Effect of Maternal Race, Residential Rurality, and Social Vulnerability on Critical Congenital Heart Defect Risk.

The development of a congenital heart defect (CHD) is multifactorial, with many cases having an unknown etiology. This study explored whether maternal race and lived environment were associated with an infant being born with a critical CHD. A cross-sectional, case-control design was conducted utilizing secondary data analysis. The CHD group (N = 199) consisted of infants diagnosed with a critical CHD within the first year of life identified from hospital databases. The non-CHD group (N = 548) was a random sample of infants selected from the state's vital statistics database. The primary outcome was a critical CHD diagnosis. Maternal race, residential rurality, and the Social Vulnerability Index (SVI) were assessed for associations with a critical CHD using bivariate and multilevel regression models. Bivariate findings reported significance among residential rurality (p < 0.001), SVI ranking overall (p = 0.017), and SVI by theme (theme 1 p = 0.004, theme 2 p < 0.001, theme 3 p = 0.007, and theme 4 p = 0.049) when comparing infants with and without a critical CHD diagnosis. Results of multilevel logistic regression analyses further identified living in a rural residential area compared to urban areas (OR = 7.32; p < 0.001) as a predictor for a critical CHD diagnosis. The findings of lived environmental level associations provides information needed for continued investigation as the burden of a critical CHD continues to impact families, suggesting further research efforts are needed to improve health disparities.

Metabolic syndrome risk among adolescents in the Deep South and the relationships with behavioral health, food insecurity, and physical activity.

PURPOSE: A combination of physical and psychosocial risk factors put adolescents at risk for poor cardiometabolic health and chronic disease burden, often recognized as metabolic syndrome. The purposes of this study were to (1) identify the prevalence of metabolic syndrome risk among adolescents, utilizing the metabolic syndrome severity index, and (2) determine the relationship between metabolic syndrome risk and behavioral health, food insecurity, and physical inactivity among adolescents. METHODS AND DESIGN: A cross-sectional, descriptive, correlational design was deployed in an inner-city high school in the Deep South. An 8-month recruitment and enrollment period yielded a sample of 55 adolescents. A battery of measures included assessment of demographic data, anthropometric, cardiovascular, and psychosocial data. Utilizing these data elements, a progressive methodological approach was used to identify metabolic severity risk as a continuous variable for use in the adolescent population. RESULTS: All participants identified as African American/Black. Among them, 71% (N = 39) were female and an average age of 16 (SD = 1.3) years old, with 67.3% (N = 37) of the sample at risk for metabolic syndrome. There was not a statistically significant relationship between metabolic syndrome severity score and behavioral health risk, food insecurity, and physical inactivity in this sample. PRACTICE IMPLICATIONS: Future use of the continuous metabolic syndrome severity score may guide practice by utilizing longitudinal data to assess the trends of metabolic syndrome severity scores in relation to disease outcomes in adolescents. This may promote the identification of psychosocial and physical interrelationships with metabolic syndrome, thus improving overall health through the development of age-appropriate interventions.

Improving care practices of the patient with type 2 diabetes in community health centers.

BACKGROUND: Diabetes ranks seventh in morbidity and mortality in the United States. In addition, more than 25 million Americans living with diabetes depend on community health centers (CHCs) for primary care. LOCAL PROBLEM: Preimplementation data in a group of CHCs indicated poor adherence to standards of care practices as recommended by the American Diabetes Association (ADA) with quarterly A1c (33.1%), annual serum laboratory tests (66.6%), and annual urine microalbumin (26.5%). METHODS: Using a pre- and postimplementation comparison method, a NP-led practice improvement project was conducted in a group of CHCs, which sought to (1) identify adherence to ADA care standards; (2) determine whether an intervention could affect adherence to ADA standards; and (3) compare pre- and postimplementation occurrences of hemoglobin A1c greater than 7.1% and greater than 9%. INTERVENTION: Intervention composed of an educational component, standing orders to facilitate care practice changes, and electronic health record utilization changes. RESULTS: Postimplementation data reveal statistically significant improvements in quarterly hemoglobin A1c (93.6%), annual serum laboratory tests (96.5%), and annual urine microalbumin screening (85.5%). CONCLUSIONS: Improvements in translation to care for standardized guidelines facilitate improvements in health outcomes for patients. This project demonstrated improvements that can decrease the morbidity and mortality experienced by persons living with diabetes and being seen within a CHC. In addition, this project demonstrated that advanced practice nurses have the training and occupy a unique position within health care to spearhead initiatives for translation of evidence into care practices.

