Implementing nursing interventions based on stress system theory alongside painting therapy for pediatric post-traumatic stress disorder following accidental injury.

OBJECTIVE: The aim of this study is to examine the impact of a nursing intervention based on stress system theory, coupled with painting therapy, on children experiencing post-traumatic stress disorder (PTSD) subsequent to an accidental injury. METHODS: The clinical data of 100 children diagnosed with PTSD following accidental injuries were retrospectively analyzed for the period spanning April 2021 to May 2023. There were 48 children who received standard nursing care between April 2021 and April 2022 in the control group, and 52 children who received nursing intervention based on stress system theory combined with painting therapy between May 2022 and May 2023 in the observation group. Scores of PTSD Self-evaluation Scale (PTSD-SS), post-traumatic growth, coping style, quality of life, and family satisfaction were compared between the two groups. RESULTS: Prior to nursing care, the scores of each dimension in the PTSD-SS, post-traumatic growth, coping style, and quality of life were similar between the two groups (P > 0.05). Following nursing intervention, the observation group exhibited lower scores in each dimension of the PTSD-SS compared to the control group. Moreover, the scores in each dimension of the children's version of the Post-Traumatic Growth Inventory (PTGI) were higher in the observation group than in the control group. Additionally, the Confrontation scores in the Medical Coping Modes Questionnaire (MCMQ) were higher in the observation group than in the control group, while the scores of Avoidance and Resignation were lower in the observation group than in the control group. The scores of each dimension in the Pediatric Quality of Life Inventory Measurement Models (PedsQL4.0) were higher than those in the control group (P < 0.05), and the family satisfaction in the observation group (96.15%) was higher than that in the control group (81.25%), with P < 0.05. CONCLUSION: The implementation of nursing intervention based on stress system theory combined with painting therapy in children with PTSD following an accidental injury can alleviate stress, help them actively cope with the condition, promote post-traumatic growth, and improve the quality of life and family satisfaction.

Challenges and coping strategies when caring for terminally ill persons with cancer: perspectives of family caregivers.

INTRODUCTION: Terminal illness is an irreversible illness that, without life-sustaining procedures, usually results in death or permanent disability from which recovery is unlikely. When involved, family caregivers are believed to improve health outcomes, such as reduced hospitalization, and establishing a patient's initial access to professional treatment services. However, caring for a patient with a terminal illness is viewed as one of the most difficult aspects of providing care. This study aimed to identify the challenges, and coping strategies developed by family caregivers to cope with the care of the terminally ill person. METHODS: An exploratory descriptive qualitative approach was used. Twenty (20) family caregivers voluntarily participated in the study from the Korle-Bu Teaching Hospital. Semi-structured interviews were conducted with the participants. The transcribed interviews were then analysed using thematic analysis. RESULTS: From the analysis, three main themes emerged: challenges, coping strategies, and social support. These themes encompassed sixteen subthemes including financial burden, bad health conditions, faith and prayer, and support from health professionals. From the study, both male and female family caregivers narrated that providing care for sick relatives undergoing terminal disease is characterized as a daily duty demanding one's time and fraught with emotional strain. In addition, even though it was a difficult job, family members who provided care for ailing relatives never gave up, citing responsibility, the importance of family, and religious beliefs as the primary motivations for doing so. CONCLUSION: The difficulties and demands of family caregiving roles for terminally ill relatives are complex and multifactorial. The findings call for multidisciplinary professional attention for family caregivers and policies that will support their lives holistically.

Resilience, avoidant coping and post-traumatic stress symptoms among female Ukrainian refugees and internally displaced people.

