Adverse Childhood Experiences and Preventive Cervical Cancer Screening Behavior.

OBJECTIVES: To examine associations between a history of adverse childhood experiences (ACEs) and receiving preventive cervical cancer screening and to investigate whether number and type of ACE exposures were predictive of cervical cancer screening uptake. SAMPLE & SETTING: Data were from 11,042 adults who completed the 2020 Texas Behavioral Risk Factor Surveillance System survey. The U.S. Preventive Services Task Force guidelines were used to indicate whether individuals had received cervical cancer screening at recommended intervals. METHODS & VARIABLES: Multiple logistic regression analysis was used to predict the likelihood of not having received the recommended preventive cancer screening by number and type of ACE exposures. Chi-square analysis was used to determine associations among demographic characteristics, cancer screening uptake, and ACE number and type. RESULTS: Individuals with one to three ACEs and those with six or more ACEs were statistically more likely not to have received the recommended cervical cancer screenings compared to those with zero ACEs. A history of physical ACEs was associated with 3.88 times the likelihood of not having received the recommended cervical cancer screening. IMPLICATIONS FOR NURSING: To promote timely cervical cancer screening and prevent retraumatization of patients with a history of ACEs, providers should implement trauma-informed care principles in their healthcare settings.

Mammography Screening Beliefs and Knowledge among a Multi-ethnic Sample of Low-income, Uninsured Women.

The purpose of this study was to examine screening mammography prevalence and its associated beliefs among a multi-ethnic sample of low-income, uninsured women. Data pertaining to the sample's demographic characteristics, mammography screening history and beliefs, and knowledge on recommended screening age were analyzed (n=533). Overall, 22.1% of the participants had never been screened. Black women were more likely than others to have never been screened, White women were more likely to be overdue, and Hispanic women were more likely to report recent screening. Fear of not knowing what will be done during mammography consistently predicted screening among the racial/ethnic groups. Concerns about "people doing mammograms being rude to women" had the highest negative correlation with mammography among Hispanic women. A majority of the sample believed that screening should begin at age 40. Interventions to increase screening mammography must incorporate information about the screening procedure and be sensitive to cultural differences in screening barriers.

Message Heard: Insights for Doctoral Program Design From Community Partners.

Developing a nursing doctoral program requires, among other considerations, thoughtful reflection on opportunities for graduates, and needs of the health-care community. To educate nurse clinicians, scientists, and leaders prepared to address complex health-care issues, colleges of nursing must engage with community stakeholders during program development. One college embraced this opportunity to dialogue through a series of semistructured focus groups and surveys to inform community partners of the developing doctoral program plan and to hear their related ideas and opinions. Themes arising from qualitative data analysis included driving forces, the value of education, and differing doctoral roles. The findings were far more enlightening than anticipated and ultimately guided the direction of program development. This study affirmed the power of meaningful dialogue with community partners to ensure a well-educated nursing workforce with the skills needed to advance nursing practice in the changing health-care environment.

Determinants of HPV vaccine awareness and healthcare providers' discussion of HPV vaccine among females.

Two human papillomavirus (HPV) vaccines are available and can prevent 98% of HPV 16 and 18 infections. This study aimed to explore determinants of 1) HPV vaccine awareness among a cohort of low-income women participating in a cancer prevention program in Central Texas and compare them to United States residents; 2) determinants of healthcare providers' discussion of HPV vaccine among female residents of the United States. Bivariate and multivariable analysis of HPV vaccine awareness using survey data (n = 359) collected between 2014 and 2016 in Central Texas, and the Health Information and Nutrition Survey (HINTS) data which is a nationally representative dataset (unweighted n = 1214) collected in 2013 were conducted. Bivariate and multivariable regression analyses of healthcare providers' discussion of the HPV vaccine using the HINTS survey data were also conducted. Compared to non-Hispanic Whites, there was a decreased likelihood of HPV vaccine awareness among non-Hispanic Blacks (OR = 0.50; 95% CI = 0.28-0.90) and Hispanics (OR = 0.55; 95% CI = 0.30-0.99) in the grant funded program, as well as non-Hispanic Blacks (OR = 0.28; 95% CI = 0.14-0.58) and Hispanics (OR = 0.22; 95% CI = 0.12-0.41) in the HINTS data. There was also a decreased likelihood of healthcare providers discussing the HPV vaccine with respondents who were 35-49 years (OR = 0.50; 95% CI = 0.30-0.84), 50-64 years (OR = 0.26; 95% CI = 0.14-0.49) or ≥ 65 years compared to those who were 18-34 years among the HINTS data respondents. Interventions to increase HPV awareness among non-Hispanic Blacks and Hispanics, as well as encourage healthcare providers' discussion of the HPV vaccination during patient encounters regardless of the patient's age are needed.