Trends in Sexual Risk Behavioral Responses among High School Students between Mississippi and the United States: 2001 to 2019 YRBSS.

BACKGROUND: Early sexual reproductive health (SRH) education is linked to a reduction in risky sexual behaviors. Sexually transmitted infections (STIs) are rising at alarming rates. Risky sexual behaviors, including initiation of sex before age 13, having more than four sexual partners, and lack of use of condoms, increase the chance of infection and cancer. Informing students about the link between risky behaviors and cancer is vital to reduce morbidity and mortality. METHODS: A trend analysis of the Youth Risk Behavior Surveillance System (YRBSS) data between 2001 and 2019 was conducted. Results from four survey responses related to sexual risk behaviors among 9th to 12th grade in Mississippi students are compared with their US peers. RESULTS: Between 2001 and 2019, favorable declines in 3 out of 4 sexual risk behaviors were observed. Declining prevalence was reported for "ever had sexual intercourse," "age of sexual initiation at age 13 or younger," and "having 4 or more sexual partners in their lifetime" are promising. However, fewer students report using condoms. The adjusted prevalence rates for Mississippi students in all 4 measures were higher than the national responses. CONCLUSIONS: Our analysis supports the need for early skill-based sex education to promote health. States with increased behavioral risk among students should consider trends in data to improve education and policy.

A case report of prostate adenocarcinoma with leptomeningeal carcinomatosis and intracerebral metastasis.

Despite the fact that prostate cancer is the most prevalent cancer in men, metastases to the central nervous system including leptomeningeal involvement by prostate carcinoma is a rare event. The prognosis of metastatic prostate cancer is very poor due to lack of CNS penetrating therapeutic agents.

A case report of endometrial adenocarcinoma with leptomeningeal metastases.

In patients with a history of solid tumors, any new onset of neurological symptoms should be assessed for central nervous system involvement even in rare cases such as gynecological malignancies that nervous system involvement is a rare event.

Is the use of recombinant cGnRH may be a future alternative to control the fish spawning? Let us go with the goldfish example.

The use of recombinant gonadotropin-releasing hormone (rGnRH) has very rarely been tested in fish to promote spawning. This study evaluated the impact of recombinant chicken gonadotropin-releasing hormone (rcGnRH) with metoclopramide on the release of sex steroids and final maturation induction in goldfish (Carassius auratus) broodstock. For this purpose, goldfish broodstock was divided into four groups and treated with 0.9% NaCl with 20 mg/kg metoclopramide (Met) (C); 10 µg/kg body weight (BW) rcGnRH with 20 mg/kg metoclopramide (rcGn10); 15 µg/kg BW rcGnRH with 20 mg/kg metoclopramide (rcGn15); and 20 µg/kg BW rcGnRH with 20 mg/kg metoclopramide (rcGn20). The capability of the rcGnRH for eliciting biological response was tested in vivo by evaluating the changes of 17ß estradiol (E2), testosterone (T), and 17α, 20ß-dihydroxy-4-pregnen-3-one (DHP) and the induced spawning. Blood samples were obtained at 0 h, 12 h, and 24 h after injection. The rcGn10, rcGn15, and rcGn20 treatments induced lower E2 concentration, especially 24 h post-injection. T levels were significantly higher in rcGn10, rcGn15, and rcGn20 treatments 12 h post-injection than at 0 h and then decreased at 24 h post-injection. Furthermore, the rcGnRH tested significantly enhanced DHP secretion in rcGn10, rcGn15, and rcGn20 treatments 12 h post-injection before a decline at 24 h post-injection. No significant difference between the sampling times was found in the C treatment for the 3 sex steroids tested. The results also displayed that rcGnRH at 10-20 µg/kg of body weight can trigger spawning with the highest speed and efficiency of spawning at 20 µg/kg. The obtained results represent a possible strategy for enhancing the artificial reproduction and ovulation of broodstock fish by rGnRH and further support the use of recombinant hormones to promote reproduction in aquaculture.

Targeting Hypertension: Working with Rural Barbershops to Identify Hypertension and Encourage Treatment.

