OBJECTIVE:To evaluate the psychometric properties of Versions 2 and 3 of the Breast Inflammatory Symptom Severity Index (BISSI). DESIGN:Secondary data analysis of clinical trial data. SETTING:Private physiotherapy practices, a public tertiary hospital, and a community in Melbourne, Australia. PARTICIPANTS:Women more than 7 days after birth with inflammatory conditions of the lactating breast (N = 43). METHODS:We performed confirmatory factor analysis of the BISSI Version 2 to examine item loading, which informed development of the BISSI Version 3 (V3). We assessed convergent validity by comparing total BISSI V3 scores with human milk sodium to potassium ratio (Na+:K+) at Trial Days 1, 3, and 10 using Bland-Altman plots. We compared item-level scores for size of affected area with objective receiver operating characteristic curve analysis to assess discriminant validity for symptom severity and Cronbach's alpha for internal reliability. RESULTS:After confirmatory factor analysis, we removed two items, resulting in a six-item BISSI V3. All retained items demonstrated comparable loading on the overall scale. Limits of agreement for total BISSI V3 scores and item-level scores for size of affected area were acceptable at all time points, with more than 90% of observations falling within 2 standard deviations of the mean difference, supporting convergent validity. Discriminant validity of the BISSI V3 was supported. We found high internal reliability at both time points CONCLUSION: Our findings provide evidence for the validity and reliability of the BISSI V3 and support its continued development and for clinical use of the BISSI V3 and human milk Na+:K+ analysis to enhance management of inflammatory conditions of the lactating breast.
The author describes the importance of data visualization in research communication.
Historically, U.S. vaccine policy relied on a stable, multi-agency infrastructure and external scientific advisory processes to maintain public health. However, beginning in 2025, radical departures from these established scientific norms occurred and led to significant changes to the federal vaccination schedule for children and pregnant women. These events have resulted in a fractured vaccine policy, with numerous states and professional organizations now bypassing federal guidance in favor of recommendations from nongovernment bodies such as the American Academy of Pediatrics and the Maternal Immunization Task Force. In this article, we trace the history of U.S. vaccine policy, detail recent federal changes, and examine the responses from state and professional entities. The fracturing of vaccine policy has far-reaching implications for the health and health care of women, childbearing and childrearing families, and newborns through decreased vaccine rates, increased disease rates, and general erosion of public trust. We explore the effect on nursing practice and emphasize the heightened pressure on health care professionals to be compassionate, evidence-based communicators. Finally, we offer a call to action for nurses to employ personalized, trusted interactions and clear, knowledgeable explanations to address vaccine hesitancy and protect community health in this rapidly evolving policy landscape.
Biological aging describes the cumulative decline in physiologic function that can differ from chronological age. Menopause marks a reproductive transition that may influence biological aging through loss of estrogen, changes in body composition, chronic inflammation, and epigenetic regulation. These pathways may contribute to heterogeneity in cardiovascular, skeletal, cognitive, and functional outcomes among postmenopausal women. Researchers use composite indices and molecular measures, including phenotypic age and DNA methylation or epigenetic clocks, to quantify these processes. However, available biomarkers vary by tissue and intended outcome. No biological aging test currently provides a validated threshold that can direct routine menopause care. In this column, I summarize mechanisms that may connect menopause with biological aging, review major biomarkers, and describe clinical outcomes and symptoms that these measures may help explain. I also discuss evidence-based opportunities for nursing intervention. Future researchers should follow diverse cohorts across the perimenopause transition and evaluate whether changes in aging biomarkers predict outcomes or treatment response.
