Catheter-Associated Urinary Tract Infection (CAUTI) in the NeuroICU: Identification of Risk Factors and Time-to-CAUTI Using a Case-Control Design.

BACKGROUND/OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) account for 25% of all hospital-acquired infections. Neuro-critically ill patients are at 2-5 times greater risk of developing CAUTI because of increased use of indwelling urinary catheters due to neurogenic urinary retention. Despite the heightened risk of CAUTI occurrence for the neuro-critically ill, there is little data on specific characteristics of CAUTIs and risk factors among this population. The aim of this study was to identify characteristics and risk factors associated with CAUTI development in the neuro-critical patient population. METHODS: In this retrospective single-center case-control study in a tertiary care dedicated 30-bed neuroICU, approximately 3 controls (exact ratio-3.2) were randomly selected for each CAUTI case between January 1st, 2016 and December 31st, 2018. Demographic, clinical and laboratory data were collected, including prospectively collected data pertaining to urinary and bowel function. Descriptive and multivariate logistic regression analysis was conducted to identify common patient characteristics, CAUTI risk factors and duration from catheterization to developing a CAUTI (Time-to-CAUTI). RESULTS: Of 3045 admissions during the study period, 1045 (34.30%) had a urinary catheter at some point during their admission. Of those, 45 developed a CAUTI, yielding a CAUTI incidence rate of 1.50%, corresponding to 4.49 infections/1000 catheter days. On average, CAUTI patients were older as compared to controls (66.44 years of age vs 58.09 years; p < 0.0001). In addition to old age, other risk factors included female gender (75.60% female vs 24.20% males in case group, p < 0.0001), increased neuroICU length of stay (18.31 in cases vs. 8.05 days in controls, p = 0.0001) and stool incontinence (OR = 3.73, p = 0.0146). CAUTI patients more often carried a primary diagnosis of SAH, and comorbidities of hypertension (HTN), vasospasm and diabetes. Time-to-CAUTI was 6 days on average, with an earlier peak for patients requiring two or more catheter placements. Presence of stool incontinence was significantly associated with CAUTI occurrence. CONCLUSION: Stool incontinence, older age, female sex, longer neuroICU LOS and presence of comorbidities such as HTN and diabetes were associated with CAUTI development in the neuro-critically ill population. Average Time-to-CAUTI after catheter placement was 6 days with earlier occurrence if more frequent catheterizations. Colonization of urinary catheters without infection might contribute to CAUTI diagnosis. Prospective research is needed to determine impact of prevention protocols incorporating these factors.

Exploring college students' sexual and reproductive health literacy.

Objective: To assess college students' sexual and reproductive health (SRH) literacy experiences, specific to contraception use and STI prevention. Participants: In Spring 2015, participants (n = 43) from a large institution participated in six focus groups (two male and four females groups). Methods: Focus groups were guided by the health literacy domains (access; understand; appraise; apply); data were analyzed in MaxQDA using the constant comparative method. Results: The Internet was the most commonly accessed source for SRH information. Participants discussed facilitators (eg, use of visuals) and barriers (eg, medical jargon) to understanding information; and personal lifestyle, advice from family/friends, symptoms, and sexual partners as appraisal factors. Participants applied information by communicating with friends/providers and seeking healthcare. However, findings were not linear nor mutually exclusive, representing the interaction of health literacy skills. Conclusion: Findings suggest that a patient-centered intervention capitalizing on technology and trusted individuals (providers/peer educators) may facilitate college students' SRH literacy.

"I'll Just Pick It Up ": Women's Acceptability of Self-Sampling Methods for Sexually Transmitted Infection Screening.

BACKGROUND: Rates of sexually transmitted infection (STI) screening are suboptimal among college women. Self-sampling methods (SSMs) may improve STI screening rates, but critical gaps remain regarding the influential characteristics of SSM to prioritize in intervention development. The purpose of this study was to explore intervention characteristics influencing the decision to adopt SSM among college women. METHODS: In-depth interviews (n = 24) were conducted with sexually active college women aged 18-24 years to explore preferred intervention characteristics of SSM. Interviews were stratified by screening status (screened or not screened). The instrument was guided by constructs from the Diffusion of Innovation theory and included characteristics of SSM, such as relative advantage, compatibility, complexity, adaptability, and risk and uncertainty. RESULTS: Overall, women felt that the SSM was not complex and that the instructions were straightforward. Participants discussed their strong preference for receiving their results via text or e-mail rather than via telephone. In addition, women described their concerns about mailing their sample and described their concern about potential contamination and tampering. The most salient advantage to use of SSM was avoiding an interaction with a health care provider. CONCLUSIONS: This study contributes to an understanding of the salient intervention characteristics influencing the use of SSM for STI screening, which can be leveraged to improve the health of students and improve rates of screening. Findings can be used to inform the development of a future innovative, theory-based intervention that promotes the use of SSM to improve STI screening rates, and ultimately decrease the burden of STI-related disease.

