Publications

Publications

Alterations in Patterns of Gene Expression and Perturbed Pathways in the Gut-Brain Axis Are Associated With Chemotherapy-Induced Nausea

Singh, K. P., Dhruva, A., Flowers, E., Paul, S. M., Hammer, M. J., Wright, F., Cartwright, F., Conley, Y. P., Melisko, M., Levine, J. D., Miaskowski, C., & Kober, K. M. (2020). Journal of Pain and Symptom Management. 10.1016/j.jpainsymman.2019.12.352
Abstract
CONTEXT: Despite current advances in antiemetic treatments, approximately 50% of oncology patients experience chemotherapy-induced nausea (CIN).OBJECTIVES: The purpose of this study was to evaluate for differentially expressed genes and perturbed pathways associated with the gut-brain axis (GBA) across two independent samples of oncology patients who did and did not experience CIN.METHODS: Oncology patients (n=735) completed study questionnaires in the week prior to their second or third cycle of chemotherapy (CTX). CIN occurrence was assessed using the Memorial Symptom Assessment Scale. Gene expression analyses were performed in two independent samples using RNA-sequencing (sample 1, n=357) and microarray (sample 2, n=352) methodologies. Fisher's combined probability method was used to determine genes that were differentially expressed and pathways that were perturbed between the two nausea groups across both samples.RESULTS: CIN was reported by 63.6% of the patients in sample 1 and by 48.9% of the patients in sample 2. Across the two samples, 703 genes were differentially expressed and 37 pathways were found to be perturbed between the two CIN groups. We identified nine perturbed pathways that are involved in mechanisms associated with alterations in the GBA (i.e., mucosal inflammation, disruption of gut microbiome).CONCLUSIONS: Persistent CIN remains a significant clinical problem. Our study is the first to identify novel GBA-related pathways associated with the occurrence of CIN. Our findings warrant confirmation and suggest directions for future clinical studies to decrease CIN occurrence.

Alterations in Patterns of Gene Expression and Perturbed Pathways in the Gut-Brain Axis Are Associated With Chemotherapy-Induced Nausea

Singh, K. P., Dhruva, A., Flowers, E., Paul, S. M., Hammer, M. J., Wright, F., Cartwright, F., Conley, Y. P., Melisko, M., Levine, J. D., Miaskowski, C., & Kober, K. M. (2020). Journal of Pain and Symptom Management. 10.1016/j.jpainsymman.2019.12.352
Abstract
Context: Despite current advances in antiemetic treatments, approximately 50% of oncology patients experience chemotherapy-induced nausea (CIN). Objectives: The purpose of this study was to evaluate for differentially expressed genes and perturbed pathways associated with the gut-brain axis (GBA) across two independent samples of oncology patients who did and did not experience CIN. Methods: Oncology patients (n = 735) completed study questionnaires in the week before their second or third cycle of chemotherapy. CIN occurrence was assessed using the Memorial Symptom Assessment Scale. Gene expression analyses were performed in two independent samples using ribonucleic acid sequencing (Sample 1, n = 357) and microarray (Sample 2, n = 352) methodologies. Fisher's combined probability method was used to determine genes that were differentially expressed and pathways that were perturbed between the two nausea groups across both samples. Results: CIN was reported by 63.6% of the patients in Sample 1 and 48.9% of the patients in Sample 2. Across the two samples, 703 genes were differentially expressed, and 37 pathways were found to be perturbed between the two CIN groups. We identified nine perturbed pathways that are involved in mechanisms associated with alterations in the GBA (i.e., mucosal inflammation, disruption of gut microbiome). Conclusion: Persistent CIN remains a significant clinical problem. Our study is the first to identify novel GBA-related pathways associated with the occurrence of CIN. Our findings warrant confirmation and suggest directions for future clinical studies to decrease CIN occurrence.

