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To provide an effective, multidimensional, and psychometrically valid measure to screen for distress among people with HIV, we developed and assessed the psychometric properties of HIV Support Source, a distress screening, referral, and support program designed to identify the unmet needs of adults with HIV and link them to desired resources and support. Development and testing were completed in three phases: (1) item generation and initial item pool testing (N = 375), (2) scale refinement via exploratory factor analysis (N = 220); external/internal item quality, and judging theoretical and practical implications of items, and (3) confirmatory validation (N = 150) including confirmatory factor analysis along with reliability and validity analyses to corroborate dimensionality and psychometric properties of the final measure. Nonparametric receiver operating characteristic (ROC) curve analyses determined scoring thresholds for depression and anxiety risk subscales. The final measure comprises 17-items representing four domains of concern: emotional well-being, financial and practical needs, physical well-being, and HIV treatment and sexual health, plus one screening item assessing tobacco and substance use. Our analyses showed strong internal consistency reliability, a replicable factor structure, and adequate convergent, discriminant, and known groups validity. Sensitivity of 2-item depression and 2-item anxiety risk subscales was 0.90 and 0.79, respectively. HIV Support Source is a reliable and valid multidimensional measure of distress that also screens for risk for clinically significant depression and anxiety. It can be implemented within a distress screening, referral, and follow-up program to rapidly assess and support the unmet needs of adults with HIV. [ABSTRACT FROM AUTHOR]

Background: Adolescent and young adult (AYA) females in low- and middle-income countries often face disparities in menstrual health (MH). Poor MH and lack of sexual and reproductive health education leads to school absenteeism, increasing risk for adverse psychosocial and educational outcomes. Further, disasters (e.g., earthquakes) are linked with unsafe living environments and sanitation facilities for women. We sought to describe MH perspectives and practices among AYAs in rural Haiti. Methods: We conducted a cross-sectional survey in two rural communities in Haiti. AYA females aged 14–24 years completed questions on demographics, the Menstrual Practice Needs Scale (36 items; MPNS-36) and the Menstrual Practices Questionnaire (4 items). We performed descriptive statistics and Chi square or Fisher's Exact tests to compare responses among sub-groups. Results: Among 200 respondents, the median age was 20 years (IQR 17–22). 51% (95% CI 44%, 58%; 102/200) were currently attending school at least 3 days/week and 97% (94%, 99%; 193/200) were not married. According to the MPNS-36, 68% (62%, 74%; 136/200) of participants had unmet MH needs. Seventy-one (77%) reused some of their menstrual materials during their last menstruation. During their last menstruation, 44% (37%, 50%; 87/200) reported they often or always skipped school because they had their menses, and 31% (25%, 37%; 62/200) sometimes skipped. Many felt always or often worried that someone or something would harm them while they were changing their menstrual materials at home and at school. Conclusions: Among AYAs in rural Haiti, three-quarters reported menses-related school absenteeism and two-thirds had unmet MH needs. AYA females often lacked a safe environment to change their menstrual materials. Given recent disasters in Haiti, (August 2021 earthquake), safe environments for MH are critically needed to offset risk for poor psychosocial and health outcomes. Future efforts to improve MH among AYAs in Haiti are needed to ensure access to MH resources and school attendance. Plain language summary: Adolescents and young adult (AYA) females in low- and middle-income countries can often lack adequate access to materials to manage their menstruation, in addition to safe spaces to change those materials. This lack of access, in addition to low levels of reproductive health education, can cause AYAs to miss school, leading to increased risk of worse psychosocial and educational outcomes. In addition, disasters (e.g., earthquakes) are linked with unsafe living environments and sanitation facilities for women. We sought to describe AYA menstrual practices and perspectives on menstrual hygiene in rural Haiti. In two rural communities in Haiti, AYA females aged 14–24 years answered questions on their demographics and menstrual hygiene practices and environments. Two-thirds of AYAs had unmet menstrual hygiene needs and three-quarters reported they skipped school (with any frequency) due to their menses. Further, more than half worried that something or someone would harm them while they were changing their menstrual materials at home and at school. AYA females often lacked a safe environment to change their menstrual materials. Given recent disasters and political unrest in Haiti, (August 2021 earthquake), it is important to improve menstrual hygiene in these LMICs to ensure safe enviornments for managing menstruation and school attendance and ultimately improve psychosocial and health outcomes. [ABSTRACT FROM AUTHOR]

