UNASSIGNED: Many older women are screened for breast cancer beyond guideline-recommended thresholds. Messaging holds promise to reduce overscreening.
UNASSIGNED: To investigate the effect of a message on older women\'s support for and intentions of stopping breast cancer screening.
UNASSIGNED: A 2-wave randomized clinical online survey trial using a nationally representative online panel was performed from May 12 to June 19, 2023. Women 65 years or older without breast cancer were eligible to participate.
UNASSIGNED: A pilot-tested breast cancer screening cessation message delivered to a hypothetical older woman with serious illnesses and functional impairment. The message was described as from 1 of 3 sources (clinician, news story, or family member). Participants were randomized into 4 groups: no message (group 1 [control]), a single message from a clinician at wave 1 and no message at wave 2 (group 2), a message from a news story (wave 1) and a clinician (wave 2) (group 3), and a message from a family member (wave 1) and a clinician (wave 2) (group 4).
UNASSIGNED: Support for stopping screening in the hypothetical older woman (primary) and screening intentions for oneself (secondary) were assessed on 7-point scales, with higher values indicating stronger support for and intentions to stop screening. Means were compared using analysis of variance. The message effect on screening intentions among participants 75 years or older and those with life expectancy of less than 10 years were also explored.
UNASSIGNED: A total of 3051 women participated in wave 1 of the trial. The mean (SD) age was 72.8 (5.9) years; 272 (8.9%) were non-Hispanic Black and 2506 (82.1%) were non-Hispanic White. Of these women, 2796 (91.6%) completed wave 2. Group 2 had significantly higher support for screening cessation in the hypothetical patient at wave 2 (mean score, 3.14 [95% CI, 2.99-3.29]) compared with group 1 (mean score, 2.68 [95% CI, 2.54-2.82]; P < .001). The effect was even stronger in group 3 (mean score, 4.23 [95% CI, 4.09-4.38]) and group 4 (mean score, 4.12 [95% CI, 3.97-4.27]) compared with both groups 1 and 2 (all P < .001). Message effects on self-screening intentions followed a similar pattern, with larger effects among participants 75 years or older or with limited life expectancy.
UNASSIGNED: In this randomized clinical trial, a breast cancer screening cessation message significantly increased older women\'s support for and intentions of screening cessation. The strongest effects were observed when the message was delivered over time from multiple sources. Future work needs to engage potential message sources to examine the feasibility and acceptability of multilevel messaging strategies and their effect on screening behavior.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT05821023.

BACKGROUND: Returning to work after long-term sick leave can be challenging, particularly in small- and medium-sized enterprises (SMEs) where support may be limited. Recognizing the responsibilities and challenges of SME employers, a web-based intervention (hereafter the SME tool) has been developed. The SME tool aims to enhance the employer\'s intention and ability to support the sick-listed employee. Based on the Self-Determination Theory, it is hypothesized that this intention is enhanced by intervening in the employer\'s autonomy, competences, and relatedness targeted at, e.g., communication with sick-listed employee, involvement of other stakeholders, and practical support. This is achieved by means of providing templates, communication videos, and information on legislation. This article describes the design of an effect and process evaluation of the SME tool.
METHODS: A randomized controlled trial (RCT) with a 6-month follow-up will be conducted with a parallel-group design with two arms: an intervention group and a control group. Sick-listed employees (≤ 8 weeks) of SMEs (≤ 250 employees) at risk of long-term sick leave and their employers will be recruited and randomly allocated as a dyad (1:1). Employers randomized to the intervention group receive unlimited access to the SME tool, while those in the control group will receive care as usual. The primary outcome is the satisfaction of the employee with the return to work (RTW) support provided by their employer. Secondary outcomes include social support, work performance, and quality of work life at the employee level and self-efficacy in providing RTW support at the employer level. Outcomes will be assessed using questionnaires at baseline and 1, 3, and 6 months of follow-up. Process evaluation measures include, e.g., recruitment and use of and perceived usefulness of the SME tool. Additionally, semi-structured interviews with employers, employees, and occupational physicians will explore the interpretation of the RCT results and strategies for the national implementation of the SME tool.
CONCLUSIONS: The SME tool is hypothesized to be valuable in addition to usual care helping employers to effectively support the RTW of their long-term sick-listed employees, by improving the employers\' intention and ability to support.
BACKGROUND: ClinicalTrials.gov, NCT06330415. Registered on February 14, 2024.

