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Pamela J Wright, Robin M Dawson, Cynthia F Corbett Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, Department of Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USACorrespondence: Pamela J Wright, Department of Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA, Tel +1-803-777-6039, Email wrightpamelaj@sc.eduIntroduction: Peri-postmenopausal women with the chronic condition polycystic ovary syndrome (PCOS) remain at cardiometabolic risk and/or subsist with established comorbidity while continuing to manage persistent PCOS signs and symptoms, such as hirsutism. Thus, PCOS transcends the reproductive years, yet there is sparse scientific literature on the peri-postmenopausal years of women with PCOS.Purpose: To explore how peri-postmenopausal women’s perceptions about PCOS have changed over the lifespan since their PCOS diagnosis.Methods: A cross-sectional survey with one qualitative question was conducted via Research Electronic Data Capture (REDCap) among women with PCOS aged ≥ 43 years, who were all recruited from PCOS-specific Facebook pages. Of the 107 women completing the survey, 72 substantively answered the qualitative question. The qualitative responses were analyzed using the steps of reflexive thematic analysis. Themes were interpreted and discussed through the lens of the bioecological conceptual model.Results: Respondents were 47.6 (± 4.1) years of age, primarily White (87.5%), employed full time (65.3%), and married (75%) with children (68%). Four overall themes were identified: 1) dismissal 2) information desert, 3) PCOS experience over the lifespan, and 4) mindset.Conclusion: The study findings illustrated the unique healthcare needs among peri-postmenopausal women with PCOS. Further research is needed to further explore their healthcare concerns and psychosocial needs followed by studies that develop and assess interventions that promote symptom and adaptive coping strategies across their lifespan.Keywords: polycystic ovary syndrome, systems theory, life course, women’s health

Background: Firefighters face many inherent occupational health hazards and increased risk for several cancers, making peak health essential. However, cardiac events and stroke continue as leading causes of on-duty deaths. Healthy diets promote prevention of cardiovascular disease and cancers. While some dietary interventions have been undertaken, sustained improvements have not been observed. Understanding firefighters' occupational influences on dietary behavior is vital for implementation of effective interventions to improve nutrition., Methods: The Theoretical Domains Framework (TDF) guided this qualitative study. Nine focus groups of firefighters who work 24-hour shifts and one interview with a fire administrator ( N = 34) were conducted in 2018 across South Carolina, United States., Findings: Predominant TDF domains of influence for workplace dietary behaviors included social/professional role and identity; social influences; environmental context and resources; knowledge; beliefs about consequences; memory, attention, and decision processes; and emotion. Four emergent themes mapped to TDF domains: "We are family": Firefighters feel a strong identity in their work and with peers; "If you are a firefighter, you've got a second job": Firefighters experience many limitations in personal and workplace resources; "That kills us": Firefighters were knowledgeable about most all occupational health and safety risks except dietary risks; and "You're tired, wore out": Occupational stress influenced nutritional choice making., Conclusions: Firefighters experience many barriers to healthy eating while at work due to unique occupational influences. The findings from this study highlighted specific behavioral domains and barriers to be intervened upon that may increase the likelihood of long-term adoption of healthier dietary practices by firefighters., Competing Interests: Conflict of InterestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The rate of preterm birth (PTB) is high in the United States and Black infants remain disproportionately affected, with the disparity between Black and White infant deaths greater today than it was under antebellum slavery., Purpose: The National Institute on Minority Health and Disparities Research Framework reflects a unique set of determinants relevant to the understanding and promotion of minority health., Methods: We have applied this framework to better understand the effects of PTB on Black parents and the distribution of the social determinants of health, including structural determinants and root causes of inequities., Discussion: This adaptation shows the intersection in maternal and infant health that shapes individuals' experiences, drives disparities and impacts perinatal outcomes in critical periods over the lifecourse., Conclusion: In our efforts to achieve health equity, it is imperative that we study the underlying mechanisms and recognize that policies, institutional structures, and social factors are drivers of racism., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Native American communities suffered disproportionately negative effects during the COVID-19 pandemic, yet no research has explored the experiences of rural Eastern Region Native Americans., Methods: Informed by the Native Reliance Model and Indigenous Standpoint Theory, we conducted a qualitative descriptive project in the Spring and Summer of 2022; data included semi-structured interviews and focus groups with 24 individuals representing five South Carolina tribal groups., Findings: Thematic analysis yielded four emergent themes: 1) "Let's just finish the Indians off": Pandemic distrust rooted in historical and contemporary Native American experiences ; 2) "We have been misled": Making sense of conflicting public health information ; 3) "I'm not giving it to some innocent person": COVID-19 mitigation behaviors as Native American cultural practice ; and 4) "We put the plan in place": Self-advocacy and action as a source of Native American pride and responsibility ., Interpretation: These participants demonstrated resiliency grounded in family and tribal ties, even in the face of personal losses, economic struggles, and healthcare barriers. To strike a balance between cultural traditions and public health recommendations, public health practitioners should 1) build partnerships with community leaders, elders, and tribal health authorities to facilitate the development of culturally respectful interventions that address specific health concerns in the context of historical traumas; and 2) implement alternative methods of communication and engagement to ensure equitable access to healthcare services in rural locations, such as collaborating with community organizations, deploying mobile health units, and utilizing traditional channels of communication within these communities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Robin M. Dawson reports financial support was provided by 10.13039/100000030Centers for Disease Control and Prevention. Hunter M. Boehme reports financial support was provided by 10.13039/100000030Centers for Disease Control and Prevention. Melissa S. Nolan reports financial support was provided by 10.13039/100000030Centers for Disease Control and Prevention., (© 2024 Published by Elsevier Ltd.)

