The benefits of undergraduate medical students delivering free preparticipation physical evaluations in collaboration with a K-12 school district.

BACKGROUND: Student-run free clinics are present at many medical schools throughout the United States. While many work with adult homeless or uninsured populations, few work with pediatric populations. We investigated the impact of volunteering at a free preparticipation sports physical clinic on medical students' educational motivation, school engagement, confidence in their clinical skills, connectedness to community, and self-efficacy. METHODS: First and second year undergraduate medical students who volunteered at a preparticipation sports physical clinic were eligible for the study. 30 students participated in the study, some volunteering multiple times, for a total of 55 post-volunteering surveys. Pre- and post-volunteering surveys were administered via REDCap. The surveys were designed using Likert scales and the General Self-Efficacy scale. Paired two tailed t-tests were used to analyze pre- and post-volunteering data. RESULTS: Students had statistically significant increases in their confidence in working with pediatric populations, performing a standard physical exam, working in an interdisciplinary setting, and communicating with patients. They also demonstrated statistically significant increases in their feelings of connectedness to their reason for practicing medicine and to the greater local community. CONCLUSIONS: This research demonstrated measurable increases in motivation and confidence in clinical skills for medical students that participated. This is a valuable experience for medical students and is a model that other medical schools can adopt to help diversify and strengthen their curriculum. In the future, we would like to collect more data to further evaluate the impact of this volunteering on medical students, patients, families, and other community stakeholders.

Building capacity for local public health: lessons from a mixed-methods evaluation of an academic-public health partnership used in response to COVID-19.

Introduction: The Massachusetts Academic Health Department Consortium (AHD) established the Academic Public Health Volunteer Corps (APHVC) to support Local Health Departments (LHDs, n = 351) to meet rapidly emerging needs during the COVID-19 pandemic through engaging student volunteers. A program evaluation captured lessons learned and informed recommendations for sustainability and future replication. Methods: The mixed-methods evaluation leveraged the Consolidated Framework for Implementation Research (CFIR). Data were stratified by LHD engagement with APHVC. Quantitative surveys informed probes for qualitative focus groups and interviews; findings were categorized into CFIR constructs using a deductive approach. Results: One-fifth of LHDs (n = 76, 27 used APHVC services, 45 did not) completed the survey. Eleven employees participated in follow-up focus groups or interviews. APHVC filled resource gaps, built capacity, and provided high-quality deliverables. LHDs experienced issues with reliability and communication of volunteers and lacked time to train volunteers. Conclusions: CFIR aided in evaluating APHVC in real time, producing actionable recommendations for best practices, dissemination, and future iterations of the program. Results are being used to enhance program effectiveness and sustainability, community health, and health equity across Massachusetts, and may help inform academic practice-based programs across the United States.

The 'Paths to everyday life' (PEER) trial - a qualitative study of mechanisms of change from the perspectives of individuals with mental health difficulties participating in peer support groups led by volunteer peers.

BACKGROUND: Worldwide, peers support has been shown to play a crucial role in supporting people with mental illness in their personal recovery process and return to everyday life. Qualitiative studies underpinning the mechanisms of change in peer support has been reviewed. However, the findings are primeraly based on the perspectives of peer support workers employed in mental health services. Thus, qualitiative studies elucidating the mechanisms of change from the recipient perspective in mental health service independent civil society settings are higly needed to further contribute to the evidence of peer support. The 'Paths to every day life' (PEER) is evaluated in a randomized trial and is substantiated by qualitative studies investigating the experiences of PEER from the perspectives of the recipients and the facilitators of peer support. The purpose of this qualitative study underpinned by critical realism was to substantiate the PEER intervention program theory by gaining deeper insight into the change mechanisms and elaborate how, when, and under what circumstances the peer support groups potentially had or did not have an impact on personal recovery from the perspectives of the recipients of peer support. METHODS: Eleven individuals were interviewed at the end of the ten-week group course. The semi-structured realist-inspired interviews were audio recorded and transcribed verbatim. The analysis was guided by reflective thematic analysis and through an abductive framework based on the program theory. Data were coded and analysed in Nvivo software. RESULTS: Four overarching themes were identified that informed and nuanced the program theory: 1) Connectedness as a prerequisite for engagement; 2) A sense of hope by working out new paths to recovery; 3) Seeing new sides of oneself; and 4) Sprout for change. CONCLUSIONS: This study substantiates the program theory and the quantitative results of the PEER trial by elaborating on mechanisms that were felt to be essential for the personal recovery process from the perspectives of the recipients of the group-based peer support. In addition, the study points out that the opportunities to act in everyday life depended on individual context and where the group participants were on their recovery journey. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04639167.

