Cervical cancer in developing countries: effective screening and preventive strategies with an application in Rwanda.

In this article we explore literature regarding cervical cancer screening methods available in developing countries. Cervical cancer is a preventable and curable disease, but it continues to threaten the lives of many women. Eighty-five percent of cases and the majority of deaths occur in developing countries. Cytology via Papinicolaou (Pap) smear is not generally a suitable method of screening in low-resource regions. Alternative methods include visual inspection by acetic acid (VIA), human papillomavirus-deoxyribonucleic acid (HPV-DNA), and careHPV-DNA. Education is needed for health care providers and women about preventive immunization and screening. A Rwandan project is described to demonstrate effective program planning and implementation.

The value of community-focused interprofessional care in peru for developing cultural competency in health professions students.

International immersion experiences for health-care students have increased over the past 10 years. Students and faculty expect these experiences to increase cultural competency; however, research on outcomes of these programs has lacked rigor. Over a 4-year period, groups of nursing and other health professions students spent 3 weeks in Peru providing primary care and health education. Students attended pre-departure seminars addressing personal travel health and safety, culture and health care in Peru, working with interpreters, and ethics of international health care. Student participants (N=77) completed an instrument assessing self-perceived cultural competency before and after the experience. Results of pre- and post-immersion scores showed significant increases in perceived cultural competency and increased self-efficacy in cultural knowledge, skills, and attitudes for four groups of students. Implications and future directions are discussed and recommended.

Leveling the playing field for nursing students with disabilities: implications of the amendments to the Americans with Disabilities Act.

Faculty have reported a significant increase in the number of nursing students with disabilities; however, misinformation regarding legislated changes in the definition of a disability, as enacted in 2008 under the American with Disabilities Act Amendments Act, has contributed to faculty confusion when working with students with disabilities. This article identifies the circumstances under which nursing faculty are legally required to provide reasonable accommodations for students with disabilities, as defined under the Americans with Disabilities Act of 1990 as amended in 2008, and the strategies faculty may use to assist students to successfully complete core requirements. When this knowledge is integrated into a nursing program's culture and curriculum, students with sensory loss, paralysis, mental illness, learning disabilities, limb differences, chronic illnesses, or other disabilities associated with impaired bodily functions can successfully complete nursing programs and provide excellent care to clients, the profession, and their communities.

CT-GalNAc transferase overexpression in adult mice is associated with extrasynaptic utrophin in skeletal muscle fibres.

Duchenne muscular dystrophy is a genetic muscle disease characterized by the absence of sub-sarcolemmal dystrophin that results in muscle fibre necrosis, progressive muscle wasting and is fatal. Numerous experimental studies with dystrophin-deficient mdx mice, an animal model for the disease, have demonstrated that extrasynaptic upregulation of utrophin, an analogue of dystrophin, can prevent muscle fibre deterioration and reduce or negate the dystrophic phenotype. A different approach for ectopic expression of utrophin relies on augmentation of CT-GalNAc transferase in muscle fibre. We investigated whether CT-GalNAc transferase overexpression in adult mice influence appearance of utrophin in the extrasynaptic sarcolemma. After electrotransfer of plasmid DNA carrying an expression cassette of CT-GalNAc transferase into tibialis anterior muscle of wild type and dystrophic mice, muscle sections were examined by immunofluorescence. CT-GalNAc transgene expression augmented sarcolemmal carbohydrate glycosylation and was accompanied by extrasynaptic utrophin. A 6-week time course study showed that the highest efficiency of utrophin overexpression in a plasmid harboured muscle fibres was 32.2% in CD-1 and 52% in mdx mice, 2 and 4 weeks after CT-GalNAc gene transfer, respectively. The study provides evidence that postnatal CT-GalNAc transferase overexpression stimulates utrophin upregulation that is inherently beneficial for muscle structure and strength restoration. Thus CT-GalNAc may provide an important therapeutic molecule for treatment of dystrophin deficiency in Duchenne muscular dystrophy.

Academic faculty qualifications for community/public health nursing: an Association of Community Health Nursing Educators position paper.

The Association of Community Health Nursing Educators (ACHNE) has developed a number of documents designed to delineate the scope and function of community/public health nursing (C/PHN) educators, researchers, and practitioners. Consistent with the mission of ACHNE, this position paper entitled Academic Faculty Qualifications for Community/Public Health Nursing has been developed by the Faculty Qualifications Task Force. The shortage of qualified nursing faculty has been well documented. In particular, this shortage has increased the difficulty in having sufficient numbers of faculty who are educationally and experientially qualified to teach in the C/PHN specialty. ACHNE is addressing this concern by setting forth preferred qualifications for faculty to teach C/PHN at both the graduate and undergraduate level. While we recognize that the current faculty shortage may require schools to use faculty to teach in areas in which they do not have appropriate formal preparation, the paper outlines best practices for teaching C/PHN, a goal we urge all schools of nursing to work toward. Task Force members developed an earlier draft of the document in fall 2008, and input was solicited and received from ACHNE members and considered in the final document, which was approved by the ACHNE Executive Board in July 2009.

