Publications

Abstract

Purpose: The aim of this study is to explore factors influencing health and health care within the sociocultural context of Cambodian Americans (CAs or Khmers) and Korean Americans (KA) and to examine intergroup similarities and differences between CAs and KAs, focusing on hepatitis B virus (HBV) and liver cancer prevention behaviors. Methods: The study used a qualitative design guided by the revised Network Episode Model (NEM) and informed by ethnographic analysis. Focus group interviews with key informants among CA community health leaders (CHLs, n= 14) and individual interviews with key informants of KA CHLs (n= 9) were audiotaped and transcribed. Results: Three categories that influenced HBV and liver cancer prevention emerged from both CAs and KAs: the socio-cultural, individual, and behavioral. Four additional subcategories (sub-themes) of sociocultural were identified as socio-history, socio-medicine, socio-linguistic, and socio-health resources. Both CAs and KAs, however, have low levels of knowledge and significant misunderstandings about HBV infection. Conclusions: The study identifies and compares the social-cultural determinant for HBV and liver cancer and highlights the factors of education, intercultural communication, and interactions within socio-cultural contexts of CA and KA subgroups. In general, conceptual overlaps are apparent between Khmers (from now on, the terms, CA and Khmer, will be used interchangeably) and Koreans except for the sub-theme of socio-history. However, differences in concept-specific attributes point to the need to account for differing conceptualizations and implications of specific ethnic groups' sociocultural contexts, and to design contextually-relevant outreach and educational interventions for targeted AAPI subgroups.

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Health literacy has been associated with adherence to antiretroviral therapy (ART) in HIV-infected adults, but this association has not been demonstrated in HIV-infected adolescents. Using an expanded health literacy model, we examined the relationship between health literacy, functional literacy, beliefs about ART, media use, and adherence to ART. Aconvenience sample of HIV-infected adolescents (n = 50) was recruited for this cross-sectional study. The primary outcome of adherence was measured with 3-day self-reports. Health literacy as measured by the Test of Functional Health Literacy in Adults (TOFHLA) was not predictive of adherence (p=.15). Participants with higher positive outcome expectancy scores regarding ART were more likely to report 100% adherence, and participants with below-grade-level reading were less likely to report 100% adherence (p < .05). Our findings highlight the importance of assessing both health beliefs and reading skills as part of adherence support for HIV-infected youth.

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This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the beneficial and adverse effects of home-use whitening toothpastes with an abrasive or chemical action or both, in the prevention and removal of extrinsic dental stains in adults.

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Purpose: In this prospective, longitudinal study, we extend our findings on persistent breast pain in patients (n=398) following breast cancer surgery and evaluate the prevalence and characteristics of persistent pain in the arm/shoulder. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the arm pain classes, were evaluated. Methods and sample: Patients were recruited from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices. Patients were assessed prior to and monthly for six months following breast cancer surgery. Results: Using growth mixture modeling, patients were classified into no (41.6%), mild (23.6%), and moderate (34.8%) arm pain classes based on ratings of worst arm/shoulder pain. Compared to the no pain class, patients in the moderate pain class were significantly younger, had a higher body mass index, and were more likely to report preoperative breast pain and swelling in the affected breast. In addition, patients in the moderate pain class reported higher levels of depression, anxiety, and sleep disturbance than the no pain class. Conclusions: Findings suggest that approximately 35% of women experience persistent levels of moderate arm/shoulder pain in the first six months following breast cancer surgery. Moderate arm/shoulder pain is associated with clinically meaningful decrements in functional status and quality of life.

Abstract

Context Patients with venous leg ulcers experience multiple symptoms, including pain, depression, and discomfort from lower leg inflammation and wound exudate. Some of these symptoms impair wound healing and decrease quality of life (QOL). The presence of co-occurring symptoms may have a negative effect on these outcomes. The identification of symptom clusters could potentially lead to improvements in symptom management and QOL. Objectives To identify the prevalence and severity of common symptoms and the occurrence of symptom clusters in patients with venous leg ulcers. Methods For this secondary analysis, data on sociodemographic characteristics, medical history, venous history, ulcer and lower limb clinical characteristics, symptoms, treatments, healing, and QOL were analyzed from a sample of 318 patients with venous leg ulcers who were recruited from hospital outpatient and community nursing clinics for leg ulcers. Exploratory factor analysis was used to identify symptom clusters. Results Almost two-thirds (64%) of the patients experienced four or more concurrent symptoms. The most frequent symptoms were sleep disturbance (80%), pain (74%), and lower limb swelling (67%). Sixty percent of patients reported three or more symptoms at a moderate-to-severe level of intensity (e.g., 78% reported disturbed sleep frequently or always; the mean pain severity score was 49 of 100, SD 26.5). Exploratory factor analysis identified two symptom clusters: pain, depression, sleep disturbance, and fatigue; and swelling, inflammation, exudate, and fatigue. Conclusion Two symptom clusters were identified in this sample of patients with venous leg ulcers. Further research is needed to verify these symptom clusters and to evaluate their effect on patient outcomes.

