COVID-19 and Death Anxiety: The Impact on Students’ Appraisals to Completing Advance Directives

This study examined possible effects of COVID-19 on students’ appraisals, coping, and responses to completing advance directives (ADs). We used the transactional model of stress and coping to explore 93 undergraduate students’ responses to an AD assignment completed in an undergraduate course during COVID-19. Students watched a recorded lecture, read content related to ADs, and examined a sample copy of a 5 Wishes document. Students completed an assignment reflecting on reactions to completing ADs. Content analysis of 65 responses indicated almost 10% of students mentioned COVID-19 or the pandemic as a reason to complete ADs. Approximately 18% mentioned their youth and 40% mentioned sudden or serious illness as reasons to complete ADs. Nearly 30% mentioned death anxiety as a reason for being unprepared to complete ADs. Instructors should consider ways to inform and help students process their emotions given contextual factors (e.g. the pandemic) when teaching about ADs.

The effectiveness of intervention based on the transactional model on improving coping efforts and stress moderators in hemodialysis patients in Tehran: a randomized controlled trial

Background Present study was conducted to determine the effect of training on coping efforts and stress moderators, based on transactional model of Lazarus and Folkman, in hemodialysis patients. Methods This is a randomized controlled clinical trial on 116 hemodialysis patients referred to dialysis centers in Tehran from May to August 2018. The patients were assigned to two experimental and control groups using a simple randomization method. The intervention included 6 training sessions in the form of coping efforts and moderators of transactional model. Data were collected before and 3 months after the intervention. Data were analyzed using SPSS 16. Results After 3 months training intervention, there was significant increase in the intervention group in the mean scores of coping efforts (P < 0.001), moderators and subscales of emotional regulation from 51.18 ± 20.42 to 64.87 ± 13.18 (P < 0.001), dispositional coping style from 45.56 ± 19.45 to 55.84 ± 18.03 and social support from 49.61 ± 20.14 to 55.55 ± 17.35 (P < 0.005). Conclusion The training based on transactional model was successful in the increase of social support, dispositional coping style and emotional regulation in hemodialysis patients. Therefore, Nurses and healthcare providers can use this program to help hemodialysis patients to increase their adaptation to the illness and reduce stress. Trial registration IRCT registration number: IRCT20180524039814N1; Registration date: 13-08-2018; Registration timing: retrospectively registered: Last update: 13-08-2018.

Technical Considerations for a Transactional Model to Realize the Digital Extended Specimen

Technological innovations over the past two decades have given rise to the online availability of more than 150 million specimen and species-lot records from biological collections around the world through large-scale biodiversity data-aggregator networks. In the present landscape of biodiversity informatics, collections data are captured and managed locally in a wide variety of databases and collection management systems and then shared online as point-in-time Darwin Core archive snapshots. Data providers may publish periodic revisions to these data files, which are retrieved, processed and re-indexed by data aggregators. This workflow has resulted in data latencies and lags of months to years for some data providers. The Darwin Core Standard Wieczorek et al. (2012) provides guidelines for representing biodiversity information digitally, yet varying institutional practices and lack of interoperability between Collection Management Systems continue to limit semantic uniformity, particularly with regard to the actual content of data within each field. Although some initiatives have begun to link data elements, our ability to comprehensively link all of the extended data associated with a specimen, or related specimens, is still limited due to the low uptake and usage of persistent identifiers. The concept now under consideration is to create a Digital Extended Specimen (DES) that adheres to the tenets of Findable, Accessible, Interoperable and Reusable (FAIR) data management of stewardship principles and is the cumulative digital representation of all data, derivatives and products associated with a physical specimen, which are individually distinguished and linked by persistent identifiers on the Internet to create a web of knowledge. Biodiversity data aggregators that mobilize data across multiple institutions routinely perform data transformations in an attempt to provide a clean and consistent interpretation of the data. These aggregators are typically unable to interact directly with institutional data repositories, thereby limiting potentially fruitful opportunities for annotation, versioning, and repatriation. The ability to track such data transactions and satisfy the accompanying legal implications (e.g. Nagoya Protocol) is becoming a necessary component of data publication which existing standards do not adequately address. Furthermore, no mechanisms exist to assess the “trustworthiness” of data, critical to scientific integrity, reproducibility or to provide attribution metrics for collections to advocate for their contribution or effectiveness in supporting such research. Since the introduction of Darwin Core Archives Wieczorek et al. (2012) little has changed in the underlying mechanisms for publishing natural science collections data and we are now at a point where new innovations are required to meet current demand for continued digitization, access, research and management. One solution may involve changing the biodiversity data publication paradigm to one based on the atomized transactions relevant to each individual data record. These transactions, when summed over time, allows us us to realize the most recently accepted revision as well as historical and alternative perspectives. In order to realize the Digital Extended Specimen ideals and the linking of data elements, this transactional model combined with open and FAIR data protocols, application programming interfaces (APIs), repositories, and workflow engines can provide the building blocks for the next generation of natural science collections and biodiversity data infrastructures and services. These and other related topics have been the focus of phase 2 of the global consultation on converging Digital Specimens and Extended Specimens. Based on these discussions, this presentation will explore a conceptual solution leveraging elements from distributed version control, cryptographic ledgers and shared redundant storage to overcome many of the shortcomings of contemporary approaches.

