Reduced to curtain twitchers? Age, ageism and the careers of four women actors.

Cultural gerontology has developed critical work around cultural representations of age and aging and their role in the reproduction of ageism. However, the cultural industries as producers and disseminators of representations remain under researched. This paper draws on a focus group with four older women actors to argue that workforce allocation and assumptions about audience demographics intersect with cultural attitudes around women's aging to impact on older women actors' career opportunities. We argue that ageism within the cultural industries is limiting our ability to develop diverse and non-ageist cultural representation of women's aging.

Mixed-Method Quasi-Experimental Study of Outcomes of a Large-Scale Multilevel Economic and Food Security Intervention on HIV Vulnerability in Rural Malawi.

The objective of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4Health) study was to evaluate the impact of a large-scale multi-level economic and food security intervention on health outcomes and HIV vulnerability in rural Malawi. The study employed a quasi-experimental non-equivalent control group design to compare intervention participants (n = 598) with people participating in unrelated programs in distinct but similar geographical areas (control, n = 301). We conducted participant interviews at baseline, 18-, and 36-months on HIV vulnerability and related health outcomes, food security, and economic vulnerability. Randomly selected households (n = 1002) were interviewed in the intervention and control areas at baseline and 36 months. Compared to the control group, the intervention led to increased HIV testing (OR 1.90; 95 % CI 1.29-2.78) and HIV case finding (OR = 2.13; 95 % CI 1.07-4.22); decreased food insecurity (OR = 0.74; 95 % CI 0.63-0.87), increased nutritional diversity, and improved economic resilience to shocks. Most effects were sustained over a 3-year period. Further, no significant differences in change were found over the 3-year study period on surveys of randomly selected households in the intervention and control areas. Although there were general trends toward improvement in the study area, only intervention participants' outcomes were significantly better. Results indicate the intervention can improve economic and food security and HIV vulnerability through increased testing and case finding. Leveraging the resources of economic development NGOs to deliver locally-developed programs with scientific funding to conduct controlled evaluations has the potential to accelerate the scientific evidence base for the effects of economic development programs on health.

The changing role of health-oriented international organizations and nongovernmental organizations.

Apart from governments, there are many other actors active in the health policy arena, including a wide array of international organizations (IOs), public-private partnerships and non-governmental organizations (NGOs) that state as their main mission to improve the health of (low-income) populations of low-income countries. Despite the steady rise in numbers and prominence of NGOs, however, there is lack of empirical knowledge about their functioning in the international policy arena, and most studies focus on the larger organizations. This has also caused a somewhat narrow focus of theoretical studies. Some scholars applied the 'principal-agent' theory to study the origins of IOs, for example, other focus on changing power relations. Most of those studies implicitly assume that IOs, public-private partnerships and large NGOs act as unified and rational actors, ignoring internal fragmentation and external pressure to change directions. We assert that the classic analytical instruments for understanding the shaping and outcome of public policy: ideas, interests and institutions apply well to the study of IOs. As we will show, changing ideas about the proper role of state and non-state actors, changing positions and activities of major stakeholders in the (international) health policy arena, and shifts in political institutions that channel the voice of diverging interests resulted in (and reflected) the changing positions of the health-oriented organizations-and also affect their future outlook. Copyright © 2015 John Wiley & Sons, Ltd.

Improvement opportunities for the achievement of reciprocal nursing academic-practice partnerships.

American healthcare reform efforts are driving healthcare organizations to demonstrate the ability to reduce costs while improving quality and optimizing healthcare outcomes. Nurses are the largest healthcare clinicians and need proper preparatory education to enter the profession as practice-ready clinicians; however, medical errors and reduced nursing board examination success rates highlight the need for improved nurse academic preparation standards. Evidence has elucidated an expanding nursing education-practice gap problem arising from inadequate integration of academic leadership and faculty within the clinical practice arena. The nursing education-practice gap has been exacerbated by governance structures in academia that limit opportunities for nursing faculty to remain actively engaged in clinical practice settings. To improve new graduate nurse practice readiness, healthcare quality, and cost-effectiveness, academic institutions must partner with healthcare delivery organizations within mutually beneficial models. The purpose of this article is to describe the expanding nursing education-practice gap problem in relevance to American healthcare quality and reform initiatives and to propose innovative solutions assigned with evidence-based standards.

