Studying the relationships between authentic leadership, structural empowerment, and civility in the palliative care sector in Portugal

Purpose This paper aims to propose a model studying the relationship of authentic leadership (AL), structural empowerment (SE) and civility in the palliative care sector. This model proposes SE as a mediator between AL and civility. Design/methodology/approach Data was collected from 213 employees working in five major public palliative care hospitals in central Portugal. The study sample was predominantly female (80.3%) and the response rate was 42.6%. Variables were measured using the Authentic Leadership Inventory, Workplace Civility Scale and Conditions of Work Effectiveness Questionnaire II scales. Hayes’ PROCESS macro for mediation analysis in SPSS was used to test the hypothesized model. Findings Results suggest that AL has a significant positive direct relationship with both SE and civility. Furthermore, SE demonstrated to play a partial mediation effect between AL and civility. Practical implications This study may be of use for healthcare administration encouraging the development of AL, suggesting that the more leaders are seen as authentic, the more employees will perceive they have access to workplace empowerment structures and a civil environment. Originality/value Considering the mainstream literature in healthcare management, to the best of the authors’ knowledge, this is the first study to date to integrate the relation of AL, SE and civility in the palliative care sector. Further, the research model has not previously been introduced when considering the mediating role structural empowerment can play between AL and civility.

Reclaiming the Classics for a Diverse and Global World Through OER

In the 2019–20 academic year, I redesigned a course on the classics to make both the texts and the context in which they were taught more accessible for and relevant to the predominantly female students of Saint Mary’s College, Notre Dame. The course was re-centered on the dialogue between the ever-evolving and diverse cultures within Greece and the Roman empire and surrounding regions such as Egypt, Ethiopia, and Persia; issues caused by slavery and economic inequality; conceptions of gender roles and sexuality, race and ethnicity, and migration and citizenship; the troubling appropriation of classical motifs and texts by fascist groups in the twentieth century and some alt-right groups and sexual predators in the twenty-first century; and on recent initiatives meant to demonstrate the diversity of both Greek and Roman cultures through documentary, artistic, and archaeological evidence (particularly in the digital humanities and in museums and libraries). I also wanted to make the course close to zero cost for students and to shift to digital texts which lent themselves to interactivity and social scholarship. Our librarian, Catherine Pellegrino, obtained multi-user e-books for modern reinterpretations of classical works still in copyright. A LibreTexts grant enabled the co-authors of this article—the course instructor (and lead author) and two paid student researchers—and a team of summer-employed student collaborators to edit, footnote, and create critical introductions and student activities for various key texts for the course. Many of these texts are now hosted on the LibreTexts OER platform. Beta versions of enriched OER texts and activities were user tested in a synchronous hybrid virtual/physical classroom of twenty-five students, who were taking the course (HUST 292) in the fall semester of 2020.

Motivation and Social Skills in Nursing Students Compared to Physical Education Students

