Publications

Abstract

Purpose: This study examined the social and contextual factors associated with continued high risk sexual behaviors among male-to-female transgender (MTFTG) adolescents living with HIV/AIDS. The study is part of a larger qualitative study of 59 racial/ethnic minority adolescents living with HIV/AIDS. Methods: In-depth focused interviews were conducted with five MTFTG adolescents (16-24 years) living with HIV. Content analysis was conducted to identify themes related to continued sexual risk behaviors. Results: Four out of five of MTFTG adolescents reported inconsistent condom use since their HIV diagnosis. Transgender stigma contributed to financial vulnerability leading to the adoption of sex work to support themselves. Sex and drugs were used to manage transgender stigma and sexual risk-taking with sex work partners was influenced by financial vulnerability. Conclusions: MTFTG adolescents with HIV have unique psychosocial needs related to transgender stigma and structural needs to decrease financial vulnerability that contribute to risky sexual behavior.

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Purpose: The purpose of this article is to explain the evolution of a situation-specific theory developed to enhance understanding of health-related behaviors of Korean Americans (KAs) who have or are at risk for a chronic hepatitis B virus (HBV) infection. Organizing Construct: The situation-specific theory evolved from an integration of the Network Episode Model, studies of health-related behaviors of people with HBV infection, and our studies of and practice experiences with Asian American individuals with HBV infection. Findings: The major concepts of the theory are sociocultural context, social network, individual-level factors, illness experience, and health-related behaviors. Conclusions: The major propositions of the theory are that sociocultural context, social network, and individual-level factors influence the illness experience, and that sociocultural context, social network, individual-level factors, and the illness experience influence health-related behaviors of KAs who have or are at risk for HBV infection. Clinical Relevance: This situation-specific theory represents a translation of abstract concepts into clinical reality. The theory is an explanation of correlates of health-related HBV behaviors of KAs. The next step is to develop and test the effectiveness of a nursing intervention designed to promote behaviors that will enhance the health of KAs who have or are at risk for HBV infection, and that takes into account sociocultural context, social network, individual-level factors, and illness experience.

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Objectives - Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children in the United States. Although changes in diet are often recommended to improve NAFLD, little is known regarding diet influence on histologic features of the disease. Methods - This was a prospective, cross-sectional registry based study. Children (n=149) enrolled in the multi-center NASH Clinical Research Network had demographic, anthropometric, clinical, laboratory and histology data obtained, including the Block Brief Food Questionnaire. Subjects were grouped by presence or absence of steatohepatitis and grades of histologic features according to NASH-CRN criteria. Results - No significant differences were found between children with steatosis compared to steatohepatitis for fraction of calories from fat, carbohydrates, and protein. Sugar sweetened beverage consumption was low and did not correlate with histologic features, although uric acid, a surrogate marker for fructose intake, was significantly increased in those with definite NASH (p=. 008). For all groups, Vitamin E consumption was insufficient compared to the recommended daily allowance. Median consumption of Vitamin E was lower in children with higher grade of steatosis (8.4 vs 6.1 vs 6.9 for grade I, II and III respectively, p = .05). Those consuming less Vitamin C had increased ballooning degeneration (p = 0.05). Conclusions - Children with NAFLD have a diet that is insufficient in Vitamin E and this may contribute to the pathophysiology of NAFLD. In children with NAFLD, reported sugar sweetened beverage consumption is low; however uric acid, which may reflect total fructose consumption, was significantly associated with NASH and should be further evaluated.

