Disentangling cognitive flexibility: a model-based assessment of women with anorexia nervosa.

Cognitive flexibility (CF) has been proposed as a potential trait marker in anorexia nervosa (AN), although findings have been inconsistent. To address this inconsistency, we applied a model that distinguishes between three subtypes of CF: task switching, switching sets, and stimulus-response mapping, which we then assessed using a paradigm-based task battery. The aim of the study was to investigate how AN is associated with these three CF subtypes. Thirty-three women with AN and 37 age- and education-matched controls performed a battery of computerized cognitive tasks to assess the three CF subtypes. Compared to the control group, individuals with AN exhibited poorer performance on the task switching and switching sets subtypes, as measured by response time switch cost, but not on the stimulus-response mapping subtype. No differences were found between the groups in response accuracy. Furthermore, switching sets as compared to the task switching and stimulus-response mapping subtypes was found to better explain the differences between the groups. These findings indicate a domain-specific impairment in CF among patients with AN, reflecting deficits observed in subtypes related to the disorder's characteristics, particularly that associated with visual perception. Therefore, CF impairment in AN should not be viewed dichotomously, but rather as a relative impairment that varies depending on the specific CF subtype.

Negative experiences of patients using medicinal cannabis: A systematic review of qualitative studies.

AIMS AND OBJECTIVES: In this study, we systematically reviewed qualitative studies concerning patients' experience with medicinal cannabis (MC) use, to gain insight into the negative effects of MC. BACKGROUND: Over the past decades, the use of MC for therapeutic purposes has increased. However, there is conflicting and insufficient data on possible negative physiological and psychological effects of MC treatment. DESIGN: A systematic review was conducted and the PRISMA guidelines were adopted. Literature searches were conducted using PubMed, PsycINFO and EMBASE. Critical Appraisal Skills Programme (CASP) qualitative checklist used to assess risk of bias in the included studies. METHODS: We included studies focusing on conventional medical treatment using cannabis-based products, approved by a physician for a particular health issue. RESULTS: Of the 1230 articles identified in the initial search, eight articles were included in the review. Following the compilation of themes in the eligible studies, six themes were identified: (1) MC approval; (2) administrative barriers; (3) social perception; (4) MC misuse/widespread effect; (5) adverse effects; and (6) dependence or addiction. These were grouped into two meta-themes: (1) administrative and social aspects of MC use; and (2) experiences of the effects of medicinal cannabis. CONCLUSIONS: Our findings call for specific attention to unique consequences associated with MC use. Further research is needed in order to assess the degree to which negative experiences associated with MC use may affect various aspects of patients' medical condition. RELEVANCE TO CLINICAL PRACTICE: Describing the complex experience of MC treatment and its spectrum of consequences for patients may enable physicians, therapists and researchers to provide more attentive and accurate MC treatment to their patients. PATIENT OR PUBLIC CONTRIBUTION: In this review, patients' narratives were explored, yet the research methods did not directly involve patients or the public.

[AN INSTRUMENT TO ASSESS HOSPITAL NURSES' PERCEIVED SELF-EFFICACY IN PROVIDING PALLIATIVE END-OF-LIFE CARE: A VALIDATION STUDY]

BACKGROUND: The trend of increasing numbers of terminally ill patients hospitalized in general wards requires nursing staff to be able to provide palliative care (PC). The self-efficacy (SE) to provide PC was found to be a leading factor predicting future professional behavior. There is no tool in the Hebrew language to evaluate SE for symptoms management and provision of psychosocial care within the PC. OBJECTIVES: To validate a Hebrew version of the "Palliative Care Self-Efficacy Scale )PCSES)" among nursing staff employed in various hospital wards. METHODS: A cross-sectional study was performed among nursing staff employed at four Israeli hospitals in oncology, internal medicine, surgical and emergency care wards. RESULTS: The PCSES questionnaire was translated into Hebrew and was completed by 588 nurses. Cronbach's alpha coefficients for the translated tool were high: 0.89 for the tool as a whole, 0.82 for the scale regarding ability to deal with questions regarding end-of-life care, and 0.85 for the symptoms management scale. As in the original tool, two factors that in combination explain 58.6% of the variance were found: ability to deal with questions regarding end-of-life care (46.43%) and symptoms management (12.2%). CONCLUSIONS: The psychometric characteristics of this tool demonstrate that it can be used to estimate SE in providing PC among nurses employed in various hospital wards. DISCUSSION: This tool should be used and evaluated among additional professionals involved in providing PC. It should also be tested as a method to identify changes in SE over time.

