Nausea, Vomiting, and Nonbloody Diarrhea in the Emergency Department.

Nausea, vomiting and diarrhea are frequent co-occurring symptoms that can mask or mimic commonly occurring conditions, or rarely, more serious concerns. The Ending the HIV Epidemic's focus on increased widespread use of PrEP, a biomedical HIV prevention strategy, highlights the importance of discussing common clinical management scenarios. The use of oral PrEP formulations has demonstrated a "startup syndrome" which involves GI upset. This case challenge of a 32year old client admitted to the ED with GI symptoms highlights key PrEP considerations including a sexual health history. Clinicians should understand common complaints associated with oral PrEP start to improve differential diagnosis and appropriate intervention.

Perceptions Toward Mental Illness and Seeking Psychological Help among Bhutanese Refugees Resettled in the U.S.

This study examined perceptions toward mental health and seeking psychological care among Bhutanese refugees in a large Midwestern U.S. city. Bhutanese adults (n = 201) completed a community health needs assessment. Survey questions addressed beliefs toward mental health and seeking psychological care. Perceptions toward mental illness and receiving psychological help were generally negative among participants. Over 71% believed others would look unfavorably on a person who sought out a counselor. Participants who had less than a high school education, were 35 years and older, and lived in refugee camps for more than 20 years had significantly greater negative beliefs toward mental illness. Over one-third (34.8%) of participants reported access to counseling services as being somewhat of a problem or a serious problem. These findings may inform future research and interventions aimed at improving mental health among Bhutanese refugees.

Making a Case for Integrating Evidence-Based Sexual Risk Reduction and Mental Health Interventions for Adolescent Girls.

Recently identified as the top concern of teens, mental health issues now compete with sexual health risks as major threats to the well-being of adolescent females. Depression and anxiety can lead to or compound the negative repercussions of sexual behavior choices that result in disproportionately high rates of sexually-transmitted infections (STIs), hetero-sexually acquired HIV, and unplanned pregnancy rates in girls ages 15-19. There are a limited number of CDC- and DHHS-recognized HIV/STI and teen pregnancy evidence-based interventions (EBIs) targeted to adolescent girls of diverse races/ethnicities and none that simultaneously address common mental health disorders. The Health Improvement Project for Teens (HIPTeens), a manualized gender-specific sexual risk reduction intervention, and the Creating Opportunities for Personal Empowerment (COPE) Program, a manualized cognitive-behavioral skills intervention that reduces depression and anxiety, are recognized by national agencies as strong EBIs that have successfully improved their targeted outcomes. Baseline data from the HIPTeens clinical trial revealed that a substantial portion of the more than 700 girls enrolled had moderate to high levels of depressive symptoms as well as other mental health challenges (e.g., binge drinking and eating, cannabis use). Thus, there is an urgent need to combine EBIs, such as HIPTeens and COPE, to curtail these leading public health problems confronting today's adolescents.

Adolescent Girls' Experiences With Sexual Pressure, Coercion, and Victimization: #MeToo.

BACKGROUND: The #MeToo social media campaign in the United States has highlighted what is a pervasive problem in many cultures-the sexual intimidation and victimization of women by men, especially those in roles of authority. METHODS: In a study of 735 girls, ages 15-19 years, enrolled in a sexual risk reduction randomized controlled trial, we captured baseline data using audio-computer assisted self-interviews to increase validity and reliability of responses to questions regarding such behaviors. RESULTS: Despite their age, one-half of these girls reported being coerced into sex acts (excluding intercourse) with 1 in 5 reporting such victimization by a man who used his position of authority. Alarmingly, 12-28% of girls reported being forced into penetrative sex acts against their will. Far too many girls reported they had had multiple episodes of such violence. LINKING EVIDENCE TO ACTION: It is clear that this study captures a common, but minimally documented, threat faced by adolescent girls ranging from men pressuring them to engage in sex activities through the use of victimization, intimidation, or provision of substances to underage girls to gain compliance. Using such evidence to enhance and tailor sexual risk reduction, health, safety, and communication interventions for both males and females is essential. Identifying triggers to at-risk situations, providing skill building in communication, negotiation and refusal skills, as well as clearly discussing consent issues among both genders are important components in evidence-based interventions if we are to impact positively the next generation to curtail sexual pressure, coercion, and violence.

Military and veteran's health integration across missions: how a college of nursing "joined forces".

BACKGROUND: To address the unique needs of our returning military and veterans, the White House initiated the Joining Forces campaign and has encouraged colleges of nursing throughout the nation to support this mission. METHODS: At the University of South Florida College of Nursing, we have implemented a multifaceted approach that addresses education, research, and employment. These military-related programs have been unified under our RESTORE LIVES (Research and Education to Rehabilitate and Restore the Lives of Veterans, Services Members and their Families) initiative. RESULTS: To accomplish this mission, we enhanced our curriculum to include veteran health care issues, developed research that addresses veteran wellness, launched an accelerated program to enable veterans and military personnel with medical experience to obtain their baccalaureate in nursing, and encouraged a culture within the college that is supportive of military-based health care and employment needs. CONCLUSIONS: We have shared our experiences through webinars and presentations and by hosting a national conference.

