Sleep quality, quality of life, fatigue, and mental health in COVID-19 post-pandemic Türkiye: a cross-sectional study.

Aim: This study explores the predictors and associated risk factors of sleep quality, quality of life, fatigue, and mental health among the Turkish population during the COVID-19 post-pandemic period. Materials and methods: A cross-sectional survey using multi-stage, stratified random sampling was employed. In total, 3,200 persons were approached. Of these, 2,624 (82%) completed the questionnaire package consisting of socio-demographic information, Pittsburgh Sleep Quality Index (PSQI), the WHO Quality of Life Brief Version (WHOQOL-BREF), Fatigue Assessment Scale (FAS), Patients Health Questionnaire (PHQ-15), GAD-7 anxiety scale, and the 21-item Depression, Anxiety, Stress Scale (DASS-21). Results: Significant differences between genders were found regarding socio-demographic characteristics (p < 0.01). Using PHQ-15 for depressive disorders, significant differences were found between normal and high severity scores (≥ 10), regarding age group (p < 0.001), gender (p = 0.049), educational level (p < 0.001), occupational status (p = 0.019), cigarette smoking (p = 0.002), waterpipe-narghile smoking (p = 0.039), and co-morbidity (p = 0.003). The WHOQOL-BREF indicated strong correlations between public health, physical health, psychological status, social relationships, environmental conditions, and sleep disorders (p < 0.01). Furthermore, comparisons of the prevalence of mental health symptoms and sleeping with PHQ-15 scores ≥ 10 (p = 0.039), fatigue (p = 0.012), depression (p = 0.009), anxiety (p = 0.032), stress (p = 0.045), and GAD-7 (p < 0.001), were significantly higher among the mental health condition according to sleeping disorder status. Multiple regression analysis revealed that DASS21 stress (p < 0.001), DASS21 depression (p < 0.001), DASS21 anxiety (p = 0.002), physical health (WHOQOL-BREF) (p = 0.007), patient health depression-PHQ-15 (p = 0.011), psychological health (WHOQOL-BREF) (p = 0.012), fatigue (p = 0.017), and environmental factors (WHOQOL-BREF) (p = 0.041) were the main predictor risk factors associated with sleep when adjusted for gender and age. Conclusion: The current study has shown that sleep quality was associated with the mental health symptoms of depression, anxiety, stress, and fatigue. In addition, insufficient sleep duration and unsatisfactory sleep quality seemed to affect physical and mental health functioning.

Reducing Test Anxiety During the COVID-19 Pandemic: A Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy.

Educational assessments can affect students' mental health, particularly during a pandemic. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are widely efficacious for reducing test anxiety, as well as general anxiety and rumination. However, the effectiveness of these two therapies for students during COVID-19 is unclear. We measured the effectiveness of ACT and CBT for managing test anxiety, general anxiety, and rumination during COVID-19 for 77 students taking Türkiye's national university entrance exam, assigned to either the ACT or CBT psychoeducation programs. Both programs reduced test anxiety, general anxiety, and rumination, and showed similar levels of effectiveness. This suggests that ACT and CBT are both important for improving students' mental health during COVID-19 and either may be beneficial.

The Good, the Bad and the Hijab: A Study of Implicit Associations Made by Practicing Muslims in Their Native Muslim Country.

Recent research indicates that wearing the hijab reduces the attractiveness of female faces perceived by practicing Muslim men and women in their native Muslim country (the United Arab Emirates). The purpose of the current research was to develop this finding to investigate whether other aspects of person perception are also affected when women wear the hijab in this Muslim country. Of particular relevance is that changes in physical attractiveness often affect the personal qualities assigned to individuals. Accordingly, we sought to determine whether such effects occur when the physical attractiveness of women is altered by wearing the hijab. To do this, we used an Implicit Association Test (IAT) to investigate how native Muslim participants in the UAE associated pleasant and unpleasant connotations with images of women either wearing the hijab or with their heads uncovered. As in previous research with native Muslim participants, female faces were again perceived as significantly less attractive when the hijab was worn. However, the accompanying IAT findings showed that these less attractive hijab-wearing images were associated more with pleasant connotations than were the matched uncovered images. These findings provide fresh insight into the effects of the hijab on perceptions of Muslim women in a Muslim country and provide support for the view that cultural clothing can influence person perception beyond physical attractiveness alone.

