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Objectives Exposure of adults to secondhand smoke (SHS) has immediate adverse effects on the cardiovascular system and causes coronary heart disease. The current study evaluated brief self-report screening measures for accurately identifying adult cardiology patients with clinically significant levels of SHS exposure in need of intervention. Design and setting A cross-sectional study conducted in a university-affiliated cardiology clinic and cardiology inpatient service. Patients Participants were 118 non-smoking patients (59% male, mean age=63.6 years, SD=16.8) seeking cardiology services. Main outcome measures Serum cotinine levels and self-reported SHS exposure in the past 24 h and 7 days on 13 adult secondhand exposure to smoke (ASHES) items. Results A single item assessment of SHS exposure in one’s own home in the past 7 days was significantly correlated with serum cotinine levels (r=0.41, p<0.001) with sensitivity ≥75%, specificity >85% and correct classification rates >85% at cotinine cut-off points of >0.215 and >0.80 ng/mL. The item outperformed multiitem scales, an assessment of home smoking rules, and SHS exposure assessed in other residential areas, automobiles and public settings. The sample was less accurate at self-reporting lower levels of SHS exposure (cotinine 0.05-0.215 ng/mL). Conclusions The single item ASHES-7d Home screener is brief, assesses recent SHS exposure over a week's time, and yielded the optimal balance of sensitivity and specificity. The current findings support use of the ASHES- 7d Home screener to detect SHS exposure and can be easily incorporated into assessment of other major vital signs in cardiology. [ABSTRACT FROM AUTHOR]

Purpose: Dental implants are used to stabilize, support, and retain prostheses in the mandible following fibula free flap reconstruction. A previous longitudinal prospective study showed that an implant-supported prosthesis (IP) provided additional improvement in masticatory performance compared to a conventional prosthesis (CP). Therefore, in this paper, the impact of implant retention and support of mandibular prostheses on neuromuscular function is reported via a within-subject analysis. Materials and Methods: Forty-six participants were enrolled in the study. Prosthetic treatment with a CP was completed in 33 subjects following oromandibular resection and fibula free flap reconstruction. Twenty-five subjects completed evaluation of the CP after an adaptation period. Standardized masticatory tests with peanuts were given to subjects on the defect and nondefect chewing sides. Electromyography (EMG) of masseter muscles and jaw movement was performed and recorded simultaneously in 19 of these subjects. IP treatment was then completed in 16 of these subjects, and 15 of them participated in the IP evaluation after an adaptation period. Of these 15 subjects, 13 completed EMG and jaw movement recordings for both CP and IP. Results: EMG activity of the defect-side masseter muscle increased significantly from CP to IP conditions when chewing on either side, but no significant change was found for nondefect-side muscle activity. Jaw movement parameters showed no significant changes from CP to IP. Conclusion: In patients restored with mandibular fibula free flap reconstruction, implant support for mandibular prostheses has the benefit of permitting greater muscle effort on the defect side, irrespective of the side on which the bolus is being chewed. The impact of an IP on jaw movements is limited. [ABSTRACT FROM AUTHOR]

Introduction: Filipino Americans (FAs) are at high risk for developing type 2 diabetes despite other Asian phenotypes. Evidence suggests that pro-inflammatory interleukin-18 (IL-18) and anti-inflammatory adiponectin biomarkers associated with visceral adipose tissue (VAT) may explain this risk. Objectives: This study aimed to quantify the biomarkers in relation to standard ranges of VAT or typical circulating concentration ranges reported in the literature of IL-18 and adiponectin, examine relationships of these markers, and determine if they were different among those participants without diabetes, prediabetes, and diabetes. Methods: A cross-sectional study was used to enroll FAs without diabetes, prediabetes, or diabetes. VAT was measured using the InBody 570© Body Composition Analyzer. Blood samples were obtained to assess plasma concentrations of IL-18 and adiponectin using enzyme-linked immunosorbent assay. All analyses were conducted using a 5% type I error rate. Mean ±SD and percentages were used to describe the sample and data where appropriate. Pearson's correlations (R) were calculated to determine the relationships between VAT and IL-18 in each group. Analysis of variance was used to determine differences in VAT, IL-18, and adiponectin among groups. Further, nonparametric procedures examined the differences in adiponectin among those within groups. Results: Seventy-five participants were enrolled. Biomarkers above the typical concentration range were observed for VAT, IL-18, and adiponectin. Adiponectin significantly differed among groups with lower values in the diabetes group vs. the nondiabetes group. Conclusions: The findings indicate that while inflammation-related biomarkers, such as adiponectin, correlate with VAT and may serve as indicators of increased risk of type 2 diabetes in FAs, correlation alone does not establish causality. [ABSTRACT FROM AUTHOR]

Background: Moral resilience is the integrity and emotional strength to remain buoyant and achieve moral growth amid distressing situations. Evidence is still emerging on how to best cultivate moral resilience. Few studies have examined the predictive relationship of workplace well-being and of organizational factors with moral resilience. Research aims: The aims are to examine associations of workplace well-being (i.e., compassion satisfaction, burnout, and secondary traumatic stress) and moral resilience, and to examine associations of workplace factors (i.e., authentic leadership and perceived congruence of organizational mission and behaviors) and moral resilience. Research design: This study uses a cross-sectional design. Participants and research context: Nurses practicing in a hospital in the United States were surveyed using validated instruments (N = 147). Individual factors were measured using demographics and the Professional Quality of Life Scale. Organizational factors were measured using the Authentic Leadership Questionnaire and a single item measuring organizational mission/behavior congruence. Moral resilience was measured using the Rushton Moral Resilience Scale. Ethical considerations: The study was approved by an institutional review board. Findings: Resilience was noted to have significant small correlations with burnout, secondary traumatic stress, compassion satisfaction, and organizational mission/behavior congruence. Burnout and secondary traumatic stress predicted less resilience, whereas compassion satisfaction and perceived congruence between organizational mission and behaviors predicted higher resilience. Discussion: Burnout and secondary traumatic stress, increasingly experienced by nurses and other health professionals, have negative effects on moral resilience. Compassion satisfaction can increase resilience, which is especially important in nursing. Organizational practices promoting integrity and confidence can have positive effects on resilience. Conclusions: Continued work to confront workplace well-being issues, especially burnout, is needed as a way of increasing moral resilience. Studies of organizational and work environment factors to bolster resilience are likewise needed to assist organizational leaders in devising the best strategies. [ABSTRACT FROM AUTHOR]

