Provision of gender affirming care among medical and allied health practitioners: The influence of transnormative beliefs in working with gender diverse patients.

Gender diverse patients (including gender diverse, transgender, and non-binary people) deserve quality health care, which has been referred to as gender affirming care. Given that practitioners' attitudes and competence can influence their provision of gender affirming care, this study used a lens of transnormativity (Bradford & Syed, 2019; Johnson, 2016) to develop a measure of practitioners' transnormative beliefs. The aim of the study was to determine if these beliefs were related to practitioners' gender affirming attitudes and perceptions of competence in gender affirming practice. Survey data were collected from Australian medical and allied health practitioners (N = 95). Exploratory factor analysis was applied to items measuring transnormative beliefs, with the results supporting three higher order factors; conditional approval, narrative, and gender role beliefs. Conditional approval reflected belief in gender diverse identity as authentic and worthy of intervention. Narrative beliefs reflected understanding of common developmental experiences among gender diverse populations, specifically experiences of victimisation and nascence. Gender role beliefs reflected belief in the existence of gender roles. In models that regressed gender affirming attitudes and self-perceived competency on all transnormative beliefs, controlling for demographics and work history, practitioners higher in conditional approval were lower in gender affirming attitudes and practitioners higher in narrative beliefs were higher in gender affirming attitudes and competency. Conditional approval was not significantly associated with competency, and gender role beliefs were not significantly associated with attitudes or competency. Results indicate that practitioners' transnormative beliefs are related to their gender affirming attitudes and suggest that targeting these beliefs through training opportunities could bridge the gap between gender diverse people's healthcare needs and the ability of healthcare practitioners to provide high quality care.

Daily use of digital technologies to feel better: Adolescents' digital emotion regulation, emotions, loneliness, and recovery, considering prior emotional problems.

INTRODUCTION: Adolescents report using digital technologies for emotion regulation (digital ER), with the aim of feeling better (i.e., improving emotions and reducing loneliness). In this 7-day diary study, we investigated associations of digital ER, emotions, and loneliness, and tested whether prior emotional problems moderated these associations. METHOD: Participants were 312 Australian adolescents (Mage = 13.91, SD = 1.52; 44% boys). Daily surveys measured digital ER; end-of-day happiness, sadness, worry, anger, and loneliness; and peak sadness, worry, and anger. End-of day emotions were subtracted from peak emotions to calculate emotion recovery for sadness, worry, and anger. Participants were randomly selected from two symptom strata (high/low) defined by depression and social anxiety measures collected before the diary. Data were analyzed using multilevel path modeling. Cross-level interactions tested whether symptom strata moderated associations. RESULTS: Digital ER was associated with more recovery from peak to end-of-day sadness and worry, but also with increased sadness, worry, anger, and loneliness by the next end-of-day. Higher end-of-day loneliness was associated with increased next-day digital ER. Prior emotional symptoms were not a significant moderator of daily digital ER and emotion associations. CONCLUSION: Adolescents who report more digital ER in a day show more recovery from the peak of negative emotion that day, but this recovery dissipates, with digital ER also associated with increased negative emotion and loneliness by the next day for all adolescents, regardless of prior symptom status. Lonelier adolescents use more digital ER by the next day, suggesting they need support to make social connections-online or offline.

Parental Support and Adolescents' Coping with Academic Stressors: A Longitudinal Study of Parents' Influence Beyond Academic Pressure and Achievement.

Adolescents face many academic pressures that require good coping skills, but coping skills can also depend on social resources, such as parental support and fewer negative interactions. The aim of this study was to determine if parental support and parental negative interactions concurrently and longitudinally relate to adolescents' ways of academic coping, above and beyond the impact of three types of academic stress, students' achievement at school (i.e., grades in school), and age. Survey data were collected from 839 Australian students in grades 5 to 10 (Mage = 12.2, SD = 1.72; 50% girls). Students completed measures of support and negative interactions with parents; academic stress from workload, external pressure (teachers/parents) to achieve, and intrapsychic pressure for high achievement; and ways of academic coping that were grouped into two positive and two negative types. Hypothesized associations were tested concurrently and from one year to the next using path modeling. Beyond the numerous significant influences of academic stress and achievement on coping, and control for age and COVID-19 timing, adolescents with more parental support reported more use of engagement coping (e.g., strategizing) and comfort-seeking, whereas those who reported more negative interactions with parents reported more use of disengagement coping (e.g., concealment) and escape. In the longitudinal model, parental support predicted an increase in engagement and comfort-seeking and a decrease in disengagement coping, whereas negative interaction with parents predicted an increase in disengagement coping. Overall, the findings support the view that coping with academic stressors will continue to depend on parent-adolescent relationships even into the teen years.

