Medical faculty's perception of students' mental health: a qualitative survey study / Percepción de los profesores de medicina sobre la salud mental de los estudiantes: un estudio cualitativo / Percepção dos docentes de medicina sobre a saúde mental dos estudantes: um estudo qualitativo

This study sought to explore the perspective of medical faculty on the mental health of their students. This qualitative study based on a focus group is part of a longitudinal research that studied the mental health of Brazilian students. One group was conducted with faculty employed at a medical school. Topics discussed covered the concept of mental health and medical education. Six professors participated in one group. The mental health of medical students is a construct that encompasses emotional aspects, ability to solve problems and multiple facets of a human being, according to the participants. Artistic practices, moments of socialization and leisure were perceived as stimulating students' good mental health. Excessive demands generate competitiveness and the teacher's expectation of the student's good performance based on their own experience can harm the student's mental health. Participants also highlighted that a pedagogical reformulation that makes sense for the student's learning process is necessary to update traditional curricula. Medical students' mental health is influenced by experiences and exchanges during the medical school, mainly between professor and student, understood as necessary and inherent to the process of becoming physician. The findings of this study show the need for curriculum changes in the medical education process and updating teacher training for good practices that reinforce good mental health.

Este estudio buscó explorar la perspectiva de los profesores de medicina sobre la salud mental de sus estudiantes. Este estudio cualitativo basado en un grupo focal es parte de una investigación longitudinal que estudió la salud mental de estudiantes brasileños. Un grupo se llevó a cabo con profesores empleados en una escuela de medicina. Los temas tratados abarcaron el concepto de salud mental y educación médica. Seis docentes participaron en un grupo. La salud mental de los estudiantes de medicina es un constructo que abarca aspectos emocionales, capacidad de resolución de problemas y múltiples facetas del ser humano, según los participantes. Las prácticas artísticas, los momentos de socialización y el ocio fueron percibidos como estimulantes de la buena salud mental de los estudiantes. Las exigencias excesivas generan competitividad y la expectativa del docente sobre el buen desempeño del estudiante basándose en su propia experiencia puede perjudicar la salud mental del estudiante. Los participantes también resaltaron que es necesaria una reformulación pedagógica que tenga sentido para el proceso de aprendizaje del estudiante para actualizar los currículos tradicionales. La salud mental de los estudiantes de medicina está influenciada por las experiencias y los intercambios durante la carrera de medicina, principalmente entre profesor y estudiante, entendidos como necesarios e inherentes al proceso de convertirse en médico. Los hallazgos de este estudio muestran la necesidad de cambios curriculares en el proceso de formación médica y de actualización de la formación docente hacia buenas prácticas que refuercen la buena salud mental.

Este estudo buscou explorar a perspectiva dos docentes de medicina sobre a saúde mental de seus alunos. Este estudo qualitativo baseado em grupo focal faz parte de uma pesquisa longitudinal que estudou a saúde mental de estudantes brasileiros. Um grupo foi conduzido com professores empregados em uma faculdade de medicina. Os temas discutidos abrangeram o conceito de saúde mental e educação médica. Seis professores participaram de um grupo. A saúde mental dos estudantes de medicina é um construto que engloba aspectos emocionais, capacidade de resolução de problemas e múltiplas facetas do ser humano, segundo os participantes. As práticas artísticas, os momentos de socialização e de lazer foram percebidos como estimuladores da boa saúde mental dos estudantes. Exigências excessivas geram competitividade e a expectativa do professor pelo bom desempenho do aluno com base na própria experiência pode prejudicar a saúde mental do aluno. Os participantes destacaram também que é necessária uma reformulação pedagógica que faça sentido para o processo de aprendizagem do aluno para atualizar os currículos tradicionais. A saúde mental dos estudantes de medicina é influenciada pelas experiências e trocas durante o curso de medicina, principalmente entre professor e aluno, entendidas como necessárias e inerentes ao processo de tornar-se médico. Os achados deste estudo mostram a necessidade de mudanças curriculares no processo de formação médica e de atualização da formação docente para boas práticas que reforcem a boa saúde mental.

Results of a brief online group application of the unified protocol for the prevention of emotional disorders in university students: a pilot study with multiple baseline experimental design / Resultados de una aplicación grupal breve en línea del protocolo unificado para la prevención de trastornos emocionales en estudiantes universitarios: un estudio piloto con diseño experimental de línea base múltiple

Los trastornos emocionales (TEs) son los trastornos más comunes entre la población joven. El desarrollo de programas preventivos de los TEs es fundamental para evitar su posible aparición. Los programas de prevención transdiagnósticos podrían presentar una ventaja sobre los existentes para mejorar las estrategias de regulación emocional. Así, el objetivo de este estudio ha sido determinar la viabilidad y eficacia preliminar de un programa breve basado en el Protocolo Unificado (PU). El proyecto consistió en un estudio piloto utilizando un diseño experimental de línea base múltiple. Nueve estudiantes universitarios recibieron un programa de 5 sesiones basado en el PU en formato grupal online. Se encontraron diferencias significativas después de la intervención en la regulación de las emociones, el apoyo social percibido y la evitación, con tamaños del efecto moderados-grandes (r de Cohen = .49 - .59). Estas mejoras mostraron aumentos en los seguimientos al mes y a los 3 meses. Esos resultados están en línea con los que muestran que los programas preventivos transdiagnósticos breves podrían ser útiles para la prevención de los TEs en población universitaria.(AU)