Electronic Distance Learning of Pre-clinical Studies During the COVID-19 Pandemic: A Preliminary Study of Medical Student Responses and Potential Future Impact.

BACKGROUND: Social distancing, implemented to decrease the spread of coronavirus disease-2019 (COVID-19), forced major changes in medical practices, including an abrupt transition from face-to-face to remote patient care. Pre-clinical medical studies were concomitantly switched to electronic distance learning. OBJECTIVES: To explore potential implications of COVID-19 on future pre-clinical medical studies. METHODS: We examined responses of pre-clinical medical students to the remote electronic learning in terms of quality of and satisfaction with teaching and technical support, attendance to classes, and the desire to continue electronic learning in the post-epidemic era. A survey of responses from first-year students at the Adelson School of Medicine was conducted. To optimize the reliability of the survey, a single research assistant conducted telephone interviews with each student, using a structured questionnaire concerning aspects of participation and satisfaction with teaching and with technical components of the remote electronic learning. RESULTS: With 100% response rate, the students reported high satisfaction with the electronic learning regarding its quality, online interactions, instructions given, technical assistance, and availability of recording for future studies. Most of the students (68.6%) noted a preference to continue < 90% of the learning online in the post-outbreak era. A high level of overall satisfaction and a low rate of technical problems during electronic learning were significantly correlated with the desire to continue online learning (P < 0.01). CONCLUSIONS: The high satisfaction and the positive experience with the electronic distance learning imposed by the COVID-19 epidemic implied a successful transition and might induce future changes in pre-clinical medical studies.

Mastery avoidance: An overlooked aspect of medical students' motivation.

Background: Previous research on medical students' motivation mostly overlooked an important concept, namely, mastery-avoidance goals. The mastery-avoidance goal is defined as engaging in a task to avoid losing knowledge or skills that have already been acquired. We aimed to explore the role of mastery-avoidance goals in changes occurring in low frustration tolerance (LFT) levels over a span of one academic year. This approach enables us to understand which type of motivational orientation is expected to explain most adaptive educational outcomes. Methods: First year medical students (n = 241) participating in a physician-patient communication course completed the surveys of motivational orientations and LFT at the beginning and at the end of the academic year. A confirmatory factor analysis supported the construct validity of the motivational orientations structure. Results: Cross-lagged analysis using structural equation modelling revealed that the mastery-approach goal was negatively related to the progression of LFT while mastery-avoidance goal was positively related. Conclusions: The findings suggest that what matters is not merely the level of motivation, but rather the type of motivational orientations that students pursue. Encouraging students to improve their current skills, while discouraging competitiveness and reducing fear of losing competence, may enhance the effectiveness of medical training programmes.

Nurses' perceptions of their relationships and communication with lesbian women seeking perinatal care.

