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Kinesiophobia in heart disease: 'it is part of the process or is it? Perspectives from cardiac rehabilitation professionals - a qualitative study in healthcare settings

Por: Jacob · A. J. · Babu · A. S. · Padickaparambil · S.
Objectives

To explore cardiac rehabilitation (CR) professionals’ perspectives on kinesiophobia in patients with cardiovascular diseases. This study aims to understand the perspectives of healthcare professionals (HCPs) regarding their perceptions, assessments and management of kinesiophobia.

Design

A qualitative descriptive study using in-depth interviews and thematic analysis.

Setting

The study was carried out through online interviews at a university teaching hospital in South India.

Participants

HCPs involved in CR, from around the world, were invited to participate through advertisements on social media and through professional forums. 12 HCPs, including CR nurses (n=1), CR physicians (n=1), cardiac surgeons (n=1), cardiac electrophysiologists (n=1), rehabilitation physicians (n=1), cardiologists (n=2), exercise physiologists (n=2) and physiotherapists (n=3), agreed to participate.

Interventions

Not applicable (qualitative study without interventions).

Primary and secondary outcome measures

Qualitative data collected through in-depth interviews focused on HCP perceptions regarding kinesiophobia and its assessment, management and awareness within CR.

Results

Thematic analysis generated 337 codes, which formed seven subthemes: the perceived burden of kinesiophobia, reasons for kinesiophobia, HCP experiences with kinesiophobia, methods of assessing kinesiophobia, management strategies, reasons why kinesiophobia is overlooked and the importance of promoting awareness of kinesiophobia.

Conclusions

CR professionals recognise kinesiophobia as a significant issue among patients with heart disease but do not recognise the term or perceive it as a separate condition; instead, they view it as part of the overall clinical presentation. There is a strong need to advocate for early recognition and assessment of kinesiophobia and for the development of structured management strategies and its inclusion into CR programmes to improve patient outcomes during recovery.

Trial registration number

The study was prospectively registered in the Clinical Trial Registry of India (CTRI/2022/05/042502). This study received approval from the Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee-2 (Student Research) with reference number IEC2:13/2022.

Mindsets and menses: decoding young womens attitudes towards menstrual leave - an observational study from South India

Por: George · N. · Mahendran · P. · Kulothungan · K. · Dharmaraj · R. B. · Muniyapillai · T. · Subramanian · T. · Muthu Ranga Babu · A. · Arumugam · A. · Subramanian · S. · Shabash Khan · S. · Selvam · S. · Veeraragavan Suresh Babu · A.
Objective

The primary objective of this study is to investigate the perceived need and attitudinal perspectives regarding menstrual leave policies among young women in rural South India. The secondary objective was to determine the socio-demographic, menstrual and workplace-related factors associated with attitudes towards menstrual leave among young women.

Design

An analytical cross-sectional study was performed from May 2023 to August 2023.

Setting

In a rural district of Tamil Nadu, South India.

Participants

The study encompassed 955 young female students above 18 years of age enrolled in educational institutions in a rural district of Tamil Nadu, India. Participants were pursuing diverse professional programmes including medical, dental, allied health sciences, pharmacy and engineering courses.

Outcome measures

The primary outcomes included assessment of basic menstrual characteristics (age of menarche, regularity, product usage and pain experiences), pain evaluation using the WaLIDD scale (which measured working ability, anatomical pain location, pain intensity via Wong Baker scale and pain duration) and attitude assessment through a 10-dimension Likert scale. The attitude assessment explored both supportive factors (pain management, environmental considerations, medical leave allocation, menstruation normalisation and performance impact) and potential concerns (medicalisation, perceptions of fragility, stigma, disclosure issues and abnormal leave usage). Secondary outcome measures encompassed the analysis of factors influencing these attitudes, followed by a multivariable linear regression model to identify significant predictors.

Results

Among 955 female students (mean age 19.56±1.33 years), the majority supported menstrual leave for maintaining hygiene (82.3%) and managing dysmenorrhoea (75.8%). A substantial proportion (64.4%) viewed it as a means of normalising menstruation discourse, while 61.6% believed it could enhance workplace performance. However, concerns existed about medicalising menstruation (47.9%) and reinforcing gender stereotypes (43.4%). Multivariate analysis revealed that medical students (B=0.67, 95% CI: 1.34 to 2.00), those with graduate-educated fathers (B=1.64, 95% CI: 0.31 to 2.97), earlier age at menarche (B=–0.23, 95% CI: –0.45 to –0.01) and participants reporting menstrual interference with daily activities (B=0.96, 95% CI: 0.02 to 0.89) held significantly more positive attitudes.

