Creation of a sexual risk index from the American College Health Association-National College Health Assessment (ACHA-NCHA) III to compare nontraditional and traditional student sexual risk.

OBJECTIVE: To examine the utility of a novel sexual risk index (SRI) to better use National College Health Assessment (NCHA) sexual health-related questions. METHODS: The first phase included discussions, testing, and recoding of the initial set of items. In the second phase, a correlation analysis was run; items were systematically removed to achieve a Cronbach's alpha of .714. RESULTS: All currently enrolled students in Spring 2020 at medium-sized, 4-year public university in Florida were recruited (n = 4,850) for the NCHA. Of the 441 total respondents, 223 students were included in the SRI analyses. Most had very low SRI scores, indicating few sexual risks. Nontraditional students were half as likely to experience academic challenges as compared to traditional students (TS; OR = .487, p = .033), while increasing SRI scores (OR = 1.182, p = .022) and decreasing GPA scores (OR = -1.975, p < .001) were associated with an increased likelihood of self-reporting academic challenges. CONCLUSIONS: Results suggest high utility and reliability of the SRI. The use of the SRI provides a better overall picture of sexual risk-taking through a score rather than comparison of individual NCHA items.

Psychometric evaluation of Suicide Management Competency Scale for nursing students: A cross-sectional study.

Suicide management skills are essential for nursing students, as they are often the initial healthcare contact for individuals at risk of suicide. Recognising signs of suicidal ideation and behaviour is critical for initiating timely interventions. This study aimed to develop and access the psychometric evaluation of the Suicide Management Competency Scale (SMCS) for nursing students. A first draft of the SMCS was initially developed following literature and focus group, and a scale containing 28 items was constructed. We recruited 216 participants from two nursing schools. Construct validity was evaluated with exploratory factor analysis (EFA). Internal consistency reliability was determined with Cronbach's alpha, and test-retest reliability was examined with intra-class correlation. After four rounds of EFA and item analysis, we reduced the number of items to 16. We deleted 12 items, including 4 items for communalities less than 0.40, 3 items for cross-loading, 3 items for factor loading less than 0.40, and 2 items for low corrected item-total correlation. The final 16-item SMCS resulted in three subscales, which explained 55.813% of the total variance: emotional challenges in suicide risk assessment, delivering suicide interventions, and suicide risk nursing competence and confidence. Cronbach's alpha was 0.854 for the total score and 0.748 to 0.847 for the subscales. The newly developed SMCS was found to have good reliability and validity, suggesting that this scale could be used to evaluate nursing students' perceived competency in managing suicide, which might help cultivate competence in nurses' ability to effectively manage and prevent suicide, thus contributing to saving lives.

Effects of Baduanjin Qigong in Individuals With Schizophrenia: A Preliminary Quasi-Experimental Pilot Study.

The current quasi-experimental study explored the effects of Baduanjin qigong on body mass index (BMI) and five metabolic indexes in people with schizophrenia. Inclusion criteria were body mass index >25 kg/m2 or metabolic syndrome. Twenty-two service users were recruited from a psychiatric center and were assigned to the experimental group (EG) or control group (CG) using blocked randomization. The EG performed Baduanjin qigong lasting 1 hour for 12 weeks three times per week, whereas the CG received routine care. Generalized estimating equations showed that the EG achieved a greater decrease in BMI and waist circumference (WC) than the CG post-intervention. Baduanjin qigong may provide an effective nonpharmacological approach to reducing BMI and WC in people with schizophrenia. This study showed that performing Baduanjin qigong for 12 weeks is a feasible and effective strategy for improving the body shape of individuals with chronic schizophrenia, thus providing results that can serve as a reference for health professionals working in psychiatry departments. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 41-48.].

The prevalence and risk factors of PTSD symptoms among nurses during the COVID-19 pandemic-A systematic review and meta-analysis.