Anxiety about aging, resilience and health Status among Chinese older adults: Findings from Honolulu and Wuhan

Zhang, K., Zhang, W., Wu, B., & Liu, S. (2020). Archives of Gerontology and Geriatrics, 88. 10.1016/j.archger.2020.104015
Abstract
A growing body of literature found that anxiety about aging is related to health and well-being of older adults. However, very few studies have been conducted on Chinese older adults residing in different countries and examined the role of resilience. Using the Pearlin's Stress Process Model, this study aims to fill in this gap by examining the relationship between anxiety about aging as the stressor and health status among Chinese older adults living in Honolulu, the United States (N = 292) and Wuhan, China (N = 532). The survey data were collected through June 2017 to September 2018, using snowball and convenience sampling strategy. The moderating role of resilience on the focal relationship is also explored. Results showed that for both samples, the negative relationship between anxiety about aging and self-rated health was significantly moderated by resilience (18 % and 13 %, respectively), implying the stress-buffering role of resilience. Although both mean levels of resilience and anxiety about aging were lower for the Honolulu sample, the moderating effect appeared to be stronger, implying that older adults in the Honolulu sample might rely more on psychological resources such as resilience in coping with stressors, compared with their counterparts in Wuhan. However, the moderating effect of resilience did not work for the association between anxiety about aging and number of chronic conditions for both samples. Our findings suggest that future research needs to take into account both social and psychological resources when examining anxiety about aging and health status among Chinese older adults residing in different cultural contexts.

Assessing providers’ approach to hypertension management at a large, private hospital in Kampala, Uganda

Green, A. S., Lynch, H. M., Nanyonga, R. C., Squires, A. P., Gadikota-Klumpers, D. D., Schwartz, J. I., & Heller, D. J. (2020). Annals of Global Health, 86(1). 10.5334/aogh.2513
Abstract
Background: Hypertension is increasingly prevalent in Uganda and its clinical management remains subop-timal across the country. Prior research has elucidated some of the factors contributing to poor control, but little is known about providers’ approaches to hypertension management and perceptions of barriers to care. This is particularly true in private health care settings – despite the fact that the private sector provides a substantial and growing portion of health care in Uganda. Objective: Our exploratory, pragmatic qualitative study aimed to examine the factors affecting the quality of hypertension care from the perspective of providers working in an urban, private hospital in Uganda. We focused on the organizational and system-level factors influencing providers’ approaches to management in the outpatient setting. Methods: We conducted interviews with 19 health care providers working in the outpatient setting of a 110-bed, private urban hospital in Kampala, Uganda. We then coded the interviews for thematic analysis, using an inductive approach to generate the study’s findings. Findings: Several themes emerged around perceived barriers and facilitators to care. Providers cited patient beliefs and behaviors, driven in part by cultural norms, as key challenges to hypertension control; however, most felt their own approach to hypertension treatment aligned with international guidelines. Providers struggled to collaborate with colleagues in coordinating the joint management of patients. Furthermore, they cited the high cost and limited availability of medication as barriers. Conclusions: These findings offer important strategic direction for intervention development specific to this Ugandan context: for example, regarding culturally-adapted patient education initiatives, or programs to improve access to essential medications. Other settings facing similar challenges scaling up management of hypertension may find the results useful for informing intervention development as well.

Assessing providers’ approach to hypertension management at a large, private hospital in Kampala, Uganda

Green, A. S., Lynch, H. M., Nanyonga, R. C., Squires, A. P., Gadikota-Klumpers, D. D., Schwartz, J. I., & Heller, D. J. (2020). Annals of Global Health, 86(1). 10.5334/aogh.2513
Abstract
Background: Hypertension is increasingly prevalent in Uganda and its clinical management remains subop-timal across the country. Prior research has elucidated some of the factors contributing to poor control, but little is known about providers’ approaches to hypertension management and perceptions of barriers to care. This is particularly true in private health care settings – despite the fact that the private sector provides a substantial and growing portion of health care in Uganda. Objective: Our exploratory, pragmatic qualitative study aimed to examine the factors affecting the quality of hypertension care from the perspective of providers working in an urban, private hospital in Uganda. We focused on the organizational and system-level factors influencing providers’ approaches to management in the outpatient setting. Methods: We conducted interviews with 19 health care providers working in the outpatient setting of a 110-bed, private urban hospital in Kampala, Uganda. We then coded the interviews for thematic analysis, using an inductive approach to generate the study’s findings. Findings: Several themes emerged around perceived barriers and facilitators to care. Providers cited patient beliefs and behaviors, driven in part by cultural norms, as key challenges to hypertension control; however, most felt their own approach to hypertension treatment aligned with international guidelines. Providers struggled to collaborate with colleagues in coordinating the joint management of patients. Furthermore, they cited the high cost and limited availability of medication as barriers. Conclusions: These findings offer important strategic direction for intervention development specific to this Ugandan context: for example, regarding culturally-adapted patient education initiatives, or programs to improve access to essential medications. Other settings facing similar challenges scaling up management of hypertension may find the results useful for informing intervention development as well.