What Predicts Online Disinhibition? Examining Perceptions of Protection and Control Online and the Moderating Role of Social Anxiety.

With the pervasive nature of social media and Internet use among young adults, researchers have begun to explore experiences of online disinhibition, defined as reductions in restraint in online versus face-to-face settings. In contributing to this literature, this study aimed to test whether perceptions of the Internet as a place where one has the ability to be invisible, anonymous, and exercise control over interactions promotes greater online disinhibition. A sample of Australian young adults (N = 687; 59.8 percent female; Mage = 19.45 years, SD = 2.07) were included in the study. The sample was split to enable exploratory and confirmatory factor analyses on the measures of Internet perceptions, with results finding two subfactors; (a) perceptions of the ability to be protected, invisible, or feel safe online (labeled protection), and (b) perceptions of control over interactions and self-presentation online (labeled control). Links between perceptions of protection and control, and online disinhibition were then examined, before testing social anxiety as a moderator of these links. Results demonstrated that perceptions of protection, but not control, significantly predicted online disinhibition in young adults. Furthermore, this relationship was moderated by social anxiety such that young adults high in both social anxiety and perceptions of protection reported the highest online disinhibition. This study highlights novel perceptions of online contexts, illustrates their links with online disinhibition, and demonstrates how social anxiety may interact with perceptions of protection in predicting online experiences.

Online Social Connection as a Buffer of Health Anxiety and Isolation During COVID-19.

Abstract COVID-19 has given rise to a myriad of social, psychological, and health-related complications. The specific mental health implications of COVID-19 are still being uncovered, but we know that there are likely to be negative outcomes for many people. This is particularly the case for vulnerable members of the community, such as those with high health anxiety, and under conditions where individuals feel isolated or disconnected from others. The objective of this study was to examine whether the level of socially motivated Internet use acts as a buffer of the relationship between health anxiety, isolation behaviors, and depression. Participants (N = 473; 67.3 percent female; Mage = 23.03, SD = 7.50) from Australia completed self-report measures during the height of the national pandemic restrictions (April-May 2020). A regression analysis revealed positive relationships between health anxiety and isolation behaviors on depression and highlighted a three-way interaction effect. Specifically, health anxiety was significantly negatively associated with depression when participants engaged in fewer isolation behaviors. However, at higher levels of isolation behaviors, the relationship between health anxiety and depression was attenuated for participants with greater levels of online social connection. The findings suggest that online social connection buffered the negative effects of health anxiety under conditions of isolation. These results offer promising avenues to mitigate against vulnerabilities during the pandemic and highlight the need to promote alternate social support mechanisms in the absence of face-to-face connection.

Alberta Stroke Program Early CT Score (ASPECTS) in real time: A prospective study of its interobserver variation among radiologists in a training hospital from a low-resource setting

Background and Objectives: The Alberta Stroke Program Early CT Score (ASPECTS) is a standardized system used to quantify the extent of ischemic involvement in cases of acute middle cerebral artery (MCA) infarct. It aids in clinical decision-making to identify patients who are more likely to benefit from thrombolytic therapy. This study aimed to determine the interobserver variation of ASPECTS among training and expert radiologists in a real-time, low-resource setting.Patients and Methods: A prospective study was conducted on non-enhanced CT (NECT) images of 79 patients with acute stroke. Patients with hemorrhagic stroke, or ischemic stroke from territories other than the MCA, were excluded. The ASPECTS of each case was assessed by three groups of radiologists--residents, fellows, and an expert. The level of agreement among them was then analyzed.Results: ASPECT scores were dichotomized into >7 and ?7. With the expert's reading as gold standard, residents had sensitivity of 0.94 [95% CI: 0.85, 0.99] and specificity of 0.68 [95% CI: 0.46, 0.85], while fellows had sensitivity of 0.96 [95% CI: 0.87, 1.00] and specificity of 0.76 [95% CI: 0.55, 0.91]. There was substantial agreement between residents and expert in overall ASPECTS rating (? = 0.66 [95% CI: 0.48, 0.85]; AC1 = 0.77 [95% CI: 0.62, 0.91]), and substantial to almost perfect agreement between fellows and expert (? = 0.76 [95% CI: 0.59, 0.92]; AC1 = 0.83 [95% CI: 0.71, 0.95]). Differences between the ASPECTS of the expert and trainees were within 2 points in most cases.Conclusion: ASPECTS is a reliable tool for both training and expert radiologists to quantify the extent of MCA infarcts. Assessment by trainees is comparable with that of the expert reader and is useful for immediate clinical decision making in low-resource settings.

