Educational readiness among health professionals in rheumatology: low awareness of EULAR offerings and unfamiliarity with the course content as major barriers-results of a EULAR-funded European survey.

BACKGROUND: Ongoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings. METHODS AND PARTICIPANTS: We developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline. RESULTS: The questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were 'professional development', 'prevention and lifestyle intervention'. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers. CONCLUSIONS: To promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.

Occupational Balance and Depressive Symptoms During the COVID-19 Pandemic: A Four-Wave Panel Study on the Role of Daily Activities in Austria.

OBJECTIVE: The aim of this study was to investigate the relationship among daily activities (paid work, childcare, caregiving, voluntary work, sports, and social contact), occupational balance, and depressive symptoms during the COVID-19 pandemic. METHODS: We analyzed data from the Austrian Corona Panel Project (four time points, 6-month period) using regression models with logarithmically transformed data and nonparametric repeated-measures tests (N = 871). RESULTS: Results showed higher depressive symptoms among women. Family caregivers (either parents or those caring for other relatives) were at the highest risk for occupational imbalance and depressive symptoms. Sports and social contact were initially associated with better outcomes, but the effects waned. There was a main effect for time point driven by the last wave (amidst the second lockdown), but no significant interaction effects between predictors and time point were found. CONCLUSION: The results provide a nuanced depiction of the relationship between different daily activities and health-related outcomes during the pandemic, highlighting groups at risk.

Patient Representatives' Perspectives on Healthcare at the Time of COVID-19 and Suggestions for Care Redesign After the Pandemic: A Qualitative Study in Twenty-Four Countries.

OBJECTIVE: Several comments and recommendations called to embed better the patients' and public voice in healthcare policymaking. Still, no studies captured patients' bottom-up perspectives regarding healthcare at the time of COVID-19 at a micro-level in a range of different countries. We, therefore, explored the perspectives of patient representatives in all six World Health Organisation (WHO) regions and extracted suggestions for care redesign after the pandemic. METHODS: We conducted semi-structured interviews with patient representatives until saturation. Thematic analysis followed a modified form of meaning condensation. We established rigour by transcript checking, inter-coder agreement, quote variation and standardised reporting. RESULTS: Disadvantaged people experienced an unprecedented inequity in healthcare from limited access to physical violence. The narratives revealed the extent of this inequity, but also opportunities for health workers to act and improve. Stigmatisation from COVID-19 differed between cultures and countries and ranged from none to feeling "ashamed" and "totally bashed". While experienced as indispensable in the future, patients refused telehealth when they were given "bad news", such as having an eye removed because of melanoma, and in end-of-life care. Patient representatives redefined their role and became indispensable influencers throughout the pandemic and beyond. CONCLUSION: We reached out to patient representatives with diverse perspectives, including those who represent minorities and marginalised patient populations. Since preferences and personal meanings drive behaviour and could be foundations for targeted interventions, they must be considered in all groups of people to increase society's resilience as a whole. Future healthcare should tackle inequity, address stigmatisation and consider patients' narratives to optimize telemedicine.

A European arena for joint innovation in healthcare: The Platform for Innovation of Procurement and Procurement of Innovation (PiPPi).

By 2000 the European Union (EU) had recognized that its innovation capacity was underperforming in comparison to similar competitors and trading partners. Although the EU has made an effort to stimulate public research and development (R&D) through policy tools like Pre-Commercial Procurement (PCP) and Public Procurement of Innovation (PPI), starting with the 2000 Lisbon strategy and continuing through the 2021 updated Guidance on Innovation Procurement, there has remained a gap in knowledge of and use of these tools, in particular within healthcare. The past decades have seen an explosion in the number and use of digital technologies across the entire spectrum of healthcare. Demand-driven R&D has lagged here, while new digital health R&D has largely been driven by the supply side in a linear fashion, which can have disappointing results. PCP and PPI could have big impacts on the development and uptake of innovative health technology. The Platform for Innovation of Procurement and Procurement of Innovation (PiPPi) project was a Horizon 2020-funded project that ran from December 2018 to May 2022 with a consortium including seven of Europe's premier research hospitals and the Catalan Agency for Health Information. To promote PCP and PPI, PiPPi established a virtual Community of Practice (CoP) that brings together all stakeholder groups to share and innovate around unmet healthcare needs. This perspective presents a brief history of PCP and PPI in Europe with a focus on digital innovation in healthcare before introducing the PiPPi project and its value proposition.

The lockdown and its consequences-Perspectives and needs of people at increased risk of severe illness from COVID-19 : Results from a qualitative longitudinal study.

