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Papers by Ana Ros

Map 2. Percentage of Florida High School Students Who are Current Tobacco Users*, 2008 ® *Current... more Map 2. Percentage of Florida High School Students Who are Current Tobacco Users*, 2008 ® *Current Tobacco Users are students who used any form of tobacco on one or more occasions during the past 30 days.

The federal government has started a voluntary pilot program with a goal of providing physical se... more The federal government has started a voluntary pilot program with a goal of providing physical security enhancements for self-contained irradiators which contain Cesium Chloride Sources. The pilot program will begin shortly, and will involve a limited number of NRC and Agreement State licenses, who volunteered for the installation of the security upgrades. The cost of these security enhancements will be

tobacco, users of any form of tobacco, current cigarette users, by county, current cigar users, c... more tobacco, users of any form of tobacco, current cigarette users, by county, current cigar users, current smokeless tobacco users, committed never smokers, tobacco prevention education, any tobacco prevention education, comprehensive tobacco use prevention education, TUPE, SHS, exposure to second hand smoke SHS, smoking allowed in the home, second hand smoke SHS exposure in the car or in a room, anti tobacco activism, community event participation, students working against tobacco SWAT participation, SWAT, social attitudes with tobacco, smoking doesn't "look cool", smokiers don't have more friends

Nursing & Health Sciences Research Journal, 2021

Nursing & Health Sciences Research Journal, 2019

Introduction: Ther e continue to be lar ge inequities in the r epr esentation of women at pr ogr ... more Introduction: Ther e continue to be lar ge inequities in the r epr esentation of women at pr ogr essive levels of training and seniority in both academic and community practice settings. Gender inequity in medicine is not only problematic in its own right but has the potential to deliver inequitable outcomes, including the neglect of important research and care that continues to disadvantage women patients. As significant evidence is emerging on gender inequities in the medical profession, it is an opportune time to review the current evidence on the persisting gaps, potential causes, and possible solutions. Methods: A r apid scoping r eview was conducted for ar ticles on the topic of gender inequity and the medical profession in PubMed and Google Scholar. The search was limited to articles published from 1990 to the search date (June 1, 2017), and included only papers published in English. Results: An initial 1055 articles were screened according to established inclusion and exclusion criteria. After initial and full-text review, supplemented by a hand search through the article references, 45 articles were included in the review. Articles were classified as a) evidence for gender inequities, b) causes of inequities, and c) solutions for inequities. Only 13% of articles found (6 studies) addressed possible interventions to reduce inequities. Significant gaps exist in the literature, particularly around part-time work options, parental and family leave options, and addressing implicit biases to reduce sexism in professional settings. Discussion: The evidence highlights substantial inequities in the r epr esentation of women in the medical profession, in both the academic and community settings, in medical literature, and in leadership positions. This review also highlighted substantial gaps in the literature on understanding what can be done to reduce these gaps. More research is needed in the area of gender inequities in medicine to improve the representation of women in medicine.

Journal of Nursing Scholarship, 2017

Purpose: Climate change is an emerging challenge linked to negative outcomes for the environment ... more Purpose: Climate change is an emerging challenge linked to negative outcomes for the environment and human health. Since the 1960s, there has been a growing recognition of the need to address climate change and the impact of greenhouse gas emissions implicated in the warming of our planet. There are also deleterious health outcomes linked to complex climate changes that are emerging in the 21st century. This article addresses the social justice issues associated with climate change and human health and discussion of climate justice. Organizing Construct: Discussion paper. Methods: A literature search of electronic databases was conducted for articles, texts, and documents related to climate change, climate justice, and human health. Findings: The literature suggests that those who contribute least to global warming are those who will disproportionately be affected by the negative health outcomes of climate change. The concept of climate justice and the role of the Mary Robinson Foundation-Climate Justice are discussed within a framework of nursing's professional responsibility and the importance of social justice for the world's people. The nursing profession must take a leadership role in engaging in policy and advocacy discussions in addressing the looming problems associated with climate change. Conclusions: Nursing organizations have adopted resolutions and engaged in leadership roles to address climate change at the local, regional, national, and global level. It is essential that nurses embrace concepts related to social justice and engage in the policy debate regarding the deleterious effects on human health related to global warming and climate change. Nursing's commitment to social justice offers an opportunity to offer significant global leadership in addressing the health implications related to climate change. Clinical Relevance: Recognizing the negative impacts of climate change on well-being and the underlying socioeconomic reasons for their disproportionate and inequitable distribution can expand and optimize the profession's role in education, practice, research, and policy-making efforts to address climate change. Climate change represents an urgent global health and environmental health challenge that requires the engagement, advocacy, and leadership of the nursing profession to mitigate the health effects on the world's people. As Lemery, Williams, and Farmer (2014) note regarding climate change and its deleterious impact on our global community:

Applied Nursing Research, 2011

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those l... more Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/ AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/ AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p b .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

Nursing & Health Sciences Research Journal, 2020

Bulletin of Spanish Studies, 2016

Journal of the European Academy of Dermatology and Venereology, 2009

Background Photodynamic therapy (PDT) using methyl aminolevulinate (MAL) is an effective first-li... more Background Photodynamic therapy (PDT) using methyl aminolevulinate (MAL) is an effective first-line treatment for actinic keratoses. A reduced incubation period may have practical advantages.

