Between the Facts and a Hard Place: Trust Judgments and Affective Responses in Information-Seeking Processes During Early COVID-19.

This study examined the formation of trust judgments of information sources about COVID-19 and the role played by emotions in this information seeking process. Twenty-seven in-depth interviews with Americans revealed that both trust and affective responses were present in information seeking of health messages, thus discovering the applicability of Risk Information Seeking and Processing (RISP) model's propositions during pandemics. Using qualitative methods to assess RISP variables in a new context (COVID-19), the study proposes modifications to the existing model. It also extends the socio-psychological traditions on which the RISP model was based, by finding that when evaluating information sources during pandemics, under conditions of high issue relevance, individuals' peripheral evaluation of messages might precede systematic evaluation and might be used as a selection criteria for further elaboration. Finally, the assessments of source credibility as a peripheral cue in this study expand current theoretical understandings by including compassion as a possible new dimension.

The Mutual Influence of the World Health Organization (WHO) and Twitter Users During COVID-19: Network Agenda-Setting Analysis.

BACKGROUND: Little is known about the role of the World Health Organization (WHO) in communicating with the public on social media during a global health emergency. More specifically, there is no study about the relationship between the agendas of the WHO and Twitter users during the COVID-19 pandemic. OBJECTIVE: This study utilizes the network agenda-setting model to investigate the mutual relationship between the agenda of the WHO's official Twitter account and the agenda of 7.5 million of its Twitter followers regarding COVID-19. METHODS: Content analysis was applied to 7090 tweets posted by the WHO on Twitter from January 1, 2020, to July 31, 2020, to identify the topics of tweets. The quadratic assignment procedure (QAP) was used to investigate the relationship between the WHO agenda network and the agenda network of the 6 Twitter user categories, including "health care professionals," "academics," "politicians," "print and electronic media," "legal professionals," and the "private sector." Additionally, 98 Granger causality statistical tests were performed to determine which topic in the WHO agenda had an effect on the corresponding topic in each Twitter user category and vice versa. RESULTS: Content analysis revealed 7 topics that reflect the WHO agenda related to the COVID-19 pandemic, including "prevention," "solidarity," "charity," "teamwork," "ill-effect," "surveillance," and "credibility." Results of the QAP showed significant and strong correlations between the WHO agenda network and the agenda network of each Twitter user category. These results provide evidence that WHO had an overall effect on different types of Twitter users on the identified topics. For instance, the Granger causality tests indicated that the WHO tweets influenced politicians and print and electronic media about "surveillance." The WHO tweets also influenced academics and the private sector about "credibility" and print and electronic media about "ill-effect." Additionally, Twitter users affected some topics in the WHO. For instance, WHO followers affected "charity" and "prevention" in the WHO. CONCLUSIONS: This paper extends theorizing on agenda setting by providing empirical evidence that agenda-setting effects vary by topic and types of Twitter users. Although prior studies showed that network agenda setting is a "one-way" model, the novel findings of this research confirm a "2-way" or "multiway" effect of agenda setting on social media due to the interactions between the content creators and audiences. The WHO can determine which topics should be promoted on social media during different phases of a pandemic and collaborate with other public health gatekeepers to collectively make them salient in the public.

"We Aren't Here to Win; We are Here Not to Lose": Emergency Physicians' Communicative Management of Uncertainty.

Healthcare providers in hospital emergency departments (EDs) work under high uncertainty and pressure to manage a variety of patients efficiently. Whereas much existing research has examined communicative implications of uncertainty from patients' perspectives, we explored ED physicians' experiences of uncertainty in their everyday work environment. Through an ethnographic fieldwork in an ED, we identified three main sources of uncertainty routinely faced by physicians: (a) patients' incorrect expectation about the role of ED; (b); patient variability and ED physicians' breadth of expertise; and (c) emerging and unexpected changes in patient cases after handoffs. We also found how ED physicians managed these uncertainties, including: (1) direct admission of scientific uncertainty to patients; (2) lowering epistemic uncertainty through swift Internet searches; and (3) maintenance of situational uncertainty. We discuss implications of these findings for researchers, providers, and hospital organizations.

Framing of and Attention to COVID-19 on Twitter: Thematic Analysis of Hashtags.

