Lung dopaminergic nerves facilitate the establishment of TH2 resident memory cells in early life.

BACKGROUND: Allergic asthma develops from allergen exposure in early childhood and progresses into adulthood. The central mediator of progressive allergic asthma is allergen-specific, TH2-resident memory cells (TRMs). Although the crosstalk between nerves and immune cells plays an established role in acute allergic inflammation, whether nerves facilitate the establishment of TH2-TRMs in the immature lung following early life allergen exposure is unknown. OBJECTIVES: The aim of this study was to identify nerve-derived signals that act in TH2 effector cells to regulate the tissue residency in the immature lung. METHODS: Following neonatal allergen exposure, allergen-specific TH2-TRMs were tracked temporally and spatially in relationship to developing sympathetic nerves in the lung. Functional mediators of dopamine signaling in the establishment of TH2-TRMs were identified by in vitro bulk RNA-sequencing of dopamine-treated TH2 cells followed by in vivo assessment of candidate genes using adoptive transfer of TH2 cells with viral gene knockdown. RESULTS: This study found that sympathetic nerves produce dopamine and reside in proximity to TH2 effector cells during the contraction phase following neonatal allergen exposure. Dopamine signals via DRD4 on TH2 cells to elevate IL2RA and epigenetically facilitate type 2 cytokine expression. Blockade of dopamine-DRD4 signaling following neonatal allergen exposure impairs lung residence of TH2 cells and ameliorates anamnestic inflammation in adults. CONCLUSIONS: These results demonstrate that maturing sympathetic nerves enable a dopamine-enriched lung environment in early life that promotes the establishment of allergen-specific TH2-TRMs. The dopamine-DRD4 axis may provide a therapeutic target to modify allergic asthma progression from childhood to adulthood.

Evaluation of a Symptom-triggered Protocol for Alcohol Withdrawal for Use in the Emergency Department, General Medical Wards, and Intensive Care Unit.

BACKGROUND: Alcohol withdrawal is common in hospitalized patients and symptom-triggered guidelines have been shown to reduce treatment duration, length of stay, and need for mechanical ventilation. OBJECTIVES: To assess the feasibility of incorporating symptom-triggered alcohol withdrawal guidelines early in the hospital course and to evaluate outcomes of patients before and after implementation of the guidelines. METHODS: This was a retrospective pre-post study of adult patients admitted from the emergency department to an urban, academic, tertiary care center. Subjects in the preguideline (PRE) group were given benzodiazepines in a nonprotocolized manner at the discretion of the treating physician, whereas subjects in the postguideline (POST) group were treated according to the alcohol withdrawal guidelines with treatment beginning in the emergency department. RESULTS: The PRE group involved 113 admissions for severe alcohol withdrawal and the POST group involved 103 admissions for severe alcohol withdrawal. The median benzodiazepine dose per day, in milligrams of chlordiazepoxide, was higher in the POST group (100 mg in the PRE group vs. 141 mg in the POST group; P<0.02). A higher percentage of patients in the POST group were admitted to the intensive care unit (4.4% in the PRE group vs. 12.6% in the POST group; P=0.05); however, more patients in the PRE group than in the POST group received continuous intravenous sedation and mechanical ventilation, although the difference was not statistically significant (P=0.37 for both variables). There was no difference between the 2 groups in length of stay in the intensive care unit or hospital or discharge disposition. CONCLUSIONS: Incorporating symptom-triggered guidelines for alcohol withdrawal early in the hospital course at a large medical center is feasible. This approach may result in increased benzodiazepine use, but it seems that it is safe and does not result in adverse outcomes.

"I connect with the ringleader:" health professionals' perspectives on promoting the sexual health of adolescent males.

In-depth interviews with nine professionals in adolescent health were used to identify perceived barriers, facilitators, and innovative strategies to reach, engage, and serve adolescent males for sexual and reproductive health care. Barriers included stigma, embarrassment, and lack of social norms around sexually transmitted infection (STI) testing for men. Facilitators included crisis situations and partner support. Clinic-based approaches to reach and engage young men included developing authentic staff-youth engagement and ensuring that access to services is easy and appealing. To be innovative, providers should become part of the real-world context of adolescent males. Technology (e.g., text messaging) and social media can be utilized to target and eliminate barriers to health care among young men.

Teenagers and texting: use of a youth ecological momentary assessment system in trajectory health research with latina adolescents.