Out-of-hospital birth training, experience and confidence of Australian rural volunteer ambulance officers.

INTRODUCTION: Unplanned out-of-hospital births represent less than 1% of ambulance requests for assistance. However, these call-outs have a high risk of life-threatening complications, which are particularly complex in rural or remote settings with limited accessibility to specialist care support. Many community hospitals no longer provide obstetrics care, so birth parents must travel to larger regional or metropolitan hospitals for assistance. Increased travel time may increase the risk of unplanned out-of-hospital birth and/or complications such as postpartum haemorrhage and neonatal mortality. Rural volunteer ambulance officers (VAOs) are an integral component of Australia's healthcare system, especially in regional and remote areas. Although VAO response to unplanned out-of-hospital births may be considered rare compared to calls to other case types, provision of adequate care is paramount in these potentially high-risk situations. This research investigates Australian rural VAOs' perceptions of their training, experience and confidence regarding unplanned out-of-hospital birth and planned homebirth with obstetric emergencies where ambulance assistance is required. METHODS: Semi-structured interviews and focus groups were undertaken from late 2021 to mid-2023 via telephone or online videoconference. Sessions were audio-recorded and transcribed verbatim. Data were analysed and coded into themes using Braun and Clarke's six-step process for semantic coding and reflexive thematic analysis. RESULTS: Twenty-eight participants were interviewed from six Australian states and territories, all of whom worked in rural and remote Australia. Ten participants were male, 17 female and one was male-adjacent, with length of VAO experience ranging from 3 months to 29 years. Participants came from seven jurisdictional ambulance services.| Four themes emerged from analysis: (1) Lack of education and exposure to birth resulted in low confidence. Most participants reported significant anxiety attending obstetric call-outs, and explained under-utilisation of specific obstetric and neonatal skills meant skills decay was an issue; (2) limitations were discussed regarding VAO scope of practice and accessing medical equipment specifically required for birthing and neonates that could impact patient care; (3) logistical and communication difficulties were discussed. Long distances to definitive care, potentially limited backup during emergencies and potential unavailability of aeromedical retrieval increased perceived complexity of cases. Telecommunication 'black holes' created a sense of further isolation for VAOs requiring support from senior clinicians; (4) there was a perception that many members of the general public were unaware VAOs often staffed the local ambulance, and expected VAOs to have the same scope of practice as a registered paramedic. Furthermore, VAOs can attend friends and family in an emergency, potentially creating psychological trauma. CONCLUSION: VAOs report being uncomfortable attending unplanned out-of-hospital births and obstetric emergencies, perceiving they have limited ability to manage complications. Backup from a registered paramedic is dependent on availability, and telecommunications are not always reliable in rural areas for online clinical advice and support. Given the distances to definitive care in regional Australia, this has serious implications for patient safety. Continued VAO education is essential for risk reduction in out-of-hospital births.

Beyond the Hospital Walls: The Role of the Ethicist in Community Healthcare Settings.

AbstractCommunity-based "free" clinics can be a key site of primary and preventive care, especially for underserved members of the community. Ethical issues arise in community clinics. Despite this-and the fact that ethics consultation is a well-established practice within hospitals-ethics support is rarely integrated within community clinics, and the clinical ethicist's role in community care settings remains unexplored. In this article I explore what community-engaged practice might look like for the clinical ethicist. I share my experience of being invited into a local community clinic where a team of volunteers, in partnership with a local church, provide care to persons experiencing housing and food security in our county. First, I outline some of the key ethical issues we encounter in our clinic, including how to promote the agency of community members, develop shared standards for clinic volunteers, and balance different values and priorities within the partnership. Second, I explore how the ethicist's knowledge and skills translate into this setting. I argue that, given the range of ethical issues that arise in community clinics and the need for ongoing dialogue, education, and critical reflection within such partnerships, there is a role for the clinical ethicist in this space. I discuss how clinical ethicists might begin to develop community-based partnerships and practices.

Chapitre 4. Le volontarisme contractuel à l'épreuve du smart contract.