Background: A condition-specific instrument is necessary to measure the health-related quality of life among those with polycystic ovary syndrome (PCOS), the most common chronic endocrinopathy among women. The first instrument was developed in 1988, followed by several revisions. However, further recommendations from all versions include additional application and measurement among different cultural populations of women with PCOS and psychometric testing based on use among larger samples of women with PCOS. Thus, the purpose of this study was to explore the factor structure of the Polycystic Ovary Syndrome Questionnaire (PCOSQ-50) using an international cross-sectional survey data from women with PCOS aged 18-42 years., Methods: Using data from the largest known international cross-sectional study of women with PCOS aged 18-42 years (n = 935) to date, exploratory factor and confirmatory analyses were conducted for the PCOSQ-50, followed by factor labeling using a thematic analysis approach., Results: Respondents were 31.0 ± 5.8 years of age, mostly White (72%), well-educated (56% had a college degree), married (69%), and employed full-time (65%). Three-quarters (74%) of the sample had one or more chronic conditions in addition to PCOS. Approximately 20% of the respondents originated from countries such as the United Kingdom, Australia, South Africa, etc. The PCOSQ-50 demonstrated good reliability but may be best described using a 7-factor model. The 7-factor model revealed goodness-of-fit. Thematic analysis suggested the following labels of those seven factors: hirsutism, fertility, isolation/trepidation, sexual function, self-esteem, emotional, and obesity., Conclusion: More research is needed to adapt the current PCOSQ-50, as well as to create an age-appropriate PCOS-specific HRQoL instrument for peri-postmenopausal women with PCOS., (© 2024. The Author(s).)

Background: Nursing Doctor of Philosophy program enrollment has declined. Undergraduate nursing student (UGS) research engagement is associated with future graduate education, an essential element for building the nursing faculty pipeline., Purpose: (a) To describe the infrastructure and culture-enhancing resources and strategies associated with building UGS research engagement and (b) to evaluate UGS research engagement., Methods: Guided by a socioecological systems model university and college documents, databases, and college of nursing survey results were used to identify approaches to, and outcomes of, engaging UGS in research. Descriptive statistics were calculated to illustrate 5-year UGS research engagement trends., Findings: Resources and strategies included grant funding, research assistant funding, student research showcases, and faculty mentorship. UGS research 5-year engagement trends included (a) a 75% increase in the number of students mentored, (b) a 30% rise in funded research proposals, and (c) a 54% increase in paid research assistantships., Discussion: Purposefully using existing resources, growing the college of nursing infrastructure, and cultivating a culture recognizing faculty contributions were approaches associated with increased UGS research engagement., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: As of May 2023, the novel SARS-CoV-2 has claimed nearly 7 million lives globally and >1.1 million lives in the United States. Low-income populations are often disproportionately affected by risk factors such as lifestyle, employment, and limited health literacy. These populations may lack the knowledge of appropriate infection precautions or have reduced access to care during illness, particularly in countries without universal health care., Objective: We aimed to explore the perceptions and experiences of COVID-19, including symptoms and risk factors among uninsured individuals seeking care at a free medical clinic, and to obtain respondents' perceptions of and suggestions for adapting a mobile health (mHealth) app to an uninsured population known to have low health literacy., Methods: We conducted a prospective multimethod survey study with a convenience sample of uninsured adults seeking care at 3 free clinics in the United States. Respondents were questioned about their risk for and awareness of COVID-19 symptoms, COVID-19 testing, current technology use, and the use of technology to facilitate their health regarding COVID-19. Data were analyzed using descriptive statistics (eg, frequencies and mean differences). In addition, a small subset of respondents from one of the clinics (n=10) participated in interviews to provide feedback about the design of a COVID-19 web-based smartphone (mHealth) app., Results: The survey respondents (N=240) were 53.8% (n=129) female, were primarily White (n=113, 47.1%), and had a mean age of 50.0 (SD 11.67; range 19-72) years. Most respondents (162/222, 73%) did not think that they were at risk for COVID-19. Although respondents reported only moderate confidence in their knowledge of the short- and long-term symptoms of COVID-19, their knowledge of the symptoms aligned well with reports published by the Centers for Disease Control and Prevention of the most common acute (590/610, 96.7%) and long-term (217/271, 80.1%) symptoms. Most respondents (159/224, 71%) reported an interest in using the mHealth app to gain additional information regarding COVID-19 and available community resources. Respondents who were interviewed provided suggestions to improve the mHealth app but had overall positive perceptions about the potential usefulness and usability of the app., Conclusions: It was encouraging that the knowledge of COVID-19 symptoms aligned well with the reports published by the Centers for Disease Control and Prevention and that respondents were enthusiastic about using an mHealth app to monitor symptoms. However, it was concerning that most respondents did not think they were at a risk of contracting COVID-19., (©Khushi S Patel, Cynthia F Corbett, Elizabeth M Combs, Sara B Donevant, Margaret J Selph, Lynette M Gibson, Robin M Dawson, Amit P Sheth, Ronda G Hughes. Originally published in JMIR Formative Research (https://formative.jmir.org), 28.07.2023.)

Purpose: Mechanisms leading to burnout, associated with high turnover in nursing, may start as early as in nursing school. Given health habits (e.g., diet, physical activity, and sleep) can exacerbate or lessen the impact of burnout, this study examined current barriers and facilitators to healthy diet, physical activity levels, and sleep among nursing undergraduates (UGs) and early-career nurses (ECNs)., Research Design: Qualitative descriptive study., Sample: 25 nursing UGs and 25 ECNs (within 3 years of graduation) from a Southeastern college of nursing., Data Collection and Analysis: After development of theory-informed interview guides, participants conducted interviews either in-person or by phone, which were audio-recorded and transcribed. Braun and Clarke's six-step thematic analysis was used to analyze the transcripts., Results: All but one (aged 54) UG was in their early 20s and ECNs were in their early to mid-20s. Most participants were white, females. Time and stress were the strongest barriers among UGs and ECNs for adherence to healthy diet, physical activity, although stress did act as a facilitator for physical activity in a subset of both UGs and ECNs. Shiftwork was a common barrier to healthy behaviors among ECNs., Conclusion: The fact that the more common and stronger barriers to healthier behaviors among UGs and ECNs were the same give credence to the idea that processes associated with burnout begin during or before nursing education and are persistent.