Conclusion

While young women generally support menstrual leave policies, particularly for hygiene and pain management, there are significant concerns about workplace stigmatisation and gender stereotyping. Educational background, parental education and personal menstrual experiences significantly influence attitudes toward menstrual leave. These findings suggest the need for carefully structured menstrual leave policies that balance biological needs with workplace/student place equality concerns.

Access to multidisciplinary outpatient heart failure clinics in Qatar: a qualitative study from the perspectives of patients and cardiologists

Por: Hajaj · A. · Grace · S. L. · Hamed Badr · A. M. · Hadi · M. A. · Abdel-Rahman · M. E. · Babu · G. R. · Turk-Adawi · K.
Objective

Heart failure clinics (HFCs) are associated with increased survival rates, lower hospitalisation and improved quality of life. This study investigated factors influencing patient access to multidisciplinary outpatient HFCs from the perspective of patients and cardiologists.

Design

This was a qualitative study. A trained researcher conducted semistructured face-to-face interviews with patients and online interviews with cardiologists. Interviews, conducted between March and October 2023, were audio-recorded. Transcripts were cleaned (deidentification, translation verification) and analysed by two trained researchers independently using systematic text condensation in NVivo v12. Codes were derived from the transcripts and grouped and organised into themes. Two authors independently coded data, reconciling disagreements with the senior author, followed by respondent validation. Member checking ensued.

Setting

Outpatient multidisciplinary HFCs in Qatar.

Participants

A purposive sample of patients diagnosed with heart failure who had attended at least one HFC appointment at Qatar’s Heart Hospital were approached in person or via phone, and cardiologists with the authority to make referrals to these clinics via the electronic medical record system were emailed; interviews ensued until theme saturation was achieved.

Results

26 individuals (14 patients and 12 cardiologists) participated in the interviews. Four major themes were identified: health system organisation (subthemes: benefits, HFC triage criteria, need/capacity), HFC referral processes (subthemes: electronic record system, patient communication and education), care continuity and communication (subthemes: patient navigators, clinician preferences) and access challenges (subthemes: transportation, costs).

Conclusions

Resources are needed to expand HFC capacity and coverage, leverage electronic medical record tools as well as telehealth, educate physicians and patients on referral guidelines and processes and engage primary care to ultimately improve patient outcomes.

Are loneliness and social network size mediators between childhood adversity and depressive symptoms? A cross-sectional replication study in Ethiopia

Por: Gerbig · P. · Reinhard · M. A. · Ababu · H. · Rek · S. · Amann · B. L. · Adorjan · K. · Abera · M. · Padberg · F. · Jobst · A.
Introduction

Loneliness and adverse childhood experiences (ACEs) constitute significant risk factors for mental disorders, with loneliness emerging as a serious global public health concern. Recent research highlights the role of loneliness as a potential link between early life adversities and current psychopathology. However, most studies have been conducted in high-income, highly individualistic countries. This cross-sectional study explores the interplay between loneliness, social network size, recalled ACEs and depressive symptoms in Ethiopia—a low-income and collectivistic cultural context.

Methods

The study included 125 psychiatric outpatients at Jimma University Medical Center in Southwest Ethiopia diagnosed with major depressive disorder, bipolar disorder or psychotic disorders, as well as 131 non-clinical participants. Trained interviewers administered the University of California, Los Angeles (UCLA) Loneliness Scale, the Childhood Trauma Questionnaire, the Social Network Index and the WHO-5 Well-Being Index. We used Mann-Whitney U tests, partial correlation and mediation analysis for data analysis.

Results

We found mild-to-moderate correlations between loneliness and ACEs (clinical group: rho=0.29, p1b1=0.07, 95% CI (0.02 to 0.13); non-clinical group: indirect effect a1b1=0.03, 95% CI (0.01 to 0.07)). In contrast, social network size was neither correlated with ACEs nor did it mediate the association between ACEs and depressive symptoms in either group.

Conclusion

This study replicates previous findings that loneliness—rather than social network size—is associated with ACEs and mediates their impact on depressive symptoms. These results support the transcultural and transdiagnostic relevance of loneliness as a universal psychological mechanism, independent of societal structure.

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