AIMS AND OBJECTIVE: To examine whether nurses' assessment of their relationships and communication with lesbian women seeking perinatal care is associated with their personal and professional characteristics and knowledge of homosexuality. BACKGROUND: Recently, there has been a growing incidence of same-sex parenthood. Nurses administer health care to lesbian women from pregnancy planning through birth, providing consultation. Although there has been a shift in attitudes towards homosexuality, discrimination is still quite common. DESIGN: This research is part of a larger cross-sectional study carried out at women's healthcare centres, concerning nurses' perceived quality of perinatal care provided to lesbian women. METHODS: The study was conducted from December 2015-April 2016 at women's health centres in Israel encompassing 184 registered nurses who completed self-report questionnaires. They were assessed as to their knowledge of homosexuality and nurse-patient relationships and communication. The Squire checklist was used. RESULTS: Most (73.4%) had prior acquaintance with lesbian women; only 17.9% had been educated as to lesbian women's unique health needs; of these, 66.7% thought that they had been given professional tools for working with lesbian women; 60.4% were unaware of the importance of knowing the patient's sexual orientation. The average score on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. A significant positive correlation was found between nurses' knowledge of homosexuality and assessment of their relationships and communication with lesbian women seeking perinatal care. In addition, nurses' personal and professional characteristics, such as place of birth, religiosity and familiarity with lesbian women, were related to their assessment of their relationships and communication. CONCLUSION: Nurses' knowledge of homosexuality and personal and professional characteristics were associated with their perceptions regarding relationships and communication with lesbian women seeking perinatal care. RELEVANCE TO CLINICAL PRACTICE: Further training might broaden, refine rigid perceptions and contribute to advancing equal perinatal nursing care of lesbian women.

Losses and Gains of Psychosocial Resources: Effects on Stress Among Women Undergoing Infertility Treatments and Participating in Social Network Systems.

This theory-driven study assessed the association between infertility-related stress and perceived losses of psycho-social resources; and the buffering effect of resource gains and type of infertility (primary/secondary) on this relationship, among women who participate in online infertility-related social network systems (SNS). Ninety women participating in infertility-related SNS completed online questionnaires assessing resource losses and gains and stress levels. Results: Resource loss significantly predicted stress (ß = .66, p < .001). Resource loss and the number of children were correlated negatively (r = -.22, p < .05). Residency was significantly related to resource loss (r = -.23, p < .05) and perceived stress (r = -.23, p < .05). Israeli participants reported lesser resource loss and lesser perceived stress, compared to participants from other countries. Surprisingly, neither resource gains related to SNS participation nor infertility-type served as moderators in the relationship between resource loss and stress. The association between resource loss and stress supports COR theory formulation of stress etiology. However, while participants noted significant resource gains from use of SNS, these did not buffer the effects of resource loss on stress. Thus, although it may be enticing to turn to SNS for social support, individuals with infertility need to be encouraged to use face-to-face social support too.

Quality of life of adult daughters of women with schizophrenia: Associations with psychological resource losses and gains.

OBJECTIVE: This study examined the relationship between perceived losses and gains of psychological resources and quality of life of adult daughters of women with schizophrenia. METHOD: Thirty one adult daughters of mothers with schizophrenia (age range 30 to 50years) and thirty women of similar socio-demographic characteristics whose mothers were mentally healthy (the control group) participated in this study. RESULTS: (a) Resource loss was higher and resource gains were lower among daughters of women with schizophrenia, compared to the control group; (b) despite resource gains total score of quality of life was significantly lower among daughters of mothers with schizophrenia compared to the controls; (c) daughters of mothers with schizophrenia had lower levels of family functioning, a higher level of negative emotions and a lower level of positive emotions; (d) resource gains moderated the negative relationship between resource loss and quality of life; (e) the most significant predictor of quality of life was the group (i.e. daughters of women with schizophrenia compared with controls); (f) quality of life was more strongly associated with resource loss than with resource gain. DISCUSSION: The findings of this research underscore the importance of raising awareness of caregivers and healthcare authorities to the needs of the unique population of daughters of women diagnosed with schizophrenia for support and even treatment.

Communication skills training in medical students: do motivational orientations predict changes over time in psychosocial attributes?