Background: Health sciences students who report low/equivocal hepatitis B titers may be required to repeat the immunization series, even though the result may not indicate non-immunity., Method: To describe hepatitis B immunity patterns, this retrospective, descriptive study utilized de-identified vaccination records and anti-HBs titers of three cohorts of sophomore nursing students entering clinical rotations in 2018-2019., Results: Only 33% of students had initial anti-HBs quantitative serum titer ≥10 mIU/ml, demonstrating immunity. After students with low/equivocal titers (n = 191, 64%) were re-immunized per institution protocol, only 2% (n = 7) were identified as non-responders. Cumulative costs incurred by students for revaccination and repeat titer exceeded $20,000, with a process time of up to 8 months., Conclusion: While rates of exposure to hepatitis B in acute care settings have steadily declined in the United States, students who go on to practice in community and public health settings have increased risk of exposure. Following best practices in demonstrating hepatitis B immunity, which include a single challenge dose followed by titer 4 weeks later, would decrease per student costs, wait time, and administrative burden associated with documentation and student counseling., (© 2022 The Authors. Public Health Nursing published by Wiley Periodicals LLC.)

Background: Universities are communities with specific health care needs, and rural campuses often do not have access to student health services (SHS)., Problem: Lack of basic services can increase health risks for students and the greater community., Methods: A theory-informed quality improvement project utilizing an organizational assessment, study survey, and proof-of-concept intervention designed to demonstrate feasibility and acceptability of a SHS clinic., Intervention: An NP-directed influenza immunization clinic was conducted on a small rural college campus in southeastern United States., Results: Seventy-eight students received influenza vaccinations, demonstrating to local stakeholders the feasibility and acceptability of SHS for primary preventative services. Ninety-seven percent of these students expressed a high likelihood that they would obtain the vaccine again., Conclusions: Results of this study can be used as an exemplar to guide health care initiatives focused on college students in rural communities., (© 2022 Wiley Periodicals LLC.)

Purpose: Hospitals are important workplaces for nurses with many perceived barriers to healthy eating, but objective assessments are lacking. This study evaluated the healthfulness of hospital consumer food environments., Design: Cross-sectional observational; Setting: South Carolina; Subjects: Cafeterias, vending machines (VM), and gift shops (GS) in hospitals of varying size, urbanization, and region., Measures: Using the Hospital Nutrition Environment Scan (HNES), primary outcomes of interest included availability, access, prices, and location of healthy foods in relation to nursing units., Analysis: Descriptive and inferential statistics by independent samples t-test, ANOVA, Mann-Whitney U, χ2, or Fisher's exact test as appropriate., Results: Thirty-one hospitals were observed from December 2019 to February 2020. Average composite HNES score (n = 28) was 46.3 ± 14.9 (-45 to 173 range), indicating sub-optimal food environments. Cafeterias (n = 31) scored an average of 30.9 ± 10.5 (-33 to 86 range). Average VM (n = 31) and GS (n = 28) scores were 11.6 ± 6.0 (-6 to 55 range) and 2.9 ± 4.0 (-6 to 32 range), respectively. Small hospitals (≤100 beds) had lower average cafeteria score (22.4 ± 10.3) than extra-large hospitals (≥500 beds; 42 ± 5.2, P < .01). Small hospitals also had lower composite HNES scores (34.4 ± 17.1) compared to extra-large hospitals (61.0 ± 14.4, P = .02). Data regarding availability, access, prices, and location were also reported., Conclusion: Due to abundant availability of unhealthy foods and beverages, hospital consumer food environments scored low on observations using the HNES, highlighting the opportunity to improve the healthfulness of facility offerings.

Introduction: About 100,000 individuals in the United States live with sickle cell disease (SCD). Palliative care (PC) can improve symptom management for these individuals. The purpose of the study was to explore (a) the experiences of people living with SCD, and (b) their knowledge and perceptions of PC., Method: Using a qualitative, descriptive design, adults with SCD were recruited from a foundation in the southeastern United States. Data included social and SCD-related demographics and audio-recorded, semi-structured focus groups. Analysis took a thematic analysis approach., Results: Participants: There were 16 African Americans who participated in the study, 75% of whom were females, and aged 22 to 71 years. Five themes were identified: unique and unpredictable impact of SCD on daily life, the changing experience of SCD over time, stigmatization/marginalization in health care interactions, perceptions of support in managing SCD symptoms/crises, and PC: "What is it?", Discussion: Participants lacked PC knowledge. PC should be offered to individuals with SCD as part of comprehensive SCD management.

Objective: Half of new human papilloma virus ( (HPV)) infections occur between the ages of 15 and 24. As preventive measures are underutilized globally; international university students are at particular risk for HPV infection and sequelae. The study aim was to explore HPV knowledge and preventive behaviors in this population. Participants: Eighty-one undergraduate and graduate international university students (49 females, 32 males) at a southeastern university. Methods: Exploratory sequential mixed methods guided by the Health Belief Model. Results: Integrated qualitative/quantitative data revealed four themes mapped to relevant HBM constructs: Perceived susceptibility to HPV ; Perceived benefits/Perceived barriers to HPV prevention; Cues to Action; and Likelihood of Engaging in Health-Promoting Behavior. Over half believed they were not at risk for HPV/sequelae. Only a quarter had received HPV vaccination. Conclusions: International university students represent an important catch-up population for HPV screening/vaccination. Results can be used to design and tailor interventions for this vulnerable population.