One of the relevant factors that explain human behavior, in the acts that develops in daily life, is motivation. The aim of this study was to determinate the level of motivation and social skills in nursing degree student and compare with the level of motivation of physical education students. A descriptive and correlational study, with a cross-sectional design was used in this research (n= 101; 22.03 + 5.8 years old), using the Spanish version of the Situational Motivation Scale (SIMS). It can be highlighted that there is a predominantly female student population in this campus, with a higher motivational level. The predominant religion is the Christian/Catholic, counting with mean values in identified regulation superior to those of the rest. Regarding social skills, thinking (optimistic or pessimistic), empathy and assertiveness are the skills that influence the degree of motivation of students. Regarding the level of motivation, Nursing students show a medium-high level and Physical Education, a high level. Motivation is intrinsic in nursing students and more extrinsic in Physical Education students, although there are also high levels of intrinsic motivation. Uno de los factores relevantes que explican el comportamiento humano, en los actos que se desarrollan en la vida diaria, es la motivación. El objetivo de este estudio fue determinar el nivel de motivación y habilidades sociales en estudiantes de enfermería y compararlo con la motivación de estudiantes universitarios de educación física. Para ello, se realizó un estudio descriptivo y correlacional, con un diseño transversal, en (n=101; 22.03+5.8 años), utilizando la Escala de Motivación Situacional (SIMS). Se puede resaltar que hay una población estudiantil predominantemente femenina, con un mayor nivel de motivación, hecho que se repite en estudiantes de Educación Física. La religión predominante es la cristiana/católica, contando con valores medios en una regulación identificada superior a la del resto. El pensamiento, la empatía y la asertividad son las habilidades que influyen en el grado de motivación de los estudiantes. Existe una relación negativa entre la motivación intrínseca y la pasividad y entre la motivación intrínseca y la agresividad. En cuanto al nivel de motivación, el alumnado de Enfermería manifiesta un nivel medio-alto y el de Educación Física, un nivel alto. La motivación es intrínseca en estudiantes de enfermería y más extrínseca en el alumnado de Educación Física, aunque también, existen altos niveles de motivación intrínseca.

Institutional ethnoracial discrimination and microaggressions among a diverse sample of undergraduates at a minority-serving university: a gendered racism approach

PurposeEthnoracial minorities report a variety of discriminatory experiences due to systemic racism. Yet, few studies have examined whether gender and race/ethnicity interact to predict institutional discrimination and racial microaggressions through an intersectional approach.Design/methodology/approachA predominantly female (60%), ethnoracial minority (20.8% Black, 31.6% Asian, 30.8% Latina/o, 8.2% White, 6.6% Middle Eastern) sample of 895 undergraduates attending a minority-serving public university in an urban setting completed self-report measures of sociodemographic characteristics, experiences of racial microaggressions and institutional discrimination.FindingsSignificant (p < 0.05) gender × race/ethnicity interaction effects were found in several institutional discrimination domains: Males reported more police/court discrimination overall, but gender differences in police/court discrimination were less pronounced for non-Black vs Black students. While males tended to report more institutional discrimination than females, the reverse was true for the Middle Eastern group: Middle Eastern females reported institutional discrimination in more domains and more discrimination getting hired than their male counterparts. There was a significant race/ethnicity × gender interaction effect for environmental microaggressions: White males reported more environmental microaggressions than White females, but gender differences were not found in the overall sample.Originality/valueThis study is the first to the authors’ knowledge to assess the interactive effects of gender and ethnicity on the type of microaggressions experienced in a diverse sample that includes individuals of Middle Eastern descent. The authors highlight the range of discriminatory events that ethnoracially minoritized undergraduates experience, even at a minority-serving institution.

Applicability of Pharmacogenomically Guided Medication Treatment during Hospitalization of At-Risk Minority Patients

Known disparities exist in the availability of pharmacogenomic information for minority populations, amplifying uncertainty around clinical utility for these groups. We conducted a multi-site inpatient pharmacogenomic implementation program among self-identified African-Americans (AA; n = 135) with numerous rehospitalizations (n = 341) from 2017 to 2020 (NIH-funded ACCOuNT project/clinicaltrials.gov#NCT03225820). We evaluated the point-of-care availability of patient pharmacogenomic results to healthcare providers via an electronic clinical decision support tool. Among newly added medications during hospitalizations and at discharge, we examined the most frequently utilized medications with associated pharmacogenomic results. The population was predominantly female (61%) with a mean age of 53 years (range 19–86). On average, six medications were newly prescribed during each individual hospital admission. For 48% of all hospitalizations, clinical pharmacogenomic information was applicable to at least one newly prescribed medication. Most results indicated genomic favorability, although nearly 29% of newly prescribed medications indicated increased genomic caution (increase in toxicity risk/suboptimal response). More than one of every five medications prescribed to AA patients at hospital discharge were associated with cautionary pharmacogenomic results (most commonly pantoprazole/suboptimal antacid effect). Notably, high-risk pharmacogenomic results (genomic contraindication) were exceedingly rare. We conclude that the applicability of pharmacogenomic information during hospitalizations for vulnerable populations at-risk for experiencing health disparities is substantial and warrants continued prospective investigation.

Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population

Purpose: Stable angina is ischemic chest pain on exertion or with emotional stress. Despite guideline-directed therapy, up to 30% of patients have suboptimal pain relief. The aims of this study were to: (1) determine the feasibility and acceptability of a randomized controlled trial (RCT) of acupuncture; and (2) evaluate preliminary efficacy of acupuncture with respect to reduction of pain and increased functional status and health-related quality of life (HRQoL). Methods: Participants with stable angina for ⩾1 month received either a standardized acupuncture protocol, twice per week for 5 weeks, or an attention control protocol. Measures included the McGill Pain Questionnaire (average pain intensity (API), pain now) and the Seattle Angina Questionnaire–7 (functional status, symptoms, and HRQoL). Feasibility was defined as ⩾80% recruitment, ⩾75% retention following enrollment, and ⩾80% completion. Descriptive statistics and mixed-effects linear regression were used for analysis. Results: The sample (n = 24) had a mean age of 59 ± 12 years, was predominantly female (63%), and represented minority groups (8% White, 52% Black, 33% Hispanic, and 8% Other). Feasibility was supported by 79% retention and 89% completion rates. The recruitment rate (68%) was slightly lower than expected. Acceptability scores were 87.9% for the acupuncture group and 51.7% for the control group. Outcomes were significantly better for the acupuncture versus control groups (API, b = −2.1 (1.1), p = 0.047; functional status, b = 27.6 (7.2), p < 0.001; and HRQoL, b = 38.8 (11.9), p = 0.001). Conclusions and implications: Acupuncture was feasible and acceptable in our diverse sample. We were slightly under the recruitment target of 80%, but participants who started the study had a high likelihood of completing it. Acupuncture shows promise for stable angina, but its effectiveness needs to be confirmed by a larger, adequately powered RCT. Trial registration number: NCT02914834 (ClinicalTrials.gov).

Either Sent by God or Used by God: Impact of COVID-19 on the Religious Lives of Black Families With Dementia

The COVID-19 pandemic has underscored systemic disparities and laid its effects on the Black community. Often overlooked is how health disparities heighten stress and affect the emotional well-being of Black American caregivers. The purpose of this study is to explore the impact of COVID-19 on church engagement for Black families affected by dementia. A qualitative design was employed to collect data from current caregivers, faith/church leaders, and persons with cognitive impairment. Participants (n = 17) were predominantly female, all identified as Black. During semi-structured interviews, participants were asked how COVID-19 has impacted their participation in faith practices. The following themes emerged: (a) ability to continue faith practices, (b) increased church engagement, (c) new normal, (d) importance of fellowship, and (e) role of technology. Participants believed COVID-19 did not impact their faith practice partly due to the ability to continue with faith traditions in a virtual format. Online worship services enabled more families affected by dementia to participate. Many church leaders expressed the intent of continuing to provide online worship services post-pandemic. Families highlighted their need to have fellowship with other parishioners. Technology was perceived as a double-edged sword that serves as both a motivator and a barrier to religious engagement. These findings will support faith leaders and churches in understanding the needs of their congregation during the COVID-19 pandemic, specifically, it will allow families living with dementia to continue engaging in religious activity and living in meaningful ways.

