An Evidence-Based Guide for Delivering Mental Healthcare Services in Farming Communities: A Qualitative Study of Providers' Perspectives.

Individuals living in rural areas often face challenges in accessing healthcare, increasing their risk of poor health outcomes. Farmers, a sub-population in rural areas, are particularly vulnerable to mental health issues and suicide, yet they exhibit low rates of help-seeking behavior. The aim of our study was to develop an in-depth understanding of the issues influencing mental help-seeking among farmers living in rural areas from the perspectives of healthcare providers, as well as to explore the strategies providers use to navigate through these issues to effectively engage with this vulnerable population. METHODS: We used a descriptive phenomenological approach to understand healthcare providers' perspectives, experiences, and approaches to providing mental healthcare to farmer clients in rural areas. Semi-structured interviews were conducted with 21 participants practicing in Canada between March and May 2023. RESULTS: Our analysis yielded five thematic areas: (1) ensuring accessibility, (2) establishing relatability, (3) addressing stoicism and stigma, (4) navigating dual roles, and (5) understanding community trauma. CONCLUSIONS: Healthcare service delivery for farmers is multifaceted. This study fills a gap in knowledge by translating these data to inform an evidence-based model and a list of recommendations for implementing agriculturally informed practices in rural areas.

Understanding the factors contributing to farmer suicide: a meta-synthesis of qualitative research.

INTRODUCTION: Farming is associated with a range of ongoing occupational stressors that place farmers at an elevated risk for suicide. The increase of farmer suicide in recent years represents an important public health concern and requires an understanding of the circumstances and risk factors that contributed to a farmer's decision to die by suicide, as well as the protective factors that can help farmers manage the stressors. Qualitative research examining farmer suicide has grown in recent years and provides a rich description of the farmers' lives leading up to their suicide that cannot be easily captured from quantitative surveys. Therefore, we conducted a systematic review and meta-synthesis to understand the risk and protective factors preceding the farmers' suicide from the perspectives of their partner, relatives, or individuals who worked closely with them. We used this information to generate a conceptual model to illustrate the intersecting nature of farm culture, work-life stressors and mental health. METHODS: We conducted a comprehensive literature search for peer-reviewed studies using electronic databases Embase, PsycINFO, Academic Search Complete, PubMed and Scopus using a combination of search terms related to farming and suicide. All searching was conducted by two independent researchers. The selected studies were critically appraised using standardized forms to assess study quality. The qualitative data from each study was analyzed using meta-ethnography to identify underlying themes related to suicide and new interpretations of the topic while retaining the original meaning of each qualitative study. RESULTS: After independently screening studies, our final sample included 14 studies. We identified seven themes that contributed to farmer suicide: maintaining a 'farmer' identity, financial crisis, support and stress of family, the community panopticon, isolation from others, access to toxins and firearms, and an unpredictable environment. Using these themes, we developed a conceptual model called the Farming Adversity-Resilience Management framework (ie FARM framework) to highlight the cyclical and dynamic pattern of farm culture and to illustrate the risk factors that contribute to vulnerability to poor mental health and even suicide. This model also identifies a variety of protective factors that can improve farmers' resilience to such stressors. CONCLUSION: This is the first study to synthesize qualitative data about farmer suicide. While the enduring challenges and stressors of farming in rural areas may never be eliminated, there may be ways to help farmers build resilience to these factors. Our FARM framework presents a new way of understanding farm culture, the occupational stressors and farmers' wellbeing while also providing direction for future research and guidance for practical interventions. Policymakers and healthcare providers should consider developing and delivering mental health literacy programs to farmers and those who work closely with them to identify symptoms of poor mental health and to facilitate attitude change. Greater access to health care should be a priority in rural areas, and clinicians should be familiar with the stressors farmers face so that they can ask questions about their work-life balance to better assess the farmer's mental health and risk of suicide.

Motivation to train during a pandemic: The role of fitness resources, mental health, and motivational profiles among student-athletes in team sports.

