How did COVID-19 measures impact sexual behaviour and access to HIV/STI services in Panama? Results from a national cross-sectional online survey.

OBJECTIVE: To describe reported changes in sexual behaviours, including virtual sex (sexting and cybersex), and access to HIV/STI testing and care during COVID-19 measures in Panama. METHODS: We conducted an online cross-sectional survey from 8 August to 12 September 2020 among adults (≥18 years) residing in Panama. Participants were recruited through social media. Questions included demographics, access to HIV/STI testing and HIV care, and sexual behaviours 3 months before COVID-19 social distancing measures and during social distancing measures (COVID-19 measures). Logistic regression was used to identify associations between variables and behavioural changes. RESULTS: We recruited 960 participants; 526 (54.8%) identified as cis-women, 366 (38.1%) cis-men and 68 (7.1%) non-binary or another gender. The median age was 28 years (IQR: 23-37 years), and 531 of 957 (55.5%) were of mixed ethnicity (mixed Indigenous/European/Afro-descendant ancestry). Before COVID-19 measures, virtual sex was reported by 38.5% (181 of 470) of cis-women, 58.4% (184 of 315) cis-men and 45.0% (27 of 60) non-binary participants. During COVID-19 measures, virtual sex increased among 17.2% of cis-women, 24.7% cis-men and 8.9% non-binary participants. During COVID-19 measures, 230 of 800 (28.8%) participants reported decreased casual sex compared with pre-COVID-19 measures. Compared with pre-COVID-19 measures, decreased casual sex was reported more frequently during COVID-19 measures by cis-men compared with cis-women (39.2% vs 22.9%, urban/rural adjusted OR (AOR)=2.17, 95% CI 1.57 to 3.01), and by Afro-descendant compared with participants of mixed ethnicity (40.0% vs 29.8%, AOR=1.78, 95% CI 1.07 to 2.94). Compared with no change in virtual sex (16.8%), increased virtual sex (38.5%, AOR=1.78, 95% CI 1.10 to 2.88) and decreased virtual sex (86.7%, AOR=16.53, 95% CI 7.74 to 35.27) were associated with decreased casual sex encounters. During COVID-19 measures, HIV/STI testing could not be obtained by 58.0% (58 of 100) of the participants who needed a test, and interrupted HIV care was reported by 53.3% (8 of 15) of participants living with HIV. CONCLUSIONS: COVID-19 measures in Panama were associated with a decrease in casual sex among cis-men and Afro-descendant people, while access to HIV/STI testing and care was seriously disrupted.

The scarlet V: how women with dyspareunia negotiate postfeminist discourses of sexual agency.

Young women must often contend with cultural scripts dictating neoliberal/postfeminist ideals of female sexual agency, including the ability to act in accord with one's personal sexual self-interest. The aim of this study was to explore how young women (n = 26) living with dyspareunia (pain experienced during penetrative sexual activity) negotiate these ideals. We found that in addition to discussing traditional discourses that assign value to women in accordance with their perceived sexual virtue, women judged themselves according to the degree to which their behaviour reflected sexual agency. Women perceived to be sexually agentic were, for the most part, lauded, while those perceived to lack sexual agency were either denigrated (in the case of high sexual activity) or seen as deficient (in the case of low sexual activity). The inability to be penetrated without pain significantly limited women's sexual repertoires. Contrasting their sexual agency with that of other women and of their past selves, women expressed feelings of disempowerment. Conceptualising agency as a spectrum rather than something that one has or lacks, as well as actively cultivating the potentialities of sexual 'transgression', may allow young women to resist heteronormative sexual hierarchies - including those rooted in a a postfeminist ethos.

Resilience in the midst of chaos: Socioecological model applied to women with depressive symptoms and socioeconomic disadvantage.

Socioeconomic disadvantage is extremely common among women with depressive symptoms presenting for women's health care. While social stressors related to socioeconomic disadvantage can contribute to depression, health care tends to focus on patients' symptoms in isolation of context. Health care providers may be more effective by addressing issues related to socioeconomic disadvantage. It is imperative to identify common challenges related to socioeconomic disadvantage, as well as sources of resilience. In this qualitative study, we interviewed 20 women's health patients experiencing depressive symptoms and socioeconomic disadvantage about their views of their mental health, the impact of social stressors, and their resources and skills. A Consensual Qualitative Research approach was used to identify domains consisting of challenges and resiliencies. We applied the socioecological model when coding the data and identified cross-cutting themes of chaos and distress, as well as resilience. These findings suggest the importance of incorporating context in the health care of women with depression and socioeconomic disadvantage.

