Qualitative enquiry on factors affecting antibiotic prescribing at primary healthcare facilities in Addis Ababa, Ethiopia.

Background: The major driver of antibiotic resistance is the huge increase in antibiotic prescribing, especially in low- and middle-income countries. Aim: This study aimed to explore factors affecting antibiotic prescribing at primary healthcare facilities in Addis Ababa, Ethiopia. Methods: The study was part of a three-phased explanatory sequential mixed method design. The study was conducted in five primary healthcare facilities through in-depth interviews of 20 prescribers and 22 key informants using pre-prepared interview guides. The data were analysed through thematic content analysis by applying ATLAS.ti 9 software. Results: The antibiotic prescribing decision of prescribers was shown to be affected by various factors. The factors related to prescribers include not updating oneself on antibiotic use and antibiotic resistance, not reviewing patient history, not considering the concerns related to antibiotic resistance during prescribing, and competency problems. The patient-related factors were low awareness about antibiotics, lack of respect for prescribers, and pressure on prescribers. The shortage of antibiotics and laboratory reagents, a lack of updated antimicrobial resistance information, patient load, inadequate capacity, private sector practice, inadequate follow-up and support, and health insurance membership were the system-related factors. Appropriate interventions should be designed and implemented to address the identified factors and improve the prescribing practice.

Species diversity and interspecific information flow.

Interspecific information flow is known to affect individual fitness, population dynamics and community assembly, but there has been less study of how species diversity affects information flow and thereby ecosystem functioning and services. We address this question by first examining differences among species in the sensitivity, accuracy, transmissibility, detectability and value of the cues and signals they produce, and in how they receive, store and use information derived from heterospecifics. We then review how interspecific information flow occurs in communities, involving a diversity of species and sensory modes, and how this flow can affect ecosystem-level functions, such as decomposition, seed dispersal or algae removal on coral reefs. We highlight evidence that some keystone species are particularly critical as a source of information used by eavesdroppers, and so have a disproportionate effect on information flow. Such keystone species include community informants producing signals, particularly about predation risk, that influence other species' landscapes of fear, and aggregation initiators creating cues or signals about resources. We suggest that the presence of keystone species means that there will likely be a positive relationship in many communities between species diversity and information through a 'sampling effect', in which larger pools of species are more likely to include the keystone species by chance. We then consider whether the number and relative abundance of species, irrespective of the presence of keystone species, matter to interspecific information flow; on this issue, the theory is less developed, and the evidence scant and indirect. Higher diversity could increase the quantity or quality of information that is used by eavesdroppers because redundancy increases the reliability of information or because the species provide complementary information. Alternatively, there could be a lack of a relationship between species diversity and information if there is widespread information parasitism where users are not sources, or if information sourced from heterospecifics is of lower value than that gained personally or sourced from conspecifics. Recent research suggests that species diversity does have information-modulated community and ecosystem consequences, especially in birds, such as the diversity of species at feeders increasing resource exploitation, or the number of imitated species increasing responses to vocal mimics. A first step for future research includes comprehensive observations of information flow among different taxa and habitats. Then studies should investigate whether species diversity influences the cumulative quality or quantity of information at the community level, and consequently ecosystem-level processes. An applied objective is to conserve species in part for their value as sources of information for other species, including for humans.

Caring for high-need patients.

OBJECTIVE: We aimed to explore the construct of "high need" and identify common need domains among high-need patients, their care professionals, and healthcare organizations; and to describe the interventions that health care systems use to address these needs, including exploring the potential unintended consequences of interventions. METHODS: We conducted a modified Delphi panel informed by an environmental scan. Expert stakeholders included patients, interdisciplinary healthcare practitioners (physicians, social workers, peer navigators), implementation scientists, and policy makers. The environmental scan used a rapid literature review and semi-structured interviews with key informants who provide healthcare for high-need patients. We convened a day-long virtual panel meeting, preceded and followed by online surveys to establish consensus. RESULTS: The environmental scan identified 46 systematic reviews on high-need patients, 19 empirical studies documenting needs, 14 intervention taxonomies, and 9 studies providing construct validity for the concept "high need." Panelists explored the construct and terminology and established that individual patients' needs are unique, but areas of commonality exist across all high-need patients. Panelists agreed on 11 domains describing patient (e.g., social circumstances), 5 care professional (e.g., communication), and 8 organizational (e.g., staffing arrangements) needs. Panelists developed a taxonomy of interventions with 15 categories (e.g., care navigation, care coordination, identification and monitoring) directed at patients, care professionals, or the organization. The project identified potentially unintended consequences of interventions for high-need patients, including high costs incurred for patients, increased time and effort for care professionals, and identification of needs without resources to respond appropriately. CONCLUSIONS: Care for high-need patients requires a thoughtful approach; differentiating need domains provides multiple entry points for interventions directed at patients, care professionals, and organizations. Implementation efforts should consider outlined intended and unintended downstream effects on patients, care professionals, and organizations.