Since the first reported outbreak in China, the Coronavirus disease 2019 (COVID-19) has raised serious concerns globally. The COVID-19 pandemic has caused a severe psychological impact on healthcare workers (HCWs), and especially nurses, who are the most numerous and exposed frontline group. This systematic review and meta-analysis aims to summarise extant literature on the effects of the COVID-19 pandemic on the psychological health of nurses, particularly concerning the prevalence and risk factors for post-traumatic stress disorder (PTSD). A systematic search was conducted on PubMed, Embase and PsycInfo from March 2020 to July 2023. Articles were included/excluded on predetermined eligibility criteria. A random-effect meta-analysis was performed using proportions to determine the pooled prevalence for PTSD among nurses. Subgroup analyses were also performed, and heterogeneity across studies was analysed using meta-regression. Relatively high prevalence rates of PTSD were reported among nurse populations during the COVID-19 pandemic in twenty-six different countries, globally. Risk factors associated with PTSD include having prior mental health co-morbidities, being a female, having high exposure/contact with COVID-19 patients, having insufficient protective conditions and having intensive workloads. The overall pooled prevalence was 29.1% (95% C.I. = 23.5%, 35.5%) using a random-effects model in 55 studies. The regression test of funnel plot asymmetry indicated a significant level of publication bias among studies. The COVID-19 pandemic is associated with significant levels of PTSD among frontline nurses globally. A high level of heterogeneity was observed across studies. Psychological, social and administrative interventions should be implemented to mitigate heavy psychological distress in nurses.

Oral health during pregnancy: an analysis of interprofessional guideline awareness and practice behaviors among prenatal and oral health providers.

BACKGROUND: Poor oral health during pregnancy has significant implications across the life course, including increased risk for adverse pregnancy, birth outcomes, and the development of early childhood caries. In efforts to improve perinatal oral health in the United States, a set of national interprofessional guidelines were developed that include recommended practice behaviors for both oral health providers and prenatal providers. The purpose of this study was to examine guideline awareness, familiarity, beliefs, and practice behaviors among both provider types. METHODS: Prenatal providers and oral health providers in Florida were recruited via random and convenience sampling to complete an online survey guided by the Consolidated Framework for Implementation Research (CFIR) and the Cabana Framework. The present analysis focused on the Individuals Involved domain (CFIR), awareness and familiarity with the guidelines (Cabana Framework), confidence, and practice behaviors as recommended by prenatal oral health guidelines (assess, advise, refer, share/coordinate). Data were analyzed using chi-square tests, independent samples t-tests, Pearson correlation coefficients, and one-way analysis of variance (ANOVA) and analyses were conducted in SPSS. RESULTS: Prenatal and oral health providers did not differ significantly in their awareness of the guidelines, but awareness was significantly associated with three of the four practice behaviors for prenatal providers. Familiarity with the guidelines was significantly higher among oral health providers and was associated with all four practice behaviors for both provider types. Five out of ten oral health belief items were significantly associated with practicing the guidelines among prenatal providers, but only two among oral health providers. Confidence in performing the practice behaviors was significantly associated with guideline implementation among both groups. Years in practice was significantly associated with performing practice behaviors for prenatal providers, but not for oral health providers. CONCLUSIONS: Our findings highlight the importance of professional organizations and the role of clinical guidelines on practice behaviors. Although provider education is a key implementation strategy, organizational and policy-level system changes could also be critical in supporting practice behaviors.

Dental patients' communication preferences for learning about HPV-related topics.

Oropharyngeal cancer (OPC) has the highest incidence of any cancer caused by human papillomavirus (HPV). Oral health providers are urged to support the use of the HPV vaccine, which was approved by the US Food and Drug Administration for the prevention of OPC in 2020. This study evaluated the preferences of dental patients regarding 11 modalities for learning about HPV-related topics from their oral health providers. An online survey was administered to US adults aged 18 to 45 years (n = 285) to assess their communication modality preferences, prior experience discussing HPV with oral health providers, and demographic characteristics. Multiple items were combined to obtain preference scores for each modality. Preference scores were compared using 2 × 3 mixed analysis of variance. Age, sex, income, and HPV vaccination status were assessed as potential confounders. One-on-one discussions were the most preferred modality for learning about HPV-related topics; however, the preference scores differed based on whether the patient had prior HPV-related discussions with oral health providers (partial η2 = 0.054). Patients who had prior discussions showed a weaker preference for one-on-one discussions than did patients who had not had prior discussions. Oral health providers are called on to promote HPV vaccination, which will require increasing communication on this subject with patients. To assure greater acceptance of their recommendations, providers will need to match their communication styles to those desired by their patients. As part of a comprehensive HPV prevention strategy that includes administration of the vaccine, oral health providers should be educated on how to confidently discuss HPV-related issues with their patients.

