It's not just about the sun, it's about a living: Rural older farmers' experience of skin cancer risk and prevention.

OBJECTIVE: To understand rural older farmers' perspectives and attitudes toward skin cancer risk and prevention. DESIGN AND SAMPLE: This study used a grounded theory approach and semi-structured interviews with 12 rural older farmers (farm owners, farmworkers ages 50 years or older) in Washington. Participants' perspectives were explored relative to Health Belief Model constructs. Inductive and deductive analyses were used to generate relevant themes. COREQ guidelines were followed. RESULTS: The findings fit well and extended the Health Belief Model, which was used to arrange key themes identified in relation to skin cancer risk and prevention, specifically participants' perceived barriers to accessing primary care and protection when outdoors, perceived benefits of sun-protective behaviors, perceived hereditary susceptibility to skin cancer, perceived severity of the increased skin cancer risk, and cues to action for skin checks. A new construct of hope was identified to emphasize the importance of establishing emotional, instrumental, and informational support systems for promoting skin cancer prevention. Participants also indicated their hope of raising awareness of skin cancer prevention among all ages. CONCLUSIONS: Findings highlighted the importance of integrating skin cancer prevention services for rural older farmers and across the lifespan. Public health approaches are needed to enhance the awareness of and access to preventive care in these underserved populations.

Risk factors and early prevention of skin cancer in rural older outdoor workers: A scoping review.

Skin cancer risk increases with age and prolonged exposure to ultraviolet radiation (UVR), particularly in rural geographical locations and for individuals with light skin complexions. However, the impact of UVR-induced skin cancer risk and sun-protective behaviors in rural older populations working outdoors has yet to be explored. A scoping review was conducted to fill this gap, with 12 articles meeting the inclusion criteria of aged 50 years and older among rural outdoor workers. Skin cancer risk factors, prevention strategies, and barriers to sun-protective behaviors were summarized for each study. The scoping review addressed some key differences in age-related effects of UVR among rural older outdoor workers compared to studies among adults in general. Findings have policy and research implications that highlight the need to design feasible preventive strategies to reduce rural disparities in cancer care and enhance access to preventive services for this high-risk population.

Discipline-Specific Writing Support in Graduate Nursing.

BACKGROUND: Scholarly writing is an essential skill for a doctorally prepared nurse. Despite the importance of writing, there are limited data on how best to support students in the process of writing skill acquisition. This article describes the development, growth, and effects of a writing support program for graduate nursing students. METHOD: A writing support program was initiated with a focus on providing discipline-specific support. Activities included oneon-one coaching, workshops, and collaboration with faculty to offer writing content within or alongside courses. RESULTS: Student and faculty evaluations show the benefits of the writing support program to enhance student confidence and skill in writing. CONCLUSION: Development of a writing support program has provided a valuable resource to graduate students and faculty in the school of nursing. Writing must be intentionally included in doctoral programs and supported with an array of practices including discipline-specific feedback. [J Nurs Educ. 2023;62(4):253-256.].

Integrating population health into nursing education: The process of gaining commitment from Washington's nursing deans and directors.

The achievement of health equity requires the expansion of nursing roles to include assessing burdens of disease, practicing cultural humility, implementing prevention strategies, and developing partnerships. In 2017, deans and directors of schools and programs of nursing in Washington State came together to commit to the integration of population health concepts and social determinants of health into all areas of nursing curricula. Through online communications and in-person meetings, facilitated in part by the authors of this paper, and with subcommittee representation from several baccalaureate nursing programs, Washington State academic nursing leaders identified new strategies to increase faculty awareness of population health and how to inspire related curricular changes to their programs. This Washington-wide initiative resulted in a white paper that was formally endorsed by 38 deans and directors representing all 14 baccalaureate and higher degree nursing programs in the state.

Count Your Calories and Share Them: Health Benefits of Sharing mHealth Information on Social Networking Sites.

This study investigates the relationship between sharing tracked mobile health (mHealth) information online, supportive communication, feedback, and health behavior. Based on the Integrated Theory of mHealth, our model asserts that sharing tracked health information on social networking sites benefits users' perceptions of their health because of the supportive communication they gain from members of their online social networks and that the amount of feedback people receive moderates these associations. Users of mHealth apps (N = 511) completed an online survey, and results revealed that both sharing tracked health information and receiving feedback from an online social network were positively associated with supportive communication. Network support both corresponded with improved health behavior and mediated the association between sharing health information and users' health behavior. As users received greater amounts of feedback from their online social networks, however, the association between sharing tracked health information and health behavior decreased. Theoretical implications for sharing tracked health information and practical implications for using mHealth apps are discussed.