Material Hardship and Mental Health Symptoms Among a Predominantly Low Income Sample of Pregnant Women Seeking Prenatal Care.

Introduction Although poverty is an established correlate of poorer mental health for pregnant women, limited research has examined the mental health effects of material hardship (i.e., difficulties meeting basic needs such as for food, transportation, or stable housing) during pregnancy. Methods The current research examined rates of material hardship among pregnant women seeking prenatal care and the relationships of both income and material hardship with depression and anxiety during pregnancy. Pregnant women (N = 892) responded to self-report measures of mental health symptoms, annual household income, and current material hardship in the waiting areas of community-based obstetrics/gynecology practices serving primarily financially disadvantaged patients. Results About 56% of the sample reported some form of material hardship. About 19% of the sample reported elevated depression, and 17% reported elevated anxiety. Both depression and anxiety were uniquely associated with lower income and greater material hardship, even after controlling for age, race/ethnicity, relationship status, and number of children in the home. Furthermore, material hardship partially mediated the effect of income on mental health symptoms. Discussion The physical, emotional, and social effects of deprivation of basic daily needs may contribute to pregnant women's experiences of mental health symptoms. These results converge with the broader literature focused on the social determinants of physical and mental health. When symptoms of depression and anxiety reflect distress related to material hardship, addressing unmet social needs may be more effective than mental health treatment.

White Female Bystanders' Responses to a Black Woman at Risk for Sexual Assault: Positive Effects of Intergroup Contact.

Although much research suggests that intergroup contact reduces prejudice, less research has examined the effects of contact on prosocial intergroup bystander behaviors. The current study examined mediators between White undergraduate women's (N = 139) contact with racial/ethnic minority group members and their intent to help a Black woman at risk for sexual assault. As expected, White women who had more frequent and higher quality contact reported greater intent to intervene. Results showed that the effect of quality intergroup contact was mediated by diversity beliefs, or the attitude that cultural heterogeneity leads to favorable outcomes. These results suggest that promoting high-quality opportunities for intergroup contact and education regarding cultural diversity could promote the safety of racially and ethnically diverse students on predominantly White campuses.

Effects of group status and victim sex on female bystanders' responses to a potential party rape.

This research examined bystander responses to 1 of 4 potential party rape scenarios. Undergraduate women (N = 249) imagined attending a party either alone or with three friends where a sober man led an intoxicated potential victim (either male or female) into a bedroom. After random assignment to conditions, participants reported on intent to help and barriers to helping the potential victim. In contrast to the classic bystander effect, bystanders in groups intended to offer more help than lone bystanders. Bystanders also intended to offer more help to potential female than male victims and experienced more barriers to helping male victims. Two of these barriers (lack of personal responsibility to help and identifying risk) explained the lower intentions to help potential male victims. Potential male victims were more likely than female victims to be perceived as gay, and bystanders reported the least intentions to help presumably gay men at risk.

Casual hook up sex during the first year of college: Prospective associations with attitudes about sex and love relationships.

This study examined bidirectional relationships among emerging adults' involvement in casual hook up sex and attitudes about sex and love relationships. At the start and end of their first year in college, undergraduates (N = 163) responded to measures of sexual behavior, sexual attitudes, and attitudes about love relationships. In cross-sectional analyses, attitudes about sex and love both were associated with involvement in casual hook up sex. In prospective analyses, initial attitudes about sexual instrumentality uniquely predicted involvement in later hook up sex, even after controlling for past hook up sex. Furthermore, involvement in hook up sex during the first year of college predicted greater sexual permissiveness and comfort with casual genital contact, even after controlling for initial sexual attitudes and hook up behaviors. None of the associations between attitudes and behavior were qualified by gender. Experiences of causal hook up sex appear to have implications primarily for emerging adults' attitudes about sexual interactions rather than their attitudes about love relationships.

Bystander education training for campus sexual assault prevention: an initial meta-analysis.

The present meta-analysis evaluated the effectiveness of bystander education programs for preventing sexual assault in college communities. Undergraduates trained in bystander education for sexual assault were expected to report more favorable attitudes, behavioral proclivities, and actual behaviors relative to untrained controls. Data from 12 studies of college students (N = 2,926) were used to calculate 32 effect sizes. Results suggested moderate effects of bystander education on both bystander efficacy and intentions to help others at risk. Smaller but significant effects were observed regarding self-reported bystander helping behaviors, (lower) rape-supportive attitudes, and (lower) rape proclivity, but not perpetration. These results provide initial support for the effectiveness of in-person bystander education training. Nonetheless, future longitudinal research evaluating behavioral outcomes and sexual assault incidence is needed.

