Caught off guard by covid-19: Now what?

Human beings are social in nature and maintaining social interactions, relationships and intimacy are fundamental needs of older adults (OAs) living in assisted living (AL) communities. Yet, these very basic human needs have been impeded by quarantine mandates imposed by the COVID-19 pandemic. The socialization aspect offered in AL, allows for an integration of the whole person: body, mind, and spirit and is beneficial in mitigating the development of co-morbidities and negative patient outcomes. Additionally, the authenticity of home comes from the caring interactions provided by an interprofessional health care staff. Utilizing the 4 M Framework, created by The John A. Hartford Foundation and Institute of Healthcare Improvement, the authors describe simple direct bedside interventions of low cost, and high patient-centered value which front-line nursing and caregiver staff can employ to maintain social connections, interactions, mentation, function and mobility among residents they care for, and care about, in AL communities.

Factors Associated With Health Service Use Among Older Adults in a Mobile Veterans Program.

The current retrospective, longitudinal study applied Andersen's Behavioral Model of Health Services Use to examine how demographic characteristics (age), available resources (e.g., a caregiver, the Mobile Veterans Program [MVP]) and health needs (e.g., cognitive and physical functioning, depressive symptoms) affect hospitalization and institutionalization outcomes among older adults using the MVP. Fifty-four Veterans (age 55 to 95) participating in the MVP for up to 2 years were examined using hierarchical linear modeling (HLM) and growth curve model. In the final HLM model, each 1-point increase in depressive symptoms was associated with 76% (p ≤ 0.05) greater risk of institutionalization and 40% (p ≤ 0.01) greater risk of hospitalization. Each 1-point increase in cognitive functioning was associated with 24% (p ≤ 0.05) lower risk of institutionalization. The relationship between caregiver burden and hospitalization was attenuated by frequency of MVP visits. Services focused on reducing depressive symptoms may influence health service use and reduce caregiver burden in this population. [Journal of Gerontological Nursing, 46(5), 15-22.].

"Are you accepting new patients?" A pilot field experiment on telephone-based gatekeeping and Black patients' access to pediatric care.

STUDY OBJECTIVES: To determine whether name and accent cues that the caller is Black shape physician offices' responses to telephone-based requests for well-child visits. METHOD AND DATA: In this pilot study, we employed a quasi-experimental audit design and examined a stratified national sample of pediatric and family practice offices. Our final data include information from 205 audits (410 completed phone calls). Qualitative data were blind-coded into binary variables. Our case-control comparisons using McNemar's tests focused on acceptance of patients, withholding information, shaping conversations, and misattributions. FINDINGS: Compared to the control group, "Black" auditors were less likely to be told an office was accepting new patients and were more likely to experience both withholding behaviors and misattributions about public insurance. The strength of associations varied according to whether the cue was based on name or accent. Additionally, the likelihood and ways office personnel communicated that they were not accepting patients varied by region. CONCLUSIONS: Linguistic profiling over the telephone is an aspect of structural racism that should be further studied and perhaps integrated into efforts to promote equitable access to care. Future research should look reactions to both name and accent, taking practice characteristics and regional differences into consideration.

Validation of a Postextubation Dysphagia Screening Tool for Patients After Prolonged Endotracheal Intubation.

BACKGROUND: Patients who receive prolonged endotracheal intubation (> 48 hours) are at risk for dysphagia. Nurses should conduct swallowing assessments after extubation because of the high likelihood of aspiration pneumonia developing. No valid and reliable postextubation dysphagia screening tools are available. OBJECTIVES: To establish content validity, analyze interrater reliability, and determine sensitivity and specificity of an evidence-based postextubation dysphagia screening tool developed by a multidisciplinary team. METHODS: A prospective nonexperimental study was conducted in 4 medical-surgical intensive care units in 4 hospitals. The study was conducted in 3 phases: (1) establishing content validity with clinical experts who participated in a Delphi survey, (2) establishing inter-rater reliability by agreement with nurses who simultaneously and independently completed the tool, and (3) establishing sensitivity and specificity with speech language pathologists and nurses who independently and blindly completed the tool for eligible patients. RESULTS: Individual item scores were > 0.82 and the overall content validity index was 0.93, indicating content validity. Interrater reliability was established (Cohen κ = 0.92). In 66 eligible patients, the prevalence of postextubation dysphagia was 56%, sensitivity of the postextubation dysphagia screening tool was 81%, and specificity was 69%. CONCLUSION: The reliability and validity of a postextubation dysphagia screening tool that can help nurses determine an extubated patient's ability to swallow after prolonged endotracheal intubation were established.