Characteristics associated with the adoption of consumer-based -self-sampling methods for sexually transmitted infection screening.

Objective: To identify theory-based innovation characteristics associated with the adoption of consumer-based self-sampling methods for sexually transmitted infection screening. Participants: Guided by the Diffusion of Innovation, survey data from people assigned female at birth (AFAB) (n = 92) were analyzed. Methods: Forward regression models and a path analysis were used to predict adoption by characteristics, using maximum likelihood estimation. Measures included acceptability, comfort, addresses healthcare needs, willingness to adopt self-sampling methods, and innovation characteristics. Results: Predictors of willingness to adopt were no clinic visit (relative advantage), convenient pick-up (relative advantage), and low cost. Variables with direct effects on adoption included: addresses healthcare needs, comfort, acceptability, and no clinic visit. Conclusions: Relative advantage was a salient factor and prioritizing this construct in intervention development may facilitate adoption. Results can guide the development of an innovative, theory-based intervention that promotes adoption of self-sampling methods, ultimately improving STI screening rates.

Fatigue-related symptom clusters and functional status of older adults in hospice.

BACKGROUND: Fatigue is frequently co-existing with other symptoms and is highly prevalent among patients with cancer and geriatric population. There was a lack of knowledge that focus on fatigue clusters in older adults with cancer in hospice care. OBJECTIVES: To identify fatigue-related symptom clusters in older adult hospice patients and discover to what extent fatigue-related symptom clusters predict functional status while controlling for depression. METHOD: This was a cross-sectional study in a sample of 519 older adult hospice patients with cancer, who completed the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression, Boston Short Form Scale, and the Palliative Performance Scale. Data from a multi-center symptom trial were extracted for this secondary analysis using exploratory factor analysis and hierarchical multiple regression analysis. RESULTS: Data from 519 patients (78 ± 7 years) with terminal cancer who received hospice care under home healthcare services revealed that 39% of the participants experienced fatigue-related symptom clusters (lack of energy, feeling drowsy, and lack of appetite). The fatigue cluster was significantly associated positively with depression (r = 0.253, p < 0.01), and negatively with functional status (r = -0.117, p < 0.01) and was a strong predictor of participants' low functional status. Furthermore, depression made a significant contribution to this predictive relationship. CONCLUSION: Older adult hospice patients with cancer experienced various concurrent symptoms. The fatigue-specific symptom cluster was identified significantly associated with depression and predicted functional status. Fatigue should be routinely monitored in older adults, especially among hospice cancer patients, to help reduce psychological distress and prevent functional decline.

Measurement Invariance of the Hospice Quality of Life Index-14 in Lung Cancer and Nonlung Cancer Patients Admitted to Hospice.

Background and Purpose: Establishing measurement invariance (MI) is important in the questionnaire validation process. This study examined the MI of the Hospice Quality of Life Index-14 (HQLI-14) when comparing hospice patients with lung cancer and those with non-lung cancers. Methods: The HQLI-14 contains 14 items to measure multidimensional concepts of quality of life. A series of confirmatory factor analyses were performed to test configural, metric, and scalar invariance. Results: The MI of the HQLI-14 was supported by increasing equality constraints on item parameters between groups. Although the configural and metric invariances were both supported, one item regarding breathlessness was noninvariant between the groups with lung and nonlung cancers. Conclusions: The HQLI-14 shows early evidence of meeting the requirements for configural, metric, and partial scalar invariance. It may be used to make meaningful comparisons between patients with lung cancer and nonlung cancers.