Emotional disorders (EDs) are the most common disorders among the young population. The development of preventive programs for EDs is essential to avoid their possible appearance. Transdiagnostic prevention programs could present an advantage over existing ones to im-prove emotional regulation strategies. Thus, the objective of this study has been to determine the preliminary feasibility and effectiveness of a brief program based on the Unified Protocol (UP). The project consisted of a pilot study using a multiple baseline experimental design. Nine university students received a 5-session program based on the UP in online-group format. Significant differences were found after the intervention for emo-tion regulation, perceived social support and avoidance, with moderate-large effect sizes (Cohen's r= .49-.59). These improvements showed in-creases at 1-month and 3-month follow-ups. Those results are in line with those showing that brief transdiagnostic preventive programs could be use-ful for the prevention of EDs in the university population.(AU)

Narcissism, perfectionism, and self-promoting behavior on social networking sites among university students in Pakistan / Narcisismo, perfeccionismo y comportamiento de autopromoción en sitios de redes sociales entre estudiantes universitarios en Pakistán

Existe un debate considerable en la literatura sobre cómo el narcisismo predice diversos comportamientos asociados con la utilidad de los sitios de redes sociales, pero los investigadores han prestado menos atención a explorar los mediadores potenciales de esta relación. Con base en la literatura existente, anticipamos que el narcisismo predice comportamientos de autopromoción en los sitios de redes sociales. El estudio actual también investigó el papel mediador del perfeccionismo multidimensional entre el narcisismo y el comportamiento de autopromoción. Se recopiló un total de 605 cuestionarios completos de estudiantes de universidades de Rawalpindi e Islamabad, Pakistán, mediante un muestreo conveniente. El estudio utilizó el Inventario de Personalidad Narcisista (Ames et al., 2006), un cuestionario de desarrollo propio sobre comportamiento de autopromoción en sitios de redes sociales y la Escala de Perfeccionismo Multidimensional (Hewitt et al., 1991). Los hallazgos indicaron que las mujeres en comparación con los hombres y las solteras en comparación con las casadas obtuvieron puntuaciones más altas en narcisismo. Los niveles educativos más altos se asociaron con tasas más altas de narcisismo. Los resultados también sugieren que el narcisismo se correlaciona con el perfeccionismo orientado a uno mismo y, más significativamente, con el narcisismo orientado a los demás. El perfeccionismo orientado a uno mismo y a los demás medió significativamente la relación entre el narcisismo y el comportamiento de autopromoción en los sitios de redes sociales.(AU)

There is considerable debate in the literature about how narcis-sism predicts various behaviors associated with the utility of social net-working sites, but researchers have paid less attention to exploring the po-tential mediators of this relationship.Based on the existing literature, we anticipated that narcissism predicts self-promoting behaviors on social networking sites. The current study also investigated the mediating role of multidimensional perfectionismbetween narcissism and self-promoting behavior. A total of 605 complete questionnaires weregathered fromstu-dents from universities from Rawalpindi and Islamabad, Pakistan using convenient sampling. The study used Narcissistic Personality Inventory (Ames et al., 2006), self-developed Self-promoting Behavior on social net-working sites questionnaire, and the Multidimensional Perfectionism Scale (Hewitt et al., 1991). Findings indicated that females as compared to males and single as comparedto married individuals scored higher on narcissism. Higher educational levels were associated with higher rates of narcissism. The results also suggestthat narcissism correlated with self-oriented per-fectionism, and more significantlywith others-oriented narcissism. Self-oriented and others-oriented perfectionism significantly mediated the rela-tionship between narcissism and self-promoting behavior on social net-working sites.(AU)

Comparison of professional competency and anxiety of nursing students trained based on two internship models: a comparative study.

BACKGROUND: Improving the professional competency of nursing students during the internship is critical. This study aimed to compare the professional competency and anxiety of nursing students trained based on two internship models. METHODS: This is a two-group posttest-only quasi-experimental design study. One hundred nursing students who passed internship models A (a previous internship model) and B (an intervention with more educator support and a more planned and programmed process) were randomly enrolled in this study. Internship model groups A and B were conducted for the students in semesters 7 and 8. The outcomes assessed in both groups were "The Competency Inventory for Registered Nurses" and Spielberger "State-Trait Anxiety Inventory". T-test and MANOVA were used to analyze the data. RESULTS: The mean scores of competency were 134.56 (SD = 43.23) and 160.19 (SD = 35.81) for the nursing students in the internship model groups A and B, respectively. The mean scores of nursing students' anxiety were 92.14 (SD = 15.36) and 80.44 (SD = 18.16) in the internship model groups A and B, respectively. MANOVA test showed a significant difference between the groups regarding professional competency (F = 10.34, p = 0.002) and anxiety (F = 11.31, p = 0.001). CONCLUSIONS: The internship model group B could improve the professional competency of nursing students to a great extent and they experienced mild anxiety; it is suggested that this intervention should be done for nursing students. Conducting more studies to evaluate the effect of this model on the nursing students' competency and anxiety after graduation and as a novice nurse is suggested.