Background: The merits and drawbacks of moral relevance models of addiction have predominantly been discussed theoretically, without empirical evidence of these potential effects. This study develops and evaluates a novel survey measure for assessing moral evaluations of patient substance misuse (ME-PSM). Methods: This measure was tested on 524 health professionals (i.e., physicians, nurses, and other health professionals) in California (n = 173), urban France (n = 102), and urban China (n = 249). Demographic factors associated with ME-PSM were investigated using analyses of variance (ANOVAs) and t-tests, with results suggesting that ME-PSM is higher among younger health professionals, nurses (when compared with physicians and other health professionals), and Chinese health professionals (when compared with French and American health professionals). Results: Results provide preliminary support for the psychometric quality of the survey measure introduced in this study, including the existence of a single latent structure and partial invariance of collected data across countries. Conclusion: The survey measure for ME-PSM which was developed and tested in the current study appears to hold potential utility for use as a measure of moral views of patient substance misuse. With development, this measure may be used to examine moral evaluations, both as factors of stigma and of other clinical factors associated with the treatment of patients with substance use disorders. [ABSTRACT FROM AUTHOR]

Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the US report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore the factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transgender women. This secondary analysis is based on data collected from the Symptom and Genetic Study that included a convenience sample of 22 self-identified transgender women, 201 non-transgender men, and 72 non-transgender women recruited in northern California. Self-reported medication adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire. Gender differences in demographic and clinical variables were assessed, as were differences between transgender women reporting high and low adherence. Transgender women had lower adherence to medications compared to non-transgender males and non-transgender females (p = .028) and were less likely to achieve viral suppression (p = .039). Within the transgender group, Black/African-Americans reported better adherence than participants who were Whites/Caucasian or other races (p = .009). Adherence among transgender women was unrelated to medication count and estrogen therapy, but consistent with other reports on the HIV population as a whole; transgender women with high adherence were more likely to achieve viral suppression compared to the transgender women with low adherence. Despite the high incidence of HIV infection in the transgender population, few studies focus on TWLWH, either in regard to their adherence to antiretroviral therapies or to their healthcare in general. To address ongoing health disparities, more studies are needed focusing on the transgender population's continuum of care in HIV therapies. [ABSTRACT FROM PUBLISHER]

Background/aim Engagement in desired occupations can promote health and wellbeing in older adults. Assessments of engagement often measure frequency, amount or importance of specific activities. This study aimed to develop a scale to measure older adults' evaluation of the extent to which their everyday activities are contributing to their health and wellness. Methods Eighteen items, each scored with a seven-point rating scale, were initially developed by content experts, covering perceptions of how daily activities contribute to physical and mental health, as well as satisfaction and activity participation in the last six months. Rasch analysis methods were used to refine the scale using the pencil and paper responses of 460 community-living older adults. Results Initial Rasch analysis indicated three unlabelled rating scale categories were seldom used, reducing measurement precision. Five items were conceptually different by misfit statistics and principal component analysis. Subsequently, those items were removed and the number of rating scale steps reduced to 4. The remaining 13-item, 4-step scale, termed the Activity Significance Personal Evaluation ( ASPEn), formed a unidimensional hierarchy with good fit statistics and targeting. Person separation reliability (2.7) and internal consistency (.91) indicated the tool is appropriate for individual person measurement. Relative validity indicated equivalence between Rasch measures and total raw scores. Conclusions ASPEn is a brief, easily administered assessment of older adults' perception of the contribution of everyday activities to personal health and wellness. ASPEn may facilitate occupational therapy practice by enabling clinicians to assess change in meaning of an older adult's activity over time. [ABSTRACT FROM AUTHOR]

Giving and receiving help are integral to creating the social environments necessary to support recovery. However, studies assessing the effects of helping behaviors have focused primarily on the benefits derived from giving help to others in 12-step programs and treatment. The current study examined the frequency of giving and receiving help among 188 persons entering sober living houses (SLHs), a type of recovery home that is common in California. Helping was assessed in three contexts: the SLH, 12-step meetings they attended, and interactions with their family and friends. Residents who gave help to others in one of these contexts tended to also receive help in that context. Residents who reported giving or receiving help in one context tended to report giving and receiving help in other contexts. Study findings suggest helping in recovery occurs in a broader, more reciprocal manner than currently conceptualized. Studies should address how giving and receiving help in different contexts affects recovery outcomes. Research is also needed to describe the determinants of giving and receiving help. Considerations for facilitating help among SLH residents are described. [ABSTRACT FROM AUTHOR]

Child protection is considered an appropriate government responsibility, but interventions into the family are also some of the most consequential for states. This study examines the normative basis for limiting parents' freedom by exploring public attitudes about a child's safety in the context of increasing risk. Using a randomized survey, we test the causal relationship between levels of risk and parental restrictions on representative samples in Norway and CA, US (n = 2148) – different welfare state and child protection models. Findings suggest that the public supports restricting parental freedom under conditions of risk and that severity of risk is taken into consideration. A majority favour restricting parental freedom under conditions of risk to the child; a minority resist restricting freedom, regardless of risk, and about one-third to one-half of respondents favour temporarily suspending parents' rights by separating children to foster care. Residents of Norway are half as likely to support unrestricted parenting, regardless of risk, and are 1.5 as likely to endorse restricted parenting. Norwegians are also 20% less likely to support separating a child from his parent compared to US respondents. The study has implications for system design based on popular notions about parents' freedom and family privacy. [ABSTRACT FROM AUTHOR]

Living alone, particularly for individuals with poor physical health, can increase the likelihood of mortality. This study aimed to explore the individual and joint associations of living alone and physical health with overall mortality among breast cancer survivors in the Women's Healthy Eating and Living (WHEL). We collected baseline, 12-month and 48-month data among 2869 women enrolled in the WHEL cohort. Living alone was assessed as a binary variable (Yes, No), while scores of physical health were measured using the RAND Short Form–36 survey (SF-36), which include four domains (physical function, role limitation, bodily pain, and general health perceptions) and an overall summary score of physical health. Cox proportional hazard models were used to evaluate associations. No significant association between living alone and mortality was observed. However, several physical health measures showed significant associations with mortality (p-values < 0.05). For physical function, the multivariable model showed a hazard ratio (HR) of 2.1 (95% CI = 1.02–4.23). Furthermore, the study examined the joint impact of living alone and physical health measures on overall mortality. Among women with better physical function, those living alone had a 3.6-fold higher risk of death (95% CI = 1.01–12.89) compared to those not living alone. Similar trends were observed for pain. However, regarding role limitation, the pattern differed. Breast cancer survivors living alone with worse role limitations had the highest mortality compared to those not living alone but with better role limitations (HR = 2.6, 95% CI = 1.11–5.95). Similar trends were observed for general health perceptions. Our findings highlight that living alone amplifies the risk of mortality among breast cancer survivors within specific health groups. [ABSTRACT FROM AUTHOR]