The question of whether free will exists or not has intrigued philosophers for centuries. About 40 years ago, cognitive neuroscientists such as Benjamin Libet have joined the discussion by demonstrating that an ERP component, the readiness potential (RP), precedes the reported time of decision to act by a few hundred milliseconds. Libet et al. (1983) argued that our brains unconsciously prepare the movement before we experience any conscious intention, which led some free will skeptics (e.g., Ebert & Wegner, 2011) to argue that free will does not exist. While Libet\'s interpretation of his findings initiated an intense philosophical debate, alternative interpretations have been put forward more recently (Bode et al., 2014; Brass et al., 2019; Schurger et al., 2012; 2021). Integration to bound models (ITB) of Libet-style experiments suggest that we accumulate information until an intention threshold is reached, which triggers our experience of intention and execution of voluntary behaviors. The RP, from this perspective reflects the decision process itself rather than the consequence of an unconscious decision. To determine if the ITB model better predicts behavioral patterns in Libet-style experiments, we added a whether-component to the classical Libet task (the Veto Libet task) and compared the behavioral measures in the Veto Libet task with the Classical Libet task. We hypothesized that the signal accumulation in the Veto Libet task would be less steep than in the Classical Libet task, resulting in longer wait times and earlier self-reported intentions to act (i.e., the W). The result in general supported our hypotheses. In addition, these behavioral differences between the Classical Libet task and the Veto Libet task established valuable behavioral correlates for future investigations into the vetoing phenomenon. Finally, this study was also the first application of the Libet task in an online setting, and the behavioral parameters were highly comparable to the previous offline studies, further supporting the possibility of using the online platform to study arbitrary decision-making.

BACKGROUND: Obesity causes many physical and mental illnesses. This study compares mindfulness-based eating awareness training (MB-EAT) versus MB-EAT plus implementation intention model for effectiveness on body mass index (BMI), weight self-efficacy, and physical activity in obese women with BMIs ≤ 25 (n = 52).
METHODS: In this randomized clinical trial, the participants were selected by the simple random sampling method and randomly divided into three groups. A 12-session MB-EAT of 150 min per session was performed for experimental group I. The experimental group II received MB-EAT alone for physical activity planning and MB-EAT plus implementation intention; also, both groups were compared to the control group. Data were measured by the scales, a questionnaire, and a checklist, and the P-values are based on the results of the generalized estimating equation (GEE) test. P < 0.001 were considered the significance level.
RESULTS: The MB-EAT and MB-EAT + implementation intention effectiveness on the two experimental groups\' BMI, weight self-efficacy, and physical activity was significantly different from the control group. In the integrated group versus the MB-EAT group, BMI, physical activity, and physical discomfort, were more effective than the weight self-efficacy subscales. Both intervention groups were effective on BMI, weight self-efficacy, and physical activity, but the integrated group\'s effectiveness was more.
CONCLUSIONS: The MB-EAT effectiveness trial is theory-based, reducing weight and the psychological and behavioral consequences of overweight and obese adults. The MB-EAT + the Implementation intention model is to plan regular and daily exercise according to each individual\'s specific circumstances.
BACKGROUND: The trial registration number: (IRCT20200919048767N1).