Background: Over the past 2 decades, numerous decision-making interventions have been developed to guide the prostate cancer (PrCA) treatment choices of patients and families. These interventions are often supported by economic decision frameworks, which do not account for the role of emotions in treatment decisions. In some instances, emotion-driven decisions can override an individual's cognitive evaluation of a decision, leading to unfavorable outcomes such as decision regret., Objectives: To produce a Prostate Cancer Treatment Decision Framework based on the Risk-as-Feelings Hypothesis., Methods: The authors reviewed seminal research in emotion and decision-making in an effort to create a context-specific decision framework., Results: Five variables, not germane to the Risk-as-Feelings Hypothesis, play prominent roles in PrCA decision-making including age, spirituality, family support, healthcare provider communication, and perception of treatment outcomes. While family support only affects decision outcomes by influencing emotion and cognitive evaluation of a PrCA decision, age, spirituality, and healthcare provider communication can have direct effects on an individual's perception of treatment outcomes., Conclusions: The Prostate Cancer Treatment Decision Framework combines new variables with older models to explain the PrCA treatment decision-making process and elucidate relationships affecting treatment outcomes and survivors' perceptions of these outcomes. The core premise of this model can be applied to other high-risk health decisions., Implications for Practice: Healthcare providers have the greatest influence on PrCA treatment decision-making. Using a shared decision-making approach, providers should take into account a patient's personal characteristics and values, in addition to clinical presentation, to help patients with treatment decisions., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Polycystic ovary syndrome (PCOS), the most common chronic endocrinopathy and the leading cause of infertility in women, has significant clinical consequences, including cardiovascular, endocrinological, oncological, and psychological co-morbidities. Endocrine Society Clinical Practice Guidelines on the Diagnosis and Treatment of PCOS recommend exercise and physical activity as first-line treatment to combat chronic disease risk. However, details about what type of exercise are not provided. Given the known beneficial effects of resistance training on the management of other chronic diseases, the purpose of this scoping review was to evaluate the scientific evidence about the physical and psychosocial effects of resistance training among women with PCOS. Studies were identified through a systematic search of PubMed, SPORTDiscus, and CINAHL databases. Peer-reviewed research studies published between January 2011 and January 2021 that evaluated a resistance training intervention for premenopausal women with PCOS were included. Studies that offered multi-component programs were excluded. Nine articles met the inclusion criteria of which seven were sub-studies of one larger clinical trial. One article reported findings from a small randomized controlled trial and the last article reported feasibility study findings. Each intervention yielded positive results across a wide range of outcome variables; however, the studies had small sample sizes and assessed different outcome variables. Evidence regarding the effects of resistance training on health outcomes for women with PCOS is positive but preliminary. Adequately powered clinical trials are required to confirm health benefits, answer research questions as to therapeutic dose, and discover behavioral strategies to promote resistance training for therapeutic management.

Background: Employees who spend substantial amounts of time in a workplace away from home are likely to acquire and consume food during work hours. Reportedly, free food at work is a common occurrence in various workplace settings such as business offices and hospitals. Little is known about the nutritional quality, prevalence, or health impact of free food at work. Furthermore, free food at work as a theoretical concept has not been previously analyzed or defined, but it is necessary to differentiate free food from other food sources in the workplace., Methods: A concept analysis of free food at work was conducted using the 8-step Walker and Avant framework. A literature review in June and July 2020 provided the basis to delineate the concept and identify its defining attributes including antecedents, consequences, and empirical referents., Findings: Free food at work is defined as food that is available for consumption in the workplace at no financial cost to employees. Critical attributes of free food at work include nutritional value, quantity, frequency, and location within the workplace. Antecedents are sources and reasons for free food provision. Consequences include influence on consumption, behaviors, attitudes, emotions, and health outcomes. Additional measurable aspects of the concept and implications are discussed., Conclusion/application to Professional Practice: The concept of free food at work was analyzed; defining attributes and empirical referents were discussed and presented in a conceptual model to encourage further study and theory development. Identifying the health impact of free food at work is an issue requiring consideration for workplace health-promoting programs.

Chemotherapy is one of the most common forms of treatment for women with breast cancer. While chemotherapy is often effective, managing side effects can be challenging. Chemotherapy education is critical in assisting patients to manage side effects and to improve the treatment experience. However, materials are often not thoroughly assessed for readability and format which could be problematic for patients learning self-care while in treatment. We used a mixed-method design to illuminate chemotherapy teaching and focused on readability and format of education materials. We scored the materials using three readability assessments: (1) Flesch Reading Ease (FRE), (2) Flesch-Kincaid (F-K), and (3) a Simple Measure of Gobbledygook (SMOG). We evaluated the format of the materials using Suitability Assessment of Materials (SAM) guidelines. Lastly, we used thematic analysis to describe the experience of 37 women with breast cancer undergoing chemotherapy education. The mean readability of the materials ranged from "difficult" to "fairly difficult" based on the FRE scoring, and the material was written on a 9th- to 13th-grade reading level. Most of the materials scored as "adequate" using SAM guidelines but lacked incorporation of graphics or illustrations. The thematic analysis revealed three major findings: (1) finding control in learning, (2) receiving unexpected support, and (3) learning in unforeseen ways. Nurses need to supplement chemotherapy education materials with individualized teaching to ensure comprehension. Additionally, nurses and website developers may want to consider implementing culturally appropriate information and use videos to combat challenging readability.

Background: Studies indicate that women with polycystic ovary syndrome have high depressive symptom scores and more perceived barriers than benefits to exercise, factors that may affect health-related quality-of-life. The purpose of this cross-sectional study was to explore the impact of perceived exercise benefits and barriers, exercise outcome expectations, and depressive symptoms on polycystic ovary syndrome-specific health-related quality-of-life., Methods: A survey link was posted on polycystic ovary syndrome Facebook groups. Women with polycystic ovary syndrome ( n  = 935) answered questionnaires about demographics, polycystic ovary syndrome-specific health-related quality-of-life, exercise benefits and barriers, exercise outcome expectations, and depressive symptoms. Data were collected using Qualtrics, transferred to SPSS, and statistically analyzed using regression analyses. Mean responses were reported for the questionnaires, with exercise benefits and barriers means divided for a ratio., Results: Respondents were 32 ± 10.6 years of age, mostly White (72%), and employed full-time (65%). The total mean scores were health-related quality-of-life, 2.7 ± 0.1; exercise outcome expectation, 2.4 ± 0.8; and depressive symptoms, 12.4 ± 5.8. The benefit/barrier ratio was 0.9. HRQoL increased 0.32 points for every additional perceived exercise benefit and 0.61 points for every additional exercise outcome expectation (EOE). HRQoL was reduced by 1.19 points for every additional perceived exercise barrier and 2.82 points for every additional one-point increase of the depressive symptoms score., Conclusions: Respondents reported low health-related quality-of-life, greater exercise barriers than benefits, neutral exercise outcome expectations, and high depressive symptoms. These results suggest that promoting exercise benefits, overcoming exercise barriers, and addressing management of depressive symptoms are important foci of future efforts to improve health-related quality-of-life among women with polycystic ovary syndrome.