Aim: To describe positive and negative spiritual responses to providing COVID‐related nursing care among nurses working in hospitals. Background: The COVID pandemic has intensified and publicised the threats to nurse well‐being. Absent from the recommendations for promoting nurse well‐being is recognition of how nurses' spirituality and/or religiosity is affected by the strain of COVID caring or how it may be affecting their well‐being. Design: Cross‐sectional, descriptive observational, mixed methods study. Methods: Data were collected from 523 registered nurses employed in three Southern California hospitals during March–May, 2022 when these hospitals' COVID case counts were <15%. Using Online survey methods, data were obtained using the Religious/Spiritual Struggles Scale–Short Form, Moral Injury Symptom Scale–Healthcare Professionals, Post‐traumatic Growth Inventory and demographic and work‐related items. STROBE guidelines for cross‐sectional observational studies were observed. Results: The mean for religious/spiritual struggles was 1.98 (range of 1–5, comparable to a little bit). Although roughly half of the sample reported the struggles were not experienced/did not apply, 23%–36.5% reported experiencing these struggles at least somewhat. The most frequent struggle was to find ultimate meaning. The mean observed for moral injury was 6.5 (range of 1–10); applying established criteria indicated it was troubling for at least 50%. The mean for post‐traumatic growth was 4 (on a scale of 0–6); using established criteria, 41% experienced PTG. Quantitative findings were illustrated by the qualitative responses that occasionally expressed spiritual tragedy and transformation concurrently. Conclusion: The professional work of nursing impacts nurses in invisible, spiritual ways that can be tragic and/or transformative. Relevance to Clinical Practice: Interventions to address nurses' mental health challenges must include attention to these invisible struggles. Nurses' mental health challenges must be met in part by addressing how they can surmount spiritual tragedy—and allow spiritual transformation. [ABSTRACT FROM AUTHOR]

The quality of propensity scores is traditionally measured by assessing how well they make the distributions of covariates in the treatment and control groups match, which we refer to as 'good balance'. Good balance guarantees less biased estimates of the treatment effect. However, the cost of achieving good balance is that the variance of the estimates increases due to a reduction in effective sample size, either through the introduction of propensity score weights or dropping cases when propensity score matching. In this paper, we investigate whether it is best to optimize the balance or to settle for a less than optimal balance and use double robust estimation to adjust for remaining differences. We compare treatment effect estimates from regression, propensity score weighting, and double robust estimation with varying levels of effort expended to achieve balance using data from a study about the differences in outcomes by HIV status in heterosexually active homeless men residing in Los Angeles. Because of how costly data collection efforts are for this population, it is important to find an alternative estimation method that does not reduce effective sample size as much as methods that aggressively aim to optimize balance. Results from a simulation study suggest that there are instances in which we can obtain more precise treatment effect estimates without increasing bias too much by using a combination of regression and propensity score weights that achieve a less than optimal balance. There is a bias-variance tradeoff at work in propensity score estimation; every step toward better balance usually means an increase in variance and at some point a marginal decrease in bias may not be worth the associated increase in variance. [ABSTRACT FROM AUTHOR]

To date, Web-based 24-hour recalls have not been validated using objective biomarkers. From 2006 to 2009, the validity of 6 Web-based DietDay 24-hour recalls was tested among 115 black and 118 white healthy adults from Los Angeles, California, by using the doubly labeled water method, and the results were compared with the results of the Diet History Questionnaire, a food frequency questionnaire developed by the National Cancer Institute. The authors performed repeated measurements in a subset of 53 subjects approximately 6 months later to estimate the stability of the doubly labeled water measurement. The attenuation factors for the DietDay recall were 0.30 for blacks and 0.26 for whites. For the Diet History Questionnaire, the attenuation factors were 0.15 and 0.17 for blacks and whites, respectively. Adjusted correlations between true energy intake and the recalls were 0.50 and 0.47 for blacks and whites, respectively, for the DietDay recall. For the Diet History Questionnaire, they were 0.34 and 0.36 for blacks and whites, respectively. The rate of underreporting of more than 30% of calories was lower with the recalls than with the questionnaire (25% and 41% vs. 34% and 52% for blacks and whites, respectively). These findings suggest that Web-based DietDay dietary recalls offer an inexpensive and widely accessible dietary assessment alternative, the validity of which is equally strong among black and white adults. The validity of the Web-administered recall was superior to that of the paper food frequency questionnaire. [ABSTRACT FROM PUBLISHER]

Despite a high prevalence of HIV in patients with serious mental health disorders, there is little information in the literature regarding details of their HIV treatment. The objective of this paper is to assess factors associated with the success of HIV therapy in people with schizophrenia, schizoaffective, and bipolar disease. The methods used are retrospective, post-study chart review, and clinician questionnaire at two HIV county clinics. Forty-nine (4.8%) study patients were identified, 51% of whom achieved an undetectable HIV viral load. These patients tended to have less drug use (42% vs. 68%), more ongoing psychiatric visits (70% vs. 58%) and were more apt to take psychiatric medicines (70% vs. 40%) than patients with detectable HIV viral loads. Both groups had many missed appointments. We were surprised to find that many patients were successful with HIV treatment despite substance abuse, uncontrolled psychiatric symptoms, and lack of psychiatric care. Missing clinic appointments had little influence on treatment outcome. [ABSTRACT FROM AUTHOR]

common concern within HIV prevention is that HIV positive MSMW do not disclose their HIV status to female partners who are thus at increased risk for HIV infection. The present study uses unique data to examine whether MSMW disclose more often to male rather than female partners. Data were collected on most recent male and/or female primary partner and four most recent casual partners from 150 MSMW (50 African American, 50 Latino, 50 White). MSMW reported on 590 partners (31% female; 69% male). Disclosure was coded as disclosure before sex, disclosure after sex, or nondisclosure. A series of multinomial logistic regressions with partners clustered within respondents were conducted to evaluate effects of respondent characteristics and partner characteristics on timing of disclosure. In bivariate and multivariate analyses there were no significant differences in odds of disclosure to male and female partners before or after sex. Although MSMW were substantially less likely to disclose to HIV negative partners before sex compared to HIV positive partners regardless of sex, when we fully interacted the multivariate model by partner sex, the odds of disclosure to HIV negative male partners compared to HIV positive male partners before sex were significantly higher than the odds of disclosure to HIV negative female partners compared to HIV positive female partners. Patterns of mutual nondisclosure and nonreciprocal disclosure were observed with both primary and casual partners. The paper makes additional methodological contributions to the measurement and analysis of disclosure. [ABSTRACT FROM AUTHOR]

