Publications

Abstract

Thoracic aortic aneurysm and dissection (TAAD) is associated with high mortality and medical expense. These poor outcomes are preventable by surgical repair; however, identifying at-risk individuals is difficult. Researchers are actively surveying the human genome (the repository of human genes) to characterize the genetic determinants of TAAD by identifying chromosomal regions likely to harbor such predisposing genes. In previous studies, investigators identified genetic markers shared by a subset of families who were ascertained to have the disease, which clustered into 2 chromosomal regions: 5q13-q15 (TAAD1) and 11q23.2-q24 (familial aortic aneurysm [FAA1]). In a subsequent study, a third chromosomal region at 3p24-25 (TAAD2) was found to contribute to TAAD in a 4-generation, 52-member family that displayed little evidence of sharing either the TAAD1 or FAA1 regions. Although additional regions of the genome may contribute to TAAD, investigators are focusing their efforts on identifying the actual genes and the specific mutations that participate in the disease process. The goal of these endeavors is to develop screening tests to identify individuals at risk for familial TAAD. This genetic discovery has significant clinical implications because high-risk individuals and families can be closely monitored and can benefit from preventative surgical repairs.

Abstract

Association studies were conducted on a large number of single nucleotide polymorphisms (SNPs) in pooled screening for association with angiographically determined coronary artery disease (CAD) and myocardial infarction (MI), followed by individual genotyping of those showing association. Forty-seven SNPs showed association with severity of CAD in a replication study applying individual genotyping in 1250 patients. Case control analysis of 340 patients with MI and 300 controls revealed significant associations of three novel genes: an immune cell receptor on chromosome 20p (p=0.02), a zinc finger protein on chromosome 3 (p=0.04), and an unknown gene on chromosome 3 (p=0.01). Associations of polymorphisms in three genes with the phenotype of familial combined hyperlipidemia (FCH), Apo A-V, PPAR alpha and microsomal triglyceride transfer protein (MTP) were established, supporting a metabolic model for the disorder based on misdirection of fatty acid metabolism. Congruence of SNP associations in non-alcoholic steatohepatitis suggests overlap of this syndrome with FCH.

Abstract

BACKGROUND: Amid a national nurse shortage, there is growing concern that high levels of nurse burnout could adversely affect patient outcomes. OBJECTIVES: This study examines the effect of the nurse work environment on nurse burnout, and the effects of the nurse work environment and nurse burnout on patients' satisfaction with their nursing care. RESEARCH DESIGN/SUBJECTS: We conducted cross-sectional surveys of nurses (N=820) and patients (N=621) from 40 units in 20 urban hospitals across the United States. MEASURES: Nurse surveys included measures of nurses' practice environments derived from the revised Nursing Work Index (NWI-R) and nurse outcomes measured by the Maslach Burnout Inventory (MBI) and intentions to leave. Patients were interviewed about their satisfaction with nursing care using the La Monica-Oberst Patient Satisfaction Scale (LOPSS). RESULTS: Patients cared for on units that nurses characterized as having adequate staff, good administrative support for nursing care, and good relations between doctors and nurses were more than twice likely as other patients to report high satisfaction with their care, and their nurses reported significantly lower burnout. The overall level of nurse burnout on hospital units also affected patient satisfaction. CONCLUSIONS: Improvements in nurses' work environments in hospitals have the potential to simultaneously reduce nurses' high levels of job burnout and risk of turnover and increase patients' satisfaction with their care.

Abstract

Staffing patterns and nurses' working conditions are risk factors for healthcare-associated infections as well as occupational injuries and infections. Staffing shortages, especially of nurses, have been identified as one of the major factors expected to constrain hospitals' ability to deal with future outbreaks of emerging infections. These problems are compounded by a global nursing shortage. Understanding and improving nurses' working conditions can potentially decrease the incidence of many infectious diseases. Relevant research is reviewed, and policy options are discussed.

