COVID-19 brings a new urgency for advance care planning: Implications of death education.

The U.S. has the highest number of coronavirus disease (COVID-19) cases and deaths of any nation. Deaths due to COVID-19, especially among older adults and people of color, have created an urgency for advanced care planning (ACP). Despite benefits of ACP, only one-third of U.S. adults have completed advance directives, in part due to a lack of death education. We recommend four actions to increase death education and ACP completion: (1) integrate death education into teacher preparation programs, (2) incorporate death education in undergraduate curricula, (3) provide better education in death and dying to future health professionals, and (4) educate the public.

The COVID-19 pandemic has changed dying and grief: Will there be a surge of complicated grief?

Worldwide, more than 3 million people have died from COVID-19. Each decedent represents a person who was loved, will be missed, and whose death elicited grief. COVID-19 has changed the way we die and grieve. Many people have died without family members and friends present and many of the bereft have grieved and mourned alone. Individuals and communities have experienced multiple losses within a short time while suffering from concomitant stress, anxiety, and depression. More deaths and more grief will continue in the foreseeable future. Preventive education is needed to prepare for and manage the likely increase in complicated grief.

Predicting Racial and Ethnic Disparities in Advance Care Planning Using the Integrated Behavioral Model.

Purpose To explain and predict racial or ethnic disparities in advance care planning (ACP) behaviors among American adults by using the Integrated Behavioral Model (IBM) and the Precaution Adoption Process Model. Methods A randomized, observational, nonexperimental, cross-sectional study design was used to survey American adults between 40 and 80 years of age ( n = 386). Results The majority of respondents (75%) had not completed ACP. Significant differences were found by race or ethnicity: 33% of Whites had completed ACP versus Hispanics (18%) and Blacks (8%). Whites had statistically significantly higher levels of most IBM constructs compared with Blacks and Hispanics. The IBM predicted 28% of the variance in behavioral intention. After controlling for sociodemographic variables, direct attitudes, indirect attitudes, and indirect perceived norms were significant predictors of behavioral intention. Conclusion The IBM and the Precaution Adoption Process Model are useful frameworks for interventions designed to increase ACP among racial or ethnic minorities in the United States.

Children and adults both see 'pirates' in 'parties': letter-position effects for developing readers and skilled adult readers.

Developing readers often make anagrammatical errors (e.g. misreading pirates as parties), suggesting they use letter position flexibly during word recognition. However, while it is widely assumed that the occurrence of these errors decreases with increases in reading skill, empirical evidence to support this distinction is lacking. Accordingly, we compared the performance of developing child readers (aged 8-10 years) against the end-state performance of skilled adult readers in a timed naming task, employing anagrams used previously in this area of research. Moreover, to explore the use of letter position by developing readers and skilled adult readers more fully, we used anagrams which, to form another word, required letter transpositions over only interior letter positions, or both interior and exterior letter positions. The patterns of effects across these two anagram types for the two groups of readers were very similar. In particular, both groups showed similarly slowed response times (and developing readers increased errors) for anagrams requiring only interior letter transpositions but not for anagrams that required exterior letter transpositions. This similarity in the naming performance of developing readers and skilled adult readers suggests that the end-state skilled use of letter position is established earlier during reading development than is widely assumed.

A national survey of emergency nurses and avian influenza threat.

INTRODUCTION: The purpose of this study was to determine the perceived likelihood of emergency nurses reporting to work during an avian influenza outbreak, to consider options if nurses decided not to report work, and to explore Protection Motivation Theory constructs as predictors of reporting to work. METHODS: A descriptive, nonexperimental, cross-sectional survey of emergency nurses within the United States. RESULTS: A total of 332 nurses (46%) responded. Most emergency nurses (84%) reported they would report to work (1 in 6 would not). The likelihood of reporting to work differed by education level, nurses' avian influenza information sources, and nurses who had family living with them. Of the nurses who decided not to report to work, the majority were willing to provide health information (90%), administer vaccinations (82%), and triage (74%) neighbors/friends from home. One third of nurses had not attended a disaster-preparedness drill within the past year. Only 20% identified formal training while on the job as a source of avian influenza information. A third of emergency nurses would be worried about getting an avian influenza vaccination because of potential adverse effects. Protection Motivation Theory accounted for almost 40% of the variance of likelihood to report to work, with response costs being the largest predictor. DISCUSSION: Disaster drills, avian influenza job training, and vaccination education are necessary to prepare emergency nurses for an outbreak. The findings support emergency nurses' willingness to work from home if they are unable to report to work. This finding is new and may have implications for disaster planning, staffing, and ED operations.