Background: Job satisfaction is significantly associated with retention. Although several factors are associated with job satisfaction and retention (pay, leadership, mentorship), the association of demographic characteristics has been understudied in the literature. Purpose: To explore whether professional role and demographic characteristics are associated with job satisfaction and intent to stay among nurses and physicians in a military medical center. Methods: We conducted a descriptive, exploratory, cross‐sectional study, and collected data via surveys. We used multiple regression to evaluate study variables. Results: Two hundred and eighty‐nine participants completed the survey. Professional role and demographic characteristics were not associated with job satisfaction. Professional role, race, and education were associated with intent to stay for military respondents. Physicians (β = 0.53, p =.0259) and Caucasians (β = −0.55, p =.0172) reported lower intent to stay; respondents with graduate degrees reported higher intent to stay (β = 2.47, p =.0045). Professional role and demographic characteristics were not associated with intent to stay for civilians. Conclusion: Job satisfaction and retention of nurses and physicians are critical to the quality of care. Civilian and military healthcare leaders should focus on interventions that enhance job satisfaction and retention as a strategy to improve patient and staff outcomes alike. [ABSTRACT FROM AUTHOR]

The musculoskeletal community is increasingly recognizing the importance of addressing mental and social health opportunities and incorporating psychosocial support in outpatient care. This secondary analysis of a longitudinal study evaluating the management of upper extremity conditions in a musculoskeletal integrated practice unit involving 102 adult patients (63% women, mean age 49 ± 13 years), aimed to identify demographic, clinical and psychosocial variables associated with involvement of an immediately available social worker. Additionally, we assess factors associated with patients seeking second opinions and level of self-efficacy. The only factor independently associated with meeting a social worker was greater symptoms of depression. There were no factors associated with presenting for advice from a second specialist. Self-efficacy score below 10 was independently associated with higher BMI, conditions involving the shoulder or upper arm compared to the hand or wrist, and greater symptoms of depression. When a social worker is available in an upper extremity practice, they are most welcomed and helpful for people with notable symptoms of depression, likely because a depression screen was used as a trigger for involvement. Less adaptive response to painful illness may be easier to measure and discuss, with the potential to increase attention to mental and social health. [ABSTRACT FROM AUTHOR]

Despite reductions in smoking rates in the general population, little is known about recent smoking trends among people living with HIV (PLWH). We compared the risk for smoking and temporal trends in smoking among PLWH and the general population in the Philadelphia metropolitan area between 2009 and 2014. We used weighted logistic regression to assess the relation between HIV and smoking, and examined temporal smoking trends. The adjusted odds ratio (OR) for smoking comparing PLWH to the general population was 1.80 (95% CI 1.55–2.09) after adjusting for socio-economic, demographic, and mental health diagnosis variables. Smoking prevalence decreased in both the PLWH and general populations during the study period, and we did not observe a significant difference in rates of decline between groups (P = 0.54). Despite overall progress in smoking cessation, a disparity persisted in smoking rates between PLWH and the general population, with and without adjustment for socio-economic, demographic, and mental health variables. Further research is needed to understand the mechanisms linking HIV and tobacco use in order to inform public health efforts to reduce smoking among PLWH. [ABSTRACT FROM AUTHOR]

Background: Medication adherence is a key contributor to survival for patients with chronic myeloid leukemia (CML). About 25% to 35% of CML patients have been reported to have suboptimal medication adherence. Objectives: Guided by psychobehavioral theory, the purpose of this research was to characterize oral CML medication adherence by specifically considering patients' financial burden and psychosocial distress. We hypothesized that psychosocial distress modulates the impact of financial burden on oral adherence to CML medication (self-reported). Methods: Data for this study are from the Cancer Support Community's Cancer Experience Registry: CML, which is an online research initiative. Patients were asked about financial burden, psychosocial distress, and medication adherence. The total analytic sample included 318 patients with CML. Results: Thirty-one percent of patients were categorized as having suboptimal CML medication adherence. Using a regression model, there was a significant interaction between financial burden and high risk of depression on treatment adherence (P = .024; n = 262). Adjusting for age and income, patients experiencing financial burden and at high risk for depression were significantly more likely to have suboptimal adherence than patients experiencing only financial burden. Discussion: To help ensure optimal benefit from CML therapy, it is essential to develop and evaluate interventions that foster patient-clinician communication and referral for services related to both financial need and psychosocial distress. Conclusion: Addressing adherence to CML medications through assessment of individual financial and psychosocial aspects of care is vital to help ensure optimal adherence and best possible treatment outcomes. [ABSTRACT FROM AUTHOR]