Diagnosis of hydronephrosis or ureteral obstruction using renal sonography among patients with cervical cancer

@#<p style="text-align: justify;"><strong>Background:</strong> Cervical cancer is the second most common malignancy among Filipino women. The recent 2018 FIGO guidelines recommend imaging in cases of grossly invasive disease to determine the presence of hydronephrosis, which would immediately classify the disease as at least stage IIIB. CT and MRI are state-of-the-art modalities that can provide such information; however, these are costly and may not be accessible in areas with limited resources. Sonography is a safe and inexpensive alternative in this regard.</p><p style="text-align: justify;"><strong>Objective:</strong> This study aimed to evaluate the diagnostic performance of renal sonography in identifying the presence of ureteral obstruction or hydronephrosis among patients with grossly invasive cervical cancer, with non-enhanced CT as the reference standard.</p><p style="text-align: justify;"><strong>Methods:</strong> A blinded, prospective study was conducted among patients diagnosed with grossly invasive cervical cancer from the Philippine General Hospital. Participants underwent same-day evaluation with both renal sonography and non-enhanced CT. The presence of either ureteral obstruction or hydronephrosis secondary to cervical cancer was independently determined. The sensitivity, specificity, positive predictive value, and negative predictive value of renal sonography were calculated, with non-enhanced CT as the reference standard.</p><p style="text-align: justify;"><strong>Results:</strong> A total of 127 participants were enrolled. The mean age was 46 years, with a range of 24 to 65 years. The majority had stage IIB (41.7%) and stage IIIB (52.0%) disease. On non-enhanced CT, 46 (36.2%) showed evidence of ureteral obstruction or hydronephrosis, while 81 (63.8%) had negative results. On renal sonography, 46 (36.2%) had positive results, and 81 (63.8%) had negative findings. The sensitivity, specificity, and positive and negative predictive values of sonography were 91.3%, 95.1%, 91.3%, and 95.1%, respectively. Among patients with stage IIIB disease, sonography was shown to have higher sensitivity and specificity of 92.1% and 96.4%, respectively. Meanwhile, among patients with stage IB to IIB disease, its sensitivity and specificity were 87.5% and 94.3%, respectively.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Renal sonography has high sensitivity and specificity in the diagnosis of ureteral obstruction or hydronephrosis in patients with grossly invasive cervical cancer. Its sensitivity is higher when used in patients with stage IIIB disease, compared with those having lower-stage tumors.</p>

Alberta Stroke Program Early CT Score (ASPECTS) in real time: A prospective study of its interobserver variation among radiologists in a training hospital from a low-resource setting

Background and Objectives@#The Alberta Stroke Program Early CT Score (ASPECTS) is a standardized system used to quantify the extent of ischemic involvement in cases of acute middle cerebral artery (MCA) infarct. It aids in clinical decision-making to identify patients who are more likely to benefit from thrombolytic therapy. This study aimed to determine the interobserver variation of ASPECTS among training and expert radiologists in a real-time, low-resource setting.

A cross-sectional triangulation analysis of the knowledge, attitudes and practices of patients from the endocrinology clinic of the Philippine General Hospital on the use of herbal dietary supplements

OBJECTIVE: This study aimed to determine the knowledge, attitudes and practices (KAP) of a selected population of patients on herbal dietary supplements (HDS).METHOD: Methodological triangulation was used to generate a conceptual framework on HDS KAP. A survey of 175 patients was performed to measure knowledge and attitudes regarding HDS and SPSS was used for data analysis. Inverviews and focus group discussions (FGDs) were conducted to further explore the attitudes and practices, and constant comparison method was used for analysis of responses.RESULTS: Respondents were generally aware of HDS. Majority of survey respondents believed that HDS are different from conventional drugs (52.0%, pThe attitude toward HDS was generally positive. Majority (64.0%, pAmong the survey respondents, only 22% were HDS users. Family was shown to promote use while cost deterred their use.CONCLUSION: Individual knowledge and attitudes on HDS exert significant influence toward HDS practices. Factors that promote use are poor knowledge and positive attitudes toward HDS. Good knowledge seems to lead to judicious use or non-use.