A zoosemiotic approach to the transactional model of communication

The analysis of social communication in other-than-human animals poses several theoretical challenges due to the complexity of individual and extra-individual variables. Some previous studies have found a valuable solution in Uexküll’s work by expanding and adapting its usage for the study of communication in a heurtistic manner. An Umwelt analysis provides a theoretical toolbox, which allows researchers to take an emic perspective on the lives and phenomenal world of other animals. However, Umwelt and its elaborations do not allow for a clear distinction between acts of perception and communication and seem to ignore factors that escape the specific communication contexts under analysis. Thus, moving away from the existing linear and cyclical approaches to communication, we propose a complementary approach to the study of social communication by combining Barnlund’s transactional model of communication with Umwelt theory and the functional circle more specifically. Our elaborated model conceives social communication as the process of creating meaning through the interaction of two (or more) subjects and emphasizes the role of species-specific and individual features in its creation. Our goal is to re-evaluate the research on social communication of other-than-human animals by advocating for the theoretical and empirical potential of Umwelt, especially pertaining to animals with complex Umwelten. Our model offers a valuable solution to the analysis of intraspecies communication that accounts for the role of private and public cues as well as the subjects’ specific behaviors, messages, and context in the creation of meaning.

Factorial Structure of the Transactional eHealth Literacy Among Vietnamese Youth: An Instrument Validation Study

The progression into the Digital Age has brought an array of novel skill requirements. Unlike traditional literacy, there are currently few measures that can reliably measure eHealth literacy. The Transactional Model of eHealth Literacy and subsequent Transactional eHealth Literacy Instrument may provide a feasible option for measuring eHealth literacy. However, this instrument has yet to be validated, which is the aim of this study. We conducted an online cross-sectional study among 236 Vietnamese young people. Using exploratory factor analysis, we ensured that a model consisting of four factors had the best fit (RMSEA = 0.116; CFI = 0.907) and the highest internal consistency (Cronbach alpha = 0.96). A confirmatory factor analysis tested measurement invariance at four levels: configural, metric, scalar, and strict invariance. Only metric invariance was partially invariant, while the rest tested fully invariant. Even with partial metric invariance, there is reason to assume that functional, communicative, critical, and translational eHealth literacy (the four levels according to the transactional model) are consistently measured when deploying the Transactional eHealth Literacy Instrument across groups. In other words, this study suggests the instrument can be used for comparisons across groups and has the potential to generate high-quality data usable for informing change agents as to whether a particular population is proficient enough to adopt novel eHealth innovations.