BACKGROUND: Although past research has focused on COVID-19-related frames in the news media, such research may not accurately capture and represent the perspectives of people from diverse backgrounds. Additionally, research on the public attention to COVID-19 as reflected through frames on social media is scarce. OBJECTIVE: This study identified the frames about the COVID-19 pandemic in the public discourse on Twitter, which voices diverse opinions. This study also investigated the amount of public attention to those frames on Twitter. METHODS: We collected 22 trending hashtags related to COVID-19 in the United States and 694,582 tweets written in English containing these hashtags in March 2020 and analyzed them via thematic analysis. Public attention to these frames was measured by evaluating the amount of public engagement with frames and public adoption of those frames. RESULTS: We identified 9 frames including "public health guidelines," "quarantine life," "solidarity," "evidence and facts," "call for action," "politics," "post-pandemic life," "shortage panic," and "conflict." Results showed that some frames such as "call for action" are more appealing than others during a global pandemic, receiving greater public adoption and engagement. The "call for action" frame had the highest engagement score, followed by "conflict" and "evidence and facts." Additionally, "post-pandemic life" had the highest adoption score, followed by "call for action" and "shortage panic." The findings indicated that the frequency of a frame on social media does not necessarily mean greater public adoption of or engagement with the frame. CONCLUSIONS: This study contributes to framing theory and research by demonstrating how trending hashtags can be used as new user-generated data to identify frames on social media. This study concludes that the identified frames such as "quarantine life" and "conflict" and themes such as "isolation" and "toilet paper panic" represent the consequences of the COVID-19 pandemic. The consequences could be (1) exclusively related to COVID-19, such as hand hygiene or isolation; (2) related to any health crisis such as social support of vulnerable groups; and (3) generic that are irrespective of COVID-19, such as homeschooling or remote working.

Vasoactive medications in extremely low gestational age neonates during the first postnatal week.

OBJECTIVE: The management of early hypotension in extremely low gestational age neonates (ELGANs) varies greatly between centers. The objective of this study was to provide updated data on the use of vasoactive medications in ELGANs during the first postnatal week. STUDY DESIGN: We identified ELGANs (22-27 weeks gestational age) cared for at Pediatrix neonatal intensive care units from 2009 to 2018. We evaluated the frequency of exposure to vasoactive medications by gestational age, and compared use of vasoactive medications between two epochs (2009-2013 and 2014-2018). RESULTS: A total of 10,070/34,234 (29%) ELGANs received ≥1 vasoactive medication. Dopamine was the most frequently used vasoactive medication. The majority (83%) of treated ELGANs initiated therapy on postnatal days 0-1. Overall use of vasoactive medications was slightly lower in 2014-2018 than 2009-2013 (28 vs 31%, p < 0.001). CONCLUSION: A substantial proportion of ELGANs were exposed to vasoactive medications during the first postnatal week.

Association between neonatal intensive care unit medication safety practices, adverse events, and death.

OBJECTIVE: Determine the associations between neonatal intensive care unit (NICU) medication safety practices, laboratory-based adverse events (lab-AEs), and death. STUDY DESIGN: We combined data from a 2016 survey of Pediatrix NICUs on use of medication safety practices with 2014-2016 infant data. We grouped NICUs based on the number of safety practices used (≤5, 6-7, and 8-10) and evaluated the association between the number of safety practices used and lab-AEs and deaths using logistic regressions. RESULTS: Of the 94 NICUs included, 17% used ≤5 medication safety practices, 51% used 6-7, and 32% used 8-10. NICUs with more safety practices did not have a difference in lab-AEs or death. CONCLUSION: In this cohort, the use of more medication safety practices was not associated with fewer lab-AEs or decreased death.

Point-of-care ultrasound in the neonatal ICU.

PURPOSE OF REVIEW: Point-of-care ultrasound (POCUS) is an emerging clinical tool in the neonatal intensive care unit (NICU). Recent literature describing the use of POCUS for various applications in the NICU has garnered increased interest among neonatologists. RECENT FINDINGS: Diagnostic applications for POCUS in the NICU include the evaluation and serial monitoring of common pulmonary diseases, hemodynamic instability, patent ductus arteriosus (PDA), persistent pulmonary hypertension of the newborn (PPHN), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH), among others. Procedural applications include vascular access, endotracheal intubation, lumbar puncture, and fluid drainage. SUMMARY: Experience with POCUS in the NICU is growing. Current evidence supports the use of POCUS for a number of diagnostic and procedural applications. As use of this tool increases, there is an urgent need to develop formal training requirements specific to neonatology, as well as evidence-based guidelines to standardize use across centers.

