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The development of efficient and reliable online assessments has become increasingly important in the digital era. We developed a 10-min online word reading assessment of global English based on the existing paper-and-pencil version of our English silent word reading test. The test includes two parts, namely, random word recognition and contextual word reading. A total of 889 participants (437 children and 392 adults; 62.7% female) took part in the study. They were from various regions including mainland China, Hong Kong SAR, Macau SAR, Poland, the United States, and the Philippines. Reliability and validity analyses on various demographics samples (by age and country/region of origin) demonstrated that the WordSword Test is highly reliable and valid (e.g., the correlation of this test with other English reading measures were above.80). Education level was positively correlated with test performance, while the correlations between age and test performance were not consistent. Ninety-seven children participants also took the paper-and-pencil version of the WordSword Test. The correlation between performances on the online and paper-and-pencil versions of the test was.879, one year apart. With more children and adults taking the WordSword Test, we ultimately hope to establish norms by area, grade level, and age. [ABSTRACT FROM AUTHOR]

Background: Cough is one of the most common presenting problems for patients in primary care and is largely managed in primary care clinical settings. Family physicians' familiarity with chronic cough guidelines and the extent to which these guidelines translate into everyday practice have not been well described. The objective of this study was to characterize current diagnosis, treatment, and referral practices among family physicians and to identify potentially impactful strategies to optimize chronic cough management in primary care. Methods: We conducted a cross-sectional survey of 5,000 family physicians to explore diagnosis, treatment, and referral practices related to chronic cough management in adults in primary care. Respondents completed the survey via paper or online. The outcome measures were self-reported numeric ratings and responses related to the survey elements. Results: 588 surveys were completed (11.8% response rate). About half (49.6%) of respondents defined chronic cough in a manner consistent with the American College of Chest Physicians (ACCP) chronic cough guidelines, with the rest differing in opinion primarily regarding duration of symptom presentation. Respondents reported trying to rule out most common causes of chronic cough themselves before referring (mean 3.41 on a 4-point scale where 4 is "describes me completely") and indicated a desire for more resources to help them manage and treat chronic cough. Years in practice and rural/urban setting influenced diagnosis and referral practices. Conclusions: Family physicians see chronic cough as a complicated condition that can be and is often diagnosed and treated entirely in a primary care setting. They also value the ability to refer in complex cases. Our results support that family physicians provide evidence-based management of chronic cough. [ABSTRACT FROM AUTHOR]

Aims: This exploratory study, using mixed methods research, aimed to (1) examine the associations among self‐efficacy, social support and regular leisure‐time physical activity of nursing staff, and (2) identify motivators and barriers to leisure‐time physical activity. Background: It is important to engage nursing staff in regular leisure‐time physical activity as a countermeasure against high occupational stress and poor health. Limited research has examined nursing staff's participation in leisure‐time physical activity and associated factors. Methods: Nursing staff employed at a community hospital in the northeastern United States were invited to participate in this cross‐sectional survey with close‐ and open‐ended questions in March 2016. Results: A total of 363 nurses and nursing assistants responded, among whom, 59.8% reported regular leisure‐time physical activity. Poisson regression models suggested that self‐efficacy and social support had an interactive association with increased prevalence of regular leisure‐time physical activity. Conclusion: Self‐efficacy and social support have an important synergistic association with regular leisure‐time physical activity of nursing staff. Effective interventions intending to facilitate nursing staff's leisure‐time physical activity should consider improving their self‐efficacy and social support. Qualitative comments suggested that work‐out areas in the workplace with release time and organized activity may promote regular leisure‐time physical activity of nursing staff. Summary statement: What is already known about this topic? Leisure‐time physical activity is beneficial to both physical and mental health.Self‐efficacy and social support have been reported as independent predictors of leisure‐time physical activity in the general population.There is limited evidence regarding nursing staff's level of participation in leisure‐time physical activity and associated factors. What this paper adds? There is a higher level of participation in leisure‐time physical activity among nursing staff than the general population.Exercise self‐efficacy and social support have a synergistic association with regular leisure‐time physical activity among nursing staff.Support and promoting physical and mental fitness are motivators, whereas lack of time and energy and physical illnesses are barriers to regular leisure‐time physical activity reported by nursing staff. The implications of this paper: Findings indicate effective interventions designed to improve both self‐efficacy and social support might help facilitate nursing staff's participation in regular leisure‐time physical activity.Findings suggest organizational support through installing work‐out areas in the workplace with release time and organized activity might enhance nursing staff's capacity to engage in leisure‐time physical activity. [ABSTRACT FROM AUTHOR]

Previous research has found that music brings back more vivid and emotional autobiographical memories than various other retrieval cues. However, such studies have often been low in ecological validity and constrained by relatively limited cue selection and predominantly young adult samples. Here, we compared music to food as cues for autobiographical memories in everyday life in young and older adults. In two separate four‐day periods, 39 younger (ages 18–34) and 39 older (ages 60–77) adults recorded their music‐ and food‐evoked autobiographical memories in paper diaries. Across both age groups, music triggered more frequent autobiographical memories, a greater proportion of involuntary memories, and memories rated as more personally important in comparison to food cues. Age differences impacted music‐ and food‐evoked memories similarly, with older adults consistently recalling older and less specific memories, which they rated as more positive, vivid, and rehearsed. However, young and older adults did not differ in the number or involuntary nature of their recorded memories. This work represents an important step in understanding the phenomenology of naturally occurring music‐evoked autobiographical memories across adulthood and provides new insights into how and why music may be a more effective trigger for personally valued memories than certain other everyday cues. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known about this topic?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates.No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. What this paper adds to existing knowledge?: It appears feasible to use the HIP to profile and compare physical health‐related risks in people with SMI across different international settings.The HIP tool identified significant differences in areas of risk across the four countries. What are the implications for practice?: The HIP could be used to identify unique clusters of health promotion needs in different countries.Use of HIP health checks may support implementation of individualized interventions. Introduction: To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim: To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method: An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results: Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion: This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi‐national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice: It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources. [ABSTRACT FROM AUTHOR]

Objective: To shorten the Patient Engagement In Research Scale (PEIRS) to its most essential items and evaluate its measurement properties for assessing the degree of patients' and family caregivers' meaningful engagement as partners in research projects. Methods: A prospective cross‐sectional web‐based survey in Canada and the USA, and also paper‐based in Canada. Participants were patients or family caregivers who had engaged in research projects within the last 3 years, were ≥17 years old, and communicated in English. Extensive psychometric analyses were conducted. Results: 119 participants: 99 from Canada, 74 female, 51 aged 17‐35 years and 50 aged 36‐65 years, 60 had post‐secondary education, and 74 were Caucasian/white. The original 37‐item PEIRS was shortened to 22 items (PEIRS‐22), mainly because of low inter‐item correlations. PEIRS‐22 had a single dominant construct that accounted for 55% of explained variance. Analysis of PEIRS‐22 scores revealed the following: (1) acceptable floor and ceiling effects (<15%), (2) internal consistency (ordinal alpha = 0.96), (3) structural validity by fit to a Rasch measurement model, (4) construct validity by moderate correlations with the Public and Patient Engagement Evaluation Tool, (5) good test‐retest reliability (ICC2,1 = 0.86) and (6) interpretability demonstrated by significant differences among PEIRS‐22 scores across three levels of global meaningful engagement in research. Conclusions: The shortened PEIRS is valid and reliable for assessing the degree of meaningful patient and family caregiver engagement in research. It enables standardized assessment of engagement in research across various contexts. Patient or public contribution: A researcher‐initiated collaboration, patient partners contributed from study conception to manuscript write‐up. [ABSTRACT FROM AUTHOR]

