Factors affecting intent to perpetrate violence against nurses: Theory of Planned Behavior approach.

BACKGROUND: The Theory of Planned Behavior (TPB) has been found to predict target behaviors. The literature examining this model lacks attention to violence toward nurses. PURPOSE: To explore the association between the public's exposure to violence and intention to employ violence toward nurses, under the TPB framework. METHODS: A cross-sectional study (705 participants) employed a self-report questionnaire. Path analysis assessed TPB variables' mediation between prior exposure to violence and violent intent toward nurses. DISCUSSION: The TPB variables, that is attitudes, subjective norms, and perceived control, mediated only the association between exposure to physical violence and intention to act violently. Subjective norms were the strongest mediator. The explained variance was 31%. CONCLUSION: When addressing violence against nurses, policymakers must consider attitudes, subjective norms, and perceived control among patients and their attendants. Violence directed at nurses and health care workers reflects societal violence and the "upstream approaches" needed to mitigate violence in health care settings.

Decision-making process regarding passive euthanasia: Theory of planned behavior framework.

BACKGROUND: Nurses have an essential role in caring for end-of-life patients. Nevertheless, the nurse's involvement in the passive euthanasia decision-making process is insufficient and lower than expected. OBJECTIVES: To explore factors associated with nurses' intention to be involved in non-treatment decisions (NTD) regarding passive euthanasia decision-making versus their involvement in the palliative care of patients requesting euthanasia, using the Theory of Planned Behavior (TPB) framework. DESIGN: A cross-sectional study utilizing a random sample. PARTICIPANTS AND RESEARCH CONTEXT: The study was conducted in one of the largest hospitals in Israel among 125 nurses employed in internal and surgical care wards. Data was collected through face-to-face interviews between March and April 2019. METHOD: A closed structured questionnaire was developed according to TPB instructions. A paired sample t test and two multiple hierarchical regressions were conducted. Variance explained (R2) and the significance of F change were calculated for each regression. The study used the STROBE statement guideline. ETHICAL CONSIDERATIONS: The study was approved by the hospital's Helsinki Committee (#20.11.2017). FINDINGS: A paired sample t test revealed that nurses' involvement in the palliative care of patients requesting passive euthanasia was significantly higher than in NTD regarding euthanasia. Regression analyses revealed that nurses' position and attitudes explain their intention to be involved in decision-making; attitudes and perceived behavioral control explain nurses' intention to be involved in the care of patients requesting euthanasia. CONCLUSIONS: According to the TPB, nurses' attitudes explained their intention to participate in decision-making regarding passive euthanasia. It is recommended to enhance open discussion of this complex issue to encourage nurses' willingness to participate in NTD decision-making regarding euthanasia.

Efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia.

Patients with chronic lymphocytic leukemia (CLL) have an increased risk for severe COVID-19 disease and mortality. The goal of this study was to determine the efficacy of COVID-19 vaccine in patients with CLL. We evaluated humoral immune responses to the BNT162b2 messenger RNA (mRNA) COVID-19 vaccine in patients with CLL and compared responses with those obtained in age-matched healthy control subjects. Patients received 2 vaccine doses, 21 days apart, and antibody titers were measured by using the Elecsys Anti-SARS-CoV-2 S assay after administration of the second dose. In a total of 167 patients with CLL, the antibody response rate was 39.5%. A comparison between 52 patients with CLL and 52 sex- and aged-matched healthy control subjects revealed a significantly reduced response rate among patients (52% vs 100%, respectively; adjusted odds ratio, 0.010; 95% confidence interval, 0.001-0.162; P < .001). The response rate was highest in patients who obtained clinical remission after treatment (79.2%), followed by 55.2% in treatment-naive patients and 16.0% in patients under treatment at the time of vaccination. In patients treated with either Bruton's tyrosine kinase inhibitors or venetoclax ± anti-CD20 antibody, response rates were considerably low (16.0% and 13.6%). None of the patients exposed to anti-CD20 antibodies <12 months before vaccination responded. In a multivariate analysis, the independent predictors of response were younger age, female sex, lack of currently active treatment, immunoglobulin G levels ≥550 mg/dL, and immunoglobulin M levels ≥40 mg/dL. In conclusion, antibody-mediated response to the BNT162b2 mRNA COVID-19 vaccine in patients with CLL is markedly impaired and affected by disease activity and treatment. This trial was registered at www.clinicaltrials.gov as #NCT04746092.

