Publications

Abstract

We explored methodological issues related to antiretroviral adherence assessment, using 6 months of data collected in a completed intervention trial involving 136 low-income HIV-positive outpatients in the Bronx, NY. Findings suggest that operationalizing adherence as a continuous (versus dichotomous) variable and averaging adherence estimates over multiple assessment points (versus using only one) explains greater variance in HIV-1 RNA viral load (VL). Self-reported estimates provided during a phone interview accounted for similar variance in VL as EDM estimates (R 2 = .17 phone versus .18 EDM). Self-reported adherence was not associated with a standard social desirability measure, and no difference in the accuracy of self-report adherence was observed for assessment periods of 1-3 days. Self-reported poor adherence was more closely associated with EDM adherence estimates than self-reported moderate and high adherence. On average across assessment points, fewer than 4% of participants who reported taking a dose of an incorrect amount of medication.

Abstract

Objective: To evaluate the associations between levels of vitamin D (25-hydroxyvitamin D) in serum and prevalent age-related macular degeneration (AMD). Methods and Design: Cross-sectional associations of serum vitamin D and early and advanced AMD, assessed from nonmydriatic fundus photographs, were evaluated in the third National Health and Nutrition Examination Survey, a multistage nationally representative probability sample of noninstitutionalized individuals (N=7752; 11% with AMD). Results: Levels of serum vitamin D were inversely associated with early AMD but not advanced AMD. The odds ratio (OR) and 95% confidence interval (CI) for early AMD among participants in the highest vs lowest quintile of serum vitamin D was 0.64 (95% CI, 0.5-0.8; P trend <.001). Exploratory analyses were conducted to evaluate associations with important food and supplemental sources of vitamin D. Milk intake was inversely associated with early AMD (OR, 0.75; 95% CI, 0.6-0.9). Fish intake was inversely associated with advanced AMD(OR, 0.41; 95% CI, 0.2-0.9). Consistent use vs nonuse of vitamin D from supplements was inversely associated with earlyAMDonly in individuals who did not consume milk daily (early AMD: OR, 0.67; 95% CI, 0.5-0.9). Conclusion: This study provides evidence that vitamin Dmay protect against AMD. Additional studies are needed to confirm these findings.

Abstract

BACKGROUND: Induction immunotherapy in addition to standard triple therapy at the time of cardiac transplantation with cytolytic antibodies has been used in recipients with pre transplant renal impairment, and to prevent rejection. Recently, anti-interlukin-2 receptor monoclonal antibodies have been used for these purposes. A retrospective study of 58 heart transplant recipients was conducted to assess the effect of basiliximab, a chimeric anti-interlukin-2 receptor monoclonal antibody on biopsy proven acute rejection, serum creatinine, creatinine clearance, hospitalizations due to infection and mortality one year after transplantation. METHODS: A total of 58 heart transplant patient's charts were reviewed. All patients received triple immunosuppressive therapy with cyclosporine or tacrolimus, mycophenolate mofetil and prednisone post transplant. Basiliximab 20 mg on day 0 and day 4 was administered as induction therapy in a subgroup of patients. Both groups had similar pre transplant characteristics. Analysis was performed at intervals of 0-17 weeks, 18-34 weeks, 35-52 weeks, and one year overall. The incidence of acute rejection episodes, post-transplant renal function, patient survival and hospitalizations due to infection was analyzed. RESULTS: Twenty-seven patients received induction therapy with basiliximab and 31 patients did not. Basiliximab induction helped reduce acute rejection overall during the first year, with 22 episodes of rejection in the induction group, and 67 episodes in the no induction group. In the 0-17 weeks following transplantation there were 20 reported rejection episodes in the induction group versus 58 rejection episodes in the no-induction group, demonstrating also reduction of rejection by induction in this group. Basiliximab induction group had preserved renal function, with higher creatinine clearance at 1 year when compared to the no induction group. There were no differences between groups in terms of hospitalizations due to infections or mortality. CONCLUSION: Induction therapy with basiliximab significantly reduced the number of acute rejection within the first year after heart transplantation, without a negative impact on patient's renal function, risk of infection or mortality.

Abstract

Stalking is a significant public health and criminal justice issue. Lack of clarity exists about which behaviors constitute stalking or harassment. This study sought to understand behaviors that college women identify as stalking. Using a cor-relational design, 841 college women responded to stalking items from the National Violence Against Women Survey. Although 32% (n = 259) self-identified the experience as stalking, when a legal definition was applied, the rate of stalking identification dropped to 26% (n = 117). Specific stalking behaviors most predictive of an experience's being labeled as stalking were identified. Psychiatric nurses interact with individuals who experience stalking, which necessitates the importance of familiarity with stalking definitions.

