psychological stress, coping and crack cocaine use.

Posttreatment health interventions for adult cancer survivors and their families: an integrated review.

PURPOSE: This review aimed to synthesize the literature regarding health interventions delivered to adult cancer survivors and their families during posttreatment phase. METHODS: An integrative literature review was conducted that included quantitative and qualitative studies. The search was carried out in four databases using the same terms or MeSH terms and included data from January 2012 to February 2024. After quality assessment, data were extracted and synthesized. The protocol was registered in PROSPERO. RESULTS: Among the seven studies included, two studies were randomized controlled trials, three were observational, and two utilized a qualitative approach. The studies originated from France, Australia, Canada, the UK, and the USA. In total, 704 participants were included, 294 were cancer survivors, 40 were non-cancer patients, 271 were family and caregivers, and 99 were healthcare professionals. The studies assessed survival durations after cancer treatment, ranging from 18 months to 6 years. The sparse interventions found across the studies used a multifaceted approach tailored to address various aspects of cancer survivorship and caregiver support. CONCLUSION: This review provides insights into the complex landscape of posttreatment support requirements for cancer survivors and their family caregivers. This finding underscores the critical necessity for additional intervention research involving comprehensive, accessible, and supportive services that address the multifaceted dimensions of survivorship for the patient and family as a unit.

Exploring Trade-Offs for Online Mental Health Matching: Agent-Based Modeling Study.

BACKGROUND: Online mental health communities (OMHCs) are an effective and accessible channel to give and receive social support for individuals with mental and emotional issues. However, a key challenge on these platforms is finding suitable partners to interact with given that mechanisms to match users are currently underdeveloped or highly naive. OBJECTIVE: In this study, we collaborated with one of the world's largest OMHCs; our contribution is to show the application of agent-based modeling for the design of online community matching algorithms. We developed an agent-based simulation framework and showcased how it can uncover trade-offs in different matching algorithms between people seeking support and volunteer counselors. METHODS: We used a comprehensive data set spanning January 2020 to April 2022 to create a simulation framework based on agent-based modeling that replicates the current matching mechanisms of our research site. After validating the accuracy of this simulated replication, we used this simulation framework as a "sandbox" to test different matching algorithms based on the deferred acceptance algorithm. We compared trade-offs among these different matching algorithms based on various metrics of interest, such as chat ratings and matching success rates. RESULTS: Our study suggests that various tensions emerge through different algorithmic choices for these communities. For example, our simulation uncovered that increased waiting time for support seekers was an inherent consequence on these sites when intelligent matching was used to find more suitable matches. Our simulation also verified some intuitive effects, such as that the greatest number of support seeker-counselor matches occurred using a "first come, first served" protocol, whereas relatively fewer matches occurred using a "last come, first served" protocol. We also discuss practical findings regarding matching for vulnerable versus overall populations. Results by demographic group revealed disparities-underaged and gender minority groups had lower average chat ratings and higher blocking rates on the site when compared to their majority counterparts, indicating the potential benefits of algorithmically matching them. We found that some protocols, such as a "filter"-based approach that matched vulnerable support seekers only with a counselor of their same demographic, led to improvements for these groups but resulted in lower satisfaction (-12%) among the overall population. However, this trade-off between minority and majority groups was not observed when using "topic" as a matching criterion. Topic-based matching actually outperformed the filter-based protocol among underaged people and led to significant improvements over the status quo among all minority and majority groups-specifically, a 6% average chat rating improvement and a decrease in blocking incidents from 5.86% to 4.26%. CONCLUSIONS: Agent-based modeling can reveal significant design considerations in the OMHC context, including trade-offs in various outcome metrics and the potential benefits of algorithmic matching for marginalized communities.

Feasibility of Whole-Body Resistance Training With Social Support Reinforcement for Older Adults Living Alone: A Mixed-Methods Pilot Study.

PURPOSE: To examine the feasibility and acceptability of progressive whole-body resistance training with social support reinforcement for older adults living alone. METHOD: This mixed methods single-group pilot study examined an intervention provided over 3 nonconsecutive days per week for 12 weeks. We evaluated quantitative data on recruitment, uptake, retention, and adherence, and measured pretest and posttest outcome scores on body composition, physical function, and psychosocial health. We conducted a focus group interview to collect qualitative data on participants' perspectives. RESULTS: Seven participants (five women and two men) completed the program (attendance rate = 88.9%). Physical function and psychosocial health improved, but soft lean and skeletal muscle mass decreased. Five themes emerged from the qualitative data. CONCLUSION: Results support the feasibility and benefits of this intervention program for older adults living alone despite challenges with recruitment and uptake. [Journal of Gerontological Nursing, 50(10), 34-41.].