BACKGROUND: There is a lack of knowledge on how people at increased risk of severe illness from Coronavirus disease 2019 (COVID-19) experienced the infection control measures. This study aimed to explore their perspectives and needs during the coronavirus outbreak. METHODS: A qualitative longitudinal interview study was conducted in Austria during lockdown due to COVID-19 containment and afterwards. People older than 65 years of age and/or affected by a chronic medical condition participated in individual telephone interviews at two time points. Thematic analysis was used to analyze the data and saturation was defined as no new emerging concepts in at least 10 subsequent interviews. RESULTS: Thematic saturation was reached when 33 individuals (75.8% female, mean age ± standard deviation [SD] 73.7±10.9 years) were included. A total of 44 lower level concepts were extracted and summarized into 6 higher level concepts. They included (i) a general positive attitude toward COVID-19 measures, (ii) challenges of being isolated from the community, (iii) deterioration of health status, (iv) difficulties with measures due to their health condition, (v) lack of physical contact and (vi) lack of information versus overload. Participants suggested environmental adaptations for strengthening resilience in people at increased risk of severe illness from COVID-19. CONCLUSION: Strategies and interventions are needed to support people at risk under pandemic conditions. Their perceptions and needs should be addressed to reduce the potential deterioration of health conditions and ensure well-being even during prolonged periods of crisis.

Rasch Model of the COVID-19 Symptom Checklist-A Psychometric Validation Study.

While self-reported Coronavirus Disease 2019 (COVID-19) symptom checklists have been extensively used during the pandemic, they have not been sufficiently validated from a psychometric perspective. We, therefore, used advanced psychometric modelling to explore the construct validity and internal consistency of an online self-reported COVID-19 symptom checklist and suggested adaptations where necessary. Fit to the Rasch model was examined in a sample of 1638 Austrian citizens who completed the checklist on up to 20 days during a lockdown. The items' fatigue', 'headache' and 'sneezing' had the highest likelihood to be affirmed. The longitudinal application of the symptom checklist increased the fit to the Rasch model. The item 'cough' showed a significant misfit to the fundamental measurement model and an additional dependency to 'dry cough/no sputum production'. Several personal factors, such as gender, age group, educational status, COVID-19 test status, comorbidities, immunosuppressive medication, pregnancy and pollen allergy led to systematic differences in the patterns of how symptoms were affirmed. Raw scores' adjustments ranged from ±0.01 to ±0.25 on the metric scales (0 to 10). Except for some basic adaptations that increases the scale's construct validity and internal consistency, the present analysis supports the combination of items. More accurate item wordings co-created with laypersons would lead to a common understanding of what is meant by a specific symptom. Adjustments for personal factors and comorbidities would allow for better clinical interpretations of self-reported symptom data.

The methodological quality is insufficient in clinical practice guidelines in the context of COVID-19: systematic review.

OBJECTIVES: The number of published clinical practice guidelines related to COVID-19 has rapidly increased. This study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. STUDY DESIGN AND SETTING: Rapid systematic review from February 1 until April 27, 2020 using MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search, including all types of healthcare workers providing any kind of healthcare to any patient population in any setting. RESULTS: There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). The majority (156; 83%) was solely built on an informal expert consensus. A process for regular updates was described in 27 guidelines (14%). Patients were included in the development of only one guideline. CONCLUSION: Despite clear scope, most publications fell short of basic methodological standards of guideline development. Clinicians should use guidelines that include up-to-date information, were informed by stakeholder involvement, and employed rigorous methodologies.

Utilization of occupational therapy services and relation to survival in people taking dementia-specific medication in Austria-A retrospective population-based study with a 13-year observation period.

OBJECTIVES: Evidence-based treatment of dementia includes pharmacological and non-pharmacological methods of which psycho-social interventions are an important component, commonly administered by occupational therapists. The aim of this study was to investigate the utilization of occupational therapy (OT) services and its association with survival in people taking dementia-specific medication in a population-based Austrian dataset compared to a two times as large control group without dementia-specific medication. METHODS/DESIGN: A retrospective study with a 13-year observation period (2003-2016) was conducted on real-world data. Two stratifications were done and we used descriptive statistics, Chi-squared/Fisher's Exact Tests and survival analyses including three Cox models. RESULTS: Data from 286,553 participants were analysed. Only 4.5% (n = 12,950) received OT services. In the dementia-medication group (n = 111,033), participants who received OT services (3.6%; n = 4032) had significantly more comorbidities (4.7%) compared to those without OT (3.5%; p < 0.001) and were also more likely to be male (4 vs. 3.5%; p < 0.001). While persons taking dementia-specific medication showed a slightly reduced survival with OT (p < 0.001) compared to those without, the result in the control group without dementia-specific medication showed a slightly better result of the participants who received OT (p < 0.001). The reduced survival in the dementia-medication group with OT is likely to be related to the higher number of comorbidities in this group. CONCLUSION: People receiving dementia-specific medication were more likely to receive OT if they had additional comorbidities, however our analysis showed that utilization of OT services in Austria was very low indicating an overall insufficient accessibility of OT services for patients who needed it.

