Innovative Strategies to Address Systemic Inequities in Youth Sexual Health Programs: A Preliminary Program Evaluation.

Disparities in sexual health outcomes between racial and ethnic groups throughout the state of Washington suggest the presence of systemic inequities impeding young people's experience with and access to sexual health care and education. Emerging innovations in sexual health look to center young people, particularly those who have been historically excluded, in the design and implementation of programs that aim to serve them. The Washington Youth Sexual Health Innovation and Impact Network (WYSHIIN) and 11 grant-funded partners engaged communities of youth across the state of Washington, including Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, and/or asexual (2SLGBTQIA+) and Black, Indigenous, and People of Color (BIPOC) youth, with the goal of equitably engaging participants and stakeholders to broaden services in schools and community settings. Evaluation staff from the Washington State Department of Health conducted virtual interviews with community partners for preliminary program evaluation purposes and identified 6 strategies for engaging youth. WYSHIIN partners highlighted strategies for centering youth voice and needs at all levels of program development and implementation, embracing holistic and culturally relevant approaches, and 2SLGBTQIA+ inclusion. These themes, reflective of wisdom across multiple Washington communities, offer strategies to address systemic issues that negatively impact youth access to and experience with sexual health care.

Psychometric Testing of the Filipino Version of the Clients' Perceptions of Providers' Cultural Competency (CPOPCC) Instrument Among LGBTQ+ Population in the Philippines.

Background and Purpose: Cultural competence is significant in addressing the health needs of vulnerable populations. This study conducted psychometric testing of a cultural competency instrument in the Philippines. Methods: Brislin's translation and a cross-sectional online design were used. Exploratory factor analysis (EFA) with varimax rotation examined construct validity of the 23-item scale among 157 adult LGBTQ+ residents. The scale revealed overall reliability (α = .85) including two subscales (α = .87, α = .81, and α = .61). The EFA yielded three theoretical factorial solutions. Conclusion: The Filipino version of the instrument demonstrated reliability and validity. Measuring clients' perceptions of provider and organizational cultural competency can improve the utilization of healthcare in Filipino LGBTQ+ communities. Future research will examine the dimensional structures of the instrument among expanded LGBTQ+ communities.

Measurement Invariance Across Sex and Time of the Center for Epidemiological Studies-Depression Scale.

Background and Purpose: The Center for Epidemiological Studies-Depression (CES-D) is widely used to compare depressive symptoms across sex, and change in depression over time, yet measurement invariance has not been demonstrated. Methods: Multiple-groups and longitudinal confirmatory factor analysis assessed measurement invariance of the CES-D in a sample of 697 Spokane Heart Study participants. Results: Findings demonstrated partial measurement invariance across sex of the CES-D across both time points with men having significantly lower depression levels than women at time one (z = -3.62, p < .01) and time two (z = -4.06, p < .01), and full temporal measurement invariance with stable levels of depression over time (z = 0.85, p = .39). Conclusions: Validity of the CES-D to compare depression across sex and time is supported.

Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the US.

Breastmilk is considered the optimal nutrition for newborns. US Black women continue to have the lowest breastfeeding initiation and duration rates. This Perspective examines factors associated with breastfeeding disparities and inequities among Black women through the lens of critical race theory and the social-ecological model. Recommendations to increase breastfeeding rates in this population include increased communication and educational strategies by health care professionals, education to recognize implicit bias and systemic racism in our health care system, early prenatal and ongoing postpartum breastfeeding support, increased community support, and breastfeeding groups developed by and for Black women. In addition, equity policies such as paid maternity leave and work policies that support milk expression would provide needed institutional support for women in the workplace.

Development of the Clients' Perceptions of Providers' Cultural Competency Instrument.

INTRODUCTION: This study developed and validated the Clients' Perceptions of Providers' Cultural Competency instrument. METHOD: A sequential exploratory mixed design identified three constructs derived from the studies of Leininger and others. Constructs were compared with publications on cultural competency. A panel of experts reviewed for content validity. RESULTS: Three hundred and nine mostly Asians and Native Hawaiians completed the questionnaire. Twenty-two items with item-to-total correlation coefficients >.2 were retained. Overall instrument Cronbach's alpha was .89. Construct validity demonstrated the three constructs accounted for 49.6% of variance supported by distinct items with Cronbach's alphas of .82, .83, and .76, respectively. Preliminary criterion validity revealed no statistically significant differences in scores based on the location of services received or race/ethnicity. DISCUSSION: The Clients' Perceptions of Providers' Cultural Competency instrument is congruent with nursing principles of equity and justice by measuring provider cultural competency from a client's perspective. Active client engagement in care contributes to transcultural nursing's goals to improve health equity.

Women's experiences with mixed use of wood and gas cookstoves and fuels in rural Lambayeque, Peru / Experiencias de mujeres en el uso mixto de combustibles para cocinar en una zona rural de Lambayeque, Perú

Introduction: Despite program efforts to encourage use of clean cookstoves and fuels to mitigate climate change, many communities continue to use wood-fueled open fires. Objectives: Describe experiences of participants with mixed use of cooking and fuel technologies (e.g. open fires and chimney stoves using wood and liquefied petroleum gas (LPG) stoves) in rural Lambayeque, Peru in 2018. Material and methods: Fifteen participants were interviewed using a qualitative exploratory research design. Data was collected through semi-structured interviews and analyzed using thematic content analysis. Results: Four categories emerged: decisions about acquiring cooking fuels are primarily based on cost; plastic trash is used to light wood-burning stoves; decisions to use gas over wood are based on quick food cooking time; and benefits and health problems are recognized, but mixed use of fuels persist. Conclusion:Use of both traditional wood cookstoves and plastic trash to ignite fires were used frequently because both are free or cheap. The environmental impact of cutting down trees isn't considered important, but interviewees did notice detriments to their wellbeing. Although gas stoves are used and benefits were mentioned, use of traditional stoves persists. We recommend that policy makers in Peru begin to address barriers to full adoption of new clean cooking technologies and consider governmental subsidies to meet families' spending priorities.