Maintaining exercise in fitness centre settings: insights from the physical activity maintenance theory.

PURPOSE: This study examines factors that influence long-term fitness centre participation, applying the Physical Activity Maintenance Theory to assess psychological and contextual influences on exercise adherence. METHODS: Semi-structured interviews were conducted with 17 regular fitness centre attendees in Taubaté, São Paulo, Brazil. Data were analysed using Bardin's Content Analysis, exploring the participants' experiences and the factors contributing to their sustained activity. RESULTS: Autonomous motivation, such as enjoyment and satisfaction from workouts, along with self-efficacy, emerged as crucial for continued fitness centre attendance. The environment, including ambiance, social support, and facility quality, significantly impacted exercise persistence. However, challenges like time constraints, weather conditions, and personal issues occasionally hindered engagement. The study also highlights the role of personalized fitness programmes in supporting long-term adherence, suggesting that tailoring these programmes to individual goals could further enhance commitment. CONCLUSIONS: The findings underscore the importance of fitness centres creating environments that align with individual needs and preferences. Customized programmes that cater to both personal and communal needs could bolster long-term adherence. Future research should explore the impact of personalized, community-integrated fitness approaches on sustaining active lifestyles, emphasizing the importance of accommodating individual preferences in maintaining regular exercise habits.

Living together-does it help or hinder the pursuit of a healthful diet, physical activity, and weight loss among cancer survivors and their chosen partners?

PURPOSE: Parental or spousal cohabitating relationships are often targeted in behavioral interventions, but the contribution of cohabitation is poorly understood. This study explored whether cohabitation status moderated the impact of social cognitive theory constructs on adiposity, diet, and exercise in a dyadic, web-based weight loss intervention among cancer survivors and their chosen partners. METHODS: The 24-week weight loss intervention was conducted among 56 dyads, comprised of a cancer survivor and their chosen partner (n = 112). Baseline and 6-month data on social cognitive theory constructs (self-efficacy, social support, and perceived barriers), and study outcomes of adiposity (weight and waist circumference), diet (calories and diet quality), and moderate-to-vigorous physical activity (MVPA) were used to perform moderated-mediation analyses among cohabitating (n = 25) versus non-cohabitating (n = 31) dyads. RESULTS: The intervention was positively associated with dietary social support (path a1: 0.36, 95% CI [0.083, 0.659]) and inversely associated with perceived dietary barriers (path a1: - 10.57, 95% CI [- 19.109, - 3.091]) and perceived exercise barriers (path a1: - 11.29, 95% CI [- 22.098, - 3.500]) among those who did not cohabitate (effects not observed among cohabitating pairs). The intervention's mediating effects through perceived barriers on weight (indirect effect (ab): - 2.21, 95% CI [- 4.794, - 0.548]), waist circumference (ab: - 1.13, 95% CI [- 2.452, - 0.171]), caloric intake (ab: - 5.09 (2.86), 95% CI [- 12.602, - 0.709]), and self-reported MVPA (ab: 0.29 (0.18), 95% CI [0.019, 0.754]) also were stronger among non-cohabitating pairs. CONCLUSIONS: These findings suggest that social support partners outside the home substantially enhance intervention impact, though relationship quality and gender dynamics warrant further exploration. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04132219.

How post overdose response efforts can address social determinants of health among people who use drugs: perspectives from the New York State Department of Health (NYSDOH) Post Overdose Response Team (PORT).

Individuals who have survived an overdose often have myriad needs that extend far beyond their drug use. The social determinants of health (SDOH) framework has been underutilized throughout the opioid overdose crisis, despite widespread acknowledgment that SDOH are contributors to the majority of health outcomes. Post Overdose Response Teams (PORTs) engage with individuals who have experienced 1 or more nonfatal overdoses and bear witness to the many ways in which overdose survivors experience instability with healthcare, housing, employment, and family structure. Employing a harm reduction model, PORTs are well-positioned to reach people who use drugs (PWUD) and to address gaps in basic needs on an individualized basis, including providing social support and a sense of personal connection during a period of heightened vulnerability. The New York State Department of Health (NYSDOH) PORT program is a harm reduction initiative that utilizes law enforcement data and several public databases to obtain accurate referral information and has been active since 2019 in NYC. This PORT program offers various services from overdose prevention education and resources, referrals to health and treatment services, and support services to overdose survivors and individuals within their social network. This perspective paper provides an in-depth overview of the program and shares quantitative and qualitative findings from the pilot phase and Year 1 of the program collected via client referral data, interviews, and case note reviews. It also examines the barriers and successes the program encountered during the pilot phase and Year 1. The team's approach to addressing complex needs is centered around human connection and working toward addressing SDOH one individualized solution at a time. Application of the NYSDOH PORT model as outlined has the potential to create significant positive impacts on the lives of PWUD, while potentially becoming a new avenue to reduce SDOH-related issues among PWUD.

