Advancing health equity in prelicensure nursing curricula: Findings from a critical review.

Nurses play a crucial role in reducing health disparities and advancing health equity for individuals and communities. The future nursing workforce relies on their nursing education to prepare them to promote health equity. Nursing educators prepare students through a variety of andragogical learning strategies in the classroom and in clinical experiences and by intentionally updating and revising curricular content to address knowledge and competency gaps. This critical review aimed to determine the extent to which health equity concepts are explicitly present in prelicensure undergraduate nursing curricula globally. Of 434 articles screened, 22 articles describing 20 studies met inclusion criteria. Frequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Notably, only two articles described overall well-integrated explicit health equity content, and there was little attention to whether students transfer this learning into practice. A focus on individualism rather than population and community was noted, highlighting the presence of whiteness in nursing. Results from this review confirm that nursing education has room to improve with respect to health equity in the curricula.

Sexual Violence in Virtual Reality: A Scoping Review.

BACKGROUND: One in four Americans report experiencing harassment online via social media and interactive gaming, which includes physical threats, stalking, sexual harassment, and sustained harassment. OBJECTIVE: The aim of this study was to gain understanding of the state of the science surrounding young adults and sexual violence/harassment harms in virtual reality (VR) as well as possible uses of VR to heal and intervene. METHODS: A scoping review was conducted in early 2023 using the Ovid Synthesis Clinical Evidence Manager and the MEDLINE database. Forty-seven articles met inclusion criteria. RESULTS: Our review found a growing body of evidence exploring incidents, effects, possible predictors, and initial strategies to prevent sexual violence in VR and to use the modality to positively intervene. Limited research addresses the effects of harms incurred in VR on (re)traumatization of survivors as well as the development and testing of VR tools used to educate, deliver bystander interventions, transform biases and perceptions via embodiment, and promote healing among survivors. CONCLUSION: Research addressing sexual violence in VR is needed and should build on the existing peripheral science on gaming and social media environments. Forensic nursing is well positioned to advance strategies of health and safety in VR, just as in the physical world. Incorporating forensic nursing avatars in VR and deploying diverse resources targeted for college-age young adults to prevent harms in VR should be explored safely and ethically. Forensic nurses are also positioned to assess for VR-related harms among patients and to work with private and government sectors to influence regulations and policies.

Trade-Offs Faced by 2-and 4-Year College Students Experiencing Food Insecurity: An Analysis of Qualitative Data.

PURPOSE: To understand the trade-offs, defined as compromises or decisions students must make to prioritize one important need over another, as a result of economic constraints, food insecure (FI) college students experience and the perceived impact of these challenges on health, well-being, and academic achievement. DESIGN: 8 Semi-structured focus groups. SETTING: Seven 2- and 4-year Minnesota colleges. PARTICIPANTS: 53 students initially screening positive for FI. METHOD: The focus groups were audio-recorded and transcribed verbatim. Thematic analysis, a systematic approach for identifying and analyzing patterns across qualitative data, was used through four analysis phases to identify themes and categories. RESULTS: We identified five themes within trade-offs: sacrificing food, missing out on relationships, sacrificing academic studies, choosing between basic needs, and maintaining physical and mental well-being. The trade-offs students described were multifaceted, caused notable stress and worry, and presented challenges to students' well-being. CONCLUSION: This study provides evidence on the complexities of FI among students and details on what students may be sacrificing as a result of making trade-offs. Understanding the trade-offs students are experiencing can help college staff to prioritize which issues to focus on to improve student health and academic performance.

A Trauma-Informed Mentoring Framework for Forensic Nurses: An Overview of STEERR-Structure, Process, and Evaluation.

ABSTRACT: The STEERR Mentoring Framework, grounded in decolonized and feminist mentorship approaches, integrates foundational principles of mentoring with the unique and complex characteristics of the role of the forensic nurse. The primary objective of the program is to support a competent, sustainable, and resilient forensic nursing workforce. In this article, we describe the development process, framework structure, and evaluation approach implemented within a 1-year pilot initiative focused on forensic nurses in the sexual assault nurse examiner role. We reflect on strategies for broader application and replication in forensic nursing programs across the United States.