Abstract

PURPOSE: To discuss the advanced practice nurse's diagnosis and management of obesity in youth in primary care. DATA SOURCES: Review of current scientific literature, practice guidelines, and a case study. CONCLUSIONS: Obesity in youth is difficult to manage. Recent research suggests a genetic and environmental etiology associated with impaired glucose tolerance, type 2 diabetes, hypertension, hyperlipidemia, and hypertriglyceridemia. Nutrition education, increasing physical activity, decreasing sedentary behaviors, and behavioral modification have been used with varying success. Management is directed at healthy lifestyle behavior change for youth and their families. IMPLICATIONS FOR PRACTICE: If obesity, impaired glucose tolerance, hypertension, hypercholesterolemia, and hypertriglyceridemia are left untreated, youth may develop type 2 diabetes and coronary artery disease later in life and suffer early morbidity and mortality.

Abstract

The hepatitis C virus (HCV) continues to penetrate populations within the United States, especially within the drug-abusing population. Therefore, drug users need access to HCV testing and medical care, and drug treatment programs are well situated to provide these services. Because directors of these programs are gatekeepers who can influence decisions about service provision, their beliefs about the value of providing particular services for drug treatment program patients are of considerable importance. Directors of 121 outpatient drug treatment programs throughout the United States responded to an in-depth telephone survey that included questions on their beliefs about providing HCV services in drug treatment programs. We constructed an eight-item scale to examine these beliefs and investigated the relationship between them and the actual HCV services offered. Overall, directors were moderately supportive of the provision of HCV medical services (on-site or through referral) during drug treatment. Our findings indicate that there is a positive significant relationship between director's beliefs and the provision of HCV antibody testing, follow-up testing, and the provision of HCV medication.

Abstract

Trichomonas vaginalis infection is highly prevalent, may have serious health consequence, and is readily treatable. However, screening has been limited by currently available tests, which tend to be insensitive, expensive, or require a delay before results are reported. The XenoStrip-Tv (Xenotope Diagnostics, Inc., San Antonio, Tex.) was evaluated on vaginal swab specimens from 936 women attending sexually transmitted disease clinics in Seattle, Wash. (n = 497), and Birmingham, Ala. (n = 439). T. vaginalis prevalence by culture (InPouch; Biomed) was 8.7% in Seattle and 21.0% in Birmingham. Compared to culture, the XenoStrip assay in Seattle was 76.7% (95% confidence interval [95% CI] = 61.4 to 88.2) sensitive and 99.8% (95% CI = 98.8 to 99.9) specific, and in Birmingham it was 79.4% (95% CI = 69.6 to 87.1) sensitive and 97.1% (95% CI = 94.8 to 98.6) specific. The positive predictive values were 97.1% in Seattle and 87.9% in Birmingham; the negative predictive values were 97.8 and 94.7%, respectively. Rapid test performance did not vary by vaginal symptoms or by the presence of other vaginal or cervical syndromes or infections. The sensitivity did vary by day of culture-positive result, with a 71% decline in XenoStrip sensitivity for every additional day delay until T. vaginalis was first detected in cultures (odds ratio = 0.29, 95% CI = 0.18 to 0.49). The rapid assay was more sensitive than wet preparation microscopy (78.5% versus 72.4% [P = 0.04]) but was less specific (98.6% versus 100% [P = 0.001]). The XenoStrip rapid assay is well suited for use in settings with a moderately high prevalence of T. vaginalis infection, particularly when microscopy is not practical.

Abstract

Background: Individuals who use sexually transmitted disease (STD) clinics are at high risk for hepatitis B virus (HBV). While HBV vaccine is frequently offered to clients in this setting, reported vaccination rates are low. More information is needed about HBV vaccine knowledge, attitudes, beliefs, and behavior among high risk populations. The current study assesses these issues at an urban STD clinic. Methods: A survey assessing knowledge, attitudes, and beliefs concerning HBV vaccine was administered to individuals seeking services at an STD clinic before seeing the physician. Immediately after the clinical visit these individuals were interviewed and asked whether they had accepted vaccination and their reasons for acceptance or rejection. Results: Fifty percent of unvaccinated study subjects elected to receive an HBV vaccine dose at the current visit. Significant predictors in a multiple logistic regression model for choosing to be vaccinated were: having a vaccinated acquaintance, perceived risk of disease, perceived healthfulness of vaccine, and clinician's recommendation. Knowledge regarding hepatitis B risks and outcomes was not related to vaccine choices. Patients expressed concern about vaccine safety and provider motivation. Conclusions: The role of acquaintances and the physician are central to the decision to be vaccinated, as are risk perception and familiarity with the vaccine. Mistrust of the medical establishment and of vaccines is a barrier to acceptance of HBV vaccine.