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Objective: To describe the systematic language translation and cross-cultural evaluation process that assessed the relevance of the Hospital Consumer Assessment of Healthcare Providers and Systems survey in five European countries prior to national data collection efforts. Design: An approach involving a systematic translation process, expert review by experienced researchers and a review by 'patient' experts involving the use of content validity indexing techniques with chance correction. Setting: Five European countries where Dutch, Finnish, French, German, Greek, Italian and Polish are spoken. Participants: 'Patient' experts who had recently experienced a hospitalization in the participating country. Main OutcomeMeasure(s): Content validity indexing with chance correction adjustment providing a quantifiable measure that evaluates the conceptual, contextual, content, semantic and technical equivalence of the instrument in relationship to the patient care experience. Results: All translations except two received 'excellent' ratings and no significant differences existed between scores for languages spoken in more than one country. Patient raters across all countries expressed different concerns about some of the demographic questions and their relevance for evaluating patient satisfaction. Removing demographic questions from the evaluation produced a significant improvement in the scale-level scores (P = .018). The cross-cultural evaluation process suggested that translations and content of the patient satisfaction survey were relevant across countries and languages. Conclusions: The Hospital Consumer Assessment of Healthcare Providers and Systems survey is relevant to some European hospital systems and has the potential to produce internationally comparable patient satisfaction scores.

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While patients with advanced cancer experience a wide range of symptoms, no work has been done to determine an optimal cutpoint for a low versus a high number of symptoms. Analytic approaches that established clinically meaningful cutpoints for the severity of cancer pain and fatigue provided the foundation for this study. The purpose of this study was to determine the optimal cutpoint for low and high numbers of symptoms using a range of potential cutpoints and to determine if those cutpoints distinguished between the two symptom groups on demographic and clinical characteristics and depression, anxiety, and quality of life (QOL). Patients with advanced cancer (n=110) completed a symptom assessment scale, and measures of depression, anxiety, and QOL. Combinations of cutpoints were tested to yield one-and two-cutpoint solutions. Using analysis of variance for QOL scores, the F-ratio that indicated the highest between-group difference was determined to be the optimal cutpoint between low and high number of symptoms. A cutpoint of ≤12 symptoms (i.e., 0-12 is low, 13-32 is high) was the optimal cutpoint for total number of symptoms. Significant differences in depression, anxiety, and QOL scores validated this cutpoint. Psychological symptoms had higher occurrence rates in the high symptom group. Findings suggest that a threshold exists between a low and a high number of symptoms in patients with advanced cancer. Psychological symptoms were significantly different between patients in the low versus high symptom groups and may play an important role in QOL outcomes in patients with advanced cancer.

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In the United States, Blacks are disproportionately impacted by HIV/AIDS. Sexual networks and concurrent relationships have emerged as important contributors to the heterosexual transmission of HIV. To date, Africa is the only continent where an understanding of the impact of sexual concurrency has been conveyed in HIV prevention messaging. This project was developed by researchers and members of the Seattle, Washington, African American and African-Born communities, using the principles of community-based participatory research (CBPR). Interest in developing concurrency messaging came from the community and resulted in the successful submission of a community-academic partnership proposal to develop and disseminate HIV prevention messaging around concurrency. The authors describe (a) the development of concurrency messaging through the integration of collected formative data and findings from the scientific literature; (b) the process of disseminating the message in the local Black community; and (c) important factors to consider in the development of similar campaigns.

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This article reports and discusses how quantitative (physiological and behavioral) and qualitative methods are being combined in an open-label pilot feasibility study. The study evaluates safety, tolerability, and acceptability of a protocol to treat depression in HIV-infected individuals, using a 2-week block of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex. Major depressive disorder (MDD) is the second most prevalent psychiatric disorder after substance abuse among HIV-positive adults, and novel antidepressant treatments are needed for this vulnerable population. The authors describe the challenges and contributions derived from different research perspectives and methodological approaches and provide a philosophical framework for combining quantitative and qualitative measurements for a fuller examination of the disorder. Four methodological points are presented: (1) the value of combining quantitative and qualitative approaches; (2) the need for context-specific measures when studying patients with medical and psychiatric comorbidities; (3) the importance of research designs that integrate physiological, behavioral, and qualitative approaches when evaluating novel treatments; and (4) the need to explore the relationships between biomarkers, clinical symptom assessments, patient self-evaluations, and patient experiences when developing new, patient-centered protocols. The authors conclude that the complexity of studying novel treatments in complex and new patient populations requires complex research designs to capture the richness of data that inform translational research.