Downregulation of CD46 during muscle differentiation: implications for gene transfer to human skeletal muscle using group B adenoviruses.

Adenoviral vectors that use the coxsackievirus and adenovirus receptor do not transduce mature muscle efficiently. Group B adenoviruses use CD46 as their cell attachment receptor. To evaluate the utility of vectors based on group B adenoviruses for gene transfer to human skeletal muscle, we assessed the expression of CD46 in biopsied normal skeletal muscle samples and in muscles from patients with Duchenne muscular dystrophy. Transcript levels of CD46 were extremely low in mature muscle and CD46 immunoreactivity was detected only on blood vessels in the muscle sections. Although myoblasts cultured from biopsied samples had robust cell surface CD46 expression by flow cytometry, CD46 transcript levels were barely detectable after differentiation of the myoblasts into myotubes. The myotubes were also much less susceptible to infection with an adenoviral vector carrying the fiber of serotype 35 adenovirus (AdF35). These results suggest that for skeletal muscle, vectors derived from group B adenoviruses may not be a suitable alternative to the commonly used Ad5 vectors.

Evaluating a conceptual model-based assignment.

Although all faculty evaluate student assignments, fewer tackle the difficult issue of evaluating its actual usefulness. Wanting to know how their undergraduate community health nursing students were understanding and using a conceptual model in clinical practice, the authors used student journal assignments to evaluate learning and application of the model. They discuss the project's outcomes and subsequent strategies implemented to enhance their own understanding of the model and facilitate improved student learning.

The Population-Focused Analysis Project for teaching community health.

New instructional methodologies that foster student inquiry, critical thinking, accountability, group work, and self-mastery skills must be created to meet the challenges of modern community health nursing. Bold steps need to be taken to examine current nursing curricula and institute innovative teaching-learning methods to achieve these outcomes. Designing a unique way of providing clinical practice in community assessment is one step toward achieving these goals. The purpose of this article is to share the development, implementation, and evaluation of the Population Focused Analysis Project (PFAP). This new approach to community assessment for baccalaureate nursing students links theory and clinical practice and provides students with an opportunity to learn about and implement the core functions of public health in relation to a selected population.

Isoform-specific expression of the Coxsackie and adenovirus receptor (CAR) in neuromuscular junction and cardiac intercalated discs.

BACKGROUND: The Coxsackie and adenovirus receptor (CAR) has a restricted expression pattern in the adult. In skeletal muscle, although CAR is expressed in immature fibers, its transcript levels are barely detectable in mature muscle. This is in contrast to the robust expression observed in the heart. However, both heart and skeletal muscle are susceptible to infection with the Coxsackie B virus which utilizes primarily CAR for cellular internalization. The specific point of viral entry in skeletal and heart muscle remains unknown. RESULTS: Using antibodies directed against the extracellular and the cytoplasmic domains of CAR, we show CAR in normal human and mouse skeletal muscle to be a novel component of the neuromuscular junction. In cardiac muscle, CAR immunoreactivity is observed at the level of intercalated discs. We demonstrate a single isoform of CAR to be expressed exclusively at the human neuromuscular junction whereas both predominant CAR isoforms are expressed at the intercalated discs of non-diseased human heart. CONCLUSION: The localization of CAR to these important junctional complexes suggests that CAR may play both a structural and a regulatory role in skeletal and cardiac muscle, and that these complexes may serve as a point of entry for Coxsackie B virus.

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

Pediatric asthma is a growing public health issue, disproportionately affecting low-income people and people of color. Exposure to indoor asthma triggers plays an important role in the development and exacerbation of asthma. We describe the implementation of the Seattle-King County Healthy Homes Project, a randomized, controlled trial of an outreach/education intervention to improve asthma-related health status by reducing exposure to allergens and irritants in the home. We randomly assigned 274 low-income children with asthma ages 4-12 to either a high- or a low-intensity group. In the high-intensity group, community health workers called Community Home Environmental Specialists (CHES) conducted initial home environmental assessments, provided individualized action plans, and made additional visits over a 12-month period to provide education and social support, encouragement of participant actions, provision of materials to reduce exposures (including bedding encasements), assistance with roach and rodent eradication, and advocacy for improved housing conditions. Members of the low-intensity group received the initial assessment, home action plan, limited education during the assessment visit, and bedding encasements. We describe the recruitment and training of CHES and challenges they faced and explain the assessment and exposure reduction protocols addressing dust mites, mold, tobacco smoke, pets, cockroaches, rodents, dust, moisture, and toxic or hazardous chemicals. We also discuss the gap between the practices recommended in the literature and what is feasible in the home. We accomplished home interventions and participants found the project very useful. The project was limited in resolving structural housing quality issues that contributed to exposure to indoor triggers.

