Obstetric History And Sexual Health Screening Among Sexual Minority Women

Sexual minority women (SMW) face multiple barriers to sexual and reproductive health care including cervical cancer screening and sexually transmitted infection (STI) screening. Despite beliefs that they are not at risk for STIs or cervical cancer, most SMW should be screened according to standard clinical guidelines. Aspects of obstetric history, including pregnancy, birth, and elective termination, may represent opportunities for these two types of screening. Guided by intersectionality theory, we reviewed the existing literature for evidence that health care experiences may be correlates to cervical cancer screening among SMW. The review identified important healthcare experience factors, including hormonal contraceptive use, pregnancy history, provider-recommended cervical cancer screening, previous discrimination in health care settings, and disclosing one’s sexual orientation to providers. We then performed secondary analyses employing cross-sectional data from the Chicago Health and Life Experiences of Women (CHLEW) Study, a diverse sample of SMW. The primary aim was to examine associations between obstetric history and the outcomes of cervical cancer and STI screening. In our final logistic regression model of cervical cancer screening, older age was associated with decreased odds (β 0.98, p\u3c0.01) of past year Pap testing. Having health insurance (β 1.72, p\u3c0.01) and being Black/African American (β 1.61, p\u3c0.05) were associated with increased odds of past year Pap testing. Variables significantly associated with increased odds of STI testing included higher numbers of lifetime sex partners (β 6.07, p \u3c0.0001 for the highest quartile group), and being bisexual (β 3.13, p\u3c0.0001). An annual income ≥$75,000 was associated with decreased odds of STI testing compared to an income of \u3c$15,000 (β 0.41, p 0.004). Decision tree analysis revealed the significance of age at coming out, early sexual initiation, and early drinking on the two screening outcomes; the models also identified specific subgroups of SMW that were less likely to report Pap testing, including SMW over 60 years old. Overall, our findings suggest the need for primary, longitudinal studies of SMW’s sexual and reproductive health. They also illustrate the significance of developmental milestones on later sexual health outcomes, and support the validity of intersectionality theory in investigating cervical cancer screening among SMW

Clinical Fellowship for an Innovative, Integrated BSN-PhD Program: An Academic and Practice Partnership

Opportunities for research-focused doctoral education must be available to nurses early in their careers in order to ensure the further development of nursing science. Early entry into the research doctorate through an integrated BSN-PhD program is one innovative approach. This approach highlights the value of integrating post-licensure clinical training into the doctoral curriculum. To better prepare innovative nurse scientists early in their careers we developed a clinical nurse fellowship within an integrated BSN-PhD program in partnership with an affiliated health system. The aims of this clinical fellowship are to integrate post-licensure clinical experience with academic preparation, cultivate scholarly reflection on the connections between research and practice, educate nurse researchers to work effectively in interdisciplinary teams, and develop nurses\u27 contributions to health care innovation. Major considerations for the development of similar clinical training opportunities include clarifying and articulating the major aims of the fellowship, enlisting the support of executive clinical leadership, and placing fellows on nursing units with experienced and advanced nursing teams and management that supports the fellowship\u27s aims. We emphasize the fully integrated and collaborative activities, decision-making, and commitment required of both academic and health system partners to successfully implement similar clinical training opportunities

Parent-Child Sex Communication Prompts, Approaches, Reactions, and Functions According to Gay, Bisexual, and Queer Sons

Minimal research on parent-child sex communication between parents and gay, bisexual, and queer (GBQ) adolescent sons prevents the formulation of interventions that would buffer or brake this youth population’s risks for HIV/STI. We sought to describe the perspectives of GBQ adolescent males on this process and the potential ways they think parents can address their sons’ informational needs, including countering youth access of sexually explicit media. We conducted 30 semi-structured interviews with GBQ male youth aged 15–20 years. Thematic and content analysis revealed four central themes: prompts and triggers, parents’ approaches, sons’ reactions, and the functions assigned to sex communication. Parents can be sources of reliable sexual health information and may be leveraged for future HIV/STI risk reduction work

Predicting cervical cancer screening among sexual minority women using Classification and Regression Tree analysis

Cervical cancer screening is a critical preventive healthcare service for all women. Sexual minority women (SMW) in the United States experience multiple health disparities including decreased access to and use of cervical cancer screening. The mechanisms driving these disparities are not clear and SMW with multiple marginalized identities may be more likely to miss recommended cervical cancer screening. This study aimed to identify subgroups of SMW that are more and less likely to be screened for cervical cancer according to American Cancer Society guidelines. We used cross-sectional data from the latest (2010–2012) wave of the Chicago Health and Life Experiences of Women (CHLEW) Study (N = 691). Informed by intersectionality theory, we performed classification and regression tree (CART) modeling to construct a data-driven, predictive model of subgroups of SMW who were more and less likely to receive guideline-recommended screening. Notably, the CART model did not include commonly tested variables such as race/ethnicity or level of income or education. The model did identify subgroups with low likelihood of receiving screening and several novel variables that may be important in understanding SMW's use of cervical cancer screening; lifetime number of sexual partners, age at drinking onset, childhood physical abuse, and internalized homonegativity. Our results point to the importance of early life experiences and identity development processes in shaping patterns of preventive healthcare use among adult SMW. Our analysis also demonstrated the potential value of CART modeling techniques for evaluating how multiple variables interact in complex ways to predict cervical cancer screening

Tumor Stiffness Is Unrelated to Myosin Light Chain Phosphorylation in Cancer Cells

<div><p>Many tumors are stiffer than their surrounding tissue. This increase in stiffness has been attributed, in part, to a Rho-dependent elevation of myosin II light chain phosphorylation. To characterize this mechanism further, we studied myosin light chain kinase (MLCK), the main enzyme that phosphorylates myosin II light chains. We anticipated that increases in MLCK expression and activity would contribute to the increased stiffness of cancer cells. However, we find that MLCK mRNA and protein levels are substantially less in cancer cells and tissues than in normal cells. Consistent with this observation, cancer cells contract 3D collagen matrices much more slowly than normal cells. Interestingly, inhibiting MLCK or Rho kinase did not affect the 3D gel contractions while blebbistatin partially and cytochalasin D maximally inhibited contractions. Live cell imaging of cells in collagen gels showed that cytochalasin D inhibited filopodia-like projections that formed between cells while a MLCK inhibitor had no effect on these projections. These data suggest that myosin II phosphorylation is dispensable in regulating the mechanical properties of tumors.</p> </div

Analysis of MLCK expression in normal and cancer tissues.

<p>Quantitative PCR (A) and western blot (B) analyses of normal and cancer tissues. RNA was isolated from various normal and cancer tissues and total MLCK (A), including all splice variants of nmMLCK and smMLCK, was detected using primers targeting exons 26 and 27. The gene for H3F3A was used as an internal control in all experiments. The data in Panel A depict the averages of qPCR analyses performed in triplicate and the error bars show the standard deviation. Panel B shows a western blot analysis using affinity purified antibodies to MLCK. GAPDH was used as a loading control.</p

Effect of inhibitors on 3D gel contractions.

<p>HUF (left) and HeLa (right) cells were grown in 3D cultures and treated with inhibitors as described. The gels were photographed 24 hrs later and the surface area of the individual gels was quantified. The data represent the mean +SEM. One way ANOVA * = p value < 0.05, *** = p value < 0.001.</p