COVID-19 brings a new urgency for advance care planning: Implications of death education.

The U.S. has the highest number of coronavirus disease (COVID-19) cases and deaths of any nation. Deaths due to COVID-19, especially among older adults and people of color, have created an urgency for advanced care planning (ACP). Despite benefits of ACP, only one-third of U.S. adults have completed advance directives, in part due to a lack of death education. We recommend four actions to increase death education and ACP completion: (1) integrate death education into teacher preparation programs, (2) incorporate death education in undergraduate curricula, (3) provide better education in death and dying to future health professionals, and (4) educate the public.

The COVID-19 pandemic has changed dying and grief: Will there be a surge of complicated grief?

Worldwide, more than 3 million people have died from COVID-19. Each decedent represents a person who was loved, will be missed, and whose death elicited grief. COVID-19 has changed the way we die and grieve. Many people have died without family members and friends present and many of the bereft have grieved and mourned alone. Individuals and communities have experienced multiple losses within a short time while suffering from concomitant stress, anxiety, and depression. More deaths and more grief will continue in the foreseeable future. Preventive education is needed to prepare for and manage the likely increase in complicated grief.

Gendered Perceptions of Odd and Even Numbers: An Implicit Association Study From Arabic Culture.

Previous studies conducted in the United States indicate that people associate numbers with gender, such that odd numbers are more likely to be considered male and even numbers considered female. It has been argued that this number gendering phenomenon is acquired through social learning and conditioning, and that male-odd/female-even associations reflect a general, cross-cultural human consensus on gender roles relating to agency and communion. However, the incidence and pattern of number gendering in cultures outside the United States remains to be established. Against this background, the purpose of this study was to determine whether people from a culture and country very different from the United States (specifically, native Arabic citizens living in the Arabic culture of the United Arab Emirates) also associate numbers with gender, and, if they do, whether the pattern of these associations is the male-odd/female-even associations previously observed. To investigate this issue, we adopted the Implicit Association Test used frequently in previous research, where associations between numbers (odd and even) and gender (male and female faces) were examined using male and female Arabic participants native to, and resident in, the United Arab Emirates. The findings indicated that the association of numbers with gender does occur in Arabic culture. But while Arabic females associated odd numbers with male faces and even numbers with female faces (the pattern of previous findings in the United States), Arabic males showed the reversed pattern of gender associations, associating even numbers with male faces and odd numbers with female faces. These findings support the view that number gendering is indeed a cross-cultural phenomenon and show that the phenomenon occurs across very different countries and cultures. But the findings also suggest that the pattern with which numbers are associated with gender is not universal and, instead, reflects culture-specific views on gender roles which may change across cultures and gender. Further implications for understanding the association of numbers with gender across human societies are discussed.

COVID-19 pandemic and psychological fatigue in Turkey.

AIM: The aim of this study was to investigate the association between the COVID-19 pandemic and psychological fatigue as a mental health issue among the population of Istanbul, Turkey. PARTICIPANTS AND METHODS: This is a cross-sectional study conducted in Istanbul, Turkey, between March and June 2020, where a total of 4,700 persons were approached and 3,672 (78%) of participants (64.4% males and 35.6% females) completed the Knowledge Attitude Practices (KAP) and Fatigue Assessment Scale (FAS) questionnaires. RESULTS: In this study, 64.1% of participants were categorized as psychologically fatigued and 35.9% as normal. There was a significant difference between fatigued and normal participants with respect to age, educational level, occupational status, place of residence and number of family members (p < .001). Other differences related to knowledge of COVID-19 were symptoms, treatment, ways of spreading (p < .001), prevention by avoiding crowded places (p = .008) and isolation (p = .002). For attitudinal items, normal participants generally showed more positive attitudes than the fatigued in believing that COVID-19 will finally be controlled, satisfaction with preventive measures taken by the authorities, reporting suspected cases with symptoms and trusting that Turkey can overcome the COVID-19 pandemic (p < .001). Multivariate stepwise regression analysis indicated that level of education, avoiding going to crowded places, eye, nose and mouth organs are sensitive organs to the virus, keeping physical distance due to epidemic affect by COVID-19 virus, isolation and treatment of people reduce the spread of COVID-19 virus and 14-days period of time, COVID-19 is mainly transmitted through contact with the respiratory droplets of an infected person, occupational status, health education programme needed and antibody treatment variables were significantly associated with fatigue after adjusting for age, gender and income variables. CONCLUSION: The current study provides valuable information for policymakers and mental health professionals worldwide regarding associations between the mental health of individuals and the ongoing outbreak, COVID-19.