Health issues disproportionately affect Latinos, but variations within this ethnic group may mean that some Latinos are harder to reach with health messages than others. This paper introduces a methodology grounded in communication infrastructure theory to better target ‘hard-to-reach’ audiences. A random digit dialing telephone survey of 739 Latinos living in two Los Angeles communities was conducted. The relationships between health access difficulties and connections to an integrated storytelling network as well as individual health communication source connections were explored. Findings suggest that Latinos who are connected to an integrated storytelling network report marginally greater ease finding healthcare, despite not being any more likely to have insurance or a regular place for healthcare. Latinos who have health access problems tended to rely more upon Spanish-language television for health information. In addition, those without healthcare access problems are more likely to indicate that they use health professionals, the Internet, mainstream TV and printed materials like health pamphlets for health information. The theoretical and methodological contributions of this work, its major findings, implications, limitations and policy guidelines are discussed. [ABSTRACT FROM AUTHOR]

frican American men who have sex with men and women (MSMW), but who do not form a sexual identity around same-sex behavior, may experience risk for HIV infection and transmission. This paper reports cross-sectional survey findings on sexual behaviors and substance use of urban non-gay- or non-bisexual-identified African American MSMW ( n = 68), who completed behavior assessment surveys using audio-computer assisted self-interviewing technology. Overall, 17.6% reported being HIV-positive. In the past 3 months, 70.6% had unprotected insertive sex with a female, 51.5% had unprotected insertive anal sex (UIAS) with a male, 33.8% had unprotected receptive anal sex (URAS) with a male, 25% had UIAS with a transgender female, and 10.3% had URAS with a transgender female. Findings indicated a bridging potential for HIV and sexually transmitted infections across groups, such that 38.2% reported concurrent unprotected sex with female and male partners and 17.6% reported concurrent unprotected sex with female and transgender female partners. In the past 3 months, 70.6% used alcohol before sex and 85% used drugs before sex. Men who used drugs before sex had a tenfold increased likelihood for unprotected sex with male partners, and men who injected drugs had a nearly fivefold increased likelihood for unprotected sex with a transgender female. Interventions to address sexual risk behaviors, especially partner concurrency, and substance use behavior for these men are warranted. [ABSTRACT FROM AUTHOR]

Although we know a great deal about the percentage of youth who drink alcohol, we know very little about the specific brands they choose to drink. This information gap needs to be addressed if public health officials are to develop more effective interventions. Unfortunately, there are no national youth surveys that collect data on alcohol brand consumption. In this paper, we describe the development and pilot testing of what we believe to be the first comprehensive, Internet-based youth survey of brand-specific alcohol use. We used online advertising in 3 U.S. cities to recruit a convenience sample of 241 respondents, ages 16 to 18 years. We used Craigslist, a network of online communities that features local classified advertisements, to recruit the sample. We used SurveyGizmo, an online software program for designing Internet surveys, collecting data, and performing basic analysis, to survey these respondents about their brand-specific alcohol consumption patterns. The survey instrument assessed each respondent's 30-day drinking history, including the frequency of consumption for each alcohol brand. Using Internet survey technology, we were able to collect information on 366 brands and still have respondents complete the instrument quickly and easily. The total number of brands consumed in the past 30 days ranged from 1 to 18, with a median of 4 brands. The top 5 brands consumed were beer brands, as were eleven of the top 15 brands. The remaining 4 brands in the top 15 included 3 brands of flavored alcoholic beverages and 1 brand of mixed drink. Among the top 15 alcohol brands consumed during heavy drinking episodes were 8 brands of beer, 4 brands of flavored alcoholic beverages, 2 brands of wine, and 1 brand of mixed drink. This pilot study helps establish the feasibility of including brand-specific questions on federal or other national youth alcohol surveys. [ABSTRACT FROM AUTHOR]

This paper describes Mexican American family members' descriptions of perceived discrimination by pediatric health care providers (HCPs) and the families' reactions to the HCPs' discriminatory conduct. A retrospective, grounded theory design guided the overall study. Content analysis of interviews with 13 participants from 11 families who were recruited from two children's hospitals in Northern California resulted in numerous codes and revealed that participants perceived discrimination when they were treated differently from other, usually white, families. They believed they were treated differently because they were Mexican, because they were poor, because of language barriers, or because of their physical appearance. Participants reported feeling hurt, saddened, and confused regarding the differential treatment they received from HCPs who parents perceived 'should care equally for all people.' They struggled to understand and searched for explanations. Few spoke up about unfair treatment or complained about poor quality of care. Most assumed a quiet, passive position, according to their cultural norms of respecting authority figures by being submissive and not questioning them. Participants did not perceive all HCPs as discriminatory; their stories of discrimination derived from encounters with individual nurses or physicians. However, participants were greatly affected by the encounters, which continue to be painful memories. Despite increasing efforts to provide culturally competent palliative care, there is still need for improvement. Providing opportunities for changing HCPs' beliefs and behaviors is essential to developing cultural competence. [ABSTRACT FROM AUTHOR]

ulrich c.m., taylor c., soeken k., o'donnell p., farrar a., danis m. & grady c. (2010) Everyday ethics: ethical issues and stress in nursing practice. Journal of Advanced Nursing 66(11), 2510-2519. Aim. This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. Background. Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care. Methods. A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analysed using descriptive statistics, cross-tabulations and Pearson correlations. Results. A total of 422 questionnaires were used in the analysis. The five most frequently occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly. Conclusion. Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed. [ABSTRACT FROM AUTHOR]

li w.-w., wallhagen m.i. & froelicher e.s. (2010) Factors predicting blood pressure control in older Chinese immigrants to the United States of America. Journal of Advanced Nursing 66(10), 2202–2212. Aim. This paper is a report of a study of the extent to which demographic characteristics, medication-related factors, hypertension-related knowledge and medication adherence predict systolic and diastolic blood pressure. Background. Little is known about predictors of hypertension control in Chinese elders. Methods. A longitudinal study with a 3-month follow-up was conducted with 90 Chinese immigrants to the United States of America aged ≥65 years and recruited from 2006 to 2007. The independent variables were measured at baseline. Blood pressure was measured at 3 months. Multiple linear regression analysis was used to evaluate the independent effects of seven variables on change in blood pressure at 3 months. Results. Participants ranged in age from 66 to 92 years (Mean 76·7,sd 6·6). The overall regression model for systolic blood pressure was statistically significant ( R2 = 0·32, F = 4·37, P < 0·01). A higher number of prescribed oral medications (sr2 = 0·06, t = 2·42, P = 0·02) and lower medication adherence (sr2 = 0·07, t = −2·60, P = 0·01) were statistically significant determinants of an increased systolic blood pressure. The overall regression model for diastolic blood pressure was statistically significant ( R2 = 0·21, F = 2·39, P = 0·03). Male gender (sr2 = 0·06, t = 2·26, P = 0·03) and lower medication adherence (sr2 = 0·11, t = −3·03, P < 0·01) were statistically significant determinants of an increased diastolic blood pressure. Conclusion. A greater number of prescribed medications and lower adherence predicted higher level of systolic blood pressure. Male gender and lower adherence were significantly associated with higher level of diastolic blood pressure. These predictors should be considered when designing interventions to help Chinese elders achieve better hypertension management. [ABSTRACT FROM AUTHOR]

This study utilised the What Is Happening In this Class (WIHIC) questionnaire to examine factors that influence Californian students' perceptions of their learning environment. Data were collected from 665 USA middle school science students in 11 Californian schools. Several background variables, such as gender, socioeconomic status, ethnicity, and class size, were included in the study. A hierarchical analysis of variance was conducted. Results from this study indicate that some scales of the WIHIC are more inclined to measure personal or idiosyncratic features of student perceptions and other class features. A variable that consistently affected students' perceptions was student gender. Generally speaking, girls perceived their learning environment more positively than did boys. [ABSTRACT FROM AUTHOR]

