Mpox in the United States: Current implications for public health nursing.

In 2022, mpox, an orthopoxvirus first isolated in 1958 in cynomolgus monkeys, became a global public health threat. While the virus can be communicated through skin-to-skin contact from any infected person to non-infected person, most cases in the United States have been in gay and bisexual men. Consequently, early public health and community-based efforts concentrated on reducing infections in this population. This article explores current mpox case count epidemiologic data and trends. In addition, vaccination indications, contraindications, adverse events, and national administration data are provided along with directions for nurses and other clinicians moving forward in the outbreak.

Social Media as a Recruitment Strategy with Transgender-Identified Individuals: Using an Ethical Lens to Direct Methodology.

Introduction: Researchers are limited when using traditional recruitment methods to access hidden and vulnerable populations, including transgender persons. Social media platforms such as Facebook can provide access to the transgender population and facilitate recruitment of a representative sample. There is little regulatory guidance for using social media as a recruitment strategy. Methodology: This article presents recruitment recommendations based on a study that generated a diverse sample of transgender-identified persons using Facebook as the sole recruitment method. Results: Despite taking precautions, computer bots penetrated the initial survey. A second survey distribution collected data from a diverse sample of transgender-identified individuals. Discussion: Researchers should design social media recruitment methods with attention to privacy and transparency. Thus, using social media platforms such as Facebook to recruit transgender participants that otherwise would be challenging to reach is a viable and ethically sound alternative to traditional recruitment methods.

Monthly injectable cabotegravir/rilpivirine to manage HIV infection in adults.

ABSTRACT: The FDA recently approved a unique treatment regimen for management of HIV-1 infection in adults. A one-time per month injection of cabotegravir/rilpivirine can replace a current, stable antiretroviral regimen in those with virologic suppression, without history of treatment failure, or known or suspected resistance with cabotegravir or rilpivirine. A one-month oral trial should be initiated before switching to the extended-release injectable formulation. Cabotegravir/rilpivirine showed continued virologic suppression without clinically relevant changes in CD4+ cell counts. Clinicians should understand this new HIV regimen, its indications and suitability for select patients, administration and dosing, interactions, and most reported adverse events.

Paradoxical Obesity and Overweight Disparities Among Sexual Minority Men: A Meta-Analysis.

This study aims to analyze the prevalence and likelihood of overweight, obesity, and elevated body mass index (BMI) among sexual minority men (i.e., men who have sex with men [MSM], men who have sex with men and women [MSMW], and all sexual minority men), using men who have sex with women (MSW) as the reference group. Studies reporting mean BMIs or prevalence or likelihood of obesity, overweight, or elevated BMI categorized by sexual orientation were included. Data were pooled and analyzed to report mean differences (MDs) of BMIs, prevalence rates, odds ratios (ORs), and their respective 95% confidence intervals (CIs). Forty-three studies were included, with a median of 26,507 participants (median 3.37% sexual minority men). The respective mean overweight, obesity, and elevated BMI prevalence rates among MSM (36%, 23%, and 39%) and MSMW (33%, 27%, and 47%) were lower than those of MSW (44%, 26%, and 55%). This finding was consistent with a significantly lower BMI (MD -1.50 [-1.93, -1.08] kg/m2) and a decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]). Sexual minority men present with a lower prevalence and likelihood of obesity and overweight than their heterosexual counterparts. The obesity paradox-a sustained catabolic state presenting with lower BMI-is a feasible explanation for this phenomenon, although further research exploring paradoxical cardiovascular findings is granted.

COVID-19 vaccination in adults living with HIV.

ABSTRACT: The Centers for Disease Control and Prevention has recommended use of vaccines manufactured by Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen to prevent COVID-19 infection in the United States. Although these vaccines are safe and have been administered to millions of persons nationwide, special populations warrant closer focus. Adults living with HIV may have specific clinical considerations that should be acknowledged when making COVID-19 vaccination prescribing decisions. This article discusses these practice considerations and provides clinical and additional guidance for nurse practitioners and other clinicians responsible for prescribing COVID-19 vaccines in adults living with HIV.

