The Impact of Primary Care Providers' Bias on Depression Screening for Lesbian Women.

Primary care providers' (PCPs) implicit and explicit bias can adversely affect health outcomes of lesbian women including their mental health. Practice guidelines recommend universal screening for depression in primary care settings, yet the guidelines often are not followed. The intersection of PCPs' implicit and explicit bias toward lesbian women may lead to even lower screening and diagnosis of depression in the lesbian population than in the general population. The purpose of this secondary analysis was to examine the relationship between PCPs' implicit and explicit bias toward lesbian women and their recommendations for depression screening in this population. PCPs (n = 195) in Kentucky completed a survey that included bias measures and screening recommendations for a simulated lesbian patient. Bivariate inferential statistical tests were conducted to compare the implicit and explicit bias scores of PCPs who recommended depression screening and those who did not. PCPs who recommended depression screening demonstrated more positive explicit attitudes toward lesbian women (p < .05) and their implicit bias scores were marginally lower than the providers who did not recommend depression screening (p = .068). Implications for practice: Depression screening rates may be even lower for lesbian women due to implicit and explicit bias toward this population. Training to increase providers' awareness of bias and its harm is the first step to improve primary care for lesbian women. Policies must protect against discrimination based on sexual orientation or gender identity.

To stay or leave: Public health nurse workforce retention in North Carolina.

States across the country have been experiencing a steady decline in public health nursing workforce, including North Carolina (NC). OBJECTIVES: To better understand retention in the NC Public Health Nurses (PHNs) workforce through an assessment of perceptions of the working environment, stress, intent to stay, and job satisfaction. DESIGN: A cross-sectional online survey using closed and open-ended questions. SAMPLE: The study population comprised of non-supervisory PHNs (n = 672) working at NC local health departments (LHD). MEASUREMENTS: Retention problem, working environment, and job satisfaction measures were adapted from the revised Casey-Fink Registered Nurse Retention Survey© (2009) to fit public health settings. RESULTS: Despite high levels of job satisfaction (79.76%, n = 473), 53% of respondents (n = 323) acknowledged a retention problem within their LHD; 35.32% (n = 203) planned to/considered leaving their position in the next 3 years for reasons other than retirement. ANOVAs and Kruskal Wallis Test results showed that those planning to leave had statistically lower scores on perceived working environment and job satisfaction and demonstrated higher negative stress levels. CONCLUSION: Like other states, NC is experiencing a PHN shortages predicted to worsen in coming years. To retain the current workforce, LHDs need to work to improve PHNs working environment, increase PHNs' pay, and alleviate stressors.

Resilience in Nurses: The Reliability and Validity of the Resilience ScaleTM.

Background and Purpose: The Resilience ScaleTM (RS) RS-25 and shortened RS-14 have measured resilience but not with nurses. Our purpose was to investigate both for nurses. Methods: A random sample of 345 registered nurses from the North Carolina Board of Nursing completed an online questionnaire. Parallel analysis, factor analysis, and receiver operating characteristic analysis were performed. Results: Previous RS factor models had poor confirmatory factor analysis fit. Exploratory factor analysis and item analyses suggested removing items. Good fit was found for an "RS-13" using a bifactor approach. Adequate internal consistency was demonstrated (omega = 0.77-0.90). The RS-13 general factor gave similar accuracy for bullying, physical and mental quality of life, stress, and intent to leave. Conclusions: A shortened RS is comparable in reliability, construct, and convergent validity. It measures nurse resilience well.

Factors in the Perioperative Nurses' Work Environment That Predict Work Engagement.

Perioperative nurse engagement and certification are associated with a culture of safety, which is crucial in perioperative environments. Therefore, examining relationships between engagement, the practice environment, and certification is warranted. The purposes of this study were to examine the relationships between the perioperative practice environment and reported nurse engagement, determine differences in engagement based on certification, and identify facilitators and barriers to attaining and sustaining certification. In this multiphase mixed-methods study, we used a convenience sample of perioperative nurses (N = 379) to examine relationships between engagement, the practice environment, and certification. Qualitative interviews were conducted (n = 15) to supplement the quantitative findings. Leadership support (ß = 0.23, P = .001) and nursing foundations for quality care (ß = 0.21, P = .01) were significant predictors of engagement. Certified nurses did not have significantly higher mean engagement scores when compared with noncertified peers. Qualitative interviews corroborated the findings.

Development and Psychometric Evaluation of a Food Resource Acceptability Questionnaire.

The stigma associated with food assistance is a significant barrier to resolution of food insecurity. Interventions and policies aimed at reducing food insecurity would benefit from the inclusion of strategies aimed at minimizing food assistance stigma. We developed the Food Resource Acceptability Questionnaire (FRAQ), a scale that measures the perceptions of stigma associated with food assistance. Qualitative interviews, modified Delphi technique, and exploratory factor analysis were used to develop and evaluate the 17-item scale. The FRAQ consists of two subscales (stigma and the belief that food is a basic right) to measure the likelihood of individuals perceiving food assistance as socially and culturally acceptable. Cronbach's alphas were 0.85, 0.80, and 0.89 for the Stigma subscale, Food as a Basic Right subscale, and the overall FRAQ, respectively. Additional research is needed to determine the applicability of the FRAQ in diverse populations.

