Publications

Abstract

Objective: To describe grandparenthood status and determine the relationship between grandparenthood status, metabolic control, and psychosocial factors in African American women with type 2 diabetes. Methods: A secondary, descriptive, exploratory analysis was conducted to examine the relationship between grandparenting status, physiologic indices related to metabolic control (body mass index, hemoglobin A1c, systolic blood pressure, low-density lipoprotein cholesterol) and psychosocial factors (emotional distress and quality of life) in a sample of 109 urban midlife African American women with type 2 diabetes. Results: Grandmothers made up 60% of the sample and were stratified into three groups on the basis of caretaking status. Grandmothers who cared for but did not live with grandchildren had the highest body mass index, hemoglobin A1c, low-density lipoprotein cholesterol, and systolic blood pressure. Caregiving grandmothers also had higher diabetes-related emotional distress scores but had better quality of life scores than did the non-caretaking grandmothers. Non-grandmothers had the lowest quality of life scores. Conclusions: These findings suggest relationships between grandmother caretaking status and metabolic and psychosocial factors. Research is needed to further examine these relationships and implications on practice and policy decisions.

Abstract

Background. The hepatitis C virus (HCV) is hyper-endemic in injecting drug users. There is also excess HCV among non-injection drug users who smoke, snort, or sniff heroin, cocaine, crack, or methamphetamine. Methods. To summarize the research literature on HCV in drug users and identify gaps in knowledge, we conducted a synthesis of the relevant research carried out between 1989 and 2006. Using rigorous search methods, we identified and extracted data from published and unpublished reports of HCV among drug users. We designed a quality assurance system to ensure accuracy and consistency in all phases of the project. We also created a set of items to assess study design quality in each of the reports we included. Results. We identified 629 reports containing HCV prevalence rates, incidence rates and/or genotype distribution among injecting or non-injecting drug user populations published between January 1989 and December 2006. The majority of reports were from Western Europe (41%), North America (26%), Asia (11%) and Australia/New Zealand (10%). We also identified reports from Eastern Europe, South America, the Middle East, and the Caribbean. The number of publications reporting HCV rates in drug users increased dramatically between 1989 and 2006 to 27-52 reports per year after 1998. Conclusion. The data collection and quality assurance phases of the HCV Synthesis Project have been completed. Recommendations for future research on HCV in drug users have come out of our data collection phase. Future research reports can enhance their contributions to our understanding of HCV etiology by clearly defining their drug user participants with respect to type of drug and route of administration. Further, the use of standard reporting methods for risk factors would enable data to be combined across a larger set of studies; this is especially important for HCV seroconversion studies which suffer from small sample sizes and low power to examine risk factors.

Abstract

Background and Aims: Hepatitis B virus (HBV) infection is significantly higher in Asian American Pacific Islanders (AAPIs) than in the general U.S. population. People chronically infected with HBV not only have the potential for developing cirrhosis and primary hepatocellular carcinoma, but also are potential sources for infecting others. Therefore, early diagnosis of HBV infection can reduce the risk of further transmission of the virus through education and vaccination of high-risk groups. The aim of this study was to screen for current and past HBV infection in this high-risk group. Methods. A community-based participatory study was conducted between 2004 and 2007. A total of 609 Korean Americans (KA) completed HBV blood screening tests in seven Korean churches in Colorado. Current HBV infection (HBsAg), past HBV infection (anti-HBc positive), and HBV susceptibility were measured. Demographic Information, including HBV vaccination history on these groups, was obtained. Results. Korean Americans had an almost ten times higher incidence of current (4%) and past HBV infection (41%) than the general U.S population. Older individuals had a higher incidence of past HBV infection and lower immunization rate. The risk of lifetime HBV infection was less among participants younger than 30 (OR: 0.07; 95% CI: 0.02-0.21) and those who self-reported HBV vaccination (OR: 0.12; 95% CI: 0.05-0.29). Variables associated with immunity due to vaccination (anti-HBc negative but positive to anti-HBs) were, age under 30 (OR: 13.86, 95% CI: 4.68-41.05), and self-reported vaccination (OR: 8.06; 95% CI: 3.43-18.92). Conclusions. Our study findings confirm the high prevalence of HBV infection among AAPIs, specifically among AAPIs in regions where AAPIs constitute a small proportion of residents. Given the high incidence of HBV infection among these community-dwelling KA, and that the majority of HBV-infected participants were unaware of their condition, focused HBV screening should be conducted to uncover individuals with HBV.