Revealing a word superiority effect using a unique variant of the Latin alphabet: the evidence from Turkish.

When visual stimuli are presented briefly, words are perceived better than nonwords. It is widely accepted that this word superiority effect reflects the efficiency with which words are perceived. However, most of what is known about the effect comes from languages (like English) using the basic Latin alphabet and little is known about whether languages using an alphabetic variant with very different properties can also produce word superiority. Here we report an experiment in which words and nonwords were presented briefly in Turkish, which uses a unique variant of the Latin alphabet containing 29 separate letters, 12 of which are close visual replications of other letters. Despite the potential for visual confusability and perceptual uncertainty, the findings revealed a clear advantage for words over nonwords, indicating that word superiority observed previously for the Latin alphabet can also be observed with the very different variant of this alphabet used for Turkish. Implications of these findings for processes involved in visual word perception are discussed.

Sleep quality, quality of life, fatigue, and mental health in COVID-19 post-pandemic Türkiye: a cross-sectional study.

Aim: This study explores the predictors and associated risk factors of sleep quality, quality of life, fatigue, and mental health among the Turkish population during the COVID-19 post-pandemic period. Materials and methods: A cross-sectional survey using multi-stage, stratified random sampling was employed. In total, 3,200 persons were approached. Of these, 2,624 (82%) completed the questionnaire package consisting of socio-demographic information, Pittsburgh Sleep Quality Index (PSQI), the WHO Quality of Life Brief Version (WHOQOL-BREF), Fatigue Assessment Scale (FAS), Patients Health Questionnaire (PHQ-15), GAD-7 anxiety scale, and the 21-item Depression, Anxiety, Stress Scale (DASS-21). Results: Significant differences between genders were found regarding socio-demographic characteristics (p < 0.01). Using PHQ-15 for depressive disorders, significant differences were found between normal and high severity scores (≥ 10), regarding age group (p < 0.001), gender (p = 0.049), educational level (p < 0.001), occupational status (p = 0.019), cigarette smoking (p = 0.002), waterpipe-narghile smoking (p = 0.039), and co-morbidity (p = 0.003). The WHOQOL-BREF indicated strong correlations between public health, physical health, psychological status, social relationships, environmental conditions, and sleep disorders (p < 0.01). Furthermore, comparisons of the prevalence of mental health symptoms and sleeping with PHQ-15 scores ≥ 10 (p = 0.039), fatigue (p = 0.012), depression (p = 0.009), anxiety (p = 0.032), stress (p = 0.045), and GAD-7 (p < 0.001), were significantly higher among the mental health condition according to sleeping disorder status. Multiple regression analysis revealed that DASS21 stress (p < 0.001), DASS21 depression (p < 0.001), DASS21 anxiety (p = 0.002), physical health (WHOQOL-BREF) (p = 0.007), patient health depression-PHQ-15 (p = 0.011), psychological health (WHOQOL-BREF) (p = 0.012), fatigue (p = 0.017), and environmental factors (WHOQOL-BREF) (p = 0.041) were the main predictor risk factors associated with sleep when adjusted for gender and age. Conclusion: The current study has shown that sleep quality was associated with the mental health symptoms of depression, anxiety, stress, and fatigue. In addition, insufficient sleep duration and unsatisfactory sleep quality seemed to affect physical and mental health functioning.

Reducing Test Anxiety During the COVID-19 Pandemic: A Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy.

Educational assessments can affect students' mental health, particularly during a pandemic. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are widely efficacious for reducing test anxiety, as well as general anxiety and rumination. However, the effectiveness of these two therapies for students during COVID-19 is unclear. We measured the effectiveness of ACT and CBT for managing test anxiety, general anxiety, and rumination during COVID-19 for 77 students taking Türkiye's national university entrance exam, assigned to either the ACT or CBT psychoeducation programs. Both programs reduced test anxiety, general anxiety, and rumination, and showed similar levels of effectiveness. This suggests that ACT and CBT are both important for improving students' mental health during COVID-19 and either may be beneficial.

Age-related visual impairments and perceiving linguistic stimuli: the rarity of assessing the visual abilities of older participants in written language research.