Relationship of Cannabis Use With Immediate, Delayed, and Working Memory: The Health and Retirement Study

Past research has examined relationship between cannabis use and cognition among adolescents and young adults, but less is known about older adults despite rapidly increasing recreational and therapeutic cannabis use by this demographic. These relationships were explored cross-sectionally using data from the 2018 wave of the Health and Retirement Study (HRS). Dependent variables included immediate and delayed memory (10-item word list) and working memory (serial sevens; range 0-5). Cannabis use was categorized as non-user (n=886), past-user (n=334), current moderate (&lt;52 uses/year; n=36), and current heavy (52+ uses/year; n=92). Mean age was 67.59 years (range: 50-98, SD=10.76). The sample was predominantly female (59%), and Caucasian (67%). Uncontrolled analyses found that cannabis use group was associated with immediate memory (F=6.14, p&lt;.001), delayed memory (F=3.75, p=.01), and working memory (F=6.91, p&lt;.001). Analyses controlled for gender, education, age, and race found that cannabis use group was no longer associated with delayed memory (F=1.74, p=.16) or working memory (F=1.66, p=.17); however, cannabis use was associated with immediate memory (F=3.75, p=.01) in controlled analyses. Current heavy users’ (M=4.94, SE=.16) immediate memory worse than that of both non-users (M=5.48, SE=.06) and past users (M=5.49, SE=.09; p&lt;.05 for both). Gender, education, age, and race significantly associated with immediate, delayed, and working memory, respectively (p&lt;.05 for all). In conclusion, relative deficits in immediate memory, but not delayed memory or working memory, were associated with current heavy cannabis use among older adults. In combination with other findings, these results may inform development of safe-use guidelines for older adults.

445 The long-term natural course of moderate tricuspid regurgitation

Aims The epidemiological and clinical burden of tricuspid regurgitation (TR) has lately gained much attention from the scientific community. In fact, recent epidemiological studies report a prevalence of moderate and severe TR in population over the age of 65 screened for valve disease ranging from 2.7% to 4%, with an independent prognostic role clearly worsening long-term survival along with the increasing severity of TR grade. Particularly, as TR is often clinically unsuspected until an advanced stage of congestive heart failure (HF), there is a great need of early diagnosis and long-term appropriate follow-up and management. Nonetheless, data focusing on the clinical and echocardiographic course of a cohort of patients suffering from moderate TR, although eagerly awaited, are lacking. To evaluate and clarify the evolution and the long-term independent clinical outcome of a cohort of patients suffering from moderate functional or organic TR. Methods We electronically searched for ambulatory and in-patients who underwent transthoracic and/or transesophageal echocardiography with a diagnosis of moderate TR, along with a complete clinical evaluation, in our centre between January 2014 and December 2019. Patients were considered eligible if a second echocardiographic examination including a careful evaluation of the severity of TR and clinical information were available for a minimum follow-up of 6 months. The primary endpoint was all-cause mortality; secondary endpoints were hospitalization for HF and TV intervention, either surgical or percutaneous. Results We enrolled 130 patients, predominantly female with multiple comorbidities, cardiovascular risk factors and history of atrial fibrillation; TR aetiology was functional in most cases (93 patients, 72%). Over a mean follow-up of 5 years, TR grade progressed to at least severe in 55 patients (42%): at multivariate analyses, diabetes mellitus (P=0.003), anaemia (P=0.03) and at least moderate mitral regurgitation or aortic stenosis (P=0.039) were all predictors of TR severity progression. The primary endpoint occurred in 41(32%) of patients and was significantly more frequent (P&lt;0.0001) in patients with severe TR at follow-up compared to those without TR severity progression. HF hospitalization and TV intervention occurred in 47 (36%) and 20 (14%) of patients: again, both were significantly more frequent in patients with severe TR (P=0.0008 and P=0.02, respectively) in comparison to those without worsened TR severity at follow-up. Conclusions Our results show that moderate TR, over a long-term follow-up period, worsens to at least severe grade in a relevant proportion of patients, conveying a significant independent risk of hard events such as all-cause death, HF hospitalization and TV intervention. Therefore, this cohort of patients should be appropriately managed and closely followed-up in order to avoid adverse clinical events related to the natural course of this valvulopathy.