Fertility knowledge and intentions to have children in a national study of Australian secondary school students.

OBJECTIVE: This paper reports on fertility knowledge and intentions to have children among a national sample of students in years 10-12. METHOD: Data were from the Fifth National Survey of Australian Secondary Students and Sexual Health. Students identified factors that could affect fertility, if they wanted children and at what age. RESULTS: Most students wanted to have children (77%). Of those who wanted children or were unsure (n=1,780), 54% were able to identify six of eight factors that could affect fertility. Male students had poorer knowledge than females. Poorer knowledge was also reported by male students who were born overseas or used marijuana and by female students who were sexually active or religious. More than half the students (59%) wanted their first child aged 25-29, while 19% wanted their first child after 30. Intentions to have children at an earlier age were associated with being religious, sexually active (females), and using marijuana (males). Students not exclusively attracted to the opposite sex were more likely to want children at an older age. CONCLUSIONS AND IMPLICATIONS: Most students typically want children in their late 20s. Many were unaware of factors that could affect their fertility and there was a mismatch between intentions and likely behaviour. These factors could be addressed as part of relationship education.

"Dude, I'm Seventeen It's Okay Not to Have Sex by This Age": Feelings, Reasons, Pressures, and Intentions Reported by Adolescents Who Have Not Had Sexual Intercourse.

This study investigated feelings, reasons, pressures, and previous sexual experiences reported by students who have not had sexual intercourse and how these factors are associated with self-rated likelihood of having sex during the next year. Using data from the Fifth National Survey of Australian Secondary Students and Sexual Health (n = 783), this study found, in general, students had positive feelings about not having sex. Reasons for not having sex such as being proud to say no and not being ready were rated higher in importance than fear of potential outcomes or religious/cultural beliefs. Students reported limited pressure from parents and friends and, despite not having sexual intercourse, more than half of the sample had experienced some form of sexual activity. Stronger likelihoods of having sex during the next year were reported by students who had previously engaged in other sexual practices, reported more pressure from friends to have sex, and had negative feelings about not having sex. Sexuality educators can use these findings to guide approaches to sex education, emphasizing feelings, intentions, and reasoning over fear tactics. Discussion of a range of sexual practices will address more closely the experiences of young students as they begin their sexual lives.

Demographic and behavioural correlates of six sexting behaviours among Australian secondary school students.

UNLABELLED: Background There has been increasing attention on assessing rates of sexting in adolescents and of the potential negative effects of the behaviour. Our aim was to assess rates and correlates of sexting in Australian students in years10, 11 and 12. METHODS: The current study was part of The Fifth National Survey of Australian Secondary Students and Sexual Health and reports on responses of 2114 students (811 male, 1303 female). Sexting was assessed using six items: sending a sexually explicit written text message; receiving a sexually explicit text message; sending a sexually explicit nude or nearly nude photo or video of themselves; sending a sexually explicit nude or nearly nude photo or video of someone else; receiving a sexually explicit nude or nearly nude photo or video of someone else; and using a social media site for sexual reasons. RESULTS: Approximately half of the students had received (54%, 1139/2097) or sent (43%, 904/2107) a sexually explicit written text message. Sexually explicit images had been received by 42% (880/2098) of students, one in four students had sent a sexually explicit image of themselves (26%, 545/2102) and one in 10 had sent a sexually explicit image of someone else (9%, 180/2095). Finally, 22% (454/2103) of students had used social media for sexual reasons. Sexting was associated with several correlates. CONCLUSIONS: Sexting was relatively common in this sample of year 10, 11 and 12 Australian students, particularly among older students, those who are sexually active, and those who use recreational substances.

Improving self-help e-therapy for depression and anxiety among sexual minorities: an analysis of focus groups with lesbians and gay men.