Smart contracts, which are computer programmes that run automatically when pre-programmed conditions are met, will impact the contractual process, especially when their development focuses on the contract formation phase. The use of digital oracles, which transmit information from the real world to the digital world, to trigger the application of the smart contract may degrade the quality of consent, replacing it with mere assent.

Acceptability and preliminary effects of the volunteer-supported Meaningful Moments program to engage older adults with advanced dementia on a hospital-based specialized dementia care unit: a mixed methods study.

BACKGROUND: Namaste Care offers practical skills for healthcare providers, volunteers, and families to meaningfully engage individuals with dementia in activities (e.g., music, massage, reminiscing, socialization, aromatherapy, snacks). A hospital-based specialized dementia care unit for patients with mid- to late-stage dementia offered an adapted version of the Namaste Care program, which was called Meaningful Moments. The aim of this study was to assess the acceptability and preliminary effects of this novel approach using trained volunteers for older adults with mid- to late-stage dementia. METHODS: A mixed methods multiphase design was used. Qualitative description was used to explore acceptability of the Meaningful Moments program delivered over 6 months through focus groups (e.g., charge nurses, therapeutic recreationists, nurses, social workers) and individual interviews with one volunteer and two family members. A prospective pre-post-test study design was used to evaluate the preliminary effects of the program for patients with dementia and family members. Outcomes included quality of life, neuropsychiatric symptoms, and pain for patients with dementia and family carer role stress and the quality of visits for families. Data were collected from June 2018 to April 2019. Descriptive analyses of participants' characteristics were expressed as a mean (standard deviation [SD]) for continuous variables and count (percent) for categorical variables. Focus group and individual interview data were analyzed using thematic analysis. The generalized estimating equations (GEE) method was used to assess change in the repeated measures outcome data. RESULTS: A total of 15 patients received the Meaningful Moments interventions. Families, staff, and volunteers perceived that patients experienced benefits from Meaningful Moments. Staff, volunteers, and families felt fulfilled in their role of engaging patients in the Meaningful Moments program. Individualized activities provided by volunteers were perceived as necessary for the patient population. There were no statistically significant improvements in patient outcomes. There was a statistically significant decline in family carer role stress. CONCLUSIONS: Using a one-on-one approach by volunteers, patients experienced perceived benefits such as improved mood and opportunities for social interactions. There is a need for tailored activities for older adults with advanced dementia through practical strategies that can offer benefit to patients.

Increasing cost-effectiveness of AEDs using algorithms to optimise location.

OBJECTIVES: Volunteer responder systems (VRSs) aim to decrease time to defibrillation by dispatching trained volunteers to automated external defibrillators (AEDs) and out-of-hospital cardiac arrest (OHCA) victims. AEDs are often underutilized due to poor placement. This study provides a cost-effectiveness analysis of adding AEDs at strategic locations to maximize quality-adjusted life years (QALYs). METHODS: We simulated combined volunteer, police, firefighter, and emergency medical service response scenarios to OHCAs, and applied our methods to a case study of Amsterdam, the Netherlands. We compared the competing strategies of placing additional AEDs, using steps of 40 extra AEDs (0, 40, …, 1480), in addition to the existing 369 AEDs. Incremental cost-effectiveness ratios (ICERs) were calculated for each increase in additional AEDs, from a societal perspective. The effect of AED connection and time to connection on survival to hospital admission and neurological outcome at discharge was estimated using logistic regression, using OHCA data from Amsterdam from 2006 to 2018. Other model inputs were obtained from literature. RESULTS: Purchasing up to 1120 additional AEDs (ICER €75,669/QALY) was cost-effective at a willingness-to-pay threshold of €80,000/QALY, when positioned strategically. Compared to current practice, adding 1120 AEDs resulted in a gain of 0.111 QALYs (95% CI 0.110-0.112) at an increased cost of €3792 per OHCA (95% CI €3778-€3807). Health benefits per AED diminished as more AEDs were added. CONCLUSIONS: Our study identified cost-effective strategies to position AEDs at strategic locations in a VRS. The case study findings advocate for a substantial increase in the number of AEDs in Amsterdam.

The role of community health and nutrition volunteers in improving the health and nutrition status of infant and young children in remote areas, Hajjah, Yemen.