Background: Rural Latino children with asthma suffer high rates of uncontrolled asthma symptoms, emergency department visits, and repeat hospitalizations. This vulnerable population must negotiate micro- and macrolevel challenges that impact asthma management, including language barriers, primary care access, parental time off from work, insurance coverage, distance from specialty sites, and documentation status. There are few proven interventions that address asthma management embedded within this unique context., Objective: Using a bio-ecological approach, we will determine the feasibility of a patient-centered collaborative program between rural Latino children with asthma and their families, school-based nursing programs, and primary care providers, facilitated by the use of a smartphone-based mobile app with a Spanish-language interface. We hypothesize that improving communication through a collaborative, patient-centered intervention will improve asthma management, empower the patient and family, decrease outcome disparities, and decrease direct and indirect costs., Methods: The specific aims of this study include the following: (1) Aim 1: produce and validate a Spanish translation of an existing asthma management app and evaluate its usability with Latino parents of children with asthma, (2) Aim 2: develop and evaluate a triadic, patient-centered asthma intervention preliminary protocol, facilitated by the bilingual mobile app validated in Aim 1, and (3) Aim 3: investigate the feasibility of the patient-centered asthma intervention from Aim 2 using a waiting-list randomized controlled trial (RCT) to investigate the effects of the intervention on school days missed and medication adherence., Results: Mobile app translation, initial usability testing, and app software refinement were completed in 2019. Analysis is in progress. Preliminary protocol testing is underway; we anticipate that the waiting-list RCT, using the refined protocol developed in Aim 2, will commence in fall 2020., Conclusions: Tailored, technology-based solutions have the potential to successfully address issues affecting asthma management, including communication barriers, accessibility issues, medication adherence, and suboptimal technological interventions., Trial Registration: ClinicalTrials.gov NCT04633018; https://www.clinicaltrials.gov/ct2/show/NCT04633018., International Registered Report Identifier (irrid): DERR1-10.2196/18977., (©Robin M Dawson, Sue P Heiney, DeAnne Hilfinger Messias, Dennis Ownby. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 01.12.2020.)

Background: Chemotherapy knowledge is linked to managing side effects, reducing exposure to potential infection, and adjusting lifestyle behaviors while going through treatment. However, no research exists regarding the influence of patients' personal attributes on chemotherapy knowledge. Aim The aim of this study was to describe the relationships of health literacy and demographics on chemotherapy knowledge among women with breast cancer undergoing treatment., Method: We used a descriptive, exploratory design with convenience sampling of women with breast cancer receiving intravenous chemotherapy who completed one mandatory education session. Participants completed a demographic questionnaire and three instruments: 1) Rapid Estimate of Adult Literacy - Short Form (REALM-SF); 2) Shortened Test of Functional Health Literacy in Adults (S-TOFHLA); and 3) Leuven Questionnaire on Patient Knowledge of Chemotherapy (L-PaKC). We used univariate linear regression and ANOVA to identify how health literacy and demographics influenced chemotherapy knowledge., Results: The REALM-SF (p = .022) and S-TOFHLA (p = .023) scores were significantly associated with chemotherapy knowledge. Chemotherapy knowledge scores were affected by marital status (p = .018) and income (p < .001) where married women had significantly higher chemotherapy knowledge scores (M = 92.6, SD = 6.6) than women who were divorced (M = 83.3, SD = 16.7) with a knowledge score difference of -9.3 between the groups (p = .02). Comparisons showed significant differences of chemotherapy knowledge between women with differing income levels., Conclusions: This study highlights the relevance of considering patients' health literacy and personal attributes such as marital status and income when teaching about chemotherapy., (Copyright © 2020. Published by Elsevier Inc.)

Background: Nurses working in hospitals face unique influences on their workplace dietary behaviors, but little is known about what nurses experience as dietary influencers in the hospital setting. Understanding these influences is paramount in developing effective programs that target healthy workplace eating. This study aimed to explore hospital shift nurses' experiences and perceptions of influences on making healthy nutritional choices while at work. Methods: This qualitative, descriptive study was guided by the Theoretical Domains Framework and analyzed using thematic analysis. Twenty-one Registered Nurses working 10- to 12-hour shifts in hospitals in South Carolina, USA, in 2018 were interviewed individually or in focus groups about their workplace dietary behaviors and influences. Findings : Framework constructs most relevant to hospital shift nurses included (a) environmental context and resources; (b) social/professional role and identity; (c) memory, attention, and decision processes; (d) social influences; (e) emotion; and (f) behavioral regulation. In addition, four major themes emerged: (a) Nursing roles and responsibilities restrict freedom of movement and minimize individual control over dietary practices; (b) The hospital food environment is oppressively unhealthy; (c) Free food is currency and influences consumption; and (d) Shift work is a major barrier to healthy eating. Conclusions/Applications to Practice : To achieve healthy eating practices in the workplace, hospital shift nurses need supportive systems, policies, and interventions that target and reduce the barriers inherent in hospital-based nursing shift work. To improve hospital shift nurses' workplace dietary behaviors, these findings should inform hospital food policies, workplace wellness programs, administrative practices, and staff education.

Objective: To examine rural-urban differences in college students' cardiovascular risk perceptions. Participants: College students in rural ( n  = 61) and urban ( n  = 57) Kentucky counties were recruited from November 2012 to May 2014. Methods: This was a secondary data analysis of a cross-sectional study examining rural-urban differences in cardiovascular risk factors. Students rated their risk for developing high blood pressure, diabetes, high cholesterol, heart disease, having a stroke, and gaining excess weight. Chi-square and logistic regression were used for data analysis. Results: Rural students had lower odds of perceived high risk for developing high blood pressure compared to urban students (odds ratio (OR): 0.32, 95% CI: 0.11-0.96) after adjusting for race, sex, and body mass index. This association was not observed after adjusting for healthcare access variables. No other significant differences were observed. Conclusions: Efforts to raise perceived risk for developing hypertension among rural college students may be warranted.