An Ethnohistory of the Transcultural Nursing Scholars and Their Contributions to the Field.

Introduction: The Transcultural Nursing Society (TCNS) recognizes transcultural nursing (TCN) scholars for creative leadership and advancing education, practice, research, and administration. The purpose of this study was to discover the historical context of scholars' professional growth and development and their contributions to and future vision for transcultural nursing. Method: Leininger's Ethnonursing Research Method was used to develop an ethnohistorical qualitative approach that included a semistructured, open-ended interview guide and data analysis plan. Data were analyzed using NVivo software and Leininger's Phases of Ethnonursing Data Analysis Enabler for Qualitative Data. Results: Analysis resulted in the discovery of five themes and 15 patterns related to the sources of scholars' interest in TCN; professional development strategies; contributions to TCN theory development, education, research, practice, service, and consultation; the responsibilities of being a TCN scholar; and their future vision for TCN. Discussion: These findings could inspire and guide TCN scholars as they pursue the study and practice of TCN.

The Andrews/Boyle Transcultural Interprofessional Practice (TIP) Model.

The goals of the Andrews/Boyle Transcultural Interprofessional Practice (TIP) model are to provide a patient- or client-centered systematic, logical, orderly, scientific process for delivering safe, culturally congruent and competent, affordable, accessible, evidence-based, and quality care for people from diverse backgrounds across the life span. Key components of the TIP model include the context from which people's health-related values, attitudes, beliefs, and practices emerge; the interprofessional health care team; effective verbal and nonverbal communication among all team members; and a five-step systematic, scientific problem-solving process-assessment, mutual goal setting, and planning, implementing, and evaluating the effectiveness of therapeutic interventions and care. The model is applicable wherever nurses practice, teach, learn, lead, consult, and conduct research domestically and globally.

Academic Partnerships: Preparing Nurse Practitioners for Underserved Populations.

Medically underserved populations suffer disproportionately from disease and poor health, and nursing schools are challenged to prepare nurse practitioner students to effectively care for underserved patients. This article describes one university's endeavor to create and evaluate academic partnerships with HIV/hepatitis C virus primary care clinics in underserved settings. Designated preceptorships and specific preparation of students tailored for this population via online modules were strategies created to increase students' readiness to practice as primary care providers and increase clinical placements for nurse practitioner students. Outcomes include student readiness to practice and student satisfaction with clinics and preceptors.

An Intervention to Improve Cultural Competence in Graduate Nursing Education.

Noting the small number of studies on the influence of an entire curriculum on graduate nursing students' cultural competence, the researchers examined the effect of a curricular intervention using a pretest-posttest design. The study, conducted from 2012 to 2014, focused solely on the Doctor of Nursing Practice program at a midwestern university. Results from a pre- and postintervention faculty curriculum survey indicated that the percentage of courses including a cultural competence objective increased from 65 percent to 81 percent. Results from the pre- and postintervention administration of the Transcultural Self-Efficacy Tool showed a statistically significant improvement in students' overall score and three subscale scores.

SNAP Participants' Eating Patterns over the Benefit Month: A Time Use Perspective.

Individuals receiving monthly benefits through the U.S. Supplemental Nutrition Assistance Program (SNAP) often fall short of food at the end of the month and some report feelings of hunger. To investigate this situation, we used time diaries from the 2006-08 American Time Use Survey and Eating & Health Module to identify the timing of days where respondents reported no eating occurrences. Analysis includes descriptive statistics, a logit model, and a simulated benefit month. We found that SNAP participants were increasingly more likely than nonparticipants to report a day with no eating occurrences over the benefit issuance cycle. This supports the view that there is a monthly cycle in food consumption associated with the SNAP monthly benefit issuance policy.

Baccalaureate Nursing Students' Attitudes of Prejudice: A Qualitative Inquiry.

BACKGROUND: Attitudes of prejudice in nursing students have the potential to impact patient care and ultimately may contribute to culturally based health disparities. The purpose of this study was to describe attitudes of prejudice reported by baccalaureate nursing students. METHOD: Baccalaureate nursing students were recruited through Web networking and e-mailing. Participants responded to a Web-based survey that contained an open-ended item requesting them to describe a time when they held an attitude of prejudice. Qualitative data were coded and analyzed for themes. RESULTS: The majority of participants (N = 50) were women (86%) and White (68%). Qualitative data analysis revealed two major themes: Prejudice Against Obese Individuals, and Prejudice Against Someone of Another Race. Many of the participants had insight that prejudice was wrong and they wanted to change. CONCLUSION: Acknowledging prejudice, as an explicit bias, is an important step toward cultural competence. Teaching strategies focused on addressing explicit and implicit bias are warranted. [J Nurs Educ. 2016;55(6):345-348.].

