The Resident-Medical Student Shadowing Program is a novel program in which first-year medical students shadowed a first-year resident during their clinical duties. It was developed to enhance the preparedness of medical students for clinical training. To examine the program’s effectiveness, a randomized control trial was conducted within a concurrent triangulation mixed methods study. Student participants were compared to controls using validated questionnaires. Participants’ experiences were further explored using semi-structured interviews. Results indicate that participation gave students an understanding of the clinical environment and their role within it, and taught them the skills and knowledge needed to perform that role. Students’ learning was enhanced by the relationship developed with their resident, facilitated by the residents’ approachability and relatability and their dedication to teaching. Residents, in turn, gained expertise in teaching and learned about professionalism. Suggestions for implementing this program in the future as well as future directions for research are discussed. / Measurement, Evaluation and Cognition

Background: there is limited research to show that a social intervention such as increasing income improves health, especially as this relates to older people. It is known that poverty is a real problem for many older people in Northern Ireland. One reason for this is that older people often do not claim the financial benefits for which they are entitled. This is a randomised controlled study that sought to investigate the health effects of an increased uptake of social security benefits. Methods: The aims of this study were to find out if an increase in income through the take up of unclaimed financial benefits lead to a significant improvement in the health status of older people and discover if this was maintained over a reasonable period of time. This was a randomised control trial based in the community. Patients were recruited from 11 general practices in South Down, Craigavon, Fermanagh and Tyrone. The intervention consisted of a benefit assessment followed by assistance completing the benefit application. The control group received the assessment but were not give assistance with the application. Instead they were given a list of agencies where help with the application could be found. A range of health, psycho-social and financial outcome was measured. Results: Of the 2180 patients who were sent invitation letters 300 agreed to a benefits assessment. 189 enrolled in the study and 149 were followed up at six months. A total of 89 patients received additional weekly benefits amounting to approximately £3277.19 per annum (£63 per week). A further 13 patients received one off payments totaling £5,731.01. All but two patients received their benefits within three months of assessment. While analysis showed trends suggesting greater improvements in social support and depression scores for the intervention group when compared with the controls the difference were not statistically significant. This is probably due to the following factors. The sample size in this study was small because of problems with the recruitment and screening of patients. More patients in the control group claimed benefits than had been anticipated and as a result it was difficult to detect differences between the two groups. Discussion: Valuable lessons have been leant and modifications to the study methodology have been suggested that will be of use to other researchers attempting to undertake similar studies in the UK.

Leadership is important to quality improvement initiatives in healthcare. However, few studies have evaluated leadership interventions to enhance nurses’ use of guideline recommendations in the field of knowledge translation. Purpose: To develop and evaluate an intervention designed to operationalize a leadership strategy composed of relations, change, and task-orientated leadership behaviours, and to examine its influence on nurses’ use of guideline recommendations in home-care nursing. Design: Sequential mixed methods pilot study with post-only cluster randomized controlled trial. Methods Phase I: Intervention Development 1. A participatory approach was used at a community healthcare organization with 23 units across the province of Ontario, Canada. The guideline selected was developed by the Registered Nurses’ Association of Ontario for the assessment and management of foot ulcers for people with diabetes. 2. Integrative literature review, qualitative interviews, and baseline chart audits were conducted. 3. Four units were randomized to control or experimental groups. 4. Clinical and management leadership teams participated in a 12-week intervention consisting of printed materials, interactive workshop, and teleconferences. Participants received summarized chart audit data, identified priority indicators for change, and created a team leadership action plan to address barriers and influence guideline use. Phase II: Evaluation 5. Chart audits compared differences in nursing process and patient outcomes. Primary outcome: eight-item nursing assessment score. 6. Qualitative interviews evaluated the intervention and leadership behaviours. Results: No significant difference was found in the primary outcome. A significant difference was observed in nurses’ documentation of five priority indicators chosen by the experimental groups (p=.02). Gaps in care included: 53%, 76%, and 94% of patients not assessed for ulcer depth, foot circulation, or neuropathy (respectively); 75% and 93% did not receive wound debridement or hydrogel dressings. Receiving data to identify priority indicators for change and developing a leadership action plan were reported as useful to guideline implementation. The experimental group described using more relations-oriented leadership behaviours conducting audit and feedback, and sending reminders. Conclusion: Findings from this pilot study suggest that leadership is a team process involving relations, change, and task-oriented behaviours enacted by managers and clinical leaders. A leadership model is proposed as a beginning taxonomy to inform future leadership intervention studies.

