Fostering cultural competence: Exploring client perception in a health coaching intervention among college students

Health coaching could be an innovative approach to develop student coaches' cultural competence (CC) among future health professionals. The current mix-method study design explored the impact of an 8-week peer health coaching intervention among college students on CC, from both student health coaches (i.e., students majored in health sciences who completed health coaching training and acted as health coach) and student clients' perspective. Nine student coaches and 24 student clients participated in the study. The quantitative analysis showed an increase in the clients' perceived level of coaches' CC between the pre- and posttest. The qualitative analysis revealed three themes, including varying levels of awareness, respectful and culturally responsive coaching, and cultural connection. Implications and recommendations for educators and researchers are discussed.

An 8-Week Peer Health Coaching Intervention among College Students: A Pilot Randomized Study

This study explored the effects of an 8-week peer coaching program on physical activity (PA), diet, sleep, social isolation, and mental health among college students in the United States. A total of 52 college students were recruited and randomized to the coaching (n = 28) or the control group (n = 24). The coaching group met with a trained peer health coach once a week for 8 weeks focusing on self-selected wellness domains. Coaching techniques included reflective listening, motivational interviews, and goal setting. The control group received a wellness handbook. PA, self-efficacy for eating healthy foods, quality of sleep, social isolation, positive affect and well-being, anxiety, and cognitive function were measured. No interaction effects between time and group were significant for the overall intervention group (all p > 0.05), while the main effects of group difference on moderate PA and total PA were significant (p < 0.05). Goal-specific analysis showed that, compared to the control group, those who had a PA goal significantly increased vigorous PA Metabolic Equivalent of Task (METs) (p < 0.05). The vigorous METs for the PA goal group increased from 1013.33 (SD = 1055.12) to 1578.67 (SD = 1354.09); the control group decreased from 1012.94 (SD = 1322.943) to 682.11 (SD = 754.89); having a stress goal significantly predicted a higher post-coaching positive affect and well-being, controlling the pre-score and other demographic factors: B = 0.37 and p < 0.05. Peer coaching showed a promising effect on improving PA and positive affect and well-being among college students.

Trends in Teaching Sexual and Reproductive Health Skills in US Secondary Schools in 35 States, 2008 to 2018

BACKGROUND

Little is known about trends in implementing skills-based instruction in US schools, specifically for sexual and reproductive health (SRH). We examined state-level trends in the percentage of US secondary schools teaching SRH skills in a required course in grades 6 to 8 and 9 to 12.

METHODS

Representative data from 35 states participating across 6 cycles of School Health Profiles (2008-2018) was analyzed. The prevalence of teaching four SRH skills was assessed through lead health education teacher self-administered questionnaires. Logistic regression models examined linear trends in the percentages of schools teaching SRH skills in grades 6 to 8 and 9 to 12. Trends were calculated for states with weighted data (response rates ≥70%) for at least 3 cycles, including 2018.

RESULTS

During 2008 to 2018, the median percentage of schools addressing each SRH skill ranged from 63.5% to 69.7% (grades 6-8) and 88.2% to 92.0% (grades 9-12). Linear decreases in SRH skills instruction were more common for grades 6 to 8 than grades 9 to 12; linear increases were comparable for both groups. Most states demonstrated no change in the percentage of schools teaching SRH skills in grades 6 to 8 and 9 to 12.

CONCLUSIONS

Limited changes and decreases in SRH skills instruction in US secondary schools suggest efforts to strengthen SRH education are needed.

School-Based Health Education Research: Charting the Course for the Future

SHAPE America has identified four goals as part of the 50 Million Strong by 2029 initiative; one of these goals is healthy behavior. School-based health education is uniquely positioned to be a primary route through which this goal can be achieved. Health education is an academic subject included in a well-rounded education, based on health behavior and learning theory, research-based and taught by licensed and trained health educators with adequate instructional time. Health education helps students acquire functional knowledge about a variety of topics and develop health-related skills resulting in personal competence and self-efficacy. The purpose of this paper is to provide an overview of the existing evidence examining school-based health education and to articulate future directions for research that will solidify school-based health education as a necessary and efficacious strategy for improving the health and wellness of youth.