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Role of a 4q25 Genetic Variant in Atrial Flutter Background The prediction of atrial fibrillation (AF) following catheter ablation of atrial flutter (Afl) would be helpful to facilitate targeted arrhythmia monitoring and anti-coagulation strategies. A single nucleotide polymorphism, rs2200733, is strongly associated with AF. We sought to characterize the association between rs2200733 and prevalent Afl and to determine if the variant could predict AF after cavotricuspid isthmus ablation. Methods and Results We performed a genetic association study of 295 patients with Afl and/or AF and 469 controls using multivariable logistic regression. The variant was then assessed as a predictor of incident AF after cavotricuspid isthmus ablation in 87 consecutive typical Afl patients with Cox proportional hazards models. The rs2200733 rare allele was associated with an adjusted 2.06-fold increased odds of isolated Afl (95% CI: 1.13-3.76, P = 0.019) and an adjusted 2.79-fold increased odds of a combined phenotype of AF and Afl (95% CI: 1.81-4.28, P < 0.001). Following catheter ablation for Afl, carrier status of rs2200733 failed to predict an increased risk of AF either among all subjects (adjusted HR: 0.94; 95% CI: 0.58-1.53, P = 0.806) or among those with isolated Afl (adjusted HR: 1.29; 95% CI: 0.51-3.26, P = 0.585). Conclusions Our study demonstrates that Afl, whether occurring in isolation or along with AF, is associated with the rs2200733 AF risk allele. Genetic carrier status of rs2200733 failed to predict an increased risk of incident or recurrent AF following catheter ablation for Afl. These findings suggest that the causal mechanism associated with rs2200733 is germane to both AF and Afl.

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Purpose We reviewed human immunodeficiency virus (HIV) and sexually transmitted infection (STI)- behavioral interventions implemented with disproportionately affected black/African-American and Hispanic/Latino youth and designed to improve parent-child communications about sex. We compared their effectiveness in improving sex-related behavior or cognitive outcomes. Methods A search of electronic databases identified peer-reviewed studies published between 1988 and 2012. Eligible studies were U.S.-based parent-child communication interventions with active parent components, experimental and quasiexperimental designs, measurement of youth sexual health outcomes, and enrollment of ≥50% black/African-American or Hispanic/Latino youth. We conducted systematic, primary reviews of eligible papers to abstract data on study characteristics and youth outcomes. Results Fifteen studies evaluating 14 interventions were eligible. Although youth outcome measures and follow-up times varied, 13 of 15 studies (87%) showed at least one significantly improved youth sexual health outcome compared with controls (p <.05). Common components of effective interventions included joint parent and child session attendance, promotion of parent/family involvement, sexuality education for parents, developmental and/or cultural tailoring, and opportunities for parents to practice new communication skills with their youth. Conclusions Parent-child communication interventions that include parents of youth disproportionately affected by HIV/STIs can effectively reduce sexual risk for youth. These interventions may help reduce HIV/STI-related health disparities and improve sexual health outcomes.

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Background: Self-care is the cornerstone of heart failure (HF) management. Numerous approaches to improving HF self-care, which involves adherence to the treatment plan, routine symptom monitoring, and the response to symptoms when they occur, have been developed with little impact on HF outcomes. On the basis of HF practice recommendations that patients receive education and counseling that emphasizes self-care and targets skill building of critical target behaviors, we are conducting a clinical trial designed to improve self-care among community-dwelling older adults using an innovative group-based, skill-building approach led by a trained health educator. Objective: This article describes the study design and research methods used to implement and evaluate the intervention. Methods: The study uses a staggered randomized controlled design to assess feasibility of providing an HF self-care intervention in a community group setting to improve HF self-care, knowledge, and health-related quality of life at 1 and 3 months. A community engagement approach is used to partner with the community throughout all phases of the project. Seventy-five older adults with HF are randomly assigned to the intervention consisting of six to eight 60-minute sessions held in community senior centers or to the wait-list control group. Focus groups are used to elicit feedback on the participants' experience in the program. Results: Preliminary study participation data (n = 60; women, 48%; black, 27%; Hispanic, 32%; mean [SD] age, 70 [10] years) and focus group feedback suggest that the delivery approach is feasible and acceptable, and the participants are very satisfied with the program. Conclusions: Implementation of a community-based HF self-care intervention delivered in partnership with established community-based centers is an innovative approach to intervention. If efficacy is demonstrated, this intervention has far-reaching implications for helping the growing population of HF patients in ethnically diverse communities.

