Dare to Ask! A Model for Teaching Nursing Students about Identifying and Responding to Violence against Women and Domestic Violence.

The role of nurses in identifying and responding to family violence and violence against women has long been established. However, nurses' readiness to fully assume this role remains low due to various barriers and the sensitive nature of the subject. As part of capacity building to address this problem, an additional national qualitative learning target, i.e., to "show knowledge about men's violence against women and violence in close relationships", was introduced into the Swedish Higher Education Ordinance for nursing and seven other educational programs between 2017 and 2018. The aim of this paper is to describe how the national qualitative learning target is incorporated into the undergraduate nursing curriculum at the Swedish Red Cross University College. An overview of relevant teaching and learning activities and how they are organized is first presented, followed by the presentation of a proposed didactic model: Dare to Ask and Act! The model details a step-by-step progression from facts and figures, including the role of gender norms, to recognizing signs of abuse in complex clinical situations, as well as developing skills that enhance the courage to ask and act. Due to the sensitive nature of violence victimization, the proposed model reflects the importance of making the subject a reoccurring theme in undergraduate nursing education in order to boost nursing students' interests and confidence to "Dare to Ask and Act!". The model also shows that making the subject a recurring theme can be achieved with minimal disruptions to and without overcrowding an existing curriculum.

Early Life Management of Osteogenesis Imperfecta.

PURPOSE OF REVIEW: This review aims to provide a review of the multidisciplinary management of infants with osteogenesis imperfecta (OI) during the first year of life, focusing on those with severe disease. The authors draw on published literature and direct experience of working in a large paediatric centre specialising in the management of rare bone disease. RECENT FINDINGS: Whilst understanding of the pathophysiology of OI has grown over the past decade, the evidence base for management of infants remains limited. There has been a greater recognition of certain subjects of concern including pain management, cervical spine deformity, and neurocognitive development. Both international consensus guidelines on rehabilitation and disease-specific growth charts have been welcomed by clinical teams. The early involvement of multidisciplinary specialist care is critical in ensuring optimal care for the infant with severe OI. A long-term perspective which focuses on the axial, craniofacial, and peripheral skeleton as well as on development more generally provides a framework which can guide the management of infants with severe OI.

Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis.

Objectives: The study aimed to generate insights on how best to enhance the compatibility between Public Health training program competencies and the implementation of competencies required by employers to address current and emerging public health needs. Methods: A survey adapted from the WHO-ASPHER Competency Framework for the Public Health Workforce was conducted online among Israeli public health managers from August to November 2021. The survey was formulated to mirror Essential Public Health Operations. Forty-nine managers participated (37.6% response rate) in an assessment of 44 public health competencies and the core organizational public health operations. Results: Analysis of Essential Public Health Operations revealed a notably high deficiency reported for Advocacy Communication and Social Mobilization for health competencies. Collaborations and Partnership and, Leadership and System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy and Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased. Conclusion: There is a clear need for public health professionals to acquire versatile and innovative competencies in response to the ever-changing health threats.

The Future Public Health Workforce in a Changing World: A Conceptual Framework for a European-Israeli Knowledge Transfer Project.

Health services quality and sustainability rely mainly on a qualified workforce. Adequately trained public health personnel protect and promote health, avert health disparities, and allow rapid response to health emergencies. Evaluations of the healthcare workforce typically focus on physicians and nurses in curative medical venues. Few have evaluated public health workforce capacity building or sought to identify gaps between the academic training of public health employees and the needs of the healthcare organizations in which they are employed. This project report describes the conceptual framework of "Sharing European Educational Experience in Public Health for Israel (SEEEPHI): harmonization, employability, leadership, and outreach"-a multinational Erasmus+ Capacity Building in Higher Education funded project. By sharing European educational experience and knowledge, the project aims to enhance professionalism and strengthen leadership aspects of the public health workforce in Israel to meet the needs of employers and the country. The project's work packages, each jointly led by an Israeli and European institution, include field qualification analysis, mapping public health academic training programs, workforce adaptation, and building leadership capacity. In the era of global health changes, it is crucial to assess the capacity building of a well-qualified and competent workforce that enables providing good health services, reaching out to minorities, preventing health inequalities, and confronting emerging health challenges. We anticipate that the methods developed and the lessons learned within the Israeli context will be adaptable and adoptable by other countries through local and cultural adjustments.

Nurses' experiences of health concerns, teamwork, leadership and knowledge transfer during an Ebola outbreak in West Africa.