INTRODUCTION: Cardiovascular disease (CVD), accounting for one in every four U.S. deaths, has had a devastating impact on Mississippi's African American population. Seeking innovative mitigation models, this study assesses CVD prevalence and reach via barbershops to rural Mississippi African Americans. METHODS: Data was collected from barbershop clientele who consented to be screened and contacted for referral to clinical care if blood pressure was found to be elevated. RESULTS: Most participants were African American (97.7%, n=2,756) and male (54.4%). Descriptive findings revealed more than one-third of participants (34.2%) had elevated blood pressure at screening. Factoring in those with hypertension in control, we found lower rates of hypertension in the male population (males 51.4% vs. females 57.8%), a sharp contrast to national rates. CONCLUSION: Evaluation findings suggest CVD prevalence in rural Mississippi is comparatively high but that barbershop partners were able to successfully reach and screen the target population.

The Mississippi Delta Health Collaborative Medication Therapy Management Model: Public Health and Pharmacy Working Together to Improve Population Health in the Mississippi Delta.

INTRODUCTION: The Mississippi Delta has high rates of chronic disease and is known for its poor health outcomes and health disparities. The University of Mississippi School of Pharmacy (UMSOP) and the Mississippi State Department of Health partnered in 2009 through the Mississippi Delta Health Collaborative to reduce health disparities and improve clinical outcomes by expanding the UMSOP's evidence-based medication therapy management (MTM) initiative, focused in Mississippi's 18-county Delta region, to federally qualified health centers (FQHCs) in 4 of those counties. METHODS: Between January 2009 and August 2018, the MTM initiative targeted FQHC patients aged 18 years or older with a diagnosis of diabetes, hypertension, and/or dyslipidemia. Pharmacists initially met face-to-face with patients to review all medications, provide education about chronic diseases, identify and resolve drug therapy problems, and take appropriate actions to help improve the effectiveness of medication therapies. Clinical parameters evaluated were systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and hemoglobin A1c (HbA1c). RESULTS: The analysis included 335 patients with hypertension (n = 287), dyslipidemia (n = 131), and/or diabetes (n = 331). Significant mean reductions occurred in the following metrics: SBP (7.1 mm Hg), DBP (6.3 mm Hg), LDL cholesterol (24.9 mg/dL), triglycerides (45.5 mg/dL), total cholesterol (37.7 mg/dL), and HbA1c (1.6% [baseline ≥6%] and 1.9% [baseline ≥9%]). CONCLUSION: Despite the cultural and environmental disadvantages present in the Mississippi Delta, the integrated MTM treatment program demonstrated significant health improvements across 3 chronic diseases: hypertension, dyslipidemia, and diabetes. This model demonstrates that a partnership between public health and pharmacy is a successful and innovative approach to care.

Fatigue, Physical and Functional Mobility, and Obesity in Pediatric Cancer Survivors.

BACKGROUND: Survivors of childhood cancer are prone to an increased risk of chronic issues such as cardiovascular disease, fatigue, weight-related problems, and emotional disturbances. OBJECTIVE: This study utilized the biopsychosocial model to examine the hypothesis that greater depression and lower mobility would be significantly associated with greater fatigue and higher body mass index in survivors of childhood cancer. METHODS: Data were analyzed for 144 children treated and followed up for an oncology condition at a southeastern academic medical center. Voluntarily, children completed the Patient-Reported Outcomes Measurement Information System 1.0, and parents completed the Family Symptom Inventory as part of a brief annual psychosocial screening battery. Height and weight were collected by a clinic nurse prior to questionnaire completion. RESULTS: Hierarchical linear regression showed that shorter time since diagnosis (ß = -.154, P < .05), greater child-reported depression (ß = .396, P < .01), and lower mobility (ß = .427, P < .01) significantly predicted greater fatigue (adjusted R = 0.54). Older age (ß = .262, P < .01) and not receiving chemotherapy (ß = -.209, P < .05) significantly predicted higher body mass index (adjusted R = 0.051). CONCLUSIONS: Findings showed that fatigue tends to improve over time after treatment but may be predicted by greater depression symptoms and lower mobility in recent survivors of childhood cancer. IMPLICATIONS FOR PRACTICE: For survivors of childhood cancer with higher levels of fatigue, treating symptoms of depression and maximizing physical and mobility may be of clinical value. With the impact of psychological and social factors not yet understood in pediatric cancer survivors, weight status in recent survivors of childhood cancer is likely a complex interaction between biological and treatment factors.