Zonal distribution of glomerular collapse in renal allografts: possible role of vascular changes.

Collapsing glomerulopathy (CG), an aggressive variant of focal segmental glomerular sclerosis, is a renal disease with severe proteinuria and rapidly progressive renal failure. The pathogenesis of CG is unknown. It strongly resembles human immunodeficiency virus (HIV)-associated nephropathy, but the patients are HIV negative. The characteristic glomerular lesion is capillary loop collapse with prominent podocytes filling Bowman's space. Interestingly, these glomerular changes are usually associated with severe tubulointerstitial injury, including tubular epithelial degenerative changes, microcystic dilation of several tubules, and interstitial inflammatory cell infiltrate. Recently, it became evident that the morphologic pattern of CG may appear not only in native kidneys, but also de novo in renal allografts, and that the pattern of CG in renal transplants is not always associated with severe proteinuria. Studies describing CG in renal allografts are all based on biopsies. We report 3 allograft nephrectomy specimens that showed a zonal distribution of the characteristic collapsing glomerular changes with associated tubulointerstitial injury. All 3 kidneys had obliterative vascular changes. One nephrectomy specimen had chronic obliterative transplant arteriopathy, 1 had acute vascular rejection, and 1 had thrombotic microangiopathy. None of the patients had severe proteinuria. Our cases suggest that the morphologic pattern of CG in renal allografts may not represent the same disease process as CG in native kidneys and provide further evidence that collapsing glomerular changes do not define the disease entity of CG, but rather represent a pattern of renal injury. Among other factors, hemodynamic disturbance may play a role in the development of the pattern of CG in renal allografts.

Using community-based participatory research to address social determinants of health: lessons learned from Seattle Partners for Healthy Communities.

Seattle Partners for Healthy Communities (SPHC) is a multidisciplinary collaboration of community agencies, community activists, public health professionals, academics, and health providers who conduct research aimed at improving the health of urban, socioeconomically marginalized Seattle communities. SPHC uses a community-based participatory research approach to address social factors that affect the health of these communities. This article describes three SPHC projects that focus on social determinants of health, particularly the development of social support and improving housing quality. The characteristics of community participation in each of these projects are discussed and show a spectrum of participation. Although projects successfully addressed proximal social factors affecting health, influencing more distal underlying factors was more difficult. Implications for researchers using a community-based participatory research approach and public health practitioners seeking to engage communities in addressing social determinants of health are presented.

Native American learning: an integrative model.

Cultural variations influence health care needs of individuals in various cultural groups. Oral tradition, dreams, and spirituality are important in the lives of many Native Americans. There are few Native American nurses, so health care is often provided to members of this group by nurses who have different cultural backgrounds and who may not understand pertinent history and cultural practices. This article describes the planning for and teaching of a class for undergraduate and graduate health care students to increase understanding of the unique health care needs of Native Americans. The structure of the class included both classroom and clinical hours. Essential components involved study and analysis of the historical events, cultural issues, and current health care needs and services of Native Americans. Approaches that can be applied to plan courses to explore health care needs of various cultures are presented.

Nursing and health sciences workforce diversity research using PhotoVoice: a college and high school student participatory project.

This participatory study used PhotoVoice and qualitative description to (a) mentor baccalaureate nursing and college students in workforce diversity research; (b) explore barriers and facilitators encountered by rural American Indian, Hispanic, and other high school students when attending college and pursuing careers in nursing or the health sciences; and (c) model a process of social action to help existing and future students. Baccalaureate nursing and graduate students participated in all stages of research, including dissemination. Five themes emerged from analysis of PhotoVoice data: (a) being afraid; (b) believing; (c) taking small steps; (d) facing fears; and (e) using support systems. Findings underscore the importance of helping students participate in efforts to increase work-force diversity through research. Increasing nursing and health sciences workforce diversity may require strategies developed within and tailored to specific cultures and communities.

Nurse educators establishing new venues in global nursing education.