BACKGROUND: Adolescent females send and receive more text messages than any others, with an average of 4050 texts a month. Despite this technological inroad among adolescents, few researchers are utilizing text messaging technology to collect real time, contextualized data. Temporal variables (ie, mood) collected regularly over a period of time could yield useful insights, particularly for evaluating health intervention outcomes. Use of text messaging technology has multiple benefits, including capacity of researchers to immediately act in response to texted information. OBJECTIVE: The objective of our study was to custom build a short messaging service (SMS) or text messaging assessment delivery system for use with adolescents. The Youth Ecological Momentary Assessment System (YEMAS) was developed to collect automated texted reports of daily activities, behaviors, and attitudes among adolescents, and to examine the feasibility of YEMAS. This system was created to collect and transfer real time data about individual- and social-level factors that influence physical, mental, emotional, and social well-being. METHODS: YEMAS is a custom designed system that interfaces with a cloud-based communication system to automate scheduled delivery of survey questions via text messaging; we designed this university-based system to meet data security and management standards. This was a two-phase study that included development of YEMAS and a feasibility pilot with Latino adolescent females. Relative homogeneity of participants was desired for the feasibility pilot study; adolescent Latina youth were sought because they represent the largest and fastest growing ethnic minority group in the United States. Females were targeted because they demonstrate the highest rate of text messaging and were expected to be interested in participating. Phase I involved development of YEMAS and Phase II involved piloting of the system with Latina adolescents. Girls were eligible to participate if they were attending one of the participating high schools and self-identified as Latina. We contacted 96 adolescents; of these, 24 returned written parental consent forms, completed assent processes, and enrolled in the study. RESULTS: YEMAS was collaboratively developed and implemented. Feasibility was established with Latina adolescents (N=24), who responded to four surveys daily for two two-week periods (four weeks total). Each survey had between 12 and 17 questions, with responses including yes/no, Likert scale, and open-ended options. Retention and compliance rates were high, with nearly 18,000 texts provided by the girls over the course of the pilot period. CONCLUSIONS: Pilot results support the feasibility and value of YEMAS, an automated SMS-based text messaging data collection system positioned within a secure university environment. This approach capitalizes on immediate data transfer protocols and enables the documentation of participants' thoughts, feelings, and behaviors in real time. Data are collected using mobile devices that are familiar to participants and nearly ubiquitous in developed countries.

Latina adolescent sleep and mood: an ecological momentary assessment pilot study.

PROBLEM: Sleep and mood represent two important malleable opportunities for adolescent health. This study investigated the sleep-mood relationship in adolescent girls. METHODS: Short-term, longitudinal design. Latina adolescents (N = 19, mean age 15) completed ecological momentary assessments on sleep (perceived quality, self-report quantity) and mood (negative affect, positive affect, and positivity ratio). FINDINGS: Adolescents sent 1,598 texts on sleep and mood. Bidirectional sleep-mood relationships were in expected directions; negative affect and the positivity ratio affect predicted adolescents' sleep quality. CONCLUSIONS: Interventions should encourage sleep-mood relationship awareness, and further research should identify significant differences to inform tailored interventions with adolescents.

College students' preferences for health care providers when accessing sexual health resources.

OBJECTIVE: Many emerging adults (18-25 year olds) report unmet health needs and disproportionately experience problems such as sexually transmitted infections. This study was conducted to examine college students' perceptions of health care providers, specifically in the context of accessing sexual health resources. DESIGN AND SAMPLE: Students (N = 52) were recruited from five diverse colleges in one state to participate in a one-to-one interview that involved walking and virtually exploring resources on and near campus. Interviews were conducted from May to November 2010. MEASURES: Open-ended one-to-one interview questions. RESULTS: Inductive qualitative analysis yielded six themes summarizing students' perceptions of provider characteristics, health care resources, the role of their peers, and students' suggestions for strengthening health care services. Importantly, students consider a variety of staff-and their student peers-to be resources for sexual health information and services. CONCLUSIONS: Findings emphasize the importance of collaboration between health service staff and broader campus staff because students often turn to campus staff initially. Postsecondary students welcome opportunities to know a provider through interactive websites that include details about providers on campus; their decisions to seek sexual health care services are influenced by their perceptions of providers' characteristics and interpersonal skills.

Developing an mHealth framework to improve diabetes self-management.

The need for improved diabetes care outcomes is paramount. Each year, 1.6 million cases are diagnosed with type 2 diabetes and as of 2006; diabetes was the seventh leading cause of death in the United States. Moreover, the financial burden associated with diabetes was estimated to be $174 billion in 2007. Studies show that effective patient-provider communication (PPC) improves diabetes self-care, diabetes outcomes, or both. There has been significant number of studies aimed at improving diabetes care through different telehealth technologies such as patient web portals. However, to the best of our knowledge, there has been limited amount of research done exploring the use of mobile technologies to improve diabetes care.