Abstract

Background: Bereavement services are central to high-quality end-of-life care, however, little is known about how frequently and why such bereavement services are used and not used. We examined family caregiver reports about how often they used bereavement services, predictors of their use, and reported reasons for not using bereavement services. Methods: Prospective cohort study of family caregivers (n = 161) of patients with cancer enrolled with hospice between October 1999 and September 2001. We conducted bivariate and multivariable analyses to determine predictors of bereavement service use, adjusted for a broad range of factors including caregiving experiences, major depressive disorder (MDD), relationship with the deceased, and demographic factors. We used content analysis to summarize responses to open-ended questions concerning why individuals did not use bereavement services. Results: We found that approximately 30% of family caregivers used bereavement services in the year postloss, and the majority of these caregivers used services in the first 6 months postloss. Even among bereaved caregivers with MDD, less than half (47.6%) used bereavement services. Factors associated with using bereavement services included being a spouse caregiver, younger age, having MDD at study enrollment, witnessing highly distressing events pertaining to the patient's death, having assisted the patient with more Instrumental Activities of Daily Living (IADLs) prior to the patient's death, having greater availability of instrumental support for oneself, and physician communication with the caregiver about the patient's prognosis before the patient's death. The most common given reason for nonuse was the perception that bereavement services were not needed or would not help. Conclusion: Addressing caregiver receptivity to bereavement services will be an important aspect of increasing appropriate use of such services. Future studies might examine specific interventions for reducing barriers and increasing receptivity to bereavement service use.

Abstract

The purpose of this article is to describe the development and implementation of a shared position with a focus on evidence-based practice (EBP) between the Visiting Nurse Service of New York and the Lienhard School of Nursing, Pace University. A preexisting relationship between the two institutions in providing student experiences in a community setting paved the way for the evolution a new collaborative effort. The shared position was initially conceived by two of the authors as an outcome of research they were conducting in the home care setting, which tested a model of mentoring frontline nurses in the EBP process on health care professional and patient outcomes. An initial conception of the new role provided a working document for discussions between the two institutions and the creation of a workable contract. The implementation of several initiatives has already provided support for the position, and each partner has benefited from building this bridge between nursing education and service. Benefits include advancing knowledge of and implementing EBP in both settings and promoting collaborative, clinically related scholarship.

Abstract

Purpose: To discuss the diagnosis and treatment of severe anemia in an older adult who presents the challenge of declining blood transfusion in a real-world scenario where critical thinking, evidence-based care, and collaboration with other providers must come together to serve this patient's unique needs. Data sources: Extensive review of the scientific literature on anemia and the situation in which a patient refuses blood transfusion presented in a case study format. Conclusions: A thorough physical assessment, complete health history, and appropriate diagnostic workup should be used to distinguish the normal effects of senescence from the signs and symptoms of anemia. Common conditions that cause anemia in the elderly include chronic disease, iron deficiency, and gastro-intestinal bleeding. These conditions may result in profound anemia. The challenge can be compounded when, because of religious tenets, a patient, does not accept a blood transfusion. This case study challenges nurse practitioners to apply knowledge, seek guidance, and make appropriate referrals to care for a patient in order to render care within the parameters of the patient's belief system. Implications for practice: The astute primary care provider recognizes that anemia is not an expected physiological change associated with aging but a manifestation of an underlying disease process. Fatigue, weakness, and dyspnea are all symptoms of anemia that, may be overlooked and attributed to the aging process. Further, in keeping with the principles of autonomy and self-determination, it. is the clinician's duty to work with all patients to restore them to a state of optimal health while respecting deeply held, spiritual beliefs.

Abstract

Objectives. We sought to investigate the relationship between varying levels of cognitive function and dental care utilization. Methods. Using data obtained from the National Health and Nutrition Examination Survey (1999-2002), we performed weighted descriptive and multivariate logistic regression analyses on 1984 individuals with at least 1 tooth and who were 60 years and older. Results. Multivariate analyses suggested that level of cognitive function was associated with dental care utilization. At a higher level of cognitive functioning, individuals were more likely to have had more frequent dental visits. In addition, a higher level of socioeconomic status, healthy lifestyle, and worse self-rated oral health-related symptoms were more likely to indicate a higher frequency of dental care utilization. By contrast, poorer oral health status as determined by clinical examinations was negatively associated with frequency of dental visits. Conclusions. The results suggest that community-dwelling older adults with low cognitive function are at risk for less frequent use of dental care. Oral health serves as a mediating factor between cognitive function and dental care utilization. There is a great need to improve oral health awareness and education among older adults, caregivers, and health care professionals.