Prenatal oral health guidelines: a theory- and practice-informed approach to survey development using a modified-Delphi technique and cognitive interviews.

BACKGROUND: Pregnancy presents an opportune time for oral health promotion and intervention; however, implementation of the prenatal oral health guidelines remains a challenge among prenatal and oral health providers. The purpose of this study was twofold: To employ a theory-based approach to identify high-priority Consolidated Framework for Implementation Research (CFIR) constructs with the greatest potential to impact prenatal oral health guideline implementation, and to operationalize and pre-test survey items based on the prioritized CFIR constructs. Identifying barriers and facilitators to guideline implementation will inform the development of targeted interventions that address gaps in adherence which can positively impact oral-systemic health. METHODS: The online survey development process employed three rounds of a modified-Delphi technique with prenatal (i.e., MD/DO, CNM) and oral health (i.e., DMD) Practice Advisory Board Members, cognitive interviews with prenatal and oral health providers, and deliberations among the research team and a Scientific Advisory Board (OBGYN, pediatric dentist, and researchers). High-impact CFIR constructs were identified and translated into survey items that were subsequently piloted and finalized. RESULTS: During three modified-Delphi rounds, a total of 39 CFIR constructs were evaluated with final input and deliberations with the Practice Advisory Board, Scientific Advisory Board, and the research team achieving consensus on 19 constructs. The instrument was pre-tested with four prenatal and two oral health providers. Overall, participants reported that the survey items were feasible to respond to, took an appropriate length of time to complete, and were well-organized. Participants identified specific areas of improvement to clarify CFIR items. The final survey instrument included 21 CFIR items across four domains, with five constructs included from the intervention characteristics domain, two from the process domain, two from the outer setting domain, and 12 from the inner setting domain. CONCLUSIONS: Lessons learned from the survey development process include the importance of soliciting diverse scientific and practice-based input, distinguishing between importance/impact and direction of impact (barrier/facilitator), and the need for additional qualitative methods during interdisciplinary collaborations. Overall, this study illustrated an iterative approach to identifying high-priority CFIR constructs that may influence the implementation of the prenatal oral health guidelines into practice settings.

COVID-19 stress, social support, and coping in international students during the COVID-19 pandemic: a moderated analysis on anxiety and depression.

OBJECTIVE: This study examined the associations between COVID-19 stress and anxiety and depression among international college students and assessed if this relationship was moderated by coping and social support. PARTICIPANTS: 219 international students at a large US university. METHODS: A cross-sectional online survey utilizing validated scales was conducted from October 1 to 25, 2020. Path analyses assessed the effects of COVID-19 stress on anxiety and depression, and whether coping and social support moderated these relationships in international students. RESULTS: COVID-19 stress was significantly associated with anxiety and depression in international students. Maladaptive coping moderated the relationship between COVID-19 stress and anxiety but did not moderate the relationship with depression. Neither adaptive coping or social support moderated the relationship between COVID-19 stress and anxiety or depression. CONCLUSIONS: Results confirm the need for additional mental health services to reach international college students at risk of anxiety and depression during the COVID-19 pandemic.

Goal Attainment Scaling in Outpatient Physical Therapy for Chronic Low Back Pain: Protocol for a Mixed Methods Study.