Perceived psychosocial abilities (i.e., competence in addressing the psychosocial aspects of patient care) and low frustration tolerance (LFT) (i.e., intolerance of physical or emotional discomfort) have been established as significant attributes of experienced medical professionals. We aimed to expand our understanding of the role motivation plays within communication skills training by investigating whether motivation precedes or, conversely, follows psychosocial attributes. According to goal orientations theory, motivation denotes the goals students pursue when engaging in learning tasks. We hypothesized that goal orientations would predict development of psychosocial attributes. More specifically, an adaptive goal orientation (i.e., mastery goal orientation) was expected to predict perceived psychosocial abilities, whereas the maladaptive goal orientations (i.e., performance-approach and avoidance goal orientations) were hypothesized to predict LFT (frustration intolerance). The study spanned two sequential years, in which two cohorts of first-year medical students (N = 151) completed questionnaires at the beginning and end of an annual physician-patient communication course. The questionnaires assessed goal orientations, perceived psychosocial abilities, and LFT. Cross-lagged analyses using Structural Equation Modeling indicated that goal orientations significantly predicted perceived psychosocial abilities, as hypothesized; however, LFT predicted maladaptive goal orientation, rather than the other way around. These findings provided further support for the contribution of goal orientations theory within medical education contexts. Medical schools are advised to consider motivational aspects when planning and implementing training programs.

Is burnout associated with referral rates among primary care physicians in community clinics?

BACKGROUND: There is little empirical research examining the effects of burnout on objective measures of primary care physicians' behaviour in the medical encounter. OBJECTIVES: We studied possible associations between primary care physicians' burnout and the rates of referrals. We conceptualized referral rate as a negative outcome of burnout because high and unnecessary referral rates incur extra costs to health care systems. METHODS: In this cross-sectional study, 136 primary care physicians in one district of one Israeli health maintenance organization (HMO) completed the Maslach Burnout Inventory in the presence of an interviewer. Data on each physician's objective workload and number of referrals for high- and low-cost imaging tests, specialist clinics and treatments by nurses were collected from the HMO's databases. RESULTS: Due to high correlations between referral rate indicators, a Confirmatory Factor Analysis revealed one factor: 'referrals for diagnostic tests and specialist clinics'. Path Analysis using Structural Equation Modelling explained a total of 18.1% of referral rate variance, with board-certified specialist mostly associated (ß = 0.31, P < 0.01), followed by burnout (ß = 0.20, P < 0.05) and objective workload (ß = 0.18, P < 0.05). CONCLUSIONS: In this preliminary investigation, we found that referral rates for diagnostic tests and specialist clinics increased independently for board-certified specialists (compared with GPs), for those with higher burnout levels and when objective workload increases. These findings support the conceptualization of referrals rates as objectively measured negative outcomes of burnout. Further replications with other objective outcomes, additional HMOs and bigger samples are warranted.

Reporting misconduct of a coworker to protect a patient: a comparison between experienced nurses and nursing students.

PURPOSE: Whistleblowing is the reporting of illegal, immoral, or illegitimate practices to persons or organizations that may affect the action. The current study compares experienced nurses to nursing students regarding their willingness to blow the whistle to protect a patient's interests. METHODS: 165 participants were divided into two groups: 82 undergraduate nursing students and 83 experienced nurses. Participants responded to two vignettes that described a colleague's and a manager's misconduct at work. RESULTS: The nursing students perceived the severity of the misconduct significantly lower compared to the experienced nurses. The nursing students also ranked the internal and external whistleblowing indices higher than the nurses, but the differences did not reach statistical significance. For each of the examined internal and external indices, professional experience was found to be significant in multivariate regression analyses. CONCLUSIONS: Even though nursing students perceived the severity of the misconduct significantly lower than the experienced nurses, the students demonstrated a greater readiness to blow the whistle, both internally and externally. Recommendations for handling comparable situations are offered.

Cognitive flexibility in women who recovered from anorexia nervosa - a model-based approach.

