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Studies have found that youth are experiencing higher anxiety levels than prior to COVID-19, and youth with type 1 diabetes are at higher risk. Medical specialty camps are a type of camp that provide opportunities for youth with chronic illnesses to share common goals, increase socialization, improve camper well-being, and increase knowledge of diabetes management. The program evaluation sought to determine the impact of a campers’ outcomes of independence and perceived competence and familial impact during COVID-19. Over half the participants were at their first diabetes camp and 71% of the campers felt their perceived competence “increased a little bit” because of camp. Over 95% of parents felt that their participation in camp had increased their diabetes knowledge. Qualitative data from parents revealed 2 themes, camp as a meeting place and learning from others. The findings from this study demonstrate that medical specialty camps influence campers’ perceptions of independence and competence and that families play an important role in creating a community of practice.

School nurses are integral to creating safe environments in U.S. schools. Many experienced increased work burden and stress during the COVID-19 pandemic. CDC collaborated with the National Association of School Nurses and the National Association of State School Nurse Consultants to distribute a 121-item online, anonymous survey to school nurses nationwide during March 7-30, 2022. Among the 7,971 respondents, symptoms of depression, anxiety and PTSD, and suicidal ideation were measured, and prevalence ratios were used to identify associations with demographics, workplace characteristics, and support. Results found high levels of work-related stressors and indicated that employment characteristics, COVID-19-related job duties, and other workplace stressors and supports affected school nurse mental health. The survey findings underscore the mental health challenges many school nurses experienced during the 2021/2022 school year. The findings can inform supportive policies and practices to reduce workplace stressors and increase workplace supports for school nurses.

Increases in mental health conditions have been documented among the general population and health care workers since the start of the COVID-19 pandemic (1-3). Public health workers might be at similar risk for negative mental health consequences because of the prolonged demand for responding to the pandemic and for implementing an unprecedented vaccination campaign. The extent of mental health conditions among public health workers during the COVID-19 pandemic, however, is uncertain. A 2014 survey estimated that there were nearly 250,000 state and local public health workers in the United States (4). To evaluate mental health conditions among these workers, a nonprobability-based online survey was conducted during March 29-April 16, 2021, to assess symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation among public health workers in state, tribal, local, and territorial public health departments. Among 26,174 respondents, 53.0% reported symptoms of at least one mental health condition in the preceding 2 weeks, including depression (32.0%), anxiety (30.3%), PTSD (36.8%), or suicidal ideation (8.4%). The highest prevalence of symptoms of a mental health condition was among respondents aged ≤29 years (range = 13.6%-47.4%) and transgender or nonbinary persons (i.e., those who identified as neither male nor female) of all ages (range = 30.4%-65.5%). Public health workers who reported being unable to take time off from work were more likely to report adverse mental health symptoms. Severity of symptoms increased with increasing weekly work hours and percentage of work time dedicated to COVID-19 response activities. Implementing prevention and control practices that eliminate, reduce, and manage factors that cause or contribute to public health workers' poor mental health might improve mental health outcomes during emergencies.

Innovative recreation services, such as non-traditional camps, can help provide diverse youth a chance to engage in physical activity, develop healthy relational skills, and meet others. Twenty-two participants took part in a new, 1-week triathlon camp held on a Mid-Atlantic University campus. Participants were recruited through local parks and recreation agencies and local youth running clubs. Scholarships were given to participants who expressed financial challenges through a USA Triathlon Youth Grant. The 1-week day camp took place on a college campus. The camp served the surrounding neighborhoods, which was accurately represented in the camper demographic (i.e., half the campers were youth of color). During the week, the campers swam, biked, ran, rock climbed, and participated in other multi-sport activities to help develop proper form and skills for triathlon. As guided by the USAT Splash, Spin, Sprint Camp manual, campers participated in daily swimming, cycling, running, and other related exercises. In addition, the camp included traditional camp activities such as indoor rock climbing, participation on a challenge course, and crafts. Eighty percent of the campers indicated they now want to do a triathlon, and 95% shared that they will tell their friends about the sport of triathlon. Using the practitioner-friendly American Camp Association’s Youth Outcomes Battery, campers indicated gains in competence, teamwork, and problem-solving confidence. The findings of this evaluation study provide evidence-based support for the potential of triathlon camp to enhance important developmental outcomes. The results from the evaluation support the desired outcomes for this type of camp, and with USA Triathlon support, other recreation services can use this model to replicate. A unique aspect of this program was its setting and participant composition. That is, this day camp, hosted in an urban area, had a diverse group of campers with youth from various ethnic and sport backgrounds. Over half (60%) of the campers were of color, providing evaluation data from often underrepresented groups of interest. This program evaluation provides a template for other camps on campus model to focus on diversity, equity and inclusion of our youth. Currently, there is only one African American female professional triathlon in the United States. We need to be more intentional offering unique programs (e.g., triathlon camps and nonprofits) to all youth. Grants can be pursued by camps, municipal parks and recreation, nonprofits to remove some of the financial barriers preventing many youth of color from exploring the sport of triathlon.