Acceptability, Feasibility, and Efficacy of Telehealth Interventions for HIV Testing and Treatment in Adult Populations.

Introduction: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the rapid adoption of telehealth to provide HIV care and treatment. However, limited information exists about the feasibility, acceptability, and efficacy of telehealth interventions at different points of the HIV care continuum. Methods: A systematic search was conducted of Ovid MEDLINE, PsycINFO, and CINAHL databases to synthesize evidence regarding the feasibility, acceptability, and efficacy of videoconferencing and video-based interventions for HIV testing and treatment in adult populations. Seventeen articles published through July 2021 were included in the review. We used descriptive methods to analyze data, and findings were reported using frequencies and percentages. Results: Findings show that videoconferencing and video-based interventions are generally feasible and acceptable. Videoconferencing is effective in improving adherence to HIV treatment and in promoting HIV testing. In addition, video-based interventions were effective in promoting HIV testing, treatment initiation, and adherence to medication. Both modalities enhanced linkage and retention in treatment for HIV-positive patients. Conclusions: Video-based and videoconferencing interventions are beneficial in HIV testing and treatment. However, the scarcity of primary studies employing these telehealth modalities means that there is a need for more research in these areas. Also, reviewed studies suffered from several limitations, including reliance on subjective measures, lack of standardized ways of evaluating acceptability and feasibility, use of small sample sizes, and short follow-up durations. In addition, there was less representation of studies from resource-limited settings disproportionately affected by HIV and AIDS. Thus, future research should focus on addressing these challenges.

Effects of telehealth-assisted interventions for secondary prevention of cardiovascular disease: A systematic review and meta-analysis.

BACKGROUND: Telehealth-assisted interventions have been used as secondary prevention measures in cardiac rehabilitation, especially for the delivery of information between healthcare service providers and patients. However, as the application of this intervention modality broadens, investigation of its effects in secondary prevention of cardiovascular disease (CVD) is necessary. AIMS: To identify the effectiveness of telehealth-assisted interventions for secondary prevention of CVD. DESIGN: Systematic review and meta-analysis. METHODS: The PRISMA protocol was used to conduct a systematic review and meta-analysis of randomised controlled trials. The full text of articles was obtained from six databases for the period from database establishment to 25 November 2021. To assess the methodological quality of the studies reviewed, the updated Cochrane risk-of-bias checklist for randomised trials was employed. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for secondary CVD prevention. RESULTS: The final analysis included 4012 individuals from 18 different trials. Telehealth-assisted interventions were shown to improve medication adherence (standardised mean difference [SMD]: 0.31; 95% confidence interval [CI]: 0.33-0.59) and reduce depression (SMD: -0.28; 95% CI: -0.46 to -0.10). CONCLUSIONS: Telehealth-assisted interventions appear to improve adherence to medication and reduce depression of individuals with CVD. These intervention strategies could be offered to both healthcare providers and individuals with CVD as an option in delivering and facilitating the use of health services to improve health behaviours and overall outcomes. Furthermore, this study may be used as guidance for future research to provide an appropriate plan of care for this population. RELEVANCE TO CLINICAL PRACTICE: The findings imply that the delivery of care remotely via telehealth-assisted interventions for secondary prevention of CVD is beneficial in improving CVD survivors' health and access to healthcare services. TRIAL REGISTRATION: The International Prospective Register of Systematic Review: (PROSPERO): CRD 42021290111.

"It could bring down Greek life as a whole": Greek life members' perspectives on party culture, safety, responsibilities and consequences.

OBJECTIVE: Describe Greek life students' perspectives of party culture, safety, and College Sexual Violence (CSV) prevention. PARTICIPANTS: 27 US undergraduates: 5 fraternity underclassmen, 6 fraternity upperclassmen, 10 sorority underclassmen, 6 sorority upperclassmen. METHODS: Students participated in one of four focus groups, separately by gender and academic year. Facilitation guide addressed partying, sexual violence, and safety. RESULTS: Greek life members described partying preferences, perceived safety threats, and actions they took to party safely. University efforts to support safe partying were not universally viewed as helpful. CONCLUSIONS: Although Greek life students strive to create safe partying environments, there remain missed opportunities to mitigate risks related to CSV. The responsibility to ensure safe partying falls too heavily on students, resulting in universities missing opportunities to provide measures that promote safety while mitigating risks and potentially serious harms.

