The COVID-19 pandemic has inflicted structural damage to public health systems that we cannot yet fully comprehend. Although much attention is now paid to COVID-19 issues of social and economic ...upheaval, public health nurses remain focused on the cracks in health care's foundation-such as the slow drip of resignations, revenue loss, and rural clinic closures-that are steadily undermining our country's ability to provide health services to all citizens. Nurses, the "health care heroes" celebrated at the start of the pandemic, remain "inside the house," and they can see the direct causal relationships between health system breakdowns and the global disruptions making headlines today.Frontline heroes can be system experts too. And yet, the visibility of nurses in public health policy remains woefully lacking. Despite nursing being the largest health care profession, chief nursing officers account for only about 0.8% of voting power on hospital boards, and nurses make up about 2.3% of voting power on community health boards.1 The National Academy of Medicine's 2021 Future of Nursing Report 2020-2030 (https://bit.ly/3NhiuJh) highlights this staggering dichotomy between nurses' presence in health systems and their representation in roles of influence. The National Academy of Medicine underscores the needs not only to invest in nursing education and practice but to cultivate the leadership potential of nurses as well.2Two articles in this special issue of AJPH (Zauche et al., p. S226; Morone et al., p. S231) describe the public health leadership roles nurses assumed duringthe pandemic, and both reach similar conclusions: the visibility of public health nurses must continue to grow. Florence Nightingale is widely acknowledged for her leadership both in the design of care and in measuring population health outcomes and instituting public health interventions. Despite Florence's legacy, the contributions of public health nurses have been largely overshadowed by prominent figures in medicine and epidemiology. A key focus of this special issue is to understand why.
Historically, cosmopolitan phytoplankton species were presumed to represent largely unstructured populations. However, the recent development of molecular tools to examine genetic diversity have ...revealed differences in phytoplankton taxa across geographic scales and provided insight into the physiology and ecology of blooms. Here we describe the genetic analysis of an extensive bloom of the toxic dinoflagellate Alexandrium fundyense that occurred in the Gulf of Maine in 2005. This bloom was notable for its intensity and duration, covering hundreds of kilometers and persisting for almost two months. Genotypic analyses based on microsatellite marker data indicate that the open waters of the northeastern U.S. harbor a single regional population of A. fundyense comprising two genetically distinct sub-populations. These subpopulations were characteristic of early- and late-bloom samples and were derived from the northern and southern areas of the bloom, respectively. The temporal changes observed during this study provide clear evidence of succession during a continuous bloom and show that selection can act on the timescale of weeks to significantly alter the representation of genotypes within a population. The effects of selection on population composition and turnover would be magnified if sexual reproduction were likewise influenced by environmental conditions. We hypothesize that the combined effects of differential growth and reproduction rates serves to reduce gene flow between the sub-populations, reinforcing population structure while maintaining the diversity of the overall regional population.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
To review factors that impact the effect of hot environments on the human body in order to develop a conceptual model of human biological response.
Methods
The organizing concept for the ...model development was the multilevel integration of three major factors, exposure to heat, sensitivity and adaptive capacity, and the heat stress response. Exposure of a vulnerable occupational group was used to illustrate the components of the model.
Findings
Components of this framework include the hazard (environmental heat stress), vulnerability factors (workplace exposure, sensitivity and adaptive capacity), and the heat stress response. The combination of the vulnerability factors of workplace exposure (work intensity, duration), sensitivity (age, gender, etc.), and adaptive capacity (hydration, clothing, work hygiene) mediate a worker's heat stress response to the hazard. A worker's heat stress response can be classified as progressing towards two outcomes: physiologic equilibrium or physiologic disequilibrium.
Conclusions
This framework provides a starting point for the design and development of studies of heat‐related illness (HRI) in farmworker and other vulnerable populations exposed to rising global temperatures.
Clinical Relevance
Identification of vulnerability factors to HRI, informs research designs which will lead to the development of public health interventions.
Forum papers are thought-provoking opinion pieces or essays founded in fact, sometimes containing speculation, on a civil engineering topic of general interest and relevance to the readership of the ...journal. The views expressed in this Forum article do not necessarily reflect the views of ASCE or the Editorial Board of the journal.