The role of sense of coherence in workplace violence directed at nurses in the shadow of COVID-19: A cross-sectional study.

AIMS: To explore (a) the associations between sense of coherence (SOC), previous exposure to COVID-19, and the intention to act violently towards nurses, and (b) the role of SOC and sociodemographic variables as risk or protective factors involved in the intention to act violently. DESIGN: A cross-sectional study with a convenience sample. METHODS: A structured self-report questionnaire was distributed from February to March 2022. The questionnaire included socioeconomic variables, previous exposure to COVID-19, and a validated questionnaire on SOC. Three vignettes (online shaming, verbal and physical violence) describing nurse-patient communication conflicts were presented to participants. A multinomial logistic regression was conducted to explore the associations with acting violently by comparing three options of no/sometimes/high intention to act violently. The study adhered to STROBE guidelines. RESULTS: Questionnaires were completed by 808 adults. SOC and religiosity were revealed as protective factors in the three vignettes. Verbal violent behaviour was found to be a risk factor for online and physical violent behaviour intention. Previous exposure to COVID-19, non-academic education, and ethnicity were found to be risk factors for the intention to behave violently toward nurses. CONCLUSION: The findings suggest that training nurses in practical SOC dimensions (enhancing comprehensible, manageable and meaningful treatment processes) may reduce patients' lack of understanding and frustration and, in turn, reduce the tendency to behave violently. IMPACT: This study focused on SOC as a variable that may affect the intention to act violently towards nurses. The results reveal that SOC may be a protective factor, where people with higher SOC will have less intention to behave violently towards nurses. The results can provide an insight for nurses, nurse leaders and policymakers, towards supplying coherent and cultural competency treatment processes for patients and assisting nurses in dealing with stressful situations during normal routines and pandemics. PATIENT OR PUBLIC CONTRIBUTION: The questionnaire was distributed among the general public by master's degree nursing students. The students distributed the questionnaires among their friends and acquaintances using a snowball-sampling approach.

Perceptions of children with cancer and their parents regarding illness: A qualitative study.

PURPOSE: The current study aims to understand inter-generational differences and similarities in the perception of illness and the available resources employed by children with cancer and their parents. METHODS: A qualitative descriptive research design was utilized, including face-to-face interviews with 108 parent-child dyads where the children had been diagnosed with cancer, by means of a semi-structured questionnaire. The participants were recruited from two pediatric hematology-oncology wards in two different hospitals in Israel. The data were analyzed using conventional qualitative content analysis. Debriefing and inter-rater reliability methods were utilized. FINDINGS: Similarities were found between the coping of children and parents with the illness. Children with cancer and their parents can find bright sides and support for coping, such as different perspectives on life, faith, positive thoughts, and family assistance. Most of the differences between the perceptions of children and parents relate to the difficulties encountered. While parents are mainly concerned about the long-term impact, children contend with ordeals involving the here-and-now. CONCLUSIONS: Parents and children demonstrate a dual process in their challenging journey. Positive and facilitating factors are intertwined with the aggravating aspects, which exist side by side. PRACTICE IMPLICATIONS: Nursing staff should advise children and their parents to attain and use external and internal sources of support found in this study to help them deal with cancer.

The Role of Extracellular Vesicles (EVs) in Chronic Graft vs. Host Disease, and the Potential Function of Placental Cell-Derived EVs as a Therapeutic Tool.

