Public health nursing education in Ireland and Norway: A comparative analysis.

BACKGROUND: Public health, primary health care, and nursing are founding principles of public health nursing. Thus, the underpinning curriculum needs to reflect these core principles. Public health nursing educators sought to delve deeper into curricula and training of public health nurse (PHNs) in Ireland and Norway OBJECTIVE: To compare PHNs' educational training in Ireland and Norway through a collaborative process DESIGN: This study used a descriptive comparative design SAMPLE: A panel of expert educators (the authors) compared national Public health nursing education strategies, guidelines, and curricula used to train PHN students RESULTS: Four core categories emerged from the analysis: general characteristics, theoretical and empirical knowledge base for PHNs practice, applying theory to clinical practice, and professional/ethical dimensions for practice. Results revealed more similarities than differences in both countries' educational models. The central difference related to the specialist role in Norway versus the generalist role in Ireland CONCLUSIONS: Workforce requirements drive the delivery of Public Health Nursing programs and educational curricula. However, it is imperative that educators evaluate their curricula in terms of fitness and practice, not just purpose.

Computer-tailored intervention increases colorectal cancer screening among low-income African Americans in primary care: Results of a randomized trial.

INTRODUCTION: Although African Americans have the highest colorectal cancer (CRC) incidence and mortality rates of any racial group, their screening rates remain low. STUDY DESIGN/PURPOSE: This randomized controlled trial compared efficacy of two clinic-based interventions for increasing CRC screening among African American primary care patients. METHODS: African American patients from 11 clinics who were not current with CRC screening were randomized to receive a computer-tailored intervention (n = 335) or a non-tailored brochure (n = 358) designed to promote adherence to CRC screening. Interventions were delivered in clinic immediately prior to a provider visit. Univariate and multivariable logistic regression models analyzed predictors of screening test completion. Moderators and mediators were determined using multivariable linear and logistic regression analyses. RESULTS: Significant effects of the computer-tailored intervention were observed for completion of a stool blood test (SBT) and completion of any CRC screening test (SBT or colonoscopy). The colonoscopy screening rate was higher among those receiving the computer-tailored intervention group compared to the nontailored brochure but the difference was not significant. Predictors of SBT completion were: receipt of the computer-tailored intervention; being seen at a Veterans Affairs Medical Center clinic; baseline stage of adoption; and reason for visit. Mediators of intervention effects were changes in perceived SBT barriers, changes in perceived colonoscopy benefits, changes in CRC knowledge, and patient-provider discussion. Moderators of intervention effects were age, employment, and family/friend recommendation of screening. CONCLUSION: This one-time computer-tailored intervention significantly improved CRC screening rates among low-income African American patients. This finding was largely driven by increasing SBT but the impact of the intervention on colonoscopy screening was strong. Implementation of a CRC screening quality improvement program in the VA site that included provision of stool blood test kits and follow-up likely contributed to the strong intervention effect observed at that site. The trial is registered at ClinicalTrials.gov as NCT00672828.

Prevalence and associated factors of paternal stress, anxiety, and depression symptoms in the early postnatal period.

Background: The changes experienced during the transition to first-time or subsequent fatherhood are mainly positive; however, fathers can also experience adverse mental health outcomes such as stress, anxiety, and depression. The aim of this study was to investigate the prevalence and associated factors of paternal stress, anxiety, and depression symptoms in the early postnatal period. Methods: A quantitative, descriptive correlational design was used. Data were collected using a self-administered questionnaire comprising of the Perceived Stress Scale, the State-Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale. Results: A total of 336 fathers were included in the study. The prevalence rates were 41.1% (n = 138) for moderate/high stress symptoms, 20.8% (n = 70) for state anxiety symptoms, 25.9% (n = 87) for trait anxiety symptoms, and 13.4% (n = 45) for depression symptoms. In the multivariable analysis, several factors were associated with increased stress, anxiety, and depression symptoms including being a subsequent father (p = 0.009), not living in a house (p = 0.009), having a history of adverse mental health (p = 0.008), and having a partner with a history of anxiety (p = 0.040). Conclusion: The findings suggest that fathers are at risk of adverse mental health in the early postnatal period which is a pivotal time for fathers in terms of bonding with their infant and redefining their relationship with their partner.

Breastfeeding skills training for health care professionals: A systematic review.