BACKGROUND: Since the Russian full-scale invasion of Ukraine, over 10 million Ukrainians have been displaced from their homes. This has contributed to an increase in post-traumatic stress (PTS) symptoms in both refugees and internally displaced persons (IDPs). Previous research has suggested that refugees may experience higher levels of PTS due to additional stressors inherent in migration to a new country, language barriers and separation from family and social support. PTS symptoms may also be exacerbated by avoidant coping which we proposed would be more prevalent amongst refugees because of the isolating effects of migration-related stressors. AIMS: The present study aimed to investigate the relationship between PTS symptoms, resilience and avoidant coping in refugees and IDPs. We predicted that refugees would report higher levels of PTS symptoms and use of avoidant coping strategies, and that avoidant coping would mediate the effect of resilience on PTS symptoms. We tested a moderated mediation model to examine whether this effect differed between IDPs and refugees. METHODS: A total of 229 women (108 IDPs and 121 refugees), who were displaced after the full-scale invasion, were recruited using online platforms and volunteering centres. They completed an online questionnaire comprising measures of PTS, resilience and coping. RESULTS: We found no significant differences in resilience, PTS symptoms or reported use of avoidance coping strategies between refugees and IDPs. As expected, avoidance coping mediated the negative association between resilience and PTS symptoms, but no group differences in this effect were observed. CONCLUSIONS: Contrary to previous research, our findings indicate that PTS symptoms may be similarly problematic for refugees and IDPs. This may be due to increased time since the invasion as many refugees may have had time to adjust. Use of avoidant coping strategies may exacerbate PTS symptoms and our study highlights the need for mental health interventions aimed at reducing PTS symptoms in Ukrainian IDPs and refugees through fostering resilience and adaptive coping strategies.

Resilience in the Face of Cancer: On the Importance of Defining and Studying Resilience as a Dynamic Process of Adaptation.

Resilience is defined as the maintenance or relatively quick recovery of mental health during and after adversity. Rather than focusing on psychopathology and its causes, resilience research aims to understand what protective mechanisms shield individuals against developing such disorders and translate these insights to improve psychosocial care. This resilience approach seems especially promising for the field of oncology because patients face stressor after stressor from diagnosis to survivorship. Helping patients to learn how they can best use the resources and abilities available to them can empower patients to handle subsequent stressors. In the past few decades, resilience has increasingly been considered as a dynamic process of adaptation. While researchers use this definition, resilience has not yet been studied as a dynamic process in the field of oncology. As a result, the potential of resilience research to gain insight into what helps protect cancer patients from developing psychopathology is limited. We discuss conceptual and methodological proposals to advance resilience research in oncology. Most importantly, we propose applying prospective longitudinal designs to capture the dynamic resilience process. By gaining insight in how cancer patients engage in protective factors, resilience research can come to its full potential and help prevent psychopathology.

Gossip and coping with social isolation: the case of migrant truck drivers in Western Europe.

This article examines how employees use gossip as a resource to cope with social isolation. Building on a qualitative study with 32 truck drivers in a Western European company, our research identified gossip in close relationships and gossip in distant relationships as distinct patterns playing a different role in coping with social isolation, and a third pattern in which gossip was not beneficial. First, gossiping with close friends at work helped drivers engage in emotion-focused coping by reducing stress and loneliness. Second, gossiping with distant colleagues helped drivers engage in problem-focused coping by exchanging knowledge involving people in the organization. Third, gossip avoidance occurred in distant relationships, where drivers limited gossip exchanges going beyond instrumentally useful information. Overall, these findings show that drivers relied on different layers of their social network to cope with social isolation. Enriching previous research, this study shows that gossip represents an essential resource for emotion-focused and problem-focused coping.

Mental health index of the elderly population in Medellín (Colombia)-2021: a factorial analysis.

Introduction: There are several risk factors associated with developing mental disorders among people over 60 years of age. Mental health encompasses multiple domains or capacities, which can comprise the psychological wellbeing of older people. Therefore, resilient coping, self-compassion, self-esteem, hopelessness, quality of life, and depression are considered the characteristics and adaptive mechanisms that bring together the main risk and protective factors for imbalance in mental wellbeing. Objective: This study aimed to establish the demographic, social, and family factors, as well as the clinical characteristics and lifestyle habits that influence the mental health of the elderly people in the city of Medellín, in the year 2021, to build a mental health index. Methodology: This study adopts a quantitative approach, employs retrospective temporality, and utilizes secondary sources. A cross-sectional survey was carried out with the SABAM Project (health and mental wellbeing of older adults from five cities in Colombia in 2021 by its Spanish acronym) database (secondary source), which is part of the research group "Public Health Observatory" of CES University (Medellín, Colombia). The database comprised 500 records of people aged over 60 years from the city of Medellín in 2021. While constructing the index, a principal component analysis was used, along with the Varimax method for factor analysis rotation. Results: The median age of the general population was 67 years (IQR 63-72); for men, the median age was 66 years (IQR 63-71) and for women, the median age was 67 years (IQR 63-72). An association was found between low socioeconomic levels, alcohol consumption, and the level of higher education (university-postgraduate) with low levels of the Mental Health Index in people over 60 years of age in Medellín during the year 2021. Conclusion: A quantitative model was developed to predict either a positive or negative prognosis in the mental wellbeing of the population over 60 years of age in the city of Medellín. The model was also used for the development of a sociodemographic profile highlighting the impact on mental health among people over 60 years of age with limited economic resources.