Assessment of pastoral needs among medical outpatients

Reports research findings on samples of hospital outpatients, hospital inpatients, and well persons from the community in an attempt to explore the content and extent of pastoral needs among medical/surgical outpatients. Analyzes and presents statistical data which lead to the conclusion that the spiritual needs of outpatients manifest greater similarity to healthy persons in the community than to hospital inpatients. Notes limitations of the study and discusses praxis implications for chaplains.

Eye muscle antibodies in patients with ocular myasthenia gravis: possible mechanism for eye muscle inflammation in acetylcholine-receptor antibody-negative patients

Myasthenia gravis is an organ-specific autoimmune disorder generally thought to be caused by an antibody-mediated attack against the skeletal muscle nicotinic acetylcholine (Ach) receptor (AchR) at the neuromuscular junction. Extraocular muscle weakness and double vision are present in about 90% of patients with myasthenia gravis and are the predominant complaints in about 20% of patients, when the condition is called ocular myasthenia gravis (OMG). While serum antibodies against the AchR are detected in most patients with generalized myasthenia gravis (GMG), they are not found in about one-third of patients with the ocular variety, and epidemiological, clinical, and serological studies suggest that OMG and GMG are two separate diseases. Both forms of myasthenia gravis are sometimes associated with thyroid autoimmunity or thyroid-associated ophthalmopathy (TAO). We have therefore tested the sera of patients with GMG and OMG by Western blotting for antibodies against porcine eye muscle membrane proteins in general, and by enzyme-linked immunosorbent assays (ELISA) specifically for reaction with two skeletal muscle antigens which are prominent marker antigens for TAO, namely, the calcium-binding protein calsequestrin and the so-called "64-kDa protein." The 64-kDa protein has recently been identified as the flavoprotein subunit of mitochondrial succinate dehydrogenase. Patients with ophthalmopathy and myasthenia were excluded. Nine of the patients had associated Graves' hyperthyroidism without evident ophthalmopathy and one had Hashimoto's thyroiditis. Antibodies against porcine eye muscle membrane antigens of M(r) 15-110 kDa were detected in patients with GMG or OMG, one or more antibodies being detected in 100% of patients with GMG and in 88% of those with OMG. The most frequently found antibodies were those targeting eye muscle membrane proteins of 15, 67, and 110 kDa. Antibodies reactive with purified calsequestrin (63 kDa) were detected in 21% of patients with OMG but in no patient with GMG. Antibodies recognizing purified succinate dehydrogenase (67 kDa) were found in 42% of patients with OMG, in 100% (5 of 5) of patients with GMG, and in 48% of all patients with myasthenia gravis not associated with Graves' hyperthyroidism. There was no close correlation between any eye muscle-reactive antibody and antibodies against the AchR in either group of myasthenic patients. The findings support the notion that immunoreactivity against skeletal muscle proteins other than the AchR may play a role in the development of the muscle weakness in AchR antibody-negative patients with OMG and GMG, although it is unlikely that any of the antibodies demonstrated in this study are directly implicated. Similarly, while the demonstration of antibodies reactive with eye muscle antigens associated with TAO in patients with OMG raises the possibility that the link between the ocular lesions of myasthenia gravis and Graves' disease may be autoimmunity against a common antigen(s), it is more likely that both disorders are mediated by cytotoxic T cells recognizing another cell membrane antigen, such as the novel thyroid and eye muscle shared protein G2s, and that serum antibodies reactive with succinate dehydrogenase Fp subunit and calsequestrin are markers of an immune-mediated eye muscle reaction.

Evaluation of vaginal tampons for collection of specimens for detection of Chlamydial infection

BACKGROUND AND OBJECTIVES

Previous studies have shown that self-inserted vaginal tampons can be used to obtain specimens for detection of Neisseria gonorrhoeae. There is a need to expand testing for infection with Chlamydia trachomatis to women who do not undergo regular gynecologic examinations.