Nurses represent the largest number of health care workers worldwide, but they are currently underutilized for global health practices. This may be due to the fact that global health programs are not incorporated in nursing education in many countries. The World Health organization (WHO) recognized the importance of building capacity and having well-prepared nurses who are able to exchange knowledge and expertise worldwide, but did not offer practical solutions. A nursing Super course recognizes the gap between what WHO advocates for and what needs to be done in nursing education to achieve well prepared nurses. A solution suggested is to develop well-structured contents that are applicable and can be shared among nursing programs worldwide. A nursing Supercourse is proposed to provide lectures prepared by expert nursing educators and researchers in global health. The nursing Supercourse has emerged from the parent Supercourse that is a virtual library of lectures developed by world experts in public health and medicine. It represents a global library of over 4,300 public health and medical lectures and a network of over 56,000 public health professionals in 174 countries of the world. These lectures are written in different languages, prepared in easy format, and can be accessed through the internet. In other words does not require the usage of any advanced technology. The Supercourse educational technology has been used successfully in Epidemiology education focusing on multiple topics in public health such as non- communicable disease prevention (NCD), chronic diseases, disaster preparedness, environmental health, and others. Training of nursing students in global health while there are attending nursing programs needs to be a part of the national and international health efforts for disease prevention and health promotion.

Perceptions of diabetes symptoms and self-management strategies: a cross-cultural comparison.

PURPOSE: The purpose of this research was to compare and contrast perceived symptoms of type 2 diabetes mellitus and self management strategies between Russian-speaking Slavic immigrant American women and non-Hispanic, nonimmigrant White American women. METHODS: The qualitative­descriptive study design was conducted with a convenience sample of Slavic immigrant women 50 years of age and older with type 2 diabetes (n = 10), and non-Hispanic, nonimmigrant White American women 50 years of age and older with type 2 diabetes (n = 10). RESULTS: Slavic immigrants reported more global holistic symptoms of diabetes, whereas nonimmigrants reported more specific physiological somatic symptoms. The nonimmigrant women used more complex diabetes self-management techniques compared with the Slavic group. A lack of education and awareness of hypoglycemia may contribute to less medication adherence in Slavic immigrants and may prevent them from being motivated to participate in diabetes self-management. DISCUSSION AND CONCLUSIONS: Health care providers caring for Slavic immigrant women with diabetes need to be aware that these women may fail to recognize the symptoms of hypoglycemia and seldom acknowledge depression, although depressive symptoms are often present. Culturally congruent health care will increase adherence and improve health outcomes for Slavic immigrant women.

Discrete redox signaling pathways regulate photosynthetic light-harvesting and chloroplast gene transcription.

In photosynthesis in chloroplasts, two related regulatory processes balance the actions of photosystems I and II. These processes are short-term, post-translational redistribution of light-harvesting capacity, and long-term adjustment of photosystem stoichiometry initiated by control of chloroplast DNA transcription. Both responses are initiated by changes in the redox state of the electron carrier, plastoquinone, which connects the two photosystems. Chloroplast Sensor Kinase (CSK) is a regulator of transcription of chloroplast genes for reaction centres of the two photosystems, and a sensor of plastoquinone redox state. We asked whether CSK is also involved in regulation of absorbed light energy distribution by phosphorylation of light-harvesting complex II (LHC II). Chloroplast thylakoid membranes isolated from a CSK T-DNA insertion mutant and from wild-type Arabidopsis thaliana exhibit similar light- and redox-induced (32)P-labelling of LHC II and changes in 77 K chlorophyll fluorescence emission spectra, while room-temperature chlorophyll fluorescence emission transients from Arabidopsis leaves are perturbed by inactivation of CSK. The results indicate indirect, pleiotropic effects of reaction centre gene transcription on regulation of photosynthetic light-harvesting in vivo. A single, direct redox signal is transmitted separately to discrete transcriptional and post-translational branches of an integrated cytoplasmic regulatory system.

Slavic women's understanding of diabetes dietary self-management and reported dietary behaviors.

BACKGROUND: Slavic women with type 2 diabetes are an understudied group for issues related to dietary self-management for diabetes and heart health. METHODS: A single home or extension office visit was conducted with ten Slavic women for an individual in-depth interview, clinical and physical assessment, and a survey questionnaire. RESULTS: Participants were in poor diabetes control. They reported changes in traditional foods to better support diabetes control and heart health. Most appeared responsive to their health care provider's recommendations and valued cooking classes from a Russian-speaking educator. Barriers included perceived expense of a healthy diet. Cultural bridges between patients and their caregivers were critical supports for self-management. DISCUSSION AND CONCLUSIONS: Support of Slavic women with diabetes should include health care providers knowledgeable about Slavic dietary and health concepts, Russian-speaking educators who can bridge between traditional foodways and the U.S. food system, and appropriate involvement of the patient's social support network.