Nursing & Health Sciences, 2011

Unhealthy substance-use behaviors, including a heavy alcohol intake, illicit drug use, and cigare... more Unhealthy substance-use behaviors, including a heavy alcohol intake, illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage their disease-related symptoms. This study, based on data from a larger randomized controlled trial of an HIV/AIDS symptom management manual, examines the prevalence and characteristics of unhealthy behaviors in relation to HIV/AIDS symptoms. The mean age of the sample (n = 775) was 42.8 years and 38.5% of the sample was female. The mean number of years living with HIV was 9.1 years. The specific self-reported unhealthy substance-use behaviors were the use of marijuana, cigarettes, a large amount of alcohol, and illicit drugs. A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance-use behaviors, including amphetamine and injection drug use, heavy alcohol use, cigarette smoking, and marijuana use. The implications for clinical practice include the assessment of self-care behaviors, screening for substance abuse, and education of persons regarding the self-management of HIV.

Journal of the Association of Nurses in AIDS Care, 2007

Peripheral neuropathy, or distal sensory polyneuropathy (DSPN), is the most common neurological p... more Peripheral neuropathy, or distal sensory polyneuropathy (DSPN), is the most common neurological problem in HIV disease. DSPN also represents a complex symptom that occurs because of peripheral nerve damage related to advanced HIV disease and in association with the use of antiretroviral therapy-particularly in individuals treated with dideoxynucleosides. Although DSPN is a frequent symptom, the specific pathophysiology is not well understood. The HIV-related neuropathies are commonly categorized as distal sensory polyneuropathies, although antiretroviral toxic neuropathies are described in the literature. Recently, mitochondrial toxicity has been identified as a possible etiology of DSPN. As individuals with HIV/AIDS survive longer, often living for decades with the disease, chronic symptoms like DSPN must be addressed. Pharmacologic approaches, complementary therapies, and self-care behaviors that may improve quality of life and limit symptoms of DSPN are important interventions for clinicians and those living with HIV/AIDS to consider in the management of peripheral neuropathy.

Journal of Chromatography A, 2003

High prevalence of uterine occlusions and sterility is found among Baltic ringed and grey seal. P... more High prevalence of uterine occlusions and sterility is found among Baltic ringed and grey seal. Polychlorinated biphenyls (CBs) are suspected to be the main cause. The CB concentrations are higher in affected than in healthy animals, but the natural variation is considerable. Thus, it might be possible to assess the health status of seals by CB analysis. The ratios of chiral compounds (enantiomeric fractions (EFs)) such as atropisomeric CBs are of particular interest, since these may reflect differences in metabolic rates. An analytical procedure was developed and used to determine the levels of atropisomeric CBs, planar-CBs (WHO-PCBs) and total CBs in seals of different health status. Comprehensive 2D gas chromatography (GC × GC) was used to separate the target analytes from other CBs and interferences and a micro electron-capture detector (ECD) was used for detection. EFs of the atropisomeric CBs were difficult to determine as the levels were low and the interferences many. Two column combinations had to be used to avoid biased results-both had a chiral column as first-dimension column. The second-dimension column was coated with either a high-polarity cyanopropyl or a liquid crystal phase. EFs were determined for five atropisomeric CBs, i.e. CBs 91, 95, 132, 149 and 174. The results were verified by GC × GC-time-of-flight mass spectrometry (TOF-MS). Some atropisomeric CBs had EFs that deviated strongly from the racemic-mixture value. The deviations were larger in liver than blubber, which indicates enantioselective metabolism. However, there was no selective passage of the studied atropisomeric CBs across placenta and no selective blood-brain barrier. Similarly, no correlation between EFs and health status was observed, although there was a correlation between the total CB levels and health status. (M. Harju). mals have high levels of persistent organic pollutants (POPs), e.g. DDTs, PCBs, PBDEs, PCDD/Fs and chlordanes. Three seal species live in the Baltic: the ringed (Phoca hispida botnica), grey (Halichoerus grypus) and harbour (Phoca vitulina vitulina) seals. In the mid-1970s, uterine occlusions were frequently found in ringed seals and grey seals. On the basis of

European Journal of Clinical Pharmacology, 1994

5-Methoxypsoralen (5-MOP) in combination with ultraviolet light exposure is used for the treatmen... more 5-Methoxypsoralen (5-MOP) in combination with ultraviolet light exposure is used for the treatment of psoriasis. The effect of food on the pharmacokinetics of 5-MOP was evaluated in a randomized, crossover study in nine healthy subjects. Each subject received the tablets with a standardized breakfast or under fasting conditions. The food had a dramatic effect on the bioavailability of 5-MOP. Five of the subjects showed no measurable quantities (detection limit of the analytical technique 1 ng.ml-1) of 5-MOP when the drug was given under fasting conditions. However, plasma peak concentration within the range 37-144 ng.ml-1 (median 102 ng.ml-1) was measured when the drug was taken with food. The time for the plasma peak concentration was within the range 2.0-5.1 h (median 3.0 h) under non-fasting conditions. The elimination half-life was within the range 1.4-2.7 h (median 1.9 h). We conclude that it is imperative that 5-MOP tablets are administered together with food.