Weight Status Among Minnesota Hispanic or Latino/a Youth: An Exploration of Protective Factors.

PURPOSE: Pediatric obesity disproportionately impacts Hispanic or Latino/a adolescents. Culturally appropriate family-based behavioral initiatives to improve weight status are warranted. The purpose of this research was to determine prevalence rates and identify protective factors associated with having overweight/obesity (body mass index ≥ 85th percentile) to inform Hispanic or Latino/a-targeted behavioral intervention development. DESIGN: Secondary data analyses of a population-based statewide survey. SETTING: Minnesota public high schools. PARTICIPANTS: Male (n = 2,644) and female (n = 2,798) Hispanic or Latino/a 9th and 11th graders (N = 5,442). MEASURES: Obesity-related behaviors (meeting fruit and vegetable [F&V] and physical activity [PA] recommendations), family caring, family country/region of origin, and weight status. ANALYSIS: Stepwise logistic regression models (F&V, PA), stratified by biological sex, were used to identify protective factors of overweight/obesity. RESULTS: The overall prevalence of meeting F&V and PA recommendations was 11.0% and 11.8%, respectively. Meeting F&V recommendations was not protective against overweight/obesity in either sex. Yet, males and females who met PA recommendations had significantly lower odds of having overweight/obesity (p < .05). In F&V and PA models, family caring was protective against overweight/obesity in females (p < .05), and family country/region of origin was protective against overweight/obesity in both sexes (p < .05). CONCLUSION: Findings illustrate a need for obesity prevention initiatives for Hispanic or Latino/a youth. More research is needed to understand the protective nature of family caring and country/region of origin.

Effects of telehealth intervention for people with dementia and their carers: A systematic review and meta-analysis of randomized controlled studies.

PURPOSE: Interventions delivered using telehealth modalities are becoming standard practice with patient populations around the world, partly because of innovation necessitated by the COVID-19 pandemic and partly due to improved infrastructure and comfort of providers, patients, and families, through technology. Though increasingly utilized, the effectiveness of telehealth interventions with families with dementia remains unclear. This gives rise to the need for investigation to develop telehealth interventions that are evidence based and not merely convenient tools. This current study is designed to systematically examine the impact and effectiveness of telehealth-delivered psychoeducational and behavioral interventions among persons with dementia and their caregivers. DESIGN: The design combines systematic review and meta-analysis. METHODS: A total of eight databases were electronically accessed and searched as of November 16, 2021. Experimental studies identifying the results of telehealth interventions for persons with dementia and associated caregivers published in English have been reviewed in this study. Standardized mean differences (SMD) offering 95% confidence intervals (CI) were developed to pool the effect size using a random effects model (in this case, Stata 16.0). The Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB-2) was used to analyze the study's methodological soundness. FINDINGS: Nineteen cases met the eligibility criteria (including 1379 persons with dementia and 1339 caregivers). Overall, telehealth interventions demonstrated effects in the expected directions on depression (SMD -0.63; 95% degree of confidence intervals (CI) -0.88 to -0.38, p < 0.001); and caregivers' perceived competency (SMD 0.27; 95% CI -0.05 to 0.50, p = 0.02). There were, however, no statistically significant effects observed on cognitive function or multiple aspects of quality of life for subjects. CONCLUSIONS: Telehealth interventions appear to effect a reduction in depression among persons diagnosed with dementia while improving the perceived competency of caregivers. CLINICAL RELEVANCE: The study's results could be used as evidence of the effectiveness of using telehealth for persons with dementia and their caregivers, including contextualizing where they are used (i.e., long-term care facilities, private homes, etc.), understanding the mechanisms in play (including intervention delivery and systems), and isolating and identifying mediating influences.

Improving patient well-being in the United States through care coordination interventions informed by social determinants of health.