Aim: To explore the perceived biopsychosocial and medical experiences of women with polycystic ovary syndrome, as presented in stories written by women on a social support website., Design: Qualitative descriptive using low inference content analysis, guided by the social construction of illness theoretical framework., Methods: In July 2018, 95 of 379 website stories were randomly selected. The stories were analysed, ending in September 2018., Results: Three major themes aligning with framework constructs were identified: Biopsychosocial struggles and management: "I can't even look in the mirror without wanting to cry," Sociocultural navigation: "I feel all alone and no one understands me." and Healthcare encounters: "I don't feel like I'm getting the help I need". These themes revealed that Polycystic ovary syndrome (PCOS) has biological and experiential components, which exist independently of each other and hold social and cultural meanings., Conclusion: Care for women with PCOS should be multidisciplinary, multidimensional, and multi-level to ameliorate biopsychosocial issues. Provider (physicians, nurse practitioners, physician assistants) education about PCOS is necessary to enhance timely diagnosis and implement individualized treatment strategies. Non-advanced practice nurses are in a unique position to have an impact on patient satisfaction and clinical outcomes by providing and reinforcing patient education, coordinating management processes, counselling via telephone or in-person appointments and facilitating referrals to ancillary providers. Evidence-based and accessible psychosocial supports and interventions will lead to improved self-esteem and effective coping skills, and reduced stigma-related stress. Lastly, policy changes are warranted to address access to care, health insurance inequities and inadequate funding for PCOS-related research., Impact: Increased awareness of PCOS and its biopsychosocial aspects will aid providers with timely diagnosis and meaningful treatment plans. Women with PCOS will gain acknowledgment, acceptance, and insight towards health care and self-management., (© 2020 John Wiley & Sons Ltd.)

Simulation-based interprofessional education (IPE) is challenging to implement, especially on rural campuses. This article describes an innovative approach to IPE implementation using telehealth technology. Twenty-nine interdisciplinary students (nursing, pharmacy, and medical) participated in a simulation-based IPE scenario using a telehealth robot. Student experiences were evaluated using a mixed-methods approach. Surveys and video-recorded debriefing sessions revealed the majority of students felt the experience was superior to their previous IPE experiences, facilitated better understanding of disciplinary roles, and provided experience using telehealth tools. Programs considering this approach should have strong community partnerships, institutional support, and shared vision among key stakeholders.

Research using mHealth apps has the potential to positively impact health care management and outcomes. However, choosing an appropriate mHealth app may be challenging for the health researcher. The author team used existing evaluation tools, checklists, and guidelines to assess selected mHealth apps to identify strengths, challenges, and potential gaps within existing evaluation tools. They identified specific evaluation tool components, questions, and items most effective in examining app content, usability, and features, including literacy demand and cultural appropriateness; technical information; practical aspects of app functionality; and evolving capabilities of mobile medical apps. Challenges included the subjective nature of the results, time required to complete the evaluation, lack of emphasis on evidence-based content, and inadequate tool flexibility. Health researchers considering the integration of mobile apps into research will benefit from evaluation tools that assess both evidence-based content and the ability of the mobile app to securely integrate with other digital technologies involved in patient care. Next steps will include the involvement of health care providers and professionals, including nurses a wide range of expertise, to develop an mHealth evaluation tool that focuses on identifying quality, evidence-based mobile apps into patient outcomes research., (© 2019 John Wiley & Sons Ltd.)

Background: Although there is an abundance of empirical evidence on principals' leadership practices and teacher satisfaction in K-12 settings, a paucity of publications explore nursing faculty job satisfaction as influenced by leadership styles of academic deans. This research examined leadership styles of nursing deans to determine whether they correlate with nursing faculty job satisfaction at public U.S. universities with high research activity., Method: A descriptive, correlational study was conducted with electronic self-administered questionnaires. The sample was recruited from 24 universities; 303 questionnaires were returned., Results: Faculty perceived that nursing deans displayed transformational leadership style more frequently. Nursing faculty were moderately satisfied in their jobs, and they were more satisfied with nursing deans who practiced attributed idealized influence., Conclusion: Three types of leadership behaviors explained significant variance in faculty job satisfaction, indicating the need for training and development focused on effective leadership behaviors. [J Nurs Educ. 2020;59(2):68-75.]., (Copyright 2020, SLACK Incorporated.)

Complications experienced by grieving young adults have developmental, mental, and behavioral components. Music offers opportunities to promote healthy grieving. While song writing has been widely used as an informal therapy for centuries, current researchers are beginning to explore its benefits. There is a noticeable lack of literature regarding the role of music in the grieving process. The aims of this study were to explore the grieving experiences of young adults who had lost a family member or friend, to identify song elements most helpful in promoting healthy grieving, and then to use these findings to compose a piece of music. Fifteen 20- to 23-year-old participants were interviewed about the death of a close friend or family member using a structured interview guide that included questions about their experience with the death and their grief, as well as questions about what song elements might help in grief. These questions included specifics about the song tempo (speed), dynamic (volume), and whether the song should contain lyrics (words). Thematic analysis was used to analyze interviews. Themes derived from the interview that should be relayed in a song included: Grief can include joy and pain together; It will get better; There is value in community; and, It is ok not to be ok For song elements, participants elected a slow tempo, a mixed or soft dynamic, and inclusion of lyrical content. All findings were integrated into a song composition that may help promote healthy grieving., (© Copyright 2019 Creative Health Care Management.)

Carbon monoxide (CO) poisoning is preventable yet remains the most common cause of U.S. non-drug poisoning. The purpose of this non-experimental study was to develop and evaluate the theory-based CO Blitz Model . Events targeted five SC communities; volunteers provided education while local firefighters installed CO alarms. At the 4-6-month follow-up evaluation, all homes still had a functioning CO alarm; most recipients could name CO sources in their homes (78%) and what to do if the alarm sounded (90%). The theory-driven process evaluation revealed the CO Blitz Model was tailorable and effective in addressing unique community resources and needs.