Abstract

Background: Despite advances in management, heart failure is associated with high rates of hospitalization, poor quality of life, and early death. Education intended to improve patients' abilities to care for themselves is an integral component of disease management programs. True self-care requires that patients make decisions about symptoms, but the cognitive deficits documented in 30% to 50% of the heart failure population may make daily decision making challenging. After describing heart failure self-care as a naturalistic decision making process, we explore cognitive deficits known to exist in persons with heart failure. Problems in heart failure self-care are analyzed in relation to neural alterations associated with heart failure. As a neural process, decision making has been traced to regions of the prefrontal cortex, the same areas that are affected by ischemia, infarction, and hypoxemia in heart failure. Resulting deficits in memory, attention, and executive function may impair the perception and interpretation of early symptoms and reasoning and, thereby, delay early treatment implementation. Conclusions: There is compelling evidence that the neural processes critical to decision making are located in the same structures that are affected by heart failure. Because self-care requires the cognitive ability to learn, perceive, interpret, and respond, research is needed to discern how neural deficits affects these abilities, decision-making, and self-care behaviors.

Abstract

The University of Miami's early intervention program, incorporating the pediatric nurse practitioner as part of the interdisciplinary team, is an illustration of what Szapocznik, Kurtines, Sansebastian, and Rio (1990) describe as the interplay between theory, research, and practice that can result in important breakthroughs in treatment. The collaborative partners are confident that the unique interdisciplinary partnership between an early intervention provider, pediatric nurse practitioner, and researchers can decrease the risk factors faced by the target families and their children; and that capacity building in this area, by increasing the readiness, interest, knowledge, skills, and resources within a setting or community, can provide primary Healthcare access as part of the array of services and interventions offered. This group of children is the most at-risk for adverse health outcomes due to environmental and social situations. The pediatric nurse practitioner's emphasis on prevention, risk assessment, cultural competence, and coordination of services has played a vital role in the health promotion, health protection, and disease prevention in this group of socially complex and vulnerable children. The relationship that has been developed between the University Pediatric Practice, the pediatric nurse practitioner, and the caregivers has created an increase in compliance, by easing the access to health care for both sick and well visits. This, in turn, has resulted in increasing the percentage of children who are fully immunized and decreasing the frequency of emergency room visits. Providing medical care and case management by a pediatric nurse to hildren in the foster care system can prevent adverse health outcomes and promote optimal health care.

Abstract

The majority of the research on the various aspects of symptom management has focused on individual symptoms. However, patients with cancer often experience multiple symptoms simultaneously as a result of their disease and treatment. In 2001, symptom management researchers began to study the impact of symptom clusters on patient outcomes. Over the past 6 years, a number of conceptual reviews as well as several research studies have been published on symptom clusters in oncology patients. This paper summarizes the conceptual basis for symptom cluster research, describes two conceptual approaches to symptom cluster research, and discusses the implications of symptom clusters for quality-of-life research. The paper concludes with an enumeration of the critical considerations that need to be addressed if this area of scientific inquiry is to move forward.

Abstract

Drug treatment staff are uniquely situated to support their clients' HCV related needs, and those with greater self efficacy to do so are more likely to provide this support. Using data collected from staff (N = 140) in 6 drug treatment programs in New York City, we determined the correlates of this self efficacy. Results indicate that medically credentialed staff and staff with more hepatitis C knowledge have greater self efficacy to support their clients' HCV related needs. There was no relationship between this self efficacy and the staff member's own HCV infection or that of a close relative. Efforts should focus on increasing staff's HCV knowledge in order to increase their confidence in providing HCV related support to their clients.

Abstract

The purpose of this training program was to prepare nursing staff in family-centered geriatric care that emphasizes providing culturally competent care to hospitalized elders at two major tertiary hospitals in New York. This research report corresponds to the first phase of a 3-year project. In this research project, a descriptive exploratory design was used to identify the levels of cultural awareness and cultural competence of nursing staff who participated in a family-centered geriatric care training program.

Abstract

Dating violence is accepted as bi-directional with both genders as victims and perpetrators. While researchers have studied perpetration and victimization, limited research has explored differences in young women who are victims and perpetrators with those who are victims only. This study compares injury and mental health symptoms of victims who reported perpetrating violence with victims who did not.