Gaps in vaccine management practices during vaccination outreach sessions in rural settings in southwestern Uganda.

BACKGROUND: Outreach efforts were developed to bolster people's access to and use of immunization services in underserved populations. However, there have been multiple outbreaks of diseases like measles in Uganda, prompting policy makers and stakeholders to ask many unanswered questions. This research study was created to uncover the discrepancies between vaccine management practices at immunization outreach sessions in rural South Western Uganda compared with existing standards. METHODS: The observational qualitative study, was done in 16 public health facilities across four districts of Uganda. Data were collected using in-depth interviews, facility record reviews, and observation. We assessed the vaccine management procedures before immunization session, transportation used, set up at the outreach site, management practices during the outreach session and packing of vaccines - according to World Health Organization immunization practice recommendations. The data were transcribed, coded and categories were formed and triangulated. Themes were generated based on a socio-ecologic framework to gain a better understanding of healthcare provider practices during immunization sessions. RESULTS: Fifty-one individuals were interviewed; four Assistant District Health Officers, four cold chain technicians, 15 focal persons for the Expanded Program on Immunization, and 28 health care providers. The respondents' mean age was 35, 43 (84.3%) were females and 24 (47.1%) had a diploma. 11 (69%) outreaches were conducted at a distance of 5-12 km from the health facility and 7 (44%) were conducted in a building. For 8 outreaches (50%) health facility staff did not check the vaccine vial monitor status before the outreach while 12(75%) did not keep the vaccine hard lid cover closed during the sessions. The main areas of concern were insufficient vaccine integrity monitoring, improper handling and storage practices, deficient documentation, and inadequate vaccine transportation. These were similar across immunization outreach sites regardless of vaccine preventable disease outbreaks occurrences. The majority of these gaps were located at the individual level but were enabled by policy/environmental factors. CONCLUSIONS: There are poor vaccine management procedures during outreach sessions contrary to established guidelines. Specific tactics to tackle knowledge deficiencies, health worker attitude, and fewer equipment shortages could improve compliance to guidelines.

Systematic Integration of Multi-Informant Externalizing Ratings in Clinical Settings.

Best practice clinical assessment of externalizing problems often necessitates collection of information from parents, youth themselves, and teachers. The present study tested the predictive validity of a psychometrically-driven scoring procedure to integrate multi-informant, dimensional ratings of externalizing problems. Participants were 2264 clinic-referred youth ages 6-18. Parents, teachers, and youth completed questionnaire ratings of externalizing problems (hyperactivity-inattention, conduct problems, and oppositionality-defiance) prior to an initial clinical appointment. The predictive validity of simple (highest informant rating; and all informant ratings separately) and more complex (latent S-1 bifactor model with specific informant factors; and moderated nonlinear factor analysis accounting for child age and sex) methods of informant integration was tested in predicting impairment, comorbidity, and number of clinical encounters. A simple model, in which all informant ratings were included, showed the best predictive validity across outcomes, performing as well or better than the use of the highest informant ratings or more complex latent variable models. The addition of child age and sex as moderators in the factor model did not improve predictive validity. Each informant (parent, teacher, and youth) contributes important information to the prediction of clinically-relevant outcomes. There is insufficient evidence at present to suggest that complex latent variable models should be favored over simpler models that preserve each informant's ratings.

Using lessons learnt from key stakeholders to increase support for scaling the Reach Up Early Childhood Parenting program.