Despite extensive anecdotal evidence on US long-haul truckers' risk interactions on the road, links between their sexual mixing and drug exchanges and their potential risk for STI/BBI acquisition and dissemination remain insufficiently documented. Grounded in social ecological theories and multi method ethnographic data, this paper examines the sexual transactions and drug exchanges of key members of US trucker risk networks within diverse trucking milieux. Research has uncovered four key trucker-centered populations and their diverse risk exchanges: (a) straight male truckers who engage in casual sex with women; (b) female sexworkers (known as 'lot lizards') who solicit truckers; (c) intermediaries who broker sex and drug exchanges between truckers, drug dealers and sexworkers; and (d) male truckchasers who cruise for truckers in physical and virtual milieux to engage in sex. Concurrent sexual partnerships of truckers have the potential to amplify initial infections by linking individuals of disparate epidemiological settings, thereby enabling pathogens to travel rapidly and efficiently to disparate regions. The comprehensive delineation of the role of long-haul trucking in potential disease spread is required for the development of effective STI/HIV prevention programs for populations of interest. [ABSTRACT FROM AUTHOR]

Objective: To determine if otolaryngologists and audiologists of the American Academy of Otolaryngology – Head and Neck Surgery have noticed an increase in the incidence of sudden sensorineural hearing loss during the coronavirus disease 2019 pandemic. Methods: A questionnaire was developed for the purpose of providing a cross-sectional descriptive analysis of perceived association between the coronavirus disease 2019 pandemic and an increase in the incidence of sudden sensorineural hearing loss. Results: Of respondents, 63.0 per cent did not notice an increase in sudden sensorineural hearing loss during the coronavirus disease 2019 pandemic. There was a weak positive correlation between patients identified with sudden sensorineural hearing loss and the percentage of coronavirus disease 2019 positive patients reported by each medical care provider (Spearman correlation = 0.20, 95 per cent confidence interval = 0.05–0.33). There was no association between geographical location and perceived increase in sudden sensorineural hearing loss (p = 0.38). Conclusion: The majority of respondents did not perceive an increase in the incidence of sudden sensorineural hearing loss during the coronavirus pandemic, regardless of geographical region. [ABSTRACT FROM AUTHOR]

Mixing languages within a sentence or a conversation is a common practice among many speakers of multiple languages. Language mixing found in multilingual speakers with aphasia has been suggested to reflect deficits associated with the brain lesion. In this paper, we examine language mixing behaviour in multilingual people with aphasia to test the hypothesis that the use of language mixing reflects a communicative strategy. We analysed connected language production elicited from 11 individuals with aphasia. Words produced were coded as mixed or not. Frequencies of mixing were tabulated for each individual in each of her or his languages in each of two elicitation tasks (Picture sequence description, Narrative production). We tested the predictions that there would be more word mixing: for participants with greater aphasia severity; while speaking in a language of lower post-stroke proficiency; during a task that requires more restricted word retrieval; for people with non-fluent aphasia, while attempting to produce function words (compared to content words); and that there would be little use of a language not known to the interlocutors. The results supported three of the five predictions. We interpret our data to suggest that multilingual speakers with aphasia mix words in connected language production primarily to bypass instances of word-retrieval difficulties, and typically avoid pragmatically inappropriate language mixing. [ABSTRACT FROM AUTHOR]

Purpose: While considerable scholarly attention has been given to "millennials" (those born between 1981 and 1997), little is known of this generation's ability to influence healthcare organizations and managerial roles in particular. This paper aims to clarify why millennials enter the healthcare management field and how their motivations correlate with preferences for working in various healthcare sectors and with various patient populations. Design/methodology/approach: Survey data were collected from 107 millennials pursuing bachelor degrees in healthcare management by using a modified version of the multidimensional work motivation scale. Further data were collected on millennials' preferences for working in various healthcare sectors and with various patient populations. Correlational analyses were conducted to examine the relationship between types of motivation and workplace preferences. Cross-cultural differences were also examined within this generational set. Findings: Results indicate a significant positive relationship between intrinsic motivation and preferences for working on the payer side of the industry and within finance and IT functions. Findings also reveal a significant positive relationship between prosocial motivation and preferences for working with more vulnerable patient populations. Variance in work motivation among cultural sub-sets of millennials suggests different upbringings, or alternatively, cultural relativity of the motivational constructs themselves. Research limitations/implications: Despite offering key insights into the next generation of healthcare managers, this study is limited by a sample of millennials from one large, metropolitan university in the USA and thus may not represent the views of all millennials. Practical implications: To select, retain and develop the next generation of healthcare managers, it is incumbent upon organizations to better understanding millennials' motivations and preferences. Originality/value: This study is the first of its kind to illuminate the motivations and preferences that underpin a key and growing segment of the healthcare workforce. Millennials, now the largest and most diverse generation on the planet, are poised to change the landscape of health care. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to describe the development and validation of the Hocus Focus Magic Performance Evaluation Scale (HFMPES), which is used to evaluate the competency of health professions personnel in delivering magic tricks as a therapeutic modality. Methods: A 2-phase validation process was used. Phase I (content validation) involved 16 magician judges who independently rated the relevance of each of the 5 items in the HFMPES and established the veracity of its content. Phase II evaluated the psychometric properties of the HFMPES. This process involved 2 magicians using the HFMPES to independently evaluate 73 occupational therapy graduate students demonstrating 3 magic tricks. Results: The HFMPES achieved an excellent scale-content validity index of 0.99. Exploratory factor analysis of the HFMPES scores revealed 1 distinct factor with alpha coefficients ≥0.8 across the 3 magic tricks. The construct validity of the HFMPES scores was further supported by evidence from a known-groups analysis, in which the Mann--Whitney U-test showed significant difference in HFMPES scores between participants with different levels of experience in delivering the 3 magic tricks. The inter-rater reliability coefficients were ≥0.75 across the 3 magic tricks, indicating that the competency of health professions personnel in delivering the 3 magic tricks could be evaluated precisely. Conclusion: Preliminary evidence supported the content and construct validity of the HFMPES, which was found to have good internal consistency and inter-rater reliability in evaluating health professions personnel's competency in delivering magic tricks. [ABSTRACT FROM AUTHOR]

Background. One in 5 people in the United States live with disability; however, the public health needs of this community have been largely overlooked. Although U.S. law mandates the availability of accessible medical exam equipment, people with mobility disabilities (PWMD) frequently encounter barriers that require self-advocacy to receive basic primary care. Objective. The purpose of this study was to qualitatively explore the impact of healthcare access barriers—specifically, the experiences of the need to self-advocate and factors that inform decisions to make accommodation requests—for PWMD. Methods. Qualitative semistructured interviews were performed across two phases of data collection with each of the 6 participants. Interpretative phenomenological analysis was used to highlight the essence of participants' experiences in making decisions to request healthcare accommodation. Results. Participants included a purposive sample of self-advocates with physical disabilities (3 men and 3 women). While individual approaches to self-advocacy varied, participants identified a process of "recognizing the normalization of disability discrimination and disability stigma" which necessitates the development of "agency in self-advocacy." This process has a lasting impact on people that includes a shared embodied experience of disability, as well as a sense of empowerment based on their collective and individual identities. Conclusions. Findings have implications for supporting individual disability consumer advocacy efforts as well as the need to address the normalization of disability discrimination within healthcare systems levels. [ABSTRACT FROM AUTHOR]