Two series of branched tetramers of the proline-rich antimicrobial peptide (PrAMP), Chex1-Arg20, were prepared to improve antibacterial selectivity and potency against a panel of Gram-negative nosocomial pathogens including Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. First, tetramerization was achieved by dithiomaleimide (DTM) conjugation of two C-terminal-cysteine bearing dimers that also incorporated C-terminal peptide chemical modification. DTM-linked tetrameric peptides containing a C-terminal hydrazide moiety on each dimer exhibited highly potent activities in the minimum inhibitory concentration (MIC) range of 0.49-2.33 μm. A second series of tetrameric analogues with C-terminal hydrazide modification was prepared by using alternative conjugation linkers including trans-1,4-dibromo-2-butene, α,α'-dibromo-p-xylene, or 6-bismaleimidohexane to determine the effect of length on activity. Each displayed potent and broadened activity against Gram-negative nosocomial pathogens, particularly the butene-linked tetrameric hydrazide. Remarkably, the greatest MIC activity is against P. aeruginosa (0.77 μm/8 μg mL -1 ) where the monomer is inactive. None of these peptides showed any cytotoxicity to mammalian cells up to 25 times the MIC. A diffusion NMR study of the tetrameric hydrazides showed that the more active antibacterial analogues were those with a more compact structure having smaller hydrodynamic radii. The results show that C-terminal PrAMP hydrazidation together with its rational tetramerization is an effective means for increasing both diversity and potency of PrAMP action., (© 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

A3-APO, a de novo designed branched dimeric proline-rich antimicrobial peptide (PrAMP), is highly effective against a variety of in vivo bacterial infections. We undertook a selective examination of the mechanism for the Gram-negative Escherichia coli bacterial membrane interaction of the monomer (Chex-Arg20), dimer (A3-APO), and tetramer (A3-APO disulfide-linked dimer). All three synthetic peptides were effective at killing E. coli. However, the tetramer was 30-fold more membrane disruptive than the dimer while the monomer showed no membrane activity. Using flow cytometry and high-resolution fluorescent microscopy, it was observed that dimerization and tetramerization of the Chex-Arg20 monomer led to an alteration in the mechanism of action from non-lytic/membrane hyperpolarization to membrane disruption/depolarization. Our findings show that the membrane interaction and permeability of Chex-Arg20 was altered by multimerization., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Proline-rich antibacterial peptides protect experimental animals from bacterial challenge even if they are unable to kill the microorganisms in vitro. Their major in vivo modes of action are inhibition of bacterial protein folding and immunostimulation. Here we investigated whether the proline-rich antibacterial peptide dimer A3-APO was able to inhibit Bacillus cereus enterotoxin production in vitro and restrict the proliferation of lethal toxin-induced Bacillus anthracis replication in mouse macrophages. After 24 h incubation, peptide A3-APO and its single chain metabolite reduced the amount of properly folded B. cereus diarrhoeal enterotoxin production in a concentration-dependent manner leading to only 10-25% of the original amount of toxin detectable by a conformation-sensitive immunoassay. Likewise, after 4 h incubation, A3-APO restricted the proliferation of B. anthracis in infected macrophages by 40-45% compared to untreated cells both intracellularly and in the extracellular cell culture milieu. Although the peptide had a minimal inhibitory concentration of >512 mg/L against B. anthracis in vitro, in systemic mouse challenge models it improved survival by 20- 37%, exhibiting statistically significant cumulative efficacy when administered at 3x5 mg/kg intraperitoneally or intramuscularly. We hypothesize that the activity in isolated murine macrophages and in vivo is due to deactivation of bacterial toxins. Bacterial protein folding inhibition in synergy with other types of antimicrobial modes offers a remarkable novel strategy in combating resistant or life-threatening infections.

Q fever is a zoonotic disease caused by Coxiella burnetii, an obligate intracellular bacterium that resides inside a phagolysosome-like niche. Chronic Q fever is typified by endocarditis, and is treated with multiple antibiotics for at least 18 months. The discovery of clinical C. burnetii isolates resistant to the first-line antibiotic doxycycline, and the problematic nature of chronic Q fever treatment have demonstrated the need for improved treatment regimes. To search for alternative antimicrobial agents, we assessed the effect of 26 antimicrobial peptides (AMPs) on the intracellular growth of C. burnetii in L929 cells at a concentration of 25 µM or their maximal non-cytotoxic concentration. Among the peptides tested, A3-APO, Cath-BF, δ-Hemolysin, Octa-1, P5 and Pleurocidin were able to significantly reduce both the total bacterial cell number and the host cell bacterial burden (average bacterial number per host cell). Combining selected AMPs with Chariot, a non-covalent carrier peptide, did not increase treatment potency when non-cytotoxic concentrations were used, with the exception of P5, which remained active at a concentration of 1.6 µM (1.8 µg/mL). Combining AMPs with each other did not further improve AMP potency, with some treatment combinations increasing the growth rate of C. burnetii by >3-fold. This is the first description of AMP cellular penetration to exhibit inhibitory affect on intracellular C. burnetii growth. These results are the first step in the development of a non-traditional antibiotic treatment for Q fever.

Background: Computer models and human surrogates used to study the forces and motion of the human neck under various loading conditions are based solely on adult data. Pediatric computer models and dummy surrogates used to improve the safety of children could be improved with the inclusion of previously unavailable pediatric muscle data., Methods: Measurements of neck circumference and neck muscle cross-sectional area (CSA) were taken from ten 50th percentile adult male and ten 10-year old male volunteer subjects. Muscle cross-sectional areas were calculated from magnetic resonance images of axial cross-sections of the neck., Results: Neck muscle cross-sectional area was calculated for six muscles/muscle groups. A power-law regression analysis was used to describe the relationship between neck circumference and neck muscle cross-sectional area., Conclusions: The cross-sectional area and the power-law functions determined by the data in this study provide a means of calculating muscle cross-sectional area for young children, where such data are currently unavailable. This will provide an opportunity to develop more representative pediatric neck models.