Abstract

Type 2 diabetes is increasing among youth, with minority youth at highest risk. This preliminary study tested the feasibility of a school-based program to prevent type 2 diabetes in youth at risk. Forty-one participants (age 12.6 ± 1.1 years; 63% female, 51% African American, 44% Hispanic, and 5% Caucasian) were randomly assigned to one of two groups. Both the experimental and control groups received nutrition education and exercise training. The experimental group also received coping skills training. Data collected included body mass index (BMI), insulin resistance, dietary intake (24-Hour Food Recall), self-efficacy (Health Behavior Questionnaire), activity (Revised Godin-Shepard Activity Survey), and parents' health promoting behaviors (Health Promoting Lifestyle Profile III). At baseline BMI ranged from 27 to 53 (M = 36.2 ± 6.0), and 95% (n = 39) demonstrated insulin resistance or pre-diabetes on an oral glucose tolerance test. After 12 months, the experimental group showed trends in improved usual food choices (p = .1) and increased dietary knowledge (p = .3). They also demonstrated lower glucose (p = .07) and insulin levels (p = .2). Experimental group parents demonstrated improved health responsibility (p = .03), healthier nutrition choices (p = .05), improved stress management skills (p = .05), increased activity (p = .2), and increased spirituality (p = .2). Data suggest a school-based program tailored to multiethnic youth may prove successful in helping these youth increase activity, improve nutrition status, and stabilize glucose and insulin metabolism, and also may be effective in changing parent health behavior.

Abstract

Young women are vulnerable to experiencing psychological, physical, and sexual violence and stalking through dating experiences. This study used a correlational design to report prevalence estimates of psychological, physical, and sexual violence and stalking that occur within the dating experiences of college women. This study also compared prevalence estimates of violence between African-American and White college women. A convenience sample of 863 (N = 863) women between 18 and 25 years of age from a private, historically African-American college in the south and a private, historically primarily White college in the mid-Atlantic completed the Abuse Assessment Screen, and a background data sheet. All participants had the option of completing a narrative note. Data analysis consisted of frequencies, and chi2. Almost half of the total sample 48% (n = 412) reported the experience of violence and of these, 39% (n = 160) reported more than one form of violence. Specific prevalence was as follows: psychological violence 22% (n = 190), stalking or harassment 31% (n = 266), physical violence 12% (n = 99), and all unwanted sexual activity 9% (n = 80). Prevalence estimates were consistent for African-American and White college students in all types of violence except in reporting threats of physical violence and threats plus actual physical violence. Study findings highlight the need for nurses to routinely screen and assess all young women for psychological, physical, and sexual violence and stalking Surveillance efforts will help identify victims and potential victims so that appropriate referrals for treatment and support can be made.

Abstract

Substance abusers are at high risk for hepatitis C (HCV) infection and also constitute a group that is medically underserved and hard to reach. We conducted a nationwide survey with 445 randomly selected drug treatment units in the United States to determine unit and patient characteristics associated with the provision of on-site medical services for HCV-infected drug users. Eighty-four percent of the 322 units that estimated having at least one HCV-infected patient reported that they provided patients with HCV-related medical care. Drug treatment units were more likely to provide at least some of this care on site if they were residential, part of a network, or affiliated with a hospital; had medical staff; and required that their patients undergo a medical examination before entering treatment. Some organizational factors appear to influence the provision of on-site medical services to HCV-positive patients in drug treatment units. Further research on the role of such factors could inform the development of effective models of care for patients with hepatitis C in drug treatment organizations.