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Objectives: This study examined patient and dental provider experiences during the periodontal visit of diabetes screening approaches involving the collection of gingival crevicular blood (GCB) and finger stick blood (FSB) for haemoglobin A1c (HbA1c) testing. Methods:At a large, urban, US periodontics and implant clinic, FSB samples from 120 patients and GCB samples from 102 of these patients were collected on special blood collection cards and sent to a laboratory for HbA1c testing, with test results sent to the patients from the laboratory. Quantitative and qualitative data from patients and qualitative data from providers were collected and analysed. Results:Quantitative and qualitative data support the feasibility and acceptability of the approaches described. Themes that arose from the interviews with providers and patients include 'a good chance to check', 'patient choice', 'FSB versus GCB testing' and 'a new way of interacting and viewing the dental visit'. Conclusions:Periodontal patients and dental providers believe that the dental visit is an opportune site for diabetes screening and generally prefer GCB to FSB collection. HbA1c testing is well tolerated, convenient and acceptable to patients, and GCB testing reduces time and liability obstacles for dental providers to conduct diabetes screening.

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Type 2 diabetes (T2D) is a growing national health problem affecting 35% of adults ≥20 years of age in the United States. Recently, diabetes has been categorized as an inflammatory disease, sharing many of the adverse outcomes as those reported from cardiovascular disease. Medical nutrition therapy is recommended for the treatment of diabetes; however, these recommendations have not been updated to target the inflammatory component, which can be affected by diet and lifestyle. To assess the current state of evidence for which dietary programs contain the most anti-inflammatory and glycemic control properties for patients with T2D, we conducted an integrative review of the literature. A comprehensive search of the PubMed, CINAHL, Scopus, and Web of Science databases from January 2000 to May 2012 yielded 786 articles. The final 16 studies met the selection criteria including randomized control trials, quasiexperimental, or cross-sectional studies that compared varying diets and measured inflammatory markers. The Mediterranean and DASH diets along with several low-fat diets were associated with lower inflammatory markers. The Mediterranean diet demonstrated the most clinically significant reduction in glycosylated hemoglobin (HbA 1c). Information on best dietary guidelines for inflammation and glycemic control in individuals with T2D is lacking. Continued research is warranted.

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The hypothesis is that fiber protects against colorectal cancer because of various biologic properties. Although several human studies have examined the relationship between fiber and colorectal carcinogenesis, the association remains unclear. This review evaluates key epidemiologic research in large populations conducted since 2003. With a combined analysis of 9 studies, results are mixed. Four studies show a statistically significant reduced risk of developing colorectal cancer with increased dietary fiber intake, and 5 studies show no association. On the basis of these equivocal findings, it cannot be concluded that a protective association exists between increased dietary fiber intake and reduced colorectal cancer risk.

Abstract

A survey was administered to male university students who tested positive for high-risk human papillomavirus. Disclosure was more likely in men with fewer partners, in main partnerships, and in longer partnerships. Disclosure was associated with discussing the Pap test/human papillomavirus vaccine with female partners and not associated with a worsening relationship.

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Objectives: This study examined edentulism trends among adults aged 50 and above in five ethnic groups in the United States: Asians, African Americans, Hispanics, Native Americans, and non-Hispanic Caucasians. Methods: Data came from the National Health Interview Surveys between 1999 and 2008. Respondents included 616 Native Americans, 2,666 Asians, 15,295 African Americans, 13,068 Hispanics, and 86,755 Caucasians. Results: In 2008, Native Americans had the highest predicated rate of edentulism (23.98%), followed by African Americans (19.39%), Caucasians (16.90%), Asians (14.22%), and Hispanics (14.18%). Overall, there was a significant downward trend in edentulism rates between 1999 and 2008 (OR = 0.97, 95% CI: 0.96, 0.98). However, compared with Caucasians, Native Americans showed a significantly less decline of edentulism during this period (OR = 1.10, 95% CI: 1.02, 1.19). Conclusions: While there was a downward trend in edentulism between 1999 and 2008, significant variations existed across racial/ethnic groups. Innovative public health programs and services are essential to prevent oral health diseases and conditions for minority populations who lack access to adequate dental care. Additionally, given the increasing numbers of adults retaining their natural teeth, interventions designed to assist individuals in maintaining healthy teeth becomes more critical.

