Publications

Abstract

Pay-for-performance (P4P) initiatives attempt to drive quality of care by aligning desired care processes and outcomes with reimbursement. P4P schemes have emerged at a time of great concern about safety and quality in health care and in the face of a growing nurse shortage. This article discusses the state of the literature linking structures for providing nursing care, measures of process heavily favored in P4P initiatives, and patient outcomes and outlines how P4P is expected to affect nursing practice. It also presents directions for managing practice settings to cope with P4P and for steering nursing's involvement in this area of health policy. As implementation broadens, it remains to be seen whether unintended consequences emerge or whether nurses are successful in using the programs and the data sets that result from them to justify investments in nursing services and solidify the profession's position.

Abstract

The authors evaluate the effectiveness of the small media campaign in raising community awareness about the importance of going for a health check up. Data were collected over time from 535 respondents ages 15-30 years using cross-sectional surveys in two low-income, predominantly African-American communities in New York city. Regression analyses indicated campaign material recognition at 15 months was significantly higher in the intervention community relative to the comparison community. There were no significant changes in social norms, attitudes, or beliefs. Media campaigns aimed at adolescents and young adults on a community-wide level are an effective means of gaining material recognition. Editors' Strategic Implications: This research illustrates the effect of a public health media campaign on awareness, but it also serves as a reminder to public health officials that awareness is not necessarily sufficient to promote attitudinal or behavioral health changes.

Abstract

Background. Both oral health problems and cognitive impairment are relatively common among older adults. Poorer oral health appears to contribute to a decline in quality of life and to be related to various medical conditions. Little is known about the relationship of cognitive function to oral health among community-dwelling older adults. Methods. The sample included 1984 dentate community-dwelling older adults 60 years old or older from the National Health and Nutrition Examination Survey (NHANES, 1999-2002) who completed both the study cognitive measure and dental examination. Weighted descriptive and multivariate regression analyses were performed. Results. Multivariate analyses showed that cognitive function was associated with oral health. Individuals with lower cognitive scores had a higher number of decayed and missing teeth and a higher proportion of periodontitis sites. The predicted number of decayed teeth increased by 0.01 with each 1-point decrease in the Digit Symbol Substitution Test score; the number of missing teeth increased by 0.02; and the percentage of sites with periodontal disease increased by 0.02. In addition, individuals' sociodemographic characteristics, health behavior, and regular dental checkups were significantly associated with oral health. Conclusions. This study suggests that community-dwelling elders with lower cognitive function scores have greater deterioration of oral health. This study provides a preliminary knowledge base for the development of early intervention strategies to address oral health problems among older adults.

Abstract

Background: Previous studies suggest that beta-adrenergic receptor (ßAR) single nucleotide polymorphisms (SNPs) are associated with out-of-hospital sudden cardiac death (SCD) and overall mortality, but did not specifically examine risk of ventricular arrhythmias (VA). Objective: This study examined the effects of functional SNPs of ß1AR and ß2AR on the risk of VA and SCD in patients with coronary artery disease (CAD). Methods: ß1AR (Ser49Gly, Arg389Gly) and ß2AR (Gly16Arg, Gln27Glu) SNPs were genotyped in a case-control study comparing 107 patients with CAD and aborted SCD due to VA with 287 CAD control subjects and 101 healthy control subjects. These variants were also examined in the Heart and Estrogen Replacement Study (HERS) cohort of women with CAD followed for SCD (n = 66) and nonfatal VA (NFVA) (n = 33) over 6.8 years. Results: In the case-control study, no statistically significant association was observed for the odds of SCD with any of the SNPs or haplotypes tested. Similarly, HERS revealed null effects for these SNPs and haplotypes in relation to risk of SCD, SCD + NFVA, and all-cause mortality. Point estimates and confidence intervals for risk of SCD associated with ß2AR27 were similar in both populations (Glu27 carriers vs Gln27 homozygotes: adjusted odds ratio 1.23 [95% confidence interval 0.75 to 2.03, P = .41] in the case-control study, and adjusted relative risk (RR) 1.18 [95% confidence interval 0.69 to 2.00, P = .55] in HERS). These null findings trend in the opposite direction and differ from previous published estimates (P = .01 and .07, respectively). Conclusion: We did not find an increase in risk of SCD associated with any of these common ßAR polymorphisms.

Abstract

A descriptive study examining the relationship of denial of illness and compliance with inhaled controller asthma medications is conducted with 51 adults taking inhaled asthma controller medications. Affective and cognitive denial are assessed with the Levine Denial of Illness Scale. Severity is determined by portable spirometry; compliance is measured for 2 weeks with DOSER, a microelectronic monitor. The mean percent compliance rate for inhaled controller medications is 36%, with only 10.4% of the participants demonstrating optimal compliance (>80%). Although cognitive denial is not significantly associated with compliance, those in the suboptimal compliance group do have significantly higher information avoidance subscale scores (M = 1.88; p =.02). Affective denial is inversely correlated with compliance (r = -.31; p =.05) and is significantly higher in the suboptimal compliance group (M = 11.51; p =.05). These study findings suggest that affective denial may be a contributor to suboptimal compliance.

