The use of Community/Public Health Nursing Competencies during the COVID-19 pandemic.

OBJECTIVES: (1) Ascertain the use of the Quad Council Competencies for Community/Public Health Nursing (QCC-C/PHN) Competencies by community/public health nurses (C/PHNs) during the COVID-19 pandemic; (2) Inform from a systems-level the need to sustain the C/PHN workforce; (3) Assess the C/PHN infrastructure for response capacity. DESIGN: Cross-sectional. Statewide email distribution lists were used for dissemination. SAMPLE: Convenience sample (n = 169) obtained using emailed Qualtrics link with the eligibility criteria of self-identification as a C/PHN who works in the state of Missouri. MEASUREMENTS: Demographic questions included employment sector, nursing education level, years of nursing, and C/PHN experience. Two Likert-type questions and one optional open-text question were created for the eight domains. RESULTS: One hundred sixty-nine participants' data were analyzed. One hundred fifty-four were employed in a local public health agency. Total 63.2% held a bachelor's degree in nursing or higher. The average number of years of nurse experience was 20.84, and C/PHN experience was 9.84. The domain of Communication Skills scored highest and Cultural Competency was the lowest. Three themes emerged from the open-ended questions including vulnerabilities of the public health system. CONCLUSION: Understanding the experiences of C/PHNs in Missouri related to the utilization of QCC-C/PHN competencies informs efforts to strengthen public health infrastructure and target resources to equip Missouri's C/PHNs.

Efficacy of implementing a BRCA screening protocol in primary care.

ABSTRACT: Breast cancer is the second leading cause of cancer death for women, whereas ovarian cancer is the deadliest gynecological cancer. Breast cancer gene 1 ( BRCA1 ) and breast cancer gene 2 ( BRCA2 ) mutations can increase the risk of developing breast and ovarian cancer. Screening can assist in prevention and early detection. This study aimed to increase provider knowledge of BRCA mutations, the use of BRCA screening tools, and genetic referrals. An Institutional Review Board-approved study was implemented for providers for training on BRCA1 and BRCA2 mutations and the importance of screening and referral for those at risk. Measures included provider confidence and knowledge after training as well as number of patient referrals. A standardized webinar was required with further education provided in multiple modalities. The number of BRCA screenings and referrals for genetic screening was monitored through the electronic health record (EHR). Eight providers including five nurse practitioners and three medical doctors participated in the complete project. As a result, 56 patients were BRCA screened, and four referrals were made to receive genetic counseling. Education enhanced knowledge, increased screening tool use, and resulted in improvement in genetic referrals through the EHR.

Incorporating Faith into Ethics Education.

ABSTRACT: Preparing students for ethical situations they will face in practice should be incorporated into nursing curricula, especially programs with a Christian focus. Linking ethical concepts with tenets from Scripture can increase students' confidence in their ability to respond through a biblical worldview to ethical dilemmas in nursing practice. Specific assignments can be geared to help students think critically about the Code of Ethics for Nurses with Interpretive Statements (Code) and biblical responses to ethical situations. Sample assignments are presented for the nine provisions of the Code.

Health Literacy Profiles of Early Intervention Providers: Use of the Health Literacy Questionnaire.