BACKGROUND: In May 2022, the American Council of Academic Physical Therapy announced a \"nationwide shortage of faculty\" in entry-level Doctor of Physical Therapy (DPT) programs across the country. As the number of physical therapist education programs continue to grow, concerns with faculty shortages increase.
METHODS: Research on reasons faculty stay in entry-level DPT programs is limited. With a nation-wide shortage of faculty and the continued growth of DPT programs across the country, more investigation into faculty retention is warranted.
METHODS: Two hundred forty-four participants responded to the quantitative survey. Ten program directors (PD) and 10 faculty members (FM) completed a qualitative interview through Zoom.
METHODS: This mixed-methods design included a quantitative survey across 264 accredited DPT programs followed by 20 qualitative online interviews. Multiple regression was completed for the data analysis, and a phenomenological approach was used to explore perceptions of job satisfaction and organizational commitment on intent to stay.
RESULTS: Two hundred thirty-six subjects (mean age = 50.04 ± 9.54 years; males = 63, females = 173; PD = 55, FM = 180) were included in the analysis. The multiple regression model significantly predicted intent to stay for all participants, F(9,211) = 12.43, P < .001; adj R2 = .32. Commitment to the organization was the greatest predictor of intent to stay, β = 0.61, t(0.622) = 5.05, P < .01. Three themes with 6 subthemes emerged from the qualitative analysis, the impact of leadership, making a commitment, and the Covid crisis.
CONCLUSIONS: Encouraging leadership to focus on structural factors such as striving to establish FMs as part of the departmental team, allowing autonomy and flexibility in the teaching role, building transparency and openness with communication, and focusing on realistic and equitable workloads could potentially increase intent to stay for faculty in entry-level DPT programs.

Background: In China, Chongqing is the first province implement a province-wide HPV vaccination free program for female students. Given the HPV vaccination of adolescents is largely dependent on the intent of their guardians, this study examined the factors associated with the parental intention to vaccinate their daughter against HPV. And we could explore how to change the factors to incentivize more guardians to vaccinate their children.
Methods: This study used a cross-sectional survey designed by multi-stage non-randomized sampling. Study participants were guardians of female students of second year of junior high in all districts and counties of Chongqing, who were most knowledgeable about the immunization status of the adolescents. Data was collected by an online survey platform between December, 2022 to March, 2023.
Results: We collected 20, 642 valid samples. Among the participating guardians, nearly 40% guardians had never heard of HPV and HPV vaccine. 68.8% guardians considered vaccinating their children against HPV, 12.5% guardians had vaccinated or vaccinating HPV vaccine for their children, and only 16.7% were reluctant to vaccinate for their children right now. Some individual characteristics of guardians (e.g. age, number of the children) were associated with the intention of HPV vaccines. Sufficient knowledge of HPV and HPV vaccine would promote the HPV vaccination, and vaccine hesitancy prevented guardians from vaccinating their children.
Conclusions: Majority of guardians held a positive intention to vaccinate their daughter, higher than the foreign uptake. Exploring the methods of social propaganda to promote HPV-related knowledge and reduce the safety concerns of guardians could help improve HPV vaccination intention.

BACKGROUND: In China, community rehabilitation workers are facing a growing challenge related to heavy occupational stress, which is having an impact on employment turnover. Previous studies have explored the effect of the public service motivation of workers in \"helping\" jobs on occupational stress or turnover intention, but there is a lack of clarification of the impact of altruism on turnover intention in the case of complex pathways involving various factors.
METHODS: A stratified sampling method was used, and a total of 82 community rehabilitation workers who assist disabled people from 34 community health centres in Jiangmen city were included in the study from August to October 2022. The turnover intention, occupational stress, burnout, quality of life, altruism, and certain sociodemographic information of community rehabilitation workers were measured using a structured questionnaire. The partial least squares method was employed to construct and test the structural equation model.
RESULTS: Although altruism had no direct impact on occupational stress or turnover intention, altruism moderated the effect of occupational stress on burnout (βMod = -0.208) and quality of life (βMod = 0.230) and weakened the mediation of burnout and quality of life between occupational stress and turnover intention.
CONCLUSIONS: This study proposes to address the dilemma of \"strong function\" and \"weak specialty\" in community rehabilitation services and to conduct positive psychological interventions for community rehabilitation workers through the guidance of altruistic values.