BACKGROUND: In Yemen, morbidity and malnutrition are major public health problems. The Community Health and Nutrition Volunteers (CHNVs) program was launched to tackle these problems through providing services to mothers and their children residing in remote villages. Since establishment of the CHNVs program in Yemen, its outcome has never been evaluated. Therefore, the aim of this study was to assess the role of CHNVs in improving the immunization, morbidity and nutritional status of infant and young children (IYC). METHODS: A comparative cross-sectional study design was conducted in Al-Maghrabah and Bani-Qais districts, Hajjah governorate. It was carried out between January and April 2023. A three-stage cluster sampling method was used. A total of 926 IYC with their mothers were interviewed using a pre-tested questionnaire. SPSS 26 was used for data analysis. The multinomial logistic regression and chi-square or fisher exact tests were used to compare the vaccination, morbidity and nutritional status of IYC between the volunteer and non-volunteer villages. Odds Ratio (OR) with 95% Confidence Interval (CI) were calculated. A p value < 0.05 was considered statistically significant. RESULTS: The IYC in volunteer villages were more likely to be fully or partially vaccinated compared to those in non-volunteer villages [OR = 2.3, 95% CI: 1.5-3.7, p < 0.0001, and OR = 1.9, 95% CI: 1.3-2.8, p = 0.001, respectively]. The specific coverage rates for BCG, and the 1st and 2nd doses of OPV/Pentavalent/Pneumo/Rota vaccines were significantly higher in the volunteer compared to non-volunteer villages [(OR = 1.8, 95% CI: 1.3-2.5, p < 0.0001), (OR = 1.5, 95% CI: 1.2-2.1, p = 0.003), and (OR = 1.5, 95% CI: 1.2-2.0, p = 0.002), respectively]. Moreover, the prevalence of diarrhea and fever among IYC was significantly lower in the volunteer compared to non-volunteer villages [(OR = 0.7, 95% CI: 0.5-0.9, p = 0.004) and (OR = 0.7 95% CI: 0.5-0.9, p = 0.045), respectively]. CONCLUSIONS: The study found that CHNVs play a significant role in improving vaccination status and the coverage rate for BCG, and 1st and 2nd doses of OPV/Pentavalent/Pneumo/Rota vaccines, and reducing the prevalence of diarrhea and fever among IYC in their villages compared to non-volunteer villages, in Hajjah governorate. Future follow-up study and expansion to other settings in different governorates is recommended.

Community Health Volunteers' experiences of implementing COVID-19 vaccine education and promotion in Kenya: a qualitative descriptive study.

Background: Vaccination was a key measure in the COVID-19 pandemic response, though much work was needed to promote vaccine uptake and acceptance. In Kenya, Community Health Volunteers (CHVs) played a key role in vaccine education and promotion. We conducted this study to explore CHVs' experiences of implementing COVID-19 vaccine education and promotion during the pandemic to increase COVID-19 vaccine uptake in two areas of Kenya. Methods: In a qualitative descriptive study, we conducted 30 structured in-depth interviews with 20 CHVs and 10 Community Health Assistants from rural Kilifi County and Kangemi, an urban informal settlement of Nairobi County in Kenya between April 2022 and July 2022. Findings: Thematic analysis generated five key themes in relation to CHVs' experiences of implementing COVID-19 vaccine education and promotion: Five key themes emerged regarding CHVs' experiences of implementing COVID-19 vaccine education and promotion: (1) vaccine preferences influenced acceptance, (2) the fear of side effects was a barrier, (3) misinformation was widespread (4) lack of trust in government and politicization of vaccines was a barrier, and (5) CHVs' efforts were a facilitator to increased uptake. Conclusion: Extensive community outreach from CHVs contributed to the high uptake of primary vaccines and boosters during the COVID-19 pandemic. CHVs acting as role models by receiving vaccinations first was particularly important in influencing communities to accept vaccinations. Findings provide evidence for prioritizing CHVs in the planning and implementation of future vaccination initiatives in Kenya and other countries.

Gente.doc: Fernando é veterinário na rede municipal e está em missão humanitária no RS

Fernando Yutaka Moniwa Hosomi é médico veterinário e está entre os integrantes da missão da Prefeitura de São Paulo ao Rio Grande do Sul (RS), que montou um hospital veterinário de campanha em Canoas para atender animais resgatados nas enchentes

The influence of actors on the content and execution of a bereavement programme: a Bourdieu-inspired ethnographical field study in Sweden.