Abstract

Background. Vaginal infections are common and have been associated with increased risk for acquisition of human immunodeficiency virus type 1 (HIV-1). Methods. We conducted a randomized trial of directly observed oral treatment administered monthly to reduce vaginal infections among Kenyan women at risk for HIV-1 acquisition. A trial intervention of 2 g of metronidazole plus 150 mg of fluconazole was compared with metronidazole placebo plus fluconazole placebo. The primary end points were bacterial vaginosis (BV), vaginal candidiasis, trichomoniasis vaginalis (hereafter, "trichomoniasis"), and colonization with Lactobacillus organisms. Results. Of 310 HIV-1-seronegative female sex workers enrolled (155 per arm), 303 were included in the primary end points analysis. A median of 12 follow-up visits per subject were recorded in both study arms (P = .8). Compared with control subjects, women receiving the intervention had fewer episodes of BV (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.49-0.63) and more frequent vaginal colonization with any Lactobacillus species (HR, 1.47; 95% CI, 1.19 -1.80) and H2O 2-producing Lactobacillus species (HR, 1.63; 95% CI, 1.16 -2.27). The incidences of vaginal candidiasis (HR, 0.84; 95% CI, 0.67-1.04) and trichomoniasis (HR, 0.55; 95% CI, 0.27-1.12) among treated women were less than those among control subjects, but the differences were not statistically significant. Conclusions. Periodic presumptive treatment reduced the incidence of BV and promoted colonization with normal vaginal flora. Vaginal health interventions have the potential to provide simple, female-controlled approaches for reducing the risk of HIV-1 acquisition.

Abstract

The long-term care (LTC) literature has been generally associated with industrialized countries. However, LTC needs are increasing in the developing world at a rate that far exceeds than experienced by industrialized countries. Using China as a case study, the purpose of this report is to provide an example of an emerging institutional care system for rural elders in a rapidly developing country. It covers two major domains of the system: service delivery and financing. The report presents several main issues involved in the development of institutional care for elders and discusses relevant policy implications.

Abstract

Aims. To describe the origins, design and outcomes of an international hospital outcomes collaboration focused on nursing issues. Background. Across countries with different cultures and histories, nursing and healthcare leaders face similar issues with respect to workforce supply, quality and safety of care and financial constraints. Until researchers began using common research protocols to investigate structure, and outcomes variables in hospital nursing across countries, studying the aspects of work environments most important to patients and nurses in large numbers of hospitals was very difficult, if not impossible. Method. Review/essay. Conclusions. The international collaborations discussed in this article led by the University of Pennsylvania have found remarkable similarities in the experiences of hospital nurses across countries in terms of positive and negative aspects of their work, sizeable differences across hospitals within countries in working conditions and investments in high-quality practice environments, and consistent evidence of connections between modifiable features of nurses' work environments and both patient well-being and factors influencing workforce stability. Relevance to clinical practice. International research collaborations allow benchmarking of countries and facilities within countries on work environment factors that are important to the provision of high quality nursing care. Results of this ongoing research initiative have helped strengthen the case that optimal management of practice environments for nurses in hospitals and other settings are a key strategy for optimising patient outcomes.

Abstract

Purpose: To determine the (a) levels of acculturation and job satisfaction, (b) relationship between acculturation and job satisfaction, and (c) effects of select sociodemographic variables in predicting job satisfaction among Filipino RNs educated in the Philippines who are working in the US. Design: Descriptive correlational. A convenience sample of Filipino RNs (N=96) present during the PNAA Eastern Regional Conference in Baltimore, MD was conducted. Methods: A survey was conducted using A Short Acculturation Scale for Filipino Americans (ASASFA) to measure acculturation, Part B of the Index of Work Satisfaction Scale (IWS) to assess job satisfaction, and a participant demographic questionnaire. Data were analyzed using A Pearson correlation coefficient and multiple regression analysis. Findings: Participants had a moderate level of job satisfaction that was positively correlated to a level of acculturation that was closer to American than to Filipino culture. Furthermore, age, length of U.S. residency, and acculturation significantly predicted perception of job satisfaction among this group of Filipino RNs. Conclusions: Job satisfaction among Filipino nurses is related to acculturation and select sociodemographic variables. Further research to determine how best to improve acculturation may lead to improved retention rates of Filipino nurses in countries to which they have migrated. Journal of Nursing Scholarship, 2008; 40:1, 46-51.