Office relocation: changes in privacy fit, satisfaction and fatigue

Purpose The purpose of this study was to examine the effect of an office move (and associated changes in settings, protocols and autonomy) on changes in privacy fit, privacy-related coping appraisal as well as changes in satisfaction and fatigue. The study builds on Altman’s (1975) privacy regulation model and the cognitive appraisal theory as a transactional model of stress. Design/methodology/approach Data was collected over two points of measurement from 61 office workers who moved from a standard open-plan office to an office that is activity based. The first questionnaire was distributed six weeks prior to the office move and the follow-up questionnaire approximately eight months after. With its longitudinal design, this study extends past research by demonstrating the changing nature of privacy fit and revealing predictors of change in privacy fit and coping appraisal. Findings Cross-lagged autoregression analysis of change confirmed suggested predictors such as increase in variety of settings and in adherence of others to protocols that positively influenced post-move privacy fit. Further, change in coping appraisal post move was predicted by an increase in perceived environmental and behavioural flexibility. Changes in privacy fit and appraisal were associated with increases in job and workplace satisfaction and decreases in emotional and mental work fatigue post move. Originality/value Results could inform physical workplace design as well as cultural interventions in organisations. To the best of authors’ knowledge, this is the first study investigating the psychological process of privacy experience by using a transactional model of stress.

P-467 Emotions, Thoughts, and Coping Strategies of Women with Infertility Problems on Changes in Treatment during Covid-19 Pandemic: A Qualitative Study

Study question What are the emotions, thoughts and coping strategies of women with infertility problems on changes in treatment during the COVID-19 pandemic? Summary answer Treatment-related procedures keep changing directions, exposing the women to high level of uncertainty. Changes in treatments may be perceived as threats to achieving parenting goals. What is known already Both infertility and the treatment process constitute a stressful experience. Literature reports that couples describe infertility as the most difficult challenge to overcome in their lives. In addition, it has been reported that women experience more anxiety, stress, and depression than men during this period. Societies and individuals affected by large-scale disasters, such as global pandemics, can develop stress-related disorders. Current data indicate that closure of fertility clinic during the COVID-19 pandemic was associated with a sharp increase in the prevalence of anxiety and depression among patients undergoing fertility treatments and was perceived as an uncontrollable and stressful event. Study design, size, duration The research was designed as a qualitative study. The data were collected from two Internet forums between October - December 2020. Blogs most frequently used by women with infertility in Turkey were simultaneously selected. The comments of 30 women were included. Participants/materials, setting, methods Data were screened by using the directed qualitative content analysis. After selecting the blog, emotions, thoughts, and coping strategies expressed by 30 women whose treatment was canceled due to the Covid-19 pandemic or who continued treatment during this period were included in the analysis. The themes created were adapted to Lazarus and Folkman’s Transactional Model of Stress and Coping. Main results and the role of chance The thematic analysis of the expression of women with infertility problems in accordance with the Transactional Model of Stress and Coping stages of Lazarus and Folkman resulted in 4 themes: psychological changes, cognitive changes, changes in social life, and coping strategies. Some women perceived changes in treatments positively, and stopping the treatments due to the uncertainty of the pandemic and its effect on pregnancy and the baby made them feel safe. The majority of women appraised the closure of fertility clinics negatively impacted their lives. They experienced despair, uncertainty, disappointment, anxiety, anger, sadness, and exhaustion from waiting. Also, some participants did not find it right to delay the treatments and felt that the healthcare personnel postponed the treatments to avoid infection. Women experienced feelings of anger, distrust, and threats toward the health authorities. Moreover, the women in our study stated that they were always at home due to the pandemic, far from friends and family, and therefore did did not feel need for self-care and considered themselves ugly. The expressions of women mostly include emotion-based coping strategies. They used activities such as praying, exercising, distracting, noticing the positive side of postponing, and stopping treatments during the pandemic, accepting, and meditating. Limitations, reasons for caution Clinics closed due to the pandemic or limited procedures caused fewer women to come to the clinics. At the same time, it is not accepted for anyone other than working in the clinic to come to the clinics for scientific studies. Therefore, comments of women have been reached through blogs. Wider implications of the findings It is believed that approaches based on Lazarus and Folkman’s model helped the health professionals to determine potential stressors for women with infertility during the pandemic, and identified areas that required strengthening and improved personal coping strategies. Trial registration number not applicable

P–467 Emotions, Thoughts, and Coping Strategies of Women with Infertility Problems on Changes in Treatment during Covid–19 Pandemic: A Qualitative Study