Psychological strains after the crisis: evaluating separation anxiety among Iranian children and adolescents in the post-COVID-19 era.

OBJECTIVES: The objective of this study was to specifically investigate Separation Anxiety Disorder (SAD), as one of the noteworthy disorders within the spectrum of anxiety disorders, among children and adolescents, after overcoming the crises caused by the Coronavirus Disease 2019 (COVID-19) pandemic. Efforts were also made to identify socio-demographic factors that could be associated with changes in SAD level and also to assess the effect of different constituting dimensions of SAD on the severity of this disorder. METHODS: In this cross-sectional study, face-to-face interviews were conducted with the parents of 317 (7-13-year-old) Iranian students, who were selected through a multi-stage random sampling method in the city of Shiraz. During the interviews, socio-demographic data were collected, and subsequently, SAD symptoms and dimensions were assessed using the Separation Anxiety Assessment Scale (Parent Version) (SAAS-P) questionnaire. Later, employing the Partition Around Medoids (PAM) statistical method, the participants were categorized into two groups with low and high levels of SAD. Also, to understand the interaction between the different dimensions of SAD, the network analysis method was employed. Finally, univariate analysis and logistic regression were utilized, with a significance level of 0.05, to determine potential associating factors with the level of SAD. RESULTS: The sample included 128 girls and 189 boys with a mean age of 9.63 ± 2.63 and 9.63 ± 1.95 years respectively. Based on the PAM method, 51.1% of the participants presented a high level of SAD. According to network analysis, it was demonstrated that the "fear of abandonment" dimension plays a central role in high levels of SAD. Based on logistic regression, female gender, age ≥ 10 years, parents' unacademic educational background, mother's employment, and child's history of physical/mental problems were significantly associated with the high level of SAD. CONCLUSIONS: A considerable number of the participants in this study presented a high level of SAD with the "fear of abandonment" being a key influential dimension of elevated levels of this disorder. Maternal employment, female gender, child's history of health issues, and low parental education were identified as important contributors to the high SAD level. Considering these factors allows for more effective diagnostic and therapeutic interventions. However, the need for further studies remains crucial.

Neuropsychiatric symptoms and lifelong mental activities in cerebral amyloid angiopathy - a cross-sectional study.

BACKGROUND: While several studies in cerebral amyloid angiopathy (CAA) focus on cognitive function, data on neuropsychiatric symptoms (NPS) and lifelong mental activities in these patients are scarce. Since NPS are associated with functional impairment, faster cognitive decline and faster progression to death, replication studies in more diverse settings and samples are warranted. METHODS: We prospectively recruited n = 69 CAA patients and n = 18 cognitively normal controls (NC). The number and severity of NPS were assessed using the Alzheimer's Disease (AD) Assessment Scale's (ADAS) noncognitive subscale. We applied different regression models exploring associations between NPS number or severity and group status (CAA vs. NC), CAA severity assessed with magnetic resonance imaging (MRI) or cognitive function (Mini-Mental State Examination (MMSE), ADAS cognitive subscale), adjusting for age, sex, years of education, arterial hypertension, AD pathology, and apolipoprotein E status. Mediation analyses were performed to test indirect effects of lifelong mental activities on CAA severity and NPS. RESULTS: Patients with CAA had 4.86 times (95% CI 2.20-10.73) more NPS and 3.56 units (95% CI 1.94-5.19) higher expected NPS severity than NC. Higher total CAA severity on MRI predicted 1.14 times (95% CI 1.01.-1.27) more NPS and 0.57 units (95% CI 0.19-0.95) higher expected NPS severity. More severe white matter hyperintensities were associated with 1.21 times more NPS (95% CI 1.05-1.39) and 0.63 units (95% CI 0.19-1.08) more severe NPS. NPS number (MMSE mean difference - 1.15, 95% CI -1.67 to -0.63; ADAS cognitive mean difference 1.91, 95% CI 1.26-2.56) and severity (MMSE - 0.55, 95% CI -0.80 to -0.30; ADAS cognitive mean difference 0.89, 95% CI 0.57-1.21) predicted lower cognitive function. Greater lifelong mental activities partially mediated the relationship between CAA severity and NPS (indirect effect 0.05, 95% CI 0.0007-0.13), and greater lifelong mental activities led to less pronounced CAA severity and thus to less NPS (indirect effect - 0.08, 95% CI -0.22 to -0.002). DISCUSSION: This study suggests that NPS are common in CAA, and that this relationship may be driven by CAA severity. Furthermore, NPS seem to be tied to lower cognitive function. However, lifelong mental activities might mitigate the impact of NPS in CAA.

The bridge relationships of PTSD and depression symptoms among snakebite victims: a cross-sectional community-based survey.