Conservation Genetics, 2010

The population status of the harbour porpoise (Phocoena phocoena) in the Baltic area has been a c... more The population status of the harbour porpoise (Phocoena phocoena) in the Baltic area has been a continuous matter of debate. Here we present the by far most comprehensive genetic population structure assessment to date for this region, both with regard to geographic coverage and sample size: 497 porpoise samples from North Sea, Skagerrak, Kattegat, Belt Sea, and Inner Baltic Sea were sequenced at the mitochondrial Control Region and 305 of these specimens were typed at 15 polymorphic microsatellite loci. Samples were stratified according to sample type (stranding vs. by-caught), sex, and season (breeding vs. non-breeding season). Our data provide ample evidence for a population split between the Skagerrak and the Belt Sea, with a transition zone in the Kattegat area. Among other measures, this was particularly visible in significant frequency shifts of the most abundant mitochondrial haplotypes. A particular haplotype almost absent in the North Sea was the most abundant in Belt Sea and Inner Baltic Sea. Microsatellites yielded a similar pattern (i.e., turnover in occurrence of clusters identified by STRUCTURE). Moreover, a highly significant association between microsatellite assignment and unlinked mitochondrial haplotypes further indicates a split between North Sea and Baltic porpoises. For the Inner Baltic Sea, we consistently recovered a small, but significant separation from the Belt Sea population. Despite recent arguments that separation should exceed a predefined threshold before populations shall be managed separately, we argue in favour of precautionary acknowledging the Inner Baltic porpoises as a separate management unit, which should receive particular attention, as it is threatened by various factors, in particular local fishery measures.

Chemosphere, 2011

Temporal trends of polyfluoroalkyl compounds (PFCs) were examined in grey seal (Halichoerus grypu... more Temporal trends of polyfluoroalkyl compounds (PFCs) were examined in grey seal (Halichoerus grypus) liver from the Baltic Sea over a period of 35 years . In total, 17 of 43 PFCs were found, including the perfluoroalkyl sulfonates (C 4 -C 10 PFSAs), perfluorooctanesulfinate (PFOSi), long chain perfluoroalkyl carboxylates (C 7 -C 14 PFCAs), and perfluoroalkyl sulfonamides (i.e., perfluorooctane sulfonamide (FOSA) and N-ethyl perfluorooctane sulfonamide (EtFOSA)), whereas saturated and unsaturated fluorotelomer carboxylates, shorter chain PFCAs and perfluoroalkyl phosphonic acids were not detected. Perfluorooctane sulfonate (PFOS) was the predominant compound (9.57-1444 ng g À1 wet weight (ww)), followed by perfluorononanoate (PFNA, 0.47-109 ng g À1 ww). C 6 -C 8 PFSAs, PFOSi and C 7 -C 13 PFCAs showed statistically significant increasing concentrations between 1974 and 1997, with a peak in 1997 and then decreased or levelled off (except for C 12 and C 13 PFCAs). FOSA had a different temporal trend with a maximum in 1989 followed by significant decreasing concentrations until 2008. Toxicological implications for grey seals are limited, but the maximal PFOS concentration found in this study was about 40 times lower than the predicted lowest observed effect concentrations (LOEC). The statistically significant decreasing concentrations or levelling off for several PFCs in the relative closed marine ecosystem of the Baltic Sea indicate a rapidly responding to reduced emissions to the marine environment. However, the high concentrations of PFOS and continuing increasing concentrations of the longer chain PFCAs (C 12 -C 14 ) shows that further work on the reduction of environmental emissions of PFCs are necessary.