Introduction: The death of a parent can have profound negative impacts on children, and a lack of adequate support can exacerbate negative life experiences. Aim: To explore the influences of various actors on the content and execution of a bereavement programme within a Swedish context, considering relational and contextual perspectives. Methods: An ethnographic field study involving six children, their parents, and eight volunteers. A theory-inspired thematic analysis was conducted, methodically inspired by Braun and Clarke, theoretically inspired by Bourdieu's concepts of position, power, and capital. Results: Confidentiality obligation was an essential element in the programme, however, the premisses varied depending on actors' positions. Volunteers and researchers had different outlets to express their experiences in the program. The programme offered the children an exclusive space for talking about and sharing experiences and feelings. Simultaneously, the programme restricted the children by not allowing them to share their experiences and feelings outside the physical space. The physical settings shaped the different conditions for interactions among the actors. The sessions adopted loss-oriented approaches, where communication between volunteers and children was guided by the volunteers. However, children created strategies for additional, voiceless communication with their peers or themselves. During breaks and mingles, shared interests or spaces connected children (and adults) more than their common experience of parental bereavement. Conclusion: The participants in the programme were significantly influenced by the structural framework of the programme, and their positions within the programme provided them with different conditions of possibility for (inter)acting. Children's daily activities and interests were both ways to cope with parental bereavement and connect them to other people.

The impact of positive-pressure breathing apparatus on muscle fatigue of volunteer firefighter.

Muscle fatigue is one of the leading causes that contributes tremendously to injuries among volunteer firefighters in the workplace. The purpose of this study was to investigate the impact of positive-pressure breathing apparatus on muscle fatigue in the shoulder, back, and legs of volunteer firefighters. A total of 60 volunteer firefighters were recruited to perform a running task on a motorized treadmill in a controlled laboratory environment. Surface electromyography and rating of perceived exertion scores were collected from all participants every 60 seconds during the running task. Results show that the median frequency values for all measured muscle groups were significantly lower, and the rating of perceived exertion score was significantly higher after running with the positive-pressure breathing apparatus. Meanwhile, there were no significant differences in the median frequency values for the upper trapezius, erector spinae, and biceps femoris between the initial and final periods of running task without load. However, the median frequency values with load for gastrocnemius, rectus femoris, and tibialis anterior exhibited a greater downward trend compared to those without load. Additionally, using a breathing apparatus can cause asymmetric muscle fatigue in bilateral upper trapezius, erector spinae, gastrocnemius, and tibialis anterior muscles. The decreased performance due to muscle fatigue increases the risk of accidents, thereby posing a threat to the safety of volunteer firefighters. This study offers valuable insights into the effects of positive-pressure breathing apparatus on muscle fatigue among volunteer firefighters. These results may serve as a reference for developing improved fatigue management strategies and optimizing the design features of breathing apparatus.

Impact of an intergenerational program to improve loneliness and social isolation in older adults initiated at the time of emergency department discharge: study protocol for a three-arm randomized clinical trial.

BACKGROUND: Social isolation and loneliness (SIL) worsens mortality and other outcomes among older adults as much as smoking. We previously tested the impact of the HOW R U? intervention using peer support from similar-aged volunteers and demonstrated reduced SIL among older adults discharged from the emergency department (ED). Generativity, defined as "the interest in establishing and guiding the next generation," can provide an alternative theoretical basis for reducing SIL via intergenerational programs between members of younger and older generations. The current protocol will examine the impact of younger intergenerational volunteers providing the HOW RU? METHODS: In this randomized clinical trial, we will compare the following three arms: (1) the standard same-generation peer support HOW R U? intervention, (2) HOW R U? intervention delivered by intergenerational volunteers, and (3) a common wait-list control group. Outcome assessors will be blinded to the intervention. Trained volunteers will deliver 12 weekly telephone support calls. We will recruit participants ≥ 70 years of age with baseline loneliness (six-item De Jong loneliness score of 2 or greater) from two EDs. Research staff will assess SIL, depression, quality of life, functional status, generativity, and perceived benefit at baseline, at 12 weeks, and 24 weeks post-intervention. DISCUSSION: We hypothesize participants receiving the intergenerational intervention will show improved outcomes compared to the control group and peer support HOW R U? INTERVENTION: We also hypothesize that participants with higher perceptions of generativity will have greater reductions in SIL than their lower generativity counterparts. Aging is experienced diversely, and social interventions combatting associated SIL should reflect that diversity. As part of a program of research following the Obesity-Related Behavioral Intervention Trials (ORBIT) model, the findings of this RCT will be used to define which intervention characteristics are most effective in reducing SIL. TRIAL REGISTRATION: ClinicalTrials.gov NCT05998343 Protocol ID:21-0074E. Registered on 24 July 2023.

