The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.

/pdf/sexually-transmitted-diseases-treatment-guidelines-4zaqk3joit.pdf

Sexually transmitted diseases treatment guidelines.

This essay is based on the assumption that a long-neglected topic of socialization, the determinants of individual differences in parental functioning, is illuminated by research on the etiology of child maltreatment. Three domains of determinants are identified (personal psychological resources of parents, characteristics of the child, and contextual sources of stress and support), and a process model of competent parental functioning is offered on the basis of the analysis. The model presumes that parental functioning is multiply determined, that sources of contextual stress and support can directly affect parenting or indirectly affect parenting by first influencing individual psychological well-being, that personality influences contextual support/stress, which feeds back to shape parenting, and that, in order of importance, the personal psychological resources of the parent are more effective in buffering the parent-child relation from stress than are contextual sources of support, which are themselves more effective than characteristics of the child.

The determinants of parenting: A process model.

The perfect complement to Nursing Research: Generating and Assessing Evidence for Nursing Practice, Ninth Edition, this knowledge builder helps you develop and reinforce basic skills essential to nursing research.

Resource Manual for Nursing Research: Generating and Assessing Evidence for Nursing Practice

Principles and Practice of Structural Equation Modeling (2nd ed.)

ContextCurrent assessment formats for physicians and trainees reliably test
core knowledge and basic skills. However, they may underemphasize some important
domains of professional medical practice, including interpersonal skills,
lifelong learning, professionalism, and integration of core knowledge into
clinical practice.ObjectivesTo propose a definition of professional competence, to review current
means for assessing it, and to suggest new approaches to assessment.Data SourcesWe searched the MEDLINE database from 1966 to 2001 and reference lists
of relevant articles for English-language studies of reliability or validity
of measures of competence of physicians, medical students, and residents.Study SelectionWe excluded articles of a purely descriptive nature, duplicate reports,
reviews, and opinions and position statements, which yielded 195 relevant
citations.Data ExtractionData were abstracted by 1 of us (R.M.E.). Quality criteria for inclusion
were broad, given the heterogeneity of interventions, complexity of outcome
measures, and paucity of randomized or longitudinal study designs.Data SynthesisWe generated an inclusive definition of competence: the habitual and
judicious use of communication, knowledge, technical skills, clinical reasoning,
emotions, values, and reflection in daily practice for the benefit of the
individual and the community being served. Aside from protecting the public
and limiting access to advanced training, assessments should foster habits
of learning and self-reflection and drive institutional change. Subjective,
multiple-choice, and standardized patient assessments, although reliable,
underemphasize important domains of professional competence: integration of
knowledge and skills, context of care, information management, teamwork, health
systems, and patient-physician relationships. Few assessments observe trainees
in real-life situations, incorporate the perspectives of peers and patients,
or use measures that predict clinical outcomes.ConclusionsIn addition to assessments of basic skills, new formats that assess
clinical reasoning, expert judgment, management of ambiguity, professionalism,
time management, learning strategies, and teamwork promise a multidimensional
assessment while maintaining adequate reliability and validity. Institutional
support, reflection, and mentoring must accompany the development of assessment
programs.

/pdf/defining-and-assessing-professional-competence-1sy606vpxu.pdf

Defining and Assessing Professional Competence

Social ecological models that describe the interactive characteristics of individuals and environments that underlie health outcomes have long been recommended to guide public health practice. The extent to which such recommendations have been applied in health promotion interventions, however, is unclear. The authors developed a coding system to identify the ecological levels that health promotion programs target and then applied this system to 157 intervention articles from the past 20 years of Health Education & Behavior. Overall, articles were more likely to describe interventions focused on individual and interpersonal characteristics, rather than institutional, community, or policy factors. Interventions that focused on certain topics (nutrition and physical activity) or occurred in particular settings (schools) more successfully adopted a social ecological approach. Health education theory, research, and training may need to be enhanced to better foster successful efforts to modify social and political environments to improve health.

https://journals.sagepub.com/doi/pdf/10.1177/1090198111418634

Social Ecological Approaches to Individuals and Their Contexts: Twenty Years of Health Education & Behavior Health Promotion Interventions

Measuring only the physical markers of violence (e.g., slapping, beating) fails to capture the chronic vulnerability and gendered nature of battered women's experiences. Instruments that measure only observable discrete events may mask the continuous nature of battering and the relation between events and experience. Our approach to measuring battering operationalizes the experiences of battered women rather than the abusive behaviors they encounter. This alternative approach emphasizes the meanings battered women attach to the violence and to battering as an enduring presence in their lives. Focus groups with 22 battered women generated qualitative data for developing scale items (Smith, Tessaro, & Earp, 1995) and a known-groups survey with 185 battered and 204 nonbattered women determined the final scale items. Factor analysis of 40 initial items revealed a strong single-factor solution. The resulting 10-item Women's Experiences with Battering (WEB) Scale demonstrated high internal consistency reliability, was significantly correlated with known-group status, exhibited good construct validity, and was not significantly correlated with a measure of social desirability. The WEB Scale provides researchers with a valid and concise measure for studying relations between battering and health or health behavior, as well as evaluating the impact of interventions on battered women or prevalence.

Measuring battering: development of the Women's Experience with Battering (WEB) Scale

Objectives. This study investigatedthe association between physician rec-ommendation for mammography andrace/ethnicity,socioeconomicstatus,andothercharacteristicsinaruralpopulation. Methods. In 1993 through 1994, wesurveyed 1933 Black women and Whitewomen 52 years and older in 10 ruralcounties. Results. Fifty-three percent of thewomen reported a physician recom-mendation in the past year. White womenreported recommendations significantlymore often than did Black women (55%vs 45%; odds ratio=1.49). Controllingfor educational attainment and incomeeliminated the apparent racial/ethnic dif-ference. After control for 5 personal, 4health, and 3 access characteristics, rec-ommendation for mammography wasfound to be more frequent amongwomen who had access to the health caresystem (i.e., had a regular physician andhealth insurance). Recommendation wasless frequent among women who werevulnerable (i.e., were older, had lowereducational attainment, had lower annualfamily income). Conclusions.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.91.1.49

The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: who gets the message about breast cancer screening?

Although variations in physicians' practice patterns and use of resources are well documented, the reasons for these variations are less well understood. The uncertainty inherent in patient care may be one explanation. Existing measures of intolerance to uncertainty, developed in contexts outside of patient care, fail to explain these variations. To address this limitation, the Physicians' Reactions to Uncertainty scale was developed. A questionnaire containing an initial pool of 61 items was mailed to a random sample of 700 physicians in North Carolina and Oregon, stratified by specialty. The items covered nine areas of physicians' reactions to uncertainty derived from interviews with physicians and a definition of the concept affective reactions to uncertainity in patient care. Factor analysis of the 428 responses received yielded two primary factors that accounted for 58% of the common variance among the 61 items. Items with unambiguous loadings on these factors defined two reliable and readily interpretable subscales: Stress from Uncertainty (Cronbach's alpha = 0.90, 13 items) and Reluctance to Disclose Uncertainty to Others (alpha = 0.75, 9 items). By virtue of its clarity and good psychometric properties, this new measure promises insights into the role that uncertainty plays in physicians' resource utilization and practice patterns.

Jo Anne Earp

Papers

Social Ecological Approaches to Individuals and Their Contexts: Twenty Years of Health Education & Behavior Health Promotion Interventions

Measuring battering: development of the Women's Experience with Battering (WEB) Scale

The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: who gets the message about breast cancer screening?

Physicians' reactions to uncertainty in patient care. A new measure and new insights.

Written case simulations: do they predict physicians' behavior?