GOAL

To compare self-inserted tampons with clinician-obtained endocervical swabs for collection of samples to be examined for chlamydial infection.

STUDY DESIGN

Women referred because of recently detected untreated chlamydial infection inserted a vaginal tampon. Two endocervical swabs were obtained after the tampon was removed. One swab was cultured for Chlamydia trachomatis. The other swab and the tampon were examined with the Testpack Chlamydia antigen detection test.

RESULTS

Sixty-nine women were studied. Chlamydial infection was detected by culture in 75.4%, by Testpack (swab) in 63.8%, and by Testpack (tampon) in 52.2%.

CONCLUSIONS

Tampon-obtained specimens evaluated in the Testpack Chlamydia test were relatively insensitive. More sensitive tests for the detection of Chlamydia trachomatis infection with self-obtained specimens should be evaluated.

Comparison of enoxacin and ceftriaxone in the treatment of uncomplicated gonorrhea

BACKGROUND AND OBJECTIVES

The increasing prevalence of resistant strains of Neisseria gonorrhoeae has prompted investigation of new agents for the treatment of this sexually transmitted disease.

GOAL OF THIS STUDY

This study compared the efficacy and safety of a single oral dose of enoxacin to intramuscular ceftriaxone in the treatment of uncomplicated anogenital infection with N. gonorrhoeae.

STUDY DESIGN

A randomized open trial was conducted at a sexually transmitted diseases clinic in Brooklyn, New York. Adults with uncomplicated gonorrhea were randomly assigned to receive 400 mg of enoxacin or 250 mg of ceftriaxone. A follow-up examination was conducted 5 to 9 days later.

RESULTS

59 women and 23 men were enrolled; 40 women and 19 men were evaluable. Enoxacin eradicated 18 of 19 endocervical, 10 of 10 urethral, 5 of 5 anorectal, and 3 of 3 pharyngeal gonococcal infections. Ceftriaxone eradicated 20 of 21 pharyngeal gonococcal infections. Fifty-nine pretreatment isolates of N. gonorrhoeae were available for antimicrobial susceptibility testing. The geometric mean minimal inhibitory concentration was 0.03 mg/1 for enoxacin and 0.005 mg/l for ceftriaxone. There were few sides effects in either group, and both drugs were ineffective against concomitant infection with Chlamydia trachomatis.

CONCLUSION

Oral enoxacin appears to be a safe and effective method of treatment for anogenital infections caused by N. gonorrhoeae.

Sexually transmitted diseases in postpubertal female rape victims

Seventy-six postpubertal women were referred from a municipal hospital emergency room within 60 h of sexual assault for evaluation. Of the 76 victims, 20 (26%) had active Chlamydia trachomatis infection detected by culture (11 subjects), a fourfold serologic titer rise (6), or both (3). The risk of acquiring C. trachomatis infection after sexual assault was 3%-16%. Pelvic inflammatory disease was detected in 8 (11%) of the 76 victims. Bacterial vaginosis was diagnosed in 38 women (50%), at least 8 of whom appeared to have been infected during the assault. Trichomoniasis was found in 17 victims (22%), at least 5 of whom may have acquired the infection at the time of the assault. In view of the high rates of these infections and the poor compliance with follow-up (76% [58/76] kept their appointments), all postpubertal victims of sexual assault should be offered treatment with ceftriaxone, 250 mg intramuscularly, followed by 100 mg of oral doxycycline and 500 mg of oral metronidazole twice daily for 7 days.