Needs and Challenges for Volunteering in Rural Areas: Lessons Learned From a Survey of a Service Organization in Rural Michigan.

BACKGROUND AND OBJECTIVES: Volunteers are the foundation of social service agencies in rural communities, yet limited research exists on their needs and challenges. Motivated by the multidimensional older voluntarism sustainability framework, this study aims to understand (1) the characteristics of volunteers, (2) the relationships between volunteers' sense of community and their own aging and volunteer retention, and (3) the unique challenges faced by volunteers and volunteer-based agencies. RESEARCH DESIGN AND METHODS: This study uses a mixed-methods design. Data were gathered via telephone interviews (n = 76) and in-person focus groups (n = 14) from the volunteer pool of a nonprofit organization in rural Michigan. Descriptive and regression analyses were conducted to understand the characteristics of the volunteers. Thematic analysis was conducted to identify unique challenges faced by rural agencies and volunteers. RESULTS: Findings show that most volunteers were over 70, women, married, volunteered weekly or more, and were affiliated with multiple agencies. Volunteers with a stronger attachment to the community and higher self-perceptions of aging were likelier to continue and increase volunteering commitments. Due to the low population density in rural areas, volunteers were concerned about the heavy burden of volunteering, the lack of social connections with fellow volunteers, and the lack of active involvement in shaping the organization. DISCUSSION AND IMPLICATIONS: Results from the study shed light on the urgent need for creative and engaging volunteer recruitment and retention strategies to sustain older adults, service agencies, and communities in rural areas.

Does volunteering decrease burnout? Healthcare professional and student perspectives on burnout and volunteering.

Background: Burnout among healthcare providers is a significant crisis in our healthcare system, especially in the context of the COVID-19 pandemic. The aim of this study was to understand what motivates healthcare workers and students to volunteer in their community as well as examine how volunteering relates to burnout. These findings can help health organizations better meet the needs of healthcare workers, as well as provide insights for non-profits that rely on volunteer professionals. Methods: Healthcare providers (N = 8), graduate healthcare students (N = 10), and undergraduate students (N = 14) who volunteered at community health fairs completed the OLBI burnout assessment and an individual semi-structured interview to characterize their attitudes toward volunteering and its relationship with burnout. Interviews were recorded, transcribed, and analyzed using a phenomenological approach, comparing themes across levels of burnout among providers and students. Results: Participants described that feeling burnt out decreased one's likelihood to volunteer, but also that volunteering prevented burnout. The OLBI scores showed that 79.2 and 20.8% of students were low and moderately burnt out respectively, and 87.5 and 12.5% of health professionals were low and moderately burnt out, respectively. Students volunteered for professional development while healthcare professionals cited a desire for a change in their day-to-day work as a reason to volunteer. Both students and health professionals often volunteered because they wanted to make a difference, it made them feel good, and/or they felt a responsibility to volunteer. COVID-19 had a wide range of effects on burnout and motivations to volunteer. Conclusion: Volunteering may be useful for preventing burnout among healthcare workers and students, but may not be helpful for those already experiencing burnout. Interview responses and the fact that none of the volunteers had high burnout levels according to their OLBI scores suggest those who choose to volunteer may be less burnt out. Healthcare organizations and schools can encourage volunteering by emphasizing the difference healthcare students and professionals can make through volunteering in the community. Increasing convenience and emphasizing professional development can help recruit and retain healthcare student volunteers. Highlighting the chance to diversify their scope of practice may help recruit and retain healthcare professional volunteers.

Comparison of Laws that Impact Volunteer Response in Three Disaster-Prone Southeastern States.