Abstract

This paper reports on research designed to assess access to care by Latino immigrant populations in the New York area. A qualitative approach and methods were employed, involving focus groups with PLWAs (persons living with AIDS) and affected men and women from Mexico, the Dominican Republic and Central America to explore the perceptions, beliefs, experiences and knowledge of HIV care issues. A total of 57 men and women participated, ranging in age from 19-61. Results included detailed information on cultural meanings of HIV/AIDS; experience of stigma and rejection; gendered health-seeking behaviour; testing issues; and satisfaction with services. Data support the conclusion that to be effective in reaching and providing services to these immigrant groups, it is crucial to understand the environment from which they come and the impact of immigration. Poverty, repressive governments, lack of education/literacy, ethnicity, class, colour-based stigma and cultural norms are crucial factors in determining their attitudes, motivations, decisions and behaviour. AIDS agencies were seen to play a crucial role in connecting PLWAs to services and resources. The key elements for the provision of services to this population appear to be those that build on cultural norms and network human and institutional resources.

Abstract

The purpose of this cross-sectional analysis (N = 53) was to (a) describe the self-reported prevalence of depressed mood and depression in women with type 2 diabetes; (b) to describe the antidepressive agents and dosages prescribed for depression treatment in women with type 2 diabetes; and (c) to examine differences in diabetes-related health outcomes (physiologic, psychosocial, and health functioning variables) with respect to depressed mood. Forty-four percent of women in this sample reported a depressed mood and 34% of the sample reported a history of depression. The majority of women with a history of depression were taking an antidepressive agent at the time of assessment (94%). Most women were treated with selective serotonin reuptake inhibitors (SSRIs). Women with depressed mood demonstrated poorer psychosocial adjustment and health functioning compared to women without a depressed mood; however, no differences in physiological outcomes were demonstrated. Only 18% of the participants were currently being treated with psychotherapy in conjunction with medication. Further research on this understudied population is indicated.

Abstract

Lack of patient information is a particular problem when a patient is transferred from one health care facility to another. The lack of information needed to develop a timely and effective plan of care for an older adult transferred to the nursing home facility may exacerbate disruptions in the older adult's care. Also, adjustment or readjustment to the nursing home or hospital environment may be prolonged. Persistence of problems or difficulty in adjustment may then lead to exacerbation of the disease processes and, ultimately, hospital readmissions. Evidence suggests that elderly patients discharged from the hospital have high readmission rates. Although the patient is most affected by a breakdown in communication, everyone in the nursing home involved in the resident's care is also affected. All staff who provide care to the resident, including nursing, medicine, nutrition, pharmacy, social work, and physical therapy staff members, must be cognizant of issues related to communication for patients being transferred. In this article, the authors discuss the development, implementation, and results of a model designed to increase the communication surrounding the transition of elderly patients from an inpatient unit to and from nursing homes.

Abstract

A growing number of older adults are afflicted with asthma; these older asthmatic individuals suffer more deleterious consequences as compared with younger asthmatic individuals. Asthma is a chronic condition requiring the person's ability to self-manage symptoms. Few educational programs have focused on older asthmatic adults' learning needs and even fewer on those of older minority individuals with this disease. Three focus groups were conducted in East Harlem. Each group consisted of 6 to 10 participants. All focus groups were led by the same coleaders and were conducted using the same semistructured format. Discussions were audio-taped and transcribed. Transcriptions were reviewed by two independent raters who determined major themes and concerns. Comparisons were made and discrepancies resolved through discussion and consensus with the team of investigators. In this pilot study, there were important similarities in the themes identified by participants in the 3 focus groups. Older individuals with asthma, their unlicensed caregivers, and health professionals all identified the following as important in the care of older adults who are asthmatic: (1) the negative impact of asthma on the individual's quality of life, (2) high cost of medications, (3) nonadherence to the medical regimen, and (4) difficulty that these individuals have in accessing the health care system.