BACKGROUND: Early intervention (EI) providers work with parents of children with or who have risk factors of developmental delay or disability through Part C of the Individuals with Disabilities Education Act. Many parents in the United States have low health literacy; therefore, EI providers should be aware of and address families' health literacy needs. EI providers need to be health literate themselves to implement evidence-based recommended practices. OBJECTIVE: This study aimed to measure health literacy levels of interdisciplinary EI providers and investigate associations between health literacy levels and demographic variables. METHODS: A survey containing the Health Literacy Questionnaire (HLQ) was completed by EI providers working at 10 EI centers in Massachusetts. Scale scores were calculated and compared across demographic variables, including EI job role, age, years of EI experience, and highest education level. KEY RESULTS: Of 715 EI providers invited to participate, 376 surveys were completed (52.6% response rate). Most participants were women (92.6%, n = 348), reported race as White (85.4%, n = 321), had a mean age of 43.1 years (standard deviation [SD] 12.9) ranging from 20 to 74 years, and English as their primary language (89.6%, n = 337). EI providers scored the lowest on HLQ Scale 5 "Appraisal of health information" (mean [M] = 2.99 (SD 0.50) [confidence interval (CI) 2.93, 3.04]), and Scale 7 "Navigating the healthcare system" (M = 3.83 (SD 0.58) [CI 3.77, 3.89]). EI providers having stronger health literacy profiles were generally older, with a higher education level, were licensed providers, or had more years of EI work experience. CONCLUSIONS: EI providers require adequate health literacy to manage their health needs and to effectively provide services to EI families. Study results may inform future targeted professional development to support improvement of EI providers' health literacy skills, including appraisal of health information and navigation of the health care system. [HLRP: Health Literacy Research and Practice. 2022;6(2):e128-e136.] Plain Language Summary: EI providers' health literacy profiles have not been previously investigated. Study results reveal EI providers struggled with health literacy skills of appraising health information and navigating the health care system, which are vital for EI practice. Health Literacy Questionnaire results can inform targeted professional development to improve EI providers' health literacy levels and their clinical practice.

Suicidality in Rural College Students: An Integrative Review.

Suicide, as the third leading cause of death among individuals aged 15 to 24 years, is substantially more frequent in non-metropolitan/rural counties, where college/university students may be at particular risk; however, little is known about risk and protective factors and prevention strategies specific to this population. The current integrated review was completed to explore such factors and evidence-based interventions. A systematic literature search was performed, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and using computerized databases, for studies published from 2008 to 2021; nine met inclusion criteria. Data were classified into subgroups, which included risk and protective factors for suicidality, stressors and risk factors for psychological distress, and barriers to psychological help-seeking. Key findings included depression as a risk factor, religiosity as a protective factor, decreased social support as a stressor, and various barriers to help-seeking. No evidence-based interventions for this population have been identified in the literature. Research is needed to explore evidence-based interventions for rural college/university students. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 15-23.].

Dynamic Energy Budget model suggests feeding constraints and physiological stress in black-lip pearl oysters, 5 years post mass-mortality event.

Mass-mortality events of marine species can disturb the structure of communities. While identifying the causes of mass-mortality events is crucial for implementing recovery strategies, monitoring is challenging in remote locations. Black-lip pearl oysters (Pinctada margaritifera) are farmed for producing black pearls within remote atolls of French Polynesia. Previous mass-mortality events have resulted in the collapse of oysters and other species; however, the causes and conditions that favour recovery are unclear. We investigated the potential for oyster population recovery 5 years after a mortality event at Takaroa Atoll (Tuamotu Archipelago). Temperature, food availability (total chlorophyll-a), growth and reproduction were monitored. Growth was also simulated using a Dynamic Energy Budget model. Despite favourable conditions, reduced growth and reproduction signalled an energetic deficit. The model overpredicted growth, and supported the hypotheses that individuals are unable to profit from the phytoplankton available and maintenance costs are high in Takaroa, ultimately explaining their poor physiological condition.

Recruitment and Retention of Occupational Therapy Practitioners and Students of Color: A Qualitative Study.