OBJECTIVE: As natural disasters become more frequent and severe, the ability of impacted states to rapidly scale up their capacity to respond and facilitate recovery through volunteers is ever more crucial. However, the legal landscape that may facilitate or hamper augmentation through volunteers has yet to be fully explored. DESIGN: This study utilized policy surveillance methodology to code relevant laws identified in searches using the Emergency Law Inventory database and Westlaw. SETTING: We assessed laws in three natural disaster-prone states: North Carolina, South Carolina, and Georgia. MAIN OUTCOME MEASURES: We assessed the presence of liability protection, license reciprocity, and scope of practice laws for health care volunteers. RESULTS: Of the three assessed legal domains, liability protection for health care volunteers across all states contained the most robust language. Liability protections apply unless the health care volunteers act with reckless disregard, willful misconduct, or gross negligence. However, nuance exists based on which organizations (state vs charitable) volunteers are affiliated with to qualify for coverage. License reciprocity for out-of-state specific health care professions entering the impacted states was available across all three states. However, only Georgia enacted federal model legislation that provides additional flexibility regarding credentialing and liability protections. Lastly, very few laws addressed the scope of practice in impacted states. CONCLUSIONS: Comparisons of laws that impact the ability of health care volunteers to respond and recover from disasters are scarce. More research needs to be performed to better understand the laws that impact volunteers in emergencies, particularly as the public health system is overtasked when providing services to impacted communities.

Endogenous Opioids and Volunteering: On the Evolutionary Significance of Helping Others.

The human tendency to help others in need has been subject to trans-, inter-, and multidisciplinary studies (e.g., anthropology, neurobiology, evolutionary psychology, economy), within the frame of studying the mechanisms and adaptive significance of human prosocial behavior. Volunteering directed to unrelated and unfamiliar individuals is one common form of such helping behavior. Helping others may be adaptive for a species at a macro-level, which in turn is mediated by neurobiological mechanisms. A key target for analysis of the neurobiological underpinnings of volunteering is the endogenous opioid system (EOS). This chapter discusses EOS activity as a potential mediator of volunteering behavior. Evidence of the congruence between EOS involvement in social group behavior and social bonding and the role of these phenomena in volunteerism is reviewed. Models and empirical evidence of the mechanisms and adaptive value of helping unrelated others are discussed and integrated, including the mammalian caregiving system, the neurobiological model of prosocial behavior, synchrony promoting social bonding, and stress-driven motivation of prosocial action in immediate needs.

Strengths, challenges, and strategies for implementing pragmatic multicenter randomized controlled trials (RCTs): example of the Personalized Citizen Assistance for Social Participation (APIC) trial.

BACKGROUND: Randomized controlled trials (RCTs) are rigorous scientific research designs for evaluating intervention effectiveness. However, implementing RCTs in a real-world context is challenging. To develop strategies to improve its application, it is essential to understand the strengths and challenges of this design. This study thus aimed to explore the strengths, challenges, and strategies for improving the implementation of a pragmatic multicenter, prospective, two-arm RCT evaluating the effects of the Personalized Citizen Assistance for Social Participation (Accompagnement-citoyen Personnalisé d'Intégration Communautaire: APIC; weekly 3-h personalized stimulation sessions given by a trained volunteer over a 12-month period) on older adults' health, social participation, and life satisfaction. METHODS: A multiple case study was conducted with 14 participants, comprising one research assistant, seven coordinators, and six managers of six community organizations serving older adults, who implemented the APIC in the context of a RCT. Between 2017 and 2023, qualitative data were extracted from 24 group meetings, seven semi-directed interviews, emails exchanged with the research team, and one follow-up document. RESULTS: Aged between 30 and 60 (median ± SIQR: 44.0 ± 6.3), most participants were women from organizations already offering social participation interventions for older adults and working with the public sector. Reported strengths of this RCT were its relevance in assessing an innovative intervention to support healthy aging, and the sharing of common goals, expertise, and strategies with community organizations. Challenges included difficulties recruiting older adults, resistance to potential control group assignments, design complexity, and efforts to mobilize and engage volunteers. The COVID-19 pandemic lockdown and health measures exacerbated challenges related to recruiting older adults and mobilizing volunteers and complicated delivery of the intervention. The strategies that mostly overcame difficulties in recruiting older adults were reducing sample size, simplifying recruitment procedures, emphasizing the health follow-up, extending partnerships, and recognizing and supporting volunteers better. Because of the lockdown and physical distancing measures, the intervention was also adapted for remote delivery, including via telephone or videoconferencing. CONCLUSION: Knowledge of the strengths and challenges of pragmatic RCTs can contribute to the development of strategies to facilitate implementation studies and better evaluate health and social participation interventions delivered under real-life conditions. TRIAL REGISTRATION: NCT03161860; Pre-results. Registered on May 22, 2017.