The sporting season across post-secondary institutions was canceled in March 2020 due to COVID-19, and student-athletes had to maintain their training at home. It is unclear what personal and contextual factors facilitated student-athletes' ability to maintain their training routines at home when social distancing and lockdown (SD/L) policies were put in place. Our cross-sectional study of 433 student-athletes examined (a) how athletes adapted their training, (b) what training barriers they experienced, (c) whether motivational profiles were associated with differences in training behaviors and mental health, and (d) what variables predicted athletes' motivation to train during this prolonged offseason. Student-athletes across Canada were recruited to complete an online survey between August and September 2020. Results showed that athletes significantly reduced their training load and intensity, with approximately 25% exercising two or fewer days a week. Barriers to training included limited access to fitness resources and equipment, having inconsistent training schedules, and experiencing emotional distractions, with some of these barriers more common among female athletes than male athletes. For motivation profiles, athletes with higher levels of intrinsic motivation tended to maintain the intensity of their workouts and experienced lower mood disturbance. A hierarchical multiple regression revealed that being male, being younger, having higher levels of intrinsic and introjected motivation, having access to fitness resources, maintaining a steady training schedule, having fewer emotional distractions, and lower mood disturbance were significant predictors to being motivated to train during the pandemic. We discuss strategies coaches and trainers can implement to best support their student-athletes.

A comparison of SARS-CoV-2 RNA extraction with the QuickGene-810 Nucleic Acid Isolation System compared to the EZ1 Advanced DSP Virus Kit.

The QuickGene-810 Nucleic Acid Isolation System is a semi-automated extraction platform which may be used for RNA extraction. New methods were required to support the rapid increase in respiratory virus testing during the SARS-CoV-2 pandemic. The aim of this study was to assess SARS-CoV-2 RNA extraction using the QuickGene-810 kit compared to the EZ1 Advanced Extraction Platform for use on the AusDiagnostics SARS-CoV-2, Influenza and RSV 8-well RT-PCR assay. Qualitative results from all clinical samples were concordant between the QuickGene-810 and the EZ1 extraction methods, demonstrating that the QuickGene-810 kit is suitable for use in pathogen diagnostics. However, there was an average difference of approximately two cycles between the cycle threshold (Ct) values for both SARS-CoV-2 targets, suggesting that the EZ1 kit yields a higher concentration of nucleic acid extract, possibly related to its use of carrier RNA and/or smaller elution volume, which infers the possibility of false negative results for samples with very low viral loads.

Bridging Allied Health Professional Roles to Improve Patient Outcomes in Rural and Remote Australia: A Descriptive Qualitative Study.

Purpose: Australia's rural and remote populations experience inequality of access to healthcare, with demand exceeding capacity for delivery of health services, often due to a maldistribution of the health workforce. A strategy which may overcome barriers to accessing adequate healthcare includes implementation of interdisciplinary collaborative teams, identified as a successful method of healthcare delivery. This study thus aimed to explore interdisciplinary allied health collaborative practice in a rural community. Methods: Role theory, as a philosophical perspective, was used to explore role perceptions and the potential for interdisciplinary collaboration between pharmacists and allied health professionals including dieticians/public health nutritionists, speech pathologists, occupational therapists, and physiotherapists, by conducting 29 interviews in a rural community. All interviews were transcribed verbatim, coded, and categorised into emerging themes. Results: Five constructs of role theory were used to describe the data: role identity, role overload, role sufficiency, role conflict, and role ambiguity. Participants identified as rural generalists and health promoters, who work within innovative and adaptive healthcare settings. Role overload was reported as considerable due to high demand for services and a lack of resources in rural and remote regions, resulting in poor role sufficiency. Overall, there was a low level of role conflict, and participants were highly in favor of interprofessional collaboration; however, uncertainty of the pharmacist's role (role ambiguity) was a major barrier identified. Health professionals with more years in practice provided few examples of how they would utilise a pharmacist in their practice, although these gave valuable insight into the potential integration of a pharmacist into an interdisciplinary health team, with allied health professionals. Conclusion: This study has applied role theory providing a greater understanding of the enablers and barriers of pharmacists working within interdisciplinary allied health teams and highlighting opportunities to bridge interprofessional roles to improve patient outcomes, especially in rural and remote communities.