BACKGROUND: Patient engagement in decisions regarding their health care may lead to improved outcomes and improved adherence to treatment plans. While there are several options for involving patients in their health care, goal setting is a readily accessible method for physical therapists to increase the involvement of patients in health care decisions. Physical therapy goals are often generated by health care providers based on subjective information or standardized, fixed-item, patient-reported outcome measures. However, these outcome measures may not fully reveal the activity and participation limitations of individual patients. Goal attainment scaling (GAS) is a patient-centered approach that allows patients to set meaningful goals. While GAS has been shown to be reliable, valid, and sensitive to change in various populations, there is limited evidence in the United States on utilizing GAS in physical therapy for patients with chronic low back pain (LBP). OBJECTIVE: The purpose of this paper is to describe the protocol for a study to (1) develop a way to apply GAS procedures for physical therapists treating patients with chronic LBP in the United States and (2) test the feasibility of applying GAS procedures for chronic LBP in an outpatient physical therapy setting. METHODS: This study used a mixed methods design with 2 phases: qualitative and quantitative. The qualitative phase of the study employed focus groups of patients with chronic LBP to identify an inventory of goals that were important and measurable. A series of prompts was developed from this inventory to assist physical therapists in collaboratively establishing goals with patients in a clinical setting. The quantitative phase of the study pilot-tested the inventory developed in the qualitative phase in patients with chronic LBP to determine feasibility, reliability, validity, and responsiveness. We also plan to compare how well GAS reveals change over time relative to traditional, fixed-item, patient-reported measures. RESULTS: Phase 1 data collection was completed in June 2020, while data collection for phase 2 was performed between March 2021 and December 2021. We anticipate that this study will demonstrate that GAS can be implemented successfully by outpatient physical therapists, and that it will demonstrate clinically important changes in patients with chronic LBP. CONCLUSIONS: GAS represents an opportunity for patient-centered care in the physical therapy management of chronic LBP. While GAS is not new, it has never been studied in real-world physical therapy for chronic LBP in a clinical setting. Due to unique time and productivity constraints, for GAS to be successfully implemented in this environment, we must demonstrate that clinicians can be trained efficiently and reliably, that GAS can be implemented in a clinical setting in under 15 minutes, and that GAS is able to detect clinically meaningful changes in patient outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32457.

Cognitive Function and Sleep in Caregivers of Persons Living with Dementia.

Poor sleep is prevalent among caregivers of persons living with dementia and increases their risk for cognitive impairment and decline. In this cross-sectional, correlational study, we compared the cognitive function scores of caregivers with poor sleep with the demographically adjusted normed scores of the National Institutes of Health Toolbox Cognition Battery. Caregivers completed a 14-day sleep diary. On average, caregivers (n = 28) were 65.14 (±10.08) years, female, and White. Their average crystallized cognitive function composite score was significantly higher and their average fluid cognitive function composite score was significantly lower than the normative scores. Caregivers performed significantly worse on the processing speed domain measure. Poor sleep may affect how caregivers, including highly educated caregivers, process and respond to information, thus can influence how they safely perform complex caregiving tasks. Health care providers should consistently assess caregivers' sleep and cognitive abilities to promptly identify changes and provide timely interventions.

Discussing HPV and oropharyngeal cancer in dental settings: gender and provider-type matter.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and the leading cause of oropharyngeal cancer (OPC), an oral cancer most often identified by dental providers. Given the rise in HPV-associated OPC and recent Food and Drug Administration (FDA) approval of the HPV vaccine to prevent OPC, dental providers have a unique role in HPV prevention. This study assessed US adults' comfort levels discussing HPV and OPC with dental providers. An online survey platform was used to recruit a nationally representative sample of US adults (n = 300). The questionnaire assessed participants' knowledge, acceptability, and comfort discussing HPV-related topics with dental providers. SPSS 24 was utilized for data analyses. In general, participants reported feeling comfortable discussing HPV and OPC with dental providers. Participants reported feeling more comfortable with dentists than dental hygienists when discussing (t = 2.85, p < .01) and receiving recommendations about the HPV vaccine (t = 2.09, p < .05). Participants were less comfortable discussing HPV as a risk factor for OPC compared to non-HPV related risk factors (t = 2.94, p < .01). Female participants preferred female providers, whereas male participants had no preference. Previous research has indicated dental providers recognize their role in HPV prevention, but research is needed to understand patients' perceptions of dental providers' role in HPV prevention. Findings demonstrate that US adults are comfortable discussing HPV and OPC with dental providers, which may be key to OPC-HPV prevention. Future research is needed to facilitate HPV communication between patients and dental providers.