To understand how to better stimulate adult sport engagement, this study investigated effects of gain-framed messages (GFM; Rothman & Updegraff, 2010) on psychological/behavioural outcomes, with or without efficacy-enhancing messages (Latimer et al., 2010). Eligible adults (30-69 years-old) were randomly assigned to one of two experimental conditions (‘GFM alone’ or ‘GFM plus efficacy-enhancing messages’), or a control condition. Participants (N = 232; 62.5% female) completed baseline/screening measures, watched their messaging intervention and reported outcomes one-week later (Time 2), and responded one-month later (Time 3). Comparing the experimental conditions showed non-significant differences for all outcomes, indicating no added benefit of efficacy-enhancing messages. Collapsing the experimental groups and comparing against the control showed significant group-by-time interactions for three ‘outcome expectancies’ (travel, social affiliation, stress relief), with reports higher among experimental participants. Results also indicated that moderate-to-vigorous physical activity significantly decreased at Time 3 within the control, but remained constant among experimental participants.

This diploma thesis represents a sum of theoretical findings about correlates and antecedents of boredom and an empirical investigation of opened questions about boredom, according to the literature. This was done through a laboratory experiment in which the author of the thesis, in order to investigate the research questions, induced boredom in the research participants. The research aim of this thesis involves three topics. The primary purpose of the experiment is to assess the experimental manipulation effects of causal attribution of attentional failure on the intensity of boredom. In order to investigate the main research questions, the author of this thesis created a specific experimental design. This includes a fictive subliminal distracting element representing an alternative cause explaining attentional failure during a task reliably eliciting boredom. Experimental design was also developed to fulfil a secondary aim of this thesis, to explore some of the correlates of boredom with emphasis on the question of relation between activation and boredom. The third aim is to investigate hypothesis about the type of activities preferred after the boredom induction by giving a choice to participants between interesting and an enjoyable videoclip. The results of the experiment do not support the main...

OBJECTIVE: To identify scalable interventions for improving sexual minority mental health and health-risk behavior, this study tested the efficacy of two self-guided online writing interventions-expressive writing and self-affirmation. To reach sexual minority young adults living in high-stigma, low-resource settings, we developed and tested these interventions in Appalachian Tennessee. METHOD: In consultation with sexual minority young adults (n = 10) and stakeholders (n = 10) living in Appalachian Tennessee, we adapted these two writing interventions that we then delivered to 108 local sexual minority young adults (Mage = 23.68, SD = 3.11). Participants, representing diverse sexual and gender identities and socioeconomic backgrounds, were randomly assigned to participate in a 3-session expressive writing intervention, self-affirmation intervention, or neutral control. Participants completed mental health and health-risk behavior measures at baseline, postintervention, and 3-month follow-up. RESULTS: Compared to the neutral control, expressive writing exerted 3-month improvements in depressive symptoms (d = 0.48) and general psychological distress (d = 0.36) whereas self-affirmation exerted improvement in suicidal ideation (d = 0.62) and drug abuse (d = 0.59). Participants who were exposed to greater contextual minority stressors common in rural regions (i.e., discrimination and victimization) experienced significantly greater 3-month reductions in depression from expressive writing and self-affirmation compared to control. Those who experienced greater discrimination also experienced significantly greater 3-month reductions in suicidality from self-affirmation compared to control. CONCLUSION: Brief writing interventions exert significant impact on the mental health of young adult sexual minorities, especially those exposed to minority stress. Future research can consider strategies for population-level implementation, especially in high-stigma, low-resource settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

