Trend in loneliness among Swiss university students during the first year of the COVID-19 pandemic.

BACKGROUND: The need to maintain physical and social distance between people and the stay-at-home recommendation/order to contain the spread of COVID-19 have raised concerns about the possible increase in loneliness. However, few studies have analyzed trends or changes in loneliness in samples of young adults. The present study aimed to explore the prevalence of loneliness and its change during the COVID-19 pandemic. PARTICIPANTS AND PROCEDURE: This is a repeated cross-sectional study analyzing data collected through six online surveys between April 2020 and March 2021 from 5,669 university students in Switzerland. Logistic regression models were used to examine trends in loneliness and associations between loneliness, well-being, life at home, COVID-19 symptoms and tests. RESULTS: Loneliness decreased between April 2020 and May-June 2020. In contrast, loneliness was higher in December 2020, January and March 2021 compared to April 2020. Loneliness was associated with younger age, studying architecture, design and civil engineering or engineering, enjoying time spent with family/partner, experiencing tensions and conflicts at home, boredom, feeling locked up and subjective well-being and current health. CONCLUSIONS: Our findings highlight an increase in loneliness during the second wave of the COVID-19 pandemic, although a seasonality effect cannot be excluded. Public health systems and educational institutions need to monitor the effects of social distancing measures and reduced social contact on students' loneliness and well-being.

German translation and validation of the Interprofessional Facilitation Scale.

We identified evidence from item response theory (IRT) to examine a German translation of the Interprofessional Facilitation Scale (IPFS). The IPFS was administered to n = 130 mixed-health profession participants in a post-interprofessional education practicum questionnaire. We used IRT analyses to examine the following three aspects of the IPFS: (a) general factor strength, (b) subscale usability, and (c) item bias. First, findings indicate a strong, general factor underlying the IPFS that supports unidimensional interpretations. Second, findings supported IPFS overall reliability, but failed to support subscale reliabilities. Third, item bias assessment using a comparator-French sample (n = 89) indicated insubstantial differences across German and French samples. Taken together, we find sufficient evidence to support the IPFS-German translation's application in IPE contexts and unidimensional interpretations. Subscores are not advisable for interpretation, and future researchers should aim to further inspect potential item bias.

Evaluation of a newly developed flipped-classroom course on interprofessional practice in health care for medical students.

Interprofessional education is expected to promote collaborative practice and should therefore be included in health professionals' curricula. Reports on interprofessional curricular development and its evaluation are rare. We therefore undertook a comprehensive quantitative and qualitative evaluation of a new, mandatory course on interprofessional collaboration for medical students during their third year of the Bachelor of Medicine study programme. The newly developed and implemented course spans over six weeks and was designed in a hybrid, flipped-classroom format. It incorporates experience- and case-based learning as well as interactions with other health professionals. Each student completes an eLearning and a clinical workshadowing individually before attending the - due to the pandemic - virtual live lectures. To assess quality and usefulness of teaching-learning formats and course structure to learn about interprofessional collaboration and to develop interprofessional competencies and identity, a quantitative and qualitative evaluation was performed with more than 280 medical students and 26 nurse educators from teaching hospitals using online surveys (open & closed-ended format). Data were analyzed descriptively and using content analysis processes. Students appreciated the flipped-classroom concept, the real-world case-based learning scenarios with interprofessional lecturer teams, and the possibility of an experience-based learning opportunity in the clinical setting including interaction with students and professionals from other health professions. Interprofessional identity did not change during the course. Evaluation data showed that the course is a promising approach for teaching-learning interprofessional competencies to medical students. The evaluation revealed three factors that determined the success of this course, namely, a flipped-classroom concept, the individual workshadowing of medical students with another health professional, mainly nurses, and live sessions with interprofessional teaching-learning teams. The course structure and teaching-learning methods showed potential and could serve as a template for interprofessional course development in other institutions and on other course topics.

Interprofessional education day 2019 - a qualitative participant evaluation.