Phillips Jr et al discuss a report From the National Academies of Sciences, Engineering, and Medicine concerning the implementation of high-quality primary care. Twenty-seven years ago, the Institute ...of Medicine launched a primary care consensus study that, at the time, seemed highly aligned with the country's appetite for health reform and managed care. Primary Care: America's Health in a New Era produced a primary care definition still used around the world; however, the report's recommendations received no traction in the US. Similarly, a 2012 Institute of Medicine report on the integration of primary care and public health largely went unheeded. While primary care is uniquely positioned to support COVID-19 testing, tracing, and vaccination and to help address pervasive health and social inequities, primary care was not considered in congressional relief packages in 2020 and many practices may be closed when they are needed most.
Nursing and Public Health Special Issue McCauley, Linda A; Waters, Catherine M; Monsen, Karen A
American journal of public health (1971)
112, Številka:
S3
Journal Article
Recenzirano
Odprti dostop
In this AJPH special issue, "Nursing and Public Health," nurses and their colleagues share novel practice insights, cutting-edge research findings, educational guidance, and urgent calls to action ...for nurses and everyone working in public health and health care today. The articles showcase nursing research, leadership, education, and practice responsesto critical public health challenges, such as the climate crisis, the COVID-19 pandemic, trauma and related issues, and workforce needs.
This specialissue of AJPH on nursing and public health celebrates a long history of nursing aimed to protect, promote, and improve public health. According to a 1926 AJPH editorial, 1 885 may have ...been the first year a graduate nurse was employed in a public health setting (https://bit.ly/37ZtUl0). Nurses were actively involved in the American Public Health Association (APHA), formally launching the APHA Public Health Nursing section of AJPH a centuryago, in 1922.
•Paper explores barriers to a universal DNP requirement for advanced practice nurses•Includes cost analysis and perceptions of the DNP in today's professional environment•Offers insight to help ...facilitate the implementation of a universal DNP standard
In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry.
The purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs.
Deans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education.
This paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition.
This paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.
OBJECTIVE:Recent findings suggest that laboring in hot occupational environments is related to kidney damage in agricultural workers. We examined hydration status and kidney function in 192 Florida ...agricultural workers.
METHODS:Blood and urine samples were collected over 555 workdays during the summers of 2015 and 2016. Urine-specific gravity (USG), serum creatinine, and other kidney function markers were examined pre- and post-shift on each workday. Multivariable mixed modeling was used to examine the association of risk factors with hydration status and acute kidney injury (AKI).
RESULTS:Approximately 53% of workers were dehydrated (USG ≥1.020) pre-shift and 81% post-shift; 33% of participants had AKI on at least one workday. The odds of AKI increased 47% for each 5-degree (°F) increase in heat index.
CONCLUSION:A strikingly high prevalence of dehydration and AKI exists in Florida agricultural workers.
Monocyte chemoattractant protein 1 (CCL2) is a recently identified prominent regulator of prostate cancer growth and metastasis. The purpose of this study was to investigate the mechanistic role of ...CCL2 in prostate cancer growth in bone. The present study found that CCL2 was up-regulated in osteoblasts (3-fold by PC-3 and 2-fold by VCaP conditioned medium) and endothelial cells (2-fold by PC-3 and VCaP conditioned medium). Parathyroid hormone-related protein (PTHrP) treatment of osteoblastic cells up-regulated CCL2 and was blocked by a PTHrP antagonist, suggesting that prostate cancer-derived PTHrP plays an important role in elevation of osteoblast-derived CCL2. CCL2 indirectly increased blood vessel formation in endothelial cells through vascular endothelial growth factor-A, which was up-regulated 2-fold with administration of CCL2 in prostate cancer cells. In vivo, anti-CCL2 treatment suppressed tumor growth in bone. The decreased tumor burden was associated with decreased bone resorption (serum TRAP5b levels were decreased by 50-60% in anti-CCL2-treated animals from VCaP or PC-3 cell osseous lesions) and microvessel density was decreased by 70% in anti-CCL2-treated animals with bone lesions from VCaP cells. These data suggest that a destructive cascade is driven by tumor cell-derived, PTHrP-mediated induction of CCL2, which facilitates tumor growth via enhanced osteoclastic and endothelial cell activity in bone marrow. Taken together, CCL2 mediates the interaction between tumor-derived factors and host-derived chemokines acting in cooperation to promote skeletal metastasis.
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