Further investigation of the effects of wearing the hijab: Perception of female facial attractiveness by Emirati Muslim men living in their native Muslim country.

The hijab is central to the lives of Muslim women across the world but little is known about the actual effects exerted by this garment on perceptions of the wearer. Indeed, while previous research has suggested that wearing the hijab may affect the physical attractiveness of women, the actual effect of wearing the hijab on perceptions of female facial attractiveness by Muslim men in a Muslim country is largely unknown. Accordingly, this study investigated the effects of the hijab on female facial attractiveness perceived by practising Muslim men living in their native Muslim country (the United Arab Emirates). Participants were presented with frontal-head images of women shown in three conditions: in the fully covered condition, heads were completely covered by the hijab except for the face; in the partially covered condition, heads were completely covered by the hijab except for the face and areas around the forehead and each side of the face and head; in the uncovered condition, heads had no covering at all. The findings revealed that faces where heads were uncovered or partially covered were rated as equally attractive, and both were rated as substantially more attractive than faces where heads were fully covered. Thus, while wearing the hijab can suppress female facial attractiveness to men, these findings suggest that not all hijab wearing has this effect, and female facial attractiveness for practising Muslim men living in their native Muslim country may not be reduced simply by wearing this garment. Indeed, from the findings we report, slight changes to the positioning of the hijab (the partially covered condition) produce perceptions of facial attractiveness that are no lower than when no hijab is worn, and this may have important implications for wearing the hijab in Muslim societies. Finally, we argue that the pattern of effects we observed is not explained by anti-Islamic feeling or cultural endogamy, and that a major contributory factor is that being fully covered by the hijab occludes external features, especially the hair and lateral parts of the head and face, which, when normally visible, provide a substantial perceptual contribution to human facial attractiveness.

Ebola, Zika, Corona What Is Next for Our World?

In the past century, there have been several pandemics. Within the context of global health, these pandemics have often been viewed from the lens of determinants such as population, poverty, and pollution. With an ever-changing world and the COVID-19 pandemic, the current global determinants of public health need to be expanded. In this editorial, we explore and redefine the major determinants of global public health to prevent future pandemics. Policymakers and global leaders should keep at heart the determinants suggested hereby in any planning, implementation, and evaluation of efforts to improve global public health and prevent pandemics.

Smoking cessation education and training in obstetrics and gynecology residency programs in the United States.

BACKGROUND: OB/GYN physicians should be involved in providing smoking cessation counseling to their patients who smoke, especially pregnant patients. However, the smoking cessation practices of OB/GYN physicians seem to be dependent on their education and training and not much is known about their training during medical school. Therefore, the purpose of this study was to assess the smoking cessation education provided by OB/GYN residency training programs in the United States. METHODS: The investigators developed and mailed a valid and reliable survey to all allopathic and osteopathic OB/GYN Residency Directors in the US (n = 275). The internal reliability coefficients (Cronbach alpha) for the four major subscales ranged from 0.63 to 0.90. Best practices in survey research were used to achieve a final response rate of 58%. RESULTS: The majority of residency programs (60%) did not have a formal, structured curriculum in tobacco topics and/or smoking cessation. In contrast, 40% of programs reported having a formal, structured tobacco education curriculum. Sixty-five percent of programs did not formally evaluate residents' competence in providing smoking cessation counseling to patients. A range of 42% to 57% of residency programs reported spending less than one hour/year on teaching various basic science and clinical science topics related to tobacco use. The majority of residency programs spent no time teaching residents about the socio-political aspects of tobacco use cessation. Lack of teaching time was identified by the majority (51%) of the residency directors as a barrier to teaching smoking cessation. CONCLUSION: Although OB/GYN physicians are expected to provide smoking cessation counseling to their patients, the majority of OB/GYN residency programs in the United States provide minimal education and training in this area. Therefore, continuing medical education on smoking cessation counseling should be broadly implemented for OB/GYN physicians.