Characterizing Sugar-Sweetened Beverage Consumption for US Children and Adolescents by Race/Ethnicity

Russo, R. G., Northridge, M. E., Wu, B., & Yi, S. S. (2020). Journal of Racial and Ethnic Health Disparities. 10.1007/s40615-020-00733-7
Abstract
OBJECTIVES: To examine racial/ethnic differences in type of SSB most frequently consumed and in correlates of youth sugar-sweetened beverage (SSB) intake.METHODS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES), 2011-2016, for children and adolescents aged 5-17 years (n = 6507). The main outcome was SSB consumption (i.e., sodas, sweetened fruit drinks, nectars, sports and energy drinks, sweetened coffees and teas, enhanced waters). Mean and proportions of SSB intake were estimated accounting for complex sampling strategy and weighting. Multivariable regression models were developed for each race/ethnicity and age group.RESULTS: Two-thirds of children and adolescents reported consuming SSB on a given day. Among consumers, mean SSB consumption was greatest for Black children and White adolescents and lowest for Asian American children and adolescents. The most popular type of SSB consumed was sweetened fruit drinks among children and soda among adolescents, except among White and Mexican American children for whom soda and Black adolescents for whom sweetened fruit drinks were most popular. Female sex and water intake were negatively associated with SSB consumption across most races/ethnicities. Screen time, dentist visits, nativity, and guardian education were associated with SSB intake among a subset of races/ethnicities.CONCLUSIONS: Associations between covariates and SSB intake as well as types of beverages preferred vary by race/ethnicity, as such chronic disease policies should not be 'one size fits all'. Targeted interventions for specific groups of vulnerable youths hold promise for further reducing SSB consumption, including directing efforts towards reducing sweetened fruit drinks for Black children.

Community Acquired Pneumonia

Taub, L.-F., & Pasklinsky, N. (2020). Springer.

Consortium Building for Nurse Scientists Interested in Symptoms Research in the Era of Precision Health

Hsiao, C. P., Dickinson, K., Gonzalez-Mercado, V., Kelly, D. L., Lukkahatai, N., McCabe, M., Mayo, S., Musanti, R., & Saligan, L. N. (2020). Journal of Nursing Scholarship, 52(2), 183-191. 10.1111/jnu.12534
Abstract
Purpose: This article aims to provide perspectives on the establishment of a consortium for nurse scientists with similar career trajectories interested in cancer-related symptoms (CRS) research. Hereby, we describe the development of and recent outcomes from the CRS consortium, the lessons learned in establishing the consortium, and future directions to advance the science of CRS. Model and Methods: New and innovative strategies are needed to address the complexity of CRS research. A CRS consortium was created to allow a mechanism for oncology nurse scientists with varying expertise to collaborate to advance CRS research. The National Institutes of Health (NIH) Symptom Science Model (SSM) guides the research of the CRS Consortium. Discussion and Conclusions: A need for improved CRS assessment and management has been identified. The CRS consortium was created as a collaborative think tank to begin to address this need. Guided by the NIH SSM, CRS consortium members have worked to define symptom phenotypes, enhance understanding of the biologic mechanisms that can contribute to symptom phenotypes, and develop tailored interventions to improve symptom management. Dissemination of the CRS consortium efforts involve publications and presentations. Clinical Implications: Nurse scientists interested in symptom science and biobehavorial research face many challenges on how to initiate and sustain independent programs of research. Through the formation of a CRS consortium, oncology nurse scientists can work together to address identified issues in symptom measurement and management.