Effect of continuous nursing on treatment compliance and side effect management of coronary heart disease.

BACKGROUND: There are relatively few studies on continuing care of coronary heart disease (CHD), and its research value needs to be further clarified. AIM: To investigate the effect of continuous nursing on treatment compliance and side effect management in patients with CHD. METHODS: This is a retrospective study with patients from January 2021 to 2023. The study was divided into two groups with 30 participants in each group. Self-rating anxiety scale (SAS) and Self-rating depression scale (SDS) were used to assess patients' anxiety and depression, and medical coping questionnaire was used to assess patients' coping styles. The pelvic floor dysfunction questionnaire (PFDI-20) was used to assess the status of pelvic floor function, including bladder symptoms, intestinal symptoms, and pelvic symptoms. RESULTS: SAS score decreased from 57.33 ± 3.01before treatment to 41.33 ± 3.42 after treatment, SDS score decreased from 50.40 ± 1.45 to 39.47 ± 1.57. The decrease of these two indexes was statistically significant (P < 0.05). PFDI-20 scores decreased from the mean 16.83 ± 1.72 before treatment to 10.47 ± 1.3the mean after treatment, which was statistically significant (P < 0.05). CONCLUSION: The results of this study indicate that pioneering research in continuous care of CHD has a positive impact on improving patients' treatment compliance, reducing anxiety and depression levels, and improving coping styles and pelvic floor functional status.

Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies?

Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.

Differences in the Communication of Cancer Diagnoses by Different Health Professionals and the Impact of Oncologist Communication on Patients' Emotions.

The field of healthcare is increasingly adopting a humanistic perspective in the physician-patient relationship. One of the more salient aspects being studied is the communication between the two. This study serves a dual purpose. Our initial aim was to study how a cancer diagnosis is disclosed to patients by different physicians (GPs/other specialists/oncologists). Secondly, we set out to study how the way in which oncologists normally communicate with their patients impacts variables such as a patient's anxiety, depression, coping mechanisms, and perception of both their health and their quality of life. A total of 177 patients answered a battery of questionnaires on sociodemographic and disease data: the SPIKES protocol, the EORTCQLQ-COMU26, and the ADAF screening questionnaire. The analyses recorded medium or high scores for some of the steps in the SPIKES protocol when delivering the diagnosis, and significant differences were observed for some of them among different physicians. The level of a cancer patient's satisfaction with the communication by oncologists was related to their levels of anxiety, depression, vulnerability, and perception of their health and quality of life. Better communication strategies are called for among all healthcare professionals to facilitate the task of breaking bad news to their patients.

"Sexual sacrifice": a qualitative exploration of husbands' experience of living with survivors of breast cancer-sexual dysfunction in Malaysia.

PURPOSE: Experiencing sexual dysfunction (SD) alongside a breast cancer (BC) diagnosis has significant consequences, not only for wives but also for their husbands. Therefore, we explored husbands' perspectives on sexuality and their encounters in dealing with wives' SD following a BC diagnosis. METHODS: This qualitative study, conducted within the phenomenological framework, focused on sexually active husbands whose wives faced SD after being diagnosed with BC in Kelantan. Husbands with an International Index of Erectile Function (IIEF-5) score above 11, indicating the absence of erectile dysfunction, were invited to participate in in-depth interviews conducted between September 2019 and March 2021. The interviews were recorded and transcribed verbatim, and the transcriptions were then managed and analyzed using the NVivo® analytic computer software. Thematic analyses were performed, taking into account the meaning-making theory. RESULTS: To grasp husbands' experiences, three themes emerged. "Sex, a calming act," delves into their understanding of sexuality and its impact severity. "Distressing sequelae yet provide better tolerance" underscores that husbands experienced adverse consequences due to their wives' imperfections and sexual challenges, but they exhibited improved tolerance in dealing with these difficulties. Lastly, "Improving lives with multiple strategies" highlights how husbands sought alternative activities in response. CONCLUSION: This study illuminates the experiences of husbands coping with their wives' SD following a BC diagnosis. Husbands had to reconsider their understanding of sexuality and sexual needs and employed various response and coping strategies. These strategies included emphasizing influences of culture (husbands' roles and rights), religious beliefs, and self-distraction, redirecting the focus to health concerns, and engaging in alternative activities.