Aim and Objective: The purpose of this study was to generate a conceptual definition and theory of grief for nurses working on the frontlines during the COVID‐19 pandemic using grounded theory methodology. Background: The COVID‐19 pandemic has had a negative impact on nurses working on the frontlines. The increasing flow of diagnosed COVID‐19 cases, diverse unknowns and demands in the treatment of patients with COVID‐19, and depression related to countless deaths can trigger grief experiences. Design: A mixed methods approach, including the qualitative method of grounded theory and a quantitative 30‐question survey, was used in this study. Methods: Eight focus group sessions were conducted with registered nurses working on the frontlines during the pandemic. Sessions were audio recorded and analysed using constant comparative data analysis. Following the interviews, a survey including demographics and self‐report inventories was completed by participants. The COREQ checklist was used to assess study quality. Results: Major concepts that emerged include 'facing a new reality', 'frustrations', 'stress' and 'coping'. Core concepts were combined into a conceptual definition of grief and a grounded theory of the experience of nurses working on the frontlines during the pandemic. Cross comparisons of qualitative and quantitative findings were made and compared with the literature. Conclusions: This study provides a better understanding of the grief experience of nurses working on the frontlines during the COVID‐19 pandemic. It is necessary to recognise professional grief and develop intervention strategies that lead to grief reconciliation. Relevance to Clinical Practice: Findings provide useful insights for healthcare administrators to provide support and develop interventions to reduce frustrations and stress of frontline registered nurses. Patient or Public Contribution: This study design involved registered nurses participating in focus group sessions. Participants detailed their experience working on the frontlines of the COVID‐19 pandemic with patients, family and hospital administration. [ABSTRACT FROM AUTHOR]

Classic instrumental variable techniques involve the use of structural equation modeling or other forms of parameterized modeling. In this paper we use a nonparametric, matching-based instrumental variable methodology that is based on a study design approach. Similar to propensity score matching, though unlike classic instrumental variable approaches, near/far matching is capable of estimating causal effects when the outcome is not continuous. Unlike propensity score matching, though similar to instrumental variable techniques, near/far matching is also capable of estimating causal effects even when unmeasured covariates produce selection bias. We illustrate near/far matching by using Medicare data to compare the effectiveness of carotid arterial stents with cerebral protection versus carotid endarterectomy for the treatment of carotid stenosis. [ABSTRACT FROM AUTHOR]

Background: Pre-injury opioid use is common, but the effects of opioid-related polysubstance use on mortality and health resources utilization (HRU) have not been investigated yet. The objective of this study was to investigate the effects of opioid-related polysubstance use on mortality and HRU among patients in trauma centres in the US. Methods: We conducted a retrospective cross-sectional study using the US National Trauma Databank from the year 2017 to 2019. Patients (≥ 18 years of age) who tested positive for opioids were included. Patients were analysed based on the number of substances used (i.e., opioids only, two substances (opioids + 1 substance), and three or more than three substances (opioids + ≥ 2 substances)), and polysubstance by type (i.e., opioids only, opioids and alcohol, opioids and stimulants, opioids and benzodiazepine, and other combinations). Multivariate logistic regression was used to determine the association between polysubstance use, mortality and HRU (i.e., need for hospital admission, ICU, and mechanical ventilation). Results: Both polysubstance by number and type analyses showed that opioid-related polysubstance use was not significantly associated with mortality compared to opioids only. The odds of hospital admission were higher among the opioids and benzodiazepines group (OR 1.15, 95% CI 1.06–1.24, p < 0.01). The need for ICU was magnified using benzodiazepines and stimulants with opioids (OR 1.44, 95% CI 1.27–1.63, p < 0.01) when compared to the opioids only group. Conclusion: Opioid-related pre-injury polysubstance use was associated with higher HRU in trauma patients. The evidence can be used by policymakers and practitioners to improve patient outcomes in trauma centers. [ABSTRACT FROM AUTHOR]

Purpose: This study examined public school (PS) speech-language pathologists’ (SLPs’) perceived confidence in managing pediatric feeding disorders (PFDs). Perceived confidence is a rater’s self-reported assurance level to manage PFDs. The study then looked for relationships between personal and professional factors that might account for perceived confidence. Geographic location as well as administrative supports and resources were also examined. Method: Participants were PS SLPs from across the United States who were recruited via American Speech-Language-Hearing Association Special Interest Groups. This study measured perceived confidence with a 5-point Likert-type scale for 17 roles and responsibilities in PFD management. Pearson and Spearman correlations were used to identify relationships with personal and professional characteristics. Results: PS SLPs perceived themselves as having low confidence in managing PFDs. Personal and professional characteristics account for low perceived confidence (e.g., number of graduate courses, clinical experience with swallowing and feeding in early intervention or medical settings, managing swallowing and feeding currently, having more administrative support). Conclusions: This study provided a more representative sample (i.e., geographic regions) of PS SLPs. Perceived confidence in PFD management is linked to factors that can be modified through personal and professional changes. [ABSTRACT FROM AUTHOR]

Background: African Americans have the highest prevalence of high blood pressure (HBP) in the United States, but the lowest blood pressure control rates among all major racial/ethnic groups. This study examined the extent to which African Americans use home remedies to treat HBP and assessed their knowledge, beliefs, attitudes, and behaviors regarding such use. Materials and Methods: This study utilized a descriptive, exploratory, cross-sectional, and correlational research design. We determined the association between knowledge, beliefs, attitudes, and behaviors and use of home remedies among participants using a principal investigator-developed online questionnaire entitled the Beliefs about Hypertension Survey (BHS). Results: Reliability for the BHS representing all four dependent variables was good (Cronbach's α = 0.848). The study sample was 254 African Americans with and without HBP (79.9% females; 83% aged 30–59). Participants were more willing to use home remedies to treat rather than to prevent HBP, with 58% of participants with HBP reporting current use of home remedies as treatment. Results of the Multivariate Analysis of Variance test indicated statistical significance (P = 0.000) only for the behavior variable (α = 0.05), with no significant differences found between participants with and without HBP with respect to knowledge, beliefs, and attitudes. Conclusion: The results suggest that diagnosis of HBP increases African Americans' willingness to use home remedies, but this group needs more education about the effects and risk factors of HBP. Further evidence-based studies will help to increase knowledge and acceptance of home remedies as a viable treatment option for HBP. [ABSTRACT FROM AUTHOR]