IMProving care After inherited Cancer Testing (IMPACT) study: protocol of a randomized trial evaluating the efficacy of two interventions designed to improve cancer risk management and family communication of genetic test results.

BACKGROUND: Implementing genetic testing for inherited cancer predisposition into routine clinical care offers a tremendous opportunity for cancer prevention and early detection. However, genetic testing itself does not improve outcomes; rather, outcomes depend on implemented follow-up care. The IMPACT study is a hybrid type I randomized effectiveness-implementation trial to simultaneously evaluate the effectiveness of two interventions for individuals with inherited cancer predisposition focused on: 1) increasing family communication (FC) of genetic test results; and 2) improving engagement with guideline-based cancer risk management (CRM). METHODS: This prospective study will recruit a racially, geographically, and socioeconomically diverse population of individuals with a documented pathogenic/likely pathogenic (P/LP) variant in an inherited cancer gene. Eligible participants will be asked to complete an initial trial survey and randomly assigned to one of three arms: A) GeneSHARE, a website designed to increase FC of genetic test results; B) My Gene Counsel's Living Lab Report, a digital tool designed to improve understanding of genetic test results and next steps, including CRM guidelines; or C) a control arm in which participants continue receiving standard care. Follow-up surveys will be conducted at 1, 3, and 12 months following randomization. These surveys include single-item measures, scales, and indices related to: 1) FC and CRM behaviors and behavioral factors following the COM-B theoretical framework (i.e., capability, opportunity, and motivation); 2) implementation outcomes (i.e., acceptability, appropriateness, exposure, and reach); and 3) other contextual factors (i.e., sociodemographic and clinical factors, and uncertainty, distress, and positive aspects of genetic test results). The primary outcomes are an increase in FC of genetic test results (Arm A) and improved engagement with guideline-based CRM without overtreatment or undertreatment (Arm B) by the 12-month follow-up survey. DISCUSSION: Our interventions are designed to shift the paradigm by which individuals with P/LP variants in inherited cancer genes are provided with information to enhance FC of genetic test results and engagement with guideline-based CRM. The information gathered through evaluating the effectiveness and implementation of these real-world approaches is needed to modify and scale up adaptive, stepped interventions that have the potential to maximize FC and CRM. TRIAL REGISTRATION: This study is registered at Clinicaltrials.gov (NCT04763915, date registered: February 21, 2021). PROTOCOL VERSION: September 17th, 2021 Amendment Number 04.

Enhancing care transitions intervention with peer support to improve outcomes among older adults with co-occurring clinical depression: a pilot study.

The Care Transitions Intervention (CTI) is an evidence-based intervention aimed at supporting the transition from hospital back to the community for patients to ultimately reduce preventable re-hospitalization. In a pilot randomized controlled trial, we examined the preliminary effectiveness of an Enhanced Care Transitions Intervention (ECTI), CTI with the addition of peer support, for a racially/ethnically diverse sample of older adults (age 60+) with co-morbid major depression. We observed a significant decline in health-related quality of life (HRQOL) after being discharged from the hospital among those who received CTI. Additionally, those who received ECTI either maintained HRQOL scores, or, saw improvement in HRQOL scores. Findings suggest the Enhanced Care Transitions Intervention can maintain or improve HRQOL and reduce disparities for older participants from diverse racial/ethnic backgrounds with clinical depression.

Arguments in favor of and against the HPV vaccine school-entry requirement in Puerto Rico: a content analysis of newspaper media.