Standardizing nurse practitioner student evaluation during high-stakes clinical examinations.

ABSTRACT: Nurse practitioners (NPs) require clinical competence in advanced health assessment skills to differentiate between normal, variations of normal, and abnormal patient findings. High-stakes clinical examinations, using live hands-on simulation scenarios and standardized patients (SPs) or other human role players, are accepted teaching and evaluation tools for NP students. Providing objective, valid, and reliable feedback to students during high-stakes clinical examinations is of considerable value for ongoing skill development. The study examined opportunities to improve the quality of student evaluation in simulation testing modes. A purposive sample of 17 video recordings of health students' comprehensive examination of an SP or physical examination teaching associate (PETA) from a nursing graduate level health assessment course was evaluated. Using a standardized rubric, students were scored live and after a comprehensive examination of a SP/PETA and via a secure web-based video platform by the faculty and an independent reviewer. Evaluator group examination score comparisons revealed that distributions of examination scores within evaluator groups were not similar. Median examination scores were significantly different between groups; faculty median examination scores significantly higher than SPs/PETAs. Efficiency of student evaluation may be increased by improving reviewer training, reducing checklist length, and adopting electronic scoring. Development of an exemplary teaching video providing explanation and detail for expected student skill performance will allow reviewers to practice and improve competence in reliable scoring, reduce time and effort of scorers, and increase accuracy of scoring.

Conflict resolution between physicians and nurse practitioners.

BACKGROUND: In the United States health care system, nurse practitioners (NPs) and physicians work very closely in the delivery of high-quality patient care across lifespans and acuities. In fact, advanced practice nurses work closer with physicians in their day-to-day care delivery than with any other group of professionals. This remains true even in states with independent practice for NPs. Because of the significant relationships between physicians and NPs, assessment of how these professionals resolve conflict is essential. PURPOSE: The purpose of this study was to determine the style of conflict resolution employed by NPs and physicians. METHODS: Nurse practitioners (n = 57) and physicians (n = 58) were randomly sampled from the Florida Department of Health-Health Care Practitioner Data Portal (N = 115). Participants completed a demographic questionnaire assessing experience in conflict resolution training and the Rahim Organizational Conflict Inventory-II, Form C, which defined the style of conflict resolution they most used and preferred. RESULTS: Results showed that 29.8% of physicians and 40.4% of NPs received formal conflict resolution/management education/training (p = .24). The dominant style of conflict resolution used for 78% of physicians and 74% of NPs was the integrating style, with no statistical difference between the two professions (p = .87). IMPLICATIONS FOR PRACTICE: Physicians and NPs lack formal education on conflict resolution in their graduate studies. In addition, both professionals tend to use similar styles of conflict resolution among one another in clinical practice, which affects their collaboration and ultimately how optimal care is delivered to patients.

Reducing sexually associated transmission of COVID-19 in men who have sex with men.

ABSTRACT: Believed to be zoonotic in origin, COVID-19 is a novel coronavirus subtype, which spreads from person to person through droplet transmission. As of late April, 2020, 895,766 cases of COVID-19 infections were recorded in the United States. This infection was responsible for 50,439 deaths. Because of close, person-to-person proximity, coupled with possible contact with body fluids, transmission of COVID-19 during sexual activity is possible. However, some activities carry higher risks of transmission than others. This article explores the risks of COVID-19 transmission associated with kissing, oral sex (fellatio and annilingus), and anal receptive and anal insertive intercourse among men who have sex with men (MSM). Recommendations for counseling MSM on safer sexual decision-making, many of which are applicable in the general prevention of sexually transmitted infections, are also provided. Nurse practitioners can serve as advocates in preventing sexually associated COVID-19 communication in MSM and contribute to the advancement of this continuously evolving area of public health science.

Use of electronic nicotine delivery systems (ENDS) in lesbian, gay, bisexual, transgender and queer persons: Implications for public health nursing.

