The first line of prevention: A public health nursing advocacy video.

Public health nurses (PHNs) serve as the first line of prevention in public health and safety threats such as the COVID-19 pandemic. Although PHNs provide vital services to protect communities and populations' health, a pervasive lack of knowledge exists regarding the PHN role among policymakers and the general public. Advocacy for investment in the public health nursing workforce remains a priority as staffing and financial constraints have created sizeable barriers for PHNs during the COVID-19 response. Creating an advocacy video with personal stories from PHNs emerges as a powerful and cost-effective strategy to increase the visibility of PHNs. For this project, interviews with PHNs from COVID-19 hot spots were used to create a 3-min advocacy video. PHNs featured in this video discussed the implications of rerouting resources to combat COVID-19 for the populations they serve. The authors disseminated the video through popular social media venues, public health and nursing organizations and nurse influencers to reach nursing students, faculty, and the public. Over an 8-week period, the video received 2732 views on social media with an average view duration of 2 min. This article includes strategies to maximize the impact of an advocacy video when shared with relevant stakeholders.

Life is a highway: Driver's license acquisition and social determinants for youth in foster care and their non-foster care peers.

BACKGROUND: Data regarding the connection between driver licensure and social determinants for youth could provide insight into the impact of driver license acquisition. These relationships are important for youth overall and particularly for foster youth given that adolescents in foster care obtain driver's licenses less often than their non-foster care peers. This integrative review explores the association between driver licensure and social determinants. METHODS: Whittemore and Knafl guidelines were used to conduct the integrative review. The articles were identified in collaboration with an expert in library science and public health. Results were organized by the Healthy People 2030 (HP 2030) Social Determinants of Health (SDOH) model. RESULTS: Six studies were included. Social and community context included social support structures helping youth get driver's licenses. Economics, including income and education, influenced license acquisition. Driver license acquisition was associated with improved well-being, security, and mental health. CONCLUSION: While fewer of those living in urban, walkable neighborhoods with access to public transportation were licensed, results from other studies suggest that car access is associated with psychological well-being. Further, licensure is disproportionately lower for populations historically marginalized from equal housing, education, and employment opportunities. Licensure plays a role in well-being.

Health out of foster care as young adults age out of foster care: A phenomenological exploration of seeking healthcare services after aging out of the US foster care system.

Some adolescents in the United States who have been abused and/or neglected by caregivers and placed in permanent custody of the state leave, or "age out" of foster care at 18 years of age. Poor health outcomes among individuals who age out are notable, yet few studies describe the phenomenon of seeking healthcare services after leaving foster care. The investigators specifically queried the phenomenon of seeking healthcare services after foster care drawing from the Phenomenology of Practice approach. We interviewed 13 young adults who aged out of care. Investigators extracted lived experience descriptions (LEDs) from interview transcripts and analyzed under phenomenological themes. Healthcare experiences were marked by avoiding self-disclosure, having no choice but to wait, missing family history, and relying on the kindness of strangers. Healthcare providers who integrate the findings into care delivery models will engage young adults with more understanding and sensitivities of ethical practice.

The influence of social determinants of health among young adults after they have left foster care in the US.

AIMS AND OBJECTIVES: To describe the influence of the social determinants of health on health care seeking among young adults after they left foster care. BACKGROUND: Extensive research suggests that stakeholders in foster care systems throughout the world struggle to consistently and effectively manage the health and well-being of youth. These struggles extend beyond time in foster care as indicated by poor health and social outcomes throughout the life course. Evidence that describes how young adults address health and related social needs after leaving foster care is missing. DESIGN: A phenomenological design, Phenomenology of Practice, was used to collect data. Content analysis was used to analyse the data, using constructs from the Healthy People 2020 SDOH Model to organise the data. METHODS: Thirteen young adults who left foster care in the southwestern US were recruited using convenience sampling. Data were collected via individual interviews. RESULTS: Young adults formerly in foster care reported using and lacking social support networks to navigate SDOH. The interrelatedness of SDOH on health outcomes after foster care is evident. CONCLUSIONS: Social support networks can help explain how young adults are both able and unable to navigate systems to address health issues. Evaluating social networks used to access care is an important aspect of assessment and intervention for these vulnerable young adults. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers facilitate healthcare access for young adults who have been in foster care through evaluation of social determinants. Assessment and care planning based on social determinants for those who have been in foster care are critical to ensure the efficacy of interventions designed to address health outcomes. Social support systems are key factors for young adults formerly in foster care to access resources, substantiating the need for ongoing assessment and development of these support systems.

Cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment resistant depression in primary care: the CoBalT randomised controlled trial protocol.

BACKGROUND: Antidepressants are often the first-line treatment for depression but only one third of patients respond fully to pharmacotherapy. This paper describes the protocol for a randomised controlled trial (RCT) designed to evaluate the clinical and cost effectiveness of cognitive behavioural therapy (CBT) as an adjunct to pharmacotherapy for patients with treatment resistant depression in primary care. METHODS/DESIGN: CoBalT is a two parallel group multi-centre pragmatic RCT. Eligible participants were those who: (i) were aged 18-75years; (ii) were currently taking antidepressant medication (for at least 6weeks at an adequate dose); (iii) scored ≥14 on the Beck Depression Inventory (BDI-II); (iv) had adhered to their medication; and (v) met ICD-10 criteria for depression (assessed using the Clinical Interview Schedule - revised version). Those who gave written informed consent were randomised to one of two treatment groups: usual care or usual care plus CBT. The primary outcome is depressive symptoms assessed using the BDI-II at 6months post-randomisation. Secondary outcomes measured at 6 and 12months include quality of life, antidepressant use and health care utilisation. Outcomes will be analysed on an intention-to-treat basis. DISCUSSION: The CoBalT trial will provide evidence on the clinical and cost effectiveness of CBT as an adjunct to antidepressant medication in the treatment of depression that has not responded to pharmacotherapy. Given the move to widen access to 'talking therapies', the results of this study will be timely.

The in vitro failure of all-ceramic crowns and the connector area of fixed partial dentures using bilayered ceramic specimens: the influence of core to dentin thickness ratio.

AIMS: To assess the effect of core to dentine thickness ratio on the bi-axial flexure strength and fracture mode and failure origin using bilayered ceramic specimens as an in vitro assessment for all-ceramic crowns and the connector area of fixed partial dentures (FPDs). METHODS: Sets of 30 bilayered composite discs, with a core layer thickness of 1mm and with core to dentine thickness ratios of 2:1, 1:1 and 1:2, were tested in bi-axial flexure with both the reinforcing core and veneering dentine loaded in tension. Mean flexure strengths, standard deviations and associated Weibull moduli (m) were determined. Optical microscopy was employed for identification of the fracture mode and failure origin for the failure all-ceramic crowns and the connector area of FPDs. RESULTS: For a core thickness of 1mm the core to dentine thickness ratio failed to influence the bi-axial flexure strength data when both the reinforcing core and veneering dentine porcelain were tested in tension. The number of fracture fragments, frequency of occurrence of specimen delaminations, Hertzian cone formations and sub-critical radial cracking in the bilayered dental ceramic composite disc-shaped specimens were dependent on the core to dentine thickness ratio and the surface loaded in tension. SIGNIFICANCE: The fracture mode and failure origin in bilayered ceramics tested to represent the failure mode of all-ceramic crowns and FPDs was dependent upon the core to dentine thickness ratio employed. However, the conventional wisdom regarding bilayered ceramic specimens with core thicknesses greater than 1mm are not followed when the core thickness was reduced to 1mm since the fracture resistance was not dependent on the core to dentine thickness ratio.