BACKGROUND: E-therapies for depression and anxiety rarely account for lesbian and gay users. This is despite lesbians and gay men being at heightened risk of mood disorders and likely to benefit from having access to tailored self-help resources. OBJECTIVE: We sought to determine how e-therapies for depression and anxiety could be improved to address the therapeutic needs of lesbians and gay men. METHODS: We conducted eight focus groups with lesbians and gay men aged 18 years and older. Focus groups were presented with key modules from the popular e-therapy "MoodGYM". They were asked to evaluate the inclusiveness and relevance of these modules for lesbians and gay men and to think about ways that e-therapies in general could be modified. The focus groups were analyzed qualitatively using a thematic analysis approach to identify major themes. RESULTS: The focus groups indicated that some but not all aspects of MoodGYM were suitable, and suggested ways of improving e-therapies for lesbian and gay users. Suggestions included avoiding language or examples that assumed or implied users were heterosexual, improving inclusiveness by representing non-heterosexual relationships, providing referrals to specialized support services and addressing stigma-related stress, such as "coming out" and experiences of discrimination and harassment. Focus group participants suggested that dedicated e-therapies for lesbians and gay men should be developed or general e-therapies be made more inclusive by using adaptive logic to deliver content appropriate for a user's sexual identity. CONCLUSIONS: Findings from this study offer in-depth guidance for developing e-therapies that more effectively address mental health problems among lesbians and gay men.

Assessing the applicability of e-therapies for depression, anxiety, and other mood disorders among lesbians and gay men: analysis of 24 web- and mobile phone-based self-help interventions.

BACKGROUND: Lesbians and gay men have disproportionately high rates of depression and anxiety, and report lower satisfaction with treatments. In part, this may be because many health care options marginalize them by assuming heterosexuality, or misunderstand and fail to respond to the challenges specifically faced by these groups. E-therapies have particular potential to respond to the mental health needs of lesbians and gay men, but there is little research to determine whether they do so, or how they might be improved. OBJECTIVE: We sought to examine the applicability of existing mental health e-therapies for lesbians and gay men. METHODS: We reviewed 24 Web- and mobile phone-based e-therapies and assessed their performance in eight key areas, including the use of inclusive language and content and whether they addressed mental health stressors for lesbians and gay men, such as experiences of stigma related to their sexual orientation, coming out, and relationship issues that are specific to lesbians and gay men. RESULTS: We found that e-therapies seldom addressed these stressors. Furthermore, 58% (14/24) of therapies contained instances that assumed or suggested the user was heterosexual, with instances especially prevalent among better-evidenced programs. CONCLUSIONS: Our findings, and a detailed review protocol presented in this article, may be used as guides for the future development of mental health e-therapies to better accommodate the needs of lesbians and gay men.

Designing a critical care nurse-led rapid response team using only available resources: 6 years later.

Rapid response teams have been introduced to intervene in the care of patients whose condition deteriorates unexpectedly by bringing clinical experts quickly to the patient's bedside. Evidence supporting the need to overcome failure to deliver optimal care in hospitals is robust; whether rapid response teams demonstrate benefit by improving patient safety and reducing the occurrence of adverse events remains controversial. Despite inconsistent evidence regarding the effectiveness of rapid response teams, concerns regarding care and costly consequences of unaddressed deterioration in patients' condition have prompted many hospitals to implement rapid response teams as a patient safety strategy. A cost-neutral structure for a rapid response team led by a nurse from the intensive care unit was implemented with the goal of reducing cardiopulmonary arrests occurring outside the intensive care unit. The results of 6 years' experience indicate that a sustainable and effective rapid response team response can be put into practice without increasing costs or adding positions and can decrease the percentage of cardiopulmonary arrests occurring outside the intensive care unit.

Young people and HIV prevention in Australian schools.

Australia has not seen a Human Immunodeficiency Virus (HIV) epidemic among young people. However, early research in the Australian context had indicated that the degree of unprotected sexual activity, partner change, and STI infection in this cohort would fuel a young people's epidemic if HIV ever reached a tipping point in the country. The difficulty of reaching young people outside school for HIV prevention has been no more successfully addressed in Australia than elsewhere. Therefore, the investment of Australian HIV prevention funds for youth has had an emphasis on school-based programs. This emphasis on formal schooling has led to a history of engagement with the ad hoc and unreliable nature of sexuality education in Australian schools. It has particularly been the catalyst for a struggle to construct young people as sexually active and as possessing a right to appropriate education, against tides of both secular and religiously-motivated resistance. The eight state and territory education sectors, along with the independent sectors, have had differing and sometimes troubled histories with HIV prevention. This paper discusses the differing HIV education policies and programs that have emerged in Australian schooling historically, and in some cases been abandoned altogether, amid strong public debates. It also considers current approaches, the new national curriculum, and future challenges. Additionally, the particular case of same sex attracted young men, who have a heightened level of vulnerability to HIV, is explored. Australian schools have struggled to address both the imperative for relevant sexuality education for same-sex-attracted young people and the broader issue of combating homophobia, which research has linked directly to this vulnerability.