North Carolina State Agencies Working to Prevent Agricultural Injuries and Illnesses.

Over the past 25 years, the North Carolina Departments of Labor, Agriculture and Consumer Services, and Health and Human Services have worked with farmers, farmworkers, commodity and trade associations, universities, and cooperative extension agents to develop programs to decrease the occurrence of injuries and illnesses among agricultural workers and their families. The Bureau of Agricultural Safety and Health in the North Carolina Department of Labor helped craft the Migrant Housing Act, created the Gold Star program, and developed numerous projects promoting rural highway safety and farm safety. The Structural Pest Control & Pesticides Division in the North Carolina Department of Agriculture & Consumer Services administers programs funded by the Pesticide Environmental Trust Fund (PETF), including the Pesticide Container Recycling Program, Pesticide Disposal Assistance Program (PDAP), and Soil Fumigation Training. The Occupational and Environmental Epidemiology Branch (OEEB) in the North Carolina Department of Health and Human Services developed public health surveillance programs for pesticide incidents and carbon monoxide poisoning. These projects, programs, and policies demonstrate the work that North Carolina state agencies are doing to improve the health of agricultural workers and their families.

[Anti-VEGF therapy for juxtafoveolar choroidal neovessels in people with high myopia: about a case]. / Le traitement anti-VEGF des néovaisseaux choroïdiens juxta-fovéolaires du fort myope: à propos d'une observation.

Choroidal neovessels are a threatening complication of high myopia, accounting for 5 to 10% of cases. They require immediate treatment because of their poor prognosis. Anti-VEGF intravitreal injections are currently a new therapeutic alternative far exceeding photodynamic therapy (PDT). Nevertheless, anti-VEGF treatment algorithm for this type of neovessels remains a matter of discussion among the authors. The purpose of this study was to highlight the difficulties in managing these neovessels and to discuss the Anti-VEGF therapeutic regimen to follow.

Mercury Spill Responses - Five States, 2012-2015.

Despite measures to educate the public about the dangers of elemental mercury, spills continue to occur in homes, schools, health care facilities, and other settings, endangering the public's health and requiring costly cleanup. Mercury is most efficiently absorbed by the lungs, and exposure to high levels of mercury vapor after a release can cause cough, sore throat, shortness of breath, nausea, vomiting, diarrhea, headaches, and visual disturbances (1). Children and fetuses are most susceptible to the adverse effects of mercury vapor exposure. Because their organ systems are still developing, children have increased respiratory rates, and they are closer to the ground where mercury vapors are most highly concentrated (2). To summarize key features of recent mercury spills and lessons learned, five state health departments involved in the cleanup (Iowa, Michigan, Missouri, North Carolina, and Wisconsin) compiled data from various sources on nonthermometer mercury spills from 2012 to 2015. The most common sites of contamination were residences, schools and school buses, health care facilities, and commercial and industrial facilities. Children aged <18 years were present in about one third of the spills, with approximately one in seven incidents resulting in symptoms consistent with acute mercury exposure. To protect the public's health after a mercury spill, it is important that local, state, and federal agencies communicate and coordinate effectively to ensure a quick response, and to minimize the spread of contamination. To reduce the number of mercury spills that occur in the United States, public health officials should increase awareness about exchange programs for mercury-containing items and educate school and health care workers about sources of mercury and how to dispose of them properly.

Carbon Monoxide Poisonings from Forklift Use During Produce Packing Operations.

In August 2013, the North Carolina Division of Public Health investigated a carbon monoxide (CO) exposure on a farm. Two employees were overcome by CO and lost consciousness while using a propane-powered forklift to load produce into a refrigerated trailer backed up to a warehouse. One employee died, and the second employee was admitted to the hospital for hyperbaric oxygen treatment. Eighteen people, ranging in age from 18 to 69 years, were potentially exposed to CO, including the two employees, a family member who discovered the employees, two bystanders who stopped to offer assistance, and 13 first responders. Thirteen people who assisted in the emergency response experienced symptoms such as headache and dizziness, and all 16 who assisted were evaluated in a local hospital emergency department and released after receiving 100% oxygen. Blood tests showed five people (the two employees, family member, and two bystanders) had elevated blood carboxyhemoglobin levels, but all first responders had levels within normal range. Firefighters measured a peak CO concentration of 2214 parts per million in the warehouse. The North Carolina Division of Occupational Safety and Health investigated and determined that the forklift, operated inside the trailer with no ventilation, was the source of the CO. Public health investigation activities included interviewing responders, obtaining ambient CO concentration measurements from the fire department, advising the local health director, reviewing medical records, and developing a line listing of exposed persons. To prevent CO poisoning, employers should consider replacing gas-powered equipment with electric equipment, which does not produce CO.

