Sexual Assault Nurse Examiner/Forensic Nurse Hospital-based Staffing Solution: A Business Plan Development and Evaluation.

Nationally and internationally, providing competent and sustainable sexual assault nurse examiner/forensic nurse coverage has been a shared challenge. This project, "Sexual Assault Nurse Examiner/Forensic Nurse Hospital-based Staffing Solution: A Business Plan Development and Evaluation," provides an example for assessment, construction, implementation, and evaluation of a business plan for a sustainable sexual assault nurse examiner/forensic nurse staffing solution. By using preexisting float pool positions and converting them to sexual assault nurse examiner emergency nurses, coverage for sexual assault nurse examiner examinations in a 16-hospital health system was established, which decreased sexual assault nurse examiner turnover related to burnout while increasing the sustainability of sexual assault nurse examiner nurses who provided quality care to patients who had experienced a sexual assault, domestic or intimate partner violence, elder or child abuse or neglect, assault, strangulation, or human trafficking. Implementation of the business plan resulted in a 179% increase in completed sexual assault nurse examiner examinations and a 242% increase in all types of completed forensic examinations from 2015 to 2019 as 7 new community hospitals were added to the health system. A sum of more than $20 000 allocated for training new sexual assault nurse examiners/forensic nurses was saved per year by using a sexual assault nurse examiner emergency nurse. By creating a supportive structure that fosters and sustains sexual assault nurse examiners/forensic nurses, both medical and mental health concerns can be addressed through trauma-informed care techniques that will affect lifelong health and healing as well as engagement in the criminal justice process for patients who have experienced sexual assault, abuse, neglect, and violence.

Age does not matter: Memory complaints are related to negative affect throughout adulthood.

OBJECTIVES: Memory complaints are present in adults of all ages but are only weakly related to objective memory deficits, raising the question of what their presence may indicate. In older adults, memory complaints are moderately related to negative affect, but there is little research examining this relationship in young and middle-aged adults. This study examined whether memory complaints and negative affect were similarly related across the adult lifespan and in adults with varying levels of objective memory performance. METHOD: The sample included 3798 healthy adults, aged 18 to 99, and was divided into five groups: young, middle-aged, young-old, old-old, and oldest-old adults. Participants completed questionnaire measures of memory complaints and negative affect (neuroticism and depressive and anxiety symptoms), in addition to lab measures of objective memory. RESULTS: Using structural equation models, we found that the relationship between memory complaints and negative affect was moderate in all the age groups, and there was no evidence for moderation by objective memory. CONCLUSION: For adults of all ages, perceived memory decline may be distressing and/or negative affect may lead to negative self-evaluations of memory.

The General Approach and Management of the Patient Who Discloses a Sexual Assault.

The effects a sexual assault on a survivor can be profound and multifaceted. Some of the aftermath may include bodily and/or anal/genital injury, sexually transmitted infection (STI) or disease (STD), post-traumatic stress disorder (PTSD), depression, suicidal ideation, and pregnancy. There is no typical experience or survivor response. So, if a survivor presents to the Emergency Departments for care, it is imperative for healing that the response is stabilizing, coordinated, and compassionate. Immediate needs of a survivor of sexual assault include: medical and/or psychiatric evaluation and stabilization, activation of community advocacy to the bedside, mandated reporting as directed by state statutes, offering and conducting (if desired by the survivor) the Sexual Assault Forensic Exam (SAFE), collaboration with law enforcement (if desired by the survivor), prophylactic medications for STI and STD, pregnancy risk evaluation and care and safe discharge planning.

Implicit health associations across the adult lifespan.

OBJECTIVE: Explicit reports of one's health self-concept (e.g. rate your overall health) are commonly used in research and clinical practice. These measures predict important health outcomes, but rely on conscious introspection so may not fully capture the different components of the health self-concept (e.g. more automatic components) that relate to actual health. This study examined the health-implicit association test (health-IAT), and how it may add to our prediction of health from self-reports. DESIGN: 1004 participants (ages 18-85) completed this web-based study with the health-IAT (assessing self-healthy implicit associations) and explicit assessments of health. MAIN OUTCOME MEASURES: Self-reported measures of physical functioning. RESULTS: The health-IAT was valid and reliable. Older age was correlated with stronger self-healthy implicit associations. Although the health-IAT did not incrementally predict self-reported markers of physical functioning when only controlling for explicit health self-concept, it was an incremental predictor once age was entered for all four models tested. CONCLUSIONS: The health-IAT appears to be a valid and reliable new measure that assesses implicit self-concept relating to physical health. Results reveal the potential value of assessing implicit health self-concept in both research and practice, especially when taking into account age.