Chronic graft-versus-host disease (cGVHD) presents with dermal inflammation and fibrosis. We investigated the characteristics of extracellular vesicles (EVs) obtained from cGVHD patients, and their potential effects on human dermal fibroblast (NHDF) cells. The anti-inflammatory and anti-fibrotic effects of placental EVs were also explored given their known anti-inflammatory properties. Fourteen cGVHD patients' EVs contained higher levels of fibrosis-related proteins, TGFß and α-smooth muscle actin (αSMA), compared to EVs from thirteen healthy subjects. The exposure of NHDF cells to the patients' EVs increased the NHDF cells' TGFß and αSMA expressions. Placental EVs derived from placental-expanded cells (PLX) (Pluri Inc.) and human villous trophoblast (HVT) cells expressing the mesenchymal markers CD29, CD73, and CD105, penetrated into both the epidermal keratinocytes (HACATs) and NHDF cells. Stimulation of the HACAT cells with cytokine TNFα/INFγ (0.01-0.1 ng/µL) reduced cell proliferation, while the addition of placental EVs attenuated this effect, increasing and normalizing cell proliferation. The treatment of NHDF cells with a combination of TGFß and placental HVT EVs reduced the stimulatory effects of TGFß on αSMA production by over 40% (p = 0.0286). In summary, EVs from patients with cGVHD can serve as a biomarker for the cGVHD state. Placental EVs may be used to regulate dermal inflammation and fibrosis, warranting further investigation of their therapeutic potential.

Extracellular Vesicles of COVID-19 Patients Reflect Inflammation, Thrombogenicity, and Disease Severity.

Severe COVID-19 infections present with cytokine storms, hypercoagulation, and acute respiratory distress syndrome, with extracellular vesicles (EVs) being involved in coagulation and inflammation. This study aimed to determine whether coagulation profiles and EVs reflect COVID-19 disease severity. Thirty-six patients with symptomatic COVID-19 infection with mild/moderate/severe disease (12 in each group) were analyzed. Sixteen healthy individuals served as controls. Coagulation profiles and EV characteristics were tested by nanoparticle tracking analysis (NTA), flow cytometry, and Western blot. While coagulation factors VII, V, VIII, and vWF were comparable, significant differences were found in patients' D-Dimer/fibrinogen/free protein S levels compared to controls. Severe patients' EVs displayed higher percentages of small EVs (<150 nm) with increased expression of exosome marker CD63. Severe patients' EVs displayed high levels of platelet markers (CD41) and coagulation factors (tissue factor activity, endothelial protein C receptor). EVs of patients with moderate/severe disease expressed significantly higher levels of immune cell markers (CD4/CD8/CD14) and contained higher levels of IL-6. We demonstrated that EVs, but not the coagulation profile, may serve as biomarkers for COVID-19 severity. EVs demonstrated elevated levels of immune- and vascular-related markers in patients with moderate/severe disease, and may play a role in disease pathogenesis.

Sophomore nursing students' perception of their Professional Behavior toward Rehabilitation patients: a cross-sectional study.

BACKGROUND: Rehabilitation is considered one of the elements of universal health coverage, emphasizing its importance for every person in need throughout the life course. Nurses play a pivotal role in the rehabilitation team as they possess the competencies to help individuals manage health problems and maximize potential well-being. Yet, little is known regarding knowledge of this subject among nursing students, as well as regarding their attitudes, thoughts, and professional behavior. This study aimed to explore: (a) Sophomore students' attitudes, feelings, thoughts, and professional behavior toward rehabilitation patients; and (b) Differences in the research variables as affected by students' previous exposure to rehabilitation patients. METHODS: A cross-sectional survey design among sophomore nursing students. A questionnaire was distributed through a commercial internet survey provider (Qualtrics.com) before the beginning of a mandatory course on "nursing rehabilitation", introduced for the first time in 2022 in all Israeli universities. Students were divided into three groups according to their previous exposure to rehabilitation patients: no professional or personal previous exposure to rehabilitation patients; previous professional or personal exposure to rehabilitation patients; and previous exposure to rehabilitation patients both in one's professional and personal life. The study adhered to the STROBE guidelines. RESULTS: The sample consisted of 122 participants. Significant differences were found between the groups by their previous exposure to rehabilitation patients. Participants with no previous exposure to rehabilitation patients were found to have lower self-perceived capability to care for rehabilitation patients and more negative professional behavior toward rehabilitation patients and their families compared to the other two groups (H = 22.06, p = 0.006, H = 23.86, p = 0.03, respectively). No other statistical differences were observed between the groups. CONCLUSIONS: The findings emphasize the importance of exposing students to the field of nursing rehabilitation and to the care of rehabilitation patients. Exposure to nursing rehabilitation specifically during one's studies, through theoretical learning and clinical experience, can promote positive attitudes, professional values, and positive professional behavior toward these patients and their families.