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Objective: There is a need to build the ranks of health care professionals engaged in substance abuse (SA)-focused clinical research. The authors simultaneously developed and evaluated SARET, the Substance Abuse Research Education and Training program. The fundamental goal of this interprofessional program is to stimulate medical, dental, and nursing student interest and experience in SA research. Evaluation aims to understand program feasibility and acceptability and to assess short-term impact. Methods: SARET comprises 2 main components: stipend-supported research mentorships and a Web-based module series, consisting of 6, interactive, multimedia modules addressing core SA research topics, delivered via course curricula and in the research mentorships. Authors assessed program feasibility and impact on student interestin conducting SA research by tracking participation and conducting participant focus groups and online surveys. Results: Thirty early health care professional students completed mentorships (25 summer, 5 yearlong) and 1324 completed at least 1 Web-module. SARET was considered attractive for the opportunity to conduct clinically oriented research and to work with health care professionals across disciplines. Mentorship students reported positive impact on their vision of SA-related clinical care, more positive attitudes about research, and, in some cases, change in career plans. Web-based modules were associated with enhanced interest in SA (35% increase, P = 0.005, in those somewhat/very interested for neurobiology module) and SA research (+38%, P < 0.001 for activation, +45%, P < 0.001 for personal impact, +7%, P = 0.089 for neurobiology). Conclusions: The SARET program stimulates SA clinical and research interest among students of nursing, medicine, and dentistry and may lend itself to dissemination.

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The original concept for this document was conceived at the meeting of the Psychiatric Mental Health Expert Panel during the Academy of Nursing 33rd Annual Meeting and Conference, Integrating Physical and Mental Health Care, held in Miami, Florida, November 9-11, 2006. Judith Haber and June Horowitz co-chaired the Expert Panel meeting at the time discussion took place regarding the need for a document centralizing recognized competencies and curricula associated with psychiatric mental health nursing practice. The Expert Panel also recognized the need for a document that identified psychiatric mental health competencies for generalist nursing practice. Catherine Kane and Margaret Brackley agreed to Co-Chair a taskforce to write these competencies. They were joined by Madeline Naegle, Sandra Talley, Marian Newton, Jeanne Clement, Patricia D'Antonio, and Elizabeth Poster. This initial group was charged with using "a model similar to the Hartford Foundation model for building capacity in geriatric nursing to develop PMH/Behavioral Health Competencies for non-PMH RNs and APRNs." Other contributing members of the Taskforce were Edna Hamera, Elizabeth LeCuyer, Mona Shattell, Geri Pearson, Rebecca Harmon and Theodora Sirota. The Taskforce convened by teleconference on April 13, 2007, and met monthly by teleconference through Fall 2008. A full draft of the document was completed and sent for editing to Geraldine Pearson and Beth Vaughn Cole. On March 24, 2009, the Taskforce convened by teleconference and agreed to distribute the draft to the membership of the International Society of Psychiatric Nursing (ISPN), the American Psychiatric Nurses Association (APNA), and the International Nurses Society on Addictions. The draft was displayed on the websites of ISPN and APNA through 2009. Comments, suggestions, edits and revisions were welcomed and the feedback was incorporated into this document. The appendices to this document include materials that informed the content of these Essentials and websites for resources.