Study question What are the emotions, thoughts and coping strategies of women with infertility problems on changes in treatment during the COVID–19 pandemic? Summary answer Treatment-related procedures keep changing directions, exposing the women to high level of uncertainty. Changes in treatments may be perceived as threats to achieving parenting goals. What is known already Both infertility and the treatment process constitute a stressful experience. Literature reports that couples describe infertility as the most difficult challenge to overcome in their lives. In addition, it has been reported that women experience more anxiety, stress, and depression than men during this period. Societies and individuals affected by large-scale disasters, such as global pandemics, can develop stress-related disorders. Current data indicate that closure of fertility clinic during the COVID–19 pandemic was associated with a sharp increase in the prevalence of anxiety and depression among patients undergoing fertility treatments and was perceived as an uncontrollable and stressful event. Study design, size, duration The research was designed as a qualitative study. The data were collected from two Internet forums between October - December 2020. Blogs most frequently used by women with infertility in Turkey were simultaneously selected. The comments of 30 women were included. Participants/materials, setting, methods Data were screened by using the directed qualitative content analysis. After selecting the blog, emotions, thoughts, and coping strategies expressed by 30 women whose treatment was canceled due to the Covid–19 pandemic or who continued treatment during this period were included in the analysis. The themes created were adapted to Lazarus and Folkman’s Transactional Model of Stress and Coping. Main results and the role of chance The thematic analysis of the expression of women with infertility problems in accordance with the Transactional Model of Stress and Coping stages of Lazarus and Folkman resulted in 4 themes: psychological changes, cognitive changes, changes in social life, and coping strategies. Some women perceived changes in treatments positively, and stopping the treatments due to the uncertainty of the pandemic and its effect on pregnancy and the baby made them feel safe. The majority of women appraised the closure of fertility clinics negatively impacted their lives. They experienced despair, uncertainty, disappointment, anxiety, anger, sadness, and exhaustion from waiting. Also, some participants did not find it right to delay the treatments and felt that the healthcare personnel postponed the treatments to avoid infection. Women experienced feelings of anger, distrust, and threats toward the health authorities. Moreover, the women in our study stated that they were always at home due to the pandemic, far from friends and family, and therefore did did not feel need for self-care and considered themselves ugly. The expressions of women mostly include emotion-based coping strategies. They used activities such as praying, exercising, distracting, noticing the positive side of postponing, and stopping treatments during the pandemic, accepting, and meditating. Limitations, reasons for caution Clinics closed due to the pandemic or limited procedures caused fewer women to come to the clinics. At the same time, it is not accepted for anyone other than working in the clinic to come to the clinics for scientific studies. Therefore, comments of women have been reached through blogs. Wider implications of the findings: It is believed that approaches based on Lazarus and Folkman’s model helped the health professionals to determine potential stressors for women with infertility during the pandemic, and identified areas that required strengthening and improved personal coping strategies. Trial registration number Not applicable

A Qualitative Study of the Impact of COVID-19 on Smoking Behavior for Participants in a Post-Hospitalization Smoking Cessation Trial

(1) Background: COVID-19 has substantially altered individual environments and behaviors. We aim to explore the impact of COVID-19 on the smoking behavior of individuals trying to quit tobacco. (2) Methods: This study presents a qualitative analysis of individual interviews focused on perceived impacts of the COVID-19 pandemic on tobacco use among 39 participants in the Helping HAND 4 (HH4) post-hospitalization smoking cessation trial (NCT03603496). (3) Results: Emergent impacts of COVID-19 included change in routine, isolation, employment changes, and financial challenges; these in turn were associated with boredom, altered cravings and triggers, and increased stress. The availability of effective coping mechanisms instead of smoking to deal with stress heavily influenced subsequent smoking behavior. These results were triangulated with the Transactional Model of Stress, providing a framework to elucidate connections between factors such as perceived control, self-efficacy, and dispositional coping style, and highlighting potential areas for intervention. (4) Conclusions: Results suggest that stress during the COVID-19 pandemic may undermine effective coping skills among individuals enrolled in a post-hospitalization smoking cessation trial. Strengthening effective coping skills (e.g., minimizing the use of tobacco as a default stress response) and increasing perceived control and self-efficacy are promising intervention targets.