Investigating the effect of wearing the hijab: Perception of facial attractiveness by Emirati Muslim women living in their native Muslim country.

The Hijab and other forms of Islamic veiling are important social, cultural, and religious symbols that are central to the identity of millions of Muslim women across the world. However, despite the large body of literature that exists on the political and socio-cultural aspects of Islamic veiling, little is known about how the appearance of women wearing the hijab is perceived by other Muslim women within their native Muslim country. To throw light on this important issue, the current study focussed on the effects of the hijab on female facial attractiveness perceived by practising Muslim Emirati women living in their native Muslim country (the United Arab Emirates) who themselves wore the hijab as everyday attire. Participants were shown frontal-head images of women in three different conditions: covered (heads fully covered by the hijab except for the face), partially covered (heads fully covered by the hijab except for the face and the hair around the forehead) and uncovered (heads with no covering). The findings showed that faces in images where heads were covered and partially covered by the hijab were rated as equally attractive but both were rated as significantly less attractive than faces in images where heads were uncovered. These findings suggest that, even for practising Muslim Emirati females living in their native Muslim country for whom wearing the hijab is a normal aspect of everyday life, perception of facial attractiveness is compromised by wearing this garment. We argue that this effect of wearing the hijab is not consistent with a preference for one's own cultural group (cultural endogamy) and may, instead, occur because wearing a hijab occludes external features, such as hair and ears, which normally contribute to the perception of human facial attractiveness. In sum, while wearing the hijab may be dominated by male attitudes towards suppressing female attractiveness towards males, the findings from this study suggest that female Muslims too perceive the negative influence of wearing the hijab on female facial attractiveness.

State Minority Health Officers' Perceptions of their Successes and Barriers to Reducing Racial and Ethnic Health Disparities.

BACKGROUND: Minimal research has been conducted to examine the impact and reach of state offices of minority health (SOMH) and their role in reducing racial and ethnic health disparities within their states. Accordingly, the purpose of this study was to describe the shared experiences of SOMH officers to provide context for why these individuals believe that state organizational efforts have not yielded much success in reducing racial and ethnic health disparity gaps. METHODS: Using a telephone interview guide, the investigators conducted telephone interviews with SOMH officers. Data were analyzed thematically based on emergent patterns in participant responses. A total of 47 of 50 state officers (94%) completed the interview. RESULTS: Though many officers were encouraged by increased awareness regarding health disparities, nearly every officer listed inadequate resources as the most impactful barrier impeding the success of their offices' missions. CONCLUSION: SOMH continue to be severely underfunded and are concerned about their potential for success, leaving them with minimal ability to engage in activities beyond educational awareness campaigns. For SOMH officers to be successful in eliminating disparities, legislators must provide them with adequate funding so they can engage in wider-reaching interventions targeting the social determinants of health.

What's in a Typeface? Evidence of the Existence of Print Personalities in Arabic.

Previous research suggests that different typefaces can be perceived as having distinct personality characteristics (such as strength, elegance, friendliness, romance, and humor) and that these "print personalities" elicit information in the reader that is in addition to the meaning conveyed linguistically by words. However, research in this area has previously been conducted using only English stimuli and so it may be that typefaces in English, and other languages using the Latinate alphabet, lend themselves unusually well to eliciting perception of print personalities, and the phenomenon is not a language universal. But not all written languages are Latinate languages, and one language that is especially visually distinct is Arabic. In particular, apart from being read from right to left, Arabic is formed in a cursive script in which the visual appearance of letters contrasts strongly with those used for Latinate languages. In addition, spaces between letters seldom exist in Arabic and the visual appearance of even the same letters can vary considerably within the same typeface depending on their contextual location within a word. Accordingly, the purpose of the present study was to investigate whether, like English, different Arabic typefaces inspire the attribution of print personalities. Eleven different typefaces were presented in Arabic sentences to skilled readers of Arabic and participants rated each typeface according to 20 different personality characteristics. The results showed that each typeface produced a different pattern of ratings of personality characteristics and suggest that, like English, Arabic typefaces are perceived as having distinct print personalities. Some of the implications of these results for the processes involved in reading are discussed.