Lymphedema Signs, Symptoms, and Diagnosis in Women Who Are in Minority and Low-Income Groups and Have Survived Breast Cancer.

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a well-known side effect of cancer and its treatment with wide-ranging prevalence estimates. OBJECTIVE: This study describes associations between breast cancer-related lymphedema (BCRL) signs, symptoms, and diagnosis for women who were African American, white, or had a low income and survived breast cancer. DESIGN: This is a cross-sectional, observational study that used a computer-assisted telephone interview. METHODS: Women who had survived breast cancer were queried on the presence of 5 lymphedema signs and symptoms (edema in the breast, axilla, arm, and/or hand; tissue fibrosis; pitting; hemosiderin staining; heaviness) and whether they had a diagnosis of BCRL. Relationships between signs/symptoms and diagnosis for each group were evaluated with kappa and chi-square statistics. RESULTS: The study sample included 528 women who had survived breast cancer (266 white and 262 African American), with 514 reporting complete data on household income; 45% of the latter reported an annual household income of ≤$20,000. Women who were African American or had a low income were nearly twice as likely as women who were white to have any of 8 signs/symptoms of BCRL. Regardless of race and income, >50% of women with all BCRL signs and symptoms reported that they were not diagnosed with BCRL. LIMITATIONS: The main limitations of our study are the lack of medical chart data and longitudinal design. CONCLUSIONS: Women who were African American or had a low income and had survived breast cancer had a greater burden of BCRL signs and symptoms than women who were white. The lack of a strong association between BCRL signs, symptoms, and diagnosis suggests that BCRL may be underdiagnosed. These findings suggest that more rigorous screening and detection of BCRL-especially for women who are African American or have a low income-may be warranted. Cancer rehabilitation programs may be able to fill this gap.

Rapid Accurate Identification of Tuberculous Meningitis Among South African Children Using a Novel Clinical Decision Tool.

BACKGROUND: Early diagnosis of tuberculous meningitis (TBM) is crucial to achieve optimum outcomes. There is no effective rapid diagnostic test for use in children. We aimed to develop a clinical decision tool to facilitate the early diagnosis of childhood TBM. METHODS: Retrospective case-control study was performed across 7 hospitals in KwaZulu-Natal, South Africa (2010-2014). We identified the variables most predictive of microbiologically confirmed TBM in children (3 months to 15 years) by univariate analysis. These variables were modelled into a clinical decision tool and performance tested on an independent sample group. RESULTS: Of 865 children with suspected TBM, 3% (25) were identified with microbiologically confirmed TBM. Clinical information was retrieved for 22 microbiologically confirmed cases of TBM and compared with 66 controls matched for age, ethnicity, sex and geographical origin. The 9 most predictive variables among the confirmed cases were used to develop a clinical decision tool (CHILD TB LP): altered Consciousness; caregiver HIV infected; Illness length >7 days; Lethargy; focal neurologic Deficit; failure to Thrive; Blood/serum sodium <132 mmol/L; CSF >10 Lymphocytes ×10/L; CSF Protein >0.65 g/L. This tool successfully classified an independent sample of 7 cases and 21 controls with a sensitivity of 100% and specificity of 90%. CONCLUSIONS: The CHILD TB LP decision tool accurately classified microbiologically confirmed TBM. We propose that CHILD TB LP is prospectively evaluated as a novel rapid diagnostic tool for use in the initial evaluation of children with suspected neurologic infection presenting to hospitals in similar settings.

How are the kids holding up? A systematic review and meta-analysis on the psychosocial impact of maternal breast cancer on children.