Aim: The aim of this article is to explore the behaviours related to pain for residents of long-term care with dementia. Background: Nurse practitioners caring for residents with dementia face the complex task of assessing and managing pain. Residents in long-term care who live with dementia may express pain differently than those without cognitive or communication impairments. Responsive behaviours that may occur in advancing dementia may also be indicators of pain. Tools that consider behaviours related to pain for cognitively impaired residents such as the PACSLAC, should be considered. Methods: This secondary analysis is a retrospective population-based descriptive study of Resident Assessment Instrument-Minimum Data Set version 2.0 assessments conducted in long-term care homes across Ontario. Findings: Results show that, in many circumstances when a resident with dementia exhibits responsive behaviors that may be related to both dementia and pain, no pain is reported. These items include wandering, resisting care, and repetitive verbalizations. The findings suggest that pain may not be identified or treated in people with dementia. Conclusions: Nurse practitioners must provide an individualized approach in order to accurately assess and treat pain for residents with dementia. By acknowledging deficits and improving practice guidelines, the hope is to improve pain management and quality of life for residents with dementia and pain.

In the 2013–14 and 2015–16 influenza seasons, reduced vaccine effectiveness (VE) was observed for the H1N1 component of the FluMist quadrivalent live attenuated influenza vaccine (QLAIV) in the USA, leading to loss of Advisory Committee on Immunization Practices recommendation. Here we demonstrate in ferrets that 2015–16A/H1N1pdm09 vaccine strain A/Bolivia/559/2013 (A/BOL13) is outcompeted in trivalent (TLAIV) and QLAIV formulations, leading to reduced protection from wild-type challenge. While monovalent (MLAIV) A/BOL13 provided significant protection from wild-type virus shedding and fever at doses as low as 3.0 log10 fluorescent focus units (FFU), it failed to provide a similar level of protection in TLAIV or QLAIV formulation, even at a 6.0 log10 FFU dose. Conversely, clinically effective H1N1 strain A/New Caledonia/20/1999 provided significant protection in MLAIV, TLAIV, and QLAIV formulations. In conclusion, reduced A/BOL13 replicative fitness rendered it susceptible to inter-strain competition in QLAIV, contributing to its reduced VE in the 2015–16 season.

Background: Cognitive impairment, including dementia, is frequently under-detected in primary care. The Consortium for Detecting Cognitive Impairment, including Dementia (DetectCID) convenes three multidisciplinary teams that are testing novel paradigms to improve the frequency and quality of patient evaluations for detecting cognitive impairment in primary care and appropriate follow-up. Objective: Our objective was to characterize the three paradigms, including similarities and differences, and to identify common key lessons from implementation. Methods: A qualitative evaluation study with dementia specialists who were implementing the detection paradigms. Data was analyzed using content analysis. Results: We identified core components of each paradigm. Key lessons emphasized the importance of engaging primary care teams, enabling primary care providers to diagnose cognitive disorders and provide ongoing care support, integrating with the electronic health record, and ensuring that paradigms address the needs of diverse populations. Conclusion: Approaches are needed that address the arc of care from identifying a concern to post-diagnostic management, are efficient and adaptable to primary care workflows, and address a diverse aging population. Our work highlights approaches to partnering with primary care that could be useful across specialties and paves the way for developing future paradigms that improve differential diagnosis of symptomatic cognitive impairment, identifying not only its presence but also its specific syndrome or etiology.