There is a general lack of information about how insufficient physical activity impacts blood pressure and physical fitness in Latin-American ethnic minorities. To describe the interactions between insufficient physical activity, blood pressure, and physical fitness outcomes in Latin-American schoolchildren of different ethnicity. This was a prospective, international, multi-center, and cross-sectional study of three Latin-American countries involving schoolchildren from seven ethnic groups of Colombia (Tikuna, Nasa, Embera), Brazil (African, Mulato), and Chile (Mapuche), and also European schoolchildren from Brazil and Chile. Data were categorized based on whether participants were physically active (PA) or insufficient physical activity (iPA) using the WHO physical activity recommendations. The main outcomes were systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure, and scores for physical and cardiorespiratory fitness (CRF, by estimated V ˙ O2max), handgrip muscle strength (HGS), and standing long jump (SLJ). Secondary outcomes were anthropometric measures (weight, height, body mass index [BMI], waist circumference [WC], waist-to-height ratio), and body fat percentage (BF%, limited data by country). Primary and secondary outcomes were ranked. For both PA and iPA categories, significant interactions between ethnic groups were found concerning SBP/DBP (F(37.7), ES 0.08; F(51.5), ES 0.08), V ˙ O2max (F(37.7), ES 0.08; F(51.5), ES 0.08), HGS (F(33.8), ES 0.07; F(5.03), ES 0.04), and SLJ (F(64.3), ES 0.14; F(64.3), 0.14). In the iPA category, Mapuche schoolchildren were classified 1st (119.5; 81.5) with highest SBP/DBP and highest MAP (94.6 mmHg); Embera schoolchildren were classified 1st with lowest V ˙ O2max (33.7 mL/kg/min); and European schoolchildren were classified 1st (19.9 kg) with lowest HGS and SLJ (121.4 m) physical fitness. Under conditions of insufficient physical activity conditions, Mapuche schoolchildren had the most detrimental blood pressure, whereas Embera, Tikuna, and European schoolchildren had the lowest levels of physical fitness. These results serve to highlight the need for the early and appropriate promotion of physical activity based on ethnic differences in Latin-American schools. [ABSTRACT FROM AUTHOR]

Advance care planning (ACP) is a conversation about values, future treatment choices, and designation of a surrogate decision-maker, held in advance of a health crisis. ACP protocols are established by home health agencies (HHAs) to support the staff in talking about patients' future treatment choices, which can include opting against acute care use. In 2016, Medicare implemented an experimental incentive program called Home Health Value-Based Purchasing (HHVBP) in 9 regionally representative states. These agencies were required to compete on value, where reimbursement rates were tied to outcomes in a Total Performance Score (TPS). With home health's aim of avoiding unplanned acute care use, in-patient hospitalization was weighted the heaviest as a poor outcome, followed by emergency department (ED) use. The purpose of this quasi-interventional study was to determine the relationship between advance care planning protocols and ED use among HHAs in the U. S. by the status of participation HHVBP intervention group. The Advance Care Planning Protocol (ACPP) score was measured by scoring survey questions. Our findings show (1) ACPP score intensity was higher in states that participated in the HHVBP program; (2) high measurement reliability for the ACPP scores; (3) no significant relationship between ACPP and ED use overall; but (4) the relationship between ACPP intensity and ED use was equal-and-opposite for the HHVBP and non-HHVBP groups. These findings suggest that the HHVBP intervention altered the influence of ACPP intensity on ED use. Recommendations are made for the HHVBP program regarding ACP's role in goal-concordant care. [ABSTRACT FROM AUTHOR]

Background: Barriers exist in nursing education for students with disabilities. Students with disabilities often experience associated stigma and a perceived lack of support by nursing faculty and academic leaders. Method: A nonexperimental descriptive design was used to examine differences in perceived marginality between nursing students with and without disabilities (n = 7,399) in the United States. Results: Participants who identified as having a disability described more marginalization (M = 45.9, SD = 10.5) than participants who did not identify as having a disability (M = 38.3, SD = 9.2), t(927) = 19.4, p <.001. Conclusion: Findings suggest marginalization exists for students with disabilities. Academic leaders and faculty should address systems, structures, and polices that potentially pose barriers to self-reporting, matriculation, and progression of students with disabilities. [J Nurs Educ. 2022;61(8):429–438.] [ABSTRACT FROM AUTHOR]

This study evaluated the effectiveness of a 6-session (12-hour) empowerment self-defense classroom delivered curriculum (i.e., IMpower) among American Indian girls. Girls (N = 74) in one middle school and two high schools on an Indian Reservation in the Great Plains region of the United States received the intervention and completed a pre-test and a post-test six months following the final program session. The surveys administered assessed hypothesized intermediary (i.e., efficacy to resist a sexual assault, self-defense knowledge), primary (i.e., sexual violence victimization), and secondary (i.e., physical dating violence, sexual harassment) outcomes. Native American girls (N = 181) in five middle schools and three high schools in a nearby city where there was no sexual assault prevention occurring completed surveys assessing sexual violence, physical dating violence, and sexual harassment victimization approximately six months apart, thus serving as a comparison to girls in the treatment condition on primary and secondary outcomes. Girls exposed to the IMpower program reported significant increases over time in efficacy to resist a sexual assault and knowledge of effective resistance strategies. Furthermore, propensity score analyses suggested that girls who received the IMpower program reported significantly fewer types of sexual assault and sexual harassment at follow-up compared to girls in the control condition. However, no effect was found for physical dating violence. These data suggest that empowerment self-defense is a promising approach in preventing sexual assault and sexual harassment among American Indian girls. [ABSTRACT FROM AUTHOR]

Validated measures predicting infant consumption of nutrient supplements or fortified foods are essential for the success of nutritional interventions to improve undernutrition. Behavioural coding of food acceptance is one promising approach, though the required time and resources are limiting. The overarching goal of the present study was to adapt a video coding (VC) protocol for use as a live coding (LC) method to assess infant food acceptance in naturalistic settings. Infants (n = 59; ages 7–24 months) were fed a small‐quantity lipid‐based nutrient supplement (SQ‐LNS) mixed with a familiar food by caregivers in the State of Morelos, Mexico. Trained coders used a VC scheme to rate infant acceptance of each spoon offer using a 4‐point scale. The VC scheme was subsequently adapted for use as an LC method to be used in participant homes and a video live coding (VLC) method to monitor reliability. Reliability and validity of the LC method were tested in a subsample of dyads (n = 20). Intraclass correlation coefficients (ICCs) indicated that the inter‐rater reliability between coders using the LC method was moderate or good when compared to VC methods (ICCs = 0.75 and 0.87). Live coded acceptance scores were also moderately associated with consumption of the SQ‐LNS (ρ = 0.50, p = 0.03). The LC scheme demonstrated initial reliability and validity as an assessment of infant food acceptance. Since VC is both resource and time‐intensive, the LC scheme may be useful for assessing infant food acceptance in resource‐limited settings. Key messages: Current measures to assess infant food acceptance in nutritional interventions are limited.This study presents a live coding scheme and protocol that can be used to objectively rate infants' food acceptance in naturalistic settings.The coding method demonstrated initial reliability with video coding methods and was associated with infants' consumption of a target food.The live coding protocol may be particularly useful for assessing infant food acceptance in resource‐limited settings. [ABSTRACT FROM AUTHOR]