When the "Golden Years" Turn Blue: Using the Healthy Aging Literature to Elucidate Anxious and Depressive Disorders in Older Adulthood.

Current treatments for disorders of emotion, like pathological anxiety, are often less effective in older adults than in younger adults and have poorly understood mechanisms, pointing to the need for psychopathology models that better account for age-related changes in normative emotional functioning and the expression of disordered emotion. This article describes ways in which the healthy aging and emotion literature can enhance understanding and treatment of symptoms of anxiety and depression in later life. We offer recommendations for how to integrate the healthy aging literatures' theories and findings with psychopathology research and clinical practice, and highlight opportunities for future research.

Predictive Validity of Explicit and Implicit Threat Overestimation in Contamination Fear.

We examined the predictive validity of explicit and implicit measures of threat overestimation in relation to contamination-fear outcomes using structural equation modeling. Undergraduate students high in contamination fear (N = 56) completed explicit measures of contamination threat likelihood and severity, as well as looming vulnerability cognitions, in addition to an implicit measure of danger associations with potential contaminants. Participants also completed measures of contamination-fear symptoms, as well as subjective distress and avoidance during a behavioral avoidance task, and state looming vulnerability cognitions during an exposure task. The latent explicit (but not implicit) threat overestimation variable was a significant and unique predictor of contamination fear symptoms and self-reported affective and cognitive facets of contamination fear. On the contrary, the implicit (but not explicit) latent measure predicted behavioral avoidance (at the level of a trend). Results are discussed in terms of differential predictive validity of implicit versus explicit markers of threat processing and multiple fear response systems.

Influence of age, thought content, and anxiety on suppression of intrusive thoughts.

Understanding differences in responses following attempts to suppress versus simply monitor intrusive thoughts is important given the established relationship between intrusive thinking and numerous forms of psychopathology. Moreover, these differences may vary as a function of age. Because of the links between aging and both enhancement in emotion regulation skills and decline in inhibition skills, older and younger adults were expected to differ in their responses (e.g., experience of negative affect and thought recurrence) to attempts at suppressing intrusive thoughts. This study examined whether efforts to suppress thought content that varied in valence and age-relevance differentially affected older (N=40, aged 66-92) and younger (N=42, aged 16-25) adults' ability to inhibit intrusive thought recurrence and their resulting negative affect. Interestingly, older adults experienced less recurrence for most thoughts than younger adults. Also, for several dependent variables (negative affect and perceived difficulty suppressing intrusive thoughts), older adults showed less decline in their magnitude of response across thinking periods (i.e., from suppression to monitoring) than did younger adults. These age effects were not generally moderated by level of trait anxiety, though higher anxiety did predict intrusive thought responding in expected directions, such as greater negative affect. These findings point to independent influences of age and anxiety, and suggest a complex mix of risk and protective factors for older adults' responses to intrusive thoughts.

Is "Cootie" in the Eye of the Beholder? An Experimental Attempt to Modify Implicit Associations Tied to Contamination Fears.

To examine the causal link between implicit associations and fear reduction, a conditioning paradigm was used in an attempt to modify contamination-related implicit associations for individuals high in contamination fear. Individuals (N = 81) were assigned to a Positive, Neutral, or No Training condition. In the Positive training condition, individuals clicked on images of potential contaminants that were followed by images of the individual's smiling face or by an approach-related word. Positive training was hypothesized to result in decreased behavioral avoidance and emotional vulnerability ratings during subsequent behavioral avoidance tasks. In the Neutral training control condition, the images of potential contaminants were followed by an equal mix of the individual's smiling, disgusted, and fearful faces or an avoidance-related word. The No Training condition served as an additional control group. Contrary to expectations, training did not shift implicit associations, nor did it affect avoidance or emotional vulnerability ratings. These results raise questions about the most appropriate form and dosage of training for this population - we conclude with suggestions for researchers to learn from these null findings when developing new training programs.

A cluster of pediatric endemic typhus cases in Orange County, California.

Murine typhus is typically a mild febrile illness caused by Rickettsia typhi, generally confined to Texas and Southern California. Clinicians should consider early treatment with doxycycline when presented with a child having protracted fever, rash, and headache.We present 5 pediatric cases and a literature review highlighting the changing epidemiology and diagnostic difficulty of typhus.