UNLABELLED: BACKGROUND/STUDY CONTEXT: It is well established that declining visual abilities are widespread amongst older adults (aged 65 years and over) and are known to have profound effects on processing a range of visual stimuli. However, the incidence of assessing the visual abilities of older adults participating in written language research using visually presented linguistic stimuli (text, words, letters) is unknown. METHODS: All 240 articles investigating perception of visually presented linguistic stimuli (text, words, letters) by older participants, published 2000-2010 in the three foremost journals in aging research, Experimental Aging Research, The Journals of Gerontology, Series B, and Psychology and Aging, were examined. RESULTS: The majority of articles (68.0%) made no mention at all of participants' visual abilities (59.2%) or relied merely on participants' self-report (8.8%). Other articles (17.9%) reported participants' visual abilities without mentioning any assessment, and only 14.2% reported participants' visual abilities following appropriate assessment. CONCLUSION: The indications are that appropriate assessments of visual abilities are used rarely in language research investigating perception of visually presented linguistic stimuli by older participants. Much greater use and reporting of these assessments is needed to help reveal the processes underlying perception of written language in older populations.

The Good, the Bad and the Hijab: A Study of Implicit Associations Made by Practicing Muslims in Their Native Muslim Country.

Recent research indicates that wearing the hijab reduces the attractiveness of female faces perceived by practicing Muslim men and women in their native Muslim country (the United Arab Emirates). The purpose of the current research was to develop this finding to investigate whether other aspects of person perception are also affected when women wear the hijab in this Muslim country. Of particular relevance is that changes in physical attractiveness often affect the personal qualities assigned to individuals. Accordingly, we sought to determine whether such effects occur when the physical attractiveness of women is altered by wearing the hijab. To do this, we used an Implicit Association Test (IAT) to investigate how native Muslim participants in the UAE associated pleasant and unpleasant connotations with images of women either wearing the hijab or with their heads uncovered. As in previous research with native Muslim participants, female faces were again perceived as significantly less attractive when the hijab was worn. However, the accompanying IAT findings showed that these less attractive hijab-wearing images were associated more with pleasant connotations than were the matched uncovered images. These findings provide fresh insight into the effects of the hijab on perceptions of Muslim women in a Muslim country and provide support for the view that cultural clothing can influence person perception beyond physical attractiveness alone.

Providing guidance on the health effects of religious/spiritual involvement: a national assessment of university counseling professionals.

This study assessed the perceptions and practices of a national sample of university counseling professionals (n = 306) regarding their provision of guidance on the health effects of religious/spiritual involvement. Relatively few (21%) discussed the physical health effects of religiosity/spirituality with their clients. The majority (52%) were unsure that such discussions would result in lower health risks; however, nearly half (48%) indicated that these would promote recovery. Almost two-thirds (64%) indicated that discussions of religious/spiritual involvement and health "should occur only with clients who indicate that religion/spirituality is important to them." A plurality (36%) of the respondents had received no formal training on this topic. Implications for clinical training, university counseling centers, and future research are discussed.

Gendered Perceptions of Odd and Even Numbers: An Implicit Association Study From Arabic Culture.

Previous studies conducted in the United States indicate that people associate numbers with gender, such that odd numbers are more likely to be considered male and even numbers considered female. It has been argued that this number gendering phenomenon is acquired through social learning and conditioning, and that male-odd/female-even associations reflect a general, cross-cultural human consensus on gender roles relating to agency and communion. However, the incidence and pattern of number gendering in cultures outside the United States remains to be established. Against this background, the purpose of this study was to determine whether people from a culture and country very different from the United States (specifically, native Arabic citizens living in the Arabic culture of the United Arab Emirates) also associate numbers with gender, and, if they do, whether the pattern of these associations is the male-odd/female-even associations previously observed. To investigate this issue, we adopted the Implicit Association Test used frequently in previous research, where associations between numbers (odd and even) and gender (male and female faces) were examined using male and female Arabic participants native to, and resident in, the United Arab Emirates. The findings indicated that the association of numbers with gender does occur in Arabic culture. But while Arabic females associated odd numbers with male faces and even numbers with female faces (the pattern of previous findings in the United States), Arabic males showed the reversed pattern of gender associations, associating even numbers with male faces and odd numbers with female faces. These findings support the view that number gendering is indeed a cross-cultural phenomenon and show that the phenomenon occurs across very different countries and cultures. But the findings also suggest that the pattern with which numbers are associated with gender is not universal and, instead, reflects culture-specific views on gender roles which may change across cultures and gender. Further implications for understanding the association of numbers with gender across human societies are discussed.

COVID-19 pandemic and psychological fatigue in Turkey.