Chemosphere, 2011

Temporal trends of polyfluoroalkyl compounds (PFCs) were examined in grey seal (Halichoerus grypu... more Temporal trends of polyfluoroalkyl compounds (PFCs) were examined in grey seal (Halichoerus grypus) liver from the Baltic Sea over a period of 35 years (1974-2008). In total, 17 of 43 PFCs were found, including the perfluoroalkyl sulfonates (C(4)-C(10) PFSAs), perfluorooctanesulfinate (PFOSi), long chain perfluoroalkyl carboxylates (C(7)-C(14) PFCAs), and perfluoroalkyl sulfonamides (i.e., perfluorooctane sulfonamide (FOSA) and N-ethyl perfluorooctane sulfonamide (EtFOSA)), whereas saturated and unsaturated fluorotelomer carboxylates, shorter chain PFCAs and perfluoroalkyl phosphonic acids were not detected. Perfluorooctane sulfonate (PFOS) was the predominant compound (9.57-1444 ng g(-1) wet weight (ww)), followed by perfluorononanoate (PFNA, 0.47-109 ng g(-1) ww). C(6)-C(8) PFSAs, PFOSi and C(7)-C(13) PFCAs showed statistically significant increasing concentrations between 1974 and 1997, with a peak in 1997 and then decreased or levelled off (except for C(12) and C(13) PFCAs). FOSA had a different temporal trend with a maximum in 1989 followed by significant decreasing concentrations until 2008. Toxicological implications for grey seals are limited, but the maximal PFOS concentration found in this study was about 40 times lower than the predicted lowest observed effect concentrations (LOEC). The statistically significant decreasing concentrations or levelling off for several PFCs in the relative closed marine ecosystem of the Baltic Sea indicate a rapidly responding to reduced emissions to the marine environment. However, the high concentrations of PFOS and continuing increasing concentrations of the longer chain PFCAs (C(12)-C(14)) shows that further work on the reduction of environmental emissions of PFCs are necessary.

British Journal of Dermatology, 2004

Background Although photodynamic therapy (PDT) is becoming an important treatment method for skin... more Background Although photodynamic therapy (PDT) is becoming an important treatment method for skin lesions such as actinic keratosis (AK) and superficial basal cell carcinoma, there are still discussions about which fluence rate and light dose are preferable. Recent studies in rodents have shown that a low fluence rate is preferable due to depletion of oxygen at high fluence rates. However, these results have not yet been verified in humans. Objectives The objective was to investigate the impact of fluence rate and spectral range on primary treatment outcome and bleaching rate in AK using aminolaevulinic acid PDT. In addition, the pain experienced by the patients has been monitored during treatment. Patients ⁄ methods Thirty-seven patients (mean age 71 years) with AK located on the head, neck and upper chest were treated with PDT, randomly allocated to four groups: two groups with narrow filter (580-650 nm) and fluence rates of 30 or 45 mW cm )2 , and two groups with broad filter (580-690 nm) and fluence rates of 50 or 75 mW cm )2 . The total cumulative light dose was 100 J cm )2 in all treatments. Photobleaching was monitored by fluorescence imaging, and pain experienced by the patients was registered by using a visual analogue scale graded from 0 (no pain) to 10 (unbearable pain). The primary treatment outcome was evaluated at a follow-up visit after 7 weeks. Results Our data showed a significant correlation between fluence rate and initial treatment outcome, where lower fluence rate resulted in favourable treatment response. Moreover, the photobleaching dose (1 ⁄ e) was found to be related to fluence rate, ranging from 4AE5 ± 1AE0 J cm )2 at 30 mW cm )2 , to 7AE3 ± 0AE7 J cm )2 at 75 mW cm )2 , indicating higher oxygen levels in tissue at lower fluence rates. After a cumulative light dose of 40 J cm )2 no further photobleaching took place, implying that higher doses are excessive. No significant difference in pain experienced by the patients during PDT was observed in varying the fluence rate from 30 to 75 mW cm )2 . However, the pain was found to be most intense up to a cumulative light dose of 20 J cm )2 . Conclusions Our results imply that the photobleaching rate and primary treatment outcome are dependent on fluence rate, and that a low fluence rate (30 mW cm )2 ) seems preferable when performing PDT of AK using noncoherent light sources.

Acta Dermato-Venereologica, 2006

Photodynamic therapy (PDT) is an efficient treatment for actinic keratosis. A common problem, how... more Photodynamic therapy (PDT) is an efficient treatment for actinic keratosis. A common problem, however, is pain. The aim of this study was to investigate pain during PDT for actinic keratosis. The possibility of using capsaicin cream for pain relief was also assessed. Pain was investigated during aminolaevulinic acid PDT in 91 patients. Size, redness, scaling and induration of the lesions were recorded. Maximum pain during treatment was registered, using a visual analogue scale (0-10). The pain-reducing efficacy of capsaicin was tested in a pilot study in six patients (10 lesions). These patients were pre-treated with capsaicin cream for one week before commencing PDT. Pain was found to be normally distributed around a mean value of visual analogue scale 4.6. Larger lesions gave more pain (p=0.001). The redness of the actinic lesions was found to be related to PDT-induced pain (p=0.01), the reduction of actinic area (p=0.007), and the cure rate (p=0.01). The redder the actinic area, the better the treatment outcome and the more pain experienced. Patients with the largest reduction in the actinic area experienced more pain (p=0.053). The most important factors for presence of pain seem to be the size and the redness of the lesion. No significant pain relief was experienced after pre-treatment with capsaicin.

