Clinical depression and punishment sensitivity on the BART

Depression is associated with altered sensitivity to reward and punishment, which can influence complex decision-making. We examined punishment sensitivity in the performance of participants with major depressive disorder (MDD) with that of a comparison group on the automatic Balloon Analogue Risk Task (BART), which is a direct measure of risk taking. The present study examined the BART performance of 30 individuals with MDD and 30 matched comparison individuals. The comparison group (M = 63.25) entered a significantly (p < 0.001; d = 1.1) higher number of pumps on the BART than the MDD group (M = 50.83). Higher levels of depression symptoms were significantly correlated (r = -0.40, p < 0.05) with entering a lower number of pumps in the MDD group. MDD patients showed an increased sensitivity to punishment on the BART: after a loss, the MDD group decreased (M = 13.7) the number of subsequent pumps they entered by a significantly (p < 0.001, d = 0.81) greater amount than the comparison group (M = 4.35). This difference applied to losses only: no difference was found between the groups regarding the magnitude of change in pumps selected after a win. Findings suggest the presence of elevated punishment sensitivity among individuals with MDD, which may contribute to the maintenance of depressive symptoms

Guided Reflection Interventions Show No Effect on Diagnostic Accuracy in Medical Students

Background: Guided reflection interventions, in an effort to reduce diagnostic error, encourage diagnosticians to generate alternative diagnostic hypotheses and gather confirming and disconfirming evidence before making a final diagnosis. This method has been found to significantly improve diagnostic accuracy in recent studies; however, it requires a significant investment of time, and psychological theory suggests the possibility for unintended consequences owing to cognitive bias. This study compared a short and long version of a guided reflection task on improvements in diagnostic accuracy, change in diagnostic confidence, and rates of corrected diagnoses.Methods: One hundred and eighty-six fourth- and fifth-year medical students diagnosed a series of fictional clinical cases, by first impressions (control condition) or by using a short or long guided reflection process, and rated their confidence in their initial diagnostic hypothesis at intervals throughout the process. In the “short” condition, participants were asked to generate two alternatives to their initial diagnostic hypothesis; in the “long” condition, six alternatives were required.Results: The reflective intervention did not elicit more accurate final diagnoses than diagnosis based on first impressions only. Participants who completed a short version of the task performed similarly to those who completed a long version. Neither the short nor long form elicited significant changes in diagnostic confidence from the beginning to the end of the diagnostic process, nor did the conditions differ on the rate of corrected diagnoses.Conclusions: This study finds no evidence to support the use of the guided reflection method as a diagnostic aid for novice diagnosticians, who may already use an analytical approach to diagnosis and therefore derive less benefit from this intervention than their more experienced colleagues. The results indicate some support for a shorter, less demanding version of the process, and further study is now required to identify the most efficient process to recommend to doctors

What’s distressing about having type 1 diabetes? A qualitative study of young adults’ perspectives

Background: Diabetes distress is a general term that refers to the emotional burdens, anxieties, frustrations, stressors and worries that stem from managing a severe, complex condition like Type 1 diabetes. To date there has been limited research on diabetes-related distress in younger people with Type 1 diabetes. This qualitative study aimed to identify causes of diabetes distress in a sample of young adults with Type 1 diabetes. Methods: Semi-structured interviews with 35 individuals with Type 1 diabetes (23–30 years of age). Results: This study found diabetes related-distress to be common in a sample of young adults with Type 1 diabetes in the second phase of young adulthood (23–30 years of age). Diabetes distress was triggered by multiple factors, the most common of which were: self-consciousness/stigma, day-to-day diabetes management difficulties, having to fight the healthcare system, concerns about the future and apprehension about pregnancy. A number of factors appeared to moderate distress in this group, including having opportunities to talk to healthcare professionals, attending diabetes education programmes and joining peer support groups. Young adults felt that having opportunities to talk to healthcare professionals about diabetes distress should be a component of standard diabetes care. Conclusions: Some aspects of living with diabetes frequently distress young adults with Type 1 diabetes who are in their twenties. Clinicians should facilitate young adults’ attendance at diabetes education programmes, provide them with opportunities to talk about their diabetes-related frustrations and difficulties and, where possible, assist in the development of peer-support networks for young adults with diabetes

Measuring and managing the work environment of the mid-level provider – the neglected human resource

BACKGROUND: Much has been written in the past decade about the health workforce crisis that is crippling health service delivery in many middle-income and low-income countries. Countries having lost most of their highly qualified health care professionals to migration increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level providers are health workers who perform tasks conventionally associated with more highly trained and internationally mobile workers. Their training usually has lower entry requirements and is for shorter periods (usually two to four years). Our study aimed to explore a neglected but crucial aspect of human resources for health in Africa: the provision of a work environment that will promote motivation and performance of mid-level providers. This paper explores the work environment of mid-level providers in Malawi, and contributes to the validation of an instrument to measure the work environment of mid-level providers in low-income countries. METHODS: Three districts were purposively sampled from each of the three geographical regions in Malawi. A total of 34 health facilities from the three districts were included in the study. All staff in each of the facilities were included in the sampling frame. A total of 153 staff members consented to be interviewed. Participants completed measures of perceptions of work environment, burnout and job satisfaction. FINDINGS: The Healthcare Provider Work Index, derived through Principal Components Analysis and Rasch Analysis of our modification of an existing questionnaire, constituted four subscales, measuring: (1) levels of staffing and resources; (2) management support; (3) workplace relationships; and (4) control over practice. Multivariate analysis indicated that scores on the Work Index significantly predicted key variables concerning motivation and attrition such as emotional exhaustion, job satisfaction, satisfaction with the profession and plans to leave the current post within 12 months. Additionally, the findings show that mid-level medical staff (i.e. clinical officers and medical assistants) are significantly less satisfied than mid-level nurses (i.e. enrolled nurses) with their work environments, particularly their workplace relationships. They also experience significantly greater levels of dissatisfaction with their jobs and with their profession. CONCLUSION: The Healthcare Provider Work Index identifies factors salient to improving job satisfaction and work performance among mid-level cadres in resource-poor settings. The extent to which these results can be generalized beyond the current sample must be established. The poor motivational environment in which clinical officers and medical assistants work in comparison to that of nurses is of concern, as these staff members are increasingly being asked to take on leadership roles and greater levels of clinical responsibility. More research on mid-level providers is needed, as they are the mainstay of health service delivery in many low-income countries. This paper contributes to a methodology for exploring the work environment of mid-level providers in low-income countries and identifies several areas needing further research