"Pain Is What the Patient Says It Is": Nurse-Patient Communication, Information Seeking, and Pain Management.

Nurse-patient conversations about pain management are complex. Given recent increases in prescription pain pill abuse, such interactions merit scholarly attention. In-depth interviews with 21 nurses were conducted to explicitly explore nurses' information seeking about pain. The participants in this study gathered pain information from patients through a variety of means and reported facing challenges and dilemmas when communicating with patients about pain management and medicinal preferences. These results have important implications for nurses, patient outcomes, and the broader health-care system and imply that continued educational and intervention efforts are essential in this complicated communicative context.

Developmental variations in the impact of intimate partner violence exposure during childhood.

BACKGROUND: Intimate partner violence (IPV) is a pervasive problem impacting individuals around the globe. The consequences of IPV extend beyond the adults in the relationship, as children witness a significant proportion of such violence. Exposure to IPV during childhood has devastating effects across multiple domains of functioning. METHODS: This article reviews empirical studies of the effects of exposure to IPV by developmental stage. RESULTS: The psychological, social, physical, and cognitive consequences of witnessing IPV are examined across development; from the impact of prenatal exposure to effects in infancy and toddlerhood, the preschool years, school-aged children, and adolescence. CONCLUSIONS: The review concludes by providing suggestions for future research based on the identified developmental variations, recommendations for developmentally-sensitive interventions for children who have witnessed IPV, and directions for policy to address the issue of violence exposure early in the lives of children.

Strengthening positive parenting through intervention: evaluating the Moms' Empowerment Program for women experiencing intimate partner violence.

This study examined the effectiveness of an evidence-based intervention in changing the positive and negative parenting practices of 120 mothers who experienced intimate partner violence (IPV) in the last 2 years. Mothers assigned to the treatment group participated in a 10-session evidence-based intervention, known as the Moms' Empowerment Program, which targets the mental health problems of women and works to increase access to resources and improve parenting abilities of women exposed to IPV. Participants were interviewed at baseline and immediately following the intervention or waitlist period, representing an elapsed time of approximately 5 weeks. After controlling for relevant demographic variables, violence severity, and mental health, women showed significantly more change in their positive parenting scores if they were in the treatment condition. No significant differences were found between the treatment and comparison groups in their negative parenting practices change scores. These findings suggest that even short-term intervention can improve positive parenting skills and parenting knowledge for women who have experienced partner abuse.

Perceived threat in childhood: a review of research and implications for children living in violent households.

The current study is a review of existing literature on perceived threat across childhood (0-19 years). There is strong evidence from this body of research that threat detection emerges in infancy and is present throughout childhood, with meaningful links to child adjustment. The wide range of methodologies employed to assess threat include biological measures (event-related potential and functional magnetic resonance imaging), observational data (gaze duration and response time), and a range of ways of gathering cognitive data (threat appraisal). Across methodologies, a uniform finding is that children who have higher threat attenuation are at increased risk for the development of anxiety disorders. It also seems that children's attention to threatening stimuli may vary across development, with heightened attention in infancy and early childhood. These findings have meaningful extensions for children who are living in violent families. Since many children living in violent homes are exposed to the threat of violence beginning in infancy, these children may be at heightened risk as compared to their nonexposed peers for the development of maladaptive patterns of threat detection and response. There is some evidence that this long-standing pattern of vigilance toward threat in key developmental periods may in part explain the increased risk of the development of anxiety disorders and posttraumatic stress disorder following exposure to violence.

Communication dilemmas in the context of cancer: survivors' and partners' strategies for communicating throughout survivorship.

More people are now living longer beyond cancer treatment and are facing the complexities associated with survivorship. Communicating amid a cancer experience, for example, can be difficult for couples, and survivors must face these challenges for extended periods of time. The current study employed a communication perspective to explore couples' conversations throughout cancer survivorship. In-depth interviews with 35 cancer survivors and 25 partners yielded insight into the specific communicative challenges couples face after completing cancer treatment. The data highlight cancer's lingering uncertainties and are discussed in terms of the dyadic challenges inherent in couples' communicative efforts.