BACKGROUND: Having a mother diagnosed with breast cancer can be a distressing time for a child. This review examines the impact maternal breast cancer has on the psychosocial functioning of children and what factors possibly moderate this relationship. METHODS: Using PRISMA guidelines, five electronic databases were systematically searched for published studies examining maternal breast cancer and the psychosocial functioning of children. RESULTS: A total of 15 studies contributed to the analysis. Results from a random effects meta-analysis show that children experience marginally elevated internalizing problems (standardized mean difference=.14, 95% CI .00, .28), significantly fewer total problem behaviors (standardized mean difference=-.13, 95% CI -.23, -.03), and no changes in externalizing problems (standardized mean difference=-.07, 95% CI -.19, .05) relative to comparison groups. Consistent with this, the narrative review suggests the children may experience elevated depression, anxiety and mental distress yet show more social competence and little aggressive or disruptive behavior. Significant moderating variables included informant type (i.e., self-ratings vs mother's ratings vs other's ratings) and comparison group used (i.e., controls vs normative data). There is also evidence that illness severity and maternal mental health may impact the results. CONCLUSIONS: The results suggest that children may be at risk for internalizing-type problems, especially when their mother experiences depression and has serious medical complications. Research using larger and more diverse samples is needed to fully understand how maternal breast cancer impacts children.

"A gift wrapped in barbed wire" positive and negative life changes after being diagnosed with inflammatory bowel disease.

PURPOSE: A growing interest in posttraumatic growth among individuals who have experienced a traumatic event has given rise to measures such as the Posttraumatic Growth Inventory (PTGI; Tedeschi and Calhoun, 1996). However, such measures may not fully represent all dimensions of change among individuals diagnosed with a chronic disease and fail to highlight the negative changes that may also occur. This study explores the positive and negative changes patients with inflammatory bowel disease (IBD) have experienced since diagnosis. METHODS: Three hundred and seventy-eight IBD patients provided answers to the qualitative question "Could you please describe the (positive/negative) effect(s) IBD has had on your life?" A grounded theory approach using NVivo was performed on participants' responses. RESULTS: Nearly 73 % of participants reported their disease positively affected their life in some way, and five themes related to positive changes emerged from the analysis: Interpersonal Relations, Personal Growth, Valuing Life, New Life Paths, and Spiritual Growth. However, almost 80 % of participants also reported their disease negatively affected their lives, with three themes emerging from the analysis: Freedom Restrictions, Psychological Side Effects, and Social Isolation. CONCLUSIONS: Our results support previous findings but also reveal that some dimensions related to the positive changes following adversity are not adequately assessed by the PTGI (e.g., appraising existing friendships, openness to try different forms of treatment or therapies, and psychological preparedness). The implications of these findings for future measurement and research of posttraumatic growth with IBD patients are discussed.

Patient compliance with telephone triage recommendations: a meta-analytic review.

OBJECTIVE: To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance. METHODS: Findings from 13 studies identified through interdisciplinary research databases (1990-2010) were meta-analyzed. Separate pooled analyses compared patients' compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes). RESULTS: Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients' intentions and health beliefs. CONCLUSION: Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation. PRACTICE IMPLICATIONS: We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call.

An exploratory study of parents' use and knowledge of car safety seats in Beijing, China.

As the number of vehicles in China rapidly increases and there is no child safety seat law, the issue of road safety for children is a growing concern. The purpose of this study was to examine parents' use and knowledge of car safety seats in Beijing, China. Using a convenience sample of 843 parents, survey results showed that only 64.8% of parents used a safety restraint for their children; the remaining 35.2% of children, of which most were toddlers or school-aged children, travelled unrestrained in vehicles. Among parents who used a safety restraint, only 24.2% were using it correctly based on the child's age (for infants), weight and height. Common reasons for not using a safety seat included difficulty finding safety seats (56.6%), cost (26.1%), and a preference to hold the child (18.1%). Moreover, a large proportion of parents prematurely transitioned their child from a safety seat to seat belt. The results highlight the need to develop injury prevention interventions that communicate the benefits and encourage the use of child safety restraints in China.