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Employers are essential partners with health professions regulators in ensuring public safety and are critical to the success of discipline monitoring programs. However, working with discipline orders and the regulatory process often causes confusion and stress for employers.This article reviews the perspectives of regulators and employers regarding discipline monitoring in nursing as well as the legal and practical considerations. The article concludes by suggesting future directions for regulators and employers.

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Obesity disproportionately affects Latina adults, and goal-setting is a technique often used to promote lifestyle behavior change and weight loss. To explore the meanings and dimensions of goal-setting in immigrant Latinas, we conducted four focus groups arranged by language ability and country of origin in an urban, public, primary care clinic. We used a narrative analytic approach to identify the following themes: the immigrant experience, family dynamics, and health care. Support was a common sub-theme that threaded throughout, with participants relying on the immigrant community, family, and the health care system to support their goals. Participants derived satisfaction from setting and achieving goals and emphasized personal willpower as crucial for success. These findings should inform future research on how goal-setting can be used to foster lifestyle behavior change and illustrate the importance of exploring the needs of Latino sub-groups in order to improve lifestyle behaviors in diverse Latino populations.

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AIM: To compare how the use of different "doses" of simulation in undergraduate clinical teaching affect faculty capacity. BACKGROUND: Since 2008, the NYU College of Nursing has used a "high dose" of simulation to substitute for 50 percent of the clinical hours in core medical-surgical courses to address a shortage of faculty and clinical sites. Johns Hopkins University School of Nursing has used limited, "low-dose" simulation hours to supplement clinical hours. METHOD: The evaluation included program data and surveys and qualitative interviews with faculty and students in each program. RESULTS: Implementing "high-dose" clinical simulation resulted in a nearly 50 percent increase in faculty capacity at NYU, expanding undergraduate enrollment from 613 students in 2007 to 900 in 2012, with no negative impacts on faculty work life or student outcomes. CONCLUSION: Substituting simulation for traditional clinical hours can be a sustainable and educationally sound option to increase faculty capacity.

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Objective: To determine the nutritional, inflammatory, and functional aspects of unintentional weight loss after cardiac surgery that warrant further investigation. Research Methods and Procedures: Twenty community-dwelling adults ≥ 65 years old undergoing cardiac surgery (coronary artery bypass graft [CABG] or CABG + valve) were recruited for this prospective longitudinal (preoperative and 4-6 weeks postdischarge) pilot study. Anthropometrics (weight, standing height, and mid-arm and calf circumference), nutritional status (Mini-Nutritional Assessment™ [MNA]), appetite, physical performance (timed chair stand), muscle strength (hand grip) and functional status (basic and instrumental activities of daily living), and inflammatory markers (plasma leptin, ghrelin, interleukin [IL]-6, high-sensitivity[hs] C-reactive protein, and serum albumin and prealbumin) were measured. Results: Participants who completed the study (n = 11 males, n = 3 females) had a mean age 70.21 ± 4.02 years. Of these, 12 lost 3.66 ± 1.44 kg over the study period. Weight, BMI, activities of daily living, and leptin decreased over time (p <.05). IL-6 increased over time (p <.05). Ghrelin, hs-CRP, and timed chair stand increased over time in those who underwent combined procedures (p <.05). Grip strength decreased in those who developed complications (p =.004). Complications, readmission status, and lowered grip strength were found in those with low preoperative MNA scores (p <.05). Conclusion: After cardiac surgery, postdischarge weight loss occurs during a continued inflammatory response accompanied by decreased physical functioning and may not be a positive outcome. The impacts of weight loss, functional impairment, and inflammation during recovery on disability and frailty warrant further study.