Objective: Interprofessional education (IPE) is when two or more students from different professions learn with, from, and about each other to improve collaboration and quality of healthcare. In October 2019, a first interprofessional education (IPE) day was held in the canton of Zurich with the aim of teaching interprofessional skills to participating students. Methodology: The IPE day was developed by an interprofessional team of students. After a short introduction, the roles and tasks of the professional groups involved were discussed. This was followed by two case studies with simulation persons and reflection rounds. For the evaluation of the day, 15 semi-structured interviews with students and lecturers were conducted and qualitatively evaluated by means of thematic analysis. Results: The students and lecturers had a very positive experience of the IPE day. Especially the participation of medical and pharmacy students, the practical case studies with simulation persons and the informal exchange during the breaks were appreciated. There was room for improvement in the development of role models. Through an open attitude and good communication, the students learned to know and appreciate the competencies of the other professional groups. All those interviewed wished for more interprofessional teaching opportunities and the students felt encouraged to apply what they had learned in their later professional practice. Conclusion: The IPE day could be carried out successfully and the didactic concept worked largely well. The evaluation provided subjective evidence that the students were able to improve the interprofessional competencies of teamwork, communication, openness, appreciation and reflectiveness. In the future, the IPE day should be anchored in the curricula.

Interprofessional peer-assisted learning and tutor training practices in health professions education-A snapshot of Germany.

Peer-assisted learning (PAL)-especially peer tutorials-are gaining momentum in health professions education, particularly in interprofessional education. As little is known about the use of peer tutorials or the preparation of tutors in this context in Germany and in other countries, this study aims to provide an overview of these interventions. A cross-sectional study with a descriptive-exploratory design was conducted. German institutions for health professions education were contacted, and individuals with pedagogical responsibilities were invited to participate in an online survey. The survey was informed by two studies in which seven domains were identified as important. These included facts about the institution, the offer of PAL, the use of tutorials, and the design of tutor training. The survey used mostly closed-ended questions. The questionnaire was completed by n = 100 participants. Overall, n = 46 participants indicated that PAL was offered at their institution. Of these 46 participants, 32 (70%) indicated that uniprofessional PAL was offered, 2 (4%) indicated that interprofessional PAL was offered, and 12 (26%) indicated that both forms of PAL were offered. Peer tutoring was the most common format in both cases (73% for uniprofessional and 64% for interprofessional PAL), and mandatory interventions were mostly used to prepare the tutors. These interventions were held by educators or lecturers and were offered mostly face-to-face as workshops or as discussions. Deepening the tutors' social competencies through training was given high relevance. Regarding content, focus was placed on communication, (self-)reflection, and group management. Eighty-eight participants expressed recommendations for future directions in terms of preparing tutors for interprofessional PAL. Minor differences between the use of uniprofessional and interprofessional PAL and tutor training were found. Nevertheless, implementation strategies varied. In future, preparatory measures for tutors should be more uniformly designed and geared to the specific requirements of uniprofessional and interprofessional learning, and that at best on an empirical basis.

Position paper of the GMA Committee Interprofessional Education in the Health Professions - current status and outlook.

In the wake of local initiatives and developmental funding programs, interprofessionality is now included in national curricula in the German-speaking countries. Based on the 3P model (presage, process, product), this position paper presents the development of interprofessional education in recent years in Germany, Austria and Switzerland and places it in an international context. Core aspects as legal frameworks, including amendments to occupational regulations as well as the formation of networks and faculty development are basic requirements for interprofessional education. New topics and educational settings take shape in the process of interprofessional education: patient perspectives and teaching formats, such as online courses, become more important or are newly established. The influence of the COVID-19 pandemic on interprofessional education is explored as well. Among many new interprofessional courses, particularly the implementation of interprofessional training wards in Germany and Switzerland are positive examples of successful interprofessional education. The objective of interprofessional education continues to be the acquisition of interprofessional competencies. The main focus is now centered on evaluating this educational format and testing for the corresponding competencies. In the future, more capacities will be required for interprofessional continuing education and post-graduate education. Structured research programs are essential to ascertain the effects of interprofessional education in the German-speaking countries. In this position paper the GMA committee on interprofessional education encourages further advancement of this topic and expresses the aim to continue cooperating with other networks to strengthen and intensify interprofessional education and collaboration in healthcare.