A reflective learning framework to evaluate CME effects on practice reflection.

INTRODUCTION: The importance of reflective practice is recognized by the adoption of a reflective learning model in continuing medical education (CME), but little is known about how to evaluate reflective learning in CME. Reflective learning seldom is defined in terms of specific cognitive processes or observable performances. Competency-based evaluation rarely is used for evaluating CME effects. To bridge this gap, reflective learning was defined operationally in a reflective learning framework (RLF). The operationalization supports observations, documentation, and evaluation of reflective learning performances in CME, and in clinical practice. In this study, the RLF was refined and validated as physician performance was evaluated in a CME e-learning activity. METHODS: Qualitative multiple-case study wherein 473 practicing family physicians commented on research-based synopses after reading and rating them as an on-line CME learning activity. These comments formed 2029 cases from which cognitive tasks were extracted as defined by the RLF with the use of a thematic analysis. Frequencies of cognitive tasks were compared in a cross-case analysis. RESULTS: Four RLF cognitive processes and 12 tasks were supported. Reflective learning was defined as 4 interrelated cognitive processes: Interpretation, Validation, Generalization, and Change, which were specified by 3 observable cognitive tasks, respectively. These 12 tasks and related characteristics were described in an RLF codebook for future use. DISCUSSION: Reflective learning performances of family physicians were evaluated. The RLF and its codebook can be used for integrating reflective learning into CME curricula and for developing competency-based assessment. Future research on potential uses of the RLF should involve participation of CME stakeholders.

A web-based tutorial to enhance student learning of activity analysis.

BACKGROUND: This paper describes the impact on learning of a web-based tutorial for the application of activity analysis, with occupational therapy students, at McGill University, Montreal, Quebec. This tutorial offers unique, interactive instructional strategies allowing for self-directed higher cognitive and reflective learning, which has not been possible, to date, in current web-based technology. SCOPE: Through repeated practice, students collaboratively (in dyads) apply concepts of activity analysis, and receive immediate feedback by comparing their answers to a standard. METHODS AND RESULTS: Comparisons of performance outcomes on summative exams before and after implementation of the tutorial are made, suggesting a decrease in variance scores indicating fewer students are falling below the class average. These results are attributed to opportunities to practice activity analysis and to receive immediate feedback. PRACTICE IMPLICATIONS: Web-based instruction can impact student learning if the instructional strategies ensure coherence with all other instructional components, match the learning outcomes, facilitate self-directed and collaborative learning, and allow for practice and feedback.

Progressive epitope-blocked panning of a phage library for isolation of human RSV antibodies.

Epitope-blocked panning is an approach to mining antigen-specific diversity from phage display antibody libraries. Previously, we developed and used this method to recover a neutralizing antibody to respiratory syncytial virus (RSV) by blocking a dominant response to a nonneutralizing epitope on a recombinant derivative of the viral F antigen. We have extended this approach to the blocking of multiple epitopes simultaneously, which led to the recovery of new antibodies of different specificity, including one new neutralizing activity. A phage display Fab library was selected on recombinant F antigen in the presence of three representative antibodies recovered in the unblocked and subsequent single-blocked panning procedures. Restriction endonuclease fingerprinting of 13 F+ clones revealed seven unique Fabs. DNA sequence analysis of five of these clones revealed five new light chains in combination with different heavy chains, three of which were very similar or identical to Fabs previously isolated from this library. The blocking antibodies did not compete with the new Fabs, demonstrating effective masking of their binding sites in the panning procedure. Conversely, these Fabs did show variable inhibition of two of the blocking antibodies suggesting a close proximity or interdependence of their epitopes. One of the antibodies did inhibit virus infection, albeit with modest potency. These results demonstrate that epitope-blocked panning is a self-progressing approach to retrieving diverse antibodies from phage libraries.