Overcoming barriers and improving public health nursing practice.

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.

Sex Partner Meeting Places Over Time Among Newly HIV-Diagnosed Men Who Have Sex With Men in Baltimore, Maryland.

BACKGROUND: Sex partner meeting places may be important locales to access men who have sex with men (MSM) and implement targeted HIV control strategies. These locales may change over time, but temporal evaluations have not been performed. METHODS: The objectives of this study were to describe the frequency of report of MSM sex partner meeting places over time and to compare frequently reported meeting places in the past 5 years and past year among newly HIV-diagnosed MSM in Baltimore City, Maryland. Public health HIV surveillance data including partner services information were obtained for this study from the Baltimore City Health Department from May 2009 to June 2014. RESULTS: A total of 869 sex partner meeting places were reported, including 306 unique places. Bars/clubs (31%) and Internet-based sites (38%) were the most frequently reported meeting place types. Over the 5-year period, the percentage of bars/clubs decreased over time and the percentage of Internet-based sites increased over time. Among bars/clubs, 4 of 5 of those most frequently reported in the past 5 years were also most frequently reported in the most recent year. Among Internet-based sites, 3 of 5 of those most frequently reported in the past 5 years were also in the top 5 most frequently reported in the past year. CONCLUSION: This study provides a richer understanding of sex partner meeting places reported by MSM over time and information to health departments on types of places to access a population at high risk for HIV transmission.

The association between COVID-19 preventive behaviors and mental health conditions.

BACKGROUND: An unintended consequence of COVID-19 quarantine preventive measures, is the increased prevalence of anxiety and depression. The purpose of this study was to examine the association between COVID-19 preventive behaviors and mental health conditions. METHODS: A cross-sectional study was conducted using secondary data collected weekly from US adults aged 18 and older nationwide as part of the COVID-19 Household Impact Survey (CIS) from the University of Chicago. Logistic regression examined associations between COVID-19 preventive behaviors (wearing a face mask, washing or sanitizing hands, and keeping six-feet distance from those outside their household), mental health conditions (self-reporting feeling nervous, anxious, or on edge, feeling lonely, and feeling hopeless about the future and a history of a mental health condition) and demographic factors. RESULTS: Majority of study participants were under 60 years (62.2%), female (55.8%), and non-Hispanic White (72.2%). Overall, participants more likely to have followed all three COVID-19 measures were those who reported high psychological distress compared to those with low distress for feeling anxious (adj. OR 1.16, 95% CI: 1.06-1.28, p = 0.002), lonely (adj. OR 1.12, 95% CI: 1.02-1.23, p = 0.019) or hopeless (adj. OR 1.10, 95% CI: 1.00-1.21, p = 0.043) for more than a day during the past 7 days. CONCLUSION: Our findings highlight that individuals with mental health conditions reported more psychological distress. Specifically, feeling depressed, anxious, lonely, and hopeless were triggered and exacerbated as a result of the pandemic and may have long-term effects on general well-being and productivity. Therefore, our findings have important implications on the need to include mental health promotion as part of pandemic response efforts. This includes developing policies and allocating funding so as to ensure sustainable mental health interventions and support, public and provider education on the importance of screening for mental health issues.

Whole grain consumption and body mass index in adult women: an analysis of NHANES 1999-2000 and the USDA pyramid servings database.

OBJECTIVE: To examine the relationship between whole grain consumption and body mass index (BMI) in a sample of American adult women. METHODS: Dietary intake data from the National Health and Nutrition Examination Survey 1999-2000 were linked to the USDA Pyramid Servings Database. Women 19 years of age and older (n = 2,092) were classified into groups based on their average whole grain (WG) intake: 0 servings, more than 0 but less than 1 serving, and > or =1 servings per day. Within these classifications, mean BMI, mean waist circumference and percent overweight/obese (BMI > or = 25) were identified as primary dependent variables. Regression and logistic regression analyses were used to assess associations between BMI, waist circumference and percent of the population overweight/obese (BMI > or =25) and WG consumption. RESULTS: Women consuming at least one serving of WG had a significantly lower mean BMI and waist circumference than women with no WG consumption (p < 0.05). Multiple regression analysis showed a significant inverse relationship between BMI and whole grain intake after adjustment for age, energy intake, dietary fiber and alcohol intake (p = 0.004). This effect was mildly attenuated but remained significant after further adjustment for level of physical activity, smoking status, ethnicity and education (p = 0.018). The odds ratio for having a BMI > or = 25 was 1.47 (95% CI 1.12-1.94; p for trend 0.013) for women consuming no WG compared to those consuming at least one serving, after adjustment for all covariates. CONCLUSIONS: These data support other research suggesting increased WG intake may contribute to a healthy body weight in adult women.