This paper reports preliminary findings from research concerning the utilization of physicians' services. Data were obtained via interviews in a sample of Los Angeles County households in 1973. The results reported herein pertain only to the adult respondents. The relationships between adjusted family income and physician visits were found to vary with the scales and methods used. The indigent report a significantly greater number of physician visits than the nonindigent. Correlation and regression and regression analyses, however, show adjusted income to be unrelated to physician visits. One-way analysis of variance showed significant variation in physician visits by age, sex, and public insurance coverage (Medicaid or Medicare). Regression analysis showed days disables, public insurance coverage, and sex to be key predictors of physician visits. Path analysis was used to test a model of utilization derived from our interpretation of arguments proposed by Monteiro (1973). Adjusted income was found to have no significant effect on visits-either directly, or indirectly via days disabled and public insurance coverage. Disability and public insurance coverage were found to be positively related to visits, the latter even with disability controlled. Age was found to be positively related to visits via its effect on disability and public insurance coverage. [ABSTRACT FROM AUTHOR]

This research work reports the usability of binary additive materials known as tile waste dust (TWD) and calcined kaolin (CK) in ameliorating the mechanical response of weak soil. The extreme vertex design (EVD) was adopted for the mixture experimental design and modelling of the mechanical properties of the soil-TWD-CK blend. In the course of this study, a total of fifteen (15) design mixture ingredients' ratios for water, TWD, CK and soil were formulated. The key mechanical parameters considered in the study showed a considerable rate of improvement to the peak of 42%, 755 kN/m2 and 59% for California bearing ratio, unconfined compressive strength and resistance to loss in strength respectively. The development of EVD-model was achieved with the aid of the experimental derived results and fractions of component combinations through fits statistical evaluation, analysis of variance, diagnostic test, influence statistics and numerical optimization using desirability function to analyze the datasets. In a step further, the non-destructive test explored to assess the microstructural arrangement of the studied soil-additive materials displayed a substantial disparity compared to the corresponding original soil material and this is an indicator of soil improvement. From the geotechnical engineering perspective, this study elucidates the usability of waste residues as environmental friendly and sustainable materials in the field of soil re-engineering. [ABSTRACT FROM AUTHOR]

If children in child protection cannot be cared for by their natural parents, should they be adopted or live in foster home? Results from a study of representative samples of populations (n = 12 330), in eight European countries—Austria, England, Estonia, Finland, Germany, Ireland, Norway and Spain—and California, USA, reveal that people would recommend adoption over foster care, if a child in public care cannot grow up with their natural parent(s). There are cross‐country differences between populations, and examining if institutional context such as type of child protection system explains differences, we find that child maltreatment‐oriented systems are more supportive of adoption than other types of systems. Citizens having little confidence in the child protection system were only weakly correlated with preference for adoption. In conclusion, people prefer adoption as placement options for children in care are more than foster homes, and possible this finding reflects a sort of refamalialization of children into the private sphere. [ABSTRACT FROM AUTHOR]

Inattention can negatively impact several aspects of a child's life, including at home and school. Cognitive and physical interventions are two promising non-pharmaceutical approaches used to enhance attention abilities, with combined approaches often being marketed to teachers, therapists, and parents typically without research validation. Here, we assessed the feasibility of incorporating an integrated, cognitive-physical, closed-loop video game (body-brain trainer or 'BBT') as an after-school program, and also evaluated if there were attention benefits following its use. Twenty-two children (7–12 years of age) with a range of attention abilities were recruited to participate in this proof of concept, single-arm, longitudinal study (24 sessions over 8 weeks, ~30 min/day). We interrogated attention abilities through a parent survey of their child's behaviors, in addition to objective performance-based and neural measures of attention. Here we observed 95% compliance as well as, significant improvements on the parent-based reports of inattention and on cognitive tests and neural measures of attention that were comparable in scale to previous work. Exploratory measures of other cognitive control abilities and physical fitness also showed similar improvement, with exploratory evaluation of retained benefits on the primary attention-related outcomes being present 1-year later. Lastly, there was no correlation between the baseline parent-rated inattention score and the improvement on the primary task-based measures of attention, suggesting that intervention-based benefits were not solely attained by those who stood the most to gain. These pilot findings warrant future research to replicate and extend these findings. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study is first, to investigate intensive care patients' perceptions of stressors; second, to investigate the health care provider's perception of what constitutes a stressor from the patient's perspective; and third, to describe how health care providers manage their patients' stressors. This was a mixed-methods study; the quantitative section replicated Cornock's 1998 study of stress in the intensive care unit (ICU), with difference in sampling to include all health care providers in the ICU, in addition to nurses. The qualitative section added information to the current literature by describing how health care providers manage their patient's stressors. This article reports the quantitative findings of this study, as the qualitative section is presented in a separate article. Background and Significance: It is important to describe ICU patients' stressful experiences to assess patient's stressors, provide holistic care to eliminate stressors, and provide feedback to health care providers. There is a need to describe the clinical practice related to stress perception and management of stressors in the critical care environment. Methodology: A mixed-methods comparative descriptive design was used for the quantitative section, and a phenomenological approach guided the qualitative section. Lazarus and Folkman's theory formed the bases for integrating all variables investigated in this study. The sample included 70 ICU patients and 70 ICU health care providers. After consenting to participate in this study, subjects were given a demographic form and a paper-based tool, the Environmental Stressors graphic data form Questionnaire. Questionnaires were filled out by subjects anonymously in the ICU and returned to the researcher in the same setting. Findings: Descriptive statistics were analyzed using SPSS data analysis software. The top 3 most stressful items ranked by the patients included "being in pain," followed by "not being able to sleep" and "financial worries"; on the other hand, health care providers perceived "being in pain" followed by "not being able to communicate" and "not being in control of yourself" as the top 3 stressors perceived by their patients. Implications for Practice: The findings of this study are crucial and may inform nursing assessments and care of the ICU patient. In addition, this information may encourage the ICU staff to manipulate and redesign the ICU environment to be less stressful. Also, the findings of this study guided the development of an ICU stressor control policy. [ABSTRACT FROM AUTHOR]

Aims: To identify and describe profiles of nursing resources and compare nurse and patient outcomes among the identified nursing resource profiles. Background: Research linking nurse education, staffing, and the work environment treats these nursing resources as separate variables. Individual hospitals exhibit distinct profiles of these resources. Methods: This cross‐sectional secondary analysis used 2006 data from 692 hospitals in four states. Latent class mixture modelling was used to identify resource profiles. Regression models estimated the associations among the profiles and outcomes. Results: Three profiles were identified (better, mixed and poor) according to their nursing resource levels. Hospitals with poor profiles were disproportionately mid‐sized, for‐profit, and had lower technology capability. Nurse job outcomes, patient mortality and care experiences were significantly improved in hospitals with better resource profiles. Conclusions: Hospitals exhibit distinct profiles of nursing resources that reflect investments into nursing. Nurse and patient outcomes and patients' experiences are improved in hospitals with better nursing resource profiles. This finding is consistent with the literature that has examined these resources independently. Implications for Nursing Management: Nurse managers can identify their nursing resource profile and the associated outcomes. Our results show the advantages of improving one's hospital nursing resource profile, motivating managers to make an informed decision regarding investments in nursing resources. [ABSTRACT FROM AUTHOR]