A psycho-social-environmental lens on radon air pollutant: authorities’, mitigation contractors’, and residents’ perceptions of barriers and facilitators to domestic radon mitigation

IntroductionRadon is a major indoor air pollutant that poses a significant risk of lung cancer to those exposed in their homes. While mitigation of high radon levels in homes has been shown to be effective, home mitigation rates remain low. This study examines the barriers and facilitators to radon mitigation in homes from the perspectives of authorities responsible for radon risk management, the mitigation industry (contractors), and residents in four European countries (Belgium, Ireland, Slovenia, and the UK) with high radon risks and low mitigation rates.MethodsA multi-method approach was used to gather data from various stakeholders, including online surveys, content analysis of legal documents, group interviews, workshops, and focus groups.ResultsAuthorities, contractors, and residents identified various facilitators to radon mitigation, including legal requirements for mitigation, awareness campaigns, low mitigation costs, availability of financial support, accreditation of mitigation contractors, and a perception of radon as a health threat. However, barriers to mitigation were also identified, such as a lack of awareness, fragmented mitigation processes, and inadequate communication between stakeholders.DiscussionThe study highlights the complexity of the radon mitigation process and suggests that interventions aimed at increasing mitigation rates should target stakeholders beyond just residents, such as constructors, health professionals, and policy makers. An integrated approach to radon mitigation, from policy to provision, is necessary to effectively lower levels of this indoor air pollutant

Factors impacting the implementation of a psychoeducation intervention within the mental health system: a multisite study using the consolidation framework for implementation research

Background: Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. Methods: The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results: Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. Important factors in the outer setting domain included structural stability within national systems and the peer payment system, while the extent of a recovery�oriented culture, leadership, implementation readiness, and buy-in were influential factors in the inner setting. The characteristics of the intervention in terms of design, evidence-base and adaptability also shaped the intervention’s implementation as did the knowledge, beliefs and self-efficacy of facilitators. In terms of processes, implementation was influenced by the degree of engagement of key individuals who championed and supported the programme. The results highlight that while some of the barriers were specific to the programme, many reflected systemic and structural challenges within health services more generally. Conclusion: Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation. Keywords: Implementation science, Barriers, Enablers, Psychoeducation, Mental health services, Framework analysis, Consolidation framework for implementation researc

Scoping review of factors influencing the implementation of group psychoeducational initiatives for people experiencing mental health difficulties and their families

Background: Despite evidence to support the effectiveness of psychoeducation for people experiencing mental health difficulties and their families, understanding issues around the implementation of such programmes is limited. Aim: The aim of this scoping review was to synthesise the peer-reviewed literature on barriers and enablers influencing the implementation of group psychoeducation in adult mental health services. Methods: Using a pre-defined search strategy and PRISMA guidelines, four databases were systematically searched. Two reviewers independently screened and applied exclusion/inclusion criteria. Qualitative, quantitative, and mixed-methods studies were included if they provided empirical evidence on the barriers and enablers. Three reviewers independently extracted data. Following this, data were analysed using a five-level implementation framework. Results: Eight articles met the inclusion criteria. Barriers to implementation were identified at all five levels of the framework: participant; practitioner; intervention; organisational; and structural level. Enablers to implementation were evident at four levels: participant; provider; intervention; and organisational level. Conclusions: The findings of the review provide preliminary information on factors that impact implementation. However, large-scale studies informed by implementation theories are required. In addition, other studies are needed to address the potential impact of different models of intervention and explore strategies to minimize obstacles and support sustainability

Changes in language use mediate expressive writings benefits on Health-Related Quality of Life (HRQOL) following Myocardial Infarction

The present study assessed linguistic mediators on the effects of expressive writing on health-related quality of life (HRQOL), depression and anxiety following myocardial infarction (MI). One hundred and twenty-one cardiac patients were randomised (expressive writing?=?61; control?=?60), 98 (expressive writing?=?47; control?=?51) provided pre- and post-data, with 89 (expressive writing?=?43; control?=?46) completing the three-month follow-up. The expressive writing group wrote (20?mins/day for three consecutive days) about their thoughts and feelings regarding their MI, and the control group wrote (20?mins/day for three consecutive days) about daily events that occurred during the year prior to the MI. The outcome measures of depression, anxiety and HRQOL were completed pre-randomisation, post-intervention and three months post-intervention; the mediating variables assessed were changes in (a) positive emotion words, (b) negative emotion words and (c) cognitive-processing words. Three months post-intervention, the expressive writing group had significantly higher HRQOL. The positive effects of expressive writing were significantly associated with increases in both positive emotion words and cognitive-processing words across the three days of expressive writing. Expressive writing is a beneficial intervention that may enhance HRQOL among cardiac patients