Abstract

Aim: This review of the literature synthesizes methodological recommendations for the use of translators and interpreters in cross-language qualitative research. Background: Cross-language qualitative research involves the use of interpreters and translators to mediate a language barrier between researchers and participants. Qualitative nurse researchers successfully address language barriers between themselves and their participants when they systematically plan for how they will use interpreters and translators throughout the research process. Experienced qualitative researchers recognize that translators can generate qualitative data through translation processes and by participating in data analysis. Failure to address language barriers and the methodological challenges they present threatens the credibility, transferability, dependability and confirmability of cross-language qualitative nursing research. Through a synthesis of the cross-language qualitative methods literature, this article reviews the basics of language competence, translator and interpreter qualifications, and roles for each kind of qualitative research approach. Methodological and ethical considerations are also provided. Conclusion: By systematically addressing the methodological challenges cross-language research presents, nurse researchers can produce better evidence for nursing practice and policy making when working across different language groups. Findings from qualitative studies will also accurately represent the experiences of the participants without concern that the meaning was lost in translation.

Abstract

For more than 25 years, advanced practice nurses have been incrementally included as a part of the health care financing structure. Following physician payment revisions at the federal level, advanced practice nurses were overtly recognized as Medicare providers and have participated in the establishment of current procedural terminology codes and the subsequent relative work values associated with payment. Success in this regard has been the result of business, political, and policy savvy that has important lessons for moving forward in any health care restructuring for both nurses and advanced practice nurses. Principles of valuing nurse work, time, and intensity in the Resource-Based Relative Value Scale are discussed with implications for future opportunities of measuring nursing work and any potential relationship to quality outcomes of care.

Abstract

Aim. This paper is a report of a study to describe Chinese women's experiences of adjusting to breast cancer diagnosis and treatment. Background. Breast cancer is the most common cancer in women, and its diagnosis and treatment are pivotal life-changing events that prompt women to make immediate adjustments. Adjustment to breast cancer has been studied as a way of coping with a stressful event and adapting to chronic illness. Adequate adjustment through coping and adaptation leads to successful completion of treatment and improved quality of life. Method. A descriptive phenomenological method was used, and 22 Chinese women were interviewed at a large cancer centre in Beijing, China, in 2004-2005. Findings. Facing breast cancer, Chinese women tried to 'make the best of it'. The essences of Chinese women's experiences were: facing the reality of cancer diagnosis, taking an active part in the cancer treatment, sustaining an optimistic spirit, sustaining physically, lessening the impact of cancer on others, and reflecting and moving on. Chinese women had similar perceptions of breast cancer to women in western countries as a fearful, stressful, life-threatening and life-changing event, and some of their intentions and actions were also similar to western women's coping strategies. However, their experiences of adjusting to breast cancer also reflected Chinese historical, social and cultural influences. Conclusions. Our findings have implications for healthcare professionals also in countries with Chinese migrants, and could be used as a basis for information and emotional and social support interventions as these can be effective in promoting adjustment to breast cancer.

Abstract

Developing community capacity to improve health is a cornerstone of community-based public health. The concept of community capacity reflects numerous facets and dimensions of community life and can have different meanings in different contexts. This paper explores how members of one community identify and interpret key aspects of their community's capacity to limit the availability and use of tobacco products. Particular attention is given to examining the interrelationship between various dimensions of community capacity in order to better understand the processes by which communities are able to mobilize for social change. The study is based on qualitative analysis of 19 in-depth interviews with key informants representing a variety of community sectors in Harlem, New York City. Findings indicate that the community is viewed as rich in human and social resources. A strong sense of community identity and connectedness underlies this reserve and serves as a catalyst for action.

Abstract

This pilot study was designed to measure nursing students’ level of cultural awareness. It replicated phase II of Rew, Becker, Cookston, Khosropour, & Martinez's (2003) methodological study that developed and tested a Cultural Awareness Scale (CAS). Using a cross-sectional design, the CAS was distributed to nursing students in three nursing programs’ (bachelor's, master's, doctoral) beginning and end courses. Cronbach's alpha for the CAS Total instrument was 0.869, with subscale scores ranging from 0.687 to 0.902, comparable to the findings of Rew et al. Given the limitations of this study, results must be viewed with a degree of caution. Recommendations include further educational research in the form of psychometric testing of the CAS among nursing students, including refinement of both the CAS instrument and the demographic tool. The authors also recommend that studies be conducted to determine the validity and reliability of the CAS with nurses in the health care arena.