Barriers to care in an ethnically diverse publicly insured population: is health care reform enough?

BACKGROUND: The Affordable Care Act provides for the expansion of Medicaid, which may result in as many as 16 million people gaining health insurance coverage. Yet it is unclear to what extent this coverage expansion will meaningfully increase access to health care. OBJECTIVE: The objective of the study was to identify barriers that may persist even after individuals are moved to insurance and to explore racial/ethnic variation in problems accessing health care services. RESEARCH DESIGN: Data are from a 2008 cross-sectional mixed-mode survey (mail with telephone follow-up in 4 languages), which is unique in measuring a comprehensive set of barriers and in focusing on several select understudied ethnic groups. We examine racial/ethnic variation in cost and coverage, access, and provider-related barriers. The study adhered to a community-based participatory research process. SUBJECTS: Surveys were obtained from a stratified random sample of adults enrolled in Minnesota Health Care Programs who self-report ethnicity as white, African American, American Indian, Hispanic, Hmong, or Somali (n=1731). RESULTS: All enrollees reported barriers to getting needed care; enrollees from minority cultural groups (Hmong and American Indian in particular) were more likely to experience problems than whites. Barriers associated with cost and coverage were the most prevalent, with 72% of enrollees reporting 1 or more of these problems. Approximately 63% of enrollees reported 1 or more access barriers. Provider-related barriers were the least prevalent (about 29%) yet revealed the most pervasive disparities. CONCLUSIONS: Many challenges to care persist for publicly insured adults, particularly minority racial and ethnic groups. The ACA expansion of Medicaid, although necessary, is not sufficient for achieving improved and equitable access to care.

The voices of Brazilian women breaking free from intimate partner violence.

Intimate partner violence (IPV) is a global problem with a direct effect on the health of the victims and their communities. With the intention to inform nursing care delivered to women experiencing IPV, this qualitative study was conducted, specifically to understand the meaning that IPV has for assaulted women and to identify the factors that contribute to breaking the cycle of violence. Data collection included interviews and discussion of photographs. Participants were recruited from within a shelter for women experiencing violence. Findings from five women were inductively coded into three categories: "experiencing violent acts," which describes the period in which the women lived with the aggressor; "marks of the violent acts," which portrays the consequences of IPV; and "women's support," which indicates the current supports or lack thereof for these women. Nurses and other healthcare providers will benefit from hearing the women's voices through their words and photographs and will recognize the need for holistic care that includes the physical, sexual, and emotional needs of abused women.

Differences in sexual behaviors among unmarried sexually active students at 2- and 4-year colleges.

Sexual risk behaviors are common among college students, but differences between 2- and 4-year students have not been explicitly tested. Survey data from 9,748 unmarried sexually active Minnesota college students (in 2010 or 2011) were used multilevel logistic regression models to test differences in eight high risk sexual health behaviors and outcomes between students attending 2- vs. 4-year colleges. Odds of sex without a condom, sex without reliable birth control, unplanned pregnancy, and STIs were significantly lower among 4-year students than 2-year students, after adjusting for demographic covariates. Health promotion approaches targeted to the needs of 2- or 4-year students may be needed. For example, messaging and outreach efforts encouraging condom use may be especially beneficial for sexual health programs at 2-year colleges.

One Health: Lessons Learned from East Africa.

Africa is faced with many of the most daunting challenges of our time. It comprises roughly 15% of the world's human population, and most of its countries are perpetually ranked "Low" on the United Nations' Human Development Index. On the other hand, Africa has arguably the largest proportion of intact natural ecosystems, biodiversity, and sociocultural capital and the lowest impact on global warming of any continent. Thus, African leaders are faced with competing demands and values among a multitude of complex issues, such as high human population growth, extreme poverty, food insecurity, land use policy, climate change, and biodiversity conservation. In this context, building sustainable national systems for human and/or animal health is one of the grand challenges of this generation. Today's complex global health and development challenges require long-term commitment and a range of approaches that are too broad for any one discipline, institution, or country to implement on its own. The One Health concept recognizes the interconnectedness of global health issues and, as such, promotes the importance of and need for international, interdisciplinary, and cross-sectoral communication and collaboration at local, national, and international levels. By taking advantage of natural cultural tendencies for shared leadership, resource allocation, and community values, African leaders are currently proactively demonstrating the principles of One Health, and thus becoming a model for this global vision. And by focusing on partnerships rather than donor-recipient relationships, they are fostering the development of shared priorities and are increasingly driving their own health agenda to fulfill their own needs.