Pathways to Resilience: Exploring Post-Traumatic Growth in the Wake of Drug-Related Deaths.

This review examines Post-Traumatic Growth (PTG) in the aftermath of Drug-Related Deaths (DRDs) amid a public health crisis underscored by an increase in overdose fatalities. It examines grief and unique challenges confronting those bereaved by DRDs, such as stigmatization, and synthesizes existing literature to elucidate pathways toward resilience and growth. Fundamental mechanisms facilitating PTG, including reframing loss, engaging in open dialogues with support, and cultivating self-compassion and hope, are highlighted, demonstrating the transformative potential of navigating bereavement with supportive communication and personal development. The review also addresses limitations within current research, such as focusing on specific bereaved populations, which may impact the generalizability of findings. Recommendations for future research include longitudinal studies and broader demographic inclusion to understand and support individuals grieving a DRD. Advocating for holistic, growth-oriented bereavement care models, this review underscores the necessity of comprehensive approaches to facilitate healing and growth in the wake of DRDs.

Job burnout and anxiety among medical staff: A latent profile and moderated mediation analysis.

BACKGROUND: Due to work pressure, work intensity, and the impact of emergencies such as the epidemic, job burnout and mental health problems among medical staff have become increasingly prominent. OBJECTIVES: Our study aims to characterize the patterns of burnout in Chinese medical staff, explore the profile differences on anxiety and self-esteem, examine whether the differences in these profiles on anxiety were mediated by self-esteem, and investigate whether this mediating process was moderated by positive coping styles among medical staff. METHODS: Data were collected from 602 medical staff in China by a convenient sampling method. A latent profile and moderated mediation analysis were performed. RESULTS: Latent profile analysis on three burnout dimensions [emotional exhaustion, cynicism, and professional efficacy] indicated two burnout profiles: low burnout (82.47% of the sample) and high burnout (17.53%). Medical staff with a low burnout profile had lower levels of emotional exhaustion and cynicism than those with a high burnout profile. It was also determined that self-esteem mediates burnout and anxiety in both high- and low-burnout medical staff. The moderating role of positive coping styles was also identified (ß = 0.30, 95%CI: 0.058-0.550). CONCLUSIONS: The identification of two distinct burnout patterns (low burnout and high burnout) provides clinical administrators with clear goals for individualizing support and interventions for medical staff with different levels of burnout. Furthermore, attention should be given to self-esteem and positive coping styles, as they act as potential mediators and moderators of medical staff's mental health problems.

Are you ready for a challenge? Personality traits influence dairy calves' responses to disease, pain, and nutritional challenges.