BNT162b2 mRNA COVID-19 vaccine booster induces seroconversion in patients with B-cell non-Hodgkin lymphoma who failed to respond to two prior vaccine doses.

This prospective study evaluated seroconversion rates in response to BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine booster in 44 B-cell non-Hodgkin lymphoma (B-NHL) patients who failed to respond to two prior doses [42 previously exposed to anti-CD20 monoclonal antibodies (moAbs) including 13 under maintenance treatment]. Seroconversion was obtained in 29.5% of the patients. Longer time from last anti-CD20 moAb (>6 months) and diagnosis of aggressive lymphoma compared to other, incurable B-NHLs were associated with increased seroconversion rates (47.8% vs.10.5%, p = 0.019 and 50% vs. 17.9%, p = 0.025 respectively). Thus, seronegative patients with B-NHL that completed anti-CD20 therapy more than 6 months prior to the booster have greater chances to achieve seroconversion.

The public's mixed emotional responses to violence directed at nurses: A mixed methods study.

AIMS AND OBJECTIVES: To understand whether exposure to an incident of violence directed at nurses, evoke among the public a sense of identification with the victim or with the perpetrator. BACKGROUND: Worldwide, evidence regarding workplace violence (WPV) in healthcare systems, explored the characteristics of the perpetrator, the healthcare settings and staff. Nevertheless, no studies examine the emotions of the public towards WPV in the healthcare systems. DESIGN: A convergent mixed method parallel design. METHODS: A structured questionnaire was distributed among 925 adults. Two scenarios were presented, with verbal and physical violence towards nurses. The participants rated how intensely they felt positive and negative emotions regarding the nurse and the perpetrator (quantitative stage). Sixty participants were also interviewed concerning their emotions regarding violence committed towards nurses (qualitative stage). Paired samples t-test were used to compare the emotions that were aroused regarding the perpetrator and the nurse. The effect size and Bonferroni correction for multiple comparisons were calculated. Constant comparative analysis method was used to analyzed the qualitative data. The STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies were used for reporting. RESULTS: Positive emotions were significantly higher towards the nurse than the perpetrator. Nevertheless, there were both positive and negative emotions towards the perpetrator and the nurse. The qualitative findings yielded two themes: (1) Mixed emotions towards the perpetrator, and (2) Mixed emotions towards the nurse. CONCLUSIONS: The public may emotionally identify with both the nurse and the perpetrator while positive and negative emotions are intertwined. Likewise, positive emotions are more intensely felt for the victims in both verbally and physically violent scenarios. RELEVANCE TO CLINICAL PRACTICE: These complemented findings highlight the need for campaigns promoting positive emotions toward healthcare professionals in an attempt to reduce and eliminate WPV in healthcare.

Reducing health disparities: Adherence to referrals for further diagnosis among asylum seeking children.

OBJECTIVE: Asylum-seeking children are most vulnerable to health problems and non-utilization of health amenities. The aim of the study was to compare adherence with referrals for further diagnostic tests among asylum-seeking children and native Israeli children. DESIGN: A retrospective cohort study. SAMPLE: The study was conducted among 3508 children born in 2016-2017, with two randomized sample groups: Israeli children (n = 243) and asylum-seeking children (n = 271). Data were retrieved from the children's medical files. MEASUREMENTS: Referrals for further diagnostic tests were defined as written referrals by a public health nurse or pediatrician. Data collected included the child's and mother's details, as well as data on referrals. A multiple logistic regression test was performed to detect risk variables for non-adherence to referrals. RESULTS: No differences were found between the groups regarding adherence to referrals for further diagnosis. Having medical insurance did not explain adherence to referrals. Asylum-seeking children have more need for further follow-up than do Israeli children. CONCLUSION: Asylum-seeking children and Israeli children respond similarly to the preventive health services offered with equal accessibility. Public health nurses have an essential role in encouraging adherence to screening tests and to referrals for further diagnostic tests and in mitigating health disparities among asylum-seeking children.

Humoral response rate and predictors of response to BNT162b2 mRNA COVID19 vaccine in patients with multiple myeloma.