Introduction: Sustainable implementation of early childhood programs requires resources, materials and methods that are adaptable, scalable and feasible for delivery through multiple sectors. Additional or modified program resources may be required to meet emerging needs, as programs go to scale. An active and effective monitoring, evaluation and learning (MEL) process may enable programs to be responsive to demands. The Reach Up: Early Childhood Parenting program, is designed primarily for disadvantaged children under 4 years of age in low- and middle-income countries (LMICs) to promote their development through playful caregiver interactions. The curriculum, training manuals and other materials and resources support implementers in the adaptation of the intervention, implementation, workforce training, monitoring and evaluation. This paper reports on how data collected from key informants drove modifications to program processes, materials and resources. Methods: We conducted in-depth interviews with 14 key informants (including program managers, lead trainers, academics, consultants and workforce personnel) on their experiences with Reach Up across 15 LMICs where the program has been implemented. We also reviewed written records generated from (i) structured small group discussions at a Knowledge Exchange meeting of 31 Reach Up partners and (ii) notes from working groups formed at the meeting and tasked to continue working post-meeting to find solutions to support ongoing implementation. The transcripts from the in-depth interviews and the meeting records were analysed using thematic analysis with a mixture of pre-defined categories and data-driven sub-themes. Results: The main findings indicated that there was a need to: (i) develop advocacy and communication resources and materials to aid prospective implementers and other stakeholders, to make decisions for implementation, (ii) revise and/or add to the content and format of the curriculum and add content in the training and other supporting manuals and (iii) enhance the training process. Conclusion: The feedback from the key global partners informed the development of new knowledge materials, resources and processes and modifications to existing program materials and resources. These will help to support advocacy, ongoing implementations, and the process of transitioning the Reach Up early childhood intervention to scale.

Utilizing Filipino key informants to guide community outreach for cancer prevention in Hawai'i.

OBJECTIVE/DESIGN: The University of Hawai'i Cancer Center works with academic and community partners to examine health disparities and inequities that persist among Pacific Island Populations through the Pacific Island Partnership for Cancer Health Equity (PIPCHE). The Partnership's Community Outreach Core (COC) assists and promotes cancer research and helps to ensure the integration of historically excluded community perspectives by utilizing community-engaged and culturally-grounded approaches to reduce cancer burdens. However, cancer health disparities among Filipinos demonstrate a need for cancer-control initiatives within this community. SAMPLE/MEASUREMENTS: COC staff conducted five semi-structured key informant interviews with Filipino nurse and healthcare leaders in Hawai'i to establishpartnerships with the community, as well as provide community-driven guidance for future cancer prevention and control efforts. RESULTS: The informants provided recommendations for COC community engagement, relationship building, and future areas of directed cancer focus. The interviews also initiated relationship-building and community collaborations for directed cancer education and resources within Filipino communities. CONCLUSION: The themes uncovered from the interviews provided guidance on how to begin addressing cancer concerns, and led to the informants' subsequent membership in our Outreach Advisory Council to engage in future collaboration with the Filipino community and a framework for future community-engaged cancer prevention efforts.

Compulsive Internet Use Scale for assessment of self-reported problematic internet use in primary school-aged children.

Introduction: The tremendous growth of internet use during past few decades has been primarily led by young people. Despite a plenitude of studies reporting the pros and cons of excessive internet use by adolescents, the internet use of primary school-aged children is under-researched. First, there is lack of reliable and valid cultural invariant self-report instruments for children younger than 11-years-old. Secondly, there is no consensus on whether primary school-aged children can reliably report on their internet use. This study aimed to examine the psychometric properties of the Compulsive Internet Use Scale (CIUS) as reported by primary school-aged children in three different countries/regions. Methods: Paper-pencil format CIUS questionnaires were completed by a total of 691 children aged 8 to 10 years old, 236 of them Latvian, 207 Lithuanian, and 248 Taiwanese, as well as by one of their parents, at two-time points, separated by a one-year interval. The parents also reported on the child's emotional and behavioral difficulties. Methods: Confirmatory factor analysis indicated that for the child self-report, a 10-item CIUS showed the best fit and good psychometric properties: solid structural validity; very good internal consistency; appropriate stability and predictive validity after 1 year; as well as sound sensitivity and specificity when compared to the 14-item CIUS parent-report form. Child self-report CIUS ratings correlated with time online reported by the child and parent and with emotional and behavioral problems reported by the parent. Discussion: This study indicates that children as young as 8-10 years old can reliably and consistently provide valuable information on their problematic use of the internet.

Training for virtual care: What do the experts think?