BACKGROUND: The incidence of comorbid depression and post-traumatic stress disorder (PTSD) symptoms is higher in snakebite victims. However, the present state and contributing factors of depression and PTSD among Chinese snakebite victims remain unclear. METHODS: A representative sample of 6837 snakebite victims were assessed with the Post-traumatic Stress Disorder Checklist (Civilian Version) and The Center for Epidemiologic Studies Depression Scale. Multivariate analyses, including network analysis, evaluated the contributing factors of PTSD and depression symptoms caused by snake bites, as well as the bridge symptoms of comorbidity networks. RESULTS: Among 6,837 snakebite victims, 79.5% reported PTSD symptoms and 81.4% reported depression symptoms. Comorbidity of PTSD and depression symptoms was found in 75.1%. Key factors included the presence sequelae after snakebite (ORPTSD = 2.31, ORDepression = 1.89), time to medical facilities (6-8 h: ORPTSD = 3.17, ORDepression = 2.46), and marital status (divorced/widowed: ORPTSD = 1.78, ORDepression = 1.76). Symptoms I1 ("Repeated disturbing memories") and D1 ("Bothered by things that don't usually bother me") bridged PTSD and depression networks. CONCLUSION: The primary psychological challenges for snakebite victims in China are PTSD and depression symptoms, which is concerning. Standardized diagnosis and treatments, timely medical care, and stable marital relationships can reduce risks. Additional psychological support and management of negative memories, especially for those with severe bridge symptoms, can be beneficial. Further research should concentrate on understanding victims' psychological states and developing effective interventions.

Is MIStreatment of women during facility-based childbirth an independent risk factor for POstpartum Depression in Ethiopia and Guinea? A mixed methods prospective study protocol-MISPOD study.

BACKGROUND: Worldwide, 10% of postpartum women experience postpartum depression, which can lead to diverse sequalae at individual, family, and societal levels. In sub-Saharan Africa, it is estimated that 17% of women experience depression in the postpartum period, which could be an underestimate as 48% of women in the region do not receive postnatal care (81% in Ethiopia and 51% in Guinea) and a large share of postpartum depression remains undiagnosed and untreated as a result. Globally, despite a critical evidence gap, there are growing reports of postpartum depression among women mistreated (disrespected and abused) during childbirth in health facilities, making a strong case to examine the association between mistreatment and postpartum depression. This study in Addis Ababa (Ethiopia) and Conakry (Guinea) uses a mixed methods design to 1) examine the link between mistreatment and postpartum depression, 2) explore the health system capacity to provide respectful maternity care and maternal mental health services, and 3) explore the experiences of women in accessing care and support for postpartum depression. METHODS: We will conduct a prospective longitudinal survey of women (434 in Addis Ababa and 408 in Conakry) from the third trimester of pregnancy to eight weeks postpartum and carry out in-depth interviews with key health system informants (20-25 in each city) and women who recovered from a clinically confirmed episode of postpartum depression (15-25 in each city). Quantitative data from the women's survey will be analysed using a multilevel mixed-effects model; qualitative data from key-informants will be analysed by using a hybrid thematic analysis approach, whereas data from women's in-depth interviews will be analysed using the phenomenological approach. The inclusion of two different settings in our study (Addis Ababa and Conakry) will enable us to apply a comparative health systems lens to explore the dynamics of respectful maternity care and maternal mental health services within the broader health systems of the two countries (Ethiopia and Guinea). DISCUSSION: The findings from this study will inform actions aimed at mitigating the mistreatment of women in maternity settings and improving promotive, preventive, and treatment interventions for postpartum depression in Ethiopia and Guinea. The findings can also be extrapolated to other low-resource settings.

Experiences Using Nonpharmacological Interventions for Chronic Fatigue: A Focus Group Study of Long-Term Survivors of Young Adult Cancers With Fatigue.

BACKGROUND: Cancer-related fatigue is a common and distressing late effect of cancer that can persist for decades after treatment completion. Although negatively affecting survivors' quality of life, few, if any, efficacious interventions for persistent, or chronic, fatigue exist. AIMS: To inform future interventions, we explored how long-term, young adult cancer survivors (YACSs) with chronic fatigue live with, and manage their fatigue over time, including their experiences with nonpharmacological interventions (NPIs) for chronic fatigue. METHODS AND RESULTS: We conducted a qualitative focus group study with 15 YACSs (13 women) with chronic fatigue, on average 7.3 years post-diagnosis. The YACS were identified and recruited through a nationwide health survey of cancer survivors (the NOR-CAYACS study). Systematic content analysis was used to identify recurrent themes. Analysis revealed five themes: (1) manifestation of fatigue, detailing chronic fatigue experiences; (2) impact on daily life, highlighting the necessity to balance rest and activity, affecting relationships; (3) NPIs, where walks in nature were notably beneficial; (4) barriers to fatigue management, including energy deficits, treatment-related bodily changes, and self-care prioritization challenges; (5) facilitators to fatigue management, emphasizing the need for regular breaks, self-care practices, and the importance of fatigue management education. CONCLUSION: This study offers novel insights into the lived experiences of YACSs with chronic fatigue, a subject scarcely examined in prior research. Our findings highlight the significant impact of chronic fatigue and the individualized strategies YACSs use to cope. The research emphasizes the need for personalized interventions to support chronic fatigue management, marking a critical step forward in addressing this often-overlooked issue in survivorship care. Future research should focus on tailored approaches to improve YACSs' quality of life.