Nurses' experiences with telephone triage and advice: a meta-ethnography.

AIMS: This study is a meta-ethnography of nurses' experiences with telephone triage and advice and factors that facilitate or impede their decision-making process. BACKGROUND: Telephone triage and advice services are a rapidly expanding development in health care. Unlike traditional forms of nursing practice, telenurses offer triage recommendations and advice to the general public without visual cues. DATA SOURCES: Published qualitative research on telephone triage and advice were sought from interdisciplinary research databases (1980-2008) and bibliographical reviews of retrieved studies. REVIEW METHODS: Our systematic search identified 16 relevant studies. Two researchers independently reviewed, critically appraised, and extracted key themes and concepts from each study. We followed techniques of meta-ethnography to synthesize the findings, using both reciprocal and refutational translation to compare similar or contradictory findings, and a line-of-arguments synthesis. RESULTS: We identified five major themes that highlight common issues and concerns experienced by telenurses: gaining and maintaining skills, autonomy, new work environment, holistic assessment, and stress and pressure. A line-of-arguments synthesis produced a three-stage model that describes the decision-making process used by telenurses and highlights how assessments largely depend on the ability to 'build a picture' of the patient and the presenting health issue. CONCLUSION: Telenurses experience a range of common concerns and issues which either impede or facilitate the decision-making process. Although 'building a picture' of the patient is key to making assessments over the telephone, final triage decisions are influenced by balancing the conflicting demands of being both carer and gatekeeper to limited healthcare services.

Non-nucleoside inhibitors of HCV polymerase NS5B. Part 2: Synthesis and structure-activity relationships of benzothiazine-substituted quinolinediones.

A new series of benzothiazine-substituted quinolinediones were evaluated as inhibitors of HCV polymerase NS5B. SAR studies on this series revealed a methyl sulfonamide group as a high affinity feature. Analogues with this group showed submicromolar potencies in the HCV cell based replicon assay. Pharmacokinetic and toxicology studies were also performed on a selected compound (34) to evaluate in vivo properties of this new class of inhibitors of HCV NS5B polymerase.

Reporting practices in confirmatory factor analysis: an overview and some recommendations.

Reporting practices in 194 confirmatory factor analysis studies (1,409 factor models) published in American Psychological Association journals from 1998 to 2006 were reviewed and compared with established reporting guidelines. Three research questions were addressed: (a) how do actual reporting practices compare with published guidelines? (b) how do researchers report model fit in light of divergent perspectives on the use of ancillary fit indices (e.g., L.-T. Hu & P. M. Bentler, 1999; H. W. Marsh, K.-T., Hau, & Z. Wen, 2004)? and (c) are fit measures that support hypothesized models reported more often than fit measures that are less favorable? Results indicate some positive findings with respect to reporting practices including proposing multiple models a priori and near universal reporting of the chi-square significance test. However, many deficiencies were found such as lack of information regarding missing data and assessment of normality. Additionally, the authors found increases in reported values of some incremental fit statistics and no statistically significant evidence that researchers selectively report measures of fit that support their preferred model. Recommendations for reporting are summarized and a checklist is provided to help editors, reviewers, and authors improve reporting practices.

Personality and consultations with complementary and alternative medicine practitioners: a five-factor model investigation of the degree of use and motives.