Interprofessional educators' competencies, assessment, and training - IPEcat: protocol of a global consensus study.

Contemporary practice in interprofessional education (IPE) has evolved predominantly focusing on the competencies for interprofessional collaboration (IPC) that learners must acquire. Competencies that educators need to successfully deliver IPC have been overlooked. This lack of attention is further confounded by a field replete with inconsistent terminology and standards and no global consensus on the core competencies needed for IPE facilitation. There are no globally accepted tools to assess interprofessional educators' competencies nor are there established training programmes that might be used as the basis for a collective global approach to these issues. The International Working Group for Interprofessional Educators Competencies, Assessment, and Training (IWG_IPEcat) seeks to address this gap using a sequential mixed-method approach, to deliver globally developed, empirically derived tools to foster IPE educator competencies. This article presents the protocol of the research project.

CXCL13 and CXCL9 CSF Levels in Central Nervous System Lymphoma-Diagnostic, Therapeutic, and Prognostic Relevance.

Background: Diagnostic delay and neurologic deterioration are still a problem for the treatment of rapidly progressing CNS lymphoma (CNSL); there is an unmet need for a diagnostic test with a high diagnostic yield and limited risk, minimizing the time to the initiation of effective treatment. Methods: In this prospective monocentric study, we analyzed the utility of CXCL13 and CXCL9 as diagnostic, therapeutic and prognostic biomarkers for CNSL. Cerebrospinal fluid (CSF) from 155 consecutive patients admitted with brain lesions of various origins was collected. Levels of CXCL13 and CXCL9 were analyzed by ELISA. Additionally, CSF was analyzed during CNSL disease course (relapse, remission, progress) in 17 patients. Results: CXCL13 and CXCL9 CSF levels were significantly increased in patients with CNSL compared to control patients with lesions of other origin. Using logistic regression and a minimal-p-value approach, a cut-off value of 80 pg/ml for CXCL13 shows high sensitivity (90.7%) and specificity (90.1%) for the diagnosis of active CNSL. CXCL9 at a cut-off value of 84 pg/ml is less sensitive (61.5%) and specific (87.1%). Both cytokines correlate with the clinical course and response to therapy. Conclusions: Our results confirm the excellent diagnostic potential of CXCL13 and introduce CXCL9 as a novel albeit less powerful marker for PCNSL.

WIPAKO® Winterthur interprofessional training concept "communication and cooperation in health professions": concept, development process and implementation.

Objective: The positioning and training of communicative and social competencies to improve interprofessional cooperation is and will be a challenge for educational institutions. The aim of this project was to reorient the interprofessional training elements of bachelor programs in terms of both content and structure, to improve the legally required practical relevance and to aim for a sustainable anchoring through the targeted design of the development process. WIPAKO® facilitates the acquisition of communicative and social competencies as a prerequisite for cooperation between the health and medical professions. Methodology: Once suitable process structures had been created, an interprofessional committee of experts defined the training elements (competencies, content, learning and teaching methods, learning objective review and evaluation) in an iterative consensus process based on various framework models and on the involvement of the various stakeholders in the individual study programs. Results: A training concept focusing on communicative and social competencies for interprofessional cooperation is available. The consistent interprofessional development of the concept promoted joint responsibility for training in the sense of an organizational development process. Conclusion: The outlined procedure for the conceptualization and implementation of a corresponding framework model and the framework model itself provide the basis for the empirical examination of competence acquisition and the sustainable anchoring of interprofessional training elements. This will provide suggestions for other educational institutions facing similar challenges.

A Longitudinal Study on Generalized Anxiety Among University Students During the First Wave of the COVID-19 Pandemic in Switzerland.

