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Employment is a social determinant of health, and women living with HIV (WLWH) are often underemployed. This correlational study examined the socioeconomic, psychosocial, and clinical factors associated with employment among WLWH (n = 1,357) and women at risk for HIV (n = 560). Descriptive and inferential statistics were used to evaluate factors associated with employment status. Employment was associated (p ≤ .05) with better socioeconomic status and quality of life (QOL), less tobacco and substance use, and better physical, psychological, and cognitive health. Among WLWH, employment was associated (p ≤ .05) with improved adherence to HIV care visits and HIV RNA viral suppression. Using multivariable regression modeling, differences were found between WLWH and women at risk for HIV. Among WLWH, household income, QOL, education, and time providing childcare remained associated with employment in adjusted multivariable analyses (R(2) = .272, p < .001). A better understanding of the psychosocial and structural factors affecting employment is needed to reduce occupational disparities among WLWH.

BACKGROUND: There are multiple issues that arise when researchers focus on and only report “statistical significance” of study findings. An important element that is often not included in reports is a discussion of clinical relevance. OBJECTIVES: The authors address issues related to significance, the use of effect sizes, confidence or credible intervals, and the inclusion of clinical relevance in reports of research findings. METHODS: Measures of magnitude, precision, and relevance such as effect sizes, confidence intervals (CIs), and clinically relevant effects are described in detail. Additionally, recommendations for reporting and evaluating effect sizes and CIs are included. Example scenarios are presented to illustrate the interplay of statistical significance and clinical relevance. RESULTS: there are several issues that may arise when significance is the focus of clinical research reporting. One issue is the lack of attention to nonsignificant findings in published works even though findings demonstrate clinical relevance. Another issue is that significance is interpreted as clinical relevance. As well, clinically relevant results from small sample studies are often not considered for publication, and, thus, findings might not be available for meta-analysis. DISCUSSION: Findings in research reports should address effect sizes and clinical relevance and significance. Failure to publish clinically relevant effects and CIs may preclude the inclusion of clinically relevant studies in systematic reviews and meta-analyses thereby limiting the advancement of evidence-based practice. Several accessible resources for researchers to generate, report, and evaluate measures of magnitude, precision, and relevance are included in this article.

Women living with HIV (WLWH) have lower employment rates and more difficulty finding and keeping employment compared with their counterparts without HIV. These disparities affect physical, psychological, and socioeconomic outcomes, and they may compound the disadvantages associated with living with HIV. Although historical literature has emphasized the impact of clinical factors on employment, current evidence suggests that socioeconomic and psychosocial factors associated with HIV should be included for a more comprehensive view. Based on this broader inclusion, a conceptual framework is presented describing how socioeconomic and psychosocial characteristics influence employment acquisition and maintenance among WLWH. The framework posits that there is a reciprocal relationship between employment acquisition and occupational productivity, and psychological health, physical health, social support, and empowerment. Implications for future research and interventions include (a) an extended conceptualization of vocational rehabilitation and (b) the use of peer support groups to increase social capital, empowerment, knowledge, and resources among WLWH.

Background Every one out of 10 nurses reported suffering from high levels of burnout worldwide. It is unclear if burnout affects job performance, and in turn, impairs patient safety, including medication safety. The purpose of this study is to determine whether nurse burnout predicts self-reported medication administration errors (MAEs). Methods A cross-sectional study using electronic surveys was conducted from July 2018 through January 2019, using the Copenhagen Burnout Inventory. Staff registered nurses (N = 928) in acute care Alabama hospitals (N = 42) were included in this study. Descriptive statistics, correlational, and multilevel mixed-modeling analyses were examined. Results All burnout dimensions (Personal, Work-related, and Client-related Burnout) were significantly correlated with age (r = -0.17 to -0.21), years in nursing (r = -0.10 to -0.17), years of hospital work (r = -0.07 to -0.10), and work environment (r = -0.24 to -0.57). The average number of self-reported MAEs in the last 3 months was 2.13. Each burnout dimension was a statistically significant predictor of self-reported MAEs (p Conclusions Nurse burnout is a significant factor in predicting MAEs. This study provides important baseline data for actionable interventions to improve nursing care delivery, and ultimately health care, for Alabamians.