Parent and patient knowledge and attitudes about cancer predisposition syndrome genetic testing in pediatric oncology: Understanding sociodemographic and parent-child differences.

BACKGROUND: Cancer predisposition syndromes (CPS) impact about 10% of patients with pediatric cancer. Genetic testing (CPS-GT) has multiple benefits, but few studies have described parent and child knowledge and attitudes regarding CPS-GT decision-making. This study examined parent and patient CPS-GT decision-making knowledge and attitudes. PROCEDURE: English- or Spanish-speaking parents of children with pediatric cancer and patients with pediatric cancer ages 15-18 within 12 months of diagnosis or relapse were eligible to participate. Seventy-five parents and 19 parent-patient dyads (N = 94 parents, 77.7% female, 43.6% Latino/a/Hispanic; 19 patients, 31.6% female) completed surveys measuring CPS-GT-related beliefs. Independent samples t-tests compared parent responses across sociodemographic characteristics and parent-patient responses within dyads. RESULTS: Spanish-speaking parents were significantly more likely than English-speaking parents to believe that CPS-GT not being helpful (p < .001) and possibly causing personal distress (p = .002) were important considerations for deciding whether to obtain CPS-GT. Parents with less than four-year university education, income less than $75,000, or Medicaid (vs. private insurance) were significantly more likely to endorse that CPS-GT not being helpful was an important consideration for deciding whether to obtain CPS-GT (p < .001). Parents felt more strongly than patients that they understood what CPS-GT was (p = .01) and that parents should decide whether patients under 18 should receive CPS-GT (p = .002). CONCLUSIONS: Spanish-speaking parents and parents with lower socioeconomic statuses were more strongly influenced by the potential disadvantages of CPS-GT in CPS-GT decision-making. Parents felt more strongly than patients that parents should make CPS-GT decisions. Future studies should investigate mechanisms behind these differences and how to best support CPS-GT knowledge and decision-making.

Mental health in people living with and beyond colorectal cancer: A patient-oriented constructivist grounded theory.

BACKGROUND: With the burden of colorectal cancer in Canada, there is a need to address the psycho-oncologic challenges, including mental health. This study aims to explore the lived mental health experiences in patients with CRC across the phases of the CRC care continuum. METHODS: We employed a patient-oriented constructivist grounded theory design and recruited English speaking participants ≥18 years, diagnosed with CRC within the last 10 years, residing in Canada. We collected data through semi-structured individual interviews using a guide co-constructed with patient research partners. Data collection and analysis were iterative, employed theoretical sampling, and culminated in a theoretical model. RESULTS: Twenty-eight participants diagnosed with CRC (18 females, 10 males), aged 18-63 years at time of diagnosis were interviewed, with representation across all CRC stages. There were 10 participants (36%) in treatment, 12 participants (43%) in follow-up, and 6 participants (21%) in the beyond phase. We constructed a patient-oriented theory illustrating the dynamic nature between one's self-identity and their mental health experiences across the CRC care continuum. Mental health experiences encompass emotional and cognitive-behavioral responses, expressed differently across phases. Mental health care experiences are also shaped by barriers, facilitators, and individual contextual factors, all of which influence their access to care. CONCLUSION: Our theory provides insight into the mental health experiences of patients with CRC across phases of the CRC care continuum. Understanding patients' emotional and cognitive-behavioral responses and care experiences can help identify opportunities to integrate mental health into CRC care.

Acknowledging and Addressing Microaggressions: A Virtual Experiential Learning Approach for Faculty.

Introduction: Although the ACGME and other accrediting organizations are increasingly emphasizing the importance of clinical learning environments that value diversity, equity, and inclusion, faculty development surrounding behavioral skills that promote inclusivity in the learning environment still needs cultivation. We designed a virtual longitudinal faculty development curriculum focused on direct observation, feedback, and practice of behavioral skills to acknowledge and address microaggressions in the learning environment. Methods: We used Kern's six steps of curriculum development to create four voluntary virtual workshops offered twice throughout the academic year, with topics including: (1) recognizing and naming microaggressions, (2) apologizing when harm has been experienced, (3) setting expectations surrounding microaggressions, and (4) debriefing microaggressions. Participant learners included residency program directors, associate program directors, and other leaders across all medical and surgical departments from one institution. Results: Thirty-one faculty from 10 departments participated in this yearlong curriculum. Pre- and postworkshop surveys analyzed participants' self-assessments of confidence and comfort in applying learned skills. Participants were more confident in openly naming bias, delivering expectations surrounding microaggressions, and debriefing microaggressions with learners. Participants also reported greater comfort in apologizing to learners when harm has occurred in public, in person, and electronically. Discussion: To create an inclusive learning environment, faculty can increase their comfort and confidence with addressing bias and microaggressions through practice and feedback. Our curriculum demonstrates how experiential learning allows for continual practice to solidify a new skill.

Social disconnection correlates of a "Wish to Die" among a large community-dwelling cohort of older adults.

