Search Results (87)

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

Paraprofessionals play a crucial role in supporting both teachers and students within a classroom, even though the specifics of their duties vary. While their responsibilities involve supporting student achievement, research has shed light that many paraprofessionals feel unprepared for their responsibilities in the classroom. This study aimed to address a gap in the existing literature by exploring how a professional development program that mirrors the trainings special education teachers receive would impact paraprofessionals and help them feel more prepared for their responsibilities in the classroom. Employing a generic qualitative methodology, this study sought to capture the experiences of 43 paraprofessionals. Data collection involved an online open-ended questionnaire at the start and conclusion of the school year. The study’s outcomes revealed five patterns in the data: (a) paraprofessionals struggled with collaborating with classroom teams at the start of the school year, (b) paraprofessionals struggled with managing student behavior at the start of the school year, (c) professional development was helpful to most of the paraprofessionals, (d) professional development led to better preparedness to address challenging behavior, and (e) professional development led to better preparedness to address the instructional needs of students with disabilities. Following a thorough analysis and synthesis, these patterns were condensed into two general themes: the importance of professional development for paraprofessionals and the importance of presenting the professional development that teachers receive on a continuous basis to paraprofessionals as well. These findings are significant for school leaders and educators, as they highlight the importance of providing professional development to paraprofessionals while supporting students with disabilities. Full article

When designing, implementing and assessing public policies, and, in particular, those affecting the public management of religious diversity, it is increasingly common to include ethnographic approaches from the field of social anthropology and the broader social sciences. Ethnographic practice can provide more representative and accurate perspectives on the actors, settings, and social phenomena subject to regulation. This article presents the findings of an ethnographic study on two minority religious communities, conducted by a team of anthropologists within the framework of a broader research project on religious freedom in Spain, led by jurists. Based on two case studies—the teaching of Evangelical religion in state schools and Islamic burial practices—our study analyses the implications of the varying degrees of public recognition, as well as how this recognition actually manifests in the everyday practice of religious groups within a context of religious diversity. The study also examines the barriers to the full participation of these communities in public institutions and civil society, as well as the discourses, strategies, and practices they develop to overcome these challenges. Full article

Background/Objectives: Sexual health research involving young adolescents remains scarce despite rising rates of early sexual debut, pregnancies, and sexually transmitted infections (STIs) in this population. We explored community stakeholders’ perspectives on engaging young adolescents in sexual health research in Western New York to inform strategies for engaging young adolescents in sexual health research. Methods: This qualitative descriptive study was conducted from April 2022 to June 2023. Seventeen community stakeholders, including health education teachers, youth counselors, and adolescent health providers, participated in semi-structured in-depth interviews. Data were analyzed using conventional content analysis, managed by MAXQDA 2020. The rigor and trustworthiness of the data were ensured through triangulation with observations, peer debriefing, team analysis, and respondent validation. Results: Participants were predominantly female (94.1%), 52.9% Black/African American, 41.2% White, and 5.9% Caucasian–Indian American, and aged 23–59 years. Four themes emerged: perspectives on conducting sexual health research with young adolescents, recruitment strategies, sexual health questions appropriate for young adolescents, and building readiness for participation in sexual health research. Participants reported the need for sexual health research with young adolescents and recommended building a trusting relationship and involving schools, parents, and trusted community organizations in the research process. Suggested research questions included those related to awareness of sex, STIs, available resources, experiences with sexual education, and desired support. The findings also revealed the need to initiate sexual health conversations early when children start asking questions, as a foundation for meaningful participation in sexual health research. Conclusions: The findings suggest that sexual health research with young adolescents is feasible and necessary, with implications for the design of developmentally appropriate sexual health research and interventions grounded in trust and community collaboration. Future research should explore the perspectives of caregivers and young adolescents to inform studies and programs that are attuned to young adolescents’ developmental needs. Full article

Background/Objectives: The pediatric mental health crisis in the United States has reached unprecedented levels. Severe shortages in specialized health care professionals, particularly child and adolescent psychiatrists (CAPs), exacerbate the challenge of delivering timely and quality mental health care, especially in rural areas like Kansas. Innovative models such as Pediatric Mental Health Care Access (PMHCA) programs and School-Based Health Clinics (SBHCs) aim to integrate mental health expertise into primary care settings to address this gap. Methods: This paper examines an integrated care model to support SBHCs developed by the Kansas PMHCA. The Interprofessional Child-Centered Integrated Care Model (ICX2) was implemented within an SBHC in Haysville, KS. ICX2 utilizes biweekly collaborative team meetings (CTMs) via zoom involving primary care, psychology, child psychiatry, social work, and school resource coordinators to discuss patient cases and enhance the primary care management of pediatric mental health. This descriptive study analyzes data from January 2023 to June 2023, focusing on patient demographics, case characteristics discussed during CTMs, and recommendations made by the interprofessional team. Results: Findings illustrate the complex biopsychosocial needs of patients seen and define themes of case consultation and recommendations. Conclusions: Integrated care programs like ICX2 can be feasibly implemented through PMHCA programs and may be an efficient intervention to bridge resource gaps. Full article