The role of psychosocial factors in the decision to enroll in physical education courses at the state college level.

OBJECTIVE: Physical education (PE) courses may provide young adults with opportunities to become active, however, enrollment in college PE courses remains low. PARTICIPANTS: This study examined psychosocial factors related to PE enrollment in a sample of 177 college students (29.4% completed a PE course). METHODS: Participants completed an online survey that inquired about demographic information, college PE enrollment, exercise self-efficacy, and several open-ended questions regarding their enrollment decisions. RESULTS: There were no differences in self-efficacy scores between PE completers and non-completers. PE completers had more positive previous experiences with PE (43.7% vs 19.3%, p < .01) while non-completers had more negative PE experiences (33% vs 12.5%, p = .03). PE completers felt that self-improvement (51.5% vs 21.3%, p < .01) was most important regarding decisions to enroll in a PE course, while non-completers were concerned with PE courses counting toward their degree (29.2% vs 9.1%, p = .02). CONCLUSIONS: These findings can help inform those involved in teaching and administration of PE courses at the state college level. Future research should further investigate how past PE experiences shape students' feelings toward PE.

Case presentation and panel discussion: Micronutrient therapy in critical illness.

Over the past decade, the use of supraphysiologic doses of micronutrients (also called metabolic resuscitation) in critically ill patients has gained significant attention. Building upon preclinical and observational human data, numerous randomized controlled trials have tested the impact of multiple micronutrients on various outcomes in critically ill patients. At the 2022 American Society for Parenteral and Enteral Nutrition Preconference Course, three world-renowned speakers delivered talks on the (1) overall role of micronutrients and, specifically, (2) selenium and vitamin C and (3) vitamin D and zinc in critically ill patients. Here, the case presentation and discussion from the postsession question and answer period are presented. The moderator for this session was Jose Pimiento, MD, and the speakers and panelists were Christian Stoppe, MD, Todd Rice, MD, and Daren Heyland, MD.

Nutrition for the high-risk surgical patient, when they need it most: Question and answer session.

Patients requiring complex or extensive surgery are often at high risk for perioperative and postoperative nutrition risk. Despite published guidelines, providing adequate nutrition to these patients continues to remain a clinical challenge. Using the case of a patient with preoperative nutrition risk who will need to undergo timely cancer resectional surgery, speakers presenting at the American Society for Parenteral and Enteral Nutrition 2022 Preconference discussed novel strategies to assess for nutrition risk, enhanced recovery after surgery, and preoperative and postoperative nutrition management in these often complex surgical patients.

Case presentation and panel discussion: Transitions in care.

There is evidence that significant quality problems arise as patients transitions in care from one setting to another. Attention to nutrition during transitions of care is important to avoid complication. During the American Society for Parenteral and Enteral Nutrition 2022 preconference course, nutrition during transition of care from pediatric to adult care, from the intensive care unit to the hospital floors and from the hospital to home was addressed.

Breaking up is hard to do: psychological entrapment and women's commitment to violent dating relationships.

Psychological entrapment occurs when people continue investing in unfavorable situations after already devoting too much to lose. We predicted that women who already invested more time and resources into their relationships would exert effort to improve their relationships following partner violence. In turn, these efforts were expected to increase women's subjective investment in, and thus, commitment to violent relationships. Undergraduate women (N = 98) in heterosexual relationships reported on partner violence and relationship duration at Time 1 and relationship sacrifices, subjective investment, and commitment at Times 1 and 2. As expected, women with violent partners who were in longer term relationships sacrificed more 6 weeks later. Unexpectedly, in multivariate analyses, Time 2 sacrifices were not significantly associated with Time 2 subjective investment, although subjective investment was positively associated with concurrent commitment. These results provide preliminary evidence for women's entrapment in violent relationships.

Effects of Humor and Bystander Gender on Responses to Antigay Harassment.

Individuals perceived to be LGBTQ+ are at risk for harassment. Although bystanders who confront harassers and support targets of harassment may promote inclusivity, the use of humor to express antigay harassment may inhibit prosocial bystander intervention. Non-LGBTQ+ undergraduates (N = 326) were randomly assigned to respond to a scenario in which a male peer disparaged another peer with antigay comments involving either the presence or absence of humor. Results showed that bystanders reported less intent to intervene in the presence of humor than in its absence. Bystander gender moderated perceptions of humorous harassing speech but not intent to intervene. In the presence of humor, men but not women perceived antigay harassment as more amusing; they also perceived the harassing peer more favorably. To promote ally behavior, bystander education may explicitly address critical thinking about the functions and effects of disparaging humor.