Multiple myeloma (MM) patients are at excess risk for clinically significant COVID19 infection. BNT162b2 mRNA COVID19 (BNT162b2) vaccine provides effective protection against COVID19 for the general population, yet its effect in MM patients may be compromised due to disease and therapy-related factors and was not yet evaluated. This single-centre prospective study included MM patients tested for serological response 14-21 days post second vaccine. Vaccinated healthy volunteers served as controls. In all, 171 MM patients, median age 70 (38-94) were included; 159 active MM and 12 smouldering myeloma (SMM). Seropositive response rate (median titer) was 76% (91 U/ml) in active MM patients vs 98% (992 U/ml) in the 64 controls (P < 0·0001), and 100% (822 U/ml) in SMM patients. Multivariate analysis revealed older age (P = 0·009), exposure to ≥4 novel anti-myeloma drugs (P = 0·02) and hypogammaglobulinaemia (P = 0·002) were associated with lower response rates. None of the novel agents significantly decreased response rate, whereas daratumumab trended towards reduced response (P = 0·08). Adverse events occurred in 53% and 55% of the MM patients and controls, respectively, all transient grade 1-2. In conclusion, BNT162b2 vaccine was safe and provided a high seropositivity rate in MM patients, independent of treatment type. Older, hypogammaglobulinaemic and heavily pretreated patients had lower response rates.

Differences in mental health and health-related quality of life between the Israeli and Italian population during a COVID-19 quarantine.

PURPOSE: Severe restrictions related to COVID-19 were implemented almost simultaneously in Italy and Israel in early March 2020, although the epidemic situation in both countries was significantly different. Therefore, the purpose of this study was to examine how and to what extent the severe restrictions affected the mental health and health-related quality of life of non-infected people, in a comparison between Israel and Italy. METHODS: A cross-sectional study was conducted during the first week of May 2020 among 510 Israeli and 505 Italian participants. Anxiety and depression levels were measured using the Patient Health Questionnaire-4 (PHQ-4), and the short form-8 health survey (SF-8) questionnaire measured health-related quality of life. Linear hierarchic regression forced steps analysis was performed to measure the unique contribution of each variable to predicting health-related quality of life. RESULTS: After adjusting for socioeconomic variables, the results showed a significantly higher anxiety level and lower health-related quality of life in the Italian participants. The anxiety and depression variables predicted lower health-related quality of life. Physical activity was found to be a protective factor. CONCLUSION: The results suggest that early monitoring of anxiety and depression in situations such as quarantine may detect the risk for decline in health-related quality of life. Establishment of professional interventions is needed in order to prevent the negative health consequences of the pandemic-related policy.

Nurses as 'second victims' to their patients' suicidal attempts: A mixed-method study.

AIMS AND OBJECTIVES: To understand the effects of patients' suicidal attempts and events on nurses' second victim symptoms and to explore the association between these experiences and nurse absenteeism and turnover. BACKGROUND: The term 'second victim' is when a healthcare professional expresses psychological symptom following adverse patient event. This has been previously shown to be associated with absenteeism and higher staff turnover. DESIGN: A mixed-methods study with a sequential exploratory approach. METHODS: A qualitative approach was used for nurses to relate their experiences of their patients' suicidal attempts. A cross-sectional quantitative study was conducted in 150 nurses who worked in internal departments. The Second Victim Experience and Support Tool was used to substantiate and measure second victim related distress of nurses who treated suicidal patients. The qualitative data were analysed by a constant comparative analysis method. The analytic analysis of the quantitative study included Pearson's correlations and hierarchical linear regression model to assess the explanatory variables to absenteeism and staff turnover. The study adhered to the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies. RESULTS: The qualitative part identified three themes and nine sub-themes, including the new variable 'sense of being alone'. The quantitative part of the study found that nurses expressed a medium level of second victim related distress. After controlling for demographic variables, second victim distress and the sense of being alone following patients' suicidal events may explain nurse absenteeism and turnover. CONCLUSIONS: Nurses who experience suicidal attempts of their patients react as second victims. These symptoms lead to nurse absenteeism and turnover. RELEVANCE TO CLINICAL PRACTICE: Nurses who experience suicidal attempts of their patients need treatment and support as second victims, the same as in any other medical adverse event. The nursing leadership should emotionally support these nurses and prevent consequential staff organisational problems.

Extracellular Vesicle MicroRNA That Are Involved in ß-Thalassemia Complications.