BACKGROUND: In March of 2020, the novel coronavirus 2019 (COVID-19) pandemic required healthcare systems to be rapidly responsive to adapt hospital guidelines for the most up-to-date care and safety protocols as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate, and non-COVID-19 patients have now returned to the emergency department for care. This increase in patient volume leads to new challenges and threats to patient and clinician safety as suspected COVID-19 patients need to be quickly detected and isolated amongst other patients with non-COVID-19 related illnesses. In addition, emergency physicians face continued personal safety concerns and increased work burden on the front lines, heightening stress and anxiety. Burnout is a serious concern for emergency physicians due to the cumulative pressures of their daily practice, even under non-pandemic circumstances. Given the prolonged course of the pandemic, burnout may likely present as a longer-term outcome of these acute stressors. METHODS: A rapidly adaptive simulation-based approach was implemented to understand and improve physician preparedness while decreasing physician stress and anxiety. A randomized control trial was conducted to test the effectiveness of a simulation preparedness intervention on physician physiologic stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory. OUTCOMES: Front-line EM physicians participated in a simulation-based educational intervention aimed to facilitate the adoption of protocols and treatment algorithms. Four virtual simulation scenarios highlighted the care pathways a practitioner might implement when managing a COVID-19 positive patient. A debriefing session followed each scenario to interactively analyze the learners' management decisions. The discussion focused on the most current hospital protocols so that any gaps in knowledge could be successfully addressed. The scenarios were iteratively updated, and the debriefing emphasis changed to deliver the newest clinical guidance and operational procedures as they evolved while continuing to highlight the aspects of care that remained challenging. Ongoing analysis of the physiological data is still being conducted. NEXT-STEPS: Mixed model analysis of physiologic and self-report measures of stress and anxiety will be used to determine if this virtual simulation intervention improves adherence to guidelines and protocols in the clinical setting and its impact on physicians while on shift. The next steps include further dissemination and objective feedback from institutions that may adopt this learning intervention.

Adoption of new agricultural technologies by farmers in developing countries is sometimes limited, despite the associated benefits. Potato farmers in Carchi, Ecuador rely heavily on pesticides to limit pest and disease damage, rather than adopting a more sustainable and economically viable alternative: Integrated Pest Management (IPM). One reason IPM adoption is limited is that farmers are uncertain about the benefits of the complex technology. Information provision builds knowledge that reduces that uncertainty and leads to adoption. Another reason for limited adoption is that other farming activities compete for time, and farmers may forget or delay IPM adoption. One way to transfer information and remind farmers to adopt IPM practices is through text messages. To evaluate the impact of text messages on IPM adoption, we conducted a Randomized Control Trial (RCT) among potato farmers in Carchi, Ecuador. The RCT allowed us to identify the causal impact of text messages by comparing adoption rates and knowledge scores between farmers who received text messages (treatment), and farmers who did not (control). After attending a one-day training, the treatment received tailored IPM messages for approximately five and a half months. At the conclusion of the trial period, treatment and control farmers reported their adoption of individual IPM practices, and were tested on their IPM knowledge. Treatment farmers adopted both simple and complex practices at higher rates than the control. Farmers who received text messages also possess more knowledge about IPM techniques than non-recipients, which is evidence of the knowledge-building effect of text messages. Furthermore, text messages were shown to be effective in encouraging the adoption of practices for which no separate inputs were required, and ineffective in encouraging practices where a separate input was required. Text messages are an positive supplement to an in-person training program because they build knowledge and remind farmers, both of which encourage the adoption of IPM, which benefits the farmer, his community, and the environment. / Master of Science

京都大学 / 新制・論文博士 / 博士(人間健康科学) / 乙第13615号 / 論人健博第15号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 梁 楠, 教授 黒木 裕士, 教授 松田 秀一 / 学位規則第4条第2項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