Dairy calves routinely experience disease, pain, and nutritional stressors such as diarrhea, dehorning, and weaning early in life. These stressors lead to changes in behavioral expression that varies in magnitude between individuals, where a greater magnitude change would suggest lower resilience in individuals to a stressor. Thus, this study first aimed to quantify the individual variation in magnitude change in feeding behaviors and activity in response to a bout of diarrhea, dehorning, and weaning. The next objective was to then investigate if personality traits were related to this magnitude of behavioral response in dairy calves, and thus their resilience toward these stressors. Calves were followed with 2 precision livestock technologies (e.g.: an automatic feeding system (AFS), and leg accelerometer) to track behavioral changes in response during the time when the stressors were present. The AFS provided daily measures of milk intake, drinking speed, rewarded and unrewarded visits to the milk feeding station, and calf starter intake. The leg accelerometer provided daily measures of steps, activity index, lying time, and lying bouts. At 23 ± 3 d of age, Holstein dairy calves (n = 49) were subjected to a series of standardized personality tests that exposed calf to novelty and fear stimuli. Factors extracted from a principal component analysis on the behaviors from the personality test were utilized to represent personality traits: Factor 1 ('Fearful'), Factor 2 ('Active') and Factor 3 ('Explorative'). The magnitude change in behaviors from the precision livestock technologies were calculated relative to the behavior performed on the day the stressor occurred (i.e., day of diagnosis; day of dehorning; day weaned). Linear regression models were utilized to determine if calf scores on each factor were associated with magnitude change in behavior for each of the stressor periods with day relative to the stressor included as a repeated measure. Models were run independently for the period leading up to and following each stressor. We found that calves varied in their behavioral responses to diarrhea, dehorning, and weaning stressors, despite being reared in the same environment and experiencing consistent management procedures. Additionally, personality traits measured from standardized tests were associated to both the direction and magnitude of change in behaviors around each stressor. For instance, with diarrhea, calves that were highly 'Fearful' had a greater magnitude change in milk intake and drinking speed following diagnosis than the least 'Fearful' calves. With dehorning, calves that were highly 'Explorative' had a greater magnitude change in lying time when dehorned, but a smaller magnitude change in lying bouts and drinking speed following dehorning, than the least 'explorative' calves. With weaning, calves that were highly 'Active' had a smaller magnitude change in unrewarded visits leading up to and following weaning than calves that were the least 'Active'. Each of the personality traits had a significant association with change in behavior surrounding each of the stressors evaluated, although these associations depended on the type of stressor. These results have implications for how individual calves experience each stressor and therefore individual animal welfare.

The relationship between sleep quality and occupational fatigue in endoscopy nurses: mediating role of positive coping style.

Background: Nursing occupational fatigue has emerged as a critical issue affecting the safety and health of nurses. This phenomenon not only impairs nurses' performance and mental well-being but also poses risks to patient safety and the quality of care provided. This study focuses on endoscopic nurses to explore the mediating role of positive coping styles between sleep quality and occupational fatigue, aiming to identify effective strategies to alleviate fatigue, thereby improving the work environment and enhancing healthcare quality. Methods: From July to August 2023, a cross-sectional design was used to select 258 endoscopy nurses from 25 top-three hospitals in 14 cities across 5 provinces in China. Data was collected through general information questionnaires, Fatigue assessment instrument, Pittsburgh sleep quality index, and Simple Coping Style Questionnaire. A structural equation model of sleep quality - positive coping style - occupational fatigue was constructed using Amos 26.0, and Bootstrap was employed to test the mediating effect. Results: The results showed that the mean scores of sleep quality, occupational fatigue, and positive coping style for endoscopy nurses were 8.89 ± 4.13, 17.73 ± 5.64, and 18.32 ± 10.46, respectively. Positive coping style were negatively correlated with sleep quality and occupational fatigue (p < 0.001). Positive coping style partially mediated the relationship between sleep quality and occupational fatigue, with a mediating effect value of 0.253, accounting for 42.10% of the total effect. Conclusion: Sleep quality can indirectly affect the level of occupational fatigue through positive coping style. Nursing managers should enhance nurses' positive coping skills, improve nurses' sleep quality, and reduce occupational fatigue among nurses.

Genetic ablation of the isoform γ of PI3K decreases antidepressant efficacy of ketamine in male mice.

About one-third of major depressive disorder (MDD) patients demonstrate unresponsiveness to classic antidepressants, and even the clinical efficacy of fast-acting drugs such as ketamine varies significantly among patients with treatment-resistant depression. Nevertheless, the lack of suitable animal models that mimic a possible ketamine-resistant phenotype challenges the understanding of resistance to drug treatment. In this study, we showed that PI3Kγ knock-out (KO) mice do not respond to classical doses of ketamine and classical antidepressants. PI3Kγ KO mice were unresponsive to both the rapid and sustained antidepressant-like effects of a single dose of ketamine in the forced swimming test. Additionally, they were unresponsive to the antidepressant-like effects induced by the tricyclic antidepressant imipramine and the selective serotonin reuptake inhibitor fluoxetine. However, acute pharmacological inhibition of PI3Kγ did not block the antidepressant-like effect of ketamine, showing that a chronic deficiency of the PI3Kγ-mediated pathway is necessary for the effects of classic doses of ketamine and antidepressants. Therefore, we propose that PI3Kγ participates in the antidepressant activity and is likely implicated in the neurobiology and phenotype observed in patients with MDD who demonstrate treatment resistance.