Introduction: Virtual care has expanded during COVID-19 and enabled continued access to healthcare services. As with the introduction of any new technology in healthcare delivery, the preparation of healthcare providers for adopting and using such systems is imperative. The purpose of this qualitative study was to explore experts' ascribed opinions on healthcare providers' continuing professional development (CPD) needs in virtual care. Methods: Semistructured interviews were conducted with a purposive sample of key informants representing Canadian provincial and national organizations with expertise in virtual care delivery. Results: Three main areas of knowledge, skills, and abilities that would be most helpful for healthcare providers in preparing to adopt and use virtual care were identified. The use of technology necessitates knowledge of how to integrate technology and virtual care in the practice workflow. This includes knowing how to use the technology and the privacy and security of the technology. Providers need to be able to adapt their clinical skills to virtual care and build rapport through good communication with patients. Virtual care is not appropriate for all visits, therefore providers need to understand when an in-person visit is necessary with respect to the nature of the appointment, as well as contextual factors for individual patients. Finally, providers need to adapt their examination skills to virtual care. Discussion: Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing continuity of care through access that is more convenient. Key informants identified barriers and challenges in adopting and using virtual care effectively, fundamental knowledge, skills and/or abilities required, and important topics and/or educational experiences to guide CPD program development on virtual care for healthcare providers.

Do Children With Attention-Deficit/Hyperactivity Disorder Symptoms Become Socially Isolated? Longitudinal Within-Person Associations in a Nationally Representative Cohort.

Objective: This study examined longitudinal associations between attention-deficit/hyperactivity disorder (ADHD) symptoms and social isolation across childhood. The study tested the direction of this association across time, while accounting for preexisting characteristics, and assessed whether this association varied by ADHD presentation, informant, sex, and socioeconomic status. Method: Participants included 2,232 children from the Environmental Risk (E-Risk) Longitudinal Twin Study. ADHD symptoms and social isolation were measured at ages 5, 7, 10, and 12. Random-intercept cross-lagged panel models were used to assess the directionality of the association across childhood. Results: Children with increased ADHD symptoms were consistently at increased risk of becoming socially isolated later in childhood, over and above stable characteristics (ß = .05-.08). These longitudinal associations were not bidirectional; isolated children were not at risk of worsening ADHD symptoms later on. Children with hyperactive ADHD presentation were more likely to become isolated, compared with inattentive presentation. This was evident in the school setting, as observed by teachers, but not by mothers at home. Conclusion: The study findings highlight the importance of enhancing peer social support and inclusion for children with ADHD, particularly in school settings. This study adds explanatory value beyond traditional longitudinal methods, as the results represent how individual children change over time, relative to their own preexisting characteristics. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Discrepancies in Mother-Child Reports of Child's Exposure to Intimate Partner Violence: Associations With Externalizing Symptoms.

The type and frequency of children's exposure to intimate partner violence (IPV) are considered as key variables in understanding children's heightened risk of externalizing symptoms. Notably, children's exposure to IPV has been primarily measured using mothers' reports of their own victimization. However, mothers and children might differently perceive children's exposure to physical IPV. To date, no research has investigated multi-rater reporting discrepancies in child's exposure to physical IPV and whether such discrepancies would be linked to externalizing symptoms. This study aimed to identify patterns of mother-child discrepancies in child's exposure to physical IPV and examine whether those patterns would be associated with children's externalizing symptoms. Participants were mothers who have experienced police-reported male-perpetrated IPV and their children (n = 153; 4-10 years). Latent profile analysis identified three profiles of mother-child discrepancies: a concordant group reporting high IPV exposure; a discordant group with mothers and children reporting high and low child's IPV exposure, respectively; a second discordant group with mothers and children reporting low and moderate IPV exposure, respectively. Profiles of mother-child discrepancies were differentially associated with children's externalizing symptoms. Findings suggest that discrepancies among informants' ratings of children's IPV exposure might have important implications for measurement, assessment, and treatment.

Construct-related validity of the strengths and difficulties questionnaires with three and five dimensions: A multitrait-multimethod analysis.

The Strengths and Difficulties Questionnaire (SDQ) is one of the most broadly used questionnaires to evaluate children's psychological adjustment, however its internal structure has been a target of ongoing controversy. Recent studies suggested a three-factor structure of the SDQ, however data is still scarce. The present study used the Multitrait-Multimethod analysis to examine SDQ construct related-validity with three and five dimensions, provided by children, their parents and teachers. A total of 415 participants were recruited from a Portuguese community sample. Both SDQ versions presented good convergence-related validity, with higher values for the five version. Findings from this study suggest that the SDQ with three dimensions could be more suitable as a screening measure of children's psychological adjustment in a community low-risk sample. Nevertheless, the SDQ still needs further psychometric improvements in order to properly collect information from multi-source samples about the prevalence of children's psychological adjustment.

Revolution in abortion care? Perspectives of key informants on the importance of abortion method choice in the era of telemedicine.