Abstract

Diabetes educators and advanced-practice nurses in diabetes care often participate in clinical research. The purpose of this article is to provide a broad overview of important decisions in planning a research study. The research process is reviewed, including the conceptual phase, the design and planning phase, the empirical phase, the analytic phase, and the dissemination phase. Issues unique to diabetes education research are highlighted.

Abstract

Amount and type of dietary fat may play a role in the pathogenesis of age-related macular degeneration (AMD) via 4 potential mechanisms: (1) atherosclerosis, (2) altering retinal integrity, (3) oxidative damage, and (4) inflammation. In this report, 11 epidemiologic studies are evaluated for evidence of associations between dietary fats and AMD. Taken together, the studies suggest a protective association of higher omega-3 polyunsaturated fats and fish intake with AMD. The relations of AMD with total and types of fat varied across populations and may reflect different patterns of fat intake. Practitioners should advise a low-fat, "heart-healthy" diet and encourage consumption of diets high in omega-3 polyunsaturated fats.

Abstract

OBJECTIVE: The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. BACKGROUND: Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited. METHODS: Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients. RESULTS: Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments. CONCLUSION: Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.

Abstract

In May 2007, Yale University sent a team of nurse practitioner faculty and students to Managua, Nicaragua, as part of a five-year project to provide health care for children who attended a small school in a poor area of the city. Over the course of four days, 88 children were examined and treated. Although the Ministry of Health of Nicaragua theoretically provides health care for all, resources are often limited and difficult to access. By working with teachers and families, the team from Yale University is attempting to help the community establish a school-based clinic to meet the day-to-day needs of the children and establish health care contacts for more serious health care needs.

Abstract

The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer to as 'dimensions of ethical practice'. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional-patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study's participants would help to improve quality of care.

Abstract

This study assessed factors that contribute to exercise in older adults at risk for health disparities living in a predominantly African American urban community. A local health database was used to gain an understanding of these factors, which then could be used to develop programs to improve health within a specific urban community. The sample included 112 participants (mean age = 81); the majority were women and African American. Participants were more likely to exercise if not insured by Medicaid, compared with those who did receive Medicaid. Adults with two or more limitations in instrumental activities of daily living (IADLs) were less likely to exercise. Among those who exercised, those with two or more limitations in IADLs were more likely to exercise less than adults with no such limitations, and adults with high blood pressure were more likely to exercise less than those without high blood pressure. The findings of this study will help generate discussion in both the community and outreach programs to invigorate exercise among older adults at risk for health disparities.

Abstract

Individuals with a history of injecting drugs are at the highest risk of becoming infected with the hepatitis C virus (HCV), with studies of patients in methadone maintenance treatment programmes (MMTPs) reporting that 60-90 percent of intravenous drug users (IDUs) have the virus. Fortunately, HCV therapy has been shown to be effective in 42-82 percent of all patients with chronic HCV infection, including IDUs. While the decision to start HCV therapy requires significant consideration, little research exists that explores the attitudes of drug users toward HCV therapy. Therefore, this paper examines how drug users perceive the treatment, as well as the processes by which HCV-positive individuals examined the advantages and disadvantages of starting the HCV medications. Interviews were conducted with 164 patients from 14 drug treatment programmes throughout the United States, and both uninfected and HCV-positive drug users described a pipeline of communication among their peers that conveys largely negative messages about the medications that are available to treat HCV. Although many of the HCV-positive individuals said that these messages heightened their anxiety about the side effects and difficulties of treatment, some patients said that their peers helped them to consider, initiate HCV treatment or both. Gaining a better understanding of drug users' perceptions of HCV treatment is important, because so many of them, particularly IDUs, are already infected with HCV and may benefit from support in addressing their HCV treatment needs. In addition, currently uninfected drug users will likely remain at high risk for contracting HCV and may need to make decisions about whether or not to start the HCV medical regimen in the future.