Background: Breastfeeding is a public health issue and the response to the low rates in the Global North needs to be multi-faceted. Within this context healthcare professionals have an important role to play in the overall multi-dimensional promotion and support of breastfeeding. As a learned skill, there is a fundamental need to improve breastfeeding skills amongst healthcare professionals. Aim: To identify, analyse and evaluate studies on breastfeeding skills education for health care professionals. Methods: The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies from June 2006 to July 2021 that examined the provision of breastfeeding skills-based education for qualified or student healthcare professionals were included. A narrative synthesis was conducted, and risk of bias independently assessed by two reviewers. Findings: Of 5,497 papers originally identified, 11 were included in the review. Nine studies were interventional, whilst two were observational. Participants included paediatric residents, midwives, nurses, care co-ordinators and other health care staff. Training took place in classrooms, practical workshops, or clinical settings. Observational or experiential teaching components in combination with theoretical knowledge were found to produce better outcomes than classroom-based interventions. However, the findings need to be interpreted with caution due to the risk of bias regarding study design-specific criteria. Discussion: There is both a paucity of studies, and from those available, a lack of quality in terms of educational interventions specifically offering skills-based training to healthcare professionals. Breastfeeding education needs to incorporate practical breastfeeding skills not just theoretical training. Lack of standardisation currently exists across guiding frameworks, course content, educator qualification and assessment strategies which impedes the optimisation of breastfeeding education and subsequent support for mothers. Serious or high risk of bias was identified in all but one of the studies included in the review. Conclusion: There is a need for high quality research evidence to optimise the design and delivery of skills-based breastfeeding education for healthcare professionals. This would have the potential to contribute to the broad suite of interventions necessary to improve support for breastfeeding.

Lymph-circulating tumor cells show distinct properties to blood-circulating tumor cells and are efficient metastatic precursors.

The leading cause of breast cancer-associated death is metastasis. In 80% of solid tumors, metastasis via the lymphatic system precedes metastasis via the vascular system. However, the molecular properties of tumor cells as they exit the primary tumor into the afferent lymphatics en route to the sentinel lymph nodes (SLNs) are not yet known. Here, we developed an innovative technique that enables the collection of lymph and lymph-circulating tumor cells (LCTCs) en route to the SLN in an immunocompetent animal model of breast cancer metastasis. We found that the gene and protein expression profiles of LCTCs and blood-circulating tumor cells (BCTCs) as they exit the primary tumor are similar, but distinct from those of primary tumors and lymph node metastases (LNMs). LCTCs, but not BCTCs, exist in clusters, display a hybrid epithelial/mesenchymal phenotype and cancer stem cell-like properties, and are efficient metastatic precursors. These results demonstrate that tumor cells that metastasize through the lymphatic system are different from those spread by blood circulation. Understanding the relative contribution of these cells to overall peripheral blood-circulating tumor cells is important for cancer therapy. Whether these two types of cell occur in cancer patients remains to be determined.

Anxiety in fathers in the perinatal period: A systematic review.

BACKGROUND: fatherhood in the perinatal period can be a time of great excitement, happiness and joy. However, a growing body of literature indicates that fathers are at risk for elevated levels of anxiety symptoms during the perinatal period. PURPOSE: the purpose of this systematic review is to determine the prevalence and levels of anxiety in fathers during the perinatal period, identify the risk factors and impact of anxiety, and establish if there are effective interventions that reduce father's anxiety. DESIGN: Systematic review. METHODS: A systematic review protocol was developed and registered with PROSPERO (reference number: CRD42017073760). The review was guided by the PRISMA reporting process. Electronic databases Medline, CINAHL, Embase, the Cochrane Library, PsycARTICLES, PsycINFO, and Psychology were searched to identify eligible studies. Studies that researched fathers during the perinatal period were included if anxiety was the primary focus of the research or was an outcome or dependent variable. Data were extracted and presented in narrative form including tables and figures. FINDINGS: Thirty-four studies met the inclusion criteria. Findings from these studies indicate that fathers experience anxiety in the perinatal period, particularly at the time of birth. Anxiety increased from the antenatal period to the time of birth, with a decrease in anxiety from the time of birth to the later postnatal period. The prevalence of anxiety ranged between 3.4% and 25.0% during the antenatal period and 2.4% and 51.0% during the postnatal period. Factors contributing to anxiety included lower education levels, lower income levels, lower co-parenting support, lower social support, work-family conflict, a partner' anxiety and depression, and being present during a previous birth. Anxiety had a negative impact on fathers' mental health, physical health, social relationships and parenting skills. Anxiety contributed to stress, depression, fatigue and lower paternal self-efficacy. Five studies reported on interventions to reduce anxiety and all the studies found that anxiety significantly decreased following the intervention. KEY CONCLUSION: Fathers experience increased anxiety from the antenatal period to the time of birth, with a decrease in anxiety from the time of birth to the later postnatal period. Anxiety during the perinatal period that can impact negatively on fathers physical and mental health, and social relationships.