INTRODUÇÃO: O transtorno de escoriação (TE) é caracterizado pela escoriação recorrente da pele, ocasionando lesões, apesar de repetidas tentativas de cessar o comportamento. Dentre os tratamentos disponíveis, a psicoterapia vem demonstrando ser a alternativa mais eficaz, mas faltam evidências para se estabelecer um método definitivo de tratamento. Os indivíduos com TE têm dificuldade em identificar e manejar suas emoções, e a escoriação pode ser uma tentativa malsucedida de regulá-las. O objetivo do presente estudo foi investigar a eficácia da psicoterapia psicodramática em grupo para melhora da regulação emocional e redução de sintomas dos portadores de TE. MÉTODO: estudo randomizado e controlado, com grupo experimental submetido à psicoterapia psicodramática em grupo (PPG) e grupo controle, à psicoterapia de apoio em grupo (PAG). Cinquenta e três pacientes foram selecionados, 26 tratados com PPG e 27 com PAG. Duas escalas foram traduzidas, adaptadas, validadas para o português brasileiro e utilizadas para avaliação do desfecho - a skin picking scale revised e a skin picking impact scale short version. Além destas, foram utilizadas a escala de dificuldade de regulação emocional, escala de impressão clínica global, escala de depressão de Beck, escala de ansiedade de Beck e escala de adequação social. RESULTADOS: Não houve diferenças relevantes dos perfis sociodemográficos e clínicos entre os grupos experimental e controle. A maioria da amostra constituiu-se de mulheres caucasianas com formação cristã e diploma universitário, com alto índice de comorbidades, sendo depressão e ansiedade as mais recorrentes. Quando a analisada em conjunto, a amostra total apresentou redução significativa da escoriação ao longo do tempo (p= < 0,001), mas não houve diferença significativa na comparação entre os grupos (p=0,410). Também houve melhora para a amostra total no impacto da escoriação (p=0,001), dificuldade de regulação emocional (p=0,023), ansiedade (p=0,001) e impressão clínica global (p= < 0,001), porém na comparação entre grupos não houve diferença significativa nestes aspectos (respectivamente p=0,336; p=0,255; p=0,524; p=0,601). Sintomas depressivos e adequação social apresentaram melhora ao longo do tratamento, com tendência a significância (p=0,081 e p=0,066, respectivamente). DISCUSSÃO: O presente estudo apresenta um perfil de paciente em tratamento por TE compatível com o relatado em estudos anteriores no que diz respeito aos aspectos sociodemográfico e clínico, além de uma boa resposta clínica ao tratamento com psicoterapia de grupo, independentemente do método utilizado (PPG ou PAG). CONCLUSÃO: A PPG não foi superior ao PAG. O tratamento em grupo pode ser uma opção para indivíduos com TE, com benefícios que extrapolam a melhora do comportamento de escoriação da pele, como por exemplo a superação do isolamento social e a melhora da regulação emocional / INTRODUCTION: Excoriation disorder (ED) is characterized by recurring skin picking, resulting in lesions, despite frequent attempts to cease such behavior. Amongst available treatments, psychotherapy has shown to be the most efficacious alternative, but there is lack of evidence in order to establish a definitive treatment method. Individuals with ED have difficulty in identifying and dealing with their emotions and excoriation may be an unsuccessful attempt at trying to regulate them. The goal of this study was to investigate the efficacy of group psychodrama psychotherapy to improve emotional regulation and reduce the symptoms of individuals with ED. METHOD: the study design was a randomized controlled trial, with the experimental group submitted to psychodrama group psychotherapy (PGP) and the control group to support group psychotherapy (SGP). Fifty-three patients were selected, 26 treated with PGP and 27 with SGP. Two scales were translated, adapted and validated to Brazilian Portuguese and utilized for outcome evaluation - the skin picking scale revised and the skin picking impact scale short version. In addition, it was used the difficulties in emotional regulation scale, the clinical global impression scale, the Beck depression inventory, the Beck anxiety inventory and the social adjustment scale. RESULTS: No relevant differences were found in the sociodemographic and clinical profiles amongst the experimental and control groups. The majority of the sample was Caucasian, female with a Christian background and university degree, with high rate of co-morbidities, the most recurrent being depression and anxiety. Both PGP and SGP were efficacious in terms of reduction of excoriation at the within subjects\' comparison (p= < 0,001), but there was no significant difference in the comparison between the groups (p=0,410). Improvement also was found for the whole sample for excoriation impact (p=0,001), difficulties in emotional regulation (p=0,023), anxiety (p=0,001) and clinical global impression (p= < 0,001), but not between the groups (respectively p=0,336; p=0,255; p=0,524; p=0,601). Depressive symptoms and social adequacy presented an improvement throughout the treatment, with a tendency towards statistical significance (p=0,081 and p=0,066, respectively). DISCUSSION: This study presents a profile of the treatment-seeking ED patient that is compatible with reports from previous studies in regards to socio-demographic and clinical features, besides a good clinical response to group intervention was observed, regardless of the method utilized. CONCLUSION: PGP was not superior to SGP. Group treatment may be an option for ED individuals, with benefits that extrapolate the improvement of skin excoriation behavior, as for example overcoming social isolation and improvement in emotional control