The effect of educational workshop on emergency department nurses' self-efficacy in patient training.

OBJECTIVE: Self-efficacy is an individual's self-perception of one's ability to perform competently and to achieve a task or goal effectively. In the nursing field, self-efficacy can be useful in predicting performance, job satisfaction, or well-being. Therefore, due to the importance of this issue, this study aimed to determine the effect of educational workshop on nurses' self-efficacy along with follow-up in patient training. METHODS: The study employed a single group quasi-experimental study with a pretest/posttest design and was conducted in one educational hospital supervised by the Kerman University of Medical Sciences in 2016. Nurses' self-efficacy was analyzed through a researcher-made questionnaire prior and after the workshop and along with the follow-up period (n = 20). Data were analyzed using descriptive statistics including mean and standard deviation and analytic statistics such as Pearson correlation coefficient, independent t-test, paired t-test, and ANOVA with P ≤ 0.05. RESULTS: This study showed that 1 month after educational workshop, the score of self-efficacy dimensions increased (P < 0.05). Furthermore, results showed that after a 3-month follow-up period, self-efficacy score increased in comparison to preintervention self-efficacy score. Results showed that the total score means of self-efficacy before the workshop was 59.01 ± 14.91 while postworkshop, self-efficacy score means was 79.83 ± 11.90. CONCLUSION: The present research results presented that educational workshop may enhance self-efficacy among nurses. According to the obtained results, it is recommended that the Ministry of Health, Treatment and Medical Training, in cooperation with nursing institutions responsible for nursing and medical in-service education adopt necessary measures to enhance self-efficacy among employees in addition to improving patient training condition at medical processes through similar workshops or conducting related studies.

Novel edible oil sources: Microwave heating and chemical properties.

The aim of this work was to investigate the effect of various microwave heating times (1, 3, 5, 10, and 15min) on the chemical properties of novel edible oil sources, including Mashhadi melon (Cucumis melo var. Iranians cv. Mashhadi), Iranian watermelon (Citrullus lanatus cv. Fire Fon), pumpkin (Cucurbita pepo subsp. pepo var. Styriaca), and yellow apple (Malus domestica cv. Golden Delicious) seed oils. The evaluated parameters were peroxide value (PV), conjugated diene (CD) and triene (CT) values, carbonyl value (CV), p-anisidine value (AnV), oil stability index (OSI), radical scavenging activity (RSA), total tocopherols, total phenolics, as well as chlorophyll and carotenoid contents. Results showed that extended microwave heating involves decreased quality of the seed oils, mainly due to the formation of primary and secondary oxidation products. Microwave heating time also affects the total contents of chlorophylls, carotenoids, phenolics and tocopherols, which clearly decrease by increasing the exposure time. The order of oxidative stability of the analyzed edible oils was pumpkin>Mashhadi melon>Iranian watermelon>yellow apple. The obtained results demonstrated the promising potential of these novel edible oils for different food applications.

Indoleamine 2,3-Dioxygenase Is Dispensable for The Immunomodulatory Function of Stem Cells from Human Exfoliated Deciduous Teeth.

OBJECTIVE: In this study, we sought to better understand the immunoregulatory function of stem cells derived from human exfoliated deciduous teeth (SHED). We studied the role of the interferon gamma (IFN-γ)-indoleamine 2,3-dioxygenase (IDO)-axis in immunoregulation of SHED compared to bone marrow derived mesenchymal stem cells (BMMSCs) under the same conditions. MATERIALS AND METHODS: In this cross-sectional study, recently isolated human T cells were stimulated either by mitogen or inactivated allogeneic peripheral blood mononuclear cells (PBMCs). These T cells were subsequently co-cultured with, either SHED or BMMSCs in the presence or absence of 1-methyl-tryptophan (1-MT) or neutralizing anti- human-IFN-γ antibodies. In all co-cultures we evaluated lymphocyte activation as well as IDO activity. RESULTS: SHED, similar to conventional BMMSCs, had anti-proliferative effects on stimulated T cells and reduced their cytokine production. This property of SHED and BMMSCs was changed by IFN-γ neutralization. We detected IDO in the immunosuppressive supernatant of all co-cultures. Removal of IDO decreased the immunosuppression of BMMSCs. CONCLUSION: SHED, like BMMSCs, produced the IDO enzyme. Although IFN-γ is one of inducer of IDO production in SHED, these cells were not affected by IFN-γ in the same manner as BMMSCs. Unlike BMMSCs, the IDO enzyme did not contribute to their immunosuppression and might have other cell-type specific roles.