Investigating the Effectiveness of Spatial Frequencies to the Left and Right of Central Vision during Reading: Evidence from Reading Times and Eye Movements.

Printed words are complex visual stimuli containing a range of different spatial frequencies, and several studies have suggested that various spatial frequencies are effective for skilled adult reading. But while it is well known that the area of text from which information is acquired during reading extends to the left and right of each fixation, the effectiveness of spatial frequencies falling each side of fixation has yet to be determined. To investigate this issue, we used a spatial frequency adaptation of the gaze-contingent moving-window paradigm in which sentences were shown to skilled adult readers either entirely as normal or filtered to contain only low, medium, or high spatial frequencies except for a window of normal text around each point of fixation. Windows replaced filtered text either symmetrically 1 character to the left and right of each fixated character, or asymmetrically, 1 character to the left and 7 or 13 to the right, or 1 character to the right and 7 or 13 to the left. Reading times and eye-movement measures showed that reading performance for sentences presented entirely as normal generally changed very little with filtered displays when windows extended to the right but was often disrupted when windows extended to the left. However, asymmetrical windows affected performance on both sides of fixation. Indeed, increasing the leftward extent of windows from 7 to 13 characters produced decreases in both reading times and fixation durations, suggesting that reading was influenced by the spatial frequency content of leftward areas of text some considerable distance from fixation. Overall, the findings show that while a range of different spatial frequencies can be used by skilled adult readers, the effectiveness of spatial frequencies differs for text on each side of central vision, and may reflect different roles played by these two areas of text during reading.

Predicting Adherence to Aromatase Inhibitor Therapy among Breast Cancer Survivors: An Application of the Protection Motivation Theory.

The purpose of this observational study was to determine if the Protection Motivation Theory could predict and explain adherence to aromatase inhibitor (AI) therapy among breast cancer survivors. Purposive sampling was used to identify 288 survivors who had been prescribed AI therapy. A valid and reliable survey was mailed to survivors. A total of 145 survivors completed the survey. The Morisky scale was used to measure adherence to AI. The survivors reported a mean score of 6.84 (±0.66) on the scale. Nearly 4 in 10 survivors (38%) were non-adherent. Adherence differed by age, marital status, insurance status, income, and presence of co-morbid conditions. Self-efficacy (r=0.485), protection motivation (r=0.310), and Response Efficacy (r=0.206) were positively and significantly correlated with adherence. Response Cost (r=-0.235) was negatively correlated with adherence. The coping appraisal constructs were statistically significant predictors medication adherence (ß=0.437) with self-efficacy being the strongest significant predictor of adherence (ß = 0.429).

Aging and the optimal viewing position effect in visual word recognition: Evidence from English.

Words are recognized most efficiently by young adults when fixated at an optimal viewing position (OVP), which for English is between a word's beginning and middle letters. How this OVP effect changes with age is unknown but may differ for older adults due to visual declines in later life. Accordingly, a lexical decision experiment was conducted in which short (5-letter) and long (9-letter) words were fixated at various letter positions. The older adults produced slower responses. But, crucially, effects of fixation location for each word-length did not differ substantially across age groups, indicating that OVP effects are preserved in older age. (PsycINFO Database Record

Reading Rate and Comprehension for Text Presented on Tablet and Paper: Evidence from Arabic.