Health and well-being are promoted when primary care teams partner with patients and provide care coordination to mitigate risks and promote optimal health. Identification of patients for care coordination is typically based on claim-driven risk assessments. Evidence shows that social determinants of health (SDOH) drive risk for adverse health outcomes but are omitted from existing risk tools. Missed opportunities for care coordination contribute to increased healthcare costs, poorer health outcomes and reduced patient well-being. To address the gap of risk-informed care coordination that includes SDOH, the aim of this project was to implement process improvement of a system's care coordination program through refined patient selection and customised engagement in intensive care coordination. A non-randomised care coordination quality improvement project was conducted at a community health centre in 2020. Inclusion criteria (i.e. presence of risk attribution score, SDOH questionnaire completed) resulted in 540 patients being offered care coordination services; Patients having at least one month of care coordination were included in the analysis (N = 216). Analysis included the 216 patients that chose participation and the 324 patients that maintained usual care. Descriptive statistics were generated to distinguish patient demographics, frequency of care coordination contact, and specific SDOH insecurities for both the study and comparison groups. Paired t-tests were incorporated to evaluate statistical significance of the intervention group. Impact on well-being, SDOH barriers, appointment adherence and health outcomes were assessed in both conditions. Intervention condition patients reported improvement in well-being [feeling anxious (t = 4.051; p < 0.000)] and reduced SDOH barriers [food access (t = 4.662; p < 0.000); housing (t = 2.203; p = 0.008)] that were significantly different from the usual care condition in the expected directions. Care coordination based on factors including SDOH risks shows promise in improving patient well-being. Future research should refine this approach for comprehensive risk assessment to intervene and support patient health and well-being.

Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System-Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses.

BACKGROUND: Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance. OBJECTIVE: This study aims to characterize factors influencing successful design and use of comprehensive CDS care maps and identify themes associated with end-user acceptance of a thoracic trauma CDS care map earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Design development and implementation strategy for a CDS care map. This stage was based on a previously developed prototype CDS care map guided by the Unified Theory of Acceptance and Use of Technology. METHODS: A total of 22 multidisciplinary end users (physicians, advanced practice providers, and nurses) were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio-recorded, and transcribed verbatim. Generation of prespecified codes and the interview guide was informed by the Unified Theory of Acceptance and Use of Technology constructs and investigative team experience. Interviews were blinded and double-coded. Thematic analysis of interview scripts was conducted and yielded descriptive themes about factors influencing the construction and potential use of an acceptable CDS care map. RESULTS: A total of eight dominant themes were identified: alert fatigue (theme 1), automation (theme 2), redundancy (theme 3), minimalistic design (theme 4), evidence based (theme 5), prevent errors (theme 6), comprehensive across the spectrum of disease (theme 7), and malleability (theme 8). Themes 1 to 4 addressed factors directly affecting end users, and themes 5 to 8 addressed factors affecting patient outcomes. More experienced providers prioritized a system that is easy to use. Nurses prioritized a system that incorporated evidence into decision support. Clinicians across specialties, roles, and ages agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently. CONCLUSIONS: End user feedback reinforces attention toward factors that improve the acceptance and use of a CDS care map for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and optimal care provision. Identifying these factors early in the development and implementation process may facilitate user-centered design and improve adoption.

Mental health of US undergraduate and graduate students before and during the COVID-19 pandemic: Differences across sociodemographic groups.

The purposes of this study were to assess differences between sociodemographic groups in student mental health before and during the COVID-19 pandemic, to investigate whether the pandemic disproportionately affected certain groups, and to examine between-group differences in pandemic-related stressors. Data from Minnesota undergraduate and graduate students who completed an online survey in 2020 (N = 2,067) were compared to data collected from students in 2018 (N = 3,627). The survey assessed days of poor mental health, stress, stress management ability, days of adequate sleep, and pandemic-related stressors (2020 only). Multivariate analyses of variance assessed differences between study years (2020 vs. 2018), sociodemographic groups (gender, sexual orientation, race, disability, international student), and their interactions with study year in predicting mental health, and the sociodemographic groups in predicting pandemic stressors, among undergraduate and graduate students. Stress management ability decreased and sleep improved from 2018 to 2020. The sociodemographic variables most associated with poorer mental health were identifying as female, a sexual minority, or having a disability. Undergraduates reported poorer mental health than graduate students. Differences between sociodemographic groups were not larger during the pandemic, except among students with disabilities. All five sociodemographic variables were related to greater pandemic stressors in some domains.