Sexual and reproductive health and access: Results of a rapid epidemiological assessment among migrant peoples in transit through Darién, Panamá.

Background: The foot transit of migrant peoples originating from the Caribbean, South America, Asia, and Sub-Saharan Africa through the Darién Forest (DF) in Eastern Panamá towards North America has increased in recent years from approximately 30,000 people/year to >133,000 in 2021. In the DF, there is no food/housing provision nor healthcare access. Very little is known of sexual and reproductive health (SRH) among this population. This study used rapid epidemiological methods to describe the SRH situation among migrant peoples in transit through the DF. Methods: This cross-sectional study randomly selected migrant people in transit (men and women) at a Migrant Reception Station in Darién, Panamá, between January 4-11, 2022. Data collection included a self-applied questionnaire (≥18 years); clinical screening (≥12 years); and HCG, treponemal antibodies, and HIV(I/II) lateral-flow tests with blood samples (≥12 years). Descriptive analyses were used to report findings. Results: In all, 69 men and 55 women participated in the self-applied questionnaire, 70 men and 51 women in clinical screening; 78 men and 63 women in HCG, treponemal antibody and HIV testing. Overall, 26.1% (18/69) men and 36.4% (20/55) women reported sexual intercourse within the past month. The last sex partner was casual among 43.0% (21/49) of men and 27.8% (10/36) of women; of those, 42.9% (9/21) of men and 80.0% (8/10) of women reported this sex was condomless. Among women, 20.0% (11/55) tested positive for pregnancy; 5 of these pregnancies were planned. Of those screened, a reproductive tract infection symptom was reported by 5.7% (4/70) of men and 58.8% (30/51) of women. A total of 32.7% (18/55) of men and 18.2% (8/44) of women reported no prior HIV testing. Of 78 men, HIV and treponemal antibodies were found among 1.3% (n = 1) and 2.6% (n = 2), and among 63 women, 3.2% (n = 2) and 3.2% (n = 2), respectively. Conclusions: This rapid epidemiological assessment found high recent sexual activity, low condom use with casual partners, and a need for increased HIV and syphilis testing and treatment. There is a need for increased testing, condom provision, and SRH healthcare access at migrant reception stations that receive migrant peoples in transit through Panamá.

Optimizing the nutrition support care model: Analysis of survey data.

BACKGROUND: Malnutrition is underrecognized and underdiagnosed, despite high prevalence rates and associated poor clinical outcomes. The involvement of clinical nutrition experts, especially physicians, in the care of high-risk patients with malnutrition remains low despite evidence demonstrating lower complication rates with nutrition support team (NST) management. To facilitate solutions, a survey was designed to elucidate the nature of NSTs and physician involvement and identify needs for novel nutrition support care models. METHODS: This survey assessed demographics of NSTs, factors contributing to the success of NSTs, elements of nutrition education, and other barriers to professional growth. RESULTS: Of 255 respondents, 235 complete surveys were analyzed. The geographic distribution of respondents correlated with population concentrations of the United States (r = 90.8%, p < .0001). Most responding physicians (46/57; 80.7%) reported being a member of NSTs, compared with 56.5% (88/156) of dietitians. Of those not practicing in NSTs (N = 81/235, 34.4%), 12.3% (10/81) reported an NST was previously present at their institution but had been disbanded. Regarding NSTs, financial concerns were common (115/235; 48.9%), followed by leadership (72/235; 30.6%), and healthcare professional (HCP) interest (55/235; 23.4%). A majority (173/235; 73.6%) of all respondents wanted additional training in nutrition but reported insufficient protected time, ability to travel, or support from administrators or other HCPs. CONCLUSION: Core actions resulting from this survey focused on formalizing physician roles, increasing interdisciplinary nutrition support expertise, utilizing cost-effective screening for malnutrition, and implementing intervention protocols. Additional actions included increasing funding for clinical practice, education, and research, all within an expanded portfolio of pragmatic nutrition support care models.

U.S. bound journey of migrant peoples InTransit across Dante's Inferno and Purgatory in the Americas.

Rapid rise of population migration is a defining feature of the 21st century due to the impact of climate change, political instability, and socioeconomic downturn. Over the last decade, an increasing number of migrant peoples travel across the Americas to reach the United States seeking asylum or cross the border undocumented in search of economic opportunities. In this journey, migrant people experience violations of their human rights, hunger, illness, violence and have limited access to medical care. In the 'Divine Comedy', the Italian poet Dante Alighieri depicts his allegorical pilgrimage across Hell and Purgatory to reach Paradise. More than 700 years after its publication, Dante's poem speaks to the present time and the perilious journey of migrant peoples to reach safehavens. By exploring the depths and heights of the human condition, Dante's struggles resonate with the multiple barriers and the unfathomable experiences faced by migrant peoples in transit across South, Central, and North America to reach the United States. Ensuring the safety of migrant peoples across the Americas and elsewhere, and attending to their health needs during their migratory paths represent modern priorities to reduce social injustices and achieving health equity.