Applied Nursing Research, 2011

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those l... more Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/ AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/ AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p b .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

Map 2. Percentage of Florida High School Students Who are Current Tobacco Users*, 2008 ® *Current... more Map 2. Percentage of Florida High School Students Who are Current Tobacco Users*, 2008 ® *Current Tobacco Users are students who used any form of tobacco on one or more occasions during the past 30 days.

The federal government has started a voluntary pilot program with a goal of providing physical se... more The federal government has started a voluntary pilot program with a goal of providing physical security enhancements for self-contained irradiators which contain Cesium Chloride Sources. The pilot program will begin shortly, and will involve a limited number of NRC and Agreement State licenses, who volunteered for the installation of the security upgrades. The cost of these security enhancements will be

tobacco, users of any form of tobacco, current cigarette users, by county, current cigar users, c... more tobacco, users of any form of tobacco, current cigarette users, by county, current cigar users, current smokeless tobacco users, committed never smokers, tobacco prevention education, any tobacco prevention education, comprehensive tobacco use prevention education, TUPE, SHS, exposure to second hand smoke SHS, smoking allowed in the home, second hand smoke SHS exposure in the car or in a room, anti tobacco activism, community event participation, students working against tobacco SWAT participation, SWAT, social attitudes with tobacco, smoking doesn't "look cool", smokiers don't have more friends

Nursing & Health Sciences Research Journal, 2021

Nursing & Health Sciences Research Journal, 2019

Introduction: Ther e continue to be lar ge inequities in the r epr esentation of women at pr ogr ... more Introduction: Ther e continue to be lar ge inequities in the r epr esentation of women at pr ogr essive levels of training and seniority in both academic and community practice settings. Gender inequity in medicine is not only problematic in its own right but has the potential to deliver inequitable outcomes, including the neglect of important research and care that continues to disadvantage women patients. As significant evidence is emerging on gender inequities in the medical profession, it is an opportune time to review the current evidence on the persisting gaps, potential causes, and possible solutions. Methods: A r apid scoping r eview was conducted for ar ticles on the topic of gender inequity and the medical profession in PubMed and Google Scholar. The search was limited to articles published from 1990 to the search date (June 1, 2017), and included only papers published in English. Results: An initial 1055 articles were screened according to established inclusion and exclusion criteria. After initial and full-text review, supplemented by a hand search through the article references, 45 articles were included in the review. Articles were classified as a) evidence for gender inequities, b) causes of inequities, and c) solutions for inequities. Only 13% of articles found (6 studies) addressed possible interventions to reduce inequities. Significant gaps exist in the literature, particularly around part-time work options, parental and family leave options, and addressing implicit biases to reduce sexism in professional settings. Discussion: The evidence highlights substantial inequities in the r epr esentation of women in the medical profession, in both the academic and community settings, in medical literature, and in leadership positions. This review also highlighted substantial gaps in the literature on understanding what can be done to reduce these gaps. More research is needed in the area of gender inequities in medicine to improve the representation of women in medicine.

Journal of Nursing Scholarship, 2017

Purpose: Climate change is an emerging challenge linked to negative outcomes for the environment ... more Purpose: Climate change is an emerging challenge linked to negative outcomes for the environment and human health. Since the 1960s, there has been a growing recognition of the need to address climate change and the impact of greenhouse gas emissions implicated in the warming of our planet. There are also deleterious health outcomes linked to complex climate changes that are emerging in the 21st century. This article addresses the social justice issues associated with climate change and human health and discussion of climate justice. Organizing Construct: Discussion paper. Methods: A literature search of electronic databases was conducted for articles, texts, and documents related to climate change, climate justice, and human health. Findings: The literature suggests that those who contribute least to global warming are those who will disproportionately be affected by the negative health outcomes of climate change. The concept of climate justice and the role of the Mary Robinson Foundation-Climate Justice are discussed within a framework of nursing's professional responsibility and the importance of social justice for the world's people. The nursing profession must take a leadership role in engaging in policy and advocacy discussions in addressing the looming problems associated with climate change. Conclusions: Nursing organizations have adopted resolutions and engaged in leadership roles to address climate change at the local, regional, national, and global level. It is essential that nurses embrace concepts related to social justice and engage in the policy debate regarding the deleterious effects on human health related to global warming and climate change. Nursing's commitment to social justice offers an opportunity to offer significant global leadership in addressing the health implications related to climate change. Clinical Relevance: Recognizing the negative impacts of climate change on well-being and the underlying socioeconomic reasons for their disproportionate and inequitable distribution can expand and optimize the profession's role in education, practice, research, and policy-making efforts to address climate change. Climate change represents an urgent global health and environmental health challenge that requires the engagement, advocacy, and leadership of the nursing profession to mitigate the health effects on the world's people. As Lemery, Williams, and Farmer (2014) note regarding climate change and its deleterious impact on our global community:

Applied Nursing Research, 2011

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those l... more Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/ AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/ AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p b .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

Nursing & Health Sciences Research Journal, 2020

Bulletin of Spanish Studies, 2016

Journal of the European Academy of Dermatology and Venereology, 2009

Background Photodynamic therapy (PDT) using methyl aminolevulinate (MAL) is an effective first-li... more Background Photodynamic therapy (PDT) using methyl aminolevulinate (MAL) is an effective first-line treatment for actinic keratoses. A reduced incubation period may have practical advantages.