Impact of COIL: Learning From Student Nurses in Norway Who Collaborated With U.S. Students.

AIM: The aim of this study was to describe the experience of Norwegian nursing students with internationalization through participation in a Collaborative Online International Learning (COIL) course. BACKGROUND: Educators in Norway and the United States collaborated to incorporate internationalization and population health concepts into virtual courses during the pandemic. Literature gaps exist in post-implementation assessment data that ascertain internationalization through the COIL experience. DESIGN: This was a qualitative study with a descriptive design. Data were collected from focus group interviews and analyzed conventional content-analysis approaches. METHODS: Fifteen Norwegian undergraduate nursing students who participated in the COIL opportunity completed focus group interviews. FINDINGS: The themes identified included, "virtual conversation builds collaborations and enhances learning," and "this opened my eyes." CONCLUSIONS: Norwegian students acknowledged they had learned transferable lessons from their global partners that could be applied to patient care of the marginalized population in Norway.

Sexual risk factors for partner age discordance in adolescent girls and their male partners.

AIMS AND OBJECTIVES: To investigate differences in sexual risk factors between adolescent girls reporting similar-aged or older sex partners. BACKGROUND: Adolescent girls are at significant risk of heterosexual-acquired HIV infection and other long-term reproductive health issues. Sexual partner age discordance in teen girls has been correlated with STIs, lack of protection, multiple partners and earlier age of sexual transition. DESIGN: A descriptive study comparing girls currently involved with age-discordant partners to those with similar-aged partners. Two-sample t-test for continuous variables and chi-squared test or Fisher's exact test for categorical variables were used to compare groups. METHODS: Baseline data from 738 sexually active, urban, adolescent girls aged 15-19 were analysed to determine which behaviours were more likely to occur in girls with older partners. Data were collected as part of a gender-specific HIV-prevention intervention in a randomised controlled trial (RCT) tailored to adolescent girls. RESULTS: Multiple reported sexual risk behaviours were found to significantly differ between the two groups at baseline. Overall, girls with older partners had more episodes of sexual instances (vaginal, anal and oral). Specific sexual risk behaviours were found to be statistically significant between the two groups. Girls with older partners started having sex at earlier ages, had more lifetime sexual partners, higher incidents of STIs and were reluctant to discuss using condoms with their partners. Girls with similar-aged partners were less willing to engage in risky sexual behaviours. CONCLUSIONS: Findings from this investigation support data from other studies. Relationships with older male partners place adolescent girls at increased risk of HIV/STIs and unintended pregnancy. RELEVANCE TO CLINICAL PRACTICE: Adolescent girls in age-discordant relationships are at risk of immediate and long-term sexual health morbidities. Identifying girls who are at increased risk by asking tailored questions will enable nurses to recommend appropriate diagnostics for this population and provide age-specific counselling.

Reflections from Refugee Adolescent Girls on Participation in a US-Based Teen Sexual Health Promotion Project.

Refugee girls may be unprepared for the sexual risk challenges facing teens in the US. We sought to understand refugee girls' general experience, discussions with parents and motivations related to participation in an evidence-based sexual risk reduction program. Through semi-structured interviews with twelve girls ages 15-17 years from nine countries, we acquired insight into the girls' reactions to the program, if they had discussed their experiences, and reflections on their decision to participate. Qualitative analysis of verbatim transcriptions identified three themes: (1) my cultural norm is not to ask; (2) groups were a safe way for me to learn and share; and (3) I learned to use my voice. As the numbers of adolescent refugees grow, we cannot ignore their need for tailored sexual health research and programming. This first-of-its-kind study provides insight into acceptability, motivation for participation, and impact of a sexual health promotion program.

Smoking, substance use, and mental health correlates in urban adolescent girls.

This study examined the associations among smoking tobacco and/or cannabis with alcohol use, depression, disordered eating and healthy behaviors among adolescent girls enrolled in an HIV prevention intervention randomized trial. Baseline self-reported behaviors from 744 sexually active, low-income, urban participants were collected using an audio computer assisted self interview. Girls ranged in age from 15 to 19 years old with a mean age of 16.5. Over 16% of girls reported smoking cigarettes, 41% smoked cannabis and 12% used both substances. Girls who smoked either substance had higher scores for depression symptoms, alcohol use and disordered eating when compared to nonsmokers. Girls who used both substances were at a higher risk for alcohol use, depression symptoms and disordered eating. The association of cannabis and tobacco with the other health related issues differed depending on age, indicating that assessment and targeting of health behavior interventions may differ depending on a girl's age. Disordered eating, depressive symptoms and cannabis use were higher among these adolescent girls than previously documented in the literature, suggesting that to improve the health of this population multi-focused interventions must target girls before they have engaged in smoking.