A Descriptive Analysis of an Ambulatory Kidney Palliative Care Program

Scherer, J. S., Harwood, K., Frydman, J. L., Moriyama, D., Brody, A. A., Modersitzki, F., Blaum, C. S., & Chodosh, J. (2020). Journal of Palliative Medicine, 23(2), 259-263. 10.1089/jpm.2018.0647
Abstract
Background: Many patients with serious kidney disease have an elevated symptom burden, high mortality, and poor quality of life. Palliative care has the potential to address these problems, yet nephrology patients frequently lack access to this specialty. Objectives: We describe patient demographics and clinical activities of the first 13 months of an ambulatory kidney palliative care (KPC) program that is integrated within a nephrology practice. Design/Measurements: Utilizing chart abstractions, we characterize the clinic population served, clinical service utilization, visit activities, and symptom burden as assessed using the Integrated Palliative Care Outcome Scale-Renal (IPOS-R), and patient satisfaction. Results: Among the 55 patients served, mean patient age was 72.0 years (standard deviation [SD] = 16.7), 95% had chronic kidney disease stage IV or V, and 46% had a Charlson Comorbidity Index >8. The mean IPOS-R score at initial visit was 16 (range = 0-60; SD = 9.1), with a mean of 7.5 (SD = 3.7) individual physical symptoms (range = 0-15) per patient. Eighty-seven percent of initial visits included an advance care planning conversation, 55.4% included a medication change for symptoms, and 35.5% included a dialysis decision-making conversation. Overall, 96% of patients who returned satisfaction surveys were satisfied with the care they received and viewed the KPC program positively. Conclusions: A model of care that integrates palliative care with nephrology care in the ambulatory setting serves high-risk patients with serious kidney disease. This KPC program can potentially meet documented gaps in care while achieving patient satisfaction. Early findings from this program evaluation indicate opportunities for enhanced patient-centered palliative nephrology care.

An Educational Intervention for Health Care Providers

Quinones, S. (2020). American Psychological Association.

Effects of Care Arrangement on the Age of Institutionalization among Community-dwelling Chinese Older Adults

Wang, J., Yang, Q., & Wu, B. (2020). Journal of Aging and Social Policy. 10.1080/08959420.2020.1726720
Abstract
Early and unnecessary institutionalization of older adults can be a heavy burden on the country and taxpayers. It is crucial to understand factors impacting the age of institutionalization of older adults in China. This study examined care arrangements of older adults in China and the relationship between these arrangements and the age of relocation to long-term care facilities (institutionalization). Results show that care arrangements affect the age of institutionalization among community-dwelling Chinese older adults. Those who were primarily cared for by sons and daughter-in-laws tended to be institutionalized at a significantly later age compared to those who were cared for by their spouses. Those who were primarily cared for by other relatives and friends, by domestic helpers, and those with no caregivers tended to have significantly earlier institutionalization compared to those who were cared for by their spouses. However, the number of older adults living in empty nest families is increasing rapidly. Traditional family support for older adults has been shrinking due to fewer children, out-migration of adult children from rural to urban areas, and increased employment of women in China. There is an acute shortage of competent and qualified elder care workers. Most Chinese domestic helpers started their work with limited or even no training, risking the safety of themselves and their employers. In addition to increasing and optimizing the investment in the elder care industry, legal protection and policy support for the elderly and domestic helpers are urgently needed to address these key issues.

Gender differences in quality of life among community-dwelling older adults in low- and middle-income countries: results from the Study on global AGEing and adult health (SAGE)

Lee, K. H., Xu, H., & Wu, B. (2020). BMC Public Health, 20(114). doi.org/10.1186/s12889-020-8212-0
Abstract
Quality of life (QoL) is an important component of individuals’ general well-being, particularly in older adults. However, factors influencing QoL among older adults in low- and middle-income countries (LMICs) have not been fully examined. Furthermore, the role of gender differences in relation to QoL in multiple LMICs has also not been examined in detail.

General surgical care of the older adult

Lim, F., & Slater, L. (2020). Springer.

Gut microbiota differences in Island Hispanic Puerto Ricans and mainland non-Hispanic whites during chemoradiation for rectal cancer: A pilot study

González-Mercado, V. J., Lim, J., Berk, L., Esele, M., Rodríguez, C. S., & Colón-Otero, G. (2020). Current Problems in Cancer. 10.1016/j.currproblcancer.2020.100551
Abstract
Purpose: To investigate whether there are differences in diversity, taxonomic composition, and predicted functional pathways of the gut microbiome between Island Hispanic Puerto Ricans (HPR) and mainland non-Hispanic whites (NHW) measured before and at the end of chemo-radiation (CRT) for Rectal Cancer. Methods: Fifty-six stool samples of newly diagnosed rectal cancer patients (25 HPR and 31 NHW) were amplicon-sequenced during chemo-radiotherapy. 16S rRNA gene data was analyzed using QIIME2, phyloseq, and LEfSe. Results: We observed similar within-sample alpha diversity for HPR and NHW participants during CRT. However, at the end of CRT, several taxa were present at significantly different abundances across both groups. Taxa enriched in the gut of HPR compared to NHW included Muribaculaceae, Prevotella 2 and 7, Gemella, Bacillales Family XI, Catenibacterium, Sutterella, Pasteurellales, and Pasteurellaceae genera, whereas over-represented taxa in NHW participants were Turicibacter and Eubacteriaceae. Significant differences in predicted HPR microbiota functions included pathways for synthesis of L-methionine and degradation of phenylethylamine and phenylacetate. Conclusion: In this pilot study, taxonomic analyses and functional predictions of the gut microbiomes suggest greater inflammatory potential in gut microbial functions among HPR rectal cancer patients undergoing CRT compared to that of NHW participants.