NUBPL mutations in patients with complex I deficiency and a distinct MRI pattern.

OBJECTIVE: To identify the mutated gene in a group of patients with an unclassified heritable white matter disorder sharing the same, distinct MRI pattern. METHODS: We used MRI pattern recognition analysis to select a group of patients with a similar, characteristic MRI pattern. We performed whole-exome sequencing to identify the mutated gene. We examined patients' fibroblasts for biochemical consequences of the mutant protein. RESULTS: We identified 6 patients from 5 unrelated families with a similar MRI pattern showing predominant abnormalities of the cerebellar cortex, deep cerebral white matter, and corpus callosum. The 4 tested patients had a respiratory chain complex І deficiency. Exome sequencing revealed mutations in NUBPL, encoding an iron-sulfur cluster assembly factor for complex І, in all patients. Upon identification of the mutated gene, we analyzed the MRI of a previously published case with NUBPL mutations and found exactly the same pattern. A strongly decreased amount of NUBPL protein and fully assembled complex I was found in patients' fibroblasts. Analysis of the effect of mutated NUBPL on the assembly of the peripheral arm of complex I indicated that NUBPL is involved in assembly of iron-sulfur clusters early in the complex I assembly pathway. CONCLUSION: Our data show that NUBPL mutations are associated with a unique, consistent, and recognizable MRI pattern, which facilitates fast diagnosis and obviates the need for other tests, including assessment of mitochondrial complex activities in muscle or fibroblasts.

Provision of servo-controlled cooling during neonatal transport.

INTRODUCTION: Therapeutic hypothermia is a time critical intervention for infants who have experienced a hypoxic-ischaemic event. Previously reported methods of cooling during transport do not demonstrate the same stability achieved in the neonatal unit. The authors developed a system which allowed provision of servo-controlled cooling throughout transport, and present their first year's experience. METHODS: Retrospective review of routinely collected patient data. RESULTS: 14 out-born infants were referred for cooling during a 12-month period. Nine infants were managed with the servo-controlled system during transport. Cooling was commenced in all infants before 6 h of life. Median time from team arrival to the infant having a temperature in the target range (33-34°C) was 45 min. Median temperature during transfer was 33.5°C (range 33-34°C). Temperature on arrival at the cooling centre ranged from 33.4°C to 33.8°C. CONCLUSION: Servo-controlled cooling during transport is feasible and provides an optimal level of thermal control.

Sexual behaviour and related knowledge among a representative sample of secondary school students between 1997 and 2008.

OBJECTIVE: This paper reports on the sexual health knowledge and risk behaviours of year 10 and 12 students between 1997 and 2008. METHOD: Data were from nationally representative cross-sectional stratified cluster samples of year 10 and 12 students in the Australian secondary school system collected at three intervals--1997, 2002 and 2008. A number of methods were used to analyse students' sexual health knowledge and behavioural data over time. RESULTS: Student knowledge of HIV/AIDS has stabilised since the 2002 survey and remains high. Between 1997 and 2008 there has been an increase in student knowledge with respect to STIs and hepatitis. Although the proportion of students reporting ever having had sexual intercourse has increased over time, the increases between 2002 and 2008 were not significant. There has been a significant increase in the number of sexual partnerships reported by students over a year, particularly for those in year 12. CONCLUSION: Student knowledge of HIV/AIDS remains high and there has been some improvement in STI and hepatitis knowledge, although knowledge in these domains is still moderate. Sexually active students were more likely to report having sex with multiple partners compared to previous surveys. Consistency of condom use has not increased since 1997. IMPLICATIONS: Although consistent condom use remains moderately high, it is of some concern that condom use has not increased since 1997 despite related increases in sexual activity among adolescents who have experienced sexual intercourse and increased rates of STIs among this group.

Long-term mechanical consequences of permanent right ventricular pacing: effect of pacing site.