Always, never, or sometimes: examining variation in condom-use decision making among Black adolescent mothers.

Our purpose in this study was to describe Black adolescent mothers' decisions regarding condom use and non-use with their male sex partners, including their children's fathers. Research on partner type and condom use has been insufficiently focused on understanding the specific influence that the biological father of the baby has on condom use among adolescent mothers. We conducted five focus groups and three interviews with 31 predominantly African-American mothers. We found that their decisions to use condoms always, never, or sometimes were based on partner type and on emotional and relationship factors. The "baby daddy" was the only partner with whom they never used condoms. HIV/STI prevention interventions for adolescent mothers must address risk taking with their children's biological fathers.

Sexual Partner Type Taxonomy Use Among Black Adolescent Mothers in the United States.

PURPOSE: Research on sexual-partner type focuses mostly on "main" and "casual" partner categories. The literature indicates that adolescent girls are less likely to use condoms with main partners, and more likely to use condoms with casual partners. Adolescent mothers may have different types of sexual partners than other adolescent girls. The purpose of this study was to explore and describe the range of male sexual partner types reported by Black adolescent mothers. DESIGN AND SAMPLE: This study was a qualitative description of the perspectives of Black, predominantly African-American, mothers (n=31). Data were generated using focus groups and interviews. The participants' ages ranged from 15-19 years. MEASURES: A semi-structured qualitative questioning guide was used to stimulate focused discussions. Transcribed data were analyzed using qualitative content analysis. RESULTS: The range of sexual partner types of the women were reflected in three themes (1) All main partners are not created equal; (2) They're not casual partners because there are strings attached; (3) "Wham, bam, thank you ma'am:" No strings attached. Nine partner types were identified under these three themes, including a "baby daddy" partner. CONCLUSION: The partner-types of Black adolescent mothers are more robust than the "main" and "casual" partner categories typically referenced in the research literature. The range of sex partners includes the birth fathers of their children. Clinicians and researchers must consider how co-parenthood status is used in the construction of the "baby daddy" partner and what implications this unique sexual partner type may have on risk reduction behaviors such as condom use.

Obesity risk in urban adolescent girls: nutritional intentions and health behavior correlates.

Obesity is an expanding epidemic and minority adolescent girls are at high risk. One way to tailor interventions for obesity prevention is to target intention to engage in particular behaviors. Data collected from adolescent girls' intentions and behaviors regarding nutrition, physical activity, and sleep patterns were used to examine nutritional intentions in relation to healthy behaviors. Adolescent girls reported behaviors that increased their risks for obesity. Nutritional intentions were significantly associated with physical activity and sleep. These results suggest that healthy behaviors tend to occur in clusters, possibly extending the theory of planned behavior beyond individual behaviors to groups of related behaviors. Nurses can intervene with high-risk adolescent girls by promoting healthy diets, recommended levels of physical activity, and adequate sleep.

Virtual Study-Abroad Through Web Conferencing: Sharing Knowledge and Building Cultural Appreciation in Nursing Education and Practice.

BACKGROUND: With a focus on building global citizens, a U.S. and Norwegian academic collaborative partnership fostered clinical learning experiences addressing cultural and health care comparisons. High-impact educational practices integrated into international clinical experiences, combined with virtual global learning classrooms, highlighted the Sustainable Development Goals. PROBLEM: Given nursing education's requirements, devising innovative strategies expanded global learning in brief but transformative experiences while integrating nontraveling students, especially relevant considering current pandemic-related travel restrictions. APPROACH: We developed an educational experience pairing U.S. students (17 in person; 64 through web conference) and Norwegian students (50 in person; 3 for web conference) in population health experiences, providing required clinical hours and a shared cultural exchange. Integration of nontraveling students in joint virtual global experiences broadened the global learning opportunity for all. CONCLUSION: This work offers insight into how faculty used a virtual global learning experience as a synergistic tool with traditional study abroad.

Multi-system influences on adolescent risky sexual behavior.

We examined multi-system influences on risky sexual behavior measured by cumulative sexual risk index and number of nonromantic sexual partners among 4,465 single, sexually experienced adolescents. Hierarchical Poisson regression analyses were conducted with Wave I-II data from the National Longitudinal Study of Adolescent Health. Individual and family factors predicted both outcome measures. Neighborhood set predicted cumulative sexual risk index only, and peer factors predicted the number of nonromantic sexual partners only. School set did not predict either outcome. There were significant associations among risky sexual behavior, drug use, and delinquent behaviors. The results highlight the need for multifaceted prevention programs that address relevant factors related to family, peer and neighborhood influence as well as individual factors among sexually active adolescents.