The Effect of Interprofessional Education on Student Readiness for Collaborative Practice.

BACKGROUND: Health care reform promotes interprofessional patient-centric health care models associated with improved population health outcomes. Interprofessional education (IPE) programs are necessary to cultivate collaborative care, yet little evidence exists to support IPE pedagogy within nursing and other health science academia. METHOD: This quasiexperimental study examined differences in pre- and posttest Readiness for Interprofessional Learning Scale (RIPLS) scores following an IPE intervention. The IPE intervention consisted of a video presentation and a debriefing session after a simulated interprofessional collaborative patient care conference that introduced baccalaureate nursing and health science students to the roles and responsibilities of clinicians in team-based primary care. Pre- and postintervention RIPLS scores were analyzed. RESULTS: Pre- and postintervention RIPLS scores increased across all subscales, with distinct variation between nursing and health science student subscales. CONCLUSION: This IPE intervention had positive effects on students' readiness for interprofessional learning. Additional research is warranted to support health science pedagogy. [J Nurs Educ. 2024;63(5):304-311.].

Evaluation of the Performance of a Card Game to Introduce Students to Interprofessional Collaboration: A Randomized 2-Group Comparison Study.

BACKGROUND: Gamification is an approach that can be used to introduce interprofessional collaboration in nursing and health science. Card games are an effective and convenient way to educate students about clinical professions. PURPOSE: We compared the perception of an experimental group of students who played an educational card game to a control group that played an uninstructive card game. METHODS: College students (n = 148) from nursing and health science majors consented to play a 30-minute card game and complete a 13-item survey. RESULTS: Perceptions of the card game were significantly better for students in the experimental group who played the interprofessional collaboration game than for those in the control group ( t = 10.33, P < .001). Survey subscales were rated significantly higher for respondents who played the interprofessional card game. CONCLUSIONS: The use of an innovative card game teaching strategy significantly increased the perception of interprofessional collaboration among college students.

AIDS exceptionalism: another constituency heard from.

Amidst current debates over resources for AIDS, we examine the policy preferences of the people who are navigating AIDS in their daily lives. Survey and ethnographic data on the prioritization of HIV/AIDS interventions were collected in a longitudinal cohort study in rural Malawi. Study participants gave higher priority to problems other than AIDS. Confining analysis to HIV-positive survey respondents only weakly raises the prioritization of HIV/AIDS services. The ethnographic data are consistent with these findings: although rural Malawians are fully aware of the risk of dying from AIDS, other problems are perceived as more pressing for their community.

Preparing Primary Care Registered Nurse Preceptors for Emerging Care Coordination and Chronic Disease Self-Management Roles.

Nurse educators must prepare the future RN work-force to practice in emerging primary care roles. This program evaluation report describes the approach taken to develop and evaluate a novel preceptor education program designed to prepare RNs to precept nursing students in primary care coordination and disease self-management roles. The program was designed as a three-stage hybrid learning intervention with the goals of preparing RNs to (a) provide primary care coordination and disease self-management support and (b) precept nursing students. Evaluation tools were designed to reflect specific learning objectives of these goals pre- and postintervention. Preliminary evaluation data indicate the preceptor program provided a useful set of educational activities to prepare primary care RN preceptors for their new roles. Participants reported increased confidence levels in primary care coordination and disease self-management and student precepting responsibilities. Nursing students' evaluations showed positive primary care clinical experiences. [J Contin Educ Nurs. 2023;54(10):454-461.].