The article offers information on perceived patient preference and clinical testing for Chlamydia and Gonorrhea in Females. Topics discussed include national survey reports mentioning about least number of sexually experienced adolescent females reported sexually transmitted infections testing within the past 12 months; adolescent females prefer less invasive methods for clinical testing; and importance of patient preference to improve adolescent willingness for testing.

While the human papillomavirus (HPV) vaccine has potential to protect against the majority of HPV-associated cancers, vaccination rates in the United States remain low. Racial/ethnic and economic disparities exist for HPV vaccination completion rates. We conducted a mixed-methods study using the theory of planned behavior framework to explore attitudes and beliefs about HPV vaccination among urban, economically disadvantaged adolescents. Fifty adolescents aged 14-18 years were recruited from community-based organizations to complete a written survey and participate in a focus group. The mean age was 15.5 ± 1.3 years; 98 % were African American or mixed race; 64 % were female; 52 % reported previous sexual intercourse; 40 % reported receipt of ≥1 HPV vaccine dose. The knowledge deficit about the HPV vaccine was profound and seemed slightly greater among males. Mothers, fathers and grandmothers were mentioned as important referents for HPV vaccination, but peers and romantic partners were not. Common barriers to vaccination were lack of awareness, anticipated side effects (i.e., pain), and concerns about vaccine safety. Characteristics associated with ≥1 vaccine dose were: having heard of the HPV vaccine versus not (65 vs. 20 %, p = 0.002) and agreeing with the statement 'Most people I know would think HPV vaccine is good for your health' versus not (67 vs. 27 %, p = 0.007). Our work indicates a profound lack of awareness about HPV vaccination as well as the important influence of parents among urban, economically-disadvantaged youth. Awareness of these attitudes and beliefs can assist providers and health officials by informing specific interventions to increase vaccine uptake. [ABSTRACT FROM AUTHOR]

Background Research has consistently demonstrated that alcohol impairs the ability to divide attention across 2 or more stimuli. However, under certain circumstances, the presentation of multiple stimuli can actually facilitate performance. The 'redundant signal effect' ( RSE) refers to the phenomenon by which individuals respond more quickly and accurately when information is presented as redundant, bimodal stimuli (e.g., visually and aurally), rather than as a single stimulus presented to either modality alone. Recent work has shown that reaction time ( RT) to redundant signals is hastened under alcohol, ameliorating the slowing effects of the drug. However, no research has examined whether RSE can reduce the impairing effects of alcohol on the ability to inhibit behavior. Methods This study examined whether the impairing effects of alcohol on inhibitory control might be altered by the presentation of redundant inhibitory signals. Inhibitory control was assessed by a go/no-go task which included single and redundant inhibitory signals. Performance was tested following placebo (0.0 g/kg) and alcohol (0.65 g/kg). The effect of redundant activation signals on alcohol impairment of response activation was also measured. Results The results showed evidence for RSE on the activation of behavior, but not for inhibitory control. Compared with placebo, alcohol slowed RT and reduced response inhibition. Redundant signals had a robust speeding effect on RT, even following alcohol. By contrast, redundant signals failed to improve inhibitory control following placebo or alcohol. Conclusions These findings have important implications for understanding how drinkers respond to multimodal signals in their everyday environments and highlight the vulnerability of inhibitory control to alcohol's impairing effects. [ABSTRACT FROM AUTHOR]