Medicolegal death investigator workplace safety hazards: A scoping review of the literature.

In the United States, medicolegal death investigation practices and policies pertaining to sudden unexpected deaths are mandated by state government. Practices vary across states, which contributes to inconsistency in job prerequisites and training. In preparation for a study focused on occupational safety and health of medicolegal death investigators in their on-scene and follow-up activities, a scoping review was conducted to document known occupational safety risks and health-related conditions associated with death investigation. Searches used Boolean and subject heading operators both broad and narrow in scope, and search terms included scene responder, hazard, investigator, forensic pathology, injury, and safety. Twenty-five articles met inclusion criteria, which included seventeen survey-mixed method designs, two systematic reviews, five quasi-experimental designs, and one case study. Twelve articles addressed mental health and eleven focused on risks associated with infectious disease. One article addressed the risk of chemical exposure from cyanide among autopsy personnel (including forensic pathologists) and nine included a wide range of employees within the setting of medical examiner or coroner offices. One article, addressing burnout, included employees in a forensic science laboratory setting as well as medicolegal death investigators and two articles included forensic pathologists and medicolegal death investigators. Only one article addressed medicolegal death investigators specifically. Articles addressing occupational and environmental hazards of medicolegal death investigators associated with musculoskeletal, respiratory, cardiovascular, radiological, nuclear, electrical, or explosive threats were not identified. There is little published about safety risks inherent in conducting death investigations. Research is needed to adequately inform health promotion and injury prevention strategies.

Barriers to HIV care in Uganda and implications for universal test-and-treat: a qualitative study.

Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 HIV clinics in Kampala, Uganda, to understand barriers to care. PLWH enrolled started/restarted on HIV treatment ≤3 months prior. PLWH were grouped as 1) "ART-experienced" or those restarted therapy after ≥12 months off, 2) ART naïve CD4 count <100 cells/uL "late presenters" or 3) ART naïve CD4 count >350 cells/uL "early presenters". In-depth interviews were conducted in Luganda, translated, and transcribed verbatim. Between May and August 2017, 58 PLWH and 20 HCWs were interviewed. High stigma and low social support emerged as themes among all as barriers to care. Alcohol abuse was a barrier for men. Fear of domestic violence and abandonment were barriers for women, limiting disclosure of their HIV status to their male partners. Clinic factors such as rapport with staff, distance, efficiency, and privacy impacted care. Future interventions to decrease delayed ART initiation should target stigma and social support. Assisted disclosure, contact tracing, and alcohol abuse treatment should be implemented. Strengthening client support, reducing wait times, and increasing privacy assurances would improve care-seeking behaviors.

Sex in the Context of Substance Use: A Study of Perceived Benefits and Risks, Boundaries, and Behaviors among Adolescents Participating in an Internet-Based Intervention.

Little research has examined adolescents' perspectives of sex with substance use. This study examined (1) adolescents' perceived benefits and risks of sex with substance use, as well as boundaries; (2) the potential for positive and negative social influences among adolescents when they discuss these topics; and (3) whether exposure to health-promoting content is associated with trajectories of sex with substance use over a 6-month period. To address the first two objectives, 176 comments were analyzed from 71 adolescents (90% female) aged 14-18 years who participated in an Internet-based sexual health promotion intervention and posted to at least one message board addressing sex with substance use. Adolescents' perceived benefits and risks of sex with substance use primarily reflected concern for the experience of sex in the moment; perceived risks and boundaries primarily reflected concern for the ability to develop and maintain meaningful relationships. Comments of 63% and 22% of adolescents, respectively, were evaluated to have potential for health-promoting and risk-promoting social influence. To address the third objective, trajectories of self-reported sex with substance use were compared between 89 intervention and 54 control participants. No significant differences were observed. However, a dose-response effect was observed; intervention participants who completed less than one third of assigned tasks reported increases in sex with alcohol or marijuana use over time, while no marked changes or much smaller changes in sex with substance use were observed among intervention participants who completed one third or more tasks. Implications for prevention and intervention programs are discussed.