Sexual health resources at Minnesota colleges: associations with students' sexual health behaviors.

CONTEXT: Sexual risk behaviors are common among college students, and research examining the environmental context of these behaviors is important for prevention. The presence of college sexual health resources is a potentially important part of that context. METHODS: In a 2010-2011 survey, 6,318 undergraduates from 28 two- and four-year Minnesota college campuses provided data on their sexual health behaviors. In addition, a specially designed inventory was used to assess the sexual health resources available on each campus. Multilevel regression was used to test the associations of four types of resources with students' condom use, birth control use, STD or HIV testing, and unplanned pregnancy. RESULTS: In models that controlled for students' personal and demographic characteristics, the higher the level of sexual health resources at a college, the lower the likelihood that students had had intercourse without birth control, intercourse without a condom and involvement in unplanned pregnancy. For example, students attending colleges with the maximum number of general clinic resources had a lower predicted probability of reporting nonuse of reliable birth control at last intercourse than students attending colleges with no resources (7% vs. 14%). After college characteristics were adjusted for, most measures of resources remained significant, although associations were reduced; two measures became significant in unexpected directions. CONCLUSIONS: Colleges' provision of sexual health resources may be associated with students' sexual health behaviors. Research using quasi-experimental or experimental designs is needed to assess the mechanisms underlying these associations; such work could lead to interventions that might help reduce students' risky behaviors.

Family home visiting outcomes for Latina mothers with and without mental health problems.

OBJECTIVE: To evaluate outcomes of a public health nursing family home visiting (FHV) intervention for Latina mothers with and without mental health problems. DESIGN AND SAMPLE: Retrospective cohort analysis of de-identified FHV data. Latina clients served by public health nurses (PHNS) in an urban Midwest public health agency (2007-2010). Of the 680 clients there were 158 with mental health problems (n = 30, 14-17 year olds; n = 128, 18-52 year olds) and 522 without mental health problems (n = 100, 14-17 year olds; n = 422, 18-52 year olds). MEASURES: Client age, number of problems, number of visits, length of service, presence of mental health problem, and Omaha System knowledge, behavior, and status scores for all client problems. Analysis included general linear mixed models adjusted for co-variables (i.e., age, comorbidities). RESULTS: All groups improved knowledge, behavior, and status. Knowledge improvement was not significantly different across groups. Behavior improved more among adults with mental health problems (p = .013). Status improved more among adolescents with mental health problems (p = .012). CONCLUSIONS: Latina mothers, particularly those with mental health problems, improve after PHN FHV services. Further study should examine intervention patterns associated with these outcomes, and seek explanations for differences in outcomes.

Health care access and utilization among Hispanic manufacturing workers along the Texas-Mexico border.

Disparities in health care access, including utilization of preventive health services, are well-documented among ethnic minority populations. This study examines factors associated with health care access and utilization among Hispanic manufacturing employees along the Texas-Mexico border. A cross-sectional survey was administered in 2010 to 228 mostly male (71%) workers. About half of participants (53%) lacked health insurance, which emerged as the most important variable related to health care access and utilization. In multivariate logistic regression analyses, relative to insured workers, uninsured workers were significantly more likely to delay getting medical care (p<.001) and to need medical services that they could not afford (p<.05). They were also less likely to receive a flu vaccine (p<.001). Additionally, uninsured women were less likely to receive screening for cervical cancer compared to insured women (p<.05). Findings support the promotion of employment-based health insurance and education programs stressing the importance of preventive health services.

Ventral hippocampal neurons are shaped by experience to represent behaviorally relevant contexts.

Memories can be recalled at different levels of resolution, from a detailed rendition of specific events within a single experience to a broad generalization across multiple related experiences. Here we provide evidence that neural representations reflecting the specificity or generality of memories are differentially represented along the dorsoventral axis of the CA3 area of the rat hippocampus. In dorsal CA3, neurons rapidly associate the identity of events with specific locations whereas, in more ventrally located CA3 regions, neurons gradually accumulate information across extended training to form representations that generalize across related events within a spatial context and distinguish events across contexts.

College students' sexual health: personal responsibility or the responsibility of the college?

OBJECTIVE: This article examines students' perceptions of individual and institutional responsibility for sexual health so that institutions can better provide for the needs of their students to increase academic success and healthy relationship outcomes. PARTICIPANTS: Students from 2- and 4-year colleges in 1 state (N=78). METHODS: From May through November 2010, the authors used go-along interviews to examine students' perceptions of resources for sexual health on their campuses. RESULTS: Participants believed that it is the college's responsibility to provide resources and the responsibility of students to access resources. Participants at 2-year schools wanted referrals to resources, whereas participants at 4-year schools expected resources to be available and emphasized the importance of a supportive community. CONCLUSIONS: Students at 2- and 4-year colleges have different expectations of their institutions; by making resources and referrals for sexual health available, colleges can better serve their students, which will result in improved health outcomes.