Introduction: Social disconnection and deaths by suicide among older adults are both important public health concerns, particularly in the context of ageing populations. The association between death ideation and behaviours, and social disconnection is well established and both functional and structural social relationships have been identified as predictive of suicide-related thoughts and behaviours. The "Wish to Die" (WTD) involves thoughts of or wishes for one's own death or that one would be better off dead is a commonly used indicator to capture death ideation. It has been shown to be as predictive as active ideation of future suicide attempt. Methods: Data were from a large cohort of community-dwelling older adults aged 50+, The Irish Longitudinal Study on Ageing (TILDA). Cross-sectional analyses of the association between numerous markers of social disconnection (loneliness, social isolation, living alone, marital status, social participation, volunteering, and attending religious service) and WTD were conducted. Results: Multiple markers of social disconnection were associated with a "wish to die". However, loneliness was the strongest risk factor while attendance of religious services was an important protective behaviour. Discussion: There is a strong association between social disconnection and a WTD among older adults. There is also a strong association between depression and a WTD, while attending religious services or similarly prosocial settings may protect older adults from experiencing negative thoughts about dying.

Modulation of High-Frequency rTMS on Reward Circuitry in Individuals with Nicotine Dependence: A Preliminary fMRI Study.

Although previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) can ameliorate addictive behaviors and cravings, the underlying neural mechanisms remain unclear. This study aimed to investigate the effect of high-frequency rTMS with the left dorsolateral prefrontal cortex (L-DLPFC) as a target region on smoking addiction in nicotine-dependent individuals by detecting the change of spontaneous brain activity in the reward circuitry. We recruited 17 nicotine-dependence participants, who completed 10 sessions of 10 Hz rTMS over a 2-week period and underwent evaluation of several dependence-related scales, and resting-state fMRI scan before and after the treatment. Functional connectivity (FC) analysis was conducted with reward-related brain regions as seeds, including ventral tegmental area, bilateral nucleus accumbens (NAc), bilateral DLPFC, and bilateral amygdala. We found that, after the treatment, individuals showed reduced nicotine dependence, alleviated tobacco withdrawal symptoms, and diminished smoking cravings. The right NAc showed increased FC with right fusiform gyrus, inferior temporal gyrus (ITG), calcarine fissure and surrounding cortex, superior occipital gyrus (SOG), lingual gyrus, and bilateral cuneus. No significant FC changes were observed in other seed regions. Moreover, the changes in FC between the right NAc and the right ITG as well as SOG before and after rTMS were negatively correlated with changes in smoking scale scores. Our findings suggest that high-frequency L-DLPFC-rTMS reduces nicotine dependence and improves tobacco withdrawal symptoms, and the dysfunctional connectivity in reward circuitry may be the underlying neural mechanism for nicotine addiction and its therapeutic target.

Fostering social health of people with dementia: evaluation of the Razem przed siebie dementia awareness campaign in Poland.

Background: Due to the need to increase social awareness about dementia and the needs of patients living with dementia in Poland, the Razem przed siebie (eng. Forward with Dementia) campaign was created. The aim of the study was to evaluate its effectiveness. Methods: To disseminate key campaign messages to the target audiences (people with dementia, carers, health and social care professionals [HSCP] and general public) a website, social and traditional media promotions, webinars and social activities were created. The campaign ran between September 2021 and April 2022. Mixed methods (online survey, reach estimates and interviews) were used to evaluate the campaign. Results: Almost 1,300 people visited the website during the campaign period. Of these, 55 carers and HSCP responded to the online survey. The most read section of the website was Understanding the diagnosis (carers [56% of 25] and HSCP [80% out of 30]). The website was mostly accessed by carers (68%) and HSCP (66.7%) through word-of-mouth recommendations. 80% carers and 90% HSCP found the website very or extremely helpful. Over 90% of carers and HSCP expressed an intention to revisit the website. Based on 31 interviews, campaign effects, change mechanisms and limitations were identified. Campaign events elicited positive emotions among people with dementia, providing them with a feeling of belonging and engagement. Esteeming personal interactions over informational campaign materials, those with dementia felt acknowledged and empowered by the events. Carers also reported positive experiences and increased interest and knowledge, though they expressed disappointment with the lack of respite care, an issue beyond the campaign's scope. HSCP perceived the campaign events positively and identified significant gaps in the dementia care system. Conclusion: Evaluation of the Razem przed siebie campaign revealed successes and limitations. While effectively incorporating anti-stigma campaign recommendations and enhancing social health for individuals with dementia, the campaign clearly showed the pressing need for systemic solutions. Despite positive perception of the campaign, there is a need for a better diagnostic and post-diagnostic support for people with dementia and their carers.

Long-term distress throughout one's life: health-related quality of life, economic and caregiver burden of patients with neurofibromatosis type 1 in China.