Factors postulated to predict weight loss after gastric bypass surgery, include race, age, gender, technique, height, and initial weight. This paper contained 1551 gastric bypass patients (85.9% female). Operations were performed by one surgeon (MLO) at community hospitals in Southern California from 1989 to 2008 with 314 being laparoscopic and 1237 open. We created the following equation: In[percent weight] = At2-Bt, where t was the time after operation (days) and A and B are constants. Analysis was completed on R-software. The model fits with R2 value 0.93 and gives patients a realistic mean target weight with a confidence interval of 95% for the first year. Conclusion. We created a curve predicting weight loss after surgery as a percentage of initial weight. Initial weight was the single most important predictor of weight loss after surgery. Other recorded variables accounted for less than 1% of variability. Unknown factors account for the remaining 6-7%. [ABSTRACT FROM AUTHOR]

This study describes predictors of secondary traumatic stress and burnout in a national sample of helping professionals, with a specific focus on the unique responses of child welfare (CW) workers. Specific worker and exposure characteristics are examined as possible predictors of these forms of occupational distress in a sample of 669 professionals from across the country who responded to mailed (e-mail and post) invitations to participate in an online survey. Email and home mailing addresses were secured from licensure boards and professional membership organizations in six states from across the country that had high rates of child related deaths in 2009. Respondents completed the Professional Quality of Life IV (Stamm, 2005) to ascertain compassion fatigue (CF) and burnout symptoms. Being male, young, Hispanic, holding rural residence, and endorsing a lack of religious participation were significant predictors of secondary traumatic stress. Similarly, being male and young predicted high burnout rates, while actively participating in religious services predicted lower burnout. CW worker job status as a professional was significantly more likely to predict CF and burnout compared to all other types of behavioral healthcare professionals. Based on the findings from this study, this paper proposes strategies for enhancing self-care for CW workers, and describes the essential elements of a trauma-informed CW agency that addresses secondary traumatic stress and burnout. [ABSTRACT FROM AUTHOR]

This study examined associations between substance use, family functioning, and self-image among four ethnic adolescent groups. Three thousand three hundred and fifteen 8th and 9th grade students were recruited from 10 schools in Los Angeles County. Participants completed a paper-and-pencil survey regarding their alcohol and marijuana use, along with their perceived family functioning and self-image and other demographic variables. Ordinal logistic regression was performed to examine associations. Results indicated that both family functioning and self-image were significantly associated with alcohol and marijuana use. Those who scored lower on family functioning and self-image were at increased risk for substance use. Furthermore, students who scored low in both family functioning and self-image were about twice as likely to report using alcohol. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) remains a pressing public health issue. Nationally, 1 in 5 women and 1 in 10 men have sustained severe physical violence from an intimate partner. Intimate partner homicides (IPH) are the most serious IPV outcome. This study examined documented IPH in Los Angeles County during 2017, analyzing if precipitating circumstances, victim demographics, victim/suspect relationship, and weapon type were related to how often a homicide was reported in online media stories. Cases were identified from the National Violent Death Reporting System (NVDRS), and standardized internet searches identified media articles associated with each case. Victim demographics from NVDRS and media articles were compared using Chi Square tests. Media report frequency, within different categorical predictor values, were examined using ANOVA models. 44 incidents were identified; averaging 5.2 articles per decedent. Univariate analyses showed significant difference in media reporting by poverty level (low versus high socioeconomic status) and presence of preceding argument. Multivariate analyses found significantly more media reports (p = 0.002) for incidents in which a preceding argument is reported, the victim was 30–39 years old and from a low socioeconomic status zip code. From our results certain characteristics of IPH are associated with greater media reporting. Promotion of consistent and responsible IPH media reporting guidelines is an opportunity to reinforce public health messaging and dispel myths. In turn, this will encourage the development of future policies and funding streams across the spectrum of preventing and stopping IPV. [ABSTRACT FROM AUTHOR]

Objective: An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods: This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results: Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully "escaped" in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F (4, 254) = 24.10, p <.001; Wilks' Λ =.725; partial η2 =.275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions: This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums. [ABSTRACT FROM AUTHOR]

Although the concept friend' is critical to both theoretical and empirical studies of social relations, it is a very ambiguous term. Most researchers seem to take its meaning for granted. This paper reports an inductive study designed to find out what aspects of real relations are correlated with applications of the label friend'. In a cross-sectional survey of 1050 adults living in northern California in 19 77, we obtained the names and descriptions of 19417 associates. Of these, 59% were labelled friends. Several regression analyses suggest that this label is likely to be applied: to an overwhelming majority of non-relatives in a largely unsystematic way; to associates lacking other, specialized role-relations; to people of the same age; to people known a long time; and to people with whom respondents had primarily sociable, rather than intimate or material, involvements. [ABSTRACT FROM AUTHOR]

With the aging process, falls and related injuries are common and unwanted events among older women. Lost balance is the last step before the frequent experience of falls. After menopause, women's bone conditions regarding health and balance performance steeply decline often resulting in serious injury. Our purpose in the study is to identify balance performance and its associations with soft tissue components among Korean-American (KA) women with three menopausal conditions. Researchers conducted a cross-sectional study with 63 KA women divided into three age groups: 25–35 years (young), 45–55 years old (middle), and 65+ years (old). Lean and fat mass on the entire body, appendicular and gynoid areas were measured by using the dual X-ray absorptiometry. Static and dynamic balance and physical performance (floor sit to stand) were tested. We found that with increased aging, lean mass, fat and body mass index were changed; balance and physical performance decreased significantly. In regression models, age and fat ratio of android/gynoid changes explain static balance and physical performance; appendicular lean mass predicted dynamic balance. With advancing age, maintaining lean mass and proportion of fat accumulation is critical for stable balance. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies suggest associations between oil and gas development (OGD) and adverse birth outcomes, but few epidemiological studies of oil wells or inactive wells exist, and none in California. OBJECTIVE: Our study aimed to investigate the relationship between residential proximity to OGD and birth outcomes in California. METHODS: We conducted a retrospective cohort study of 2,918,089 births to mothers living within 10 km of at least one production well between January 1, 2006 and December 31, 2015. We estimated exposure during pregnancy to inactive wells count (no inactive wells, 1 well, 2–5 wells, 6+ wells) and production volume from active wells in barrels of oil equivalent (BOE) (no BOE, 1–100 BOE/day, >100 BOE=day). We used generalized estimating equations to examine associations between overall and trimester-specific OGD exposures and term birth weight (tBW), low birth weight (LBW), preterm birth (PTB), and small for gestational age birth (SGA). We assessed effect modification by urban/rural community type. RESULTS: Adjusted models showed exposure to active OGD was associated with adverse birth outcomes in rural areas; effect estimates in urban areas were close to null. In rural areas, increasing production volume was associated with stronger adverse effect estimates. High (>100 BOE=day) vs. no production throughout pregnancy was associated with increased odds of LBW [odds ratio(OR)= 1.40, 95% confidence interval (CI): 1.14, 1.71] and SGA (OR = 1.22, 95% CI: 1.02, 1.45), and decreased tBW (mean difference = -36 grams, 95% CI: -54, -17), but not with PTB (OR = 1.03, 95% CI: 0.91, 1.18). CONCLUSION: Proximity to higher production OGD in California was associated with adverse birth outcomes among mothers residing in rural areas. Future studies are needed to confirm our findings in other populations and improve exposure assessment measures. [ABSTRACT FROM AUTHOR]