INTRODUCTION: Long-term right ventricular apical (RVA) pacing has been associated with adverse effects on left ventricular systolic function; however, the comparative effects of right ventricular outflow tract (RVOT) pacing are unknown. Our aim was therefore to examine the long-term effects of septal RVOT versus RVA pacing on left ventricular and atrial structure and function. METHODS: Fifty-eight patients who were prospectively randomized to long-term pacing either from the right ventricular apex or RVOT septum were studied echocardiographically. Left ventricular (LV) and atrial (LA) volumes were measured. LV 2D strain and tissue velocity images were analyzed to measure 18-segment time-to-peak longitudinal systolic strain and 12-segment time-to-peak systolic tissue velocity. Intra-LV synchrony was assessed by their respective standard deviations. Interventricular mechanical delay was measured as the difference in time-to-onset of systolic flow in the RVOT and LV outflow tract. Septal A' was measured using tissue velocity images. RESULTS: Following 29 ± 10 months pacing, there was a significant difference in LV ejection fraction (P < 0.001), LV end-systolic volume (P = 0.007), and LA volume (P = 0.02) favoring the RVOT-paced group over the RVA-paced patients. RVA-pacing was associated with greater interventricular mechanical dyssynchrony and intra-LV dyssynchrony than RVOT-pacing. Septal A' was adversely affected by intra-LV dyssynchrony (P < 0.05). CONCLUSIONS: Long-term RVOT-pacing was associated with superior indices of LV structure and function compared with RVA-pacing, and was associated with less adverse LA remodeling. If pacing cannot be avoided, the RVOT septum may be the preferred site for right ventricular pacing.

Human papillomavirus and cervical cancer: Gardasil vaccination status and knowledge amongst a nationally representative sample of Australian secondary school students.

The aim of this paper was to measure student knowledge of HPV and risks associated with cervical cancer, explore associated factors, correlate knowledge of HPV and cervical cancer with other domains of sexual health related knowledge and estimate student self-reported rates of HPV immunisation. Data were from a nationally representative cross-sectional stratified cluster sample of year 10 and 12 students in the Australian secondary school system. Contingency table, comparison of means, correlation and multiple OLS regression analyses of students answering HPV (n=1927) and cervical cancer (n=2680) knowledge questions was undertaken. Student HPV and cervical cancer knowledge was generally poor. Young women exhibited better knowledge than young men however the difference was, to some extent, accounted for by vaccination for HPV. Sexually active students and those having more sexual partners in the previous year did not report higher levels of HPV and cervical cancer knowledge. The large majority of young women surveyed reported a HPV vaccination as did a small proportion of young men. Students who reported being vaccinated had higher levels of knowledge about HPV and cervical cancer. Student knowledge of HPV and cervical cancer is considerably limited. There is some evidence that being vaccinated for HPV improves a person's level of understanding of the disease and cervical cancer. The recent national public health campaign focussing on cervical cancer vaccination for young women may be partly responsible for a lack of understanding of HPV as a common STI.

An overview of policies for managing polybrominated diphenyl ethers (PBDEs) in the Great Lakes basin.

The Great Lakes are an important environmental and economic resource for Canada and the United States. The ecological integrity of the Great Lakes, however, is becoming increasingly threatened by a number of persistent, bio-accumulative and harmful chemicals that enter the Great Lakes ecosystem through fluvial and atmospheric deposition. Polybrominated diphenyl ethers (PBDEs), a class of brominated flame retardant, are among such chemicals, whose concentration in the Great Lakes has greatly increased in recent years. Despite growing concern over the possible health and environmental effects of these compounds, only four of the eight Great Lakes states have enacted regulations to ban/restrict the use of PBDE while the two Canadian Great Lakes provinces are yet to endorse any regulation. Of the three main commercial PBDE mixtures (pentaBDE, octaBDE and decaBDE), penta- and octaBDE are no longer manufactured or imported into the United States and Canada. DecaBDE, however, still finds use in a variety of products. In the present paper, the authors review the current regulations and policies for managing PBDEs in the Great Lakes jurisdictions and briefly review commercially available non-bromine chemical alternatives to PBDE. As these alternatives are comparatively more expensive than PBDE, future adoption of more eco-friendly flame retardants by the polymer industry will likely depend on stricter legislation regulating the use of PBDE and/or an increased public demand for PBDE-free products.