Aging as Adaptation.

In traditional gerontological terms, adaptation is usually understood as the production of physical aids to mitigate the impairment effects caused by age-related disabilities, or as those alterations organizations need to make under the concept of reasonable adjustment to prevent age discrimination (in the UK, e.g., age has been a protected characteristic under the Equality Act since 2010). This article will be the first to examine aging in relation to theories of adaptation within cultural studies and the humanities. It is thus an interdisciplinary intervention within the field of cultural gerontology and cultural theories of adaptation. Adaptation studies in cultural studies and the humanities have moved away from fidelity criticism (the issue of how faithful an adaptation is to its original) toward thinking of adaptation as a creative, improvisational space. We ask if theories of adaptation as understood within cultural studies and the humanities can help us develop a more productive and creative way of conceptualizing the aging process, which reframes aging in terms of transformational and collaborative adaptation. Moreover, for women in particular, this process of adaptation involves engagement with ideas of women's experience that encompass an adaptive, intergenerational understanding of feminism. Our article draws on interviews with the producer and scriptwriter of the Representage theater group's play My Turn Now. The script for the play is adapted from a 1993 coauthored book written by a group of 6 women who were then in their 60s and 70s, who founded a networking group for older women.

Simulation-Enhanced Interprofessional Education for Ambulatory Care Registered Nurses and Health Professions Students.

Ambulatory care RNs and health professions students have limited education on interprofessional care before entering clinical settings. This article describes a program evaluation of a simulation-enhanced interprofessional education (Sim-IPE) experience designed for ambulatory care RNs and health professions students. An 11-item electronic post-Sim-IPE survey was administered to collect perceptions of the Sim-IPE experience. Most responses indicated the Sim-IPE promoted learning about each other's roles, was designed for their level of knowledge and skills, and provided sufficient information. The participants indicated that they felt supported and would use their learning in a clinical setting. Open-ended survey responses identified positive aspects of the Sim-IPE, areas for improvement, and suggestions for future Sim-IPE. The National League for Nursing Jeffries Simulation Theory was used to guide a program evaluation of the Sim-IPE. The program evaluation identified positive aspects and areas for improvement for future interprofessional education experiences. [J Contin Educ Nurs. 2023;54(5):226-232.].

Effects of Medicare wellness visits on health promotion outcomes.

BACKGROUND: The American older adult population has the highest historical prevalence of chronic disease and underuses wellness visit benefits. Little is known about how Medicare wellness visits (MWVs) affect health outcomes. PURPOSE: The aim of this retrospective case-control study was to examine how MWVs affect health outcomes by measuring two kinds of data for case and control groups at baseline versus 15 months: (1) the differences in blood pressure, fasting lipids, and glucose levels and (2) the completion frequencies for seven screenings and vaccinations. METHODOLOGY: Informed by Pender's Health Promotion Model, this design used purposively matched samples from a large American Midwestern Medicare population active between January 2013 and January 2016, with a total sample size of 252, consisting of the case group ( N = 120) and control group ( N = 132). The case and control group samples were matched according to gender, age, marital status, Charlson index scores, smoking status, and pharmaceutical classes. The two groups, case (MWV recipients) and matched control (MWV nonrecipients), were compared at different time points using a doubly multivariate repeated-measures analysis procedure. Descriptive statistics were computed to compare completion frequencies between groups. RESULTS: A doubly repeated multivariate analysis of variance (MANOVA) and descriptive statistics revealed significant differences between the case and control group for three of the four health outcomes. The case group had increased completion frequencies in pneumococcal vaccination. CONCLUSIONS: Additional research controlling for more variables is warranted to better understand MWV efficacy on health outcomes. IMPLICATIONS: Primary care providers need to study how MWVs affect longitudinal health outcomes.

Primary-care registered nurse telehealth policy implications.