Background: Fundamental movement skills (FMS)—including muscular strength, endurance, and mobility—are linked to better health-related quality of life and higher physical activity in children. Rural children often score lower on FMS tests than urban peers due to resource limitations rather than ability. Thus, increasing access to FMS activities in under-resourced rural areas is essential. The primary objective was to test the feasibility of Hoosier Strength in a rural middle school sample, and the secondary objective was to observe the preliminary changes in FMS-related outcomes pre- to post-intervention and at follow-up. The exploratory objective was to explore how participants responded to different coaches on the Hoosier Strength coaching team (i.e., gender, coaching style during activities). Methods: This study used a Hybrid Type 3 design to evaluate feasibility and FMS outcomes, integrating qualitative and quantitative data. The four-week intervention included a test group (n = 24; 14 females, 10 males; mean age: females 12.4 ± 0.5 years, males 12.7 ± 0.4 years) and a control group (n = 12; 8 females, 4 males; mean age: females 12.9 ± 0.3 years, males 12.7 ± 0.3 years). Data analysis included descriptive statistics for feasibility indicators (Acceptability of Intervention Measures [AIM], Intervention Appropriateness Measure [IAM], and Feasibility of Intervention Measure [FIM]), linear regression for mobility and muscular endurance changes, t-tests for psychological need satisfaction and frustration, and regression analysis for squat knowledge and post-intervention confidence. Results: (1) There was high feasibility across the 4-week Hoosier Strength intervention and at follow-up; (2) there were no statistically significant changes in squat performance; (3) participants’ confidence in their ability to squat at the end of the intervention was significantly predicted by their squat knowledge at baseline; and (4) participants prioritized leadership and team management over tactical analysis, highlighting a preference for coaches who foster teamwork. Conclusions: The findings offer a transparent approach for evaluating the feasibility and preliminary outcomes of the Hoosier Strength intervention in an under-resourced rural middle school, thereby encouraging further investigation into strength training interventions in rural schools. Full article

Background: Many schools are committed to the “Five Steps to a Health Promoting School guide” created by the Schools for Health in Europe (SHE) network to avoid chronic disease and promote healthy environments. Objectives: The aim of this study was to evaluate schools’ health promotion policies and practices via the SHE rapid assessment tool. Methods: From February 2019 to June 2019, a cross-sectional survey based on this tool was conducted in nine international schools that are part of a private network operating in multiple countries. The entire school community was offered the opportunity to participate. The survey consisted of 37 questions aligned with the whole-school approach to health promotion and addressed orientation, healthy school policy, the physical and social environment, health skills, community links, and staff well-being using a three-point scale. A univariate analysis was subsequently performed. Results: A total of 929 people responded, 59.7% of whom were women, representing 74 different nationalities (82.5% Europeans). The average age was 25.9 years, ranging from 7 to 77 years. The participants included 57.2% students, 21.3% teachers, 15.3% families, 3.2% management teams, 1% counsellors/psychologists, 1% administrative/service staff, 0.5% catering staff, 0.3% nursing/medical staff, and 0.2% maintenance staff. The findings revealed that 80% of the respondents felt that most of these health promotion needs were being partially or fully addressed, predominantly with medium or high priority. However, 30% of the respondents indicated that the school had not yet assessed the students’ and employees’ health and well-being needs or fully promoted a healthy work-life. Conclusions: The SHE rapid assessment tool serves as an effective initial step in identifying key indicators within the school community, offering insights for future action towards becoming a health-promoting school. These results underscore the importance of addressing social and behavioural determinants of health within different international educational settings to promote positive sociorelational well-being and youth development. By fostering the well-being of children, adolescents, and the educational community, schools play a pivotal role in reducing the risk factors for chronic diseases and supporting psychosocial adaptation. Full article