OBJECTIVE: The COVID-19 pandemic and government measures implemented to counter the spread of the infection may be a major stressor affecting the psychological health of university students. This study aimed to explore how anxiety symptoms changed during the pandemic. METHODS: 676 students (76% females) at Zurich University of Applied Sciences participated in the first (T0) and second (T1) survey waves. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-Scale-7 (GAD-7). Risk and protective factors (e.g., COVID-19-related variables) were examined. RESULTS: GAD-7 scores decreased significantly from T0 to T1 (mean change: -0.446, SE = 0.132, 95% CI: -0.706, -0.186, t = -3.371, df = 659, p = 0.001). Participants with moderate-to-severe anxiety score were 20.2 and 15.6% at T0 and T1, respectively. The following positively predicted anxiety: older age, female gender, non-Swiss nationality, loneliness, participants' concern about their own health, and interaction between time and participants' concern about their own health. Resilience and social support negatively predicted anxiety. CONCLUSIONS: Our findings provide information for public health measures and psychological interventions supporting the mental health of university students during the COVID-19 emergency.

Students' experience and adherence to containment measures during COVID-19 in Switzerland.

BACKGROUND: Young adults are not considered a risk group, but the public health response to COVID-19 impacts all citizens. We investigated the impact on young adults' and their adherence to containment measures addressing potential gender differences. METHODS: In April 2020 12 341 students of the Zurich University of Applied Sciences were invited to a longitudinal health survey. Survey topics spanned socio-demographic data, students' health status and behavior, COVID-19 specific impact, concerns, information sources, adherence to containment measures, and trust in government bodies. Group comparisons by gender and multivariate ordinal regression models assessing adherence to restrictions of mobility and social contacts were conducted (n = 2373). RESULTS: Mean age was 26.4 (SD = 5.6), 70% were female. 43.5% reported some concern about their own health, 2.7% stated major worries. Women experienced more conflicts (p < 0.000) and, enjoyed time with the family more (p < 0.000). Men felt less locked up (p = 0.001). The most frequented COVID-19 information source was public media (48%) and confidence in government bodies was high (82%) for both genders. Men yielded lower adjusted odds (OR; 95%-CI) of adherence regarding the following measures: social distancing (0.68; 0.53-0.87), non-utilization of public transport (0.74; 0.56-0.97), 5-person limit for social gatherings (0.47; 0.35-0.64) and the stay at home rule (0.64; 0.51-0.82). CONCLUSION: Early in the pandemic a high degree of adherence was observed in this young academic population. Containment measures restricting movement and social contact yielded considerable differences by gender, information source and perceived susceptibility to the virus. More targeted communication may increase adherence regarding mobility restrictions.

Depressive Symptoms in Swiss University Students during the COVID-19 Pandemic and Its Correlates.

BACKGROUND: COVID-19 containment measures and the uncertainties associated with the pandemic may have contributed to changes in mental health risks and mental health problems in university students. Due to the high burden of the disease, depression is of particular concern. However, knowledge about the prevalence of depressive symptoms in Swiss university students during the pandemic is limited. We therefore assessed the prevalence of depressive symptoms and their change during the COVID-19 pandemic in a large sample of Swiss university students. METHODS: We assessed depressive symptoms in two cross-sectional cohorts of university students (n = 3571) in spring and autumn 2020 during the COVID-19 pandemic and compared them with a matched sample of the Swiss national population (n = 2328). Binary logistic regression models estimated prevalence with corresponding 95% confidence intervals (95% CI). RESULTS: Adjusted prevalence of depressive symptoms in female (30.8% (95% CI: 28.6-33.0)) and male students (24.8% (95% CI: 21.7-28.1)) was substantially higher than in the matching female (10.9% (95% CI: 8.9-13.2)) and male (8.5% (6.6-11.0)) pre-pandemic national population. Depressive symptoms in the two consecutive student cohorts did not significantly differ. CONCLUSIONS: More than a quarter of Swiss university students reported depressive symptoms during the COVID-19 pandemic, which was substantially higher as compared to the matched general population. Universities should introduce measures to support students in such times of crisis and gain an understanding of the factors impacting mental health positively or negatively and related to university structures and procedures.

Student views of interprofessional education facilitator competencies: A cross-sectional study.