Improving home-based providers' communication to primary care providers to enhance care coordination.

OBJECTIVES: Health care system fragmentation is a pervasive problem. Research has not delineated concrete behavioral strategies to guide providers to communicate with personnel in other organizations to coordinate care. We addressed this gap within a particular context: home-based providers delivering depression care management (DCM) to older adults requiring coordination with primary care personnel. Our objective was to pilot test a communication protocol ('BRIDGE - BRinging Inter-Disciplinary Guidelines to Elders') in conjunction with DCM. METHOD: In an open pilot trial (N = 7), home-based providers delivered DCM to participants. Following the BRIDGE protocol, home-based providers made scripted telephone calls and sent structured progress reports to personnel in participants' primary care practices with concise information and requests for assistance. Home-based providers documented visits with participants, contacts to and responses from primary care personnel. A research interviewer assessed participant outcomes [Symptom Checklist-20 (depressive symptoms), World Health Organization Disability Assessment Schedule-12, satisfaction] at baseline, three months, and six months. RESULTS: Over 12 months, home-based providers made 2.4 telephone calls and sent 6.3 faxes to other personnel, on average per participant. Primary care personnel responded to 18 of 22 requests (81.8%; 2 requests dropped, 2 ongoing), with at least one response per participant. Participants' depressive symptoms and disability improved significantly at both post-tests with large effect sizes (d ranged 0.73-2.3). Participants were satisfied. CONCLUSION: Using BRIDGE, home-based providers expended a small amount of effort to communicate with primary care personnel, who responded to almost all requests. Larger scale research is needed to confirm findings and potentially extend BRIDGE to other client problems, professions, and service sectors.

Modeling the impact of twitter on influenza epidemics.

Influenza remains a serious public-health problem worldwide. The rising popularity and scale of social networking sites such as Twitter may play an important role in detecting, affecting, and predicting influenza epidemics. In this paper, we develop a simple mathematical model including the dynamics of ``tweets'' --- short, 140-character Twitter messages that may enhance the awareness of disease, change individual's behavior, and reduce the transmission of disease among a population during an influenza season. We analyze the model by deriving the basic reproductive number and proving the stability of the steady states. A Hopf bifurcation occurs when a threshold curve is crossed, which suggests the possibility of multiple outbreaks of influenza. We also perform numerical simulations, conduct sensitivity test on a few parameters related to tweets, and compare modeling predictions with surveillance data of influenza-like illness reported cases and the percentage of tweets self-reporting flu during the 2009 H1N1 flu outbreak in England and Wales. These results show that social media programs like Twitter may serve as a good indicator of seasonal influenza epidemics and influence the emergence and spread of the disease.

Prescription histories and dose strengths associated with overdose deaths.

OBJECTIVE: Misuse, abuse, and diversion of prescription drugs are large and growing public health problems that have resulted in an overdose epidemic. We investigated whether short-acting or extended-release opioids were more frequently prescribed to those who died of an overdose and whether there was a linear relationship between dose strength and associated overdose deaths. METHODS: The study population was North Carolina residents in 2010. We conducted a retrospective, population-based, descriptive study of medication histories of overdose decedents using data from vital statistics, medical examiner records, and a prescription drug monitoring program. RESULTS: Unintentional or undetermined drug overdoses were responsible for 892 deaths. Out of 191 deaths involving methadone, only two were patients in opioid treatment programs. Immediate-release oxycodone was involved in the greatest number of opioid-related deaths. Out of 221 oxycodone deaths, 134 (61%) of the decedents filled a prescription for oxycodone in the 60 days prior to death. The most common strength dispensed within 60 days to a decedent who died of an oxycodone overdose was 10 mg for immediate-release (72 prescriptions). Immediate-release oxycodone products (rho = 1.00, P < 0.01) and extended-release fentanyl products (rho = 1.00, P < 0.01) showed strong increasing linear trends between dose strength and proportion of prescriptions dispensed to decedents. CONCLUSIONS: A significant proportion of overdose decedents had been prescribed the same type of drugs that contributed to their death, especially for decedents who died from overdoses involving oxycodone, hydrocodone, and alprazolam. Higher dose strengths for certain opioids had higher associated mortality, and certain immediate-release opioids may be considered for public health prevention efforts.