Coronavirus disease 2019 (COVID-19) has drastically changed health-care delivery models within primary-care settings. Primary-care providers are limiting routine care face-to-face office visits while triaging COVID-19 symptomatic patients to hospital emergency rooms. Primary-care providers are rapidly adopting telehealth modalities for care provisions during this unprecedented pandemic to allow practices to continue delivering primary care while preventing community spread of COVID-19. Federal legislation has responded to emergent public-health needs by removing barriers that have impeded widespread adoption of telehealth modalities. This legislation has omitted professional registered nurses (RNs) from delivering reimbursable telehealth services, which is problematic for primary-care practice. RNs historically have led telehealth service delivery and should therefore be included in new legislation as eligible health professionals permitted to provide reimbursable telehealth services. RNs improve quality outcomes in primary care within innovative team-based care models and are essential clinicians capable of providing ongoing care coordination and disease management for patients needing to stay on track with their usual care needs.

Asking God about the date you will die: HIV testing as a zone of uncertainty in rural Malawi.

Testing for HIV is becoming more available in Africa. Global advocates of testing see it as key to AIDS prevention. However, testing is not always perceived as a good thing by people at risk. Here, we consider testing from the perspective of people in a high-prevalence community. Using qualitative data from rural Malawi, we show that the decision to test is not as straightforward as suggested in the testing advocacy literature, but is marked by uncertainty and ambivalence. Reluctance to test is connected to the perception that testing inevitably leads to a positive diagnosis, and subsequent deterioration and death. This fear is in turn linked to overestimation of the transmissibility of HIV. We recommend that testing advocates address this concern that being tested means having a death sentence pronounced, and emphasize the benefits of testing for the majority who are HIV-negative, as well as the minority who are HIV-positive.

Registered nurse education in primary care: Barriers and resolutions.

BACKGROUND: American health care is facing unprecedented challenges due to population aging, chronic disease prevalence, and financial restructuring. The Affordable Care Act (ACA) is transforming the primary care landscape from a reactive, episodic, fee-for-service system to a proactive, preventive, value-based system. A proactive, preventive, and value-based primary care model requires Registered Nurses (RNs) prepared to lead integrated, team-based, coordinated, and proactively managed care. The Health Resources and Service Administration (HRSA) forecasted an inadequate supply of RNs prepared to meet future primary care demands and highlighted the lack of education as a key problem. The primary care RN workforce shortage requires immediate attention by academic, political, and research stakeholders. HRSA has responded with academic funding to increase primary care RN education. PROCEDURES: This article describes key barriers and resolutions one HRSA-funded academic institution experienced while implementing a primary care RN education program, along with research implications for the future of primary care nursing. RESULTS: This article describes the project's stakeholder, faculty, and student engagement methods. This article also describes the clinic RN preceptor development program, and depicts the Primary Care RN Education Program Student Clinical Experience Preceptorship Model. CONCLUSIONS: Nursing education must align with transforming healthcare models while anticipating potential barriers and resolutions to enhancing curriculum with primary care nursing education and clinical experiences. This article provides insight for other academic institutions interested in developing primary care curriculum and academic-clinic partnership models to foster community-based primary care clinical experiences.

Are Medicare wellness visits improving outcomes?

BACKGROUND: As the largest and unhealthiest population in American history enrolls as Medicare beneficiaries, it is vital for primary care providers to understand how to maximize Medicare wellness provisions. The Baby Boomer population has been documented to have the highest chronic disease prevalence related to preventable lifestyle behaviors. Perpetual unhealthy lifestyle behaviors associated with chronic disease prevalence are detrimental to life quality and the American Medicare resource structure. Since 2011, the Affordable Care Act provisions have included free wellness visits designed to prevent disease for Medicare beneficiaries, who continue to grossly underuse these services. OBJECTIVES: This systematic review was conducted to evaluate the quality, level, and strength of evidence regarding Medicare wellness service efficacy on related health outcomes. DATA SOURCES: The methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for selection of 21 research-based articles included in the analysis. Results from the 21 eligible studies revealed low research quality and vigor; therefore, lacking causality and generalizability of medicare wellness visit (MWV) efficacy on health promotion outcomes. CONCLUSIONS: The evidence is focused on how MWVs are affecting preventive care utilization instead of patient health outcomes. In the interest of reducing chronic disease prevalence and the economic burden on our health care system, it is important to understand how these services affect health promotion outcomes. IMPLICATIONS FOR PRACTICE: The results of this systematic literature review substantiate the need for primary care providers to study MWV efficacy on health promotion outcomes for the Medicare population.