LEAP and TEACCH represent two comprehensive treatment models (CTMs) that have been widely used across several decades to educate young children with autism spectrum disorders. The purpose of this quasi-experimental study was to compare high fidelity LEAP (n = 22) and TEACCH (n = 25) classrooms to each other and a control condition (n = 28), in which teachers in high quality special education programs used non-model-specific practices. A total of 198 children were included in data analysis. Across conditions, children's performances improved over time. This study raises issues of the replication of effects for CTMs, and whether having access to a high quality special education program is as beneficial as access to a specific CTM. [ABSTRACT FROM AUTHOR]

Aims: Explore the knowledge, experiences, preferences, and concerns related to fertility preservation as an option for building a biological family among women with cystic fibrosis. Design: Convergent mixed methods study design. Methods: We recruited women with cystic fibrosis of childbearing age in the United States through cystic fibrosis centres, snowball sampling, and social media. Participants completed an anonymous survey about fertility and fertility preservation (n = 50). We also conducted audio‐recorded, semi‐structured interviews with a subset of women to gain a better understanding of their perspectives (n = 20). We transcribed the interviews verbatim and analysed them using thematic analysis. Results: For the quantitative arm, 78% of women indicated that they would like to have a child in the future; however, 74% reported never having had conversations about fertility preservation with their providers. For the qualitative arm, four major themes emerged: (1) Women with cystic fibrosis have inadequate knowledge about fertility and fertility preservation; (2) fertility is a low priority area for the cystic fibrosis care team; (3) women with cystic fibrosis recommend that the cystic fibrosis care team provide specific fertility resources; and (4) providers and literature lack information on fertility and cystic fibrosis. Integrated findings identified that while the majority of women with cystic fibrosis want to become mothers in the future, including post‐lung transplantation, they have not received education on fertility preservation, and there is a general lack of knowledge on the topic of fertility in cystic fibrosis. Conclusion: Women with cystic fibrosis desire to have children but have little knowledge about fertility preservation, and cystic fibrosis providers do not initiate family planning discussions. Impact: Findings from the study support that additional education is needed for women with cystic fibrosis who are considering parenthood. Clinical care models should include early, regular, and thoughtful discussions about reproductive health issues, including fertility preservation. [ABSTRACT FROM AUTHOR]

Aims: To describe beginning nursing student learning styles and to determine whether there are relationships between learning style and sociodemographic or educational background. We also aim to compare these data with the normative values of the 3.1 version of the Kolb learning style inventory and verify its reliability. Background/Literature: Learning style is related to the way in which an individual interacts with learning conditions, involving cognitive, affective, physical and environmental aspects. In nursing education, few studies have focused on knowing the learning styles of beginning nursing students, despite the need for students to develop critical thinking skills required of nurses. Design: Descriptive, cross‐sectional, correlational, multi‐site study. Method: The study took place at five universities in Brazil and one university in the United States. Data were collected from a sample of beginning nursing students (n = 176) in 2019, using the Portuguese and English 3.1 versions of Kolb's learning style inventory. Results: Most students' learning styles were classified as divergers (34.10%), while 28.41% were assimilators, 23.86% were accommodators and 13.63% were convergers. Kolb describes learning as a four‐stage cyclical process grounded in experience. The mean score of one learning stage, the concrete experience, showed those who attended public high schools compared with private high schools was higher (mean = 26.22; p =.0019), and there were different results between Brazilian state universities, Brazilian federal universities and the American university (p =.0149). Conclusion: The diverger style was the most common among beginning nursing students in Brazil and the United States. There was a significant relationship between learning style, the educational background of students, the type of institution they attend and their previous experience with some active learning methodologies. Relevance to clinical practice: Aligned with Kolb's experiential learning theory, nurse educators must be aware of student learning styles so they may use teaching strategies to meet their students' needs. [ABSTRACT FROM AUTHOR]

The ability to increase palliative and hospice services in the United States requires comprehensive, standardized education for clinicians. With a rise in the number of patients living with serious illnesses, medical-surgical nurses would benefit from more palliative and end-of-life care education. In this study, nurses' comfort in addressing physical, emotional, and spiritual needs for patients receiving palliative and hospice care was examined. [ABSTRACT FROM AUTHOR]

Survival for hypoplastic left heart syndrome (HLHS) has improved dramatically. Little is known about early family function, quality of life (QOL), or well-being/adjustment for parents of infants with HLHS. Parent/family outcomes over time, predictors, and differences in 143 mothers and 72 fathers were examined. Parents reported better family function compared with published norms, but 26% experienced family dysfunction. QOL and well-being were significantly lower than adult norms. QOL scores generally declined over time, whereas self-reported well-being improved. Responses from mothers and fathers showed different trends, with mothers having worse scores on most measures and at most time points. Being a single parent was a risk factor for poorer family function, but not for lower individual QOL or well-being. Family characteristics, stress, and coping skills were predictive of outcomes. Parents' psychosocial responses to the challenges of life with infants with HLHS change over time. Individually tailored psychosocial support is needed. [ABSTRACT FROM AUTHOR]

This study utilized web-based data collection and latent profile analysis to visualize and describe the relational well-being of youth experiencing foster care-related sibling separation. Legally authorized representatives for 724 youth in seven states in the U.S.A. completed a brief electronic questionnaire assessing youth's social competence, emotional competence, sibling warmth, and sibling interaction quality. Six profiles of relational well-being emerged from the analysis and included youth who were "struggling—all domains," "struggling—sibling relationships," "thriving—all domains," "near struggling—all domains," "mixed—thriving sibling relationships/near-struggling social-emotional competence," and "average—all domains." Significant differences were observed for the proportion of youth in a particular profile based on their current out-of-home care status, permanency plan goal, and the survey respondent's relationship to the youth. Implications for future research and practice are discussed. [ABSTRACT FROM AUTHOR]

A large proportion of the morbidity and almost all of the mortality of sickle cell disease (SCD) now occurs in adulthood. Children with SCD underuse disease-modifying and curative treatments, in part because of how patients/parents understand SCD morbidity and mortality. Whether practitioners provide prognostic information to families is unknown. We emailed a 31-item survey to 1,149 pediatric hematologist-oncologists and analyzed 96 responses. Most said discussing prognosis would change patient/parent willingness to start hydroxyurea, but fewer actually discuss prognosis when they want to start hydroxyurea (91% vs. 75%, p=.001). Similarly, most said discussing prognosis would change adherence to therapy, but fewer actually discuss prognosis to motivate adherence (78% vs 31%, p<.001). Most (77%) addressed prognosis when the "patient or their parent bring it up." Respondents reporting frequent life expectancy discussions were more likely to report a pathway for such discussions (p=.017). Pediatric hematologists may not conduct prognostic discussions without prompting, although these conversations may be important for shared, informed decision-making. [ABSTRACT FROM AUTHOR]

