Preparing students to address the social determinants of health in integrated care settings.

BACKGROUND: Health professionals are increasingly being called to address the social determinants of health (SDOH) and, to do so effectively, often requires an integrated approach to care. As a result, accreditation standards across multiple professions have emphasised the importance of interprofessional education (IPE). APPROACH: This paper describes large-scale, community-engaged learning that is required annually of students from nursing, pharmacy, public health, and social work. Through a series of asynchronous and synchronous activities that are informed by the Interprofessional Education Collaborative core competencies, students are trained to be SDOH change makers who can readily adopt integrated care service delivery frameworks into their future practice. EVALUATION: Approximately 1000 students have participated in this event since the University launched its IPE curriculum in 2017. Student consistently report achievement of the course learning objectives, with 91% of students reporting that the learning activities enhanced their understanding of their professional roles/responsibilities in regards to addressing poverty and food insecurity. IMPLICATIONS: Two key lessons learned from these efforts are described, including the benefits of a trauma-informed pedagogical approach and special considerations for large-scale learning.

Acute serum protein and cytokine response of single dose of prednisone in adult volunteers.

Pharmacological glucocorticoids are the most prescribed anti-inflammatory medications, and are chemical variants of cortisol, the circadian and stress hormone. Both endogenous and pharmacological glucocorticoids bind the glucocorticoid receptor (NR3C1) with high affinity, and both then bind downstream gene promoter elements (GRE) to drive positive gene transcription of many proteins. Glucocorticoid/GR complexes also bind distinct negative gene promoter elements (nGRE) to inhibit expression of genes involved in NF-κB innate immunity signaling. We sought to define the acute response of a single dose of prednisone (0.2 mg/kg) in young adult volunteers, with blood samples taken at baseline, 2, 3, 4 and 6 h post-oral dose. To control for circadian morning cortisol hitting the same molecular pathways, a day of blood draws was done without oral prednisone (same time of day), one day prior to drug day. Serum samples were processed for steroid hormone profiles (mass spectrometry; 9 steroidal hormones), proteomics (SOMAscan aptamer panels, 1,305 proteins), and inflammatory markers (Meso Scale Discovery; 10 pro-inflammatory cytokines). The pharmacological effect of the prednisone dose was shown by significant declines of adrenal steroids by 3 h after dosing. IL-10 showed drug-related increase to 4 hrs, then decrease to 6 hrs. IL-8 showed drug-related decrease in serum by 4 h, consistent with direct negative action of GR/ligand on IL-8 gene promoter. Proteomics data showed beta-2 microglobulin, TNFSF15, TSH, CST3, NBL1 to show time-related decreases with prednisone, while CXCL13 showed increases, although these require validation. In summary, a single low dose of prednisone leads to broad suppression of the adrenal axis within 3 h, and down-regulation of inflammatory serum proteins by 6 h.

Attaining Mutual Goals in Telehealth Encounters: Utilizing King's Framework for Telenursing Practice.

Access to essential health-promoting nursing care is increasingly facilitated through the expanding scope and capabilities provided through the utilization of telehealth technologies. Telehealth technologies facilitate the nursing process with clients at a distance in multiple ways, such as video conferencing, video conferencing with peripheral diagnostic tools, and store and forward modalities. Nursing care needs to remain the focus of care, but technology is a useful ancillary tool to help clients achieve health outcomes. The authors of this article discuss nursing practice and the use of telehealth technology and how King's concepts and theory of goal attainment can be used as a guiding framework.

Enhancing Telehealth Education in Nursing: Applying King's Conceptual Framework and Theory of Goal Attainment.

Telehealth technologies are increasingly used in the provision of nursing care to clients and populations. The education of nurses must include content and practice with telehealth technologies. The authors of this article discuss how one school of nursing has infused telehealth content and resources into undergraduate and graduate curricula using King's conceptual system and theory of goal attainment as a guide.

Gestational Diabetes Mellitus and Metabolic Disorder Among the Different Phenotypes of Polycystic Ovary Syndrome.

OBJECTIVES: Polycystic ovary syndrome (PCOS) is a common endocrine disorder related to several metabolic consequences. However, there remains uncertainty regarding the metabolic features of various phenotypes. The aim of this study was to explore the relationship between the prevalence of gestational diabetes mellitus (GDM) and metabolic disorders among the four different phenotypes of PCOS. METHODS: A cross-sectional study was performed in Royan Institute including 208 pregnant women with a history of infertility and PCOS. Using the diagnostic criteria of the American Diabetes Association (ADA), pregnant women with a documented diagnoses of PCOS were further categorized into four different phenotypes (A, B, C, and D) as defined by the Rotterdam criteria. RESULTS: The prevalence of GDM failed to demonstrate a significant relationship among the four phenotypes of PCOS. The mean levels of fasting blood sugar, plasma glucose concentrations at three hours (following the 100 g oral glucose tolerance test) and triglyceride levels were significantly higher in phenotype B compared to the remaining phenotypes (p < 0.050). There was a statistically significant difference between the mean free testosterone level and phenotypes A and C groups (1.8±1.6 vs. 1.1±1.0, p = 0.003). CONCLUSIONS: Women with a known diagnosis of PCOS who exhibited oligo/anovulation and hyperandrogenism demonstrated an increase of metabolic disorders. These results suggest that metabolic screening, before conception or in the early stages of pregnancy, can be beneficial particularly in women with PCOS phenotypes A and B. Early screening and identification may justify enhanced maternal fetal surveillance to improve maternal and fetal morbidity among women affected with PCOS.

Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial).

OBJECTIVE: To investigate the effects of an antenatal yoga program on perceived maternal labor pain and delivery outcomes. MATERIAL & METHODS: This randomized control trial was conducted with sixty primiparous women, aged 18-35 years old, who were randomly assigned to either an antenatal yoga program or control groups. Labor pain and discomfort level of the participants were measured using a Visual Analogue Scale at cervical dilatation of 3-4 c and at 2 and 4 h after the initial measurement. Demographic and obstetrical information were collected. The antenatal yoga program consisted of a 1-h supervised yoga class, three times a weekly, starting at 26 weeks gestation. . RESULTS: Participants in control group reported higher pain intensity compared to experimental group at 3-4 cm of dilatation (p = 0.01) and at 2 h after the first and the second measurements (p = 0.000). Mothers in the antenatal intervention group that completed the yoga class required a decreased frequency of labor induction in comparison with control group (p = 0.008). In addition, mode of delivery of the intervention group resulted in a lower percentage of cesarean section than control group (p = 0.002). Lastly, the intervention group experienced a shorter duration of the second and third stages of labor. Interval level data was analyzed by using an independent t-test and chi-square. CONCLUSION: Yoga during pregnancy may contribute to a reduction pain of labor and improved adequacy of childbirth.

Nurses' body size and public confidence in ability to provide health education.

PURPOSE: To replicate research about confidence level in receiving health teaching from either an overweight or a weight-appropriate RN. METHODS: A quasi-experimental post-test only design was used. Participants were randomly assigned to be shown images of a nurse, either overweight or weight-appropriate, then asked to rate their confidence in health teaching received from that nurse. Descriptive statistics, t test for independent samples, and covariate analyses were performed. RESULTS: A significant difference in confidence p=0.000 was noted between participants who viewed the image of a weight-appropriate nurse and participants who viewed the image of an overweight nurse. CONCLUSIONS: Weight-appropriate nurses may inspire more confidence in their teaching. Further study is indicated to explore the implications of these findings for practice. CLINICAL RELEVANCE: Nurses need to be conscious of clients' perceptions of weight when planning teaching interventions.