Health and wellbeing of staff working at higher education institutions globally during the post-COVID-19 pandemic period: evidence from a cross-sectional study.

BACKGROUND: The ongoing global crisis of Higher Education (HE) institutions during the post-COVID-19 pandemic period has increased the likelihood of enduring psychological stressors for staff. This study aimed to identify factors associated with job insecurity, burnout, psychological distress and coping amongst staff working at HE institutions globally. METHODS: An anonymous cross-sectional study was conducted in 2023 with staff at HE institutions across 16 countries. Job insecurity was measured using the Job Insecurity Scale (JIS), burnout using the Perceived Burnout measure question, psychological distress using the Kessler Psychological Distress Scale (K10), and coping using the Brief Resilient Coping Scale. Multivariable logistic regression with a stepwise variable selection method was used to identify associations. RESULTS: A total of 2,353 staff participated; the mean age (± SD) was 43(± 10) years and 61% were females. Most staff (85%) did not feel job insecurity, one-third (29%) perceived burnout in their jobs, more than two-thirds (73%) experienced moderate to very high levels of psychological distress, and more than half (58%) exhibited medium to high resilient coping. Perceived job insecurity was associated with staff working part-time [Adjusted Odds Ratio 1.53 (95% Confidence Intervals 1.15-2.02)], having an academic appointment [2.45 (1.78-3.27)], having multiple co-morbidities [1.86 (1.41-2.48)], perceived burnout [1.99 (1.54-2.56)] and moderate to very high level of psychological distress [1.68 (1.18-2.39)]. Perceived burnout was associated with being female [1.35 (1.12-1.63)], having multiple co-morbidities [1.53 (1.20-1.97)], perceived job insecurity [1.99 (1.55-2.57)], and moderate to very high levels of psychological distress [3.23 (2.42-4.30)]. Staff with multiple co-morbidities [1.46 (1.11-1.92)], mental health issues [2.73 (1.79-4.15)], perceived job insecurity [1.61 (1.13-2.30)], and perceived burnout [3.22 (2.41-4.31)] were associated with moderate to very high levels of psychological distress. Staff who perceived their mental health as good to excellent [3.36 (2.69-4.19)] were more likely to have medium to high resilient coping. CONCLUSIONS: Factors identified in this study should be considered in reviewing and updating current support strategies for staff at HE institutions across all countries to reduce stress and burnout and improve wellbeing.

The effect of group art therapy on the stress coping ability of Chinese international students in South Korea: using the person-in-the-rain test.

Introduction: This study aimed to determine the effectiveness of group therapy on the stress coping skills of Chinese students in Korea using a pre-test post-test control group design. Methods: Thirty participants were randomly placed into an experimental group (EG; n = 15) and a control group (CG; n = 15). The EG completed eight 120-min sessions of group art therapy. The Person-in-the-Rain (PITR) drawing test was conducted with both groups before and after the EG completed art therapy. Results: The test revealed that EG members demonstrated lower stress and significantly higher stress resources and coping abilities than the CG members after the intervention. The group art therapy program improved the EG participants' ability to deal with stress. Discussion: This study's findings may offer insights useful for determining how best to provide psychological and emotional support to international students who have left their home countries and are continuing their academic journeys abroad.

Financial toxicity, coping strategies, and quality of life among Chinese patients with hematologic malignancies: a cross-sectional study.