Mediterranean diet accordance has been associated with slower rates of cognitive decline, a common feature in more advanced Parkinson's disease (PD). Thus, a brief tool was needed to monitor Mediterranean diet accordance of older adults with PD. Relative validity, acceptability, and feasibility of the 21-item online screener, Mediterranean Eating Pattern for Americans (MEPA-III) was assessed. Maximum diet accordance is reflected by a MEPA III score of 21 points. Forty-four adults completed the online reference tool, the VioScreen™ Food Frequency Questionnaire (FFQ), and then the MEPA-III screener three to seven days later. MEPA-III scores averaged 10.7 ± 2.7. When FFQ responses were coded to match those of MEPA-III screener components, agreement for individual components averaged 71.5%, with 8 of 21 component scores with kappas ≥ 0.31 (p < 0.05). Total MEPA-III scores were concordant with those from the FFQ (r = 0.50, p < 0.001). Participants reported that the MEPA-III screener was acceptable (median score 8 out of a possible 10). The screener was feasible because the median completion time was 4.1 min (range 1.6–14.9). The online MEPA-III screener demonstrates good validity, acceptability and feasibility and can be used to characterize a Mediterranean-style diet pattern among participants with PD. [ABSTRACT FROM AUTHOR]

LGBTQ+ (lesbian, gay, bisexual, transgender, queer, etc.) youth are at increased risk for negative outcomes. Yet little is known about their engagement with communities and resources that may ameliorate risk, particularly online. Oriented by a uses and gratifications approach, this secondary analysis (n = 4,009) of LGBTQ+ youth (aged 14–29) compares online versus offline experiences. Respondents were significantly more likely to participate in LGBTQ+ communities online. Youth were also more active, and felt safer and more supported, when participating in online LGBTQ + communities. Additionally, respondents sought online information, support, and resources at higher rates than offline. Increased attention toward online programming and resource development is warranted. [ABSTRACT FROM AUTHOR]

This article presents the development and evaluation of a labor support workshop aimed at providing senior undergraduate nursing students with education on the provision of labor support. In collaboration with a Lamaze educator, a two and half hour interactive educational session was developed. The workshop included both a didactic and a hands-on component which included physical labor support strategies, which could be utilized in the clinical setting. Pre-and postintervention data was collected on students' knowledge and self-efficacy in the provision of labor support, as well as, data on their use of these strategies while in the clinical setting. The labor support workshop was well received by students (4.9/5) and increased their self-reported knowledge (p = <.001) and self-efficacy (p = <.001) in the provision of labor support. [ABSTRACT FROM AUTHOR]

Environmental conditions and resources that may influence provider's behaviors have been investigated in birth environments focusing on location rather than conditions and available resources. Using a descriptive, cross sectional design, we surveyed a random sample of certified nurse-midwives (CNMs), obstetricians, family practice physicians, and certified professional midwives (CPMs) to describe conditions, resources, and workforce present during U.S. births. In all, 1,243 midwives and physicians reported most environmental resources were present at almost 100% of births they attended. Conditions varied: room noise acceptability restriction of phone calls/texts from any source and lighting kept to a minimum. Trainees were present at most births regardless of setting and provider type. The impact of room noise, phone calls/texting, and lighting on outcomes should be determined. The roles and impact of personnel, including trainees, should be described. The extent to which clusters of resources are associated with outcomes might provide new directions for interventions that improve care. [ABSTRACT FROM AUTHOR]

Self-directed care (SDC) is a service delivery model in which individuals diagnosed with a severe and persistent mental illness (SPMI) direct their behavioral healthcare by managing an individual budget and purchasing the goods and services they deem most helpful in meeting their needs and supporting their recovery. Participants may purchase conventional mental health services as well as alternative goods (e.g., books, clothing) and services (e.g., fitness classes) to support their recovery. Several quantitative studies have examined the types of purchases commonly made by SDC participants. This qualitative study builds on this research by reporting findings from interviews with 18 SDC participants on the factors that influence their purchasing decisions, the benefits derived from SDC purchases, and perceived barriers experienced in making desired purchases. Findings reveal the extent to which money matters in mental health recovery and suggest that individualized budgeting and purchasing contribute to SDC participants' mental wellness and stability, enhance their control over service choices, and, most notably, provide some material relief in ongoing struggles with chronic poverty. Findings also highlight the importance of flexible spending guidelines and streamlined approval processes; overly proscriptive policies may undermine participants' self-determination. Additional implications for SDC practice, policy, and research are discussed. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the effects of an intensive cognitive-communication rehabilitation (ICCR) program for young individuals with chronic acquired brain injury. Method: ICCR included classroom lectures; metacognitive instruction, modeling, and application; technology skills training; and individual cognitive-linguistic therapy. Four individuals participated in the intensive program (6 hr with 1-hr lunch break × 4 days × 12 weeks of treatment): 3 participants completed 3 consecutive semesters, and 1 participant completed 1 semester. Two controls did not receive treatment and completed assessments before and after the 12-week treatment interval only. Results: All 4 experimental participants demonstrated significant improvements on at least 1 standardized cognitive-linguistic measure, whereas controls did not. Furthermore, time point significantly predicted participants' scores on 2 of the 4 standardized outcome measures, indicating that as duration in ICCR increased, scores also increased. Participants who completed multiple semesters of ICCR also improved in their therapy and personal goals, classroom behavior, life participation, and quality of life. Conclusion: After ICCR, participants showed gains in their cognitive-linguistic functioning, classroom participation, and individual therapy. They also demonstrated improvements outside the classroom and in their overall well-being. There is a gap between the large population of young adults with acquired brain injury who wish to return to higher education and a lack of rehabilitation programs supporting reentry into academic environments; ICCR is a first step in reducing that gap. [ABSTRACT FROM AUTHOR]

Background: Mental health nurse educators use online education in an effort to offer students the ability to practice varying skills in a safe environment. Purpose: The purpose of this study was to compare the effectiveness and student satisfaction of live classroom versus online education in delivering therapeutic crisis management skills content to pre-licensure nursing students as measured by overall grade point average (GPA), test scores, class grade, and student satisfaction survey results. Methods: This quasi-experimental, post-hoc comparative study had a two-group post-test design. The participants were pre-licensure psychiatric mental health nursing students who were presented a 30-min lecture followed by group work with case studies and interventions. Results: There were no statistically significant differences between the live classroom and online education group. Conclusions: This study indicates that therapeutic crisis management techniques can be taught a variety of ways for academic success and may validate the feasibility of online education within mental health nursing curricula. [ABSTRACT FROM AUTHOR]

Background: Sexually Transmitted Diseases (STDs) are among the most prevalent infectious diseases in young people. The present study assessed the knowledge of STDs among college students. Methods: This cross-sectional descriptive study that was conducted on 345 undergraduate students at a large public university in the United States. The students were recruited by convenience sampling method. The Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ) was applied in the survey. The study participants responded to the survey anonymously through the Qualtrics online portal. Descriptive statistical analyses were conducted to examine the knowledge levels of the STDs in young adults. Independent Samples t-test and Analysis of Variance (ANOVA) were used to determine the correlation between the knowledge level and demographic data of the subjects. Moreover, SPSS was used for data analysis. Results: In total, 345 undergraduate students aged 18-22 years participated in the present study. Among them, 196 (56.8%) were male. The samples' Mean±SD score of STD knowledge was 15.66±5.84 (out of 27 points in total). The study participants who previously received sexual education courses achieved higher knowledge scores, compared to the others. Conclusion: The study results revealed a lack of STD knowledge in young adults. There is a need for conducting educational programs among college students to improve their understanding of STDs etiology and prevention. [ABSTRACT FROM AUTHOR]