AIM: To describe nurses' experiences of health concerns, teamwork, leadership and management and knowledge transfer during an Ebola outbreak in West Africa. DESIGN: The study has a qualitative descriptive design. METHODS: The 44 nurses who had worked in an Ebola Treatment Centre in Kenema in 2014 and 2015 were invited by email to respond to a questionnaire. The qualitative, open-ended answers were analysed using a thematic analysis. Data have been coded systematically, with the identification of semantic patterns presented in four themes. RESULTS: The themes are as follows: personal health management-a way to feel safe and secure for delegates and affiliates; pre-deployment training-crucial for a joint value base and future collaboration; the importance of a professional democratic approach and being a good role model; and the value of timely in-depth knowledge transfer of experienced former delegates.

New diagnostic modalities and emerging treatments for neonatal bone disease.

Bone disease in the neonatal period has often been regarded as an issue affecting premature infants, or a collection of rare and ultra-rare disorders that most neonatologists will see only once or twice each year, or possibly each decade. The emergence of targeted therapies for some of these rare disorders means that neonatologists may be faced with diagnostic dilemmas that need a rapid solution in order to access management options that did not previously exist. The diagnostic modalities available to the neonatologist have not changed a great deal in recent years; blood tests and radiographs still form the mainstays with other techniques usually reserved for research studies, but rapid access to genomic testing is emergent. This paper provides an update around diagnosis and management of bone problems likely to present to the neonatologist.

Early life vitamin D depletion alters the postnatal response to skeletal loading in growing and mature bone.

There is increasing evidence of persistent effects of early life vitamin D exposure on later skeletal health; linking low levels in early life to smaller bone size in childhood as well as increased fracture risk later in adulthood, independently of later vitamin D status. A major determinant of bone mass acquisition across all ages is mechanical loading. We tested the hypothesis in an animal model system that early life vitamin D depletion results in abrogation of the response to mechanical loading, with consequent reduction in bone size, mass and strength during both childhood and adulthood. A murine model was created in which pregnant dams were either vitamin D deficient or replete, and their offspring moved to a vitamin D replete diet at weaning. Tibias of the offspring were mechanically loaded and bone structure, extrinsic strength and growth measured both during growth and after skeletal maturity. Offspring of vitamin D deplete mice demonstrated lower bone mass in the non loaded limb and reduced bone mass accrual in response to loading in both the growing skeleton and after skeletal maturity. Early life vitamin D depletion led to reduced bone strength and altered bone biomechanical properties. These findings suggest early life vitamin D status may, in part, determine the propensity to osteoporosis and fracture that blights later life in many individuals.

Global nursing in an Ebola viral haemorrhagic fever outbreak: before, during and after deployment.

BACKGROUND: Nurses are on the forefront and play a key role in global disaster responses. Nevertheless, they are often not prepared for the challenges they are facing and research is scarce regarding the nursing skills required for first responders during a disaster situation. OBJECTIVES: To investigate how returnee nursing staff experienced deployment before, during and after having worked for the Red Cross at an Ebola Treatment Center in Kenema, West Africa, and to supply knowledge on how to better prepare and support staff for viral haemorrhagic fever outbreaks. METHODS: A descriptive, cross-sectional approach. Questionnaires were administered to nurses having worked with patients suffering from Ebola in 2014 and 2015. Data collection covered aspects of pre-, during and post-deployment on clinical training, personal health, stress management, leadership styles, socio-cultural exposure and knowledge transfer, as well as attitudes from others. Data was analysed using both quantitative and qualitative methods. RESULTS: Response-rate was 88%: forty-four nurses from 15 different countries outside West Africa answered the questionnaire. The respondents identified the following needs for improvement: increased mental health and psychosocial support and hands-on coping strategies with focus on pre- and post-deployment; more pre-deployment task-oriented clinical training; and workload reduction, as exhaustion is a risk for safety. CONCLUSIONS: This study supplies knowledge on how to better prepare health care staff for future viral haemorrhagic fever outbreaks and other disasters. Participants were satisfied with their pre-deployment physical health preparation, whereas they stressed the importance of mental health support combined with psychosocial support after deployment. Furthermore, additional pre-clinical training was requested.

Relation of socioeconomic status to overweight and obesity: a large population-based study of Chinese adults.

BACKGROUND: China has been going through significant changes in social and economical aspects and with great socioeconomic disparity in different regions. However, data on the association between socioeconomic status (SES) and obesity are not available in Tianjin, China. AIM: This study aimed to investigate the association between SES and high adiposity among the adult population in Tianjin. SUBJECTS AND METHODS: A total of 7351 individuals aged 20-79 were included in this study. Socioeconomic information was collected through an interview following a structured questionnaire. Waist circumference, body weight and height were measured following standard procedures. Overweight and obesity were defined according to the criteria of the Working Group on Obesity in China. Data were analysed using multinomial logistic regression with adjustment for potential confounders. RESULTS: Stratified analysis showed that higher monthly income and education were related to decreased odds of abdominal overweight/obesity in women, while high education was associated with increased odds of general overweight/obesity in men. Retirement increased the odds of abdominal overweight and obesity and non-manual work was associated with low odds of abdominal obesity in women. CONCLUSIONS: SES was associated with general and abdominal overweight/obesity and sex may play a role in such an association.