Paternal postnatal depression in Ireland: Prevalence and associated factors.

BACKGROUND: it is well established that fatherhood has a long term positive and protective effect on men's health. However, there is also evidence that the transition to fatherhood can be complex and demanding and can lead to distress, anxiety and increased risk of depression. OBJECTIVE: this study aimed to investigate the prevalence of paternal postnatal depression, and to examine associations with a range of demographic and clinical factors. METHODS: a cross-sectional study design was used to collect primary data from 100 fathers, whose partner gave birth to an infant in the previous 12 months. Data were collected using the Edinburgh Postnatal Depression Scale. RESULTS: the prevalence of paternal postnatal depression was 12% using the Edinburgh Postnatal Depression Scale cut off score of 12 or above, when the cut off score was reduced to 9 or above the prevalence was 28%. The factors found to increase the risk of paternal postnatal depression included having an infant with sleep problems, a previous history of depression, a lack of social support, poor economic circumstances, not having paternity leave and not being married. CONCLUSION: the results add to the growing body of evidence that paternal postnatal mental health is a significant public health issue, and indicates a need for assessment and support for fathers during this life stage.

Stress in fathers in the perinatal period: A systematic review.

BACKGROUND: despite the evidence that fatherhood has a long-term positive and protective effect on men's health, there is also evidence that fatherhood in the perinatal period can be complex and demanding. Due to the potential increase in stressors in the perinatal period, there is reason to hypothesise that it is a time of increased stress for fathers. However, it is not clear how significant a problem stress is for fathers during this stage of life. This is in part, due to the fact that the available research has not been systematically reviewed. PURPOSE: the purpose of this systematic review was to critically appraise the empirical evidence that examined stress in fathers in the perinatal period. DESIGN: systematic review. METHODS: a systematic review protocol was developed and registered with PROSPERO (Reference number: CRD42016035821). The review was guided by the PRISMA reporting process. Electronic databases Medline, CINAHL, the Cochrane Library, PsycARTICLES, PsycINFO, Psychology and Behavioural Sciences Collections were searched to identify studies that met the inclusion criteria. Studies that researched fathers in the perinatal period were included if stress was the principal focus of the research, if stress was in the title and/or aim of the study or if stress was an outcome or dependent variable. Data were extracted and presented in narrative form including tables and figures. FINDINGS: eighteen studies met the inclusion criteria. The findings indicate that fathers experience stress in the perinatal period, particularly at the time of birth. Stress levels were found to increase from the antenatal period to the time of birth, with a decrease in stress levels from the time of birth to the later postnatal period. There are a number of factors that contribute to stress in fathers in the perinatal period and these included negative feelings about the pregnancy, role restrictions related to becoming a father, fear of childbirth and feelings of incompetence related to infant care. The review found that stress has a negative impact on fathers, with higher stress levels contributing to mental health issues such as anxiety, depression, psychological distress and fatigue. KEY CONCLUSION: during the perinatal period fathers experience stress and face unique stressors that can impact negatively on their health and social relationships.

Potential involvement of the cyclooxygenase-2 pathway in the regulation of tumor-associated angiogenesis and growth in pancreatic cancer.

Angiogenesis plays a crucial role in tumor development and growth. The present investigation was undertaken to test the potential involvement of the cyclooxygenase-2 (COX-2) pathway in the regulation of angiogenesis and growth in pancreatic cancer. We compared the angiogenic characteristics of a COX-2-positive human pancreatic tumor cell line, BxPC-3, with those of a COX-2-negative pancreatic tumor cell line, AsPC-1. Cultured BxPC-3 cells promoted a marked increase of endothelial cell migration in comparison with migration that occurred in the absence of cancer cells. Furthermore, BxPC-3 cell culture supernatants induced endothelial cell capillary morphogenesis in vitro and neovascularization in vivo. In contrast, cultured AsPC-1 cells elicited a modest effect on endothelial cell migration and neovascularization in vivo. Pretreatment of BxPC-3 cells with the selective COX-2 inhibitor NS-398 (50 micro M) dramatically decreased angiogenic responses of endothelial cells. NS-398 (25-100 micro M) caused inhibition of BxPC-3 cell proliferation but had no effect on AsPC-1 cell growth. SC-560, a selective COX-1 inhibitor, had no effect on growth of either cell lines. These results suggest an involvement of COX-2 in the control of tumor-dependent angiogenesis and growth in certain pancreatic cancers and provide the rational for inhibition of the COX pathway as an effective therapeutic approach for pancreatic tumors.