OBJECTIVES: As interest in and use of complementary and alternative medicine (CAM) providers continues to grow, it is important to understand which characteristics incline people to experiment with and become frequent consumers of CAM practitioners. The purpose of this study was to examine how personality, as assessed by the five-factor model, was related to the breadth, frequency, and types of provider-based CAM use. Relationships between the personality factors (Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism) and motives for consulting CAM providers were also explored. METHODS: A convenience sample of 184 current CAM clients recruited through the offices of 12 conventional medicine and 17 CAM practitioners completed a survey package including measures of health status, CAM use, personality, and motivations for using CAM. RESULTS: Only Openness and Agreeableness were consistently linked to different dimensions of CAM use, with each associated with consultations with CAM practitioners, and homeopaths and naturopaths in particular. After controlling for sociodemographic and health status variables in the stepwise multiple regressions, Openness was associated with the variety of CAM providers tried, whereas Agreeableness was linked to both the breadth and frequency of CAM consultations. Holistic and proactive health motivations were associated with both personality factors, and Agreeableness was also associated with motives reflecting a desire for shared decision-making. CONCLUSIONS: Findings indicate that individuals who are open and agreeable, as described by the five-factor model of personality, consult CAM practitioners to a greater extent. The motives involved suggest a congruency between CAM and their own perspectives regarding health and patient-provider interactions, which may have implications for understanding treatment adherence and outcomes.

When one door closes, another door opens: physician availability and motivations to consult complementary and alternative medicine providers.

The aim of this study was to examine the attitudes, behaviours, and intentions to consult complementary and alternative medicine (CAM) providers, of health-care consumers living in a region with low physician availability. A survey was completed by a convenience sample of 235 CAM clients and nonconsumers recruited from an underserved urban centre in Canada. Nearly half had experienced difficulties getting an appointment with a physician when needed, and those who had experienced difficulties were more dissatisfied with conventional health care. Most participants (85.1%) indicated that they would consider consulting a CAM provider should they have difficulty getting an appointment with a physician in the future, including nearly 60% of the CAM nonconsumers. Participants who had more experience with CAM, greater perceived control over their symptoms, and were dissatisfied with conventional health care, were more likely to express intentions to use CAM should they experience access difficulties in the future. By situating the motivations for CAM within the context of physician availability our findings highlight the importance of geographical context, or place, for understanding attitudes towards CAM and its utilisation.

U.S. Food and Drug Administration and off-label use of expandable metal biliary stents within the peripheral vasculature.

Expandable metal stents are used to maintain the patency of compromised ducts, lumens, and vessels. As medical devices, there products are regulated by the Center for Devices and Radiological Health of the U.S. Food and Drug Administration (FDA). During the past several years, the FDA has become aware of the increasing prevalence of off-label use of expandable metal stents cleared for biliary use within the peripheral vasculature. The authors provide an overview of how the FDA regulates medical devices and expandable stents and summarize safety issues reported to the Agency with regard to the off-label use of these biliary stents.

Patient satisfaction with nurse practitioner care in emergency departments in Canada.

PURPOSE: To measure patient satisfaction with care delivered by nurse practitioners (NPs) in emergency departments (EDs) in Canada using a psychometrically valid survey. DATA SOURCES: All patients who received care from an NP in six participating EDs in Ontario province over a 1-week period were asked to complete a self-administered patient satisfaction survey designed specifically to assess satisfaction with NP care in EDs. CONCLUSIONS: One hundred and thirteen patients completed the survey. Principal components analysis of the survey revealed three factors or subscales: Attentiveness, Comprehensive care, and Role clarity. Scores on the three subscales indicated that patients were satisfied with Attentiveness (M = 3.72, SD = 0.38) and Comprehensive care (M = 3.52, SD = 0.49) and had a moderate understanding of Role clarity (M = 2.99, SD = 0.66). Participants with higher income levels reported higher levels of satisfaction with the attentiveness they received, whereas patients with previous experience with an NP reported higher levels of satisfaction with the comprehensive care they received. There was no appreciable increase in patient satisfaction with the NP based on age, gender, education, or health status. IMPLICATIONS FOR PRACTICE: These findings indicate that attentiveness, comprehensive care, and role clarity are reflected by the NP in emergency healthcare settings as indicated by the patient's responses to the survey. This study supports that meeting expectations is a critical component of patient satisfaction.