Patient choice of medical or surgical abortion is a standard of quality abortion care, but the choice of surgical abortion is constrained in England and Wales, particularly since the COVID-19 pandemic and introduction of telemedicine. This qualitative study explored the perspectives of abortion service providers, managers, and funders on the need to offer a choice of methods within early gestation abortion services in England and Wales. Twenty-seven key informant interviews were conducted between August and November 2021, and framework analysis methods were used. Participants presented arguments both for and against offering method choice. Most participants felt that it was important to maintain choice, although they recognised that medical abortion suits most patients, that both methods are very safe and acceptable, and that the priority for abortion services is to maintain timely access to respectful care. Their arguments related to practicalities around patient needs, the risk of reinforcing inequalities in access to patient-centred care, potential impacts on patients and providers, comparisons to other services, costs, and moral issues. Participants argued that constraining choice has a greater impact on those who are less able to advocate for themselves and there were concerns that patients may feel stigmatised or isolated when unable to choose their preferred method. In conclusion, although medical abortion suits most patients, this study highlights arguments for maintaining the option of surgical abortion in the era of telemedicine. More nuanced discussion of the potential benefits and impacts of self-management of medical abortion is needed.

HPV vaccination and cervical cancer screening promotion among Black individuals: social ecological perspectives from key informants interviews.

OBJECTIVES: Rates of HPV infection and HPV-related cancers are elevated in the Black population of the US. Efforts to promote HPV vaccination and cervical cancer screening are important to reducing the cancer burden among Black populations. The purpose of this qualitative descriptive study guided by social ecological model (SEM) was to describe from the perspective of key informants, the challenges and opportunities for HPV vaccination and cervical cancer screening promotion among Black adults. DESIGN: Twenty-three key informants participated in individual interviews over zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy prior to data analysis. Two qualitatively trained researchers analyzed the data using content analysis. RESULTS: Participants were aged 50 ± 4.1 years, 12 were females, and 18 identified as Black. Participants included health care providers, teachers, church and community leaders. Themes included HPV and cancer literacy, influence of religion, health care provider recommendations, social and cultural influences, accessibility and availability of services, economic constraints, limited community resources, and HPV vaccine mandates. CONCLUSIONS: SEM factors contribute to low HPV vaccine uptake and cervical cancer screening and these factors need to be addressed. Interventions addressing SEM factors peculiar to Black populations may promote HPV vaccination and cancer screening in this population.

Differences in Self and Proxy Assessments of Self-Determination in Young People with Intellectual Disability: The Role of Personal and Contextual Variables.

BACKGROUND: Assessing self-determination in students with intellectual disabilities (IDs) is a primary step in facilitating progress monitoring. Researchers have developed both self and proxy assessments to favor a more in-depth evaluation of self-determination expression. However, to date, limited research has explored the congruence between both assessments. METHODS: To address this need, the present study analyzes the differences between 219 adolescents with ID; 63% being males with an age range from 13 to 21 years (M = 16.8; SD = 1.72); and their teachers in their assessment of self-determination and explores which factors (students' age, sex, level of ID and opportunities at school) might explain those differences. The participants were recruited intentionally. Students with IDs completed two questionnaires: the AIR Self-Determination Scale and the Spanish version of the Self-Determination Inventory, which was also completed by their teachers. RESULTS: Significant differences were found in the self-determination assessment, with teachers rating it lower. Further, students' sex and the opportunities they were provided at school to engage in self-determined actions were found to explain the differences in self-determination assessment. CONCLUSIONS: Research and practice initiatives to assess self-determination in young people with IDs must consider that informants' points of view might be influenced by students' sex and by contextual opportunities to engage in self-determined actions. Implications for further research and practice are discussed.

The impact of correlated exposures and missing data on multiple informant models used to identify critical exposure windows.

There has been heightened interest in identifying critical windows of exposure for adverse health outcomes; that is, time points during which exposures have the greatest impact on a person's health. Multiple informant models implemented using generalized estimating equations (MIM GEEs) have been applied to address this research question because they enable statistical comparisons of differences in associations across exposure windows. As interest rises in using MIMs, the feasibility and appropriateness of their application under settings of correlated exposures and partially missing exposure measurements requires further examination. We evaluated the impact of correlation between exposure measurements and missing exposure data on the power and differences in association estimated by the MIM GEE and an inverse probability weighted extension to account for informatively missing exposures. We assessed these operating characteristics under a variety of correlation structures, sample sizes, and missing data mechanisms considering various exposure-outcome scenarios. We showed that applying MIM GEEs maintains higher power when there is a single critical window of exposure and exposure measures are not highly correlated, but may result in low power and bias under other settings. We applied these methods to a study of pregnant women living with HIV to explore differences in association between trimester-specific viral load and infant neurodevelopment.