Research attention has been paid to providing evidence on undergraduate/pre-licensure health sciences students' interprofessional education competency requirements, placements, and attainment. Although interprofessional facilitator training has been identified as critical to interprofessional learner outcomes, scant research has examined student perceptions of valued facilitator competencies. This short report investigates students' views of important attributes for interprofessional facilitation using a cross-sectional observation-survey design. A survey was conducted in a pre-licensure sample of n = 343 students (response rate 68%) from four health professions (nursing, midwifery, physical therapy, and occupational therapy). After completing a semester-long interprofessional education course, students completed a survey vis-à-vis rating the importance of interprofessional facilitator competency with regard to 25 abilities, 12 teacher profiles, and 10 characteristics. Taken together, results indicate the need for a multifaceted view of interprofessional facilitator competencies. Our findings will inform training targeted to specific facilitator competencies, as needed for optimizing the delivery of interprofessional education.

Top tips for interprofessional education and collaborative practice research: a guide for students and early career researchers.

Interprofessional research within the contexts of education and health and social care practice has grown exponentially within the past three decades. To maintain the momentum of high-quality research, it is important that early career researchers embarking on their first research journey and new to interprofessional education or interprofessional collaborative practice feel supported in making their contribution to the field. This guide, developed by the Center for the Advancement of Interprofessional Education (CAIPE) Research Group, has been written with these groups in mind who are embarking on their first research journey, and new to the interprofessional field. It aims to raise awareness of academic resources and share practical advice from those who have previously experienced problems when undertaking interprofessional research in education or health and social care practice.

Swiss University Students' Risk Perception and General Anxiety during the COVID-19 Pandemic.

University students were confronted with abrupt changes to their daily lives by the COVID-19 lock-down. We investigated Generalized Anxiety Disorder Scale-7 (GAD-7) and anxiety levels, and the association between perceived impact on well-being, studies, and daily lives and anxiety levels, adjusted for gender, age, social class and affiliation. Early in the lock-down all students of the Zurich University of Applied Sciences (N = 12,429) were invited to a voluntary longitudinal health survey. Participation rate was 20% (n = 2437): 70% females, median age 25 yrs. (IQR 23-28). A total of 10% reported a deterioration of well-being compared to pre-Corona. LCA yielded three classes varying in perceived COVID-19 impact: 1 (low, n = 675), 2 (moderate, n = 1098), and 3 (strong, n = 656). Adjusted proportion of moderate to severe anxiety by class were 45% (95% CI: 28.0-62.0), 15.5% (95% CI: 13.1-17.9), and 5.1% (95% CI: 4.7-5.6), respectively. Multivariate regression analyses yielded an OR for moderate to severe anxiety of 3.88 (95% CI: 2.5-6.0, class 2) and 22.43 (95% CI: 14.5-34.6, class 3) compared to class-1. The investigated association implies that containment measures have a selective effect on anxiety in students. The diversity of students' perception and associated anxiety should be monitored and considered in future response to pandemics.

Perceptions of who is in the healthcare team? A content analysis of social media posts during COVID-19 pandemic.

Social media posts can be used to explore public perceptions of interprofessional teams and healthcare professionals. The aim of this study was to use social listening technique to explore unfiltered public perceptions of the professionals involved in healthcare teams during the COVID-19 pandemic, in a naturalistic online setting, and to elaborate on the emotional reactions in response to an online social media post. A cross-sectional retrospective review of comments on a specific social media post was conducted between 15 March and 28 April 2020 using summative content analysis. One image that was widely circulated on social media platforms with two questions: 'Who society thinks works at hospital? versus who really works at hospitals?' was selected. Three platforms were searched, Facebook®, Twitter®, and LinkedIn®. Only publicly available posts were included. Out of the initial 40 posts identified, 21 posts which had 1759 comments were analysed and 1576 were included for coding. Of the emerging nine themes, perceptions of who is in the team was the largest (40.5%, n = 639), followed by agreement (23.1%, n = 364) and feeling excluded (16.2%, n = 255). Of emotional expressions, 42.1% were positive and 57.9% negative. The most frequent emotions were frustration (54.4%, n = 857) followed by gratitude (16.3%, n = 257) and relief (15.9%, n = 250). The post brought considerable attention to the role of the interprofessional team and generated many feelings of frustration and exclusion. For this reason, the response to this social media post is very important and not to be overlooked. Healthcare professionals need to work together to strengthen their presence as an interprofessional team, united to deliver safe effective quality care for patients. The current COVID-19 pandemic and the media attention should be taken as an opportunity by the interprofessional community to work together to combat negative media stereotypes. Further research is warranted on public perceptions of the healthcare team.