Fraudulent emails, otherwise known as phishing emails, use a range of influence techniques to persuade individuals to respond, such as promising a monetary reward or invoking a sense of urgency. The current study explored a number of factors that may impact the persuasiveness and trustworthiness of emails by examining participant judgements of 20 pre-designed emails that varied according to (a) whether they used loss or reward-based influence techniques, (b) whether they contained particular authentic design cues, (c) whether they referenced a salient current event (the Rio Olympics), and (d) whether participants had been previously exposed to information regarding online scams in general. Results suggest that the presence of authentic design cues and the type of influence technique used significantly impacted participant judgements. Findings are discussed in relation to theoretical models of phishing susceptibility. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the spirituality and religiosity of 30 non‐directed (altruistic) living kidney donors in the USA and explore how they may have affected their motivations to donate and donation process experiences. Background: The rise in non‐directed donors and their ability to initiate kidney chains offer a novel approach to help alleviate the overextended kidney transplant wait list in the USA. However, little is known about the non‐directed donors’ motivations, characteristics and experiences. Design: We conducted a qualitative‐dominant study and used a grounded theory approach to analyse data. Methods: Thirty participants completed in‐depth interviews between April 2013–April 2015. Three analysts independently read and coded interview transcripts. Grounded theory techniques were used to develop descriptive categories and identify topics related to the non‐directed donors donation experience. Results: Sixteen of the 30 non‐directed donorss discussed the topic of spirituality and religiosity when describing their donation experiences, regardless of whether they were actively practising a religion at the time of donation. Specifically, three themes were identified within spirituality and religiosity: motivation to donate, support in the process, and justification of their donation decisions postdonation. Conclusions: Findings from this study are the first to describe how spirituality and religiosity influenced the experiences of U.S. non‐directed donorss and may help improve non‐directed donors educational resources for future spiritual or religious non‐directed donors, and the overall non‐directed donors donation experience in efforts to increase the living donor pool. Relevance to clinical practice: Spirituality and religiosity are often overlooked yet potentially influential factors in Western medicine, as demonstrated through the experiences of Jehovah's Witnesses and their religious restrictions while undergoing surgery and the beliefs of Christian Scientists against taking medications and receiving medical procedures. Understanding needs of non‐directed donors specifically with spirituality and religiosity can better position kidney transplant centres and teams to improve predonation screening of non‐directed donor candidates and provide support services during the donation process. [ABSTRACT FROM AUTHOR]

This study extends a typology of parent–offspring drug talk styles to early adolescents and investigates associations with adolescent substance use. Data come from a self-report survey associated with a school-based, 7th grade drug prevention curriculum. Mixed methods were used to collect data across four measurement occasions spanning 30 months. Findings highlight the frequencies of various drug-talk styles over time (i.e., situated direct, ongoing direct, situated indirect, ongoing indirect, never talked), messages adolescents hear from parents, and comparisons of alcohol, cigarette, and marijuana use by drug-talk style. This study advances an understanding of parent–adolescent communication about substances and holds practical implications for drug prevention efforts. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Academic programmes in speech–language pathology are increasingly providing telehealth/telepractice clinical education to students. Despite this growth, there is little information describing effective ways to teach it. Aims: The current exploratory study analyzed the perceptions of speech–language pathology/therapy (SLP/SLT) faculty, student and SLP/SLT clinicians to ascertain effective pedagogical approaches for telepractice service delivery, rank the relative importance of telepractice skills and knowledge competencies, and define any pedagogical challenges to teaching them. Methods & Procedures: Qualitative data were collected from two sources: three open‐ended questions within an online survey (SLP/SLT faculty n = 31, graduate students n = 16, telehealth (‘telepractice’) clinicians n = 16); and follow‐up telephone interviews (n = 22). Data were analyzed with a grounded theory approach followed by a summative rank‐order analysis of themes. Outcomes & Results: All three groups agreed the most effective telepractice instructional approach was telepractice demonstrations (such as students role playing or watching a supervisor). Professional development approaches such as workshops or training manuals were less effective and didactic approaches such as lecture‐only were ineffective. Skills and knowledge competencies students needed before entering the workforce were, in order of implied importance: telepractice clinical skills, telepractice technology skills, legal knowledge pertinent to telepractice and knowledge of telepractice literature. The most important telepractice clinical skills students needed to acquire were appropriate selection of telepractice materials and engaging the client over the internet. Many participants said teaching and learning telepractice was more challenging than in‐person service delivery because of the difficulties in selecting appropriate telepractice clinical materials, managing technology problems and engaging with clients over the internet. Conclusions & Implications: Despite substantial limitations to this investigation, findings imply that telepractice instruction, like other methods of SLP/SLT clinical education, may be most effective when students engage in critical thinking and problem‐solving issues through intense practice. Because the skills and competencies associated with telepractice appear to vary in their perceived value, academic programmes may wish to consider prioritizing how they are taught, giving students additional instruction in the selection of telepractice clinical materials and development of online interpersonal communication skills. For some clinical educators, the challenges associated with telepractice may necessitate additional educator training. [ABSTRACT FROM AUTHOR]

Background and Purpose: The Behavior Change Strategies for Healthy Eating Scale (BCSHES) has potentially broad implications for use by researchers, practitioners, and educators across various medical and allied health professions. To date, however, the psychometric properties of the BCSHES have not been rigorously evaluated, potentially limiting its use. The purpose of this study was to thoroughly evaluate the psychometric properties of the BCSHES. Methods: The Rasch Rating Scale Model was used to analyze BCSHES data on a sample of 191 graduate/professional program students. Results: Messick's framework for construct validity was used to discern validity evidence, which noted the BCSHES possessed very strong psychometric properties and is capable of yielding valid and reliable scores. Conclusions: Use of the scale is encouraged, where appropriate. [ABSTRACT FROM AUTHOR]

Over the past decade, reimbursement in the US health care system has undergone rapid transformation. The Affordable Care Act and the Medicare Access and CHIP Reauthorization Act are some of the many changes challenging traditional modes of practice and raising concerns about practitioners' ability to adapt. Recently, physician satisfaction was proposed as an addition to the Triple Aim in acknowledgment of how the physician's attitude can affect outcomes. To understand how physicians perceive alternative payment models (APMs) and how those perceptions may vary by their organizational role, non-leader physicians ( N = 31), physician leaders ( N = 67), and health system leaders ( N = 49) were surveyed using a mixed-methods approach. Respondents to the electronic survey, who were identified from a Jefferson College of Population Health program participant database, rated their organizations' responses to APMs and provided commentary. Analysis of the Likert scale quantitative data indicates a significant difference in ratings between the 3 groups, particularly between health system leaders and non-leader physicians. The aggregated Attitudes Toward APMs Scale indicates that health system leaders were statistically significantly more likely to rate themselves and their organizations as better prepared for APMs compared to non-leader physicians and physician leaders. Qualitative analysis of comments indicates that non-leader physicians are more negative of APMs, often expressing frustration at added administrative burdens, barriers to implementation, and inconsistent or unclear measurement requirements. These findings indicate that the negative feelings non-leader physicians and physician leaders, in particular, expressed could contribute to physician burnout and decreased professional satisfaction, and impede the effective implementation of APMs. [ABSTRACT FROM AUTHOR]