Leveraging Community Engagement to Develop a Mobile Health Application for Older Women With HIV Infection.

OBJECTIVE: To develop a mobile health app for older women with HIV infection that will be used in a larger study. DESIGN: A qualitative study design. SETTING: Baltimore-Washington metropolitan area clinics and communities. PARTICIPANTS: Ten women 50 years and older (mean age = 62.8 years, standard deviation = 3.62, range = 58-69 years) who self-identified as Black or African American and were infected with HIV. METHODS: At the start of the study, we used relevant empirical and the self-determination theory to inform the draft Web-based app content that was shared with two focus groups. Data were analyzed with input from a community advisory board (CAB) to inform the development of the mobile health app. RESULTS: We inductively identified eight subthemes within the coding structure of two overall themes: Navigating Content, Functions, and Features and Enhancing Provider Interaction With Patients that represented the perspectives of participants regarding the app. From the eight subthemes, we integrated the contributions from the CAB, which we then used to further optimize the app. CONCLUSION: The app was designed to provide support, tools, and resources for older women with HIV. Engagement of community collaborators could be challenging because of multiple personal and structural barriers. Nonetheless, the potential community member benefits are invaluable. If successful, the Web-based app could be a model to address the needs of older persons with HIV infection.

Maternal flaxseed diet during pregnancy or lactation increases female rat offspring's susceptibility to carcinogen-induced mammary tumorigenesis.

Flaxseed contains several dietary components that have been linked to low breast cancer risk; i.e., n-3 polyunsaturated fatty acids (PUFAs), lignans and fiber, but it also contains detectable levels of cadmium, a heavy metal that activates the estrogen receptor (ER). Since estrogenic exposures early in life modify susceptibility to develop breast cancer, we wondered whether maternal dietary intake of 5% or 10% flaxseed during pregnancy or lactation (between postpartum days 5 and 25) might affect 7,12-dimethylbenz[a]anthracene (DMBA)-induced mammary tumorigenesis in the rat offspring. Our data indicated that both in utero and postnatal 5% and 10% flaxseed exposures shortened mammary tumor latency, and 10% flaxseed exposure increased tumor multiplicity, compared to the controls. Further, when assessed in 8-week-old rats, in utero 10% flaxseed exposure increased lobular ER-alpha protein levels, and both in utero and postnatal flaxseed exposures dose-dependently reduced ER-beta protein levels in the terminal end buds (TEBs) lobules and ducts. Exposures to flaxseed did not alter the number of TEBs or affect cell proliferation within the epithelial structures. In a separate group of immature rats that were fed 5% defatted flaxseed diet (flaxseed source different than in the diets fed to pregnant or lactating rats) for 7 days, cadmium exposure through the diet was six-fold higher than allowed for humans by World Health Organization, and cadmium significantly accumulated in the liver and kidneys of the rats. It remains to be determined whether the increased mammary cancer in rats exposed to flaxseed through a maternal diet in utero or lactation was caused by cadmium present in flaxseed, and whether the reduced mammary ER-beta content was causally linked to increased mammary cancer risk among the offspring.

Linkage-to-care Methods and Rates in U.S. Emergency Department-based HIV Testing Programs: A Systematic Literature Review Brief Report.