Beta thalassemia major (ßT) is a hereditary anemia characterized by transfusion-dependency, lifelong requirement of chelation, and organ dysfunction. MicroRNA (miRNA) can be packed into extracellular vesicles (EVs) that carry them to target cells. We explored EV-miRNA in ßT and their pathophysiologic role. Circulating EVs were isolated from 35 ßT-patients and 15 controls. EV miRNA was evaluated by nano-string technology and real-time quantitative polymerase chain reaction (RT-qPCR). We explored effects of EVs on cell culture proliferation, apoptosis, and signal transduction. Higher amounts of small EV (exosomes) were found in patients than in controls. The expression of 21 miRNA was > two-fold higher, and of 17 miRNA < three-fold lower in ßT-EVs than control-EVs. RT-qPCR confirmed differential expression of six miRNAs in ßT, particularly miR-144-3p, a regulator of erythropoiesis. Exposure of endothelial, liver Huh7, and pancreatic 1.1B4 cells to ßT-EVs significantly reduced cell viability and increased cell apoptosis. ßT-EV-induced endothelial cell apoptosis involved the MAPK/JNK signal-transduction pathway. In contrast, splenectomized ßT-EVs induced proliferation of bone marrow mesenchymal stem cells (BM-MSC). In summary, the miR-144-3p was strongly increased; ßT-EVs induced apoptosis and decreased endothelial, pancreatic, and liver cell survival while supporting BM-MSC proliferation. These mechanisms may contribute to ßT organ dysfunction and complications.

Association Between Witnessing and Justifying Workplace Violence Towards Nurses in Israel.

BACKGROUND: Workplace violence perpetrated by patients and their families towards nurses has become a global problem. PURPOSE: The present study explores associations between individuals' having witnessed violent incidents in the past and holding attitudes justifying violence in the present, and their intention to behave violently in a nurse-patient interaction at a healthcare facility. DESIGN: A cross-sectional study sampled 1,350 participants from among the general public in Israel. METHODS: A self-administered questionnaire measured attitudes regarding violence towards nurses and confronted the participants with two vignettes eliciting verbal and physical violence towards nurses. Multiple logistic regression was conducted to explore the association between attitudes and intention to act violently. A mediation analysis (using the PROCESS macro) was conducted to explore the mediation factors. RESULTS: Over half of the participants witnessed an incident of verbal violence in health care and substantially fewer witnessed a physically violent event (51.5% and 16.1%, respectively). An attitude of highly justifying violence was found to be directly associated with the intention to act verbally and physically violent. Past witnessing of verbal or physical violence in healthcare settings had an indirect association through an attitude that justifies violence, which served as a mediating factor for the intention to act verbally and physically violent in a situation presented via the vignettes. CONCLUSIONS: Witnessing a violent event in healthcare systems has social consequences that may cause normalization of violence and lead to the intention to use verbal or even physical violence towards nurses. CLINICAL RELEVANCE: Nurses should be encouraged to report incidents of violence, while healthcare and judicial systems must address this issue seriously. It is recommended that systems alerting for risk indicators be applied, to identify patients with a potential for violence in healthcare facilities. Healthcare policymakers and workers must act to promote an environment of zero tolerance for violence in order to minimize such events. In order to prevent violence towards healthcare staff, a holistic multisystem approach should be implemented, involving a focus by sociocultural elements on social values and structures, as violence in healthcare reflects violence in society at large.

Knowledge and information credibility evaluation strategies regarding COVID-19: A cross-sectional study.

BACKGROUND: The novel coronavirus disease (COVID-19) pandemic has not only caused significant challenges for health systems worldwide, but also fueled a surge in misinformation. Nurses as frontline health care providers should be equipped with the most accurate information on COVID-19. PURPOSE: This study examines nurses' knowledge and strategies of information credibility sourcing. METHOD: A cross-sectional survey among nurses and laypersons with no health care background. The questionnaire dealt with knowledge and ability assess credibility of COVID-19 information. FINDINGS: Nurses' knowledge of COVID-19 preventative behaviors was significantly higher than that of laypersons; however, there was no difference in science-based knowledge of COVID-19. In contrast to laypersons, nurses in this study were better able to discern the credibility of health-related information about COVID-19 than laypersons. Yet they rarely used scientific criteria in evaluating conflicting information. DISCUSSION: Given the importance of assessing the credibility of information, both information literacy skills and science-based knowledge about COVID-19 should be offered.

