Development and initial validation of a sexual and gender minority competency-based survey for health service professionals.

Sexual and gender minority (SGM) individuals endure a number of health disparities, such as higher rates of violence, mental health conditions, and medical concerns. These disparities are exacerbated by the fact that SGM individuals face stigmatizing health care provider and system-related experiences. The primary purpose of this study was to quantify health service providers' SGM health competency by developing a measure, namely the Health Care Competency Assessment Form-Sexual and Gender Minority Patients (HCAF-SGM). Further, we examined correlates of SGM health competency based on leading theories of prejudice, primarily the dual process model of prejudice and social identity theory. The study comprised two phases: item development and pilot testing, followed by a primary online survey administration with several health care professionals and training organizations (N = 155). Study findings supported a one-factor HCAF-SGM score, suggesting that health care providers view their competency regarding SGM individuals in a holistic manner, without differentiating between knowledge, attitude, and skill. The measure was found to be negatively associated with right-wing authoritarianism and positively correlated with specific social identities most salient to the topic of SGM health (i.e., health care professional and SGM). The HCAF-SGM shows promise as a reliable and valid assessment of perceived provider health care competency. Implications for SGM health-related measurement, clinical supervision, and training are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perinatal Depression Educational Training for Graduate Nursing Students.

The purpose of this study was to implement and assess an educational intervention for nursing students pertaining to perinatal depression (PD) screening and treatment. A single group (n = 59), repeated-measures design (i.e., pre- and post-intervention assessments) was used to assess the impact of an online intervention. Demographics, Theory of Planned Behavior constructs, intention to screen and treat PD, and PD-related knowledge were tested. The intervention resulted in positive gains in PD-related perceived behavioral control (PBC), attitudes, subjective norms, knowledge, intention to screen and treat PD, and perceived importance of screening and treating PD from pre- to post-intervention. PBC demonstrated a small-to-moderate positive association with perceived importance of screening and treating PD at post-intervention. Results from the current study suggest that the PD online educational intervention is effective in improving participants' PD-related PBC, attitudes, subjective norms, knowledge, and intention to screen and treat PD.

Perinatal depression screening rates, correlates, and treatment recommendations in an obstetric population.

INTRODUCTION: The current study aimed to assess perinatal depression (PD) screening and treatment practices of obstetrical health care providers. METHOD: Retrospective record reviews (n = 557) evaluated the PD screening, referral, and treatment practices at an Obstetrician/Gynecology practice. This study assessed the frequency of screening for PD, rates of elevated Edinburgh Postnatal Depression Scale (EPDS) scores, treatment recommendations, demographic correlates, and predictors of elevated EPDS scores. RESULTS: PD screening completion rates were: 60.1% (intake), 35% (glucola test), and 85.5% (6-week follow-up). Rates of clinically elevated EPDS scores were: 18.21% (intake), 17.43% (glucola test), and 13.00% (6-week follow-up). Correlates of clinically elevated EPDS scores at intake and 6-week follow-up were history of depression, history of anxiety, and young age. History of depression and anxiety were associated with an increased likelihood of having a clinically significant EPDS score at intake. Intake EPDS score and history of depression were associated with an increased likelihood of having a clinically significant EPDS score at 6-week follow-up. DISCUSSION: Obstetric/gynecology providers should screen for perinatal depression at every obstetrical appointment. It is important to thoroughly assess history of depression and anxiety. Education and training for health care providers and perinatal women may improve the mental health experience of perinatal women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychometric assessment of the Edinburgh Postnatal Depression Scale in an obstetric population.

The prevalence and negative effects of perinatal depression are well known. The Edinburgh Postnatal Depression Scale (EPDS) is a common screening tool for perinatal depression and it is recommended for use by several professional organizations. The current study tested competing EPDS factor structures and assessed EPDS change from intake to 6-week follow-up, and identified demographic correlates in an outpatient obstetric sample. Using a retrospective observational study design, medical records were coded for demographic, mental health, and EPDS patient data (n = 524). Confirmatory factor analysis, t-tests, and ANOVA were utilized. Findings included: (1) a 3-factor model (i.e. anxiety, depression, anhedonia) of the EPDS displayed the best fit to the current data; (2) small declines in all 3 subscales of the EPDS from intake to 6-week follow-up appointments and; (3) demographic correlates of EPDS subscales included history of depression, history of anxiety, race, and pregnancy status (i.e. first child or not). The 3-factor structure can be used in clinical practice to assess perinatal depression in a nuanced fashion. Given that history of depression and anxiety are risk factors for perinatal depression, a thorough assessment of these items in clinical practice is needed.

A systematic review of interventions for healthcare professionals to improve screening and referral for perinatal mood and anxiety disorders.

Postpartum depression affects approximately 11% of women. However, screening for perinatal mood and anxiety disorders (PMAD) is rare and inconsistent among healthcare professionals. When healthcare professionals screen, they often rely on clinical judgment, rather than validated screening tools. The objective of the current study is to review the types and effectiveness of interventions for healthcare professionals that have been used to increase the number of women screened and referred for PMAD. Preferred Reporting Items for Systematic Reviews and Meta-Analyses was utilized to guide search and reporting strategies. PubMed/Medline, PsychInfo/PsychArticles, Cumulative Index to Nursing, Allied Health Literature (CINAHL), and Health Source: Nursing/Academic Edition databases were used to find studies that implemented an intervention for healthcare professionals to increase screening and referral for PMAD. Twenty-five studies were included in the review. Based on prior quality assessment tools, the quality of each article was assessed using an assessment tool created by the authors. The four main outcome variables were the following: percentage of women screened, percentage of women referred for services, percentage of women screened positive for PMAD, and provider knowledge, attitudes, and/or skills concerning PMAD. The most common intervention type was educational, with others including changes in electronic medical records and standardized patients for training. Study quality and target audience varied among the studies. Interventions demonstrated moderate positive impacts on screening completion rates, referral rates for PMAD, and patient-provider communication. Studies suggested positive receptivity to screening protocols by mothers and providers. Given the prevalence and negative impacts of PMAD on mothers and children, further interventions to improve screening and referral are needed.