Assessing breast tumor margin by multispectral photoacoustic tomography.

An unmet need exists in high-speed and highly-sensitive intraoperative assessment of breast cancer margin during conservation surgical procedures. Here, we demonstrate a multispectral photoacoustic tomography system for breast tumor margin assessment using fat and hemoglobin as contrasts. This system provides ~3 mm tissue depth and ~125 µm axial resolution. The results agreed with the histological findings. A high sensitivity in margin assessment was accomplished, which opens a compelling way to intraoperative margin assessment.

Aspirin inhibits highly invasive prostate cancer cells.

Cell adhesion, proteolytic degradation and cell migration are interrelated processes responsible for the invasion and metastasis of cancer. One of the crucial molecules involved in cancer metastasis is urokinase-type plasminogen activator (uPA). An elevated concentration of uPA is a strong indicator of poor prognosis. In addition to the proteolytic activity of uPA, which degrades the extracellular matrix, uPA also binds to its receptor (uPAR) and controls cell adhesion and migration through the reorganization of actin cytoskeleton. We have recently demonstrated that constitutively active nuclear factor-kappa B (NF-kappaB) is responsible for the increased secretion of uPA and that inhibition of NF-kappaB suppresses secretion of uPA and cell migration of highly invasive cancer cells. Aspirin and other nonsteroidal anti-inflammatory drugs have been recently shown to have a chemopreventive effect in colon and pancreatic cancers. Here we show that aspirin inhibits NF-kappaB, resulting in the suppression of uPA secretion from the highly invasive human prostate cancer cells PC-3. Furthermore, aspirin inhibited migration of PC-3 cells, suggesting an effect on the uPA-uPAR signaling complex. Finally, aspirin suppressed adhesion of PC-3 cells to fibronectin (FN), which binds to an alpha3beta1 integrin receptor, and to vitronectin (VN), which binds to alphavbeta3 integrin receptor. Altogether, our data suggests that aspirin inhibits the formation of uPA-uPAR-FN-alpha3beta1 and uPA-uPAR-VN-alphavbeta3 complexes, resulting in the suppression of cell adhesion and cell motility of the highly invasive prostate cancer cells PC-3. These results indicate that aspirin may contribute directly to reducing invasion and metastasis of prostate cancers by inhibiting cell migration and invasion.

Biologic activity of spores and dried powder from Ganoderma lucidum for the inhibition of highly invasive human breast and prostate cancer cells.

OBJECTIVE: Ganoderma lucidum has been used in East Asia as a home remedy to prevent or cure cancer. Furthermore, Ganoderma lucidum is one of the herbs in the herbal mixture PC-SPES that has become an alternative herbal therapy for prostate cancer. Because the dried powder of ganoderma is commercially available as a dietary supplement itself, the purpose of this study was to evaluate the biologic activity of samples of Ganoderma lucidum from different sources. METHODS: Samples of Ganoderma lucidum were characterized morphologically and evaluated for their ability to inhibit cell migration of highly invasive breast cancer MDA-MB-231 cells and prostate cancer PC-3 cells. Because the inhibition of cell motility is directly linked to the inhibition of the signaling pathway for constitutively active NF-kappaB in breast and prostate cancer cells, we determined how different samples of Ganoderma lucidum inhibit constitutively active NF-kappaB in a reporter gene assay. RESULTS: Some of the samples of Ganoderma lucidum demonstrated strong inhibition of cancer cell migration comparable to the inhibition of constitutively active NF-kappaB, whereas other samples showed less or no activity in highly invasive estrogen receptor-negative breast cancer cells or androgen receptor-negative prostate cancer cells, respectively. Interestingly, we did not find any correlation between the purity and composition (spores versus powder) of Ganoderma lucidum and biologic activity. CONCLUSIONS: Ganoderma lucidum has demonstrated strong activity against breast and prostate cancer cells. Nevertheless, the composition of samples did not correlate with their ability to inhibit cell migration and activation of NF-kappaB in vitro.

Multifocal papillary-cystic neoplasm of the pancreas.

This case report describes the second known instance of a multifocal capillary pancreatic neoplasm. Both cases occurred in young African American females. A less-than-total pancreatectomy was performed to maintain endocrine function.