Communication about Sexual Consent and Refusal: A Learning Tool and Qualitative Study of Adolescents' Comments on a Sexual Health Website.

Sexual communication skills are needed to create healthy romantic relationships. Arguably, these skills also can be used to prevent some instances of unwanted sex. This study presents a qualitative analysis of adolescents' comments after reading a teen-friendly article on sexual consent as part of a web-based sexual health promotion intervention. The sample was comprised predominantly of female adolescents recruited from a Midwest urban region in the United States. Adolescents varied with respect to self-efficacy to request, provide, and deny consent, as well as the perceived need to ask for consent in the context of established relationships. Many adolescents perceived that nonverbal methods of communication were sufficient to request, provide, or deny sexual consent. Factors that make it difficult to discuss sexual boundaries and say "no" to unwanted sex included low self-efficacy and an underlying desire to nurture or preserve a relationship. Cultural norms must be changed to support verbal, affirmative sexual consent. In addition, adolescents must be aided in the development of skills to request sexual consent, say "yes" to specific activities, and say "no" to others. Without supportive norms and skills to enhance self-efficacy, adolescents may be unwilling to engage in verbal communication about sexual consent and boundaries.

Effects of telehealth interventions for adolescent sexual health: A systematic review and meta-analysis of randomized controlled studies.

INTRODUCTION: Telehealth interventions to advance adolescent sexual health have evolved and are being used to promote adolescent sexual health knowledge and healthy sexual behaviors. However, as this area of intervention modality expands, there is a need to pause and examine the effects of telehealth interventions on adolescent sexual health outcomes. Addressing this knowledge gap will inform researchers and practitioners on the current state of evidence of telehealth interventions and inform further intervention development and testing. This study aimed to explore the meta-effects of telehealth interventions on self-efficacy of using condoms, condom use practices, and sexually transmitted infection testing behaviors among adolescents. METHODS: A systematic review and meta-analysis of randomized controlled trials were conducted. Seven databases (Academic Search Complete, CINAHL, EMBASE, MEDLINE, PubMed, OVID (UpToDate), and Web of Science) were searched for relevant full-text articles from the inception to May 2021. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random effects model to calculate the pooled effects of telehealth interventions for adolescents. Stata 16.0 was used for statistical analysis. RESULTS: A total of 15 studies (N = 5499) that used telehealth interventions with adolescents were included in the analysis. Telehealth interventions were found to increase self-efficacy for condom use (standardized mean difference: 0.22; 95% confidence interval: 0.08-0.36), practice for condom use (standardized mean difference: 0.35; 95% confidence interval: 0.23-0.47), and being screened/tested for sexual transmitted infections (standardized mean difference: 0.61; 95% confidence interval: 0.31-0.92). DISCUSSION: Telehealth interventions show promise as effective intervention delivery solutions for improving self-efficacy and certain sexual health behaviors among adolescents. These telehealth strategies could be important alternatives to in-person visits to accessing sexual health information or services near where they live. Future research should consider testing telehealth strategies where there is evidence of impact to move the field forward.

Effects of telehealth-assisted interventions among people living with HIV/AIDS: A systematic review and meta-analysis of randomized controlled studies.