Womb Outsourcing: Commercial Surrogacy in India.

Infertility affects more than 7 million American couples. As traditional treatments fail and the costs of hiring a surrogate increase in the United States, transnational commercial surrogacy becomes a feasible alternative for many couples. Infertile couples may opt for this choice after reading enticing Internet advertisements of global medical tourism offering "special deals" on commercial surrogacy. This is particularly true in India where couples from the United States can purchase transnational surrogacy for less than one-half or even one-third of the costs in the United States, including the cost of travel. The majority of surrogate mothers in India come from impoverished, poorly educated rural areas of India. Commercial surrogacy offers the lure of earning the equivalent of 5 years of family income. This multidisciplinary review of the literature suggests that the issue of commercial surrogacy is complex and influenced by a number of factors including expensive infertility costs, ease of global travel, and the financial vulnerability of Indian commercial surrogate mothers and their families. Questions are being raised about decision making by the surrogate mother particularly as influenced by gender inequities, power differentials, and inadequate legal protection for the surrogate mother. More research is needed to understand commercial surrogacy, especially research inclusive of the viewpoints of the Indian mothers and their families involved in these transactions.

Sacred healing stories told at the end of life.

INTRODUCTION: Cancer is a challenging disease to diagnose and treat, and oftentimes even with the best medical intervention, it spreads and is deemed incurable, requiring a shift from cure to end-of-life care. This study used a spirituality measure and the PATS© storytelling intervention developed by the principal investigator to better understand the experience of being diagnosed with cancer and being told no further curative treatments are warranted. PURPOSE: The purpose of this exploratory study was to implement a storytelling approach to explore the experience of living with terminal cancer. Second, the study documented the presence of spirituality and healing in the narratives. METHOD: The qualitative data were analyzed by narrative analysis developed by Riessman. FINDINGS: Seven synoptic stories were written and later sorted into healing categories. The narrative analysis yielded three themes. There were instances of religion and spirituality found in the transcribed stories. The participants' scores on the Spiritual Health Inventory indicated the presence of spirituality. CONCLUSION: Storytelling allowed the seven study participants to share personal experiences and achieve a sense of connectedness and intimacy. The use of the PATS© intervention is a way to facilitate physical, emotional, and spiritual healing and provide holistic end-of-life care.

Can complementary/alternative medicine be used to treat infertility?

Infertility affects more than 7.3 million American women. When traditional treatments fail, alternative methods may be sought, but unfortunately some of them could be exploitative rather than legitimate. The intent of this article is to examine various complementary alternative medicine (CAM) treatments and techniques, and assess their known efficacy in the treatment of infertility. For research purposes, the National Institutes of Health has divided CAM into five domains: (1) whole medical systems; (2) mind-body medicine; (3) biologically based practices; (4) manipulative and body-based practices; and (5) energy medicine. Each of these domains is defined and discussed. Scientific evidence relating to the efficacy of procedures is presented and correlated to fertility outcomes. Information for nursing interventions is included as a means of better understanding what the infertile couple needs.

Postprandial walking is better for lowering the glycemic effect of dinner than pre-dinner exercise in type 2 diabetic individuals.

OBJECTIVES: In prior studies of exercise done before or after breakfast and lunch, postprandial activity generally reduces glycemia more than pre-meal. This study sought to examine the effects of exercise before or after an evening meal. DESIGN: Examined the differing effects of a single bout of pre- or postprandial moderate exercise or no exercise on the glycemic response to an evening (dinner) meal in individuals with type 2 diabetes. SETTING: Community-dwelling participants tested at a research university in Virginia. PARTICIPANTS: Twelve men and women subjects (mean age of 61.4+/-2.7 years) with type 2 diabetes treated with diet and/or oral medications. INTERVENTION: Three trials conducted on separate days consisting of a rest day when subjects consumed a standardized dinner with a moderate glycemic effect and 2 exercise days when they undertook 20 minutes of self-paced treadmill walking immediately before or 15 to 20 minutes after eating. MEASUREMENTS: Blood samples taken every 30 minutes over a 4-hour period and later assayed for plasma glucose; from these data both absolute and relative changes in glucose levels were determined, as well as the total glucose area under the curve (AUC) of the 4-hour testing period. Initial samples were additionally assayed for glycated hemoglobin and lipid levels. RESULTS: Twenty minutes of self-paced walking done shortly after meal consumption resulted in lower plasma glucose levels at the end of exercise compared to values at the same time point when subjects had walked pre-dinner. Total glucose AUC over 4-hours was not significantly different among trials. CONCLUSION: Postprandial walking may be more effective at lowering the glycemic impact of the evening meal in individuals with type 2 diabetes compared with pre-meal or no exercise and may be an effective means to blunt postprandial glycemic excursions.