Abstract

UNLABELLED: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder in the United States; however, few data are available about racial and ethnic variation. We investigated relationships between ethnicity, NAFLD severity, metabolic derangements, and sociodemographic characteristics in a well-characterized cohort of adults with biopsy-proven NAFLD. Data were analyzed from 1,026 adults (≥18 years) in the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) from 2004 to 2008, for whom liver histology data were available within 6 months of enrollment. Associations between ethnicity (i.e., Latino versus non-Latino white) and NAFLD severity (i.e., NASH versus non-NASH histology and mild versus advanced fibrosis) were explored with multiple logistic regression analysis. We also investigated effect modification of ethnicity on metabolic derangements for NAFLD severity. Within the NASH CRN, 77% (N = 785) were non-Latino white and 12% (N = 118) were Latino. Sixty-one percent (N = 628) had NASH histology and 28% (N = 291) had advanced fibrosis. Latinos with NASH were younger, performed less physical activity, and had higher carbohydrate intake, compared to non-Latino whites with NASH. Gender, diabetes, hypertension, hypertriglyceridemia, aspartate aminotransferase (AST), platelets, and the homeostasis model assessment of insulin resistance (HOMA-IR) were significantly associated with NASH. Age, gender, AST, alanine aminotransferase, alkaline phosphatase, platelets, total cholesterol, hypertension, and HOMA-IR, but not ethnicity, were significantly associated with advanced fibrosis. The effect of HOMA-IR on the risk of NASH was modified by ethnicity: HOMA-IR was not a significant risk factor for NASH among Latinos (odds ratio [OR] = 0.93; 95% confidence interval [CI]: 0.85-1.02), but was significant among non-Latino whites (OR, 1.06; 95% CI: 1.01-1.11).CONCLUSION: Metabolic risk factors and sociodemographic characteristics associated with NASH differ by ethnicity. Additional insights into NASH pathogenesis may come from further studies focused on understanding ethnic differences in this disease.

Abstract

Sexual and partner violence are widespread problems on college campuses. By changing attitudes, beliefs, and behavior, bystander education programs have been found to prevent sexual and partner violence and improve the responses of peers to survivors. The purpose of this study is to evaluate the effectiveness and feasibility of a bystander education program that was adapted to a specific university setting. A convenience sample of 202, full-time undergraduate students aged 18-22 years participated in the bystander education program and completed pre- and post-test measures of attitudes related to sexual and partner violence and willingness to help. Paired sample t-tests were used to examine changes in scores between pre- and post-test conditions. After the program, participants' reported decreased rape myth acceptance and denial of interpersonal violence, and increased intention to act as a bystander and an increased sense of responsibility to intervene. Mental health nurses can use principles of bystander education in violence prevention programs and in providing support to survivors.

Abstract

Purpose: The purpose of this study was to analyze the national practice of fulfilling 500 clinical hours as a requirement for graduation from nurse practitioner (NP) programs at the master's level and to compare this standard to a comprehensive approach of evaluating attainment of clinical competencies. Data sources: The National Organization of NP Faculties (NONPF) and specialty accreditation bodies publications were used for references to clinical hour and core competency requirements for graduation from NP programs. Data from one university from student documentation on a commercial electronic tracking system were also analyzed. Conclusions: Data analysis revealed that the 500 clinical hours correlated to populations, skills performed, required levels of decision making, and expected diagnoses. However, assurance that these clinical hour requirements translated to exposure to all core competencies for entry into practice could not be established. Implications for practice: A more comprehensive approach to the evaluation of student core competencies by implementing one or more performance-based assessments, such as case-based evaluations, simulations, or objective structured clinical examinations (OSCEs), as a strategic part of NP evaluation prior to graduation is proposed. This change is viewed as critical to the continued success of NP programs as master's level education transitions to direct BS to DNP educational preparation for advanced nursing practice.

Abstract

The purposes of this study were to identify distinct latent classes of individuals based on subjective reports of sleep disturbance; to examine differences in demographic, clinical, and symptom characteristics between the latent classes; and to evaluate for variations in pro- and anti-inflammatory cytokine genes between the latent classes. Among 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 of their FCs, growth mixture modeling (GMM) was used to identify latent classes of individuals based on General Sleep Disturbance Scale (GSDS) obtained prior to, during, and for four months following completion of radiation therapy. Single nucleotide polymorphisms (SNPs) and haplotypes in candidate cytokine genes were interrogated for differences between the two latent classes. Multiple logistic regression was used to assess the effect of phenotypic and genotypic characteristics on GSDS group membership. Two latent classes were identified: lower sleep disturbance (88.5%) and higher sleep disturbance (11.5%). Participants who were younger and had a lower Karnofsky Performance status score were more likely to be in the higher sleep disturbance class. Variation in two cytokine genes (i.e., IL6, NFKB) predicted latent class membership. Evidence was found for latent classes with distinct sleep disturbance trajectories. Unique genetic markers in cytokine genes may partially explain the interindividual heterogeneity characterizing these trajectories.