AIM: The aim of this study was to investigate the association between the COVID-19 pandemic and psychological fatigue as a mental health issue among the population of Istanbul, Turkey. PARTICIPANTS AND METHODS: This is a cross-sectional study conducted in Istanbul, Turkey, between March and June 2020, where a total of 4,700 persons were approached and 3,672 (78%) of participants (64.4% males and 35.6% females) completed the Knowledge Attitude Practices (KAP) and Fatigue Assessment Scale (FAS) questionnaires. RESULTS: In this study, 64.1% of participants were categorized as psychologically fatigued and 35.9% as normal. There was a significant difference between fatigued and normal participants with respect to age, educational level, occupational status, place of residence and number of family members (p < .001). Other differences related to knowledge of COVID-19 were symptoms, treatment, ways of spreading (p < .001), prevention by avoiding crowded places (p = .008) and isolation (p = .002). For attitudinal items, normal participants generally showed more positive attitudes than the fatigued in believing that COVID-19 will finally be controlled, satisfaction with preventive measures taken by the authorities, reporting suspected cases with symptoms and trusting that Turkey can overcome the COVID-19 pandemic (p < .001). Multivariate stepwise regression analysis indicated that level of education, avoiding going to crowded places, eye, nose and mouth organs are sensitive organs to the virus, keeping physical distance due to epidemic affect by COVID-19 virus, isolation and treatment of people reduce the spread of COVID-19 virus and 14-days period of time, COVID-19 is mainly transmitted through contact with the respiratory droplets of an infected person, occupational status, health education programme needed and antibody treatment variables were significantly associated with fatigue after adjusting for age, gender and income variables. CONCLUSION: The current study provides valuable information for policymakers and mental health professionals worldwide regarding associations between the mental health of individuals and the ongoing outbreak, COVID-19.

Effects of increased letter spacing on word identification and eye guidance during reading.

The effect of increasing the space between the letters in words on eye movements during reading was investigated under various word-spacing conditions. Participants read sentences that included a high- or low-frequency target word, letters were displayed normally or with an additional space between adjacent letters, and one, two, or three spaces were present between each word. The spacing manipulations were found to modulate the effect of word frequency on the number and duration of fixations on target words, indicating, more specifically, that letter spacing affected actual word identification under various word-spacing conditions. In addition, whereas initial fixations landed at the preferred viewing position (i.e., to the left of a word's center) for sentences presented normally, landing positions were nearer the beginnings of words when letter spacing was increased, and even nearer the beginnings of words when word boundary information was lacking. Findings are discussed in terms of the influence of textual spacing on eye movement control.

African American primary care physicians' perceptions and practices regarding smoking cessation therapy.

African American smokers (34% of males and 23% of females) need formal interventions to assist them in quitting smoking, a major method of preventing premature mortality from smoking-related illnesses. The purpose of this study was to examine African American primary care physicians' perceptions and practices regarding smoking cessation counseling. A national random sample (n=202) of primary care physicians was asked about their perceptions and practices regarding smoking cessation therapy. Most (89%) placed themselves in the maintenance stage for asking their patients about their smoking status and regularly documented the smoking status of their patients (70%). Most physicians did not comply with all of the components of the U.S. Public Health Services' smoking cessation guidelines (e.g., 5 A's and 5 R's). The component most often implemented of the 5 A's was to "advise" patients to quit (89%), and "arrange" followup was the least frequently (60%) used component. Perceived barriers to engaging in smoking cessation interventions were time (38%) and patients not interested in quitting (19%). Although physicians used many of the steps in the 5 A's and 5 R's, they were far less compliant in recommending nicotine replacement therapy, prescribing pharmacotherapy, and providing support and/or follow-up for patients who were willing to quit smoking. Physicians need more academic preparation in providing smoking cessation counseling since few received such training in medical school (31%) or during their residency programs (18%).

The patient-centered medical home and why it matters to health educators.

The Patient-Centered Medical Home (PCMH) is an approach to providing comprehensive care for children, youth, and adults in the primary care setting. PCMH emphasizes planned care, care coordination, family-centered approaches, and quality of care while also improving access to care and modernizing the care experience. Although health educators as a group have not traditionally focused their efforts on the primary care setting, the PCMH model increases the potential for their inclusion. Health educators, given their training and expertise, are likely to be well positioned to contribute to primary care oriented with a PCMH model. Health educator roles within PCMH that are especially relevant include participating in a team approach to care, attention to coordination and integration of care, and preventive and end-of-life care. Such roles may be realized in direct delivery of patient education such as health coaching, serving as a facilitator or connector to community resources, or involvement in practice or practice organization quality improvement and population-based assessment efforts. If implemented properly, the involvement of health educators in this new model of care has the potential to enhance how primary care is delivered, improve the health of Americans with regard to chronic conditions, and reduce related health care costs.

Ebola, Zika, Corona What Is Next for Our World?