The prevalence and determinants of hypothyroidism in hospitalized patients with type 2 diabetes mellitus.

The purpose of this study was to investigate the prevalence of hypothyroidism among hospitalized patients with type 2 diabetes mellitus and its related factors, and to assess the prevalence of macrovascular and microvascular diseases among type 2 diabetes mellitus inpatients with hypothyroidism and euthyroidism. A total of 1662 type 2 diabetes mellitus inpatients hospitalized at the Metabolic Diseases Hospital, Tianjin Medical University from 1 January 2008 to 1 March 2013 were included in this study. Information on demographic and anthropometric factors and additional variables related to hypothyroidism were collected from medical records. Prevalence rates were calculated and standardized using direct method based on the age-specific and sex-specific structure of all participants. Data were analyzed using binary logistic regression with adjustment for potential confounders. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and 77.0 % of the patients with hypothyroidism had subclinical hypothyroidism. The prevalence of hypothyroidism increased with age, and was higher in women (10.8 %) than in men (3.4 %). Older age (odds ratio, 1.74; 95 % confidence interval, 1. 05 to 2.89), female gender (odds ratio, 2.02; 95 % confidence interval, 1.05 to 3.87), and positive thyroid peroxidase antibody (odds ratio, 4.99; 95 % confidence interval, 2.83 to 8.79) were associated with higher odds of hypothyroidism among type 2 diabetes mellitus inpatients. The type 2 diabetes mellitus inpatients with hypothyroidism had higher prevalence of cerebrovascular diseases than those with euthyroidism after adjustment for age and gender. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and most patients had subclinical hypothyroidism. Older age, female gender, and positive thyroid peroxidase antibody could be indicators for detecting hypothyroidism in type 2 diabetes mellitus inpatients.

Prevalence of Overweight and Obesity among Chinese Adults: Role of Adiposity Indicators and Age.

OBJECTIVES: The role of different body fat indicators and age in assessing the prevalence of obesity is unclear. We aimed to examine to what extent different body fat indicators including BMI, waist circumference (WC) and waist-to-hip ratio (WHR) affect the prevalence of overweight and obesity among Chinese adults taking age into account. METHODS: This population-based cross-sectional study included a random sample of 7,603 adults aged 20-79 years across entire Tianjin, China. BMI, WC, and WHR were used to define overweight and obesity following standard criteria. Prevalence rates were calculated and standardized using local age- and gender-specific census data. Logistic regression was used in data analysis. RESULTS: Using the combination of BMI, WC, and WHR, the prevalence of overweight and obesity was 69.8%, and increased with age till the age of 60 and a decline thereafter. The prevalence of overweight assessed by BMI was higher than that assessed by WC and WHR, while the prevalence of obesity defined by BMI was much lower than that defined by WC or WHR. CONCLUSION: The prevalence of overweight and obesity is about 70% among Chinese adults. Adiposity indicators and age play an important role in the prevalence of overweight and obesity.

Shared governance: a way to improve the care in an inpatient rehabilitation facility.

BACKGROUND: Rehabilitation care is specialized and individualized requiring effective and efficient communication to achieve optimal patient outcomes. PURPOSE: To examine how effective implementation of shared governance could improve care delivery, promote patient-centered care, and improve patient outcomes. DESIGN: The shared governance approach included all members of the rehabilitation team (i.e., physical therapist, occupational therapist, speech therapist, registered nurse and nurse aide) and was implemented over 6 months. FINDINGS/CONCLUSIONS: The major end products of this shared governance effort were improved staff communication, problem solving, patient outcomes, and staff satisfaction on our stroke and brain injury unit. CLINICAL RELEVANCE: When effectively implemented and sustained, shared governance between all rehabilitation team stakeholders can increase the effectiveness of communication along with more positive patient and staff outcomes.

The importance of reciprocity for female caregivers in a super-aged society: a qualitative journalistic approach.

As Japan is facing a super-aged society, Japanese women find themselves on the front line as traditional family caregivers. Our aim was to describe the observations and thoughts of one Japanese woman's experience of living with her elderly parents in the suburbs of Tokyo. One open-ended interview was performed and analyzed using content analysis with a methodological departure in qualitative journalistic interviewing. The case was a single woman in her late 40s living with her aged parents. Reciprocity was identified as the glue holding the joy and burdens of the role of caregiving for elderly parents. Moreover, gender was identified as a motivator for reciprocity from a macro to a micro level in a super-aged society.

