Screening for childhood adversity among adult primary care patients.

BACKGROUND AND PURPOSE: Over half of Americans reports a history of adverse childhood experiences (ACEs), which have been associated with many chronic health conditions. Yet primary care providers infrequently screen patients for ACEs and fail to consider the relationship between ACEs and adult health. Therefore, the purposes of this study were to test the effectiveness and feasibility of a screening interview for ACEs and to confirm the prevalence of ACEs among individuals with chronic health conditions. METHODS: Screening interviews were conducted with 71 adults in a primary care setting. Patients' ACE history, nurse practitioner comfort with screening, time to screen, and patient follow-up care recommendations were gathered through questionnaires. Adverse childhood experience prevalence was analyzed by descriptive statistics. Relationships between ACEs, number of clinic visits, time to screen, and follow-up care recommendations were analyzed by bivariate statistics. CONCLUSIONS: Over half of participants reported more than four ACEs, with ACEs common among participants with chronic health conditions (93%). Adverse childhood experience scores were positively correlated with number of clinic visits, time to screen, and recommendations for follow-up care. Findings support screening primary care patients for ACEs. IMPLICATIONS FOR PRACTICE: Adverse childhood experiences are prevalent among primary care patients with chronic conditions. Using interviews to screen for ACEs in primary care settings is effective and feasible.

Primary care of women who have sex with women. Recommendations from the research.

Research on women who have sex with women has increased in the last decade. Attention has been brought to this group of women through the IOM report, which noted a lack of research related to their care. Most of the research has not been published in nursing literature. This article reviews this literature with recommendations for primary care practice.

'Tech' versus 'talk': a comparison study of two different lecture styles within a Master of Science nurse practitioner course.

BACKGROUND: Generation Y students have a strong preference for technology that has caused educators to re-evaluate their instructional techniques. Limited published literature exists evaluating the benefits of electronic lecture delivery to students enrolled within nursing degree programs, with no publications to date comparing traditional to blended learning modalities. OBJECTIVES: To retrospectively compare student outcomes, including overall course grade and individual examination scores, between two cohorts of students utilizing two distinctly different methods of lecture delivery, traditional and blended. METHODS: IRB approval was granted to retrospectively compare student outcomes from fifty-two students enrolled within Northeastern University's Master of Science Nurse Practitioner degree program. A total of 23 students were enrolled in the traditional section taught in 2010 and 29 students were enrolled in the blended section taught in 2011. Student'st-test was used to compare studied outcomes between each section. A p-value of ≤0.05 was considered to be statistically significant. RESULTS: The students enrolled within blended course scored statistically significantly higher than their counterparts within the traditional course for three of the four studied outcomes, including overall course score. CONCLUSIONS: This study demonstrates that nursing students enrolled within a more technologically advanced course may have improved performance over students enrolled in courses with traditional lecture styles given their generational preferences for learning.

Lesbians' attitudes and beliefs regarding overweight and weight reduction.

AIM AND OBJECTIVE: This article presents data on attitudes and beliefs about overweight/weight reduction in lesbians. The project was developed to have information on which to base future culturally sensitive interventions to reduce cardiovascular risk in lesbians. BACKGROUND: Lesbians have been found to have high rates of obesity/overweight and to be more accepting of it. Researchers have hypothesised that this is attributed to different attitudes towards body weight and shape in lesbians than heterosexuals. Little is known about acceptable ways to intervene to decrease cardiovascular risk in lesbians in view of these attitudes. DESIGN: omen over 21 who self-identified as lesbian and reported one or more cardiovascular risk factors were recruited from medical providers and community resources. Twenty-five women participated in five focus groups that explored practices, attitudes and beliefs about cardiovascular risk and culturally acceptable strategies to reduce cardiovascular risk in lesbians. METHOD: Demographic and risk factor information was collected from focus group members by questionnaire. Focus groups were audiotaped and transcribed. Investigators reviewed the transcripts and identified, coded and categorised data to begin to identify emergent themes. RESULTS: Lesbian participants with risk factors for cardiovascular risk expressed concern about the health consequences of weight but want a focus on their general health rather than exclusively on the BMI. There is not homogeneity in attitudes and beliefs about weight and overweight among lesbians, and generational differences were found. Minority stress, anxiety and depression and homophobia were major factors in health behaviours and barriers to changing unhealthy behaviours. RELEVANCE TO CLINICAL PRACTICE: Lesbian participants with risk factors for cardiovascular disease were eager to be involved in individual and group culturally sensitive programs that focus on improved health and well being. Recommended interventions include lesbian specific multidimensional group interventions that could deal with the multiple factors involved in causing and maintaining the behaviours.

Relationships between aggression, depression, and alcohol, tobacco: implications for healthcare providers in student health.