PURPOSE: Vaccine requirements are effective population-based strategies to increase vaccination rates. In 2018, Puerto Rico's DOH announced that the HPV vaccine would be required for school entrance. This study explored arguments in favor of and against the HPV vaccine school-entry requirement in PR. METHODS: We conducted a content analysis of two Puerto Rican newspapers. Articles (n = 286) published between 1/1/2015 and 7/31/2018 containing the Spanish terms for "HPV" and "human papillomavirus" were included. Data were summarized using descriptive statistics. Articles that mentioned the HPV vaccine school-entry requirement (n = 33) were reviewed qualitatively using applied thematic analysis. RESULTS: The top five primary focus areas were education about HPV and the HPV vaccine, advertisements promoting the HPV vaccine, general vaccine information, cervical cancer and screening information, and the HPV vaccine school-entry requirement. Of the 33 articles that mentioned the requirement, 61% presented arguments in favor, 15% presented arguments against, 12% presented both arguments, and 12% only mentioned the existence of the requirement or were the DOH announcement. Arguments in favor centered on cancer prevention, high rates of HPV-associated cancers, and population wellness. Arguments against included worries about sexual transmission of HPV, HPV vaccine's side effects, issues related to the policy (e.g., mandatory), and lack of education. CONCLUSION: Understanding reasons people support or oppose an HPV vaccine school-entry requirement is important for the policy processes to be successful. Education efforts must continue to change the HPV vaccine narrative. Messages should be crafted to educate and gain support among parents and stakeholders towards this population-based cancer prevention strategy.

The Intersection of Problems, Policy, and Politics: The Adoption of an HPV Vaccine School-Entry Requirement in Puerto Rico.

Persistent human papillomavirus (HPV) infections can cause cancer (e.g., cervical/vaginal/penile/anal/oropharyngeal). The HPV vaccine prevents cancer, yet U.S. vaccination rates remain low. We explored sociopolitical factors in the adoption of Puerto Rico's HPV vaccine school-entry requirement. Multiple streams framework explains how the intersection of problems, policy, and politics streams influence policy adoption. Policy entrepreneurs work on joining these streams. Interviews (n = 20) were conducted with stakeholders (e.g., physicians/researchers/nonprofit organizations' leaders). Data were analyzed using applied thematic analysis. High incidence of HPV and HPV-related cancers in Puerto Rico were indicators of problems. Focusing events included Rhaiza's case and the HPV-Advisory Panel Report. During summer 2017, a policy window opened; the Department of Health (DOH) adopted the requirement in summer 2018. Stakeholders discussed policy initiatives. Political turnover positively influenced the process. Policy entrepreneurs created an extended period of intersection resulting in the adoption of the requirement. Findings can inform policy initiatives to improve HPV vaccination rates and reduce HPV-related cancers.

On making forecasts from binary sequences: Uncovering implicit cues.

The purpose of this article is to examine the statistical characteristics of binary sequences with the aim of uncovering the implicit cues that people use when making forecasts of what comes next. Information theory was used to quantify these statistical characteristics. In 2 experiments people were presented with 100 intact sequences of 20 Xs and Os and simply asked to forecast whether the 21st event in each sequence will be an X or an O. Multilevel logistic regression models were used to estimate the odds associated with these forecasts under different experimental manipulations. In a third experiment people judged the forecastability of sequences in a paired-comparison task. The results from the first 2 experiments showed that third-order redundancy (i.e., information provided by knowledge of the preceding pairs of events) was the most salient cue influencing forecasts. Experiment 3 showed that judgments of forecastability were based on this cue as well. When examining intact sequences with the goal of forecasting what comes next, people are more sensitive to higher-order transitional probabilities than has been previously suggested. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Depressive symptoms and quality of life in people with a diagnosis of schizophrenia: An exploratory study of the potential mediating role of health-promoting lifestyles.

PURPOSE: To examine health-promoting lifestyles mediates the relationship between depressive symptoms and quality of life (QOL) in people with schizophrenia. DESIGN AND METHODS: A cross-sectional exploratory study design was conducted. Two-hundred and seventy-three participants were administered demographic data, health-promoting lifestyle profile, Beck Depression Inventory II, and World Health Organization Quality of Life-BREF. The Hayes PROCESS macro was employed to analyze data. FINDINGS: The results showed self-actualization fully mediated the environmental domain of QOL, physical health, psychological health, and social relationships domains were partial mediation. PRACTICE IMPLICATIONS: This study recommends that professionals reinforce persons' self-actualization when the QOL is affected by depressive symptoms in people with schizophrenia.