Father support breastfeeding self-efficacy positively affects exclusive breastfeeding at 6 weeks postpartum and its influencing factors in Southeast China: a multi-centre, cross-sectional study.

BACKGROUND: The exclusive breastfeeding condition in China is not optimism now. Maternal breastfeeding self-efficacy stands as a pivotal factor influencing exclusive breastfeeding. Interestingly, studies have suggested that father support breastfeeding self-efficacy is a pivotal mediator in infant breastfeeding. Thus, the current research aimed to investigate the association between father support breastfeeding self-efficacy and exclusive breastfeeding at six weeks postpartum, and the influencing factors of father support breastfeeding self-efficacy. METHODS: This research was structured as a multi-centre cross-sectional study, involving 328 fathers, whose partners were six weeks postpartum, and recruited from two public hospitals in Southeast China. Self-designed demographic questionnaires, namely, Father Support Breastfeeding Self-Efficacy Scale-Short Form, Breastfeeding Knowledge Questionnaire, Positive Affect Scale and the 14-item Fatigue Scale, were applied. Descriptive statistics, Chi-square test, logistic regression univariate analysis and multiple linear regression were used to analyse data. RESULTS: Results indicate a significant difference between the infant feeding methods at six weeks postpartum and fathers with different levels of support breastfeeding self-efficacy (p < 0.05). Particularly, father support breastfeeding self-efficacy positively affected exclusive breastfeeding at six weeks postpartum after adjusting all the demographic characteristics of fathers (OR: 2.407; 95% CI: 1.017-4.121). Moreover, results show that the significant influencing factors of father support breastfeeding self-efficacy include breastfeeding knowledge, fatigue, positive affect, successfully experienced helping mothers to breastfeed, spousal relationships and companionship time. CONCLUSIONS: High-level father support breastfeeding self-efficacy effectively increased exclusive breastfeeding rate at six weeks postpartum. To enhance the exclusive breastfeeding rate, nurses or midwives can endeavour to design educational programmes or take supportive interventions customised for fathers, such as enhancing their breastfeeding knowledge education, reducing fatigue and mobilising positive emotions, thereby bolstering paternal self-efficacy in breastfeeding.

Autistic and schizotypal traits exhibit similarities in their impact on mentalization and adult attachment impairments: a cross-sectional study.

BACKGROUND: Deficits in mentalizing and attachment occur in the autism and schizophrenia spectrum, and their extended traits in the general population. Parental attachment and the broader social environment highly influence the development of mentalizing. Given the similarities in the symptomatology and neurodevelopmental correlates of autism spectrum disorder (ASD) and schizophrenia (SCH), it is crucial to identify their overlaps and differences to support screening, differential diagnosis, and intervention. METHODS: This cross-sectional study utilized questionnaire data from 2203 adults (65.1% female, mean age[SD] = 37.98[9.66]), including participants diagnosed with ASD, SCH, and those exhibiting subclinical traits to investigate the associations between mentalizing, attachment, and perceived social support during adolescence across the autistic and schizotypy spectrum. RESULTS: It was revealed that both autistic and schizotypal traits have comparable effects on insecure adult attachment, primarily through challenges in mentalizing. The impact of mentalizing deficits on adult attachment slightly varies between autistic and schizotypal traits. Conversely, perceived social support during adolescence relates to improved mentalizing and secure adult attachment as a protective factor during development. CONCLUSIONS: These outcomes highlight the significance of supportive therapeutic relationships and community care while suggesting directions for further research and collaborative treatments addressing ASD and SCH, considering the differential impact of mentalizing on adult attachment.

Peer support provider and recipients' perspectives on compassion in virtual peer support stroke programs: "You can't really be supportive without compassion".