PURPOSE: Financial toxicity is used to describe the financial hardship experienced by cancer patients. Financial toxicity may cause negative consequences to patients, whereas little is known in Chinese context. This study aimed to explore the level of financial toxicity, coping strategies, and quality of life among Chinese patients with hematologic malignancies. PATIENTS AND METHODS: We conducted a prospective, observational study among 274 Chinese patients with hematologic malignancies from November 2021 to August 2022 in Sun Yat-sen University Cancer Center. Clinical data were extracted from electronic clinical records. Data on financial toxicity, coping strategies, and quality of life were collected using PRO measures. Chi-square or independent t test and multivariate logistic regression were performed to explore the associated factors of financial toxicity and quality of life, respectively. Effects of financial toxicity on coping strategies were examined using Chi-square. RESULTS: The mean age of the participants was 50.2 (± 14.6) years. Male participants accounted for 57.3%. About half of the participants reported high financial toxicity. An average median of ¥200,000 on total medical expenditures since the diagnosis was reported. The average median monthly out-of-pocket health expenditure relating to cancer treatment was ¥20,000 (range ¥632-¥172,500) after reimbursement. Reduce daily living expenses (64.9%), borrowing money (55.7%), and choosing cheaper regimens (19.6%) were the commonly used strategies to cope with financial burden. Financial toxicity was negatively associated with quality of life (ß = 0.071, P = 0.001). CONCLUSIONS: Financial toxicity was not uncommon in patients with hematological malignancies. Reducing daily living expenses, abandoning treatment sessions, and borrowing money were the strategies commonly adopted by participants to defray cancer costs. Additionally, participants with high level of financial toxicity tended to have worse quality of life. Therefore, actions from healthcare providers, policy-makers, and other stakeholders should be taken to help cancer patients mitigate their financial toxicity.

Predicting psychological distress in advanced ovarian cancer patients during the COVID-19 pandemic.

PURPOSE: This longitudinal study investigated distress rates in patients with advanced ovarian cancer during the COVID-19 pandemic and examined whether time, illness representations, and coping strategies predicted distress levels. METHODS: UK patients with stage 3 or 4 ovarian cancer were recruited between September 2020 and March 2021. Data were collected at baseline (T0), 2 months (T1), and 4 months (T2) post-enrolment. Validated questionnaires assessed distress (anxiety, depression, PTSD, fear of progression) and predictors (coping strategies and illness perceptions), analysed via multilevel modelling. RESULTS: Seventy-two participants returned a questionnaire at T0, decreasing to 49 by T2. High distress was observed, with over 50% of participants experiencing anxiety and depression consistently. Nearly 60% reported clinical levels of fear of progression at some point. PTSD rates resembled the general population. Although distress levels remained stable over time, some individual variability was observed. Time had minimal effect on distress. Coping strategies and illness perceptions remained stable. Threatening illness perceptions consistently predicted distress, while specific coping strategies such as active coping, acceptance, self-blame, and humour predicted various aspects of distress. Together, these factors explained up to half of the distress variance. CONCLUSION: The findings have implications for routine screening for distress and the inclusion of psychological treatment pathways in advanced ovarian cancer care. Addressing illness representations is crucial, with attention to informational support. Future research should explore the long-term effects of heightened distress and the effectiveness of interventions targeting illness perceptions. This study informs current clinical practice and future pandemic preparedness in cancer care.

International medical learners and their adjustment after returning to their countries of origin: a qualitative study.

INTRODUCTION: International medical trainees, including residents and fellows, must cope with many challenges, such as differences in cultural hierarchical systems, languages, and acceptance. Nonetheless, the need for adjustment perpetuates even after training is completed abroad. When some international trainees return to their countries of origin, they continue to face adjustment challenges due to reverse culture shock. Others must make many further readjustments. This study presents an exploration of the adjustment and coping strategies of international medical learners after returning to their countries of origin upon completion of their programs. METHOD: This study employed a qualitative approach grounded in interpretivism and utilised inductive thematic analysis following Braun and Clarke's method. Semi-structured, in-depth individual interviews were employed to explore the participants' coping strategies. Participants included international medical learners who were (1) international medical graduates who had already returned to their countries of origin, (2) non-Canadian citizens or nonpermanent residents by the start of the programs, and (3) previously enrolled in a residency or fellowship training programme at the University of Toronto, Ontario, Canada. RESULTS: Seventeen participants were included. Three main themes and seven subthemes were created from the analysis and are represented by the Ice Skater Landing Model. According to this model, there are three main forces in coping processes upon returning home: driving, stabilising, and situational forces. The sum and interaction of these forces impact the readjustment process. CONCLUSION: International medical learners who have trained abroad and returned to their countries of origin often struggle with readjustment. An equilibrium between the driving and stabilising forces is crucial for a smooth transition. The findings of this study can help stakeholders better understand coping processes. As healthy coping processes are related to job satisfaction and retention, efforts to support and shorten repatriation adjustment are worthwhile.