INTRODUCTION: Taking antiretroviral therapy (ART) is a daily necessity for people living with HIV but these individuals experience multiple barriers and challenges to medication adherence. Interventions to support medication adherence have yielded effects in the expected direction, but the extent to which telehealth or virtually delivered interventions to promote adherence are effective among people living with HIV/AIDS remains unknown. We aimed to address this knowledge gap and inform future research and practice that promotes the well-being of people living with HIV/AIDs through telehealth interventions addressing medication use. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using the following databases: Academic Search Complete, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PubMed, OVID (UpToDate), and the Web of Science. Relevant full-text articles published through September 2021 were retrieved. The revised Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for people living with HIV/AIDS. Stata 16.0 was used for statistical analysis. RESULTS: A total of 12 studies (N = 3557 participants) that used telehealth-assisted interventions for people living with HIV/AIDS were included. Telehealth interventions were found to increase the adherence to treatment (standardized mean difference [SMD]: 0.21; 95% confidence interval (CI): 0.03 to 0.40), to reduce depressive symptoms (SMD: -2,74; 95% CI: -3.39 to -2.09), and to improve perceived quality of life (SMD: 0.74; 95% CI: 0.37 to 1.10). DISCUSSION: The meta-effects of telehealth-assisted interventions include significantly enhanced adherence to treatment, improved quality of life, and reduced depressive symptoms among people living with HIV/AIDS. These findings suggesting that delivering health management interventions remotely through telehealth-assisted modalities was both feasible and effective in yielding health benefits for people living with HIV/AIDS. Integrating telehealth-assisted interventions as a modality in HIV/AIDS care might support continuity of care and sustained well-being. Future research should evaluate telehealth intervention outcomes and examine mediating, moderating, or other tailorable variables affecting intervention effectiveness.

Pathways to Breast Cancer Diagnosis and Treatment Among Women in Ghana: A Qualitative Study.

Background: Breast cancer is the leading cause of cancer death among Ghanaian women and most women are identified once they develop symptoms. Women then must navigate a complex health care system to get diagnosed and receive orthodox medicine. We describe Ghanaian women's pathways of care from breast cancer-related symptom detection to treatment receipt. Methods: We conducted a qualitative study using an empirical phenomenological approach. We used a purposive sampling technique to recruit 31 women with breast cancer who were receiving treatment at Komfo Anokye Teaching Hospital in Kumasi, Ghana. They participated in semistructured in-depth interviews between November 2019 and March 2020. All interviews were transcribed verbatim and analyzed using a deductive coding approach. Results: Women navigate approximately nine steps from symptom detection to receiving orthodox breast cancer treatment. The breast cancer care pathway is not linear and women frequently move among different management approaches, including alternative therapy (faith healing and traditional herbal healing). All the women detected the symptoms themselves. Some of the women sought orthodox medicine due to information from the media. Conclusions: Alternative therapy providers play a critical role in the breast cancer diagnosis and care pathways in Ghana underscoring the need to formally integrate them into the health care system. Breast cancer awareness programs through the media and educational programs aimed at alternative therapy providers may reduce the time from symptom detection to receipt of orthodox medicine.

Sociodemographic and health disparities among students screening positive for food insecurity: Findings from a large college health surveillance system.

Food insecurity among college students has begun to be recognized as a pressing social issue. However, much of the research in this area to date is limited by factors like small sample sizes and convenience sampling. The objective of this study was to assess sociodemographic and health disparities among two- and four-year post-secondary students screening positive for food insecurity, using one of the largest relevant health surveillance databases available. This study included analyses of pooled annual data (2015-2018; n = 13,720) from students participating in state-based surveillance of 27 two- and four-year Minnesota post-secondary institutions. Food security was determined using a validated two-item screener. Disparities were examined across numerous factors including: sociodemographic, economic, academic, institutional, nutrition and weight-related health risk and resiliency. In total, 24% of students experienced food insecurity. Findings highlighted stark disparities, with notably high positive screening rates of food insecurity among non-Hispanic Black (43%), transgender/non-binary (42%) and first-generation (33%) students. Food insecurity was significantly associated with nearly every adverse health factor examined, despite controlling for demographics (p < 0.0001). Overall, these findings represent one of the largest peer-reviewed studies of college food insecurity to date and underscore robust differences between who experiences food insecurity and who does not. They also highlight troubling health risks that accompany food insecurity. Importantly, the COVID-19 pandemic has worsened these realities. To inform prevention efforts, additional research is urgently needed, including cohort studies, controlled trials, and quasi-experimental research based on rigorous evaluation of policy initiatives now being considered at institutional, state and federal levels.