In the past century, there have been several pandemics. Within the context of global health, these pandemics have often been viewed from the lens of determinants such as population, poverty, and pollution. With an ever-changing world and the COVID-19 pandemic, the current global determinants of public health need to be expanded. In this editorial, we explore and redefine the major determinants of global public health to prevent future pandemics. Policymakers and global leaders should keep at heart the determinants suggested hereby in any planning, implementation, and evaluation of efforts to improve global public health and prevent pandemics.

Further investigation of the effects of wearing the hijab: Perception of female facial attractiveness by Emirati Muslim men living in their native Muslim country.

The hijab is central to the lives of Muslim women across the world but little is known about the actual effects exerted by this garment on perceptions of the wearer. Indeed, while previous research has suggested that wearing the hijab may affect the physical attractiveness of women, the actual effect of wearing the hijab on perceptions of female facial attractiveness by Muslim men in a Muslim country is largely unknown. Accordingly, this study investigated the effects of the hijab on female facial attractiveness perceived by practising Muslim men living in their native Muslim country (the United Arab Emirates). Participants were presented with frontal-head images of women shown in three conditions: in the fully covered condition, heads were completely covered by the hijab except for the face; in the partially covered condition, heads were completely covered by the hijab except for the face and areas around the forehead and each side of the face and head; in the uncovered condition, heads had no covering at all. The findings revealed that faces where heads were uncovered or partially covered were rated as equally attractive, and both were rated as substantially more attractive than faces where heads were fully covered. Thus, while wearing the hijab can suppress female facial attractiveness to men, these findings suggest that not all hijab wearing has this effect, and female facial attractiveness for practising Muslim men living in their native Muslim country may not be reduced simply by wearing this garment. Indeed, from the findings we report, slight changes to the positioning of the hijab (the partially covered condition) produce perceptions of facial attractiveness that are no lower than when no hijab is worn, and this may have important implications for wearing the hijab in Muslim societies. Finally, we argue that the pattern of effects we observed is not explained by anti-Islamic feeling or cultural endogamy, and that a major contributory factor is that being fully covered by the hijab occludes external features, especially the hair and lateral parts of the head and face, which, when normally visible, provide a substantial perceptual contribution to human facial attractiveness.

Re-evaluating split-fovea processing in word recognition: effects of word length.

Several studies have claimed that, when fixating a word, letters to the left and right of fixation project to different hemispheres and are consequently subjected to different processes. In support of this claim, Lavidor M, et al. (2001; hereafter LES&B) report that lexical decisions were affected by increasing the number of letters to the left of fixation but not to the right, and that this indicates divided hemispheric access at the point of fixation to length-sensitive processes in the right hemisphere (RH). We re-evaluated these claims in Experiment 1 using Lavidor et al.'s original stimuli and procedure of merely instructing participants where to fixate. In contrast to the earlier study, increases in the number of letters to the left and right of the designated fixation location produced near-identical effects on reaction time, and increases to the left actually improved response accuracy and increases to the right impaired it. When larger stimuli were used to improve stimulus perceptibility and an eye-tracker monitored fixation accuracy (Experiment 2), left and right increases in the number of letters again produced near-identical effects on reaction time (and accuracy), but frequent and substantial fixation errors were revealed. When an eye-tracker ensured accurate fixations (Experiment 3), left and right increases in the number of letters again produced near-identical effects on reaction time and accuracy. Thus, the findings of all three experiments provide no support for the findings of LES&B (2001) and no evidence of split-fovea processing. The findings also indicate the dangers of assuming fixation of precisely-specified locations within words, both in experiments designed to reveal split-foveal processing and hemispheric asymmetry and in more normal circumstances of word perception.

Assessing effects of viewing distance on normal Chinese reading: some methodological and theoretical implications.

Viewing distance determines a range of factors affecting reading performance. Previous studies of Chinese-character reading have shown considerable disagreement and inconsistency in their choice of viewing distances, however, with obvious implications for research in this area. The present study aimed to resolve this issue by determining the optimal viewing distance for studies of normal Chinese reading. Stimuli were pages of text that were composed of a standard Chinese typeface (Song) that was presented in a standard size (10.5 pt). Forty reading distances were used, ranging from 2.5 to 100.0 cm. Distances within the range of 7.5-55.0 cm produced faster reading rates than did the distances at either end of the continuum, and a regression model showed that 35 cm was the optimal viewing distance. These findings indicate an optimal range of retinal image sizes between 2.0 degrees and 0.3 degrees per character. The implications of these findings for understanding the processes that are involved in Chinese reading and for the appropriate presentation of Chinese stimuli in experiments are discussed.