Research findings on cognitive flexibility (CF) functioning in women who recovered from anorexia nervosa (RAN) were found to be inconsistent. This was attributed to the multiple definitions of CF and the diverse measuring tools used to assess it. Applying a deductive approach to explore CF function may address these inconsistencies; thus, we used a model that divides CF into three subtypes, namely, stimulus-response mapping, switching sets and task switching. Additionally, we explored the association between CF subtypes and the disorder's clinical measures to assess the relation of CF to recovery. Forty-three RAN and 54 healthy controls performed tasks designed to assess CF subtypes based on the model's division, and the RAN group completed the Eating Disorder Examination Questionnaire. The results showed that the RAN group performed significantly worse than controls only in the stimulus-response mapping subtype. Additionally, there were no correlations between CF subtypes and clinical symptoms or the disorder measures - current and nadir body mass index, age of onset, time since recovery, and disorder duration. In conclusion, the study revealed CF impairment after recovery from AN, specifically in stimulus-response mapping. The variability in performance of the CF subtypes supports the application of a theory-driven perspective viewing CF as a modular ability in RAN. Additionally, CF is unrelated to clinical measures post-recovery and thus may not be used as a criterion for evaluating recovery.

The vagina dialogues: genital self-image and communication with physicians about sexual dysfunction and dissatisfaction among Jewish patients in a women's health clinic in southern Israel.

INTRODUCTION: The health-care system offers a variety of solutions for problems related to sexual dysfunction. To gain access to treatment options, women must be willing to discuss these issues with their physicians. AIM: To examine the extent to which women discuss issues of sexual dysfunction with their physicians and to examine the contribution of aspects of sexual dysfunction, level of satisfaction, body image, and genital self-image to their comfort with communicating with physicians about these issues. METHODS: One hundred ten secular-appearing, Hebrew-speaking Jewish women waiting for a routine gynecological appointment at a clinic in southern Israel responded to a self-report questionnaire. MAIN OUTCOME MEASURES: The Female Sexuality Function Index was used to assess sexual dysfunction, Gray's Modified Questionnaire to assess body image, and the Genital Self-Image Scale to assess genital self-image. We compiled a new measure to assess level of comfort in discussing sexual functioning and satisfaction with a physician. RESULTS: Forty-four percent of the women had discussed sexual functioning issues with a gynecologist. Of those, 91.7% reported that the gynecologist initiated the discussion. The proportion of participants who would consult a gynecologist about sexual dysfunction was 74.5%, but only 41% would consult a family physician. Half of the women would expect a gynecologist to initiate such consultations, but only 20% would expect a family physician to do so. In a multivariate regression analysis, genital self-image was the only significant predictor of women's comfort level with discussing sexual dysfunction with a gynecologist. CONCLUSIONS: The respondents perceived the gynecologist, rather than the family physician, as an appropriate professional to consult regarding sexual dysfunction. However, they expected the gynecologist to initiate the discussion. Women with a positive genital self-image are more comfortable in consulting about sexual dysfunction. Gynecologists should be made aware of their significant role in eliciting women's cooperation in such consultations and in contributing to improving women's genital perception.

The Relationship between Socio-Demographic Factors, Preventive Health Behaviors and Acceptance of COVID-19 Vaccine among Israeli Pregnant Women during the Coronavirus Pandemic.

BACKGROUND: The outbreak of the Coronavirus disease led the World Health Organization to publish recommendations regarding preventive health behaviors (PHB). Pregnant women are at a higher risk of severe COVID-19 infection and adherence to these recommendations is critical. There are little data regarding PHB among pregnant women. The current study aims to evaluate the contribution of socio-demographic factors and COVID-19 vaccinations in predicting PHB among pregnant women. METHOD: 202 pregnant Israeli women (mean age = 30.8 years) participated in an online survey in 2021. RESULTS: 88% of the women were vaccinated and few had been infected. Of the women, 75.2% reported wearing face masks in closed spaces, while 12.4% reported wearing masks outdoors; 63.9% of the women did not travel abroad for fear of infection by the virus and 51% avoided crowded events. A simultaneous regression analysis to predict PHB indicated that pregnancy week and Coronavirus vaccination significantly and positively predicted PHB, but religious status was a negative predictor. Age, number of children, and level of education were not associated with PHB. CONCLUSIONS: These findings can be helpful as a preliminary evidence base for policy-making at present and for future epidemics regarding guidelines on PHB adjusted for pregnant women.