BACKGROUND: An increasing number of U.S. emergency departments (EDs) have implemented ED-based HIV testing programs since the Centers for Disease Control and Prevention issued revised HIV testing recommendations for clinical settings in 2006. In 2010, the National HIV/AIDS Strategy (NHAS) set an linkage-to-care (LTC) rate goal of 85% within 90 days of HIV diagnosis. LTC rates for newly diagnosed HIV-infected patients vary markedly by site, and many are suboptimal. The optimal approach for LTC in the ED setting remains unknown. OBJECTIVE: The objective was to perform a brief descriptive analysis of the LTC methods practiced in EDs across the United States to determine the overall linkage rate of ED-based HIV testing programs. METHODS: We conducted a systematic review of literature related to U.S. ED HIV testing in the adult population using PubMed, Embase, Web of Science, Scopus, and Cochrane. There were 333 articles were identified; 31 articles were selected after a multiphasic screening process. We analyzed data from the 31 articles to assess LTC methods and rates. LTC methods that involved physical escort of the newly diagnosed patient to an HIV/infectious disease (ID) clinic or interaction with a specialist health care provider at the ED were operationally defined as "intensive" LTC protocol. "Mixed" LTC protocol was defined as a program that employed intensive linkage only part of the coverage hours. All other forms of linkage was defined as "nonintensive" LTC protocol. An LTC rate of ≥85% was used to identify characteristics of ED-based HIV testing program associated with a higher LTC rate. RESULTS: There were 37 ED-based HIV testing programs in the 31 articles. The overall LTC rate was 74.4%. Regarding type of protocol, nine (24.3%) employed intensive LTC protocols, 25 (67.6%) nonintensive, two (5.4%) mixed, and one (2.7%) with unclear protocols. LTC rates for programs with intensive and nonintensive LTC protocols were 80.0 and 72.7%, respectively. Four (44.4%) with intensive protocols and nine (36.0%) with the nonintensive protocols had LTC rates > 85%. The linkage staff employed was different between ED programs. Among them, 25 (67.6%) programs used exogenous staff, 10 (27.0%) used the ED staff, and two had no information. All the programs in the nonintensive group utilized drop-in HIV/ID clinic or medical appointments while seven of nine of the programs in the intensive group physically escorted the patients to the initial medical intake appointment. There were no significant differences in characteristics of ED-based HIV testing programs between those with ≥85% LTC rate versus those with <85% within the intensive or nonintensive group. CONCLUSION: Intensive LTC protocols had a higher LTC rate and a higher proportion of programs that surpassed the >85% NHAS goal compared to nonintensive methods, suggesting that, when possible, ED-based HIV testing programs should adopt intensive LTC strategies to improve LTC outcomes. However, intensive LTC protocols most often required involvement of multidisciplinary non-ED professionals and external research funding. Our findings provide a foundation for developing best practices for ED-based HIV LTC programs.

Vitamin E bioavailability from fortified breakfast cereal is greater than that from encapsulated supplements.

BACKGROUND: Conflicting results from vitamin E intervention studies suggest supplemental vitamin E malabsorption. OBJECTIVE: We compared vitamin E bioavailability from a supplement with that from a fortified breakfast cereal. DESIGN: Vitamin E bioavailability was evaluated by using deuterium-labeled all-rac-alpha-tocopherol in three 4-d trials (2 wk apart). Five fasting subjects sequentially consumed the following (with 236 mL fat-free milk): 400 IU d(9)-alpha-tocopheryl acetate (400-IU capsule), 41 g ready-to-eat wheat cereal containing 30 IU d(9)-alpha-tocopheryl acetate (30-IU cereal), and 45 g cereal containing 400 IU d(9)-alpha-tocopheryl acetate (400-IU cereal). Five months later (trial 4), they consumed a 400-IU capsule with 41 g vitamin E-free cereal. Blood was obtained up to 72 h after the start of each trial. RESULTS: The mean (+/-SD) vitamin E bioavailabilities of the 30-IU cereal and the 400-IU cereal were 6 +/- 2 and 26 +/- 8 times, respectively, the vitamin E bioavailability of the 400-IU capsule. The areas under the 0-72-h d(9)-alpha-tocopherol curves for the 400-IU capsule, the 30-IU cereal, and the 400-IU cereal were 30 +/- 7, 153 +/- 43, and 765 +/- 164 micro mol. h/L (all trial comparisons, P < 0.0001). In trial 4, 3 subjects barely responded and 2 subjects had areas under the curve that were similar to their 400-IU cereal responses. CONCLUSION: The low bioavailability of vitamin E from the 400-IU capsule and the variability observed when the capsule was consumed with cereal suggest that encapsulated vitamin E is poorly absorbed when consumed with a low-fat meal and that bioavailability can be enhanced by food fortification with vitamin E.

Elevated insulin receptor protein expression in experimentally induced colonic tumors.

Insulin is associated with augmented colon carcinogenesis in vivo, but the mechanism(s) of growth promotion is not known. This study investigates the expression profile of a key component of the insulin signaling pathway, the insulin receptor (IR), in colonic tumors in comparison to normal colonic mucosa and the effects of dietary lipids. Male F344 rats harboring preneoplastic lesions were randomly allocated to three high fat diet groups: beef tallow (HFB), corn oil (HFC), fish oil (HFF) or a low fat corn oil (LFC) diet for 16 weeks. Colonic tumors and mucosae were analyzed for IR protein by Western blot and immunohistochemical analyses. IR mRNA expression was also analyzed by semi-quantitative RT-PCR. Western blot analysis demonstrated that IR protein level was significantly greater (P < or =0.001) in tumors than in normal-appearing mucosae in each diet group, and varied (P < or =0.001) among the tumors in the order HFF>LFC>HFB>HFC. Immunohistochemical assessment of the tumors as compared to the normal mucosa confirmed the elevated expression of IR protein in the tumor cells compared to normal mucosae. Immunoreactivity was noted in the nuclear compartment. In normal colonic mucosae, IR protein levels were lower (P < or =0.001) in the saturated fat diet group (HFB) than the three unsaturated fat diet groups (LFC, HFC and HFF). IR mRNA transcript levels did not differ between colonic tumors and mucosae, and no significant diet effect was observed. These results demonstrate that steady state levels of IR are elevated in colonic tumors above that of normal mucosae in vivo irrespective of the dietary lipid environment. However, the IR mRNA transcript levels did not reflect any significant diet effect and remained relatively steady between the tumor and normal mucosa, indicating altered post transcriptional regulation of IR in tumor tissues compared to normal mucosae.