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Aims and objectives. To assess postoperative pain management in neonatal brachial plexus palsy children who underwent a primary nerve repair, release only and/or a release and transfer procedure. Background. Previous studies have noted pain management inadequacies in postoperative pain management in certain paediatric populations. However, this is the first study to focus on postoperative pain management in this particular population. Methods. Seventy-five patients, who underwent a primary nerve repair, release only and/or a release and transfer procedures at our institution, were reviewed. Postoperative pain management was assessed on a patient and drug administration level through appropriate pain scale use; appropriate dosage for the medication prescribed; appropriate reassessment of pain following medication administration; and complications leading to a longer hospital stay. Results. Based on our institution's guidelines following drug administration, 64 patients were not appropriately reassessed for pain. Based on the drug's duration following drug administration, 40 patients were not appropriately reassessed for pain. Twenty-eight per cent of all medication administrations were not properly reassessed for pain based on the drug's duration and 62% of the time based on our institution's guidelines. Fifty per cent of all medication administrations were not properly dosed and 51 patients were not appropriately dosed at least once during their hospital stay. Pain scales were documented incorrectly 20% of the time and administered improperly to 13 patients. Conclusions. Opportunities for improvement in postoperative pain management in the paediatric population - particularly those with neonatal brachial plexus palsy - exist. Relevance to clinical practice. Findings from this study demonstrate that healthcare professionals may have (1) insufficient knowledge regarding pain and/or (2) inadequate direction and guidance to appropriately assess and document pain in the paediatric population. Improvements for these individual healthcare professionals and clinical settings are needed to overcome postoperative pain management issues in the future. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Adolescent substance use is associated with numerous adverse health outcomes. A hospitalization represents an opportunity to identify and address substance use. We sought to describe self-reported and documented substance use among hospitalized adolescents. METHODS: We conducted a cross-sectional survey of adolescents aged 14 to 18 years old admitted to two pediatric hospitals between August 2019 and March 2020. Using previously validated questions, we assessed the proportion of adolescents reporting ever, monthly, and weekly use of alcohol, marijuana, tobacco, electronic cigarettes, and other illicit drugs and nonmedical use of prescription medications. We reviewed medical records for substance use documentation. RESULTS: Among 306 respondents, 57% were older (16--18 years old), 53% were female, and 55% were of non-Hispanic white race and ethnicity. The most frequently reported substances ever used were alcohol (39%), marijuana (33%), and electronic cigarettes (31%); 104 (34%) respondents reported ever use of >1 substance. Compared with younger adolescents, those aged 16 to 18 years were more likely to report ever use of alcohol (29% vs 46%; P = .002), marijuana (22% vs 41%; P < .001), and ≥2 drugs (26% vs 40%; P = .009). A positive substance use history was rarely documented (11% of records reviewed), and concordance between documented and self-reported substance use was also rare. CONCLUSIONS: In this study of hospitalized adolescents, the most commonly reported substances used were alcohol, marijuana, and electronic cigarettes. Positive substance use documentation was rare and often discordant with self-reported substance use. Efforts to improve systematic screening for substance use and interventions for prevention and cessation in hospitalized adolescents are critically needed. [ABSTRACT FROM AUTHOR]

Purpose. The impact of a rapid peptide nucleic acid fluorescence in situ hybridization (PNA FISH) assay with an antimicrobial stewardship intervention on the treatment of Candida infections was studied. Methods. The utility of implementing the PNA FISH assay with an antimicrobial stewardship intervention in hospitalized patients with candidemia was evaluated by measuring the median time to Candida species identification, time to targeted therapy, and clinical outcomes, including time to culture clearance, hospital length of stay, and hospital mortality. Secondary objectives included determining the cost-effectiveness of the PNA FISH assay by assessing estimated antifungal drug costs (as average wholesale price) before (June 26, 2009-September 19, 2010) and after (September 20, 2010- June 13, 2011) test implementation and confirming test accuracy. For both groups, laboratory personnel notified the physician of the results of Gram's stain from blood culture. Results. Time to targeted therapy significantly decreased after the implementation of the PNA FISH assay (p = 0.0016). The postimplementation group had a higher rate of culture clearance (p = 0.01). Median time to species identification was 0.2 day with the PNA FISH test versus 4 days with routine methods (p < 0.001). Accounting for the cost of the test itself and the cases in which patients were switched to more expensive therapy on the basis of the test, we estimated that the PNA FISH test resulted in savings of approximately $415 per patient. Conclusion. Implementing a PNA FISH test to identify Candida species from yeast-positive blood cultures in conjunction with a pharmacy-driven antimicrobial stewardship protocol decreased the time to targeted antifungal therapy and the time to culture clearance. [ABSTRACT FROM AUTHOR]