To determine the effects of gamification on student education, researchers implemented "Kaizen," a software-based knowledge competition, among a first-year class of undergraduate nursing students. Multiple-choice questions were released weekly or biweekly during two rounds of play. Participation was voluntary, and students could play the game using any Web-enabled device. Analyses of data generated from the game included (1) descriptive, (2) logistic regression modeling of factors associated with user attrition, (3) generalized linear mixed model for retention of knowledge, and (4) analysis of variance of final examination performance by play styles. Researchers found a statistically significant increase in the odds of a correct response (odds ratio, 1.8; 95% confidence interval, 1.0-3.4) for a round 1 question repeated in round 2, suggesting retention of knowledge. They also found statistically significant differences in final examination performance among different play styles.To maximize the benefits of gamification, researchers must use the resulting data both to power educational analytics and to inform nurse educators how to enhance student engagement, knowledge retention, and academic performance.

Although most cancer survivors are at risk for being lost in the transition from treatment to survivorship, rural breast cancer survivors face special challenges that might place them at particular risk. This small-scale preliminary study had 2 specific aims: (aim 1) establish the feasibility of rural breast cancer survivors participation in a longitudinal quality of life (QOL) intervention trial and (aim 2) determine the effects of the Breast Cancer Education Intervention (BCEI) on overall QOL. Fifty-three rural breast cancer survivors were randomized to either an experimental (n = 27) or a wait-control arm (n = 26). Participants in the experimental arm received the BCEI consisting of 3 face-to-face education and support sessions and 2 face-to-face and 3 telephone follow-up sessions, along with supplemental written and audiotape materials over a 6-month period. Breast Cancer Education Intervention modules and interventions are organized within a QOL framework. To address the possible effects of attention, wait-control participants received 3 face-to-face sessions and 3 telephone sessions during the first 6 months of participation in the study, but not the BCEI intervention. Research questions addressing aim 1 were as follows: (a) can rural breast cancer survivors be recruited into a longitudinal intervention trial, and (b) can their participation be retained. Research questions for aim 2 were as follows: (a) do participants who received the BCEI show improvement in overall QOL, and (b) is the QOL improvement sustained over time. Data were analyzed using repeated-measures general linear mixed models. Results demonstrated the ability to recruit and retain 53 rural breast cancer survivors, that the experimental arm showed improvement in overall QOL (P = .013), and that there were significant differences in overall QOL between the experimental and wait-control groups at both months 3 and 6. Thus, it appears that at least some rural breast cancer survivors can and will participate in a larger trial and will maintain their participation and that those that do participate experience significant QOL benefit.

Introduction: It is estimated that 2-3 million children in the US have diagnosed hypertension that can track to adulthood and is a risk factor for cardiovascular disease (CVD). However, the prevalence of instance elevations of blood pressure (BP) in children is estimated to greatly exceed the prevalence of hypertension. There is increasing evidence that risk factors for CVD, including hypertension and instance elevations in BP, begin in childhood. It is unclear when the elevations in BP first appear in children and what factors influence BP. Few studies have examined instance elevations in BP in preschool children and/or what factors influence BP. Hypothesis: The purpose of this study was to determine the prevalence of elevated BP readings in a group of rural and urban preschool children and to determine if there were differences in BP status (normal, prehypertensive, or hypertensive range) based on race, gender, location, prematurity status, or body mass index (BMI) status. Methods: A cross-sectional comparative design was used to address the purpose. A convenience sample of 56 3-5 year old children (27 rural, 29 urban; 37 male, 19 female; 33 Black, 21 White) were recruited from Head Start Centers. Height, weight, and BP were collected according to protocols at the Centers. Results: Based on pediatric percentiles, 30% of the children had elevated BP readings; 14% Pre-Hypertensive readings (6 males; 2 female; 4 Black; 4 White); 16% Hypertensive readings (6 males; 3 females; 5 Black, 4 White). Seventy-six percent of elevated BP readings were systolic BP (SBP); 47% of those with elevated BP readings had diastolic elevations, while 23.5% had elevations in both SBP and DBP. Nine participants were overweight; 5 were obese. Over 65% of the children with BP elevations were normoweight. There were no differences in BP status based on race, gender, location, prematurity or BMI Status. There was a small effect size for the relationship between race, BMI status, prematurity and BP status. Conclusions: Thirty percent of 3-5 year-old children in this sample had elevated BP readings, the majority of which were SBP. BP should be measured in children at each visit to health care providers and elevations in BP readings addressed early to prevent later hypertension and other CVDs.