An active lifestyle postpones dementia onset by more than one year in very old adults.

The purpose of this study was to test the hypothesis that an active lifestyle delays age at dementia onset. This study included 388 incident dementia cases (DSM-III-R criteria) that developed over a 9-year follow-up period among 1,375 baseline dementia-free community dwellers with good cognitive function (MMSE >23) (mean age = 81.2) from the Kungsholmen Project. An active lifestyle was defined as participation in mental, physical, or social activity. We used linear regression models to estimate influence of baseline active lifestyle on age at onset of incident dementia and general linear models to estimate mean age at dementia onset. Age at onset of dementia was significantly older in persons who had higher levels of participation in mental, physical, or social activity (ß: 0.18, 0.29 and 0.23 respectively, p < 0.001 for all the activities) independent of education, medical condition, functional status, and other confounders including APOE. When the three types of activities were integrated into an index, we found that the broader the spectrum of participation in the activities, the later the onset of disease (ß = 0.93, p = 0.01 for participating in two activities, and ß = 1.42, p < 0.001 for three activities). There were 17 months difference in mean age at dementia onset between the inactive group and the most active group. An active lifestyle operates as a protective factor for dementia by delaying the clinical onset of the disease. These findings highlight the relevance of encouraging old adults to have active lifestyles, which could have a great impact on public health.

Leisure activities in late life in relation to dementia risk: principal component analysis.

AIMS: To explore the underlying dimensions of a set of interrelated lifestyle factors and test the hypothesis that an active lifestyle may protect against dementia. METHODS: The study population consisted of 776 participants aged >or=75 years who were dementia-free at both baseline and the first follow-up examinations. Participation in leisure activities was assessed at baseline of the survey, and principal component analysis was used to identify their underlying factors. RESULTS: During the 9-year follow-up from exposure assessment, 212 subjects developed dementia. Higher factor scores of physical, mental, and social dimensions of an active lifestyle was each related to a lower dementia risk. A significant dose-response association between participation in the diverse dimensions and lower dementia risk was observed. CONCLUSION: An active lifestyle may protect older people against dementia, and the higher level of engagement the stronger protection.

Mental, physical and social components in leisure activities equally contribute to decrease dementia risk.

BACKGROUND: There is accumulating evidence in the literature that leisure engagement has a beneficial effect on dementia. Most studies have grouped activities according to whether they were predominantly mental, physical or social. Since many activities contain more than one component, we aimed to verify the effect of all three major components on the dementia risk, as well as their combined effect. METHODS: A mental, social and physical component score was estimated for each activity by the researchers and a sample of elderly persons. The correlation between the ratings of the authors and the means of the elderly subjects' ratings was 0.86. The study population consisted of 776 nondemented subjects, aged 75 years and above, living in Stockholm, Sweden, who were still nondemented after 3 years and were followed for 3 more years to detect incident dementia cases. RESULTS: Multi-adjusted relative risks (RRs) of dementia for subjects with higher mental, physical and social component score sums were 0.71 (95% CI: 0.49-1.03), 0.61 (95% CI: 0.42-0.87) and 0.68 (95% CI: 0.47-0.99), respectively. The most beneficial effect was present for subjects with high scores in all or in two of the components (RR of dementia = 0.53; 95% CI: 0.36-0.78). CONCLUSIONS: These findings suggest that a broad spectrum of activities containing more than one of the components seems to be more beneficial than to be engaged in only one type of activity.

An active and socially integrated lifestyle in late life might protect against dementia.

The recent availability of longitudinal data on the possible association of different lifestyles with dementia and Alzheimer's disease (AD) allow some preliminary conclusions on this topic. This review systematically analyses the published longitudinal studies exploring the effect of social network, physical leisure, and non-physical activity on cognition and dementia and then summarises the current evidence taking into account the limitations of the studies and the biological plausibility. For all three lifestyle components (social, mental, and physical), a beneficial effect on cognition and a protective effect against dementia are suggested. The three components seem to have common pathways, rather than specific mechanisms, which might converge within three major aetiological hypotheses for dementia and AD: the cognitive reserve hypothesis, the vascular hypothesis, and the stress hypothesis. Taking into account the accumulated evidence and the biological plausibility of these hypotheses, we conclude that an active and socially integrated lifestyle in late life protects against dementia and AD. Further research is necessary to better define the mechanisms of these associations and better delineate preventive and therapeutic strategies.