Potentially traumatic events and serious life stressors are prospectively associated with frequency of doctor visits and overnight hospital visits.

OBJECTIVE: Cumulative lifetime exposure to potentially traumatic events and serious life stressors has been linked with both mental and physical health problems; however, less is known about the association between exposure to potentially traumatic events and serious life stressors with health care use. We investigated whether a higher number of potentially traumatic events and serious life stressors were prospectively associated with an increased number of doctor visits and nights spent in the hospital. METHODS: Participants were drawn from the Health and Retirement Study, a prospective and nationally representative study of adults aged 50+ in the United States (n=7168). We analyzed the data using a generalized linear model with a gamma distribution and log link. RESULTS: A higher number of potentially traumatic events and serious life stressors were associated with an increased number of doctor visits and nights spent in the hospital. On a 10-point scale, each additional potentially traumatic event or serious life stressor was associated with an 8% increase in doctor visits after controlling for sociodemographic factors (RR=1.08, 95% CI=1.06-1.11; p<.001). Each additional potentially traumatic event or serious life stressor was also associated with an 18% increase in the number of nights spent in the hospital after controlling for sociodemographic factors (RR=1.18, 95% CI=1.10-1.27; p<.001). CONCLUSION: Exposure to potentially traumatic events and serious life stressors is associated with increased doctor visits and nights spent in the hospital, which may have important implications for the current standard of care.

The effect of an evidence-based intervention on women's exposure to intimate partner violence.

This study tested the effectiveness of an evidence-based intervention for reducing women's exposure to intimate partner violence (IPV). One-hundred and twenty women who had experienced IPV in the last 2 years were assigned to a treatment or comparison group condition using a sequential assignment paradigm. Treatment group participants completed a 10-session evidence-based intervention, the Mom's Empowerment Program, designed to treat common mental health issues after exposure to IPV and assist women with access to resources. Women were interviewed at baseline and at 6- to 8-month follow-up regarding the level of IPV they had experienced. Violence victimization significantly decreased for women in both conditions between the baseline interview and the 6- to 8-month follow-up. Participation in treatment was related to an augmented effect of violence reduction such that women participating in the intervention experienced greater declines in violence than those who did not participate in the treatment program. These findings support the hypothesis that this treatment model, which combines mental health and advocacy services, is effective in reducing violence revictimization risk for women exposed to IPV.

Perceptions and Portrayals of Skin Cancer among Cultural Subgroups.

Health communication scholars have a responsibility to be certain that both healthcare practitioners and government agencies accurately communicate health information to the public. In order to carry out this duty, health communication scholars must assess how messages are being received and if they are being received at all by the public. This paper details a two part study which assesses this phenomenon within the context of skin cancer. Study 1 utilized 29 in depth qualitative interviews to identify subcultures among college students whose communication puts them at risk for skin cancer by encouraging poor sun exposure behaviors. The results indicate that farmers, African Americans, and individuals who regularly participate in outdoor athletics are at risk groups. Study 2 reports a content analysis of the known population of skin cancer Public Service Announcements (PSAs) available via the internet in 2013. The aforementioned groups were not present in any of the PSAs. Detailed results and implications are discussed.

Size and histologic characteristics of lymph node material retrieved from tissue discarded after routine pathologic examination of lung cancer resection specimens.

Redissection of discarded lung resection specimens after routine pathology examination reveals missed lymph node metastasis. We sought to determine if size can be used to grossly select lymph nodes for microscopic examination. This is a prospective cohort study of lymph nodes retrieved from discarded lung resection specimens. The association between size and histologic characteristics of retrieved material was compared by the Wilcoxon-Mann-Whitney test. We retrieved 1094 grossly 'lymph node-like" tissue from 112 remnant lung resection specimens, of which 345 (32%) proved not to be lymph nodes and 71 (9%) of 749 lymph nodes had metastasis. Metastasis was present in discarded nodes in 26 (23%) of 112 patients. The non-lymph node tissue was significantly smaller than lymph nodes (P < .0001); lymph nodes with metastases were significantly larger than those without metastases (P < .0001). However, there was significant size overlap between the 3 types of grossly lymph node-like tissue. Thirty-two percent of nodes with metastasis were less than 1 cm; 15% of patients had at least 1 lymph node less than 1 cm with metastasis. The size difference between lymph nodes with and without metastasis is clinically unhelpful because of broad overlap. Size is insufficiently discriminatory and cannot be relied on to select materials for histologic examination. A third of grossly retrieved material was non-lymph node tissue. This probably occurs during routine pathologic examination and likely contributes to the low N1 lymph node count.