Introducción: A pesar de los esfuerzos del programa para alentar el uso de estufas y combustibles limpios para mitigar el cambio climático, muchas comunidades continúan utilizando fuegos abiertos a leña. Objetivo: Describa las experiencias de los participantes con el uso mixto de la cocina y las tecnologías de combustible (por ejemplo, fuegos abiertos y estufas de chimenea que usan estufas de leña y gas licuado de petróleo (GLP)) en la zona rural de Lambayeque, Perú, en 2018. Material y métodos: Quince participantes fueron entrevistados utilizando un diseño de investigación exploratoria cualitativa. Los datos se recopilaron a través de entrevistas semiestructuradas y se analizaron mediante análisis de contenido temático. Resultados: Surgieron cuatro categorías: las decisiones sobre la adquisición de combustibles para cocinar se basan principalmente en el costo; la basura plástica se usa para encender estufas de leña; las decisiones de usar gas sobre la madera se basan en el tiempo de cocción de comida rápida; y se reconocen los beneficios y los problemas de salud, pero persiste el uso mixto de combustibles. Conclusión: El uso de estufas de leña tradicionales y basura plástica para encender incendios se usaba con frecuencia porque ambos son gratuitos o baratos. El impacto ambiental de la tala de árboles no se considera importante, pero los entrevistados notaron daños en su bienestar. Aunque se usan estufas de gas y se mencionaron los beneficios, el uso de estufas tradicionales persiste. Recomendamos que los encargados de formular políticas en Perú comiencen a abordar las barreras para la adopción total de nuevas tecnologías de cocina limpia y consideren los subsidios

Development and Psychometric Testing of the Workplace Civility Index: A Reliable Tool for Measuring Civility in the Workplace.

BACKGROUND: Fostering civility in practice and academic health care settings is a desirable goal for individuals, teams, and organizations and is paramount to safe patient care. METHOD: A convenience sample of 393 nursing faculty and practice-based nurses in the United States participated in a study to test the psychometric properties of the Workplace Civility Index (WCI). RESULTS: A factor analysis and other reliability analyses support the use of the WCI as a valid and reliable measurement to measure perceptions of workplace civility acumen. CONCLUSION: The WCI is a 20-item psychometrically sound instrument used to measure perceptions of workplace civility among individuals and groups within work environments. The index may be completed as an individual exercise; however, it is highly recommended that the index be completed with a trusted coworker, colleague, or work group to improve self-awareness, give and receive constructive feedback, and form the basis for continuing strengths and addressing areas for improvement. J Contin Educ Nurs. 2018;49(9):400-406.

Exploratory Factor Analysis of the Caffrey Cultural Competency in Health Care Scale.

BACKGROUND AND PURPOSE: The purpose of this study was to psychometrically analyze the Caffrey Cultural Competence in Healthcare Scale (CCCHS), a scale that measures self-assessed cultural competency of nursing students participating in international immersion experiences during their nursing curriculum. METHODS: A sample of 105 health professions students completed the CCCHS. Inter-item correlations, exploratory factor analysis (EFA), and Cronbach's α were used to examine validity and reliability. RESULTS: Results indicated that items were positively related. A 1-factor model of the CCCHS was found in which all items loaded onto a single factor at > .30, except two items dealing with national policy, which may not be a component of cultural competence. CONCLUSION: The CCCHS was internally consistent (α = .93) and is a valid and reliable scale consisting of a unidimensional factor.

Development and Testing of the Healthy Work Environment Inventory: A Reliable Tool for Assessing Work Environment Health and Satisfaction.

BACKGROUND: Fostering healthy work environments that enhance job satisfaction and reflect high levels of employee engagement and productivity is imperative for all organizations. This is especially true for health care organizations where unhealthy work conditions can lead to poor patient outcomes. METHOD: A convenience sample of 520 nursing faculty and practice-based nurses in the United States participated in a study to test the psychometric properties of the Healthy Work Environment Inventory (HWEI). RESULTS: A factor analysis and other reliability analyses support the use of the HWEI as a valid and reliable instrument to measure perceptions of work environment health. CONCLUSION: The HWEI is a 20-item psychometrically sound instrument to measure perceptions of the health of the work environment. It may be completed either as an individual exercise or by all members of a team to compare perceptions of work environment health, to determine areas of strength and improvement, and to form the basis for interviewing. [J Nurs Educ. 2016;55(10):555-562.].

Leishmania donovani P23 protects parasites against HSP90 inhibitor-mediated growth arrest.

In Leishmania donovani, the HSP90 chaperone complex plays an essential role in the control of the parasite's life cycle, general viability and infectivity. Several of the associated co-chaperones were also shown to be essential for viability and/or infectivity to mammalian cells. Here, we identify and describe the co-chaperone P23 and distinguish its function from that of the structurally related small heat shock protein HSP23. P23 is expressed constitutively and associates itself with members of the HSP90 complex, i.e. HSP90 and Sti1. Viable P23 gene replacement mutants could be raised and confirmed as null mutants without deleterious effects on viability under a variety of physiological growth conditions. The null mutant also displays near-wild-type infectivity, arguing against a decisive role played by P23 in laboratory settings. However, the P23 null mutant displays a marked hypersensitivity against HSP90 inhibitors geldanamycin and radicicol. P23 also appears to affect the radicicol resistance of a HSP90 Leu33-Ile mutant described previously. Therefore, the annotation of L. donovani P23 as HSP90-interacting co-chaperone is confirmed.