Public knowledge, attitudes, and intention to act violently, with regard to violence directed at health care staff.

BACKGROUND: Violence directed at health care staff is widely prevalent. Few studies have explored public attitudes regarding violence against health care staff. PURPOSES: To examine the Israeli public's attitudes regarding violence against health care staff and their intention to act violently in various health care settings. METHOD: A cross-sectional study among 609 adult participants used a self-report questionnaire. The questionnaire dealt with attitudes regarding violence toward health care staff and presented the participants with three scenarios of violence in a health care setting. Logistic regression was conducted to explore variables that may explain the public's intentions to act violently. FINDINGS: The participants expressed condemnation of violence toward health care staff. Men displayed more violent attitudes than women. Participants who justified violence and were supportive of violent behavior displayed significantly more intentions to act violently. DISCUSSION: Actions taken to eliminate violence in the health system must be based on cooperation between health policymakers, health care workers, and the public.

Extracellular vesicles of multiple myeloma cells utilize the proteasome inhibitor mechanism to moderate endothelial angiogenesis.

Bone marrow microenvironment is known to support angiogenesis, thus contributing to progression of multiple myeloma (MM). Bortezomib, a proteasome inhibitor (PI) widely used in MM treatment, has anti-angiogenic activity. Extracellular vesicles (EVs), shedding from cell surface, serve as mediators in cell-to-cell communication. We have hypothesized that MM cells (MMCs) treated with bortezomib generate EVs that could diminish angiogenesis, thus limiting MM progression. In the present study, EVs were obtained from MMCs (RPMI-8226), untreated (naïve) or pre-treated with bortezomib. EVs were outlined using NanoSight, FACS, protein arrays and proteasome activity assays. The impact of MMC-EVs on endothelial cell (EC) functions was assessed, employing XTT assay, Boyden chamber and Western blot. A high apoptosis level (annexin V binding 70.25 ± 16.37%) was observed in MMCs following exposure to bortezomib. Compared to naïve EVs, a large proportion of bortezomib-induced EVs (Bi-EVs) were bigger in size (> 300 nm), with higher levels of annexin V binding (p = 0.0043).They also differed in content, presenting with increased levels of pro-inflammatory proteins, reduced levels of pro-angiogenic growth factors (VEGFA, PDGF-BB, angiogenin), and displayed lower proteasome activity. Naïve EVs were found to promote EC migration and proliferation via ERK1/2 and JNK1/2/3 phosphorylation, whereas Bi-EVs inhibited these functions. Moreover, Bi-EVs appeared to reduce EC proteasome activity. EVs released from apoptotic MMCs following treatment with bortezomib can promote angiogenesis suppression by decreasing proliferation and migration of EC. These activities are found to be mediated by specific signal transduction pathways.

Organizational commitment and quality of life at work among public health nurses in Israel.

OBJECTIVE: To test the relationship between job satisfaction, professional self-image, work environment, organizational commitment (OC), and quality of life at work (QoLW) among public health nurses in Israel. To determine which variables can predict OC and QoLW among public health nurses. DESIGN AND SAMPLE: One hundred and thirty-two public health nurses participated in this cross-sectional study with a structured self-administered questionnaire that examined OC, professional self-image, job satisfaction, nursing work environment, and QoLW. Pearson correlation tested correlations between variables and multiple regression was conducted to predict OC and QoLW. MEASUREMENTS: The five measurements (job satisfaction, professional self-image, work environment, OC, and QoLW) based on validity questionnaires with high internal confident. RESULTS: All five variables showed a significant positive correlation. Job satisfaction (t = 5.77, p < 0.001) and nursing work environment (t = 4.55, p < 0.001), contributed significantly to the explanation of OC and QoLW variance. Nursing work environment (t = 6.42, p < 0.01) and job satisfaction (t = 2.99, p < 0.01) were the variables that predicted QoLW. CONCLUSIONS: Nursing managers should be proactive and create a professional environment for nurses to encourage their OC and QoLW as factors that may influence public health nurses.