Higher levels of stress and different coping strategies are associated with greater morning and evening fatigue severity in oncology patients receiving chemotherapy

Wright, F., Kober, K. M., Cooper, B. A., Paul, S. M., Conley, Y. P., Hammer, M., Levine, J. D., & Miaskowski, C. (2020). Supportive Care in Cancer. 10.1007/s00520-020-05303-5
Abstract
Purpose: A cancer diagnosis and associated treatments are stressful experiences for most patients. Patients’ perceptions of stress and their use of coping strategies may influence fatigue severity. This study extends our previous work describing distinct profiles of morning (i.e., Very Low, Low, High, and Very High) and evening (i.e., Low, Moderate, High, and Very High) fatigue in oncology patients by evaluating for differences in stress and coping strategies among these fatigue classes. Methods: This longitudinal study evaluated for changes in morning and evening fatigue in oncology patients (n = 1332) over two cycles of chemotherapy (CTX). Patients completed measures of cumulative exposure to stressful life events (SLEs) (i.e., the Life Stressor Checklist-Revised), general stress (i.e., Perceived Stress Scale [PSS]), cancer-specific stress (i.e., Impact of Event Scale-Revised [IES-R]), and coping strategies (i.e., Brief Cope). Differences among the latent classes were evaluated using analyses of variance, Kruskal-Wallis, or chi-square tests. Results: Patients in both the Very High morning and evening fatigue classes reported higher numbers of and a higher impact from previous SLEs and higher PSS scores than the other fatigue classes. The IES-R scores for the Very High morning fatigue class met the criterion for subsyndromal PTSD. Patients in the Very High evening fatigue class used a higher number of engagement coping strategies compared with the Very High morning fatigue class. Conclusions: Our findings suggest that interventions to reduce stress and enhance coping warrant investigation to decrease fatigue in patients undergoing CTX.

Immigrant Status, Resilience, and Perceived Oral Health Among Chinese Americans in Hawaii

Wu, B., Pei, Y., Zhang, W., & Northridge, M. (2020). Research on Aging, 164027520912493. 10.1177/0164027520912493
Abstract
OBJECTIVES: This study aims to examine the associations among immigrant status, resilience, and perceived oral health for Chinese American older adults in Hawaii.METHOD: Data derived from 430 Chinese American adults aged 55 years and older residing in Honolulu, HI. We compared the self-rated oral health and oral health problems between U.S.-born Chinese Americans and foreign-born Chinese Americans by using ordered logistic regression and ordinary least squares regression models.RESULTS: Findings suggest that immigrant status and lower levels of resilience are associated with poorer self-rated oral health and more oral health problems for Chinese American older adults in Hawaii. Resilience is more strongly associated with self-rated oral health for U.S.-born Chinese American than for foreign-born Chinese Americans, but this pattern was not evident for oral health problems.DISCUSSION: Older Chinese American immigrants in Hawaii are disadvantaged in terms of their oral health. Understanding their susceptibilities may lead to targeted interventions.

The Impact of Geriatric-Specific Triage Tools Among Older Adults in the Emergency Department

Pham, K. D., & Lim, F. A. (2020). Critical Care Nursing Quarterly, 43(1), 39-57. 10.1097/CNQ.0000000000000290
Abstract
As the aging population grows, emergency department (ED) service utilization among those 65 years and older is expected to rise. In 2017, it was estimated that approximately 49 million Americans were 65 years and older. Not surprisingly, the number of ED visits by older adults is also increasing, given that this population is more likely to have multiple comorbidities. Emergency department visits by older adults pose specific challenges in risk stratification and optimizing their care based on the use of geriatric-specific triage tools. The aim of this integrative review is to appraise the impact of geriatric-specific triage tolls used in the ED and offer meaningful discussion on how to best address older adults in the ED setting. Findings from this review will help inform the efforts of clinicians, educators, researchers, and public health policy stakeholders charged in the care and advocacy for vulnerable older adults.