Introduction: Neurofibromatosis type 1 (NF1) is a rare genetic disorder, with lack of evidence of disease burden in China. We aimed to describe the economic burden, health-related quality of life (HRQL), and caregiver burden of NF1 patients in China. Methods: We conducted an online cross-sectional survey employing the China Cloud Platform for Rare Diseases, with 223 caregivers of NF1 pediatric patients (patients under 18), and 226 adult patients. Economic burden was estimated using direct and indirect costs related to NF1 in 2021, and the Work Productivity and Activity Impairment Questionnaire: General Health V2.0 (WPAI-GH). HRQL measures included EQ-5D-Y proxy version and PedsQL™ 4.0 Generic Core Scales (PedsQL GCS) proxy version for pediatric patients, and EQ-5D-5L and PedsQL™ 3.0 Neurofibromatosis Module (PedsQL NFM) for adult patients. Caregiver burden was estimated by Zarit Burden Interview (ZBI). Results: For pediatric patients, the average direct cost in 2021 was CNY 33,614 (USD 4,879), and employed caregivers' annual productivity loss was 81 days. EQ-5D-Y utility was 0.880 ± 0.13 and VAS score was 75.38 ± 20.67, with 52.6% patients reporting having problems in "pain/discomfort" and 42.9% in "anxiety/depression." PedsQL GCS total score was 68.47 ± 19.42. ZBI score demonstrated that 39.5% of caregivers had moderate-to-severe or severe burden. For adult patients, average direct cost in 2021 was CNY 24,531 (USD 3,560). Patients in employment reported an absenteeism of 8.5% and presenteeism of 21.6% according to the results of WPAI-GH. EQ-5D-5L utility was 0.843 ± 0.17 and VAS score was 72.32 ± 23.49, with more than half of patients reporting having problems in "pain/discomfort" and "anxiety/depression" dimensions. PedsQL NFM total score was 68.40 ± 15.57. Conclusion: Both pediatric and adult NF1 patients in China had a wide-ranging economic burden and low HRQL, especially in the psychological dimension. Caregivers for NF1 pediatric patients experienced considerable caregiver burden. More attention and support from policymakers and stakeholders are required to relieve NF1 patients' and caregivers' distress.

Suicide warning signs of self-identification in patients with mood disorders: a qualitative analysis based on safety planning.

Introduction: Warning signs serve as proximal indicators of suicide risk, making early recognition imperative for effective prevention strategies. This study aimed to explore self-identified suicide warning signs among Chinese patients with mood disorders based on safety planning framework. Methods: Researchers collaborated with patients to develop a safety plan and compiled warning signs based on it. Word frequency and network analysis were conducted to identify key warning signs. Directed content analysis categorized these signs into cognitive, emotional, behavioral, or physiological themes according to the suicide mode theory. Additionally, we examined potential variations in reported warning signs among participants with different demographic characteristics, including age, gender, and history of suicide attempts. Results: "Low mood" and "crying" emerged as prominent warning signs, with "social withdrawal" closely following. Patients commonly reported emotional themes during suicidal crises, often experiencing two to three themes simultaneously, primarily focusing on emotional, behavioral, and physiological themes. Males exhibited a higher proportion of concurrently reporting three sign themes compared to females (P < 0.05), while no difference was observed in warning signs among patients with other demographic traits. Discussion: This study offers a nuanced understanding of warning signs among mood disorder patients in China. The findings underscore the necessity for comprehensive suicide risk management strategies, emphasizing interventions targeting emotional regulation and social support. These insights provide valuable information for enhancing suicide prevention and intervention efforts.

From trauma to resilience: advancing cultural responsiveness and equity in the Muskowekwan First Nation's healing journey.

Introduction: The Muskowekwan First Nation (MFN) in Saskatchewan, Canada, epitomizes the enduring strength and cultural preservation of the Saulteaux people. This community faces the lasting effects of colonial trauma, especially the violence, abuse, and adversity experienced by students at the Muskowequan Indian Residential School (MIRS). Decades of abuse by institutional leaders caused generational trauma, contributing to current mental health and well-being challenges. This study highlights the community's role in sharing experiences and shaping healing processes to develop the MFN Family Healing and Wellness Centre in response to urgent community concerns. It examines the integration of Justice, Diversity, Equity, and Inclusion (J-DEI) principles and cultural responsiveness in fostering community resilience and mental well-being. Methods: Adopting a community-based participatory research framework, this study employs a mixed-methods approach, including community engagement sessions and surveys. Collaborating closely with the MFN leadership, it draws upon the specialized expertise of Author2 and Author1, leaders in Indigenous health and research. The research uses qualitative and quantitative data collection, emphasizing the importance of community input and leadership in shaping the research process and outcomes. Results: Findings emphasize the community's commitment to spiritual and cultural practices as vital healing components. Amidst the heightened awareness of the lingering effects of the MIRS within the MFN community, these insights informed the development of the Centre, ensuring it incorporates the community's desires for culturally relevant healing practices. The grand opening of Phase I of the Centre in February 2023 emerged as a significant step forward, symbolizing a move towards holistic community health that honors resilience, holistic wellness, and cultural continuity. Discussion: This case study contributes to the literature on integrated, culturally responsive healthcare models that address the needs of Indigenous peoples and communities. The study provides insights to guide the Centre's future programs and services, ensuring they are culturally tailored and responsive to the community's needs. By illustrating the potential for traditional wisdom and contemporary health practices to foster well-being, the case study advocates for holistic approaches to healing in Indigenous settings, offering a replicable framework for similar initiatives globally.

