Trauma-Informed Primary Care Education in a Military Heath Care Clinic

Background: Military service members and their families are a unique population that faces stressors at an increased rate in a distinctive environment. Trauma-informed primary care provides a holistic, person-centered approach to health care that acknowledges past trauma universally. Practitioners who specialize in trauma-informed care promote health, healing, and recovery from trauma and its effect on diseases and disorders. Purpose: The purpose of this project is to educate clinic staff about trauma-informed primary care and to provide licensed independent providers universal client educational materials about the effects of trauma on health. Methods: Pre- and post-intervention surveys were used to evaluate affinity for and understanding of trauma-informed primary care. The intervention was comprised of two educational videos. Next, the providers were given universal client education sheets for their clients. A third survey was sent to the providers that included a self-reported rate of distribution. Results: Fifteen clinic staff members participated in the educational intervention. Staff reported improved affinity for trauma-informed primary care, with a mean practice improvement of 3.64 (p \u3c .001). The providers continued to improve their affinity for trauma-informed primary care. However, they did not significantly increase their use of the universal client education sheet. Conclusion: Educating staff about trauma-informed primary care increases affinity for this type of approach. However, it did not increase the providers use of a universal client education sheet. In this project, this may be a significant change in practice that needs to evolve over more time with greater affinity for trauma-informed primary care

Cervical Cancer in Cameroon: A Three Pronged Approach to Increase Awareness, Vaccination, Screening and Treatment

Problem: Cameroon has a disproportionately high burden of cervical cancer due to low awareness that the disease is preventable with prophylactic vaccines, lack of screening and treatment of pre-cancerous lesions, and high prevalence of human immunodeficiency virus (HIV). Between 2007-2013, the Cameroon Baptist Convention Health Services (CBCHS) devised three programs to: (1) increase awareness about cervical cancer; (2) immunize girls aged 9-13 years against human papilloma virus (HPV); and (3) conduct cervical cancer screening and treatment. Approaches: In collaboration with clinicians and researchers at University of Massachusetts and Northeastern University, CBCHS conducted education programs about HPV vaccine and cervical cancer for parents, adolescents, health care workers, and community members. The HPV vaccination demonstration project was implemented in three settings: schools, healthcare facilities, and in communities. CBCHS conducted cervical cancer screening in six sites using a “see and treat approach”. Findings: Following approval by the Ministry of Health, CBCHS nurses educated girls, parents, and communities about HPV, cervical cancer, and HPV vaccine through multimedia coverage. A total of 6,851, 6,517 and 5,876 girls were immunized with first, second and third doses, respectively. Achieving an 84.6% 3-dose completion rate. Since 2007, 30,617 women have been screened with visual inspection with acetic acid and digital cervicography. Women with precancerous lesions were treated with cryotherapy or loop electrical excision procedure. Lesions suspicious for cancer were biopsied for histology. Of those screened, 3,015 (10%) self reported HIV-positivity, 19,837 (64%) were HIV-negative, and the HIV status of the remaining women was unreported (25%). The percentage of HIV infected women diagnosed with cancer was consistently higher than the percentage of HIV uninfected women diagnosed with cancer. Lessons Learned: The project demonstrated that, with adequate education of stakeholders, HPV vaccination and cervical cancer screening programs are acceptable and feasible methods to improve cervical cancer outcomes in Cameroon

C-reactive protein, Epstein-Barr virus, and cortisol trajectories in refugee and non-refugee youth: Links with stress, mental health, and cognitive function during a randomized controlled trial.

Experiencing childhood adversity has been associated with significant changes in inflammation, cell-mediated immunocompetence, and cortisol secretion. Relatively few studies have examined, longitudinally, alterations to inflammatory processes during adolescence, especially outside Western contexts; none have evaluated biomarker trajectories for at-risk youth in response to a structured behavioral intervention. We conducted a randomized controlled trial evaluating the efficacy of a humanitarian intervention targeting stress-alleviation, with 12-18 year-old Syrian refugees (n = 446) and Jordanian non-refugees (n = 371) living side-by-side in war-affected communities in Jordan. We measured C-reactive protein (CRP), Epstein-Barr virus antibodies (EBV), and hair cortisol concentration (HCC) at three timepoints (pre/post intervention and 11 month follow-up), and assessed three main outcomes (psychosocial stress, mental health, and cognitive function). Using growth mixture models, regressions, and growth curve models, we identified three distinct trajectories for CRP, two for EBV, and three for HCC, and examined their associations with age, gender, BMI, poverty, and trauma. We found associations with BMI for CRP, refugee status for EBV, and BMI and gender with HCC trajectory. In terms of health outcomes, we found associations between rising CRP levels and perceived stress (B =  -2.92, p = .007), and between HCC hypersecretion and insecurity (B = 7.21, p = .017). In terms of responses to the intervention, we observed no differential impacts by CRP or EBV trajectories, unlike HCC. These results suggest that commonly-assayed biomarkers do not associate with health outcomes and respond to targeted interventions in straightforward ways. Our study is the first to examine multiple biomarker trajectories in war-affected adolescents, in order to better evaluate the extent, timing, and malleability of the biological signatures of poverty, conflict, and forced displacement

The cycle of substance misuse and victimization

The primary aim of this qualitative research study was to explore women\u27s experiences of sexual assault while under the influence of a substance. The secondary aim was to learn about women\u27s experiences with sexual assault services, specifically sexual assault nurse examiners. A phenomenological approach was chosen to guide the researcher toward an understanding of the meaning of the experience. Data was gathered using individual, in-depth interviews with eight women. The data was analyzed to discover what it was like to be sexually assaulted while under the influence. Through analysis and interpretation of the data a theme of struggling to survive was chosen to communicate the meaning of the experience. In addition, a model of a cycle of substance misuse and victimization is offered for consideration. The study findings reveal the complex relationship between the participants\u27 substance use and their victimization. This research points to the need for specific nursing interventions for women who have been sexually assaulted while under the influence and for follow-up programs designed to assist women break the cycle of substance misuse and victimization. The research provides valuable insight into victims\u27 experiences that can be used to advance nursing care to victims of sexual assault

Adverse Childhood Experiences and Chronic Diseases: Identifying a Cut-Point for ACE Scores

Adverse Childhood Experiences (ACEs) contribute to many negative physiological, psychological, and behavioral health consequences. However, a cut-point for adverse childhood experience (ACE) scores, as it pertains to health outcomes, has not been clearly identified. This ambiguity has led to the use of different cut-points to define high scores. The aim of this study is to clarify a cut-point at which ACEs are significantly associated with negative chronic health outcomes. To accomplish this aim, a secondary analysis using data from a cross-sectional study was conducted. The Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used for data collection. Descriptive statistics, nonparametric regression, and logistic regression analyses were performed on a sample of 10,047 adults. Data from demographic and self-report health measures were included. The results showed that a cut-point of four or more ACEs was significantly associated with increased rates of chronic disease. Participants with at least one chronic disease were almost 3 times more likely (OR = 2.8) to be in the high ACE group. A standardized cut-point for ACE scores will assist in future research examining the impact of high ACEs across cultures to study the effect of childhood experiences on health