Developmental changes in threat and self-blame for preschoolers exposed to intimate partner violence (IPV).

The presence of threat and self-blame in children exposed to violence in the home has been linked to a number of negative behavioral and emotional consequences across developmental periods. Little research, however, has examined self-reported attributions of threat and self-blame in children under the age of 6. The current study evaluated the developmental trajectories of appraisals of threat and self-blame in preschool-aged children recently exposed to intimate partner violence. It was hypothesized that (a) children's appraisals of threat and self-blame would naturally decrease over time and (b) there would be a main effect of child sex on appraisals of self-blame but not threat, such that girls would report higher levels of self-blame than boys. Participants included 68 preschool-aged children (ages 4-6) who were interviewed at two time points over the course of 1 year. Multilevel modeling was employed to examine the effects of violence exposure, child age, and child sex over time. Children's attributions of threat were stable over the course of 1 year, but greater child age was related to lower appraisals of threat. Children's appraisals of self-blame increased over time, and there was a trend for girls to report more self-blame than did boys. It appears that without intervention, young children may be at risk of developing relatively stable maladaptive cognitive patterns, thereby heightening their risk of subsequent developmental psychopathology. Furthermore, girls may need additional intervention targeted at addressing attributions of self-blame.

Uncertainty management and information seeking in cancer survivorship.

Uncertainty is a common experience among people coping with chronic illness. For many individuals, managing information is used as a means of coping with illness-related uncertainty. In-depth interviews with 60 cancer survivors and partners were conducted. Many of the participants in this study reported feeling uncertain about the challenges awaiting them in cancer survivorship and reported experiencing various information behaviors and challenges relating to their uncertainty management. These results have important implications for health care providers and imply that continued care and information provision, after cancer treatment is complete, would facilitate adaptive survivorship.

Perpetration patterns and environmental contexts of IPV in Sweden: relationships with adult mental health.

Although excellent data exist on the overall prevalence of childhood exposure to intimate partner violence (IPV), there is less information available on the specific patterns of IPV exposure in childhood and how they influence adult mental health. The current study examines 703 Swedish adults who reported exposure to IPV in childhood. Participants were part of a large national study on violence exposure. They provided an extensive history of their exposure to IPV and maltreatment experiences during childhood via electronically administered questionnaires. Mean comparison and multivariate regression methods were employed to assess differences in violence severity by reported perpetration pattern (mother-only, father-only, bidirectional or other), the association between violence severity and environmental context, and the contribution of these characteristics to adult mental health outcomes. Overall, violence perpetrated in public and by fathers was more severe and was related to poorer mental health outcomes in adulthood for child witnesses. These findings provide important insight into possible clinical "flags" for identifying children at high risk for exposure to IPV and abuse in the home.

Dual intervention to improve pathologic staging of resectable lung cancer.

BACKGROUND: Detection of lymph node metastasis is of immense prognostic value in patients with resectable non-small cell lung cancer (NSCLC), but routine pathologic nodal staging is suboptimal. To determine the impact on the rate of detection of nodal metastasis, we tested dual intervention with a prelabeled lymph node specimen collection kit to improve intraoperative node dissection and a fastidious gross dissection of the lung resection specimen for intrapulmonary lymph nodes. METHODS: We matched dual-intervention cases with controls staged using standard surgical specimen collection and pathologic examination protocols. Controls were hierarchically matched for extent of resection, laterality, surgeon, pathologist, and T stage. All statistical comparisons were made with exact conditional logistic regression, to account for the matched case-control design. RESULTS: One hundred dual-intervention cases were matched with 100 controls. The dual interventions resulted in approximately a 3-fold increase in the number of lymph nodes examined and the number of lymph nodes with metastasis detected; they also increased the proportion of patients with lymph node metastasis from 21% to 35% (p = 0.02). There were strong trends toward higher aggregate stage distribution, and eligibility for postoperative adjuvant chemotherapy in the dual-intervention cases. CONCLUSIONS: The combination of interventions improved the thoroughness and accuracy of pathologic nodal staging. A prospective randomized trial to test the survival impact of the dual interventions is warranted.