Cyberbullying has provoked public concern after well-publicized suicides of adolescents. This mixed-methods study investigates the social representation of these suicides. A content analysis of 184 U.S. newspaper articles on death by suicide associated with cyberbullying or aggression found that few articles adhered to guidelines suggested by the World Health Organization and the American Foundation for Suicide Prevention to protect against suicidal behavioral contagion. Few articles made reference to suicide or bullying prevention resources, and most suggested that the suicide had a single cause. Thematic analysis of a subset of articles found that individual deaths by suicide were used as cautionary tales to prompt attention to cyberbullying. This research suggests that newspaper coverage of these events veers from evidence-based guidelines and that more work is needed to determine how best to engage with journalists about the potential consequences of cyberbullying and suicide coverage. [ABSTRACT FROM PUBLISHER]

ABSTRACT BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 ( HHFKA) directed the US Department of Agriculture ( USDA) to revise school meal standards to increase healthy food offerings. A critical stakeholder in the implementation of standards is Food Service Directors ( FSDs). We sought to examine FSDs' perspectives on revised school meal standards to gain insight into successful implementation strategies. METHODS Semistructured interviews were conducted with FSDs (N = 9) from high schools that had achieved HealthierUS Schools Challenge: Smarter Lunchrooms ( HUSSC: SL) status. Qualitative interview data were team coded in Atlas.ti v7 and analyzed with principles of constant comparative analysis. RESULTS FSDs reported overall positive perceptions of the revised school meal standards and its potential impacts, as well as improved fruit and vegetable consumption, despite initial challenges with plate waste, procurement of whole grain-rich products, and fast paced sodium targets. Implementation was described as complex, ongoing processes; with time and in-service trainings, student acceptance to these changes improved. CONCLUSIONS These findings are directly relevant to future reauthorization of the Child Nutrition Act and to revisions to the implementation time line for the federal school meal standards related to sodium, whole grains, and flavored milk. Insights into FSDs' strategies suggest that more time and targeted technical assistance at federal, state, and local levels is warranted. [ABSTRACT FROM AUTHOR]

Substance misuse intervention in healthcare settings is becoming a US national priority, especially in the dissemination and implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT). Yet, the referral to treatment component of SBIRT is understudied. This proof-of-concept investigation tested an enhanced coordinated hospital-community two session brief intervention designed to facilitate the referral to treatment of hospitalized medical patients with an alcohol use disorder. Participants (N = 9) attended the second session of the brief intervention held in the community in most cases (56%), while one out of three (33%) received some level of post-brief intervention alcohol and/or other drug treatment. Alcohol use and alcohol-related problems also statistically improved. Based, in part, on the results plus the widespread dissemination of SBIRT, next step investigations of brief interventions to help bridge hospitalized medical patients in need to community substance abuse treatment are warranted. [ABSTRACT FROM AUTHOR]

Objective The study investigated whether state mandates for private insurers to provide services for children with autism influence racial disparities in outcomes. Methods The study used 2005/2006 and 2009/2010 waves of the National Survey of Children with Special Health Care Needs. Children with a current diagnosis of autism were included in the sample. Children residing in 14 states and the District of Columbia that were not covered by the mandate in the 2005/2006 survey, but were covered in the 2009/2010 survey, served as the mandate group. Children residing in 32 states that were not covered by a mandate in either wave served as the comparison group. Outcome measures assessed included care quality, family economics, and child health. A difference-in-difference-in-differences (DDD) approach was used to assess the impact of the mandates on racial disparities in outcomes. Results Non-white children had less access to family-centered care compared to white children in both waves of data, but this difference was not apparent across mandate and comparison states as only the comparison states had significant differences. Parents of non-white children reported paying less in annual out-of-pocket expenses compared to parents of white children across waves and groups. DDD estimates did not provide evidence that the mandates had statistically significant effects on improving or worsening racial disparities for any outcome measure. Conclusions This study did not find evidence that state mandates on private insurers affected racial disparities in outcomes for children with autism. [ABSTRACT FROM AUTHOR]

Aim and objective To explore and understand the experiences of medical-surgical nurses as first responders during clinical deterioration events. Background Nurses are key players in identifying and responding to deterioration events to escalate the level of care essential to address specific needs of patients. Delays in recognising signs and symptoms of patient deterioration and activation of Rapid Response Teams have been linked to a lack of nontechnical skills (leadership, teamwork, situational awareness) resulting in increased patient morbidity and mortality. Design A descriptive, qualitative approach was used. Methods A purposive sample of 28 medical-surgical nurses was recruited and interviewed from an integrated healthcare system located in the USA. Interviews were conducted from October 2014-February 2015. Interviews were audio recorded and transcribed verbatim. Transcripts were entered into Max QDA. The constant comparative method was used for data analysis. Results Three patterns emerged from the data analysis: Recognising and Responding to the Event, Managing the Event and Challenges Encountered during the Event. From the patterns, seven themes emerged. Themes for pattern one, Recognising and Responding, were early warning signs, continuity in patient care assignments and intuition. Themes for pattern two, Managing the Event, were cognitive, technical and behavioural skills. The theme for pattern three, Challenges Encountered during the Event, was work environment complexity. Conclusion Listening to the stories of medical-surgical nurses provided insight into how they recognised and managed patients experiencing clinical deterioration events. Furthermore, insight into the challenges that medical-surgical nurses encountered in caring for deteriorating patients were identified. Relevance to clinical practice Implication for practice in the areas of continuity of patient assignments, formal clinical deterioration education, work environment and team collaboration and communication was presented. [ABSTRACT FROM AUTHOR]

The article discusses research regarding rural grocery storeowners' perceptions of their communities, their business practices, and factors that influence their sustainability and the ability to support healthy food choices in Nebraska as of 2016. According to the article, storeowners reported on strategies that they employ to remain competitive by focusing on customer service and product quality. The public health aspects of obesity in America are examined, along with small U.S. stores.

Many health promotion practitioners and researchers use the self-report International Physical Activity Questionnaire (IPAQ) to estimate physical activity (PA) level. Reporting days/week and minutes/day engaging in PA can be challenging for participants. Thus, the purpose of this study was to develop a streamlined, enhanced scoring method of the IPAQ that could reduce participant burden and improve research reporting. IPAQ data from 1471 U.S. university students (79% White, 58% female) at 8 universities were scored using IPAQ traditional short-form scoring algorithm (IPAQ-TSA) to generate metabolic equivalents (METS/minute/week) and an IPAQ Streamlined Scoring Algorithm (IPAQ-SSA) without minutes/day using weighted exercise intensity and days/week. IPAQ-TSA and IPAQ-SSA measures categorize participants into high, moderate, or low PA level based on their PA patterns. Spearman rank correlations between IPAQ-SSA and IPAQ METS (r = 0.69, p < 0.001) were moderate. Correlations between IPAQ-TSA and IPAQ-SSA categories were strong (r = 0.71, p < 0.001), but χ2 tests revealed significantly lower proportion of participants in IPAQ-TSA low PA level than IPAQ-SSA (2.7 vs. 43.5%) suggesting IPAQ-TSA may overestimate PA. In conclusion, the IPAQ-SSA is shorter, eliminates recall bias of reporting minutes/day of PA, and may be sufficiently descriptive of PA, which would be helpful for health promotion practitioners and researchers. However, validation with objective PA measures is warranted. [ABSTRACT FROM AUTHOR]