Enhancing cultural sensitivity in the implementation of the Fertility Quality of Life Tool in Sudan: a science diplomacy perspective.

Background: Infertility is a global health challenge impacting quality of life, particularly in low and middle-income countries such as Sudan. The Fertility Quality of Life (FertiQoL) tool, a standardized questionnaire, is pivotal in assessing fertility-related quality of life. However, existing research on its utility has primarily been conducted in Global North and High-Income Countries, highlighting the need to shift away from neocolonialism to promote truly inclusive research and effective healthcare practices. Science diplomacy, through the adaptation and culturally sensitive implementation of research tools, can serve as a catalyst for addressing health disparities on a global scale. This study aims to assess methodological and cultural considerations that impact the implementation of the FertiQoL tool in Sudan, framed within the context of science diplomacy and neocolonialism. By investigating the challenges and opportunities of utilizing this tool in a non-Western cultural setting, we seek to contribute to the broader discussion on decolonizing global health research. Methods: Utilizing an explanatory sequential design involving surveys and interviews, we conducted a study in a Sudanese fertility clinic from November 2017 to May 2018. A total of 102 participants were recruited using convenience sampling, providing socio-demographic, medical, and reproductive history data. The Arabic version of FertiQoL was administered, with 20 participants interviewed and 82 surveyed (40 self-administered and 42 provider-administered). We applied descriptive statistics, one-way ANOVA, thematic analysis, and triangulation to explore methodological and cultural nuances. Results: Most participants were educated women who lived in urban areas. While the ANOVA results revealed no statistically significant differences in FertiQoL scores based on the mode of administration [core score (F(2,99) = 1.58, p = 0.21, η 2 = 0.03) and domain scores: emotional (F(2,99) = 1.85, p = 0.16, η 2 = 0.04); mind/body (F(2,99) = 1.95, p = 0.15, η 2 = 0.04); relational (F(2,99) = 0.18, p = 0.83, η 2 = 0.04); and social (F(2,99) = 1.67, p = 0.19, η 2 = 0.03)], qualitative insights unveiled vital cultural considerations. Interpretation challenges related to concepts like hope and jealousy emerged during interviews. Notably, the social domain of FertiQoL was found to inadequately capture the social pressures experienced by infertile individuals in Sudan, underscoring the importance of region-specific research. Despite these challenges, participants perceived FertiQoL as a comprehensive and valuable tool with broader utility beyond assessing fertility-related quality of life. Conclusion: Our findings emphasize the significance of incorporating cultural sensitivity into the interpretation of FertiQoL scores when implementing it globally. This approach aligns with the principles of science diplomacy and challenges neocolonial structures by acknowledging the unique lived experiences of local populations. By fostering cross-cultural understanding and inclusivity in research, we can enhance the implementation of FertiQoL and pave the way for novel interventions, increased funding, and policy developments in the Global South, ultimately promoting equitable global health.

Pregnant individuals perspectives towards receiving COVID-19 vaccination during their pregnancy: an in-depth qualitative study.

Introduction: Pregnant individuals have an increased risk of severe illness from coronavirus disease 2019 (COVID-19) infection. Vaccination is an effective strategy to prevent severe illness and complications for pregnant individuals. Pregnant individuals are often excluded from research and remain hesitant to receive vaccination against COVID-19. It is pivotal to study factors related to vaccine uptake and hesitancy among pregnant individuals. We studied barriers and facilitators for pregnant individuals choice and motivation regarding vaccination against COVID-19 during pregnancy to aid future pregnant individuals in their decision to vaccinate against various infectious agents. Methods: In this qualitative study, pregnant individuals were interviewed between October 2021 and January 2022 using a semi-structured approach. A topic list was used to explore their feelings, perceptions and ideas regarding vaccination against COVID-19 during pregnancy. Interviews were transcribed verbatim and thematic analyses was performed using MAX QDA. Results: After nine interviews, saturation was reached. Three main themes were identified that influenced pregnant individuals choice and motivation regarding vaccination: health consequences, ambiguity of information and societal motivation. Health consequences mainly concerned the effect for their offspring, and the unknown long-term effects of COVID-19 vaccination. The advice from the Dutch institute for Public Health and Environment changed from not vaccinating pregnant individuals after release of the developed vaccine, to routinely vaccinating all pregnant individuals after research data were available from the United States of America (USA). This change of policy fuelled doubt and confusion for vaccination. Arguments in favor of vaccination from the social perspective were specific behaviour rules and restrictions due to the pandemic. E.g. without vaccination people were unable to travel abroad and having to take a COVID-19 test every time entering a public place. Conclusion: Pregnant individuals need clear, unambiguous information concerning health consequences, short- and long-term, particularly for their offspring, in the decision-making process regarding COVID-19 vaccination. Additionally, the societal perspective needs to be addressed. Besides the aforementioned themes, general counselling should focus on misperceptions of vaccine safety and the role of misinformation which are also important in the non-pregnant population. This study underlines the importance of including pregnant individuals in research programs to obtain specific information targeted to their needs.