Nursing & Health Sciences, 2011

Unhealthy substance-use behaviors, including a heavy alcohol intake, illicit drug use, and cigare... more Unhealthy substance-use behaviors, including a heavy alcohol intake, illicit drug use, and cigarette smoking, are engaged in by many HIV-positive individuals, often as a way to manage their disease-related symptoms. This study, based on data from a larger randomized controlled trial of an HIV/AIDS symptom management manual, examines the prevalence and characteristics of unhealthy behaviors in relation to HIV/AIDS symptoms. The mean age of the sample (n = 775) was 42.8 years and 38.5% of the sample was female. The mean number of years living with HIV was 9.1 years. The specific self-reported unhealthy substance-use behaviors were the use of marijuana, cigarettes, a large amount of alcohol, and illicit drugs. A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance-use behaviors, including amphetamine and injection drug use, heavy alcohol use, cigarette smoking, and marijuana use. The implications for clinical practice include the assessment of self-care behaviors, screening for substance abuse, and education of persons regarding the self-management of HIV.

Journal of the Association of Nurses in AIDS Care, 2007

Peripheral neuropathy, or distal sensory polyneuropathy (DSPN), is the most common neurological p... more Peripheral neuropathy, or distal sensory polyneuropathy (DSPN), is the most common neurological problem in HIV disease. DSPN also represents a complex symptom that occurs because of peripheral nerve damage related to advanced HIV disease and in association with the use of antiretroviral therapy-particularly in individuals treated with dideoxynucleosides. Although DSPN is a frequent symptom, the specific pathophysiology is not well understood. The HIV-related neuropathies are commonly categorized as distal sensory polyneuropathies, although antiretroviral toxic neuropathies are described in the literature. Recently, mitochondrial toxicity has been identified as a possible etiology of DSPN. As individuals with HIV/AIDS survive longer, often living for decades with the disease, chronic symptoms like DSPN must be addressed. Pharmacologic approaches, complementary therapies, and self-care behaviors that may improve quality of life and limit symptoms of DSPN are important interventions for clinicians and those living with HIV/AIDS to consider in the management of peripheral neuropathy.

Journal of Chromatography A, 2003

High prevalence of uterine occlusions and sterility is found among Baltic ringed and grey seal. P... more High prevalence of uterine occlusions and sterility is found among Baltic ringed and grey seal. Polychlorinated biphenyls (CBs) are suspected to be the main cause. The CB concentrations are higher in affected than in healthy animals, but the natural variation is considerable. Thus, it might be possible to assess the health status of seals by CB analysis. The ratios of chiral compounds (enantiomeric fractions (EFs)) such as atropisomeric CBs are of particular interest, since these may reflect differences in metabolic rates. An analytical procedure was developed and used to determine the levels of atropisomeric CBs, planar-CBs (WHO-PCBs) and total CBs in seals of different health status. Comprehensive 2D gas chromatography (GC × GC) was used to separate the target analytes from other CBs and interferences and a micro electron-capture detector (ECD) was used for detection. EFs of the atropisomeric CBs were difficult to determine as the levels were low and the interferences many. Two column combinations had to be used to avoid biased results-both had a chiral column as first-dimension column. The second-dimension column was coated with either a high-polarity cyanopropyl or a liquid crystal phase. EFs were determined for five atropisomeric CBs, i.e. CBs 91, 95, 132, 149 and 174. The results were verified by GC × GC-time-of-flight mass spectrometry (TOF-MS). Some atropisomeric CBs had EFs that deviated strongly from the racemic-mixture value. The deviations were larger in liver than blubber, which indicates enantioselective metabolism. However, there was no selective passage of the studied atropisomeric CBs across placenta and no selective blood-brain barrier. Similarly, no correlation between EFs and health status was observed, although there was a correlation between the total CB levels and health status. (M. Harju). mals have high levels of persistent organic pollutants (POPs), e.g. DDTs, PCBs, PBDEs, PCDD/Fs and chlordanes. Three seal species live in the Baltic: the ringed (Phoca hispida botnica), grey (Halichoerus grypus) and harbour (Phoca vitulina vitulina) seals. In the mid-1970s, uterine occlusions were frequently found in ringed seals and grey seals. On the basis of

European Journal of Clinical Pharmacology, 1994

5-Methoxypsoralen (5-MOP) in combination with ultraviolet light exposure is used for the treatmen... more 5-Methoxypsoralen (5-MOP) in combination with ultraviolet light exposure is used for the treatment of psoriasis. The effect of food on the pharmacokinetics of 5-MOP was evaluated in a randomized, crossover study in nine healthy subjects. Each subject received the tablets with a standardized breakfast or under fasting conditions. The food had a dramatic effect on the bioavailability of 5-MOP. Five of the subjects showed no measurable quantities (detection limit of the analytical technique 1 ng.ml-1) of 5-MOP when the drug was given under fasting conditions. However, plasma peak concentration within the range 37-144 ng.ml-1 (median 102 ng.ml-1) was measured when the drug was taken with food. The time for the plasma peak concentration was within the range 2.0-5.1 h (median 3.0 h) under non-fasting conditions. The elimination half-life was within the range 1.4-2.7 h (median 1.9 h). We conclude that it is imperative that 5-MOP tablets are administered together with food.