Notes from the field: elemental mercury spill in school bus and residence - North Carolina, 2013.

On September 16, 2013, the North Carolina Division of Public Health was notified of an elemental (metallic and liquid) mercury spill on a school bus. An elementary student boarded the bus with approximately 1 pound (454 g) of elemental mercury contained in a film canister, which the student had taken from an adult relative who had found it in a neighbor's shed. The canister was handled by several students before the contents spilled on the bus floor. Ten passengers aboard the bus were exposed, including eight students and two staff members. Although elemental mercury is not readily absorbed from skin contact or ingestion, it does vaporize at room temperatures and inhalation of the vapor can be harmful. The bus driver promptly notified school officials. Firefighters and a local hazardous materials team directed decontamination procedures (i.e., changing clothes and washing hands and shoes) for the 10 exposed passengers. The bus was immediately taken out of service and sent for disposal because of its age and the cost of decontamination.

Six-month utilization of psychotherapy by older adults with depressive symptoms.

We explored psychotherapy utilization patterns for community-dwelling older adults with depressive symptoms identified during a statewide initiative designed for identifying risk of substance misuse. Individuals screening negative for substance misuse, but positive for depressive symptoms, agreed to participate in monthly interviews conducted over 6 months (n = 144). Results showed that 39 (27%) received psychotherapy, of which nearly two-thirds reported four or fewer visits. Mental health counselors were the most frequently reported service providers (50-62.5%). Location of service varied considerably. This study documents low rates of psychotherapy use and few visits. Current efforts to increase psychotherapy access are discussed.

Health care utilization and hypertension management in community-based elderly Korean immigrants.

Despite the nation-wide efforts to improve the health status of minority immigrants, studies documenting the outcomes of these efforts are lacking. The purpose of this study is to examine health care utilization and hypertension management in community-based elderly Korean immigrants to the US In this descriptive study, 70 elderly Korean immigrants were recruited from a Korean senior center and church. Health care utilization was assessed with a self-report questionnaire and hypertension management was ascertained through the objective measurement of blood pressure and a self-report questionnaire. Result indicated that 87 % of elderly Korean immigrants received regular health check-ups. Although their hypertension was not managed effectively, all participants with a diagnosis of hypertension were aware of it and were taking blood pressure medications. This study provides an overview of health care utilization and hypertension management in elderly Korean immigrants as well as ideas on ways to reach out to minority older adults for further health promoting interventions.

Advanced practice nursing education: challenges and strategies.

Nursing education programs may face significant difficulty as they struggle to prepare sufficient numbers of advanced practice registered nurses to fulfill the vision of helping to design an improved US healthcare system as described in the Institute of Medicine's "Future of nursing" report. This paper describes specific challenges and provides strategies to improve advanced practice nursing clinical education in order to ensure that a sufficient number of APRNs are available to work in educational, practice, and research settings. Best practices are identified through a review of classic and current nursing literature. Strategies include intensive interprofessional collaborations and radical curriculum revisions such as increased use of simulation and domestic and international service work. Nurse educators must work with all stakeholders to create effective and lasting change.

Report of survey results for newly licensed registered nurses in Washington state.

Current projections for the need for nurses in Washington state are based on an increase in the need for health care, the aging of the population, and the inability of the nursing educational institutions to supply adequate numbers of graduates. Yet many new graduates are providing anecdotal evidence that they cannot find a job in nursing. This study gathered information regarding the employment of newly licensed registered nurses in Washington between May 2009 and August 2010. Questionnaires were administered to a randomly selected sample of 2,200 newly licensed nurses; 532 responses were returned. Nearly 81% reported current employment as a registered nurse and 69.5% reported that they were very or somewhat satisfied with their employment situation. The job search strategies, type of job sought, and factors contributing to their success are reported. Factors contributing to the success of their job search and to job dissatisfaction are explored.