Smoking and rates of tobacco abuse remain higher in lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons. There has been very little scholarly inquiry about the emerging trend of use of electronic nicotine delivery systems (ENDS; e.g., vaping and eCigarettes [eCigs]) in LGBTQ populations. The purpose of this article is to: (a) explore the most recent prevalence data regarding smoking and tobacco abuse in LGBTQ persons, (b) reveal strategies the tobacco industry has historically used in marketing their products to the LGBTQ community, (c) review data from the few studies evaluating use of ENDS in LGBTQ persons, (d) provide evidence-based methods public health nurses can employ to discourage use of ENDS in LGBTQ persons by addressing two identified causes of ENDS use in LGBTQ populations (harassment/discrimination in LGBTQ youth and binge drinking in LGBTQ adults), and (5) encourage cessation among those already using ENDS.

Demonstrating Nursing Excellence Through Equality: The Relationship Between Magnet® Status and Organizational LGBTQ Client Services and Support.

Introduction: Human Rights Campaign annually scores health care treatment of lesbian, gay, bisexual, transgender, and queer (LGBTQ) employees and clients among four measured dimensions in its Healthcare Equality Index (HEI). The purpose of this study was to determine if the score organizations earned on the 2018 HEI dimension measuring LGBTQ client services and support correlated with organizations' American Nurses Credentialing Center Magnet® recognition status, a distinction of nursing excellence. Method: Using a secondary data analysis approach, data obtained from Human Rights Campaign that specifically rated LGBTQ client services and support in 2018 HEI participating organizations (n = 626) were compared with the most recent inventory of American Nurses Credentialing Center Magnet health care organizations (n = 477). Results: LGBTQ client services and support HEI scores positively correlated with Magnet status (p = .0002). Discussion: Provision of LGBTQ client services and Magnet recognition is strongly related to higher quality nursing care, suggesting organizations earning Magnet recognition provide more equitable services to its LGBTQ clients.

Reducing Risk: Counseling Men Infected with HIV Who Have Sex with Men on Safer Sex Practices with Seroconcordant Partners.

The incidence of new HIV infections in the United States continues to be greatest among men who have sex with men (MSM). MSM infected with HIV often seek seroconcordant sexual partners based on intent to limit psychosocial, legal, and health risks they perceive as higher with serodiscordant sexual partners. However, the rationales for limiting sexual relationships exclusively with other MSM infected with HIV may be rooted in misinformation or misperception. Thus, these clients may have a unique sexual health knowledge deficit that nurses, social workers, and other clinicians need to address to help them reduce risk. This article focuses on sexually related health risks that are distinct to MSM infected with HIV seroconcordant partners. Data on the most recent HIV-infection incidence rates in MSM in the United States is provided. Discussion concentrates on the risk these individuals may have in communicating and acquiring sexually transmitted diseases other than HIV, the risk of HIV superinfection, and how sexually transmitted diseases affect persons who are immunocompromised differently than those who are immunocompetent. Finally, recommendations for healthcare professionals who counsel MSM infected with HIV in sexual decision making is provided.

Meningococcal Vaccination in Men Who Have Sex with Men.

Recent outbreaks of meningitis in men who have sex with men (MSM) in Los Angeles, Chicago, New York City, and other locations across the United States have heightened public health concerns regarding the increasing incidence of meningococcal infections in this vulnerable population. MSM have unique risk factors that result in greater threat from certain infectious diseases, including meningococcal infection. Men who have sex with men who are infected with HIV are at even higher risk. This article explores the increased risks among MSM in contracting and communicating meningococcal infection, use of vaccination as primary prevention, and outreach strategies that may help address this issue and lessen the disease burden associated with meningococcal infection in these sexual minorities.

Knowledge of Vaccination Needs of HIV-Infected Men Who Have Sex with Men in a National Sample of "Gay Friendly" Health care Providers.