Impact of the All of Us research program

Llanto, K., Lim, F., & Ea, E. (2020). Nursing, 50(3), 67-68. 10.1097/01.NURSE.0000654172.46117.18

Lifestyle Risk Factors in Esophageal Cancer: An Integrative Review

Zhao, X., & Lim, F. (2020). Critical Care Nursing Quarterly, 43(1), 86-98. 10.1097/CNQ.0000000000000295
Abstract
Esophageal cancer (EC) is a prevalent type of cancer, affecting more than 16 000 people annually in the United States. Being a high-burden disease, the comprehensive management of EC is challenging, particularly for older adults. In addition, Asian countries have some of the highest age-standardized incidence rates of EC in the world. Epidemiologic studies have revealed that cigarette and cigar smoking, alcohol drinking, obesity, being overweight, and areca chewing increase the risk of EC. This integrative review aims to elucidate the association between lifestyle factors such dietary habits, smoking, and alcohol consumption and EC among the Asian populations with Chinese, Japanese, and Taiwanese ethnicity. The synthesis of the literature found that environmental factors play an important role in the risk of EC occurrence. Although most of the risk factors showed a positive relationship in increasing the risk, studies included in this review reported inconclusive results on whether tea and coffee are risk factors. The consumption of very hot beverages and low intake of green vegetable are associated with EC. Smoking, alcohol intake, and their interaction with diets were found to be the biggest factor in the development of EC. Registered nurses can educate about esophageal thermal injury among persons who have preference for drinking burning-hot beverages and those with multiple risk factors, such as those who smoke and drink excess alcohol, as well as promoting health behaviors and serving as patient advocates.

Necrotizing fasciitis associated with malignancy

Chen, L., Tayban, K., Caravanos, C., Shaz, D., & Halpern, N. (2020). Journal of the American Association of Nurse Practitioners, 32(2), 109-112. 10.1097/JXX.0000000000000251

Nurses’ judgments of patient risk of deterioration at change-of-shift handoff: Agreement between nurses and comparison with early warning scores

Lavoie, P., Clarke, S. P., Clausen, C., Purden, M., Emed, J., Mailhot, T., Fontaine, G., & Frunchak, V. (2020). Heart and Lung. 10.1016/j.hrtlng.2020.02.037
Abstract
Background: Nurses begin forming judgments regarding patients’ clinical stability during change-of-shift handoffs. Objectives: To examine the agreement between incoming and outgoing nurses’ judgments of deterioration risk following handoff and compare these judgments to commonly used early warning scores (MEWS, NEWS, ViEWS). Methods: Following handoffs on three medical/surgical units, nurses completed the Patient Acuity Rating. Nurse ratings were compared with computed early warning scores based on clinical data. In follow-up interviews, nurses were invited to describe their experiences of using the rating scale. Results: Sixty-two nurses carried out 444 handoffs for 158 patients. While the agreement between incoming and outgoing nurses was fair, correlations with early warning scores were low. Nurses struggled with predicting risk and used their impressions of differential risk across all the patients to whom they had been assigned to arrive at their ratings. Conclusion: Nurses shared information that influenced their clinical judgments at handoff; not all of these cues may necessarily be captured in early warning scores.

Perioperative care of the older adult

Lim, F., & Slater, L. (2020). Springer.

Primary health care providers’ advice for dental checkups and dentist visits among children: Results from the Medical Expenditure Panel Survey 2001-2016