Evaluation of ofloxacin in the treatment of uncomplicated gonorrhea

In an open study, a single oral dose of 400 mg of ofloxacin was administered to 40 men and 20 women who required treatment for uncomplicated gonococcal infection. Thirty-six men and 13 women were evaluable. Ofloxacin eradicated 49 of 49 urethral or endocervical gonococcal infections and 1 of 1 pharyngeal infection. There were 55 pretreatment isolates of Neisseria gonorrhoeae available for antimicrobial susceptibility testing. Twenty-four (43.6%) produced penicillinase. Eighteen (32.7%) isolates that did not produce penicillinase had penicillin MICs greater than or equal to 1.0 micrograms/mL. Twelve (21.8%) isolates had tetracycline MICs greater than or equal to 16 micrograms/mL. The geometric mean minimal inhibitory concentrations (range) for 55 pretreatment N. gonorrhoeae isolates were: ofloxacin, 0.014 (.0078-.03) micrograms/mL; penicillin, 6.30 (.125-128) micrograms/mL; and tetracycline 1.61 (.03-128) micrograms/mL. There were few side effects. Ofloxacin appears to be an effective and safe oral therapy for the treatment of infections caused by N. gonorrhoeae including infections due to penicillin- and tetracycline-resistant strains.

Comparison of ofloxacin and ceftriaxone in the treatment of uncomplicated gonorrhea caused by penicillinase-producing and non-penicillinase-producing strains

Eighty-nine patients with uncomplicated gonorrhea, including 31 patients (34.8%) infected with penicillinase-producing strains of Neisseria gonorrhoeae, were treated with oral ofloxacin (single 400-mg dose) or intramuscular ceftriaxone (250-mg dose). All 47 patients who received ofloxacin and 41 of 42 patients who received ceftriaxone were cured.

Spread and persistence of infection with a trachoma biovar strain of Chlamydia trachomatis in multiplying and nonmultiplying McCoy cells

The trachoma biovar of Chlamydia trachomatis enters host cells in culture with difficulty, and cell-to-cell spread resulting in amplification of the initial growth usually does not occur. An experimental model was devised to demonstrate that, by using conditions that more closely approximate those encountered in man, the trachoma biovar of C. trachomatis can readily achieve cell-to-cell passage. Fresh McCoy cells were sequentially added to monolayers that had been inoculated with a trachoma biovar strain of C. trachomatis 3, 6, and 9 days earlier. Subsequent incubation resulted in intercellular propagation, with an increase in the number of inclusions from 500 to 80,000 per coverslip. A second experiment demonstrated the reproducibility of this phenomenon and showed that cell-to-cell spread can occur at a low rate in overcrowded, not overlaid, cell layers; it also showed that, in multiplying cell layers, the infection tends to become persistent.

Evaluation of difloxacin in the treatment of uncomplicated urethral gonorrhea in men

Difloxacin is a new quinolone antimicrobial agent with in vitro activity against both Neisseria gonorrhoeae and Chlamydia trachomatis and a long (26-h) half-life. A single oral dose of 200 mg of difloxacin was used to treat 30 men with uncomplicated urethral gonorrhea in an open trial. Of the isolates of N. gonorrhoeae, three produced penicillinase and two were resistant to tetracycline. N. gonorrhoeae was eradicated from all 29 evaluable patients. The geometric mean MIC of difloxacin for 30 pretreatment N. gonorrhoeae isolates was 0.014 (range, less than or equal to 0.0039 to 0.03) microgram/ml. Four (13.3%) of the 30 subjects with gonococcal urethritis also had C. trachomatis recovered from their pretreatment cultures. Treatment with difloxacin was associated with the eradication of C. trachomatis from all four men. In addition, C. trachomatis was isolated from the posttreatment culture of only one man who had a negative culture before treatment. Nineteen patients (65.5%) reported adverse experiences, and 17 of them (58.6%) developed symptoms suggestive of central nervous system dysfunction. An oral dose of 200 mg of difloxacin is effective treatment for uncomplicated urethral gonorrhea and may also eliminate a coexisting infection with C. trachomatis. Side effects may limit the utility of this agent.

Alternating skew on lateral gaze (bilateral abducting hypertropia)

We report thirty-three patients with alternating skew deviation on lateral gaze. The right eye was hypertropic in right gaze, and the left eye was hypertropic in left gaze. Most patients had associated downbeat nystagmus and ataxia and were diagnosed as having lesions of the cerebellar pathways or the cervicomedullary junction. This contrasts with a previous report in which alternating skew was seen mainly in lesions of the midbrain pretectum.