Automated blood sampling and glucose sensing in critical care settings.

BACKGROUND: Tight glycemic control (TGC) studies in intensive care units (ICU) have shown substantial improvements in clinical outcomes. However, implementation of TGC in ICU practice is partly constrained by the lack of automated continuous blood glucose monitoring systems that can facilitate clinically accurate feedback of glycemic data. The aim of this work is to develop a portable automated blood sampling system for integration with a glucose sensor for use in critical care settings. METHODS: clinical prototypes for glucose sensing in blood were developed based on two distinct technologies: mid-infrared laser absorption spectroscopy and electrochemistry. Concurrently, an automated peripheral venous blood sampling system was developed for integration with the glucose sensing system. RESULTS: The glucose sensing prototypes were validated clinically with various biological samples in a continuous mode. A customized micropump was employed in conjunction with a novel peripheral venous catheter system to automatically sample blood from the subject's forearm. Microvolumes of blood were sampled in continuous and intermittent modes at clinically relevant user-defined frequencies. The clinical feasibility of blood sampling, along with continuous glucose sensing, was demonstrated. CONCLUSION: Cascade's automated peripheral venous blood sampling system, in combination with a flow-through glucose sensor system, offers several advantages over current state-of-the-art systems. This includes the potential for significantly improved workflow in the ICU, minimal discomfort to the patient, and accurate glucose measurement in whole blood, thus helping achieve tight glycemic control.

Protein kinase C induces motility of breast cancers by upregulating secretion of urokinase-type plasminogen activator through activation of AP-1 and NF-kappaB.

Cell migration is a crucial process in cancer metastasis that does not require extracellular matrix degradation-a characteristic of cell invasion. The urokinase-type plasminogen activator (uPA) system is responsible for invasion through uPA enzymatic activity and for migration through the binding of uPA to the uPA receptor (uPAR). Constitutively high levels of uPA are characteristic of the highly metastatic breast cancer cells MDA-MB-231, but the mechanisms underlying constitutive uPA expression are not fully characterized. In this report we show that inhibition of protein kinase C (PKC) represses constitutive (nonstimulated) migration of MDA-MB-231 cells. Bisindolylmaleimide I (Bis I) inhibits cell migration and constitutive activation of transcription factors AP-1 and NF-kappaB, suggesting that PKC is responsible for increased migration of MDA-MB-231 cells. It is clear that the inhibition of PKC occurs at the transactivation levels of AP-1 and NF-kappaB because Bis I did not affect constitutive DNA binding of AP-1 and NF-kappaB. Furthermore, we show that Bis I did not affect the levels of IkappaBalpha, suggesting that PKC-mediated cell migration is IkappaBalpha independent. Finally, we demonstrate that constitutive secretion of uPA is repressed by Bis I, implying an important role for AP-1 and NF-kappaB in cell migration. Our data demonstrate a connection among PKC, constitutively active AP-1 and NF-kappaB, constitutive secretion of uPA, and cell migration of highly invasive breast cancer cells. Thus, PKC controls cell motility by regulating expression of uPA through the activation of AP-1 and NF-kappaB. The disruption of PKC, AP- 1, and NF-kappaB signaling in breast cancer may be used to develop therapies for breast cancer prevention and intervention by reducing the secretion of uPA.

Ganoderma lucidum suppresses motility of highly invasive breast and prostate cancer cells.

A dried powder from basidiomycetous fungi, Ganoderma lucidum, has been used in East Asia in therapies for several different diseases, including cancer. However, the molecular mechanisms involved in the biological actions of Ganoderma are not well understood. We have recently demonstrated that phosphatidylinositol 3-kinase (PI 3-kinase) and nuclear factor-kappaB (NF-kappaB) regulate motility of highly invasive human breast cancer cells by the secretion of urokinase-type plasminogen activator (uPA). In this study, we investigated the effect of G. lucidum on highly invasive breast and prostate cancer cells. Here we show that spores or dried fruiting body of G. lucidum inhibit constitutively active transcription factors AP-1 and NF-kappaB in breast MDA-MB-231 and prostate PC-3 cancer cells. Furthermore, Ganoderma inhibition of expression of uPA and uPA receptor (uPAR), as well secretion of uPA, resulted in the suppression of the migration of MDA-MB-231 and PC-3 cells. Our data suggest that spores and unpurified fruiting body of G. lucidum inhibit invasion of breast and prostate cancer cells by a common mechanism and could have potential therapeutic use for cancer treatment.