Luo, H., Garcia, R. I., Moss, M., Bell, R., Wright, W., & Wu, B. (2020). Journal of Public Health Dentistry. DOI:10.1111/jphd.12356
Abstract
Tooth decay is the most common chronic disease in children. In the United States, national survey data from 2011 to 2014 showed that about 24% of children aged 2–5 years have experienced dental caries in their primary teeth, with 11% having untreated caries; 58% of adolescents aged 12–19 years have experienced dental caries in their permanent teeth, with 19% having untreated caries.1 Hispanic and non‐Hispanic black children aged 2–8 years have two times as much untreated caries in their primary teeth as non‐Hispanic white children.2Untreated dental caries can cause pain and affect children's ability to speak, eat, and learn.3 Children's oral health is a key public health priority.4 To improve children's health, collaboration between medical and dental care professionals is needed.5 In recent years, efforts have been implemented to promote the integration of medicine and dentistry. For example, in 2000, Oral Health in America: A Report of the Surgeon General called for individuals, health professionals, and their communities to work together to bridge the long‐standing gap between medical and dental care to reduce disparities6; in 2011, the Institute of Medicine reinforced the call for multidisciplinary health‐care teams working together to improve oral health7; in 2014, the Health Resources and Services Administration (HRSA) launched initiatives to introduce core clinical competencies within primary care practices that specifically address oral health8; and, the Affordable Care Act (ACA) has included pediatric dental services as one of 10 essential health benefits that must be offered by all small‐group and individual health plans.9 In addition, other professional organizations have also promoted early dental visits.10-12A few cross‐sectional studies13-17 have reported the provision of preventive dental services and referrals to dental providers by non‐dentist physicians. Yet, the impact of the above‐mentioned policy initiatives and efforts over time on pediatric primary care providers (PCPs) offering dental checkup advice and the effectiveness of such recommendation on having a dental visit has not been assessed recently. Our study aimed to assess whether a recommendation by a PCP was effective in increasing the use of dental services. The findings may inform new strategies to further promote the integration of medicine and dentistry.The objectives of this study were to assess: (a) the trend of the proportion of children being given dental checkup advice from PCPs by age and by race/ethnicity; (b) the trend of the proportion of children having a dental visit by whether or not they were given dental checkup advice over 2001–2016; and (c) predisposing and enabling factors associated with being given dental checkup advice and having a dental visit.

Prototype development, usability, and preference of a culturally-relevant pictorial aid to facilitate comprehension of likert-type levels of agreement in caregivers of children living with HIV in Ghana

Ramos, S. R., Paintsil, E., Ofori-Atta, A., Kusah, J. T., Amissah, K. A., Alhassan, A., Ofori, I. P., & Reynolds, N. R. (2020). CIN - Computers Informatics Nursing, 38(1), 45-52. 10.1097/CIN.0000000000000584
Abstract
Pictorial illustrations of Likert-type scales are culturally useful and may reduce error associated with usage of Westernized self-report measures in low- and middle-income countries. Pictorial illustrations can be encounter-specific decision aids in populations with low literacy or English proficiency. In an unanticipated finding from the SANKOFA study, caregivers of children living with human immunodeficiency virus experienced challenges comprehending Likert-type scales. A cross-sectional, qualitative study was conducted with a SANKOFA participant subset (n = 30) in Ghana. Using an informatics-based formative design approach, we developed a culturally-relevant pictorial aid to assess usability and preference when compared to a Likert-type self-report measure. Ninety percent (n = 27) of substudy participants preferred the pictorial of a traditional Bolga basket over a shallow basket. Forty-three percent (n = 13) preferred the pictorial aid over the Likert-type measure. Fifty percent reported the pictorial aid was easy to use. Fifty-seven percent preferred the Likert-type measure, potentially because English proficiency is regarded in Ghana as a means of upward social and financial mobility. Such cultural norms may have contributed to the lack of consensus and must be considered for pictorial aids to be meaningful. Pictorial aids have been designed for use in clinical and research settings. They reduce barriers associated with lower textual literacy while facilitating comprehension and decision-making.

Regulación de la enfermería en México: actores, procesos y resultados

Aristizabal, P., Nigenda, G., Squires, A., & Rosales, Y. (2020). Ciencia & Saude Coletiva, 25(1), 233-242. 10.1590/1413-81232020251.28462019
Abstract
This paper aims to analyze the regulatory structure of nursing in Mexico through its legislation and perspectives of participant stakeholders. A case study was undertaken using qualitative and quantitative data sources, as well as from the review of official documents. The analysis included data from the sources according to the four realms proposed by the Moran & Wood (1993) model. The more advanced realm was the market entry since the state regulates entry through a license of practice. The regulation of competition is weak, showing very reduced areas of autonomous practice. The labor market is offering a wide variety of entry options with clear signs of deterioration. The dominant payment mechanism is salary, showing a structure that incorporates a component that does not impact on pensions at the end of the labor cycle. The regulation of nursing is a component of its professionalization, and as such, it is understood as a multidimensional consolidating process, particularly realms related to the regulation of competition, market structure, and payment mechanisms, in which nursing representatives should play a more active role in the future.