In this study we describe nurse–physician teamwork, estimate its association with surgical patient outcomes (30-day mortality and failure-to-rescue), and determine whether these relationships depend upon other modifiable hospital nursing characteristics (nurse staffing and education levels) known to be associated with patient outcomes. This cross-sectional analysis included linked data from 29,391 nurses representing 665 acute care hospitals and 1,321,904 adult patients who underwent a general surgical, vascular, or orthopedic procedure. Surgical patients cared for in hospitals with better nurse–physician teamwork had significantly lower odds of 30-day mortality (odds ratio [OR] = 0.95) and failure-to-rescue (OR = 0.95). In addition, the odds of death and failure-to-rescue were lower for patients in hospitals with both higher nurse–physician teamwork and more favorable patient-to-nurse staffing ratios. Similar trends were observed related to nursing education levels. Improving interprofessional teamwork is one strategy to improve patient outcomes with the added importance of also considering additional features of their nursing workforce. [ABSTRACT FROM AUTHOR]

Objective: To investigate long-term effects of GOALS executive function training in Veterans with chronic TBI. In a recently completed study Veterans with chronic TBI showed improvement immediately post-GOALS but not control training on measures of executive function, functional task performance, and emotion regulation. We now examine the long-term maintenance of post-GOALS training changes in the same sample. Setting: San Francisco VA Health Care System (SFVAHCS), and VA Northern California Health-Care System (VANCHS) in Martinez. Participants and Design: 24 Veterans with chronic TBI were assessed at baseline, post-GOALS training, and long-term follow-up 6+ months following completion of training with a structured telephone interview, neuropsychological and complex functional performance measures, and self-report measures of daily and emotional functioning. Results: Participants reported an increased likelihood of involvement in competitive employment/volunteering at follow-up (61%) compared to baseline (26%; χ2 = 5.66, p <.01, ѱ =.35). Repeated measures MANOVAS indicated improvement on attention/executive function (F = 13.85, p <.01, partial η2 =.42), complex functional task performance (GPS Total: F = 9.12, p <.01, partial η2 =.38) and daily functioning (MPAI Total: F = 3.23, p <.05, partial η2 =.21), and reduction in overall mood disturbance (POMS Total: F = 3.42, p <.05, partial η2 =.22) at follow-up relative to baseline. Discussion: Training in attention regulation applied to participant-defined goals is associated with meaningful long-term improvement in cognitive skills, emotion regulation, and daily functioning in Veterans with chronic TBI. [ABSTRACT FROM AUTHOR]

Purpose: To assess the esthetic and functional outcome, as well as the volume maintenance, of autogenous block grafts placed in anterior sextants of thin periodontal biotype subjects over a long-term period. Materials and Methods: Fifteen consecutive patients were followed up yearly for an average of 40 months after autogenous block grafting. Preoperative and postoperative cone beam computed tomographic scans were analyzed to evaluate bone volume maintenance around the implants placed in the grafted sites. Clinical parameters (mucosal recession and implant transparency through the soft tissue) were assessed at prosthesis delivery and follow-up to evaluate the esthetic outcome. Digital photographs were used to confirm clinical outcomes. Results: The average augmentation per site was 2.2 times the initial buccolingual (BL) width, and 97% of the augmented width was maintained after 3.3 years. The difference between preaugmentation and postaugmentation BL width, 3.3 versus 7.4 mm, was statistically significant (P < .0001; CI 95%: 3.4 to 4.9 mm). There was a lack of implant transparency or mucosal recession around the implants in all 15 patients after an average of 40 months. Conclusions: Autogenous block grafting seems to be a predictable treatment modality to reconstruct alveolar ridge defects in the long term. A thin periodontal biotype did not seem to affect the volume of transplanted bone for the population studied. [ABSTRACT FROM AUTHOR]

Objective: The purpose was to compare nurse education, patient‐to‐nurse staffing, nursing skill mix, and nurse work environments across hospitals depending on extent of rurality. Design: Cross‐sectional, comparative, and descriptive. Sample: The final sample included 566 urban, 49 large, 18 small, and 9 isolated hospitals from California, Florida, and Pennsylvania. Measurement: Data collected from large random samples from the 2005–2008 Multi‐State Nursing Care and Patient Safety Study funded by the National Institute of Nursing Research and National Institutes of Health were linked to 2005–2006 American Hospital Association data. Rural–Urban Commuting Area codes developed by the University of Washington and the United States Department of Agriculture Economic Research Service were used to determine the extent of hospital rurality across the sample. Results: Hospital percentages of baccalaureate prepared nurses differed significantly among urban (38%), large (28%), small (31%), and isolated rural hospitals (21%). Patient‐to‐registered nurse ratios in urban (4.8), large (5.6), small (5.6), and isolated rural hospitals (7.3) differed. Rural hospital nursing skill mix differed, and was lowest in isolated rural hospitals (65%). Nursing foundations for quality care were poorer in large, small, and isolated rural hospitals. Conclusion: Results support bolstering rural nursing resources in more remote locations, potentially through rural health policies. [ABSTRACT FROM AUTHOR]

Objectives Household stressors, such as food insecurity, contribute to the home emotional environment and negatively affect child development. Little research on this topic has been conducted among very young children. This study aimed to examine the relationship between food insecurity and the home emotional environment, as well the extent to which the relationship may be mediated by maternal symptoms of depression. Frequency of praise, affection, and discipline of young children by mothers were examined as markers of the home emotional environment. Methods Data were collected in a cross-sectional study of mothers of children under the age of five (N = 4231). Logistic regression was used to assess the relationship between level of food security and frequency of praise and discipline of children. Mediation analysis using the KHB method was conducted to test whether maternal mental health mediated the relationship between food insecurity and each outcome. Results Low and very low food security were significantly associated with higher odds of disciplining children with high frequency. Controlling for all covariates, frequency of praise was not significantly associated with level of household food insecurity. Differences in praise and discipline frequency were found by language of interview, maternal education, and employment. Conclusions for Practice Parent-child interactions, specifically related to discipline, are related to food insecurity. Further research should consider cultural patterns and mechanisms behind the relationship between food insecurity and the home environment. Household stressors begin affecting children at young ages, and early intervention is essential to prevent further negative sequelae as children grow older. [ABSTRACT FROM AUTHOR]