IMPORTANCE: Matching the demographics of health professionals and patient populations increases access to quality care. However, a consensus has not been reached regarding the most effective strategies for recruitment and retention of diverse practitioners. OBJECTIVE: To answer the question "What are the perceived challenges to and facilitators of the recruitment and retention of occupational therapy practitioners (OTPs) and students of color?" DESIGN: A qualitative interpretive, constructionist design was used. Purposive recruitment that used convenience sampling was conducted at the 2017 American Occupational Therapy Association Annual Conference & Expo and via the National Black Occupational Therapy Caucus Facebook group. Data were collected online from three focus groups and four interviews. SETTING: Online through social media. PARTICIPANTS: The total sample included 5 OTPs and 7 students; 91.7% identified as African-American or Black. OUTCOMES AND MEASURES: Inductive analysis was used to interpret the open-ended questions. After transcription, each interview or focus group transcript was reviewed with Colaizzi's seven-step method of data analysis. RESULTS: Five themes were identified: (1) lack of representation in and knowledge about occupational therapy, (2) feeling like an outsider, (3) need for financial support, (4) individualized mentor-mentee relationships, and (5) connections with national organizations specifically for people of color. CONCLUSIONS AND RELEVANCE: This study identified experiences of OTPs and students of color and how identified barriers can be addressed. Implications for the profession include purposive recruitment, professional development for faculty, provision of mentoring, and financial support. Future research should focus on creation and evaluation of evidence-based strategies for the recruitment and retention of students of color in occupational therapy. WHAT THIS ARTICLE ADDS: This study provided voices of OTPs and students of color regarding challenges and facilitators experienced in the profession. With an accurate understanding of experiences of people of color, effective strategies can be developed to foster their successful transition into the occupational therapy workforce.

Evaluation of the Jail-Based Occupational Therapy Transition and Integration Services Program for Community Reentry.

IMPORTANCE: Transition and integration reentry services continue to grow in carceral settings; however, related provision of occupational therapy is limited. OBJECTIVE: To examine the implementation fidelity of an occupational therapy-administered interprofessional reentry program initiated in an urban jail. DESIGN: Retrospective, mixed quantitative and qualitative design. SETTING: Community-based reentry services provided prerelease in a Midwestern urban jail and postrelease in the local St. Louis community. PARTICIPANTS: Occupational therapy practitioners tracking process measures for identifying reentry project feasibility. INTERVENTION: Provision of recruitment, assessment, and skilled occupational therapy services with people held in a short-term jail facility and follow-up during community reentry. OUTCOME AND MEASURES: Detailed logs were analyzed to describe attendance at and duration of sessions. We coded barriers to and facilitators of implementation from weekly team meeting notes and logs using social-ecological categories. RESULTS: Findings indicate that it was feasible to implement prerelease jail-based services (N = 63) because of jail operations and community partnerships (facilitators) and to overcome institutional policies and environmental limitations (barriers). Full 8-wk prerelease programming was completed by 38% (n = 24) of participants, and 52% (n = 33) participated less than 8 wk. All who completed the full prerelease program and transitioned to the community (n = 15) initiated postrelease occupational therapy services. CONCLUSIONS AND RELEVANCE: The iterative feedback provided by process evaluation supported the feasibility of implementing the jail-based Occupational Therapy Transition and Integration Services program. WHAT THIS ARTICLE ADDS: This process evaluation provides evidence that implementation of an occupational therapy-based transition program in an urban jail is feasible.

Using the Health Literacy Questionnaire (HLQ) with Providers in the Early Intervention Setting: A Qualitative Validity Testing Study.

More than one in four parents in the United States of America (USA) have low health literacy, which is associated with reduced health equity and negatively impacts child health outcomes. Early intervention (EI) programs are optimally placed to build the health literacy capacity of caregivers, which could improve health equity. The health literacy of interdisciplinary EI providers has not previously been measured. This study used the Health Literacy Questionnaire (HLQ) with EI providers (n = 10) to investigate evidence based on response (cognitive) processes. Narratives from cognitive interviews gave reasons for HLQ score choices, and concordance and discordance between HLQ item intent descriptions and narrative data were assessed using thematic analysis. Results found scales with highest concordance for Scales 3, 6, and 9 (each 96%, n = 24). Concordance was lowest on Scale 5 (88%, n = 22), although still strong with only 12% discordance. Three themes reflecting discordance were identified: (1) Differences between Australian and USA culture/health systems; (2) Healthcare provider perspective; and (3) Participants with no health problems to manage. Results show strong concordance between EI providers' narrative responses and item intents. Study results contribute validity evidence for the use of HLQ data to inform interventions that build health literacy capacity of EI providers to then empower and build the health literacy of EI parents.