Undergraduate Public Health Education: Alternative Choices within the BSPH Degree.

The University of South Florida's College of Public Health has been in existence since 1984. After many years of only offering a public health minor, a Bachelors of Science in Public Health was offered. This article explores the creation, development, scheduling, and lessons learned of this degree.

The co-existence of life and death for the perioperative nurse.

Death and life co-exist in organ procurement surgery; untimely death for one provides hope for continued life for others. Drawing from interactionist theory, the impact of personal and environmental forces and functions specific to organ procurement surgery were examined. Seven nurses (6 women, 1 man aged 34-58 years) were provided with an opportunity to describe their experiences. Three core themes emerged from the qualitative analysis of the interviews: existential issues, coping strategies, and support for each other. Nurses spoke of ways in which they contribute to this challenging work and draw on inner resources.

The psychosocial burden of HPV: a mixed-method study of knowledge, attitudes and behaviors among HPV+ women.

Despite an increased awareness and 'normalization' of Human Papillomavirus (HPV) following the release of the HPV vaccine, the psychosocial impact of an HPV infection, the most common sexually transmissible infection (STI), must not be overshadowed. This study employed in-depth interviews (N = 52) and quantitative surveys (N = 154) to assess the knowledge, emotional impact and behavioral consequences of an HPV-related diagnosis in women who had received abnormal Pap test results. Findings revealed confusion over test results and themes related to stigma, fear, self-blame, powerlessness and anger emerged. The promotion of the HPV vaccine should not obfuscate the psychosocial burden associated with an HPV diagnosis.

Mortality and management of 96 shark attacks and development of a shark bite severity scoring system.

Humans share a fascination and fear of sharks. We predict that most shark attacks are nonfatal but require skilled, timely medical intervention. The development of a shark bite severity scoring scale will assist communication and understanding of such an injury. We retrospectively reviewed records of the prospectively maintained International Shark Attack File (ISAF) at the University of Florida. The ISAF contains 4409 investigations, including 2979 documented attacks, 96 of which have complete medical records. We developed a Shark-Induced Trauma (SIT) Scale and calculated the level of injury for each attack. Medical records were reviewed for the 96 documented shark attack victims since 1921. Calculated levels of injury in the SIT Scale reveal 40 Level 1 injuries (41.7%), 16 Level 2 injuries (16.7%), 18 Level 3 injuries (18.8%), 14 Level 4 injuries (14.6%), and eight Level 5 injuries (8.3%). The overall mortality of shark attacks was 8.3 per cent. However, SIT Scale Level 1 injuries comprised the greatest percentage of cases at 41.7 per cent. Injury to major vascular structures increases mortality and necessitates immediate medical attention and definitive care by a surgeon. Shark bites deserve recognition with prompt resuscitation, washout, débridement, and follow up for prevention of infection and closure of more complex wounds.

Oncology nurses' perceptions of barriers to discussion of fertility preservation with patients with cancer.

Infertility is a common result of cancer treatment; however, opportunities exist for patients to preserve fertility prior to treatment. Recent evidence suggests that healthcare providers, including nurses, do not consistently discuss fertility preservation (FP) with patients. This qualitative, cross-sectional pilot study used a focus group and in-depth interviews to explore knowledge, attitudes, and practice behaviors related to nurses' discussion of FP with patients with cancer. Results indicate that only half of the nurses discuss FP methods with patients, even though most believe that having discussions with patients about fertility is part of their role. Factors associated with the discussion of FP among nurses included (a) knowledge (FP procedures, fertility institutes and clinics, resources for patients, and practice guidelines), (b) attitudes (difficulty finding facilities, time constraints, role, comfort level, ethical issues, financial considerations, and patient characteristics), and (c) behaviors (patient initiation, physician behaviors, patient characteristics, and timing). Discussion should be stimulated among nurses about the role of nurses in the FP discussion, and educational interventions and practice guidelines should be developed that are aimed at oncology nurses to help facilitate discussions with patients.

HPV knowledge among HPV+ women.

