Midwifery Practice Leaders' Experiences of Practice Changes Early in the COVID-19 Pandemic: A Qualitative Exploration.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic generated considerable upheaval in all sectors of the US health care system, including maternity care. We focused this inquiry on midwifery practice leaders' experiences and perspectives on changes that occurred in their practices early in the pandemic. METHODS: This was a qualitative descriptive study using thematic analysis. The data were responses to an open-ended question in a survey of pandemic-related employment and clinical practice changes. Findings are presented from a constructivist perspective, describing the experiences and perspectives of a group of US midwifery practice leaders during the initial phase of the COVID-19 pandemic. RESULTS: Two main themes emerged from the analysis: demands on midwives and driving forces. Demands on midwives were 3-fold: clients' needs, modification of care, and midwives' needs. These encompassed the psychological, physical, and emotional toll that caring for women during the pandemic placed on midwives. Driving forces were those entities that spurred and directed change and included regulations, institutions, financial logistics, and team dynamics. Survey respondents in community (home and birth center) practices reported substantial increases in inquiries and client volume, and many respondents expressed concern about withdrawal of students from clinical placements. DISCUSSION: Midwifery practices experienced profound changes in their work environments during the COVID-19 pandemic, with both positive and negative characteristics. These challenges in providing birth care were similar to those reported in other countries. Results indicated existing guidance for maternity care during emergencies did not meet clients' needs. Coordinated planning for maternity care in future prolonged health emergencies should incorporate best practices and include midwives in the process.

What People Really Think About Safety around Horses: The Relationship between Risk Perception, Values and Safety Behaviours.

The equestrian industry reports high rates of serious injuries, illness and fatalities when compared to other high-risk sports and work environments. To address these ongoing safety concerns, a greater understanding of the relationship between human risk perception, values and safety behaviours is required. This paper presents results from an international survey that explored relationships between a respondents' willingness to take risk during daily activities along with, their perceptions of risk and behaviours during horse-related interactions. Respondents' comments around risk management principles and safety-first inspirations were also analysed. We examined what humans think about hazardous situations or activities and how they managed risk with suitable controls. Analysis identified three important findings. First, safe behaviours around horses were associated with safety training (formal and/or informal). Second, unsafe behaviours around horses were associated with higher levels of equestrian experience as well as income from horse-related work. Finally, findings revealed a general acceptance of danger and imminent injury during horse interactions. This may explain why some respondents de-emphasised or 'talked-down' the importance of safety-first principles. In this paper we predominantly reported quantitative findings of respondents self-reported safety behaviours, general and horse-related risk perceptions despite injury or illness. We discussed the benefits of improved safety-first principles like training, risk assessments, rider-horse match with enriched safety communications to enhance risk-mitigation during human-horse interactions.

The Effectiveness of a School-Based Intervention for Adolescents in Reducing Disparities in the Negative Consequences of Substance Use Among Ethnic Groups.

Ethnic minority youth are disproportionately affected by substance use-related consequences, which may be best understood through a social ecological lens. Differences in psychosocial consequences between ethnic majority and minority groups are likely due to underlying social and environmental factors. The current longitudinal study examined the outcomes of a school-based motivational enhancement treatment intervention in reducing disparities in substance use consequences experienced by some ethnic minority groups with both between and within-subjects differences. Students were referred to the intervention through school personnel and participated in a four-session intervention targeting alcohol and drug use. Participants included 122 youth aged 13-19 years. Participants were grouped by ethnicity and likelihood of disparate negative consequences of substance use. African American/Hispanic/Multiethnic youth formed one group, and youth identifying as White or Asian formed a second group. We hypothesized that (1) there would be significant disparities in psychosocial, serious problem behavior, and school-based consequences of substance use between White/Asian students compared to African American/Hispanic/Multiethnic students at baseline; (2) physical dependence consequences would not be disparate at baseline; and (3) overall disparities would be reduced at post-treatment follow-up. Results indicated that African American/Hispanic/Multiethnic adolescents demonstrated statistically significant disparate consequences at baseline, except for physical dependency consequences. Lastly, significant reductions in disparities were evidenced between groups over time. Our findings highlight the efficacy of utilizing school-based substance use interventions in decreasing ethnic health disparities in substance use consequences.

Preventing and Investigating Horse-Related Human Injury and Fatality in Work and Non-Work Equestrian Environments: A Consideration of the Workplace Health and Safety Framework.

It has been suggested that one in five riders will be injured due to a fall from a horse, resulting in severe head or torso injuries. Attempts to reduce injury have primarily focussed on low level risk controls, such as helmets. In comparison, risk mitigation in high risk workplaces and sports is directed at more effective and preventative controls like training, consultation, safe work procedures, fit for purpose equipment and regular Workplace Health and Safety (WHS) monitoring. However, there has been no systematic consideration of the risk-reduction benefits of applying a WHS framework to reducing horse-related risks in workplaces, let alone competition or leisure contexts. In this article, we discuss the different dimensions of risk during human-horse interaction: the risk itself, animal, human and environmental factors and their combinations thereof. We consider the potential of the WHS framework as a tool for reducing (a) situation-specific hazards, and (b) the risks inherent in and arising from human-horse interactions. Whilst most-if not all-horses are unpredictable, the majority of horse-related injuries should be treated as preventable. The article concludes with a practical application of WHS to prevent horse-related injury by discussing effective evidence-based guidelines and regulatory monitoring for equestrian sectors. It suggests that the WHS framework has significant potential not only to reduce the occurrence and likelihood of horse-related human accident and injury, but to enable systematic accident analysis and investigation of horse-related adverse events.

Irritability in the pediatric population.

Irritability is a common symptom associated with several pediatric mental health disorders including depression, anxiety, attention-deficit/hyperactivity disorder, and oppositional defiant disorder. Recommended treatments may be significantly different based on the target symptoms. Diagnostic clarification is achieved over time using screening tools, individual and family history, coordination with schools, and targeted observation.