BACKGROUND: Peer support programs demonstrate numerous benefits, including emotional, instrumental, informational, and affirmational social support. Since the COVID-19 pandemic, many peer support stroke programs in Canada have been delivered virtually. Compassion must be consistently applied to build meaningful interactions, but the shift to virtual services may have changed the quality of interaction and compassion in virtual services. While compassion is recommended in health and social services to improve outcomes, satisfaction, and service quality, compassion in virtual peer support stroke programs remains understudied. We aimed to describe compassionate support in virtual peer support stroke programs from peer support providers' and recipients' perspectives. METHODS: This qualitative descriptive study was guided by Sinclair & colleagues' model of compassion. Peer support recipients or peer support providers participated in interviews transcribed and analyzed using a hybrid thematic analysis. RESULTS: Sixteen were peer support recipients, six were peer support providers, and two were both peer support providers and recipients. Participants agreed that compassion was essential in these programs. Participants perceived compassion to be a result of the virtues of compassionate facilitators (i.e., genuineness, passion, and empathy), relational space, and communication within the virtual peer support stroke program (e.g., sense of awareness or intuition of compassion, aspects of engaged peer support provision), virtuous response (e.g., knowing the person and actions that made the peer support recipient feel like a priority). Compassion was facilitated by listening and understanding peer support recipients' needs as they relate to stroke (i.e., seeking to understand peer support recipients and their needs), attending to peer support recipients' needs (e.g., timely actions to address their needs), and achieving compassion-related program outcomes (e.g., alleviating challenges and enhancing wellbeing). The absence of these components (e.g., lacking genuineness, passion and empathy) was a barrier to compassion in virtual peer support stroke programs. CONCLUSIONS: Study findings describe facilitators and barriers to perceived compassion in virtual peer support stroke programs and provide practical recommendations that can be adapted into programs to improve program quality.

Peer support needs, preferences and experiences of adults with acquired neurological disability: a scoping review protocol.

INTRODUCTION: Peer support is a promising adjunct to traditional rehabilitation methods for helping adults with acquired neurological disability adjust to and navigate life with a disability. However, there is limited guidance on how to implement peer support for this cohort. To help inform peer support practices, the aim of this scoping review is to determine what is currently known about the peer support needs, preferences and experiences of adults with acquired neurological disability. METHODS AND ANALYSIS: The scoping review will be conducted according to guidelines published by Arksey and O'Malley, Levac et al and Peters et al. Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Systematic searches on five electronic databases (CINAHL, Embase, MEDLINE, PsycINFO and Scopus) will be conducted to identify peer-reviewed research published since 2013 that investigates any type of peer support for adults (18-65 years) with any acquired neurological disability. Information about the study, participant and peer support characteristics, as well as data pertaining to the key outcomes of interest (ie, needs, preferences and experiences), will be charted, summarised and reported. Qualitative data will be analysed using thematic synthesis, and findings will be discussed with 4-6 people with lived experience of acquired neurological disability. ETHICS AND DISSEMINATION: The review does not require an ethics application. It is anticipated that findings will be disseminated through journal publications and conference presentations. Translation of the findings to non-academic audiences will be informed by the consultation with lived experience experts.

An evaluation of support to the second victims in Tshwane District Health Services, South Africa.

BACKGROUND:  Initiatives to reduce patient safety incidents (PSI) and support healthcare professionals who may experience psychological trauma as a result are becoming increasingly common. However, little is known about the quality of the support provided by Tshwane District Health Services. Therefore, it is necessary to assess their assistance for the second victims in order to evaluate their effectiveness. METHODS:  A cross-sectional study was conducted, and 319 healthcare professionals from six primary health care institutions were invited to participate in the study. The sociodemographic information, work experience, emotional support, familiarity with the concept of the 'second victim' and involvement with PSIs were collected. RESULTS:  The mean age was 39.8 years, ranging from 22 years to 66 years. The majority of participants were females (n = 249; 78.1%), nurses (n = 153; 49.2%), and those with 5-9 years of experience (n = 82; 25.8%). Most participants (n = 168; 52.7%) were aware of the possibilities of emotional support, while less than half (n = 142; 44.5%) were familiar with the term 'second victim'. The cumulative incidence of adverse events in the institutions was 19.4%, and the majority of second victims (n = 39; 62.9%) emotionally felt the need to speak with someone about it, preferably outside of the workplace. Less than 5% of individuals received support that was initiated by existing structures at their workplace. CONCLUSION:  Frameworks exist to assist second victims, although they are only known to some healthcare professionals. However, their current use in Tshwane health facilities is ineffective. After experiencing PSIs, second victims often rely on psychological assistance outside of the workplace.Contribution: Authorities need to determine the causes behind some healthcare professionals' lack of awareness regarding the support framework for second victims, as well as their growing tendency to rely on psychologists outside of the workplace, and corrective measures should be implemented.

Caregivers' expectations of their non-verbal autistic children in rural KwaZulu-Natal.