Conservation Genetics, 2010

The population status of the harbour porpoise (Phocoena phocoena) in the Baltic area has been a c... more The population status of the harbour porpoise (Phocoena phocoena) in the Baltic area has been a continuous matter of debate. Here we present the by far most comprehensive genetic population structure assessment to date for this region, both with regard to geographic coverage and sample size: 497 porpoise samples from North Sea, Skagerrak, Kattegat, Belt Sea, and Inner Baltic Sea were sequenced at the mitochondrial Control Region and 305 of these specimens were typed at 15 polymorphic microsatellite loci. Samples were stratified according to sample type (stranding vs. by-caught), sex, and season (breeding vs. non-breeding season). Our data provide ample evidence for a population split between the Skagerrak and the Belt Sea, with a transition zone in the Kattegat area. Among other measures, this was particularly visible in significant frequency shifts of the most abundant mitochondrial haplotypes. A particular haplotype almost absent in the North Sea was the most abundant in Belt Sea and Inner Baltic Sea. Microsatellites yielded a similar pattern (i.e., turnover in occurrence of clusters identified by STRUCTURE). Moreover, a highly significant association between microsatellite assignment and unlinked mitochondrial haplotypes further indicates a split between North Sea and Baltic porpoises. For the Inner Baltic Sea, we consistently recovered a small, but significant separation from the Belt Sea population. Despite recent arguments that separation should exceed a predefined threshold before populations shall be managed separately, we argue in favour of precautionary acknowledging the Inner Baltic porpoises as a separate management unit, which should receive particular attention, as it is threatened by various factors, in particular local fishery measures.

Chemosphere, 2011

Temporal trends of polyfluoroalkyl compounds (PFCs) were examined in grey seal (Halichoerus grypu... more Temporal trends of polyfluoroalkyl compounds (PFCs) were examined in grey seal (Halichoerus grypus) liver from the Baltic Sea over a period of 35 years . In total, 17 of 43 PFCs were found, including the perfluoroalkyl sulfonates (C 4 -C 10 PFSAs), perfluorooctanesulfinate (PFOSi), long chain perfluoroalkyl carboxylates (C 7 -C 14 PFCAs), and perfluoroalkyl sulfonamides (i.e., perfluorooctane sulfonamide (FOSA) and N-ethyl perfluorooctane sulfonamide (EtFOSA)), whereas saturated and unsaturated fluorotelomer carboxylates, shorter chain PFCAs and perfluoroalkyl phosphonic acids were not detected. Perfluorooctane sulfonate (PFOS) was the predominant compound (9.57-1444 ng g À1 wet weight (ww)), followed by perfluorononanoate (PFNA, 0.47-109 ng g À1 ww). C 6 -C 8 PFSAs, PFOSi and C 7 -C 13 PFCAs showed statistically significant increasing concentrations between 1974 and 1997, with a peak in 1997 and then decreased or levelled off (except for C 12 and C 13 PFCAs). FOSA had a different temporal trend with a maximum in 1989 followed by significant decreasing concentrations until 2008. Toxicological implications for grey seals are limited, but the maximal PFOS concentration found in this study was about 40 times lower than the predicted lowest observed effect concentrations (LOEC). The statistically significant decreasing concentrations or levelling off for several PFCs in the relative closed marine ecosystem of the Baltic Sea indicate a rapidly responding to reduced emissions to the marine environment. However, the high concentrations of PFOS and continuing increasing concentrations of the longer chain PFCAs (C 12 -C 14 ) shows that further work on the reduction of environmental emissions of PFCs are necessary.