Physician-Patient Communication Course: When the Inauguration of a New Israeli Medical School Coincided with COVID-19 Pandemic.

Purpose: The curriculum of the Adelson School of Medicine at Ariel University, the newly established sixth medical school in Israel, includes a simulation center-based extended course on physician-patient communication, aiming to help students master the core competency of interpersonal and communication skills. For more than a year following the emergence of the COVID-19 pandemic, the school suspended most face-to-face (F2F) encounters, transforming most teaching activities to remote platforms. The paper outlines the ways we adapted teaching of this course to these circumstances, the reactions of students and mentors to the changes and results of 1st year students' survey. Methods: During the lockdown in the first year 48 of 70 first-year students participated in a voluntary anonymous online evaluation of the course assessing motivation to become a physician; perceptions, feelings and attitudes towards the communication course, and advantages and disadvantages of online and F2F medical interviews. Results: 46.1% of the responding students reported that the pandemic strengthened their desire to become physicians. 56.3% claimed that they were able to a relatively large extent to empathize with COVID-19 patients who were exposed to the virus; 79.1% viewed their mentors as positive role models of communication skills. The students were able to receive and offer social support to their peers. They evaluated very highly the short instructional videos produced by the faculty. Conclusion: During the lockdown, the respondents generally indicated positive attitudes towards the communication course, the mentors and the inclusion of physician-patient communication as a topic in medical education. The students and mentors reported many disadvantages and few advantages of remote learning. Yet inevitably remote learning including online-based simulations is a step towards preparations for future practice within virtual medical care and telemedicine. The limitations of this study include the cross-sectional design, small sample size and self-reporting.

Coping with preoperative anxiety in cesarean section: physiological, cognitive, and emotional effects of listening to favorite music.

BACKGROUND: Listening to music has a stress-reducing effect in surgical procedures. The effects of listening to music immediately before a cesarean section have not been studied. The objective of this study was to assess the effects of listening to selected music while waiting for a cesarean section on emotional reactions, on cognitive appraisal of the threat of surgery, and on stress-related physiological reactions. METHODS: A total of 60 healthy women waiting alone to undergo an elective cesarean section for medical reasons only were randomly assigned either to an experimental or a control group. An hour before surgery they reported mood, and threat perception. Vital signs were assessed by a nurse. The experimental group listened to preselected favorite music for 40 minutes, and the control group waited for the operation without music. At the end of this period, all participants responded to a questionnaire assessing mood and threat perception, and the nurse measured vital signs. RESULTS: Women who listened to music before a cesarean section had a significant increase in positive emotions and a significant decline in negative emotions and perceived threat of the situation when compared with women in the control group, who exhibited a decline in positive emotions, an increase in the perceived threat of the situation, and had no change in negative emotions. Women who listened to music also exhibited a significant reduction in systolic blood pressure compared with a significant increase in diastolic blood pressure and respiratory rate in the control group. CONCLUSION: Listening to favorite music immediately before a cesarean section may be a cost-effective, emotion-focused coping strategy. (BIRTH 39:2 June 2012).

Can achievement goal theory provide a useful motivational perspective for explaining psychosocial attributes of medical students?