Is Animal-Assisted Therapy for Minimally Conscious State Beneficial? A Case Study.

OBJECTIVE: The goal of this single case study was to qualitatively investigate the effects of animal-assisted therapy in a patient in a minimally conscious state. METHOD: We present a 28-year-old female patient in a minimally conscious state following polytrauma after a sports accident leading to cerebral fat embolism causing multiple CNS ischemic lesions. She received eight animal-assisted therapy sessions and eight paralleled control therapy sessions over 4 weeks. We investigated the reactions of the patient during these sessions via qualitative behavior analysis. RESULTS: The patient showed a broader variability and higher quality of behavior during animal-assisted therapy compared to control therapy sessions. CONCLUSION: The observed behavioral changes showed higher arousal and increased awareness in the presence of an animal. The presented case supports the assumption that animal-assisted therapy can be a beneficial treatment approach for patients in a minimally conscious state.

APRIL and BAFF: novel biomarkers for central nervous system lymphoma.

BACKGROUND: Early diagnosis of CNS lymphoma (CNSL) is essential for successful therapy of this rapidly progressing brain tumor. However, in patients presenting with focal brain lesions, fast and reliable diagnosis of PCNSL remains a challenge. A proliferation-inducing ligand (APRIL) and B cell activating factor (BAFF) are important factors in the pathophysiology, diagnosis, and prognosis of systemic B cell malignancies. However, their utility as biomarkers for the diagnosis of CNSL and their effects on CNSL cells remain unclear. METHODS: In this prospective study, we analyzed the levels of APRIL and BAFF in the cerebrospinal fluid (CSF) of 116 patients with suspected focal brain lesions, including 53 CNSL patients. Additionally, we serially measured their levels during chemotherapy and relapse. Furthermore, we analyzed the effect of APRIL and BAFF on two B cell lymphoma cell lines using proliferation, viability, and chemotaxis assays. RESULTS: CSF levels of APRIL and BAFF reliably differentiated CNSL from other focal brain lesions (including primary and metastatic brain tumors, autoimmune-inflammatory lesions, and neuroinfectious lesions) with a specificity of 93.7% (APRIL, BAFF) and a sensitivity of 62.3% (APRIL) and 47.1% (BAFF). Serial CSF analysis of CNSL patients during chemotherapy and relapse demonstrates a close correlation of APRIL CSF levels and the course of this disease. In vitro, APRIL and BAFF showed anti-apoptotic effects during MTX treatment and mediated chemotaxis of malignant B cells. CONCLUSION: This study extends the spectrum of valuable diagnostic biomarkers in CNSL. In patients with focal brain lesions, measurement of APRIL in CSF could help accelerating the diagnosis of CNSL. Moreover, our results highlight an important role of APRIL and BAFF in the pathophysiology of CNSL.

Unilateral Asterixis in Arm and Leg Caused by Internal Capsula Stroke.

We report an unusual clinical manifestation of ischemic stroke with acute right-sided asterixis affecting the arm as well as the leg due to a lesion in the left posterior limb of the internal capsula. After treatment with intravenous thrombolysis the patient made a good recovery. Notably, in this case unilateral asterixis affected the arm as well as the leg, resulting in postural and gait instability. In addition, damage in the basal ganglia-thalamo-cortical network, as in our patient, has to be distinguished from other supratentorial causes of acute asterixis like thalamic or frontal lobe lesions linked to the cerebello-brainstem-thalamo-frontal lobe circuits.