OBJECTIVE: To assess knowledge and information seeking among women recently receiving an HPV+ diagnosis. METHODS: A 2-phase mixed methods design was used. In both phase I (qualitative) and phase II (quantitative), women with scheduled gynecological exams and Pap smears at clinic sites were approached to participate. RESULTS: Women expressed confusion about HPV, and most could not correctly articulate the meaning of their diagnosis. Women do engage in further information seeking, especially through the Internet. CONCLUSION: Identifying gaps in knowledge among HPV+ women who need clear messages to facilitate their comprehension of the diagnosis is an important public health activity.

HIV prevention education and testing among youth: is there a correlation?

With the advent of highly effective antiretroviral therapies, case-finding for human immunodeficiency virus (HIV) is critically important, especially among high-risk youth. Our study found a significant increase in participation in voluntary HIV counseling and testing services immediately after implementation of a brief sexually transmitted infection (STI)/HIV educational program in alternative education and juvenile detention facilities.

Factors contributing to intervention fidelity in a multi-site chronic disease self-management program.

BACKGROUND AND OBJECTIVES: Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. METHODS: The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. RESULTS: This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. CONCLUSION: Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

Women's reactions to HPV diagnosis: insights from in-depth interviews.

Research links certain types of the human papillomavirus (HPV) to subsequent development of cervical cancer. Women (n=52) recently diagnosed with HPV following an abnormal Pap smear participated in in-depth interviews to explore their knowledge of HPV, their emotional responses to diagnosis, and the extent of their disclosure of their HPV diagnosis to others. Women had many knowledge deficits about HPV. Emotions related primarily to stigma, fear, self-blame, powerlessness, and anger. Most women disclosed their disease to significant others, usually to a sexual partner. Women's lack of accurate knowledge may contribute to the array of emotions they experience. Whereas education about HPV may reduce the potency of these emotions, information alone may be inadequate for achieving optimal patient care. Health care providers can be important in treating the emotional elements associated with diagnosis as well as the condition itself.

The shifting sands for applicants to maternal and child health training programs.

OBJECTIVE: Anecdotal evidence suggests that fewer students today than in decades past are applying to maternal and child health (MCH) graduate training programs with previous clinical degrees. The purpose of this study was to determine the extent to which applicants accepted to an MCH training program demonstrated a shift away from the tradition of having a prior health professional degree and discuss options needed to provide responsive training. METHODS: Twenty years of demographic face sheet data (1983 through 2002) for admitted applicants to the MCH training program at the University of South Florida College of Public Health were examined. RESULTS: Quantitative analysis of admission records confirmed the anecdotal data. Today's applicants are more likely to possess undergraduate nonclinical backgrounds rather than clinical health professional training. Statistically significant differences were found between the students with clinical and without clinical degrees for ethnicity, GRE score, GPA, and the length of time needed to complete the MPH degree. CONCLUSION: Adjustments in MCH curricula may be necessary to be responsive to the "shifting sands" of clinical and public health work experience among program applicants. However, curriculum modifications need to be ones that maintain the zeal of the new generation of MCH students without diluting the rigor of traditional professional preparation. Some possible responses of training programs are suggested.

Evaluation of the "Respect Not Risk" firearm safety lesson for 3rd-graders.

The purpose of this study was to evaluate the MORE HEALTH "Respect Not Risk" Firearm Safety Lesson for 3rd-graders in Pinellas County, Florida. Six schools representative of various socioeconomic levels were selected as the test sites. Qualitative and quantitative data were collected. A total of 433 matched pretests/posttests were used to determine the effectiveness of the class in increasing student knowledge about firearm safety. The results revealed a significant increase in the mean scores on the posttest compared with the pretest. Qualitative findings showed the lesson was positively received by both students and teachers, and 65% of responding students reported discussing the lesson with family members. School nurses are encouraged to take a leading role in promoting firearm injury prevention to students.

Teen parents and academic success.

The purpose of this study was to explore the personal life stories of women who became mothers while still in their teen years. The focus was on themes that evolved as important in the lives of these women, including family support, partner support, mentor support, economic opportunity, resiliency, optimism, and spirituality. Each of the 22 women in the study offered her formulas for success that are useful for consideration by school nurses. Factors the women perceived to contribute to their success in achieving a master's or doctoral degree are explored. This study helps to identify the support and community efforts necessary to improve the outcome for teen mothers today. Their unique stories are exemplars of resiliency and achievement.

Abstinence-only education: how we got here and where we're going.

This paper examines the history of abstinence education in the United States and the empirical evidence of its effectiveness in preventing teenage pregnancy. It concludes that abstinence education has not yet been proven effective, and therefore recommends that federal policy and funding should be directed towards teen pregnancy prevention programs that have demonstrated success.