Attitudes of prejudice as a predictor of cultural competence among baccalaureate nursing students.

The purpose of this study was to explore the relationship between attitudes of prejudice and cultural competence among nursing students. Using a mixed-methods design, a convenience sample of students (N = 129) currently enrolled in a baccalaureate nursing program was recruited via Web networking. Data regarding attitudes of prejudice, cultural competence, prior cultural experience, and integration of cultural competence were obtained via a Web-based survey. Multiple linear regression was used to predict cultural knowledge, attitudes, and consciousness. Although all three regression models were statistically significant, the significant predictors varied within each model. Greater prejudice was a significant predictor of less culturally competent attitudes toward providing nursing care. Existing prejudice among nursing students needs to be addressed to help promote positive cultural attitudes and, ultimately, cultural competent nursing care.

Higher food prices may threaten food security status among American low-income households with children.

Children in food-insecure households are more likely to experience poorer health function and worse academic achievement. To investigate the relation between economic environmental factors and food insecurity among children, we examined the relation between general and specific food prices (fast food, fruits and vegetables, beverages) and risk of low (LFS) and very low food security (VLFS) status among low-income American households with children. Using information for 27,900 child-year observations from the Early Childhood Longitudinal Study-Kindergarten Class of 1998-1999 linked with food prices obtained from the Cost of Living Data of the Council for Community and Economic Research, formerly known as the American Chamber of Commerce Researchers' Association, fixed effects models were estimated within stratified income groups. Higher overall food prices were associated with increased risk of LFS and VLFS (coefficient = 0.617; P < 0.05). Higher fast food and fruit and vegetable prices also contributed to higher risk of food insecurity (coefficient = 0.632, P < 0.01 for fast food; coefficient = 0.879, P < 0.01 for fruits and vegetables). However, increasing beverage prices, including the prices of soft drinks, orange juice, and coffee, had a protective effect on food security status, even when controlling for general food prices. Thus, although food price changes were strongly related to food security status among low-income American households with children, the effects were not uniform across types of food. These relations should be accounted for when implementing policies that change specific food prices.

Exploring faculty health and wellbeing: creating a caring scholarly community.

BACKGROUND: Nursing educators worldwide are challenged to integrate the care of culturally diverse people into coursework to prepare a nursing workforce to deliver culturally congruent care (CCC). Care that recipients consider safe, satisfying, and beneficial is the essence of CCC. To effectively teach and role model such care for students, it is important for faculty to experience it at work. While substantive literature exists on promoting health, wellbeing, and a healthy work environment for nurses in practice, there is a limited focus on these topics for nursing faculty. PURPOSE: The purpose of this study was to discover care practices that helped faculty teach students to provide CCC. This article reports' findings related to the theme that care is essential for the health and wellbeing of general nursing faculty who prepare students to provide CCC. THEORETICAL FRAMEWORK AND METHOD: This qualitative ethnonursing research study, guided by the culture care theory, used open-ended interviews to discover care practices that enhanced faculty's ability to teach students to provide CCC. The study was conducted in two public university baccalaureate nursing programs in urban and rural settings in the Southeastern United States. Purposive sampling was used to recruit 27 tenured, tenured-track, and clinical nursing faculty. Interview data were analyzed using Leininger's four phases of ethnonursing data analysis. Qualitative criteria were used to ensure rigor and included participant confirmation of patterns and themes. FINDINGS AND DISCUSSION: Faculty health and wellbeing were described as embracing each other's cultural similarities and differences, caring for self, caring for others, offering respect, and engaging in mentoring/co-mentoring. Evidence-based recommendations to promote faculty health and wellbeing are presented. Creating a caring scholarly community that supports nursing faculty health and wellbeing provided essential support for faculty who prepared students, often through role modeling, to provide CCC.

Knowledge and injury prevention practices in homes of older adults.

This study aimed to describe the prevalence of preventive safety measures in homes with older, urban-dwelling adults; determine the relationship between sociodemographic variables and injury prevention measures; and describe older adults' knowledge of safety topics. Teams conducted interviews and home observations in 603 homes to confirm preventive safety measures. Households with older adults were rarely observed to have recommended smoke alarm (34%) or carbon monoxide coverage (22%). Water temperature was safe in 64% of homes. Among households headed by someone other than the older adult, odds of having a working smoke alarm on every floor were much lower than in older adult-headed households (95% confidence interval: 0.04-0.35). Few older adults interviewed about safety knowledge correctly answered several items related to fire and carbon monoxide. Effort is needed to improve knowledge and promote the lifesaving benefits of injury countermeasures so that older adults can be adequately protected.