Evaluation of Health Information Websites on Labor and Birth

The Internet is a leading source of information for women during pregnancy with 99% of pregnant women accessing web-based health information related to pregnancy and birth weekly (Declercq, Sakala, Corry, Applebaum, & Herrlich, 2013b). A plethora of information on birth is available through the Internet (Daniels & Welder, 2015; Jolivet & Corry, 2010; Lothian, 2008), yet there are no guidelines or recommendations to direct women to credible websites to prepare for an in-hospital birth. In general, providers are unaware of the health sites their patients access (Martin & Robb, 2013; Weston & Anderson, 2014). There is a need for evidence to inform providers regarding websites they can confidently recommend to patients. The literature is lacking studies that have evaluated health information websites, specifically those related to women’s health. The purpose of this DNP project was to critically evaluate websites pregnant women commonly used for labor and birth information, identify areas in which websites are deficient, and provide information to fill the gap. Websites were evaluated using Health Information Technology Institute (HITI) criteria, Flesch reading ease scale, and Flesch-Kincaid grade level. Content on induction of labor (IOL) and pain management was evaluated based on current, evidence-based information. Although government websites met the majority of the criteria, no website met all target criteria. Therefore, I created a model website using HITI and readability criteria with evidence-based content on IOL and pain management during labor and birth. Feedback on the website by a sample of stakeholders (n = 9) was positive. The project adds to the literature by providing evaluative information about health information websites used by pregnant women seeking information about labor and birth. Providers can utilize the results of the project to formulate recommendations about the most credible websites for their patients. While there is currently no perfect website, this evaluation notes that government websites provided the highest quality information. This project highlights the need for additional evaluation of websites used by pregnant women and the need for discussions between women and providers on Internet use in order for providers to confidently guide patients to accurate and complete information.Doctor of Nursing Practic

Gender, marginalised groups, and young people’s mental health: a longitudinal analysis of trajectories

Background Individuals from marginalised groups experience higher levels of mental health difficulties and lower levels of wellbeing which may be due to the exposure to stress and adversity. This study explores trajectories of mental health over time for young women and girls and young people with other marginalised identities.Methods We conducted a secondary analysis on N=14,215 children and young people (7,501 or 52.8% female, 6,571 or 46.2% male, and 81 or 0.6% non-binary or questioning) who completed a survey at age 11 to 12 years and at least one other annual survey aged 12 to 13 years and/or aged 13 to 14 years. We used group-based trajectory models to examine mental health difficulties.Results Except for behavioural difficulties, young women’s and girls’ trajectories showed that they consistently had higher levels of mental health difficulties compared to young men and boys. A similar pattern was shown for nonbinary and questioning children and young people. Children and young people with economic disadvantage and/or special education needs, and/or for whom there were welfare concerns, were generally more likely to experience higher levels of mental health difficulties.Conclusions This information could inform public policy, guidance and interventions

Instrumentation issues in implementation science

Background Like many new fields, implementation science has become vulnerable to instrumentation issues that potentially threaten the strength of the developing knowledge base. For instance, many implementation studies report findings based on instruments that do not have established psychometric properties. This article aims to review six pressing instrumentation issues, discuss the impact of these issues on the field, and provide practical recommendations. Discussion This debate centers on the impact of the following instrumentation issues: use of frameworks, theories, and models; role of psychometric properties; use of ‘home-grown’ and adapted instruments; choosing the most appropriate evaluation method and approach; practicality; and need for decision-making tools. Practical recommendations include: use of consensus definitions for key implementation constructs; reporting standards (e.g., regarding psychometrics, instrument adaptation); when to use multiple forms of observation and mixed methods; and accessing instrument repositories and decision aid tools. Summary This debate provides an overview of six key instrumentation issues and offers several courses of action to limit the impact of these issues on the field. With careful attention to these issues, the field of implementation science can potentially move forward at the rapid pace that is respectfully demanded by community stakeholders

The Somatic Genomic Landscape of Chromophobe Renal Cell Carcinoma

We describe the landscape of somatic genomic alterations of 66 chromophobe renal cell carcinomas (ChRCCs) based on multidimensional and comprehensive characterization, including mitochondrial DNA (mtDNA) and whole genome sequencing. The result is consistent that ChRCC originates from the distal nephron compared to other kidney cancers with more proximal origins. Combined mtDNA and gene expression analysis implicates changes in mitochondrial function as a component of the disease biology, while suggesting alternative roles for mtDNA mutations in cancers relying on oxidative phosphorylation. Genomic rearrangements lead to recurrent structural breakpoints within TERT promoter region, which correlates with highly elevated TERT expression and manifestation of kataegis, representing a mechanism of TERT up-regulation in cancer distinct from previously-observed amplifications and point mutations

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Understanding the impact of gender identity nonaffirmation: The mediating role of psychological needs thwarting

Transgender and gender nonconforming (TGNC) people report high levels of violence, discrimination, and stigma, and this has repeatedly been linked to mental health problems (Testa et al., 2015). However, research examining the general psychological processes underpinning these relationships is in its infancy. Combining understanding from the gender minority stress and resilience model (Testa et al., 2015), Hatzenbuehler’s (2009) integrative mediation framework and basic psychological need theory (Ryan & Deci, 2017), we investigated psychological needs thwarting (i.e., thwarted competence, relatedness, and autonomy) as intermediary variables in the relationship between a specific type of TGNC discrimination—gender identity nonaffirmation—and psychological distress and life satisfaction outcomes. We based this model on a two-wave longitudinal panel design where data were obtained from 454 TGNC people living in England, who participated in surveys on two measurement occasions, 12 months apart. Autoregressive analysis revealed that thwarted competence mediated the relationship between gender identity nonaffirmation and depression (β = .05, SE = 0.02, p = .021), stress (β = .05, SE = 0.02, p = .021), and life satisfaction (β = −.05, SE = 0.02, p = .034); thwarted autonomy mediated the relationship between nonaffirmation and depression (β = .03, SE = 0.02, p = .049) and life satisfaction (β = −.04, SE = 0.02, p = .049); and thwarted relatedness mediated the relationship between nonaffirmation and depression (β = .05, SE = 0.02, p = .039). We discuss practical and theoretical implications for the fields of gender minority stress, basic psychological need theory, and TGNC mental health

Understanding factors that affect wellbeing in trans people “later” in transition: a qualitative study

PurposeAlthough cross-sectional studies have demonstrated that trans people present with lower quality of life and wellbeing than the general population, few studies have explored the factors associated with this, particularly in those who have medically transitioned some time ago. This paper aims to fill the gap in the literature on what factors are associated with wellbeing in trans people who initiated medical transition some time ago.MethodsThis study used semi-structured one-to-one interviews with 23 participants to investigate the factors that impact upon the wellbeing of trans people, who had initiated Gender Affirming Medical Treatment (GAMT) five or more years ago. The content of the interviews was analysed with an inductive, grounded theory approach to identify common themes within the interviews.ResultsThe four themes identified include some consistencies with cisgender populations (while being viewed through the lens of trans experience), as well as those more specific to the trans experience. Together these themes were: Interactions with healthcare services, Seeking societal acceptance, Quality of social support, The ‘double-edged sword’ of media and social media. Each of the themes identifies a factor that participants highlighted as impacting, either positively or negatively, on their wellbeing.ConclusionsThe results highlight the importance of social support, protective legislations, awareness of trans issues in the general public, and the need of improving the knowledge held by non-specialist healthcare providers.</div

Additional file 1 of Gender, marginalised groups, and young people’s mental health: a longitudinal analysis of trajectories

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