Residents\' participation is crucial for sustainable old neighborhood regeneration. Residents\' intentions to participate in the regeneration are low in China, resulting in unsustainable neighborhood development problems. Therefore, it is essential to investigate the drivers of residents\' participation. Residents\' behavioral mechanisms are deeply embedded in their social networks, especially in acquaintance social networks typical of old neighborhoods in China. By constructing a mediated moderation model based on the Theory of Planned Behavior (TPB) and danwei system and taking the old neighborhood regeneration in Xi\'an as a case study, this paper investigates the paths and mechanisms of the social network embeddedness, TPB, and danwei system on residents\' participation intention. The results show that social network embeddedness can improve residents\' intention to participate in regeneration through both direct and indirect pathways, and its indirect effect is much larger than the direct effect. Attitude, subjective norm, and perceived behavioral control significantly and positively mediated the contribution of social network embeddedness on participation intention. However, the specific mediating effect of attitude is significantly smaller than the other two. The danwei system has a significant moderating effect in the first stage of the relationship between social network embeddedness and participation intention. These imply that the extrinsic social factor of social network embeddedness is internalized as a driving force for convergence and motivation of residents\' participation intentions mainly through the normative pressure and exchange of experiences between acquaintances and that the danwei system reinforces this extrinsic-intrinsic facilitation process through the danwei\'s \"physical presence.\" These findings provide revelatory countermeasures for exploring the factors that motivate residents to participate actively in neighborhood regeneration and encourage their involvement at the intervention level.

BACKGROUND: This study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences.
METHODS: Our cross-sectional observational study utilized a structured online survey. Participants included doctors, nurses, and in-home/community care providers. The survey measured moral distress using established scales, assessed coping mechanisms, and evaluated turnover intentions. Statistical analysis examined the relationships between race, gender, moral distress, and turnover intention, focusing on identifying disparities across different healthcare roles. Complex interactions were examined through Classification and Regression Trees.
RESULTS: Racialized and gender minority groups faced higher levels of moral distress. Profession played a significant role in these experiences. White women reported a higher intention to leave due to moral distress compared to other groups, especially white men. Nurses and care providers experienced higher moral distress and turnover intentions than physicians. Furthermore, coping strategies varied across different racial and gender identities.
CONCLUSIONS: Targeted interventions are required to mitigate moral distress and reduce turnover, especially among healthcare workers facing intersectional inequities.

BACKGROUND: The attrition rate of Chinese medical students is high. This study utilizes a nomogram technique to develop a predictive model for dropout intention among Chinese medical undergraduates based on 19 individual and work-related characteristics.
METHODS: A repeated cross-sectional study was conducted, enrolling 3536 medical undergraduates in T1 (August 2020-April 2021) and 969 participants in T2 (October 2022) through snowball sampling. Demographics (age, sex, study phase, income, relationship status, history of mental illness) and mental health factors (including depression, anxiety, stress, burnout, alcohol use disorder, sleepiness, quality of life, fatigue, history of suicidal attempts (SA), and somatic symptoms), as well as work-related variables (career choice regret and reasons, workplace violence experience, and overall satisfaction with the Chinese healthcare environment), were gathered via questionnaires. Data from T1 was split into a training cohort and an internal validation cohort, while T2 data served as an external validation cohort. The nomogram\'s performance was evaluated for discrimination, calibration, clinical applicability, and generalization using receiver operating characteristic curves (ROC), area under the curve (AUC), calibration curves, and decision curve analysis (DCA).
RESULTS: From 19 individual and work-related factors, five were identified as significant predictors for the construction of the nomogram: history of SA, career choice regret, experience of workplace violence, depressive symptoms, and burnout. The AUC values for the training, internal validation, and external validation cohorts were 0.762, 0.761, and 0.817, respectively. The nomogram demonstrated reliable prediction and discrimination, with adequate calibration and generalization across both the training and validation cohorts.
CONCLUSIONS: This nomogram exhibits reasonable accuracy in foreseeing dropout intentions among Chinese medical undergraduates. It could guide colleges, hospitals, and policymakers in pinpointing students at risk, thus informing targeted interventions. Addressing underlying factors such as depressive symptoms, burnout, career choice regret, and workplace violence may help reduce the attrition of medical undergraduates.
BACKGROUND: This is an observational study. There is no Clinical Trial Number associated with this manuscript.