Iron availability of a fortified processed wheat cereal: a comparison of fourteen iron forms using an in vitro digestion/human colonic adenocarcinoma (CaCo-2) cell model.

In this three-phase study we first compared the availability of fourteen Fe forms in a wheat-based ready-to-eat breakfast cereal using an in vitro digestion/human colonic adenocarcinoma (CaCo-2) cell model. We then investigated the effect of milk and/or coffee on those fortified cereals found in phase 1 to show promising increases in Fe availability. The Fe forms assessed in phase 1 were reduced (control), carbonyl, electrolytic, FePO(4), FeSO(4), FeCO(3), Na(2)FeEDTA, Ferrochel (Albion Laboratories, Clearfield, UT, USA; ferrous bis-glycinate), encapsulated ferrous fumarate, FeSO(4), ferrous lactate and Biofer (LipoTech, Britwell Salome, Oxfordshire; FeSO(4)), SQM (Sea-Questra-Min Iron; Quali Tech, Chaska, MN, USA; polysaccharide-complexed FeSO(4)) and Sun Active (Taiyo Kagaku, Yokkaichi, Japan). All these forms increased Fe uptake compared with the unfortified cereal. Relative to the control, the following increases in Fe availability were observed: electrolytic, 52 %; ferrous fumarate, 30-35 %; Sun Active, 78 %; Ferrochel, 125 %; Na(2)FeEDTA, 291 %. Recent human studies have shown similar data with regard to Ferrochel, FeSO4 and Na(2)FeEDTA, with the latter being more bioavailable. Our phase-2 studies indicated that the addition of milk to FeSO(4)-fortified cereal increased Fe availability, but this availability was markedly decreased by the addition of coffee to the digest. Conversely, a loss in availability from Na(2)FeEDTA was observed with the addition of milk; however, the addition of coffee did not markedly affect Fe availability from this form. In phase-3 studies we observed increased Fe availability upon the addition of milk to cereals containing Ferrochel, FeSO(4), Sun Active, a mixture of reduced Fe and Na(2)FeEDTA or reduced Fe. For these forms we did not assess the behaviour after the addition of coffee. In conclusion, when considering possible fortificants for optimizing Fe bioavailability within a foodstuff, it is of paramount importance to consider the interaction between the fortified foodstuffs and other components of the meal (such as milk and coffee with a breakfast).

Dietary intake of whole and refined grain breakfast cereals and weight gain in men.

OBJECTIVE: Prospective studies have suggested that substituting whole grain for refined grain products may lower the risk of overweight and obesity. Breakfast cereal intake is a major source of whole and refined grains and has also been associated with having a lower BMI. The aim of this study was to prospectively assess the association between whole and refined grain breakfast cereal intakes and risk of overweight (BMI >or= 25 kg/m(2)) and weight gain. RESEARCH METHODS AND PROCEDURES: We examined 17,881 U.S. male physicians 40 to 84 years of age in 1982 who were free of cardiovascular disease, diabetes mellitus, and cancer at baseline and reported measures of breakfast cereal intake, weight, and height. RESULTS: Over 8 and 13 years of follow-up, respectively, men who consumed breakfast cereal, regardless of type, consistently weighed less than those who consumed breakfast cereals less often (p value for trend = 0.01). Whole and refined grain breakfast cereal intake was inversely associated with body weight gain over 8 years, after adjustment for age, smoking, baseline BMI, alcohol intake, physical activity, hypertension, high cholesterol, and use of multivitamins. Compared with men who rarely or never consumed breakfast cereals, those who consumed >or=1 serving/d of breakfast cereals were 22% and 12% less likely to become overweight during follow-up periods of 8 and 13 years (relative risk, 0.78 and 0.88; 95% confidence interval, 0.67 to 0.91 and 0.76 to 1.00, respectively). DISCUSSION: BMI and weight gain were inversely associated with intake of breakfast cereals, independently of other risk factors.