Examining Driving and Participation 5 Years After Traumatic Brain Injury.

Participation is often considered a primary goal of traumatic brain injury (TBI) rehabilitation, but little is known about the influence of driving on participation after TBI. The objective of this study was to examine the independent contribution of driving status to participation at 5 years post TBI, after controlling for demographic, psychosocial, and functional factors. Participants ( N = 2,456) were community-dwelling individuals with moderate to severe TBI, age 18 to 65 at time of injury, and enrolled in the TBI Model Systems (TBIMS) National Database (NDB). Hierarchical linear regressions for the dependent variable of participation at 5 years post TBI were performed. Findings showed that driving was a highly significant independent predictor of participation and was a stronger relative predictor of participation than FIM® Cognitive, FIM® Motor, and depression. The independent contribution of driving to participation suggests the need to develop evidenced-based occupational therapy assessments and interventions that facilitate safe engagement in the occupation of driving to address the long-term goal of improved participation.

Evidence-Based Interventions for Increasing Work Participation for Persons With Various Disabilities.

Title I of the Americans With Disabilities Act prohibits discrimination in employment; however, 26 years later, employment rates for persons with disabilities hover at 34%. This systematic review investigates the effectiveness of evidence-based interventions to increase employment for people with various disabilities. Forty-six articles met the inclusion criteria for evidence-based interventions. The majority of studies assessed interventions for persons with mental health disabilities. Strong evidence was found for ongoing support and work-related social skills training prior to and during competitive employment for persons with mental health disabilities. Moderate evidence supported simulation and use of assistive technology, especially apps for cueing and peer support to increase work participation for persons with intellectual disabilities, neurological/cognitive disabilities, and autism spectrum disorder. Many of the strategies to increase work participation were appropriate for occupational therapy intervention. Suggestions were made for research, specifically looking at more rigorous evaluation of strategies in the long term.

Mothers With Physical Disability: Child Care Adaptations at Home.

OBJECTIVE: This study describes how women with physical disability experience caregiving for a new infant and how they adapt their home environment and care tasks. METHOD: In 2013, we conducted 2-hr telephone interviews with 22 women with significant physical disability who had delivered babies within the previous 10 yr. The semistructured, open-ended interview protocol addressed wide-ranging pregnancy-related topics. NVivo was used to sort the texts for content analysis. RESULTS: Night care, bathing, and carrying the baby were identified as the biggest challenges. Typical adaptations (with and without occupational therapy consultation) included use of a wrap for carrying the infant, furniture adaptations for mothers using wheelchairs, and assistance from caregivers. CONCLUSION: Women with physical disability can be fully capable of caring for an infant and can find ways to adapt their environment. Further research may determine the role of occupation therapy.

Does type of disability and participation in rehabilitation affect satisfaction of stroke survivors? Results from the 2013 Behavioral Risk Surveillance System (BRFSS).

BACKGROUND: Studies show that stroke survivors typically have lower life satisfaction than persons who have not been diagnosed with stroke. OBJECTIVE: To determine if significant differences in life satisfaction exist between stroke survivors with and without functional limitations and whether specific functional limitations, as well as participation in outpatient rehabilitation affect the odds of reported life satisfaction for stroke survivors. METHOD: Chi square analysis was used to examine data from the 2013 BRFSS to determine the relationship of functional limitations as well as participation in rehabilitation services to life satisfaction for stroke survivors. Logistic regression analysis was used to determine what variables increased the odds of reported poor life satisfaction. RESULTS: Stroke survivors experiencing difficulty with cognition, depression and IADLs showed significantly lower life satisfaction than those who did not experience these functional limitations. Survivors exhibiting activity limitations had almost twice the odds of reporting poor life satisfaction and those experiencing limitations in cognition and IADLs had 2.88 times and 1.81 times the odds as others without these limitations of reporting poor life satisfaction, respectively. Participation in outpatient rehabilitation reduced the odds of reporting of poor life satisfaction by approximately one half. CONCLUSIONS: Rehabilitation focused on addressing these functional limitations would increase life satisfaction for persons diagnosed with stroke. Future research on specific types of cognitive and daily living limitations would assist policy makers and referral sources in making appropriate referrals to rehabilitation.