Objective: To assess produce availability, quality and price in a large sample of food stores in low-income neighbourhoods in California.Design: Cross-sectional statewide survey.Setting: Between 2011 and 2015, local health departments assessed store type, WIC (Supplemental Nutrition Program for Women, Infants, and Children)/SNAP (Supplemental Nutrition Assistance Program) participation, produce availability, quality and price of selected items in stores in low-income neighbourhoods. Secondary data provided reference chain supermarket produce prices matched by county and month. t Tests and ANOVA examined differences by store type; regression models examined factors associated with price.Subjects: Large grocery stores (n 231), small markets (n 621) and convenience stores (n 622) in 225 neighbourhoods.Results: Produce in most large groceries was rated high quality (97 % of fruits, 98 % of vegetables), but not in convenience stores (25 % fruits, 14 % vegetables). Small markets and convenience stores participating in WIC and/or SNAP had better produce availability, variety and quality than non-participating stores. Produce prices across store types were, on average, higher than reference prices from matched chain supermarkets (27 % higher in large groceries, 37 % higher in small markets, 102 % higher in convenience stores). Price was significantly inversely associated with produce variety, adjusting for quality, store type, and SNAP and WIC participation.Conclusions: The study finds that fresh produce is more expensive in low-income neighbourhoods and that convenience stores offer more expensive, poorer-quality produce than other stores. Variety is associated with price and most limited in convenience stores, suggesting more work is needed to determine how convenience stores can provide low-income consumers with access to affordable, high-quality produce. WIC and SNAP can contribute to the solution. [ABSTRACT FROM AUTHOR]

The current study assesses how characteristics of medical marijuana use are related to general health status and past year change in health. An analytic sample of 312 patients were recruited from 16 medical marijuana dispensaries across Los Angeles, California. Patients completed a short intercept survey and a longer patient survey. Surveys asked information about health, marijuana use behaviors, preferred ways to use marijuana, marijuana recommendation, and sociodemographic information. Data were analyzed using hierarchical linear modeling of patients nested within dispensaries. For general health status, patients who smoke marijuana, have more medical conditions for which they received their medical marijuana recommendation, and use marijuana more times per day report lower levels of general health. The number of days using marijuana per month was related to worse health in the past year. Medical marijuana use does not appear to improve overall health status according to the results presented here, but is limited by the cross-sectional nature of the study. As the legalization of medical marijuana use continues to grow across the United States, identifying how marijuana is related to health will allow physicians to better determine who may benefit from its use. [ABSTRACT FROM AUTHOR]

The infant brain may be predisposed to identify perceptually salient cues that are common to both signed and spoken languages. Recent theory based on spoken languages has advanced sonority as one of these potential language acquisition cues. Using a preferential looking paradigm with an infrared eye tracker, we explored visual attention of hearing 6- and 12-month-olds with no sign language experience as they watched fingerspelling stimuli that either conformed to high sonority (well-formed) or low sonority (ill-formed) values, which are relevant to syllabic structure in signed language. Younger babies showed highly significant looking preferences for well-formed, high sonority fingerspelling, while older babies showed no preference for either fingerspelling variant, despite showing a strong preference in a control condition. The present findings suggest babies possess a sensitivity to specific sonority-based contrastive cues at the core of human language structure that is subject to perceptual narrowing, irrespective of language modality (visual or auditory), shedding new light on universals of early language learning. [ABSTRACT FROM AUTHOR]

Nightclubs are a setting in which young adults purposefully seek out experiences, such as drug use and alcohol intoxication that can expose them to physical harm. While physical harm occurs fairly frequently within clubs, many patrons have safe clubbing experiences. Further, not all patrons experience potential harms the same way, as there are differences in aggression and intoxication. In this article, we draw on data from a research study in which we sought to better understand the role of social drinking groups in experiences of risk within nightclubs, as the majority of patrons attend with others. We collected data from 1642 patrons comprising 615 social drinking groups as they entered and exited nightclubs in a major US city. We focused on six experiences that might cause physical harm: alcohol impairment, alcohol intoxication, drug use, physical aggression, sexual aggression, and impaired driving. We aggregated patron responses across social groups and used latent class statistical analysis to determine if and how experiences tended to co-occur within groups. This analysis indicated that there were five distinct classes which we named limited vulnerability, aggression vulnerability, substance users, impaired drivers, and multi-issue. We assessed the groups within each class for distinctions on characteristics and group context. We found differences in the groups in each class, such as groups containing romantic dyads experienced less risk, while those groups with greater familiarity, greater concern for safety, and higher expectations for consumption experienced more risk. Group composition has an impact on the experiences within a club on a given night, in particular when it comes to risk and safety assessment. [ABSTRACT FROM AUTHOR]

The Epic electronic health record (EHR) platform supports structured data entry systems (SDES), which allow developers, with input from users, to create highly customized patient-record templates in order to maximize data completeness and to standardize structure. There are many potential advantages of using discrete data fields in the EHR to capture data for secondary analysis and epidemiological research, but direct data acquisition from clinicians remains one of the largest obstacles to leveraging the EHR for secondary use. Physician resistance to SDES is multifactorial. A 35-item questionnaire based on Unified Theory of Acceptance and Use of Technology, was used to measure attitudes, facilitation, and potential incentives for adopting SDES for clinical documentation among 25 pediatric specialty physicians and surgeons. Statistical analysis included chi-square for categorical data as well as independent sample t-tests and analysis of variance for continuous variables. Mean scores of the nine constructs demonstrated primarily positive physician attitudes toward SDES, while the surgeons were neutral. Those under 40 were more likely to respond that facilitating conditions for structured entry existed as compared to the two older age groups ( p = .02). Pediatric surgeons were significantly less positive than specialty physicians about SDES effects on Performance ( p = .01) and the effect of Social Influence ( p = .02); but in more agreement that use of forms was voluntary ( p = .02). Attitudinal differences likely reflect medical training, clinical practice workflows, and division specific practices. Identified resistance indicate efforts to increase SDES adoption should be discipline-targeted rather than a uniform approach. [ABSTRACT FROM AUTHOR]

The relationship between compassion fatigue and mindfulness in mental health professionals compared to Master of Social Work (MSW) students is explored. A convenience sample of mental health professionals (n = 40) and MSW students (n = 111) completed the Five Facet Mindfulness Questionnaire and Professional Quality of Life Scale. Results indicate a medium, negative correlation between compassion fatigue and mindfulness, with high levels of compassion fatigue associated with lower levels of mindfulness. There was no statistically significant difference between mental health workers and MSW students on the combined dependent variables. Results suggest that mindfulness protects against compassion fatigue regardless of professional or student status. [ABSTRACT FROM AUTHOR]