It's called "Going out to play": a video diary study of Hmong girls' perspectives on running away.

How do Hmong immigrant adolescent girls decide to run away, return home, leave again, or stay home? Video diaries by 11 sexually exploited runaway Hmong girls, ages 13-16, revealed four themes: "fighting restrictions," or resisting family and cultural expectations and desires to be like other American teens; "not running away, going out to play," which captured impulsive decision making; "unrestrained partying," which described runaway experiences but minimized the dangers faced; and "trying to change," or returning home because of family bonds and wanting to "be someone good." Given their limited ability to anticipate risks, interventions should focus on runaway prevention initiatives for Hmong families and teens.

Intergenerational photovoice projects: optimizing this mechanism for influencing health promotion policies and strengthening relationships.

Intergenerational photovoice groups are promising for promoting health through the topic that is explored and through group dynamics that can foster healthy relationships and communication. To investigate the potential benefits of intergenerational photovoice projects, photovoice groups were conducted in urban Minnesota, United States, and in rural Morelos, Mexico, between 2009 and 2012 with Mexican-origin adults and their adolescent relatives. Seven photovoice groups of adult-adolescent dyads met for eight sessions and developed exhibits highlighting their views on health and migration and made policy recommendations, using messages conveyed through their words and photographs. Informal process evaluation and focus groups were used to elicit feedback about photovoice project participation. Photovoice project themes were descriptively analyzed. Focus group evaluation data were thematically summarized, and facilitator reflections were descriptively summarized to identify factors associated with intergenerational photovoice groups. Seventy-five participants were recruited. Photovoice themes represented effects of migration on health, family, and well-being. The following two evaluative themes were identified: (a) participant sentiments about the benefits of photovoice participation and (b) facilitator observations of intergenerational photovoice group benefits and challenges. Participants described opportunities to learn new things and barriers to healthy relationships that the project was eliminating by providing them with time to work together. Used in health promotion, photovoice is a valuable tool that contributes to understanding the complex underlying factors influencing behaviors and health.

Differences in Abuse and Related Risk and Protective Factors by Runaway Status for Adolescents Seen at a U.S. Child Advocacy Centre.

OBJECTIVES: This study examined the abuse prevalence and characteristics, and risk and protective factors, among both runaway and non-runaway adolescents evaluated at a Child Advocacy Center (CAC) in Minnesota, which had implemented a referral program to assess runaways for potential sexual assault or sexual exploitation. METHODS: A cross-sectional analysis of self-report and chart data for the 489 adolescent girls who were evaluated between 2008 and 2010. Chi-square and t-tests by runaway status compared abuse experiences, trauma responses, health issues, and potential protective assets associated with resilience between runaways and non-runaways. Bivariate logistic regressions explored the relationship of these risk and protective factors to self-harm, suicide attempts, and problem substance use, separately for runaways and non-runaways who had experienced sexual abuse. RESULTS: Runaways were significantly more likely than non-runaways to have experienced severe sexual abuse, to have used alcohol and drugs, and reported problem substance use behavior, higher levels of emotional distress, more sexual partners, and they were more likely to have a sexually transmitted infection (STI). Runaways had lower levels on average of social supports associated with resilience, such as connectedness to school, family or other adults. Yet higher levels of these assets were linked to lower odds of self-harm, suicide attempt and problem substance use for both groups. CONCLUSIONS AND IMPLICATIONS: CACs should encourage referrals of runaway adolescents for routine assessment of sexual assault, and incorporate screening for protective factors in addition to trauma responses in their assessments of all adolescents evaluated for possible sexual abuse, to guide interventions.

Health care reform and young adults' access to sexual health care: an exploration of potential confidentiality implications of the affordable care act.

One provision of the 2010 Affordable Care Act is extension of dependent coverage for young adults aged up to 26 years on their parent's private insurance plan. This change, meant to increase insurance coverage for young adults, might yield unintended consequences. Confidentiality concerns may be triggered by coverage through parental insurance, particularly regarding sexual health. The existing literature and our original research suggest that actual or perceived limits to confidentiality could influence the decisions of young adults about whether, and where, to seek care for sexual health issues. Further research is needed on the scope and outcomes of these concerns. Possible remedial actions include enhanced policies to protect confidentiality in billing and mechanisms to communicate confidentiality protections to young adults.