Examining patient-centered communication and access for veterans with disabilities.

OBJECTIVE: To determine if there are significant differences in patient-centered communication and access to care experienced by veterans with disabilities compared to veterans without disabilities and nonveterans with disabilities and what variables contribute to the likelihood of poor patient-centered communication and access to care. METHODS: χ(2) analyses were used to determine differences in patient-centered communication and access to care. Logistic regression analyses were used to identify variables contributing to poor patient-centered care. RESULTS: Veterans with disabilities were significantly less likely to say that a physician listened to their concerns, explained care so they understood, treated them with respect, spent enough time with them, and were less likely to get necessary care or experience a delay in getting care than veterans without disabilities. No significant differences were found when comparing patient-centered communication between veterans and nonveterans with disabilities. Veteran status protects against poor patient-centered care, whereas disability status increases the likelihood of poor patient-centered care. CONCLUSIONS: Health care providers should consider the unique strengths and limitations presented by veterans with disabilities in their patient-centered communication. Future research in partnership with veterans with and without disabilities is needed to determine effective strategies to improve patient-centered communication and health care access.

The relationship of disability and employment for veterans from the 2010 Medical Expenditure Panel Survey (MEPS).

BACKGROUND: Veterans with disabilities, especially those with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) have difficulty obtaining and maintaining competitive employment. OBJECTIVE: To determine if there are significant differences in employment between veterans with and without disability, between veterans with a disability and nonveterans with a disability, and to investigate the association of veteran status and disability with employment. METHODS: Chi square analyses were conducted on data obtained from the 2010 Medical Expenditure Panel Survey to determine if significant differences in employment occurred between veterans with disabilities, veterans without disabilities and nonveterans with disabilities. Multivariate regression analyses were used to determine how veteran status and disability are associated with employment. RESULTS: Significant differences in employment were found between veterans with and without a disability; however, no significant differences existed in employment between veterans and nonveterans with a disability. Multivariate analysis showed that veteran status (aOR=1.80), having any disability (aOR=7.29), social disability (aOR=3.47) or a cognitive disability (aOR=3.16) were associated with not being employed. CONCLUSIONS: Veterans with disabilities are more likely not to be employed than veteran populations without disabilities. Veterans; however have unique disabilities, different than nonveterans with disabilities, that need to be addressed, such as social and cognitive disabilities resulting from TBI and PTSD. Future research should focus on evaluating the effectiveness of employment programs and policies designed to address the unique issues faced by veterans with disabilities.

The relationship between employment and veteran status, disability and gender from 2004-2011 Behavioral Risk Factor Surveillance System (BRFSS).

BACKGROUND: In 2011, about 1.8 million or 8 percent of the 22.2 million veterans were women in the US. The unemployment rate for female veterans of the wars in Iraq and Afghanistan rose to 13.5%, above the 8.4% for non-veteran adult women. OBJECTIVE: To examine data from the Behavioral Risk Factor Surveillance System (BRFSS), from 2004-2011 to determine the relationship between employment and veteran status, disability and gender. METHODS: Chi square analysis was used to determine if significant differences existed between the employment rate of female veterans with disabilities and female veterans without disabilities, female non-veterans with disabilities and male veterans with disabilities. Binomial logistic regression analysis was used to determine how veteran status, disability and gender affected the likelihood of not being employed. RESULTS: Significant differences were found in employment rate between female veterans with disabilities and female veterans without disabilities, but not when compared to female non-veterans with disabilities or male veterans with disabilities. Disability was the strongest factor increasing the likelihood of not being employed, though veteran status and female gender were also predictive. CONCLUSIONS: Female veterans with disabilities experience low levels of employment. Policies and programs are needed to address the unique needs of these veterans.