Gonococcal growth inhibitor 1 (GGI-1) is a 44-residue peptide with potent anti-Legionella activity. It has been isolated from Staphylococcus haemolyticus but, to date, its chemical synthesis has not been reported. Acquisition of this peptide via this means would enable a more detailed examination of its antimicrobial properties. However, its synthesis represents a significant challenge because of two predicted "difficult sequences" within the peptide. Its successful solid-phase assembly is reported in this paper, and was accomplished by use of simple palliative measures including the introduction of a single pseudo-proline isostere in order to counteract on-resin aggregation. The peptide had moderate antimicrobial activity against Escherichia coli but was inactive against another Gram-negative bacterium and two Gram-positive bacteria (Bacillus species). It had significant haemolytic activity, with a H(50) (concentration of peptide that causes 50 % haemolysis) of 20 and 125 μM for two blood samples from different donors. An alternative therapeutic index to that proposed for GGI-1 in a recent publication is proposed.

We report the synthesis of a series of bivalent 1,2,3-triazole linked galactopyranosides as potential inhibitors of cholera toxin (CT). The inhibitory activity of the bivalent series was examined (ELISA) and the series showed low inhibitory activity (millimolar IC(50)s). Conversely, the monomeric galactotriazole analogues were strong inhibitors of cholera toxin (IC(50) = 71-75 μM).

In this study, 39 antimicrobial peptides, most with documented low haemolytic activity and potent efficacy against Gram-negative and Gram-positive bacteria, were evaluated for their haemolytic activity against human red blood cells as well as their antimicrobial activity against Escherichia coli, Burkholderia thailandensis, Bacillus globigii and Bacillus anthracis. The majority of the peptides had a minimum inhibitory concentration (MIC) of <10 μM against B. globigii. However, only eight of these (CaLL, Ci-MAM-A24, LLaMA, Ltc2a, OV-5, papillosin, smapspin and smapspin-G) had a MIC<10 μM against B. anthracis. All except one (papillosin) were ineffective at 100 μM against B. thailandensis and none had potent activity against E. coli. Potent activity against B. anthracis was associated with significant haemolytic activity, but the ratio of the concentration of peptide that caused 50% haemolysis to the concentration that inhibited growth of B. anthracis by 50% (the therapeutic index) varied from 0.8 to 34.2. Two peptides (papillosin and Ltc2a) had a therapeutic index >30 and could be considered as candidates for further development for potential medical countermeasures against anthrax. Although B. globigii has often been used as a non-pathogenic simulant for B. anthracis, in this study it was found that the sensitivity of B. globigii to peptides was not a reliable predictor of the sensitivity of B. anthracis to the same peptides., (Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.)

SMAP-29 (sheep myeloid antimicrobial peptide-29) is a peptide with potent antibacterial properties. However, it is also highly cytotoxic both to human red blood cells (hRBCs) and human embryonic kidney (HEK) cells. In this study, some of the amino acids of SMAP-29 were changed in an attempt to reduce haemolytic activity whilst maintaining high antibacterial efficacy. These analogues, plus other analogues described in the literature with potent antimicrobial activity against Gram-positive bacteria coupled with no or low haemolytic activity, were evaluated for their cytotoxicity (hRBCs and HEK cells) as well as antimicrobial efficacy against two Gram-positive (Bacillus anthracis and Bacillus globigii) and two Gram-negative bacteria (Escherichia coli and Burkholderia thailandensis). The analogues previously described in the literature were found to have low antibacterial and haemolytic activity. Two of the designed analogues had comparable antibacterial efficacy with SMAP-29 against B. anthracis but reduced haemolytic activity and therefore had a therapeutic index that was enhanced 2.3-2.6-fold over that of SMAP-29., (Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.)

Antimicrobial peptides (AMPs) are produced by all forms of living organisms and represent a novel class of antibiotics to treat infectious diseases. In this study, 29 AMPs of varying length and characteristics were synthesised chemically and were evaluated for their ability to inhibit the growth of Bacillus globigii, Bacillus anthracis and Burkholderia thailandensis. Amongst the peptides tested, sheep myeloid antimicrobial peptide-29 (SMAP-29) was the most potent, inhibiting both B. globigii and B. anthracis at submicromolar concentrations. However, SMAP-29 was less effective against B. thailandensis (minimum inhibitory concentration of 71 microM). Haemolytic activity and cytotoxicity were determined using human blood cells and human embryonic kidney 293S cells, respectively. Most of the peptides tested showed varying degrees of haemolytic activity and cytotoxicity, with SMAP-29 being highly haemolytic and cytotoxic under the conditions tested. Nevertheless, strategies to reduce toxicity whilst maintaining high antimicrobial activity are worth pursuing in light of the results obtained., (Crown Copyright 2010. Published by Elsevier B.V. All rights reserved.)

Introduction: Anthrax toxin comprises a protective antigen (PA) of MW 83 kDa, a lethal factor (LF) and an edema factor (EF). Upon binding to its receptor on cell surfaces, PA(83) is enzymatically cleaved to a 63 kDa product (PA(63)), followed by binding of LF or EF, receptor-mediated internalisation of these factors, and production of their toxic effects. The high-affinity binding of PA(83) to its receptor is essential for the intoxication process. To study the interaction between the PA and its receptor, and inhibition of the binding, an enzyme-linked immunosorbent assay (ELISA) was developed., Methods: One of the two known anthrax toxin receptors (capillary morphogenesis factor 2; CMG2) was adsorbed onto wells of a 96-well plate. Either PA(83) or PA(63) was then added to the receptor-coated wells, followed by sequential addition of anti-PA antibody, anti-species antibody-enzyme conjugate, and enzyme substrate at appropriate time intervals., Results: Best results were obtained by overnight incubation of CMG2 in PBS at 4 degrees C. CMG2 was used at 1 microg/ml because of the cost of the commercial product. The rate of change of absorbance was low, and was measured over 3 h to obtain accurate results. The assay results increased almost linearly with CMG2 concentration to 10 microg/ml. PA(83) was also used at 1 microg/ml, but the assay values reached a plateau at approx. 10 microg/ml. Binding was divalent cation-dependent, almost irreversible, and free CMG2 was a potent inhibitor of binding (I(50) in the nM range). Binding of PA(63) was similar to that of PA(83)., Discussion: The high-affinity binding and divalent cation dependence confirm the validity of the assay as a model for toxin-receptor binding in vivo and as a means of evaluating toxin-receptor binding and inhibitors of the binding. Attempts to use crude lysates of J774A.1 cells or von Willebrand factor as an alternative source of anthrax toxin receptor were not successful.