Responding to everyday problems and crises: Measuring community resilience.

Resilience is of the upmost importance to deal with everyday problems faced by communities. The concept of community resilience is gaining prominence in disaster management policy and practice, and it has been shown to be an important factor during pandemic recovery such as during the SARS-CoV-2 outbreak. We present an instrument for community resilience assessment adapted for disasters like the pandemics. The instrument was based on the theory-based and evidence-informed Communities Advancing Resilience Toolkit (CART) Assessment Survey, adapted for the first time to Portuguese. Another strong feature of this study relates to the targeted participants, namely human service workers (598). They are key informants for their close involvement with communities. This version of the CART was reliable. A confirmatory factor analysis indicated a good relationship between the observed variables and their underlying latent constructs. Moreover, tests for measurement invariance across participants showed that differences in factor variances and covariances were not attributable to age-based differences in the properties of the scales themselves. Our findings support the fundamental idea that it is worthwhile to have an instrument to measure community resilience. Thus, our study adds to the evaluation of the CART, supporting its value as a robust instrument to measure resilience at the community level in different countries.

Parent, Teacher and Observational Reports of Emotional and Behavioral Problems in Young Autistic Children.

Emotional and behavioral problems (EBPs) frequently occur in young autistic children. Discrepancies between parents and other informants are common but can lead to uncertainty in formulation, diagnosis and care planning. This study aimed to explore child and informant characteristics are associated with reported child EBPs across settings. Participants were 83 4-8-year-old autistic children and their parents and teachers in the Autism Spectrum Treatment and Resilience (ASTAR) study. Questionnaires of child EBPs were completed by parents and teachers, and self-reported parenting stress and wellbeing measures were obtained. An observation of parent-child/researcher-child interaction was also completed. Parents reported more EBPs than teachers and parent-teacher agreement was low, particularly for emotional problems. Greater parenting stress and being verbal was associated with more parent- but not teacher-reported EBPs. More observed behaviors that challenge were displayed by minimally verbal children. More parenting stress could be associated with the presence of more EBPs in the home; alternatively, parenting stress may confound reports. It is essential for assessments of EBPs in autistic children to take a multi-informant approach. Better understanding of the associations between informant characteristics and informant discrepancies of EBPs is needed.

A Comparison of Parent, Teacher, and Youth Ratings on the Inventory of Callous-Unemotional Traits.

The current study compared the validity of self-, parent-, and teacher-report versions of the Inventory of Callous-Unemotional Traits (ICU), a widely used measure of callous-unemotional (CU) traits, at several different ages. Participants (N = 236, 60.6% girls) were children in Grades 3, 6, and 8 (Mage = 11.55, SD = 2.23) from a public school system in the southern United States. We tested the association of all three ICU versions with several validators: parent- and teacher-reported conduct problems, peer nominations of characteristics associated with CU traits, and sociometric peer nominations of social preference. Results revealed an interaction between the ICU version and grade in the overall level of CU traits reported, with teacher-report leading to the highest ratings in sixth grade and being higher than parent-report in third grade. Furthermore, the validity of the different versions of the ICU varied somewhat across grades. Specifically, findings support the validity of both teacher- and self-report in third grade, but self-report was the only version to show strong validity in the eighth grade.

Key informant perspectives on 3 am last drinks legislation in Queensland, Australia.

INTRODUCTION: The objective of this study was to explore key informant attitudes towards the 'Last Drinks at 3am' legislation in Safe Night Precincts in Queensland, Australia. METHOD: Sixty-six interviews were conducted with a range of stakeholders including licensees, law enforcement and frontline health professionals. Interviews were semi-structured and analysed using thematic analysis. Key informants responded to questions regarding their experiences of, and opinions about, the last drinks legislation. RESULTS: Key informants reported a range of experiences around the impact of last drinks restrictions, including reduced staffing costs and patron-related problems within licensed venues. While some venues reported that their businesses lost money, others reported no change in income or that they changed their business model to compensate. Law enforcement and health professionals reported a range of benefits including reduced alcohol-related anti-social behaviour, drunkenness and injury. CONCLUSIONS: The majority of key informants reported that the last drinks legislation reduced harm, while having minimal detrimental impact on business.