Prevalence of genital pathogens among female prostitutes in New York City and in Rotterdam

The authors studied the prevalence of genital microorganisms among 300 female prostitutes in brothels in New York City and 60 female prostitutes attending a sexually transmitted diseases clinic in Rotterdam, The Netherlands. Rates of isolation of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in the two cities were 9.3% and 8.3%, 25.3% and 16.6%, 57.3% and 74.9%, and 73% and 79%, respectively. Trichomonas vaginalis was detected in 3.6% of New York prostitutes and in 16.6% of those in Rotterdam. Nonspecific vaginitis was found in 33% of prostitutes examined in New York. In New York, Asian prostitutes were more likely to be infected with C. trachomatis (33 of 102; 32.3%) than were prostitutes of other ethnic backgrounds (44 of 194; 21.5%; P less than .05.

How sensitive is the Papanicolaou smear in the diagnosis of infections with Chlamydia trachomatis?

Fifty-three patients who presented to the sexually transmitted disease clinic at Boston City Hospital had simultaneous cervicovaginal Papanicolaou smears and cultures for Chlamydia trachomatis taken prior to the initiation of antibiotic therapy. Eleven of the chlamydial cultures had positive results. None of the Papanicolaou smears satisfied the morphologic criteria for the diagnosis of chlamydial infection. This suggests that the Papanicolaou smear is an insensitive technic for the diagnosis of chlamydial infection of the cervix.

Growth of host cells and Chlamydia trachomatis in medium containing serum from 16-week-old calves

We compared fetal bovine serum with five batches of serum from calves of various ages. HeLa and McCoy cells grown in only one batch of calf serum (from 16-week-old calves) had morphology, growth kinetics, and cloning efficiency similar to those of cells grown in fetal bovine serum. Cells maintained in calf serum from this batch supported the growth of two laboratory strains of Chlamydia trachomatis, a genital strain (E/UW-5/Cx) in McCoy cells and a lymphogranuloma venereum strain (440L) in HeLa cells. McCoy cells maintained in calf serum also supported the growth of C. trachomatis from clinical specimens. The batch of serum from 16-week-old calves was an effective alternative to fetal bovine serum for the growth of cells and of C. trachomatis. Other laboratories may be able to use calf serum for the maintenance of cells and for the isolation of Chlamydia spp. Before use, however, each batch of calf serum will have to be carefully evaluated to ensure that it is equivalent to fetal bovine serum.

Comparison of methods for cultivation and isolation of Chlamydia trachomatis

McCoy cells treated with cycloheximide, iododeoxyuridine, and DEAE-dextran and untreated McCoy cells were inoculated with two stock strains of Chlamydia trachomatis and with 231 urethral specimens from men, 53 (23%) of which contained C. trachomatis. Isolation rates, number and quality of inclusions, and quality of the cell monolayers were compared. There were no significant differences between the isolation rates in the four systems, although the most isolations were made in the untreated and cycloheximide-treated cells. Cycloheximide-treated cells produced, from both the clinical specimens and the two stock strains, significantly more inclusions than any of the other systems. The monolayer of the cycloheximide-treated cells and the inclusions that grew in these cells were optimal for examination and detection of C. trachomatis.

Human chlamydial infections

Chlamydiae are obligate intracellular parasites, bacteria with a peculiar biology. They belong to the genus Chlamydia which includes two species: C. psittaci and C. trachomatis. A wide range of hosts, including birds, mammals and man can be infected by chlamydiae. The diseases chlamydiae can produce include psittacosis, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, urethritis, cervicitis, pelvic inflammatory disease, and neonatal pneumonia. The diagnosis of chlamydial infection may be made by visualization of the organism in direct smears, isolation of the agent in cell culture, or by demonstrating a significant rise in antibody titer. Chlamydial infection may be treated with tetracycline, erythromycin, or sulfonamides.