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Objectives: Given the existence of many potential oral health complications for adults with diabetes (especially for those who do not practise regular oral self-care), and the specific importance of regular interdental cleaning, the research determined the proportion of U.S. adults with diabetes who practise daily interdental cleaning and their socio-demographic, economic and oral health characteristics related to this practice. Methods: Analyses were conducted using data collected from 573 dentulous adults with diabetes ≥ 30 years who participated in the U.S. 2009-2010 National Health and Nutrition Examination survey. Using complex sample survey software, findings were extrapolated to >15 million U.S. adults. Descriptive statistics were used to determine the frequency of interdental cleaning, and chi-square tests were used to identify salient individual characteristics related to this practice. Results: 41.2% reported that they never used any interdental device, while 24.8% indicated that they practised interdental cleaning daily. Statistically significant relationships (P < 0.05) with daily interdental cleaning included female sex, ever having had treatment for gum disease and using mouthwash daily for a dental problem. Conclusions: Because so many adults with diabetes do not practise regular interdental cleaning, and in view of the important role that dental hygienists fulfil as oral healthcare educators, there is a great need for dental hygienists to teach and motivate adults with diabetes to practise regular interdental cleaning. This need is especially great for subgroups of these adults who are men, have not been treated for periodontitis and do not regularly use a mouthwash for dental problems.

Abstract

In 2005, New York University Colleges of Dentistry and Nursing formed an organizational partnership to create a unique model of interprofessional education, research, service and practice. This paper describes the first eight years of experience, from the early reaction of the public to the partnership, to examples of success and past and current challenges.

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Background: The international migration of nurses has become a major issue in the international health and workforce policy circles, but analyses are not based on a comprehensive theory. Purpose: The purpose of this article was to compare the concepts of an integrated nursing turnover theory with the concepts of one international migration framework. Methods: An integrated turnover theory is compared with a frequently used migration framework using examples of each. Discussion: Migration concepts relate well to turnover concepts, but the relative importance and strength of various concepts may differ. For example, identification, development, and measurement of the concept of national commitment, if it exists, is parallel to organizational commitment and may be fruitful in understanding the processes that lead to nurse migration. Conclusions: The turnover theory provides a framework for examining migration concepts and considering how these concepts could relate to each other in a future theory of migration. Ultimately, a better understanding of the relationships and strengths of these concepts could lead to more effective policy.

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Background & Aims: Iron deficiency is often observed in obese individuals. The iron regulatory hormone hepcidin is regulated by iron and cytokines interleukin (IL) 6 and IL1β. We examine the relationship between obesity, circulating levels of hepcidin, and IL6 and IL1β, and other risk factors in patients with nonalcoholic fatty liver disease (NAFLD) with iron deficiency. Methods: We collected data on 675 adult subjects (>18 years old) enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network. Subjects with transferrin saturation <20% were categorized as iron deficient, whereas those with transferrin saturation ≥20% were classified as iron normal. We assessed clinical, demographic, anthropometric, laboratory, dietary, and histologic data from patients, and serum levels of hepcidin and cytokines IL6 and IL1β. Univariate and multivariate analysis were used to identify risk factors for iron deficiency. Results: One-third of patients (231 of 675; 34%) were iron deficient. Obesity, diabetes, and metabolic syndrome were more common in subjects with iron deficiency (P < .01), compared with those that were iron normal. Serum levels of hepcidin were significantly lower in subjects with iron deficiency (61 ± 45 vs 81 ± 51 ng/mL; P < .0001). Iron deficiency was significantly associated with female gender, obesity, increased body mass index and waist circumference, presence of diabetes, lower alcohol consumption, black or American Indian/Alaska Native race (P ≤ .018), and increased levels of IL6 and IL1β (6.6 vs 4.8 for iron normal, P ≤ .0001; and 0.45 vs 0.32 for iron normal, P ≤ .005). Conclusions: Iron deficiency is prevalent in patients with NAFLD and associated with female gender, increased body mass index, and nonwhite race. Serum levels of hepcidin were lower in iron-deficient subjects, reflecting an appropriate physiologic response to decreased circulating levels of iron, rather than a primary cause of iron deficiency in the setting of obesity and NAFLD.

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We conducted a meta-analysis of Parkinson's disease genome-wide association studies using a common set of 7,893,274 variants across 13,708 cases and 95,282 controls. Twenty-six loci were identified as having genome-wide significant association; these and 6 additional previously reported loci were then tested in an independent set of 5,353 cases and 5,551 controls. Of the 32 tested SNPs, 24 replicated, including 6 newly identified loci. Conditional analyses within loci showed that four loci, including GBA, GAK-DGKQ, SNCA and the HLA region, contain a secondary independent risk variant. In total, we identified and replicated 28 independent risk variants for Parkinson's disease across 24 loci. Although the effect of each individual locus was small, risk profile analysis showed substantial cumulative risk in a comparison of the highest and lowest quintiles of genetic risk (odds ratio (OR) = 3.31, 95% confidence interval (CI) = 2.55-4.30; P = 2 × 10-16). We also show six risk loci associated with proximal gene expression or DNA methylation.