Comparing the immunoregulatory effects of stem cells from human exfoliated deciduous teeth and bone marrow-derived mesenchymal stem cells.

Stem cells from human exfoliated deciduous teeth (SHED) have been introduced recently and possess characteristics similar to mesenchymal stem cells (MSCs). Because of their convenient accessibility and safety of harvest, SHED can be a preferable source for the ever-increasing MSCs' applications  While they are new, their immunoproperties have not been adequately studied. In this study, we aimed to explore the effect of SHED on T lymphocytes and compare it to conventional MSCs (BMMSCs).At first the isolated T lymphocytes were activated specifically/nonspecifically in vitro and cocultured with SHED or BMMSCs under the same conditions, subsequently their proliferation and cytokine secretion (IL-2 and IFN-γ) were measured.In our experiment, BMMSCs and SHED inhibit the proliferation and cytokine production of both PHA and alloantigen stimulated T lymphocytes in a dose-dependent manner. In direct and indirect contact to T lymphocytes, the inhibition of BMMSCs (but not of SHED) was significantly different The cytokine production from activated T cells was affected differently by two types of MSCs. The inhibition decreased by the separation of lymphocytes and MSCs by a semipermeable membrane, but it was not abolished.This study showed that SHED suppress the activation of human T lymphocytes in vitro like other MSCs. Compared to BMMSCs, this suppression was alleviated. In the equal conditions, the pattern of immune-modulation of BMMSCs and SHED was different, suggesting that SHED do not exert the exact mechanisms of BMMSCs' immunosuppression., This finding should be verified by further studies focused on the detailed mechanisms  of the immunomodulation of SHED and also BMMSCs.

A new, efficient, and simple method for the one-pot synthesis of alpha-acetoxyphosphonates from aldehydes under solvent-free conditions.

A simple, efficient, and new method has been developed for the synthesis of alpha-acetoxyphosphonates from aldehydes through a one-pot reaction of aldehydes with diethylphosphite in the presence of acetic anhydride under solvent-free conditions using magnesium oxide. This method is easy, rapid, and high yielding for the one-pot synthesis of alpha-acetoxyphosphonates from aldehydes.

A randomized, double-blind, placebo-controlled trial of concomitant pilocarpine with head and neck irradiation for prevention of radiation-induced xerostomia.

BACKGROUND: Xerostomia is one of the disturbing side-effects of radiotherapy to the head and neck region. Pilocarpine has been approved for the treatment of this condition in the chronic phase, but its use concurrent with radiation could also be beneficial for prevention or reduction of the subsequent radiation-induced xerostomia. We undertook to test this hypothesis in a clinical trial. METHODS: At the start of radiotherapy, randomization was performed to either pilocarpine 5 mg three times daily or placebo in a double-blind setting. The drug was started with irradiation and continued until 3 months after the end of radiotherapy. Xerostomia was evaluated 6 months after the end of radiation by a subjective visual analog scale questionnaire. Also the objective grade of xerostomia was recorded by two separate observers. RESULTS: A total number of 60 patients were randomized into the trial, but unfortunately only 39 patients were finally evaluated for xerostomia, 18 in the pilocarpine and 21 in the placebo group. Mean age was 42 years, and mean parotid dose was 58 Gy. Mean subjective xerostomia was 40.3 mm in the pilocarpine group and 57 mm in the placebo group (P = 0.02). Also mean objective xerostomia grade was 2.2 in the pilocarpine group and 2.6 in the placebo group (P = 0.01). Subjective and objective xerostomia results were positively correlated (P = 0.01). Age and the parotid dose did not have a significant effect on xerostomia. CONCLUSIONS: Compared to placebo, pilocarpine used with radiotherapy could lead to a significant diminishment of subsequent radiation-induced xerostomia.