The effectiveness of tablet computers to supplement or replace paper-based text in everyday life has yet to be fully revealed. Previous investigations comparing reading performance using tablets and paper have, however, reported inconsistent results. Furthermore, the interpretability of some previous findings is limited by lack of experimental control over variables like text display conditions. In the current study, we investigated reading performance for text presented on tablet and paper. Crucially, the levels of luminance and contrast were matched precisely across tablet and paper. The study used Arabic text which differs substantially from the languages used previously to investigate effects of tablet and paper on reading, thus offering a distinctive test of the influence of these two media on reading performance. The results suggest that when text display conditions are well-matched, there is no reliable difference in reading performance between the two media. Also, neither the order of medium (reading from tablet or paper first), nor familiarity with using a tablet significantly influence reading performance. These results call into question previous suggestions that reading from tablets is linked to poorer reading performance, and demonstrate the benefits of controlling text display conditions. These findings are of interest to reading scientists and educators.

Predicting Racial and Ethnic Disparities in Advance Care Planning Using the Integrated Behavioral Model.

Purpose To explain and predict racial or ethnic disparities in advance care planning (ACP) behaviors among American adults by using the Integrated Behavioral Model (IBM) and the Precaution Adoption Process Model. Methods A randomized, observational, nonexperimental, cross-sectional study design was used to survey American adults between 40 and 80 years of age ( n = 386). Results The majority of respondents (75%) had not completed ACP. Significant differences were found by race or ethnicity: 33% of Whites had completed ACP versus Hispanics (18%) and Blacks (8%). Whites had statistically significantly higher levels of most IBM constructs compared with Blacks and Hispanics. The IBM predicted 28% of the variance in behavioral intention. After controlling for sociodemographic variables, direct attitudes, indirect attitudes, and indirect perceived norms were significant predictors of behavioral intention. Conclusion The IBM and the Precaution Adoption Process Model are useful frameworks for interventions designed to increase ACP among racial or ethnic minorities in the United States.

The Impact of Perceived Stress and Coping Adequacy on the Health of Nurses: A Pilot Investigation.

Stress and coping abilities influence the health and work performance of nurses. However, little is known about the combined influence of stress perception and perceived coping adequacy and its impact on the health of nurses. This study examined the relationship between stress, coping, and the combined influences of perceived stress and coping abilities on health and work performance. A valid and reliable questionnaire was completed by 120 nurses in a Midwestern hospital in the USA. In general, the nurses were not healthy: 92% had moderate-to-very high stress levels; 78% slept less than 8 hours of sleep per night; 69% did not exercise regularly; 63% consumed less than 5 servings of fruits and vegetables per day; and 22% were classified as binge drinkers. When confronted with workplace stress, 70% of nurses reported that they consumed more junk food and 63% reported that they consumed more food than usual as a way of coping. Nurses in the "high stress/poor coping" group had the poorest health outcomes and highest health risk behaviors compared to those in other groups. The combined variables of perceived stress and perceived coping adequacy influenced the health of nurses. Therefore, worksite health promotion programs for nurses should focus equally on stress reduction, stress management, and the development of healthy coping skills.

Effects of Spatial Frequencies on Word Identification by Fast and Slow Readers: Evidence from Eye Movements.

Recent research has shown that differences in the effectiveness of spatial frequencies for fast and slow skilled adult readers may be an important component of differences in reading ability in the skilled adult reading population (Jordan et al., 2016a). But the precise nature of this influence on lexical processing during reading remains to be fully determined. Accordingly, to gain more insight into the use of spatial frequencies by skilled adult readers with fast and slow reading abilities, the present study looked at effects of spatial frequencies on the processing of specific target words in sentences. These target words were of either high or low lexical frequency and each sentence was displayed as normal or filtered to contain only very low, low, medium, high, or very high spatial frequencies. Eye movement behavior for target words was closest to normal for each reading ability when text was shown in medium or higher spatial frequency displays, although reading occurred for all spatial frequencies. Moreover, typical word frequency effects (the processing advantage for words with higher lexical frequencies) were observed for each reading ability across a broad range of spatial frequencies, indicating that many different spatial frequencies provide access to lexical representations during textual reading for both fast and slow skilled adult readers. Crucially, however, target word fixations were fewer and shorter for fast readers than for slow readers for all display types, and this advantage for fast readers appeared to be similar for normal, medium, high, and very high spatial frequencies but larger for low and very low spatial frequencies. Therefore, although fast and slow skilled adult readers can both use a broad range of spatial frequencies when reading, fast readers make more effective use of these spatial frequencies, and especially those that are lower, when processing the identities of words.