BACKGROUND: Psychosocial competence and frustration tolerance are important characteristics of skilled medical professionals. In the present study we explored the usefulness of applying a comprehensive motivational theory (Goal orientations), for this purpose. According to goal orientation theory, learning motivation is defined as the general goals students pursue during learning (either mastery goals - gaining new knowledge; or performance goals - gaining a positive evaluation of competence or avoiding negative evaluation). Perceived psychosocial abilities are a desirable outcome, and low frustration tolerance (LFT), is a negative feature of student behavior. The hypothesis was that the mastery goal would be positively associated with psychosocial abilities while performance goals would be positively associated with LFT. METHODS: 143 first-year medical students completed at the end of an annual doctor-patient communication course a structured questionnaire that included measures of learning goal orientations (assessed by Pattern of Adaptive Learning Scale - PALS), psychosocial abilities (assessed by Psychological Medicine Inventory- student version -PMI-S) and Low Frustration Tolerance (LFT). RESULTS: All study variables were found reliable (Cronbach's α ranged from .66 to .90) and normally distributed. Hierarchical multiple regression analysis revealed significant associations supporting the hypotheses. The mastery goal orientation was positively associated with perceived psychosocial abilities (PMI-S) (ß = .16, p < .05) and negatively associated with low frustration tolerance (ß = -.22, p < .05) while performance goal orientation was significantly associated with low frustration tolerance (ß = .36, p < .001). CONCLUSIONS: The results suggest that the goal orientations theory may be a useful theoretical framework for understanding and facilitating learning motivation among medical students. Limitations and suggestions for practice within medical education context are discussed.

Nurses' Perceptions of the Quality of Perinatal Care Provided to Lesbian Women.

Aim: Based on the Theory of Reasoned Action (TRA), we examined whether attitudes of nurses from different ethnic groups, subjective norms, behavioral intentions, assessments of relationships and communication were associated with their perceptions of the quality of perinatal care provided to lesbian women. Background: Nurses administer healthcare, provide pertinent information and consultation to lesbians from pregnancy planning through birth. Introduction: During the past few decades, worldwide, there has been a rise in lesbian-parenting. Despite the changes in Israeli society's public and legal reality, intolerance and discrimination to the homosexual population is still prevalent in Israel's healthcare system. Methods: A cross-sectional study conducted between 12/2015-4/2016. Of the 270 nurses approached, 184 completed a self-report anonymous questionnaire (a response rate of 74%). Findings: This is an important and timely study reflecting nurses' perceptions of the quality of perinatal care provided to lesbians. The study findings reflect that attitudes, subjective norms, behavioral intentions, assessments of relationships and communication of nurses from different ethnic groups are associated with their perceptions of the quality of perinatal care provided to the lesbians. The hierarchical regression analysis demonstrated that attitudes, subjective norms, behavioral intentions, assessments of relationships and communication of nurses contributed 56% to the variance of nurses' perception of their own quality of perinatal care. Discussion: TRA conceptualization predicted the quality of care of nurses from different ethnic groups treating lesbians in a perinatal setting. Conclusion: TRA provides a useful framework for understanding and predicting the motivational effect of health care personnel with the lesbian population, being at risk for stigmatization and receiving less quality perinatal care. Implications for nursing and heath policy: Our findings revealed the importance of formulating a recognized policy in the field of LGBT medicine at the national level. Further training of nurses as to the lesbians' unique health needs, might improve the nurses' relationships and communication as well as the quality of perinatal nursing care.

Implicit and explicit attitudes toward gay men and lesbian women among heterosexual undergraduate and graduate psychology and nursing students.

Objectives: To examine implicit and explicit attitudes toward gay men and lesbian women among heterosexual undergraduate and graduate psychology and nursing students. Methods: Implicit attitudes were measured via the Implicit Association Test and explicit attitudes via the Attitudes Toward Lesbian Women and Gay questionnaire. Main results: All groups held negative implicit attitudes toward gay men and lesbian women. Among undergraduates, nursing students reported holding more negative explicit attitudes toward gay men and lesbian women than psychology students. Conclusion: The curricula in both nursing and psychology studies need to address the medical and paramedical needs and issues of sexual minorities.