The primary label for people who are sexually attracted to children (“pedophile”) is conflated with sexual offending behavior and tainted with stigma. In the present pre-registered mixed-method study, we therefore investigated attitudes and preferences regarding "pedophile/hebephile" and other labels among 286 people who report a stronger or equally strong sexual attraction to prepubescent and pubescent children than to adults. Overall, quantitative data showed acceptance of “pedophile/hebephile” as well as a range of alternative labels in a personal (Labeling Oneself) and a professional context (Being Labeled by Others). “Minor-attracted person” and “pedophile/hebephile” received generally higher support than other terms and appeared to be least divisive across three major online fora. Qualitative data revealed four themes: “Contested self-labels,” “Person-first language and pathologizing sexuality/identity,” “Stigma and shame,” and “Reclaiming the pedophile label.” Our results allow deeper insight into reasons for adopting certain labels over others, as well as difficulties of finding a non-stigmatizing label. We discuss limitations of the study and practical implications for clinical and research contexts.

Introduction: Antipsychotic use in Long-Term Care (LTC) in Ontario, Canada continues to pose a challenge in the care of older adult patients living in these institutions. The dangers and patterns of inappropriate prescribing have been documented frequently. Most of the current literature focuses on dementia and behavioral and psychological symptoms of dementia, the role of prescribers, or on interprofessional interventions with person-centered care to address the behavior. Very little discussion has focused on the role of nurse practitioners and other frontline long-term care staff in the assessment and interactions with residents that may result in prescriptions of antipsychotics. Objectives: The purpose of this population based retrospective study of data from all LTC facilities in Ontario, Canada in 2019-2020 was to determine the extent to which antipsychotic medications were used in and the factors associated with this use. Reflections about the NP role are discussed. Results: The results demonstrate that over thirty percent of residents in LTC continue to receive antipsychotics and those with the responsive behaviours are significantly more likely to be prescribed antipsychotics. Conclusions: The findings identify a potential link between over-burdened front-line staff and increased antipsychotic prescriptions, as well as continued use of antipsychotics in attempts to prevent harm to residents and staff at long-term care homes. Recommendations are made that include changes to legislation that will ensure optimal front-line care and time for care, increased training for front line staff and, in particular, how the role of the nurse practitioner in LTC can be utilized to optimize the appropriate use of antipsychotics, and the support of discontinuing or decreasing the dose of antipsychotics when required.

Game theory may be a fruitful basis for educational theory. After describing games and related concepts like "utility," the author sets up examples of how games may be used as a basis for selecting teaching strategies. For instance, a teacher may decide to change many aspects of his teaching style, rather than just one at a time, if there is a greater probability that the changes will affect his pupil's performance. (JK)

This study is aimed to prove how Virtual Environments (VE) and Information and Communication Technologies (ICT) can be used as a tool to verify professional competencies. The incursion of virtual environments in education has shown that there is much potential in distance learning development. To find out how it influences the achievement of competencies, there was made an experimental study with a post-test design and control group. Students were divided into two groups; each of them was submitted to a different test. The results demonstrate that with the implementation of VE using ICT, the students who used the VE had a better performance than students who used the traditional evaluations. Confirmed with the 83% of the sample who achieved the highest levels (50% got strategical professional competencies, and 33% got autonomous professional competencies). Considering the study, the authors could notice that students do develop professional competencies along virtual environments, reflected not only in the level of competence achieved by the ones tested on the virtual environment but also in the average time they spend to do the test. Therefore, virtual environments have positives effects in the education field.

Nurses have the knowledge and skills to recognize and intervene when the condition of patients on medical or surgical units deteriorates. Despite this, deterioration is sometimes missed resulting in unexpected ICU admissions. This study explored the nursing process factors associated with unexpected ICU admissions. A chart audit was undertaken in a large urban hospital and data were collected measuring nursing assessment (vital signs), communication and documentation. Results showed that the most common reason for an unexpected ICU admission was respiratory distress. At the same time, respiratory rate was the least documented vital sign. Communication, documentation and recognition of patient deterioration play a key role in intervening and preventing unexpected ICU admissions. Attention to adequate staffing levels as well as implementation of clinical tools may assist nurses to more readily address patient deterioration and prevent unexpected ICU admissions.