'Teach a Man to Fish': The Doctrine of Sustainability and Its Effects on Three Strata of Malawian Society.

This paper analyzes the social impacts of the commitment to "sustainability" in donor-funded AIDS programs. Using survey, interview, and ethnographic data from rural Malawi, we examine how efforts to mobilize and empower local communities affect three strata of Malawian society: the villagers these programs are meant to help, the insecure local elites whose efforts directly link programs to their intended beneficiaries, and, more briefly, national elites who implement AIDS policies and programs. We describe indirect effects of sustainability on the experiences, identities, and aspirations of Malawians-effects that are much broader and deeper than the direct impacts of funding.

The Malawi Diffusion and Ideational Change Project 2004-06: Data collection, data quality, and analysis of attrition.

In this paper we evaluate the quality of survey data collected by the Malawi Diffusion and Ideational Change Project by investigating four potential sources of bias: sample representativeness, interviewer effects, response unreliability, and sample attrition. We discuss the results of our analysis and implications of our findings for the collection of data in similar contexts.

Hearsay Ethnography: Conversational Journals as a Method for Studying Culture in Action.

Social scientists have long struggled to develop methods adequate to their theoretical understanding of meaning as collective and dynamic. While culture is widely understood as an emergent property of collectivities, the methods we use keep pulling us back towards interview-situated accounts and an image of culture as located in individual experience. Scholars who seek to access supra-individual semiotic structures by studying public rituals and other collectively-produced texts then have difficulty capturing the dynamic processes through which such meanings are created and changed in situ. To try to capture more effectively the way meaning is produced and re-produced in everyday life, we focus here on conversational interactions-the voices and actions that constitute the relational space among actors. Conversational journals provide us with a method: the analysis of texts produced by cultural insiders who keep journals of who-said-what-to-whom in conversations they overhear or events they participate in during the course of their daily lives. We describe the method, distinguishing it from other approaches and noting its drawbacks. We then illustrate the methodological advantages of conversational journals with examples from our texts. We end with a discussion of the method's potential in our setting as well as in other places and times.

Thermal Micro-Environment during Poultry Transportation in South Central United States.

This observational study was conducted to characterize the thermal micro- climate that broilers experienced in commercial poultry transporters under various weather conditions and typical management practices in the South Central USA. We continuously monitored temperature and relative humidity in 45 interior locations of 28 fully-loaded commercial trailers over 2 year spans from 2015⁻2016 in South Central USA. In the cold season, double boarding of the exterior area of the transport modules maintained temperatures at least 8 °C warmer than ambient temperatures as low as -16 °C. Overall, temperature at all locations decreased as transporters traveled from farms to processing plants during winter trips with double boards. In the hot season, assistance by evaporative cooling during on-farm loading resulted in interior temperatures within ± 2 °C of ambient conditions (up to 36 °C) during road transport. In the summer months, trailers uniformly gained 2 °C as vehicles travelled for 45 min from farms to plants. Apparent equivalent temperatures of the monitored summer trips averaged 80.5 °C, indicating possible heat stress conditions based on the thermal comfort zones defined by literature index values. For longer trips, cooling assistance on the farms may be insufficient to prevent temperatures from rising further into extremely hot conditions in the transporters, leading to a dangerous thermal environment.