Abstract

This study examines predictors of Western physician utilization using the Andersen's Behavioral Model of Health Services Use for Chinese elders who reside in Shanghai and immigrant Chinese elders who reside in the US Chinese elders are under-studied relative to their population size and in the US are known to underutilize the healthcare system. Underutilization is highly correlated with poor health and well-being. A unique dataset allowed us to examine predictors of physician utilization for Chinese elders who resided in different countries, in an effort to determine how being an immigrant affects utilization. One hundred and seventy-seven Chinese elders in Boston and 420 Chinese elders in Shanghai participated in the survey. Multiple regression analyses were conducted separately for each sample. Predictors of physician visits for the Boston sample are insurance status, health, and social network, and for the Shanghai sample, use of Chinese medicine, health, and marital status predicted physician visits. We found that access to care variables significantly affects physician utilization for immigrant elders, and that Chinese elders in Shanghai utilize a bicultural system of care. The results indicate that in order to create effective healthcare practices for elder Chinese, alternative healthcare beliefs should be understood by Western physicians.

Abstract

This chapter presents the results of two related exploratory, qualitative studies on drug use and HIV risk conducted in the cities of Managua and Chinandega, Nicaragua between 2002 and 2005. The objectives of this research were to: identify methods of reaching drug using populations in the country; provide an initial description of the patterns of drug use, emphasizing regional differences; explore the relationship between drug use and HIV transmission; and provide preliminary recommendations for the development of drug use and HIV prevention efforts and for future research directions. The study designs included ethnographic observation and interviews to assist in gaining entry into drug-using communities, in-depth interviews with drug users and traffickers (121) and focus groups (13) with sectors of the population likely to provide different perspectives on the research domains: health professionals working with high-risk behavior groups, female sex workers, gay men, university students, taxi drivers, injection drug users, and family members of drug users. Drug use, the availability of drugs and distribution were reported, and included: ubiquitous drug supplies; the involvement of all social strata; the impact of crack on drug-use patterns; concerns about use by children and youth; well-established local distribution mechanisms; group drug purchase and sharing, and (limited) needle use and equipment sharing. Sexual risks included unprotected sex with partners and sex for drugs and/or drug money. The lack of drug prevention education in the community and schools, and limited treatment resources were also reported. Conclusions highlight the need for public and policy acknowledgement and response regarding drug use, and the link between HIV/AIDS and drugs in the country.

Abstract

Problem: Factors that predict successful transition from pediatric to adult care for adolescents with sickle cell disease are not fully understood, making transfer decisions difficult. Methods: Seventy-four adolescents (14-21 years) participated in this descriptive correlational study to investigate the relationships of age, gender, knowledge about sickle cell disease, disease severity, and family relationships to independence. Findings: Knowledge, severity, and family relationships explained only 25% of the variance for independence in the final model; family relationships were inversely correlated. Conclusions: Factors exerting stronger influences on independence remain unknown. Cultural factors may be important among this predominantly African American population.

Abstract

This study examined gender differences in factors related to contributory behavior among the oldest-old aged 80+ in Shanghai, China. The study population included a randomly selected sample of 349 community dwelling respondents who lived in five districts. Male and female respondents contributed equally to others in informal networks, but in different ways. Objective health status and social ties are related to contributory behavior for both males and females. However, financial status and vision impairment had a different impact on males and females. Healthy aging and strong social networks are two key components for contributory behaviors.

Abstract

We previously demonstrated the role of a phospholipid transfer protein (PLTP) gene variation (rs2294213) in determining levels of high-density lipoprotein cholesterol (HDL-C) in hypoalphalipoproteinemia (HypoA). We have now explored the role of PLTP in hyperalphalipoproteinemia (HyperA). The human PLTP gene was screened for sequence anomalies by DNA melting in 107 subjects with HyperA. The association with plasma lipoprotein levels was evaluated. We detected 7 sequence variations: 1 previously reported variation (rs2294213) and 5 novel mutations including 1 missense mutation (L106F). The PLTP activity was unchanged in the p.L106F mutation. The frequency of the rs2294213 minor allele was markedly increased in the HyperA group (7.0%) in comparison with a control group (4.3%) and the hypoalphalipoproteinemia group (2.2%). Moreover, rs2294213 was strongly associated with HDL-C levels. Linear regression models predict that possession of the rs2294213 minor allele increases HDL-C independent of triglycerides. These findings extend the association of rs2294213 with HDL-C levels into the extremes of the HDL distribution.

Abstract

Note 48 Concepts and tools in genetics and genomics 48 Introduction 48 Genes and chromosomes 49 Gene expression and protein synthesis - regulation of gene expression 49 DNA and human diversity 51 Complex, multifactorial disorders 53 Approaches used to conduct genetic studies 53 Expression analyses: RNA-based studies 57 Proteome analyses: protein-based studies 59 The new frontier: systems biology 60 Research-related issues unique to the study of pain alleles 60 Genetics and pain sensitivity 60 The complexities of determining genetic risk factors for chronic pain 60 Pharmacogenetics and analgesic drugs 61 Molecular biologic tools in the elucidation of pain mechanisms and drug discovery 63 References 63 The genetics of pain is a complex trait, due to a combination of genetic and environmental factors.