Objective Novel treatments for adults with anorexia nervosa (AN) are lacking. Recent scientific advances have identified neurobiologically-driven temperament contributors to AN symptoms that may guide development of more effective treatments. This preliminary study evaluates the acceptability, feasibility and possible benefits of a multicenter open trial of an intensive 5-day neurobiologically-informed multifamily treatment for adults with AN and their supports (SU). The temperament-focused treatment combines psychoeducation of AN neurobiology and SU involvement to develop skills to manage traits contributing to disease chronicity. Method Fifty-four adults with AN and at least one SU (n = 73) received the 5-day treatment. Acceptability, feasibility, and attrition were measured post-treatment. Clinical outcome (BMI, eating disorder psychopathology, family function) was assessed post-treatment and at >3-month follow-up. Results The treatment had low attrition, with only one drop-out. Patients and SU rated the intervention as highly acceptable, and clinicians reported good feasibility. At post-treatment, patients demonstrated significantly increased BMI, reduced eating disorder psychopathology, and improved family function. Benefits were maintained in the 39 patients who completed follow-up assessment, with 62% reporting full or partial remission. Discussion Preliminary results are promising and suggest this novel treatment is feasible and acceptable. To establish treatment efficacy, fully-powered randomized controlled trials are necessary.

This article describes the development of nurse practitioner (NP) competencies for advance care planning. Nurse practitioners are well positioned to implement advance care planning with their patients; however, very few patients have an advance care plan. A modified Delphi method was used to engage NPs in achieving consensus for advance care planning competencies. In round 1, draft competencies were developed from the findings of a survey of NP beliefs, knowledge, and level of implementation of advance care planning. In round 2, 29 NPs participated in the evaluation of the draft competencies and their components. Revisions were made, and a final round was conducted where 15 of the original NP participants confirmed their consensus with the final document. The final document includes 4 competencies, each with several elements: (1) Clinical Practice, (2) Consultation and Communication, (3) Advocacy, and (4) Therapeutic Management. Advance care planning competencies will provide NPs with a guide that can be used to ensure that they are able to clearly identify their distinct role in advance care planning. These competencies may inform the integration of advance care planning in a variety of health care settings and with other health care providers.

Objective Our research focuses on laxative misuse, which has been understudied in previous eating disorders (ED) research, to understand its prevalence and correlates among individuals seeking ED treatment. We also test the association between laxative misuse and binge eating to examine the assumption that laxative misuse is intended to compensate for binge eating. Method Participants were 2,295 ED treatment-seeking adults (29.5 ± 10.5) who self-reported their disordered eating behaviors on the Eating Disorder Questionnaire. Participants met DSM-5 diagnostic criteria for anorexia nervosa (AN: 11.5%, n = 264), bulimia nervosa (BN: 39.0%, n = 896), binge-eating disorder (14.9%, n = 343), or other specified feeding or eating disorder (34.5%, n = 792). Results Nearly 25% of participants (n = 571) reported misusing laxatives during the last month. Laxative misusers with AN reported significantly higher frequency of laxative misuse relative to misusers with BN (F(1,440) = 5.226, p = .023, ηp2= .012). Among laxative misusers, there was no association between frequency of binge eating and frequency of laxative misuse. Discussion Laxative misusers with AN tend to misuse laxatives more frequently than those with BN. Binge eating was not related to laxative misuse in our sample. Future research may use real-time data collection to understand the function of laxative misuse and to validate our cross-sectional findings.

This study examined the prevalence of reported suicide attempts among family members of individuals with an eating disorder (ED). 1870 individuals presenting for ED treatment reported whether their family members ever made a suicide attempt using the Eating Disorders Questionnaire. A lifetime suicide attempt by any family member was reported by 10.8% (n = 202) of the sample and ranged from 7.0% of those with eating disorder not otherwise specified to 16.1% of those with purging disorder. Controlling for age and gender, individuals with bulimia nervosa had a higher prevalence of any familial suicide attempt and mother suicide attempt than individuals with EDNOS; no other differences were observed across ED diagnoses. There were no differences in prevalence of reported suicide attempts made by fathers, brothers, sisters, uncles, or aunts by ED diagnosis. Findings support a growing literature indicating a familial association between EDs and suicide risk.