Abstract

Purpose: To examine the frequency and course of delirium in older adults admitted to a surgical intensive care unit (SICU). Design and Methods: Prospective, observational cohort study of 114 English-speaking participants and their surrogates, aged 65 and older, admitted to an SICU, and managed by a surgical critical care service. Chart reviews and surrogate interviews were conducted within 24 hours of SICU admission to collect information regarding evidence of dementia using the short form of the Informant Questionnaire on Cognitive Decline in the Elderly. Participants were also screened for delirium daily throughout their hospitalization with either the Confusion Assessment Method-ICU (CAM-ICU) while in the SICU or the CAM while on medical/surgical units. Results: In this population of older adults, 18.4% had evidence of dementia on admission to the SICU. Few older adults (2.6%) were admitted to the hospital with evidence of preexisting delirium, but 28.3% developed delirium in the SICU and 22.7% during the post-SICU period. A total of 52 of 114 (45.6%) participants were delirious sometime during their hospital stay or 24 hours before hospital admission. Episodes of deep sedation and nonarousal were uncommon, occurring in only 9.7% of the sample. Conclusions: Older adults admitted to SICUs were at high risk for developing delirium during hospitalization. Further research is needed to elucidate the risk factors for, and outcomes of, delirium in this uniquely vulnerable population.

Abstract

Objectives: China's health care system is bifurcated in nature between rural and urban areas. In addition, there is a huge gap in socioeconomic status between rural and urban residents. The purpose of the study was to examine the factors related to dental visits among elders in rural and urban areas of Shanghai, China. Methods: Using a stratified random sampling method, a cross-sectional, face-to-face survey was conducted among elders aged 60 years and above in Shanghai during 2003-04. A total of 1,044 older respondents were included in the sample. Results: There was a significant urban and rural difference in dental visit rates over the 12-month period of the study. Results from the logistic regression analysis suggested that residing in urban areas was a significant positive factor related to dental visits. In addition, being younger, being able to pay out-of-pocket medical expenses, having had regular medical checkups, having a higher number of limitations because of chronic conditions, and being more concerned about eating a healthy diet were associated with increased odds of dental visits. Conclusions: Results suggest that urban-rural differences, as reflected in the socioeconomic status gap, disparity in medical insurance coverage, and access to dental care, have a significant impact on the use of dental services by Chinese elders. Individual sociodemographic characteristics, health status, and health attitude are important explanatory variables.

Abstract

Purpose: To assess knowledge and attitude toward hepatitis B virus (HBV) infection among Korean immigrants in two cities in the Rocky Mountain region and to determine whether sociodemographic and cultural factors are related to the level of HBV knowledge. Methods: Community-based participatory study was conducted in five Korean churches in the Rocky Mountain region to develop baseline data on HBV infection and vaccination behavior. All documents, including announcements, brochures, consent forms, and questionnaires were in Korean and English, and trained Korean interviewers collected the surveys by reviewing the questionnaires with participants at the churches. Results: Knowledge of HBV infection was low and city of residence did not have a statistically significant impact on HBV infection knowledge. in the total sample, 62% identified transmission by sharing utensils and 21% believed that HBV was hereditary, while only 21% thought that HBV was spread through sexual contact. The majority of participants (61%) rated their English level as "minimum". Knowledge of HBV infection was found to be associated with both demographic and acculturation factors (p <.05). Conclusion: This study found not only a low level of knowledge of HBV infection but also misunderstanding of the risks of HBV infection. Knowledge of HBV infection was significantly associated with education and acculturation; therefore, culturally sensitive and group-tailored public health education for Korean and other Asian American Pacific Islanders should be developed to clarify misconceptions and misunderstandings about HBV infection.

Abstract

Background. In spite of the disproportionate prevalence of hepatitis C virus (HCV) infection among drug users, many remain uninformed or misinformed about the virus. Drug treatment programs are important sites of opportunity for providing HCV education to their patients, and many programs do, in fact, offer this education in a variety of formats. Little is known, however, about the level of HCV knowledge among drug treatment program patients, and the extent to which they utilize their programs' HCV education services. Methods. Using data collected from patients (N = 280) in 14 U.S. drug treatment programs, we compared patients who reported that they never injected drugs (NIDUs) with past or current drug injectors (IDUs) concerning their knowledge about HCV, whether they used HCV education opportunities at their programs, and the facilitators and barriers to doing so. All of the programs were participating in a research project that was developing, implementing, and evaluating a staff training to provide HCV support to patients. Results. Although IDUs scored higher on an HCV knowledge assessment than NIDUs, there were many gaps in HCV knowledge among both groups of patients. To address these knowledge gaps, all of the programs offered at least one form of HCV education: all offered 1:1 sessions with staff, 12 of the programs offered HCV education in a group format, and 11 of the programs offered this education through pamphlets/books. Only 60% of all of the participating patients used any of their programs' HCV education services, but those who did avail themselves of these HCV education opportunities generally assessed them positively. In all, many patients were unaware that HCV education was offered at their programs through individual sessions with staff, group meetings, and books/pamphlets, (42%, 49%, and 46% of the patients, respectively), and 22% were unaware that any HCV education opportunities existed. Conclusion. Efforts especially need to focus on ensuring that all drug treatment program patients are made aware of and encouraged to use HCV education services at their programs.