PURPOSE: To determine the prevalence of aggression, depression, and at-risk health behaviors in a random sample of undergraduate college students and to explore the relationship between these variables. DATA SOURCES: The study survey was sent to 2500 undergraduate students; 428 participated, responding to items from the National College Health Risk Behavior Survey about alcohol, drug and tobacco, violence and aggression, the Beck Depression Inventory II, and items adapted from the Overt Aggression Scale. CONCLUSIONS: Almost one third of the sample reported cigarette smoking, 22% moderate depression, 81% drink alcohol, with 58% drinking more than five drinks at least once in the last month. Reports of verbal and physical aggression were also common. Moderate depression was related to cigarette smoking, physical, and verbal aggression, but not to heavy alcohol use. An understanding of these relationships can be utilized to screen and intervene with students at risk. IMPLICATIONS FOR PRACTICE: The results call for increased screening and treatment of depression in college students, and suggest that students with aggressive behaviors are at the highest risk for depression, and should be a group to receive specific attention for screening.

The effect of oppressed group behaviours on the culture of the nursing workplace: a review of the evidence and interventions for change.

AIM: The aim of the present study was to review the current literature on oppressed group behaviours in nursing, with emphasis on interventions to change the behaviours, and on instruments that have been developed to measure it. BACKGROUND: Oppressed group behaviours have been described in nurses for over two decades and their presence has been related to decreased nurse self-advocacy, and other negative aspects of the nursing workplace. EVALUATION: Systematic review of the literature on oppressed group behaviour in nursing. KEY ISSUES: Oppressed group behaviours are frequently found in nurses. Interventions have been created and tested to decrease oppressed group behaviours. CONCLUSION: Oppressed group behaviours are frequently found in nurses. Interventions exist that can decrease oppressed group behaviours and the decrease is related to increased work force performance, satisfaction and retention of nurses in the workplace. IMPLICATIONS FOR NURSE MANAGERS: Nurse Managers can improve the workplace by measuring oppressed group behaviours and utilizing interventions to break the cycle of oppression in the workplace culture. Utilizing these innovations improve the workplace culture for nursing.

Cancer prevention and screening behaviors in lesbians.

The incidence of cancer diagnosis has increased in the United States highlighting the need for astute cancer prevention and screening behaviors. Previous literature has suggested that lesbians may not follow the American Cancer Society's (ACS) guidelines regarding prevention and screening for cancer due to disparity in access to care and increased use of alcohol and tobacco. The purpose of this study was to examine the cancer prevention and screening behaviors of lesbians using the ACS guidelines as the standards for comparison, and to determine factors that influence mammography screening. A 102-item self-report survey was distributed to lesbians nationwide using various methods including snowballing sampling techniques. The sample included 1139 self-identified lesbians from 44 states. In general, healthy lifestyle behaviors were followed. The majority of the women did not smoke, ate plenty of fruits and vegetables, ate protein sources low in fat and consumed alcohol at a moderate rate. However, safe sex practices were often not used by participants. Most women did have mammograms and Papanicolaou smears (PAP) as recommended; however, adherence to self-breast examination guidelines was not followed. Women who were older, had higher yearly incomes, did not smoke, performed regular self breast exams and had regular physical exams were most likely to have a mammogram. Over half of the women met American Cancer Society guidelines for prevention and screening for breast and cervical cancer. However, strategies are needed to increase compliance with these guidelines in order to improve cancer health outcomes.

Cytogenetic, spectral karyotyping, fluorescence in situ hybridization, and comparative genomic hybridization characterization of two new secondary leukemia cell lines with 5q deletions, and MYC and MLL amplification.

Cytogenetic studies of patients with therapy-induced acute myeloid leukemia (t-AML) have demonstrated whole chromosome loss or q-arm deletion of chromosomes 5 and/or 7 in a majority of cases. We have established two cell lines, SAML-1 and SAML-2, from two patients who developed t-AML after radiation and chemotherapy for Hodgkin disease. In both cases, the leukemia cells contained 5q deletions. SAML-1 has 58 chromosomes and numerous abnormalities, including der(1)(1qter-->1p22::5q31-->5qter), der(5)(5pter-->5q22::1p22-->1pter), +8, der(13)i(13)(q10)del(13)(q11q14.1), and t(10;11). Fluorescence in situ hybridization (FISH) with unique sequence probes for the 5q31 region showed loss of IL4, IL5, IRF1, and IL3, and translocation of IL9, DS5S89, EGR1, and CSFIR to 1p. SAML-2 has 45 chromosomes, del(5)(q11.2q31) with a t(12;13)ins(12;5), leading to the proximity of IRF1 and RB1, and complex translocations of chromosomes 8 and 11, resulting in amplification of MYC and MLL. Comparative genomic hybridization and spectral karyotyping were consistent with the G-banding karyotype and FISH analyses. Because a potential tumor suppressor(s) in the 5q31 region has yet to be identified, these cell lines should prove useful in the study of the mechanisms leading to the development of t-AML.