This article addresses the validation of an instrument designed to measure organizational leadership practices for inclusion and evaluates the said instrument’s factorial structure and convergent validity. This work responds to the need for quantitative tools to assess how school principals promote inclusion, in recognition of its importance for guaranteeing student access to an equitable quality education at all levels, from early childhood education through high school. The above-referenced instrument was developed based on a comprehensive literature review and consultations with experts, resulting in a 36-item scale structured in six key dimensions: D1: Professional Development; D2: Inclusive Vision; D3: Support for the Teaching–Learning Process; D4: Building Networks; D5: Participation and Dialog, and D6: Resource Management. The validation process included a confirmatory factor analysis that supported the existence of a hierarchical structure of a general factor of leadership for inclusion that determines the aforementioned key dimensions, with adequate fit indices (χ²(588) = 1694.624, p < 0.001, CFI = 0.945, TLI = 0.941, RMSEA = 0.060, SRMR = 0.034) and high internal consistency in the general scale (α = 0.98, Ω = 0.96). In terms of convergent validity, the instrument showed significant and consistent correlations with related constructs such as teacher self-efficacy and pedagogical leadership. This study highlights the importance of leadership for inclusion as a central element of fostering participation and learning in diverse school contexts, by providing a reliable tool for continuous improvement of the school management team’s performance of its functions. Also, it is important input for education policymakers charged with formulating student equity, who recognize the enhanced well-being and active participation in the social environment that result from the greater inclusion of students in their educational communities. Full article

The reality in South Africa is that township school environments are not safe for early-career educators. According to South Africa’s Constitution in the Bill of Rights, every learner has the right to a free, reputable education. Although educators are obligated to facilitate this free education, the right to education does not supersede the right to safety because, without protection, more rights will be violated. This study aimed to explore forms of violence perpetrated by school management teams and learners against early-career educators in township schools in Soshanguve, South Africa. A qualitative research method was used to access deeper information on the topic. Clarke’s six steps of thematic analysis were used to analyse the data. Semi-structured interviews were used to gather information. The major findings of this study revealed four forms of violence experienced by early-career educators, which included physical and verbal violence, financial violence and sexual violence. This study recommends that parents should make a habit of checking their children’s schoolwork. This will hold learners accountable for their work. Parents should minimise engaging in conflict in the presence of their children, as this can have adverse emotional and psychological effects on them. They should provide a supportive environment for their children, which can foster a positive parent–child relationship. In addition, the community should play a proactive role in combating substance abuse by ensuring that substances are not accessible to children. Full article

The development of leadership competencies is a current topic in the scientific community. The weaknesses detected in our study reflect the limited treatment offered to this area of work and the current struggle of rural elementary school directors in navigating the challenges of the digital era. The following methods and techniques were used at the theoretical and empirical levels: analytical–synthetic, historical–logical, inductive–deductive, systemic, documentary analysis, observation, surveys, interviews, and self-assessment scales. The systematized theory is based on the process of development of leadership competence in school directors as a dimension of educational quality. This research introduced a professional development strategy for the development of leadership competence in primary school directors consisting of three stages, with their objectives and actions contributing to raising the scientific methodological level of these management teams, including workshops, consultancies, accompaniments, and case studies, as well as monitoring their transformation. The proposed strategy improves the educational leadership skills of school principals, encourages mastery of content, and increases the degree of motivation and interest in management work. It is based on the diagnosis of their reality, and it includes the combination of improvement, methodological, and self-improvement actions to stimulate reflection and the active involvement of participants in their own transformation process. Full article

In the Ugandan curriculum, theoretical teaching predominates in conveying water-related topics due to its efficiency and low resource requirements. However, this teacher-centred approach limits student interaction and collaborative learning. Conversely, game-based learning can enhance social skills, critical thinking, and engagement, yet it remains underutilised in Ugandan education. To address this gap, this study developed three educational games: Water Conservation Snakes and Ladders (WCSL), Water Awareness Quartet Cards (WAQC), and Water Pollution Puzzle (WPP). These games were implemented in four schools—three primary and one secondary—where students engaged in competitive, team-based play. The impact of these games on learning outcomes was assessed through pre- and post-test questionnaires. Descriptive and thematic analysis indicated a significant positive effect, with WAQC showing a 25% greater influence on performance than WCSL (18%) and WPP (14%). The findings also underscored the importance of age in determining game acceptability and enjoyment. To enhance education on water-related issues, it is recommended that these topics be integrated into both Science and Social Studies curricula and taught consistently across academic terms. Ultimately, the Ugandan government should consider incorporating game-based learning strategies into schools to improve student engagement and learning in water resource management. Full article

This paper presents a framework for implementing improvement science in a district or educational organization. Findings from interviews with 17 experienced educational improvers indicate critical elements for a school district to effectively support and build the capacity of individuals and teams situated at multiple levels in the district in organizing, implementing, and sustaining improvement science methods. Utilizing a systems-thinking approach, this study conceptualizes how to institutionalize improvement science across an educational organization. To institutionalize the use of improvement science, district leaders must center schools and integrate the work in existing structures, offer support, and create coaching, growth management, and knowledge management plans. Full article