Bystander Responses to Intimate Partner Misconduct: Barriers to Responding to Physical and Sexual Violations.

All forms of unchecked acts of violence against women may harm individual women while also normalizing the ways in which women are routinely violated. Violence against women manifests across a continuum of linked behaviors, yet few studies have investigated bystander responses to less extreme forms of intimate partner violence. We examined bystander responses to different forms of misconduct: physical (grabbing and imminent slapping) or sexual (groping and unwanted kissing). Undergraduates (N = 402) read and responded to dating conflict scenarios in which they witnessed a young man verbally insult a young woman while perpetrating either sexual or physical misconduct. Across conditions, 42% of participants described misconduct as abusive, although this was significantly more common among those assigned to the physical (52%) than sexual (32%) conditions. Compared with those in the sexual misconduct condition, participants in the physical misconduct condition reported greater intent to directly intervene. Furthermore, participants in the physical misconduct condition also reported more barriers to intervention, including less awareness/attention to misconduct, less perceived danger to the victim, and less personal responsibility to intervene. In multivariate analyses, less awareness/attention to misconduct and less personal responsibility uniquely predicted lower intent to intervene; these same barriers also explained the tendency for bystanders to report lower intent to intervene in response to sexual than physical misconduct. These results suggest the need for education to promote awareness of the continuum of violence against women. Education also is needed to increase feelings of personal responsibility to challenge the normalization of less extreme violent acts.

A review of procedural skills performed by advanced practice providers in emergency department and critical care settings.

Advanced practice providers (physician assistants and nurse practitioners) are part of the interdisciplinary teams integral to successful care and improved outcomes for acutely ill patients in intensive care units and emergency departments. Between physician shortage and increased complexity of patients with often rapidly deteriorating conditions, the addition of advanced practice providers and expansion of acute care provider roles result in positive outcomes including decreased hospital length of stay, improved continuity of care, decreased hospital costs and increase inpatient, physician and staff nurses job satisfaction. This article attempts to examine the role that advanced practice providers (APPs) play in performing diagnostic and therapeutic procedures in acute care settings, education provided in physician assistant (PA) and nurse practitioner (NP) programs, and post-graduate training required to achieve competency and comfort in performing procedures. PA and NP training and credentialing often vary at the state level and by practice site. This article aims to collect information on how these roles compare as well as which procedures are actually being performed by advanced practice providers in the emergency department and critical care settings. Considering the healthcare system move towards team-based care, procedures performed by APPs align with the needs of the patient population served and correspond to the procedures done within the teams by physician providers. Independently billing under national provider identifier is cost effective but can be influenced by the current physician reimbursement system or lack of understanding of APP billing process by health care systems. Though there is limited research in this area, this article serves as a starting point to examining the current utilization and utility of APPs performing procedures in the emergency department and critical care settings.

Individual and Institutional Predictors of IPV/SV Screening in College Health Centers.

Intimate partner violence (IPV) and sexual violence (SV) are significant public health issues for women, particularly for college women. IPV and SV have been associated with numerous adverse health consequences and involvement in unhealthy behaviors. Given the health risks and high rates of IPV/SV among college women, it is important to understand and promote screening in this population. The purpose of this study was to examine college women's experiences with IPV/SV screening at college health centers and identify individual and institutional characteristics associated with screening. Random samples of female undergraduate college students from five colleges in the northeast United States were recruited to participate in an anonymous online survey in January 2015. Inclusion criteria included at least one visit to the college health center during the preceding fall semester. Participants were questioned regarding demographics and whether they were screened or asked about IPV/SV at the college health center. A total of 873 women met the inclusion criteria and completed surveys. Only 10.2% of the college women in the study reported that they were screened for IPV/SV at their most recent visit to the college health center. Participants from public colleges/universities were 3 times more likely than others to report screening, whereas participants from urban college/university campuses were more than twice as likely as others to report screening. College women who went to the college health center for a gynecological or sexual health reason were nearly 4 times as likely as other women to report being screened for IPV/SV. Low rates of IPV/SV screening at college health centers represent missed opportunities. Further research across more numerous and diverse college sites is needed to understand the factors that promote or inhibit IPV/SV screening in college health centers to develop interventions to facilitate routine screening practices.