Disability, employment and stress regarding ability to pay for housing and healthy food.

OBJECTIVE: To determine if disability is a significant factor in increasing the likelihood of experiencing stress regarding the ability to pay for housing and healthy food. PARTICIPANTS: 24.6% (n=16206) of 65,960 adults who responded to the social context optional module of 2009-2010 Behavioral Risk Factor Surveillance System identified themselves as having a disability. Adults with disabilities reported that they experienced significantly more stress about having money to pay for housing and healthy food than adults without disabilities. METHODS: This research was a quantitative study using a publicly available dataset. A series of logistic regressions were performed to determine the extent that disability affected the likelihood of stress about having enough money for housing and healthy food. RESULTS: Employed persons with a disability are 1.6 times and 1.9 times as likely as persons without a disability to experience stress about not having enough money to pay for housing and healthy food, respectively. Persons not employed with a disability are 1.56 times and 1.83 times as likely to experience stress about not having enough money to pay for housing and healthy food, respectively. For persons with a disability, being female, in poor health, without a health plan and having a lower income were also significant. Education and employment were not significant predictors of experiencing stress regarding money for food or housing. CONCLUSIONS: Having a disability is more predictive of experiencing stress about having enough money for housing and healthy food than employment, though variables such as low income and having a health plan, dependent on employment are significant. Therefore, strategies and policy recommendations to reduce stress by increasing employment and income for persons with disabilities were presented.

Bioactivity and bioavailability of ginsenosides are dependent on the glycosidase activities of the A/J mouse intestinal microbiome defined by pyrosequencing.

PURPOSE: To investigate the ability of bacteria in the intestinal microbiome to convert naturally occurring primary ginsenosides in red ginseng extract to active secondary ginsenosides. METHODS: Anti-proliferative ginsenoside activity was tested using mouse lung cancer LM1 cells. Permeabilities were evaluated in Caco-2 cell monolayers. Systemic exposure of secondary ginsenosides was determined in A/J mice. 16S rRNA gene pyrosequencing was used to determine membership and abundance of bacteria in intestinal microbiome. RESULTS: Secondary ginsenoside C-K exhibited higher anti-proliferative activity and permeability than primary ginsenosides. Significant amounts of secondary ginsenosides (F2 and C-K) were found in blood of A/J mice following oral administration of primary ginsenoside Rb1. Because mammalian cells did not hydrolyze ginsenoside, we determined the ability of bacteria to hydrolyze ginsenosides and found that Rb1 underwent stepwise hydrolysis to Rd, F2, and then C-K. Formation of F2 from Rd was the rate-limiting step in the biotransformation of Rb1 to C-K. CONCLUSION: Conversion to F2 is the rate-limiting step in bioactivation of primary ginsenosides by A/J mouse intestinal microbiome, whose characterization reveals the presence of certain bacterial families capable of enabling the formation of F2 and C-K in vivo.

Research focused on children and youth.

We reviewed 22 articles on children and youth published in 2011 in the American Journal of Occupational Therapy and organized the articles by level of research and research type according to a framework adapted from the International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2007). The largest percentage of articles described intervention effectiveness studies classified as Level III or IV. The bulk focused on the Body Function/Body Structure construct of the ICF, but as a whole the studies addressed all the constructs except Biomedical Molecular/Cellular. Rigor remains a concern, although laudable efforts have been made to increase strength of the evidence. Longitudinal, efficacy, and qualitative studies, as well as studies examining adolescents and the transition to adulthood, were absent from articles in this review and are important areas for future investigation. Several studies explicitly addressed intervention fidelity, an imperative in evidence-based research needed to move the profession toward the Centennial Vision.