OBJECTIVES: The purpose of this study was to assess knowledge levels regarding vaccination needs of healthy, HIV-infected (with CD4 counts >200 cells/mm(3) ) men who have sex with men (MSM) in a national sample of "gay friendly" health providers. DESIGN AND SAMPLE: Participants (n = 92) were sent a demographic questionnaire and case vignette asking for correct identification of vaccine needs of an HIV-infected MSM with a CD4 count >200 cells/mm(3) . Participants were recruited from the Gay and Lesbian Medical Association's Health Provider Index. MEASURES: Descriptive statistics and Fisher's exact test were used to answer the research questions and define the sample. RESULTS: The vast majority of the sample (n = 83; 90%) misidentified correct vaccine needs of and/or selected inappropriate vaccines for the HIV-infected MSM. Greater familiarity with the CDC Adult Vaccination Schedule (p = .027), practice specialization (p = .004), and administration of vaccinations within location of practice (p = .009) were associated with greater knowledge of the patient's vaccine needs. CONCLUSIONS: Health care providers who prescribe vaccines to HIV-infected MSM need more education regarding their vaccine needs. Nurses can reduce disparities in HIV-infected MSM by advocating for vaccination and augmenting providers' comprehension of vaccine needs of this population.

Certification and education as determinants of nurse practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States.

PURPOSE AND BACKGROUND: In 2008, a consortium of advanced practice nursing organizations authored the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. The document's aim is to provide guidance for states to adopt uniformity in the regulation of advanced practice registered nurse roles. Despite a target date to complete that work by 2015, there remains an extensive amount of variation in how states define the scope of practice (SOP) for nurse practitioners (NPs). DATA SOURCES: Based on the National Council of State Boards of Nursing online database, state (N = 51 [includes the District of Columbia]) NP practice acts and/or rules and regulations documents were examined for language describing SOP for NPs consistent with the language of the advanced practice registered nurse (APRN) Consensus Model. CONCLUSIONS: Results indicated that 18 states and the District of Columbia (37%) had specific regulations defining NP SOP by certification and/or educational preparation while 23 (45%) did not. The remaining nine states (18%) had SOP regulations that were interpreted as being ambiguous in relation to certification and/or educational preparation. IMPLICATIONS FOR PRACTICE: The findings suggest much work is needed to ensure NP SOP accurately reflects NP board-certification and graduate educational preparation.

Assessment and treatment of depression in gay and bisexual men in emergency settings.

Gay and bisexual men are at higher risk for certain mental health disorders, including anxiety, depression, and suicide. These individuals often present to emergency settings in need of evaluation and treatment. Despite the utilization of emergency mental health services by this population, clinicians are often underprepared in responding to their unique needs. This article discusses depression in gay and bisexual men and provides an evidence-based approach in treating these men in emergency settings. Directives for future research and advanced practice nursing education are also presented.

Serosorting Sexual Partners by Gay and Bisexual Men to Prevent HIV Infection: Implications for Public Health Clinicians.

The most recent Centers for Disease Control and Prevention epidemiological statistics in the United States demonstrate that gay and bisexual men are at most risk for acquiring new HIV infections. While public health campaigns aimed at gay and bisexual males have resulted in improved HIV screening and greater awareness of the need for safer sex practices, barebacking has become a practice of increasing incidence. This act carries the highest risk of HIV transmission and acquisition; and data suggest HIV disease burden is higher among ethnic minorities. Serosorting-purposely seeking HIV serocordant partners--to help lower risk of HIV infection is common. While this can be a positive step in preventing the spread of HIV, it carries serious threats that must be acknowledged. The purpose of this article was to explore the positive and negative aspects of serosorting in the prevention of HIV, describe ways in which health care providers can approach the topic with clients, provide clinical practice implications, and suggest some direction for future research.

Preexposure prophylaxis: An emerging clinical approach to preventing HIV in high-risk adults.

The HIV antiretroviral drug emtricitabine/tenofovir disoproxil fumarate (Truvada) was recently approved as preexposure prophylaxis (PrEP) therapy for adults at high risk for sexually acquired HIV infection. This article reviews the data supporting the efficacy of PrEP, and provides other relevant data regarding the implementation of PrEP.