BACKGROUND:  Caregiver expectations have been shown to impact child outcomes. There is limited research regarding caregivers of non-verbal autistic children in rural South Africa. Autistic individuals form part of a larger environment, which they influence and which impacts them. Caregivers form part of this environment. OBJECTIVES:  This study aims to explore caregivers' expectations of communication, education, social implications and intervention for their non-verbal autistic child in rural KwaZulu-Natal (KZN). METHOD:  Bronfenbrenner's ecological and bioecological systems theory framed the study and allowed the child's interaction with their environment to be understood through the use of a qualitative study design via interviews. Eleven caregivers (pilot study: n = 1 and main study: n = 10) of non-verbal autistic children were selected and interviewed. Data were analysed thematically. RESULTS:  Caregivers had varied expectations. Grandparents were often the primary caregivers (microsystem). Relationships within the mesosystem (caregiver and therapist) and caregiver's understanding affected their feelings and expectations that changed over time (chronosystem). Education was the predominant expectation. The study highlighted limited resources (schools) within the exosystem. Caregivers reported both support and judgement from their communities. CONCLUSION:  There is a need for public awareness, caregiver counselling and autism support groups in rural KZN and more specialised education options in order to improve caregivers' expectations.Contribution: This study contributes to the limited literature in the field of autism in South Africa, more specifically the rural context and communication disorders.

Supportive Care Needs of Young Adults With Endometriosis: An Open-Ended Online Survey and Exploration of Unmet Needs.

OBJECTIVE: The aim of this study is to identify and explore the unmet needs of adolescents and young adults living with endometriosis. DESIGN: An open-ended online survey was conducted, with questions derived from prior research looking at areas of unmet need in healthcare, career and work, financial, information, psychological, social and cultural domains. SETTING AND POPULATION: Self-selecting 18-25 year olds with surgically diagnosed endometriosis (self-reported) currently living in Australia were included as participants. METHODS: Invitation to participate in an open-ended online survey was shared through the social media of Australian endometriosis organisations and the Royal Women's Hospital, Melbourne. Surveys were analysed qualitatively through template analysis. MAIN OUTCOME MEASURES: Recording of the unmet supportive care needs of this population was carried out. RESULTS: One hundred and thirty-one respondents fit the eligibility criteria of being aged 18-25 years (median age 23 years). Most were born in Australia (94%), university-educated (54%) and lived in a metropolitan setting (69%). There was a range of unmet needs that were presented across education, work, healthcare and relationships. Group-specific challenges were identified: doctors either over- or underemphasising future fertility; disrupted sexual and romantic life due to painful sex; managing pain in the classroom and workplace where periods are taboo; and being gender-queer in gynaecological medical spaces. CONCLUSIONS: The increasingly young age at which patients are receiving an endometriosis diagnosis precipitates a shift in patient care. The treatment decisions that are being made must be reflective of the unique needs of the adolescents who carry the burden of the disease. Clinicians are advised to be aware of and discuss needs with their patients. PATIENT OR PUBLIC CONTRIBUTION: The nine open-ended questions in this survey were developed from data from a preliminary series of interviews with endometriosis patients in a tertiary women's healthcare centre. In asking these data-informed questions to the online endometriosis community, patients across broader sociocultural demographics and disease states (including less symptomatic endometriosis) have provided a broader understanding of their supportive care needs.

"It's not just about you": International students' vulnerabilities and capacities during the first phase of the COVID-19 pandemic in Canada.

In Canada, the COVID-19 pandemic was initially characterized by emergency government responses that disrupted daily life, especially for marginalized groups. This study explored the vulnerabilities and capacities of international students studying at a university in Calgary, Canada during the first phase of the pandemic. Guided by the Capacities and Vulnerabilities Analysis framework, we thematically analyzed 11 semi-structured interviews with international students. We found that material vulnerabilities included balancing finances, housing conditions, lack of information, food inaccessibility, reliance on public transport, and poor mental health, social vulnerabilities included lack of social support, culture shock, and racism, and attitudinal vulnerabilities included "nowhere to go", feeling like a burden, and perception of Canada as safe. Material capacities included financial support, knowledge about pandemic, and mental health supports, social capacities included local social support and multilingualism, and attitudinal capacities included resilience, religious and spiritual beliefs, "it's not just about you", and reflexivity. We found overlapping and complex relationships between vulnerabilities and capacities, indicating that while international students' vulnerabilities were exacerbated and introduced challenges during the pandemic, students uniquely leveraged their capacities to offset and recover from challenges. Findings from this study may be informative for stakeholders involved in disaster responses, especially universities and governments, to support international students' capacities and address their vulnerabilities.