Chemosphere, 2011

Temporal trends of polyfluoroalkyl compounds (PFCs) were examined in grey seal (Halichoerus grypu... more Temporal trends of polyfluoroalkyl compounds (PFCs) were examined in grey seal (Halichoerus grypus) liver from the Baltic Sea over a period of 35 years (1974-2008). In total, 17 of 43 PFCs were found, including the perfluoroalkyl sulfonates (C(4)-C(10) PFSAs), perfluorooctanesulfinate (PFOSi), long chain perfluoroalkyl carboxylates (C(7)-C(14) PFCAs), and perfluoroalkyl sulfonamides (i.e., perfluorooctane sulfonamide (FOSA) and N-ethyl perfluorooctane sulfonamide (EtFOSA)), whereas saturated and unsaturated fluorotelomer carboxylates, shorter chain PFCAs and perfluoroalkyl phosphonic acids were not detected. Perfluorooctane sulfonate (PFOS) was the predominant compound (9.57-1444 ng g(-1) wet weight (ww)), followed by perfluorononanoate (PFNA, 0.47-109 ng g(-1) ww). C(6)-C(8) PFSAs, PFOSi and C(7)-C(13) PFCAs showed statistically significant increasing concentrations between 1974 and 1997, with a peak in 1997 and then decreased or levelled off (except for C(12) and C(13) PFCAs). FOSA had a different temporal trend with a maximum in 1989 followed by significant decreasing concentrations until 2008. Toxicological implications for grey seals are limited, but the maximal PFOS concentration found in this study was about 40 times lower than the predicted lowest observed effect concentrations (LOEC). The statistically significant decreasing concentrations or levelling off for several PFCs in the relative closed marine ecosystem of the Baltic Sea indicate a rapidly responding to reduced emissions to the marine environment. However, the high concentrations of PFOS and continuing increasing concentrations of the longer chain PFCAs (C(12)-C(14)) shows that further work on the reduction of environmental emissions of PFCs are necessary.

British Journal of Dermatology, 2004

Background Although photodynamic therapy (PDT) is becoming an important treatment method for skin... more Background Although photodynamic therapy (PDT) is becoming an important treatment method for skin lesions such as actinic keratosis (AK) and superficial basal cell carcinoma, there are still discussions about which fluence rate and light dose are preferable. Recent studies in rodents have shown that a low fluence rate is preferable due to depletion of oxygen at high fluence rates. However, these results have not yet been verified in humans. Objectives The objective was to investigate the impact of fluence rate and spectral range on primary treatment outcome and bleaching rate in AK using aminolaevulinic acid PDT. In addition, the pain experienced by the patients has been monitored during treatment. Patients ⁄ methods Thirty-seven patients (mean age 71 years) with AK located on the head, neck and upper chest were treated with PDT, randomly allocated to four groups: two groups with narrow filter (580-650 nm) and fluence rates of 30 or 45 mW cm )2 , and two groups with broad filter (580-690 nm) and fluence rates of 50 or 75 mW cm )2 . The total cumulative light dose was 100 J cm )2 in all treatments. Photobleaching was monitored by fluorescence imaging, and pain experienced by the patients was registered by using a visual analogue scale graded from 0 (no pain) to 10 (unbearable pain). The primary treatment outcome was evaluated at a follow-up visit after 7 weeks. Results Our data showed a significant correlation between fluence rate and initial treatment outcome, where lower fluence rate resulted in favourable treatment response. Moreover, the photobleaching dose (1 ⁄ e) was found to be related to fluence rate, ranging from 4AE5 ± 1AE0 J cm )2 at 30 mW cm )2 , to 7AE3 ± 0AE7 J cm )2 at 75 mW cm )2 , indicating higher oxygen levels in tissue at lower fluence rates. After a cumulative light dose of 40 J cm )2 no further photobleaching took place, implying that higher doses are excessive. No significant difference in pain experienced by the patients during PDT was observed in varying the fluence rate from 30 to 75 mW cm )2 . However, the pain was found to be most intense up to a cumulative light dose of 20 J cm )2 . Conclusions Our results imply that the photobleaching rate and primary treatment outcome are dependent on fluence rate, and that a low fluence rate (30 mW cm )2 ) seems preferable when performing PDT of AK using noncoherent light sources.

Acta Dermato-Venereologica, 2006

Photodynamic therapy (PDT) is an efficient treatment for actinic keratosis. A common problem, how... more Photodynamic therapy (PDT) is an efficient treatment for actinic keratosis. A common problem, however, is pain. The aim of this study was to investigate pain during PDT for actinic keratosis. The possibility of using capsaicin cream for pain relief was also assessed. Pain was investigated during aminolaevulinic acid PDT in 91 patients. Size, redness, scaling and induration of the lesions were recorded. Maximum pain during treatment was registered, using a visual analogue scale (0-10). The pain-reducing efficacy of capsaicin was tested in a pilot study in six patients (10 lesions). These patients were pre-treated with capsaicin cream for one week before commencing PDT. Pain was found to be normally distributed around a mean value of visual analogue scale 4.6. Larger lesions gave more pain (p=0.001). The redness of the actinic lesions was found to be related to PDT-induced pain (p=0.01), the reduction of actinic area (p=0.007), and the cure rate (p=0.01). The redder the actinic area, the better the treatment outcome and the more pain experienced. Patients with the largest reduction in the actinic area experienced more pain (p=0.053). The most important factors for presence of pain seem to be the size and the redness of the lesion. No significant pain relief was experienced after pre-treatment with capsaicin.

Applied Nursing Research, 2011

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those l... more Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/ AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/ AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p b .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.