Economic recession from the coronavirus outbreak continues to have negative rippling effects on local and international financial investments in public–private partnership (PPP) projects in Ghana, a developing country. Together with poor reports on operating cash-inflows for PPP projects such as those covering schools, hospitals, railways, fishing harbors, cocoa warehouses, recreational parks and affordable housing, there is an urgent need to develop and institutionalise sustainable and robust financial risk management measures. These measures are meant to mitigate financial losses, promote sustainability practices and prolong the longevity of infrastructure developments within PPP pacts. Therefore, this study aims to assess the mitigation measures of PPP infrastructure management in Ghana. Primary data from survey questionnaires were utilised in this study, with the data obtained from PPP practitioners and experts. Data were grouped into project type, sectors and practitioners of PPP projects to aid the analysis using tools such as the Kruskal–Wallis test, the Mann–Whitney U test and factor analysis. The results demonstrate sustainable and green finance, the innovative skills and competencies of project teams, green financial risk models and inclusive cost reduction strategies as crucial to minimising financial risks in PPP project delivery. These findings have significant implications for PPP practitioners and researchers in Ghana and similar developing countries to understand and develop measures to respond to financial risks for sustainable PPP project development and future research studies. Full article

Moebius syndrome is a collection of orofacial anomalies with highly variable features affecting many different systems but characterised by bilateral facial palsy and absent eye abduction. We largely regard Moebius syndrome as a diagnosis of exclusion. Lack of awareness and knowledge means that children often fall between services, leading to treatment delays and difficulty interfacing with social care and schools, with long-term impact on physical health and psychosocial development. We developed a multidisciplinary team comprising core clinicians (lead physician, geneticist, speech and language therapist, psychologist and specialist nurse) and an expanded group to encompass the other affected systems. The interactions between our specialties lead to the development of a treatment protocol, which we present. The protocol harnesses the aspects of care of children with a range of other rare diseases at a specialised paediatric centre and synthesises them into a holistic approach for MBS and related conditions. Management is sequenced on an “ABC-style” basis, with airway, feeding, vision and speech taking priority in the early years. We define management priorities as airway stabilisation with swallow assessment, ocular surface protection and maintenance of nutritional support. Management principles for issues such as speech, reflux, drooling and sleep issues are outlined. In later years, psychological support has a prominent role geared towards monitoring and interventions for low mood, self-esteem and bullying. Full article

Background: Most people believe that student–athletes experience fewer difficulties related to mental health than non-sport participants. However, several studies have shown high depression levels or emotional difficulties in adolescent athletes. Most secondary school students have access to athletic trainers in their schools. Secondary school athletic trainers (SSATs) are medical professionals who can provide health care for student–athletes, and they could be appropriate supporters in providing mental health management in secondary schools. However, there are no studies that have addressed their preparedness and confidence level to manage potential risk factors and mental health disorders. This study aims to ascertain preparedness and confidence levels from SSATs’ perspectives in handling mental health disorders using a survey based on the mental health management guidelines and consensus statement. Methods: This is a cross-sectional study design. The research team created an online survey questionnaire based on the National Athletic Trainers’ Association (NATA) Mental Health Guidelines for Secondary School and Interassociation Recommendation: A Consensus Statement. Utilizing the NATA Research Survey Service, the online survey was emailed to SSATs who self-categorized as secondary school athletic trainers in the NATA membership system. (n = 171, 65% completion rate). SPSS was used to analyze the survey data. Result: This study found that 29.2% of SSATs reported they have policies or guidelines regarding mental health disorders management for minors. The most frequent policy was mandatory reporting in cases in which an individual is being abused or neglected (80.5%). The highest confidence area was aligned with the most frequent policy. The least frequent policy was considering unique stressors and triggers with student–athletes to recognize the potential mechanisms that may cause a mental illness or exacerbate an existing mental illness (58.5%). Even though the least frequent policy was not aligned with the least confidence area, it was the second lowest confidence level. This study identified significant differences between two different employment structures: school-based employment and hospital-based employment structures. Policies were more common in school-based employment than in hospital-based employment structures. Conclusion: This study demonstrated the gap between organizational and individual preparation. The majority of SSATs respondents expressed moderate to high confidence in their ability to manage mental health disorders, despite the lack of mental health policies or procedures in their secondary schools. This study recommends that SSATs create guidelines or procedures in the areas where they are least confident and prepared to offer mental health management for minor student–athletes. They can use the interassociation recommendations and the NATA guidelines for mental health care to close the gap. Full article