Psychological factors among Appalachian women with abnormal Pap results.

PURPOSE: Women who receive an abnormal Pap result may experience negative psychological factors. The purpose of this study is to assess the baseline occurrence of negative psychological factors and evaluate the relationships between psychological factors and demographic characteristics among Appalachian women who received abnormal Pap results. METHODS: We conducted a secondary analysis of data collected from Appalachia Kentucky women (N = 521) ages ≥18 enrolled in an intervention. Data included sociodemographics, Beck depression and anxiety inventories, fatalism, and personal control measures. Multiple variable logistic regression was used to investigate the association between demographics and psychological factors. FINDINGS: Participants were predominantly White (96.2%), with mean age 28.93 ± 11.03 years, and the majority (77%) had yearly income below $20,000. Depression was reported by 34.6% (n = 173); 10% (n = 50) experienced moderate or severe anxiety; 20.6% (n = 107) had fatalistic beliefs; and 55.1% (n = 289) believed they lacked personal control over cancer. Women with lower income had higher occurrence of depression (P = .003). Women with moderate to severe anxiety were significantly older than those with low to moderate depression (34.44 vs 28.34, P < .001). Controlling for other variables, as age increased, the odds of fatalistic beliefs increased, OR (95%) = 1.042 (1.022, 1.062). When education level increased, the odds of fatalistic beliefs decreased, OR (95%) = 0.873 (0.800, 0.952). CONCLUSIONS: Given the high occurrence of depression, anxiety, and fatalistic beliefs among this population, health care providers should assess for underlying mental health diagnoses and psychological distress during each patient encounter and provide recommendations to address them.

Pattern Recognition of the COVID-19 Pandemic in the United States: Implications for Disease Mitigation.

The novel coronavirus (COVID-19) pandemic presents a severe threat to human health worldwide. The United States (US) has the highest number of reported COVID-19 cases, and over 16 million people were infected up to the 12 December 2020. To better understand and mitigate the spread of the disease, it is necessary to recognize the pattern of the outbreak. In this study, we explored the patterns of COVID-19 cases in the US from 1 March to 12 December 2020. The county-level cases and rates of the disease were mapped using a geographic information system (GIS). The overall trend of the disease in the US, as well as in each of its 50 individual states, were analyzed by the seasonal-trend decomposition. The disease curve in each state was further examined using K-means clustering and principal component analysis (PCA). The results showed that three clusters were observed in the early phase (1 March-31 May). New York has a unique pattern of the disease curve and was assigned one cluster alone. Two clusters were observed in the middle phase (1 June-30 September). California, Texas and Florida were assigned in the same cluster, which has the pattern different from the remaining states. In the late phase (1 October-12 December), California has a unique pattern of the disease curve and was assigned a cluster alone. In the whole period, three clusters were observed. California, Texas and Florida still have similar patterns and were assigned in the same cluster. The trend analysis consolidated the patterns identified from the cluster analysis. The results from this study provide insight in making disease control and mitigation strategies.

The Adaption of the Work Environment Survey for Public Health Nurses.

The study presents the iterative process of the adaption and psychometric properties evaluation of the Work Environment/Support/Encouragement section of the Revised Casey-Fink Nurse Retention Survey© (2009) to measure the work environment of public health nurses (PHNs). This secondary data analysis was based on data collected from a convenience sample of 596 PHNs across North Carolina that were originally used to study PHNs workforce retention. Classical test theory analyses were used to evaluate scale reliability and identify potential problematic items that were further examined from a substantive perspective using content validity survey. Confirmatory factor analysis and exploratory factor analysis were performed to evaluate the construct validity and assist further development of the scale. Analyses suggest a three-factor structure for the retained 19-item scale including managerial support, professional nursing role, and recognition, with reliability ranging from alpha of .859 to .959.

Auditory and speech processing and reading development in Chinese school children: behavioural and ERP evidence.

By measuring behavioural performance and event-related potentials (ERPs) this study investigated the extent to which Chinese school children's reading development is influenced by their skills in auditory, speech, and temporal processing. In Experiment 1, 102 normal school children's performance in pure tone temporal order judgment, tone frequency discrimination, temporal interval discrimination and composite tone pattern discrimination was measured. Results showed that children's auditory processing skills correlated significantly with their reading fluency, phonological awareness, word naming latency, and the number of Chinese characters learned. Regression analyses found that tone temporal order judgment, temporal interval discrimination and composite tone pattern discrimination could account for 32% of variance in phonological awareness. Controlling for the effect of phonological awareness, auditory processing measures still contributed significantly to variance in reading fluency and character naming. In Experiment 2, mismatch negativities (MMN) in event-related brain potentials were recorded from dyslexic children and the matched normal children, while these children listened passively to Chinese syllables and auditory stimuli composed of pure tones. The two groups of children did not differ in MMN to stimuli deviated in pure tone frequency and Chinese lexical tones. But dyslexic children showed smaller MMN to stimuli deviated in initial consonants or vowels of Chinese syllables and to stimuli deviated in temporal information of composite tone patterns. These results suggested that Chinese dyslexic children have deficits in auditory temporal processing as well as in linguistic processing and that auditory and temporal processing is possibly as important to reading development of children in a logographic writing system as in an alphabetic system.