Publications

Abstract

Objective: Examine the relationship between race and ethnicity and area-level social deprivation and Medicare home health care (HHC) agency quality for seriously ill older adults receiving HHC. Methods: A linear probability fixed effects model analyzed the association between patient-level predictors and HHC agency quality (star-rating), controlling for neighborhood level fixed effects. Linear mixed regression modeled the relationship between area-level social deprivation and receiving care from a high-quality HHC agency. An interaction term between race and social deprivation index quartiles examined whether racial disparities in accessing high-quality HHC agencies depended on the level of neighborhood social deprivation. Results: The final sample consisted of 213 491 Medicare beneficiaries. Reduced access to high-quality HHC was associated with identifying as Black (1.2 % point lower, P <.001), having Medicaid (5.5 % point lower, P <.0001), and living in a neighborhood with high social deprivation (6.5% point lower, P <.001). The effect of race on access to high-quality HHC persisted regardless of the level of neighborhood social deprivation. Conclusions: For people living with serious illness, living in areas with higher social deprivation is associated with lower-quality HHC. Patient race and ethnicity has a consistent effect reducing access to high-quality HHC agencies, regardless of neighborhood. Future research must investigate ways to improve access to high-quality HHC for racial and ethnic historically marginalized populations who are seriously ill, especially in areas of high social deprivation. This includes understanding what policies, organizational structures, or care processes impede or improve access to high-quality care.

Abstract

Objectives: Home health care (HHC) plays a pivotal role in serving millions of US adults aging in place. Although the HHC population is growing rapidly in both size and diversity, driven by an aging US population and a changing demographic profile, there are increasing concerns of equity in HHC, particularly regarding how vulnerable populations are affected under current HHC practices. The purpose of this study was to examine the variations in accessing high-quality HHC in racial and ethnic minority groups and persons living with dementia. Design: Cross-sectional, secondary analysis. Setting and Participants: Older adults who received HHC in 2016 from agencies with a star rating of overall care quality from the Home Health Compare program. Methods: Start of care data from the 2016 HHC Outcome and Assessment Information Set was linked to Master Beneficiary Summary File, Home Health Compare, and Provider of Services file to address the aim. Multinomial regressions were used in analysis when risk-adjusting for individual and agency characteristics. Results: Our risk-adjusted estimates, based on data from 574,682 older adults aged ≥65 years served by 8634 HHC agencies nationwide (2290 offering high-quality care, 4023 providing moderate-quality care, and 2321 delivering low-quality care), revealed significant disparities. Non-Hispanic Blacks (relative risk ratio, 0.62; 95% CI, 0.61–0.64) and Hispanics (relative risk ratio, 0.72; 95% CI, 0.70–0.74) were significantly less likely to receive care from high-quality agencies. Additionally, having dementia exacerbated disparities in accessing high-quality HHC between racial and ethnic minorities and white Americans. Conclusions and Implications: Racial and ethnic minority individuals face significant disadvantages in accessing high-quality HHC, with persons living with dementia from these groups being the most disadvantaged. Further research is warranted to investigate the referral and admission processes for HHC. Our findings highlight the need for actions from clinicians and policymakers to tackle potential biases in the aforementioned care processes.

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Background: Adolescent mental health is a major public health concern in the United States and schools are an ideal location to offer mental health services. Objective: An examination of combined racial/ethnic disparities pertaining to socio-demographic and contextual factors associated with adolescent utilization of school based mental health services (SBMHS) was conducted to optimize the use and potential benefits of these services. Method: Data from the 2019 National Survey on Drug Use and Health was used to estimate multilevel and multivariable logistic regression models. Indicators included socio-demographics, depression, religiosity, parental monitoring and support, and school and academic engagement. Results: Asian adolescents were less likely to utilize SBMHS compared to their White counterparts (OR = 0.62; 95% CI = 0.41, 0.95). All five racial/ethnic groups reported a statistically higher likelihood of utilizing SBMHS as depressive symptoms increased (OR = 1.15–1.28). Black adolescents were the only racial/ethnic group who reported lower odds (OR = 0.93; 95% CI = 0.88, 0.98) of utilizing SBMHS as their religiosity increased. Parental monitoring and support was not associated with SBMHS use for any group. White, Black, and Asian adolescents reported greater odds of utilizing SBMHS as their school and academic engagement increased (OR = 1.12; 95% CI = 1.05, 1.19; OR = 1.15; 95% CI = 1.01, 1.31; OR = 1.43; 95% CI = 1.04, 1.95, respectively). Conclusion: Findings enhance understanding of the racial/ethnic disparities involved with adolescent utilization of SBMHS and may help identify those in need, tailor interventions, and optimize use of evidence-based treatments.

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AIMS: Compare racial/ethnic disparities in the prevalence of non-obese type 2 diabetes (T2D) and the proportion of non-obese individuals among T2D patients.METHODS: This cross-sectional study used ICD-9/10 codes to ascertain T2D. Participants were classified as non-obese by BMI (<25 kg/m2 for normal weight; <23 kg/m2 for Asian Americans), waist circumference (<102 cm for males, <88 cm for females), and waist-to-hip ratio (<0.9 for males, <0.85 for females). The statistical analysis used marginal standardization of predicted probabilities from multivariable logistic regression to calculate the prevalence.KEY RESULTS: Among 276,736 participants (mean age 51.7, 61.2% female), non-obese T2D prevalence varied: 6.85% (BMI), 4.17% (waist circumference), 3.63% (waist-to-hip ratio). Asian participants had the highest prevalence of normal-weight T2D (2.70% vs. 1.92% in White, OR 1.44, 95% CI: 1.22-1.69) and non-obese T2D by waist circumference (8.04% vs. 3.36%, OR 2.61, 95% CI: 2.35-2.89). Black participants had the highest prevalence using waist-to-hip ratio (5.37% vs. 2.91%, OR 1.91, 95% CI: 1.80-2.03).CONCLUSION: Asian Americans showed higher non-obese T2D prevalence by BMI and waist circumference, while Black adults had higher prevalence by waist-to-hip ratio, suggesting different fat distribution patterns.

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Background: The recent global pandemic posed extraordinary challenges for healthcare systems. Frontline healthcare workers required focused, immediate, practical, evidence-based instruction on optimal patient care modalities as knowledge evolved around disease management. Objective: This course was designed to provide knowledge to protect healthcare workers; combat disease spread; and improve patient outcomes. Methods: A team of global healthcare workers responded by rapidly creating a competency-based online course. To promote transcultural applicability, the course was developed by an international team of more than 45 educators from over 20 countries. Course delivery included a built-in language translation tool, routine updates, and several innovative course design elements. User feedback was collected to determine efficacy of course content, structure, unique delivery elements, and delivery options. Results: An initial population of online learners (n = 147) living in 23 different countries and representing 22 languages completed the course and participated in post-course surveys. An additional population of learners (n = 505) attended an in-person offering of course materials. Course participants gave positive feedback and several requested additional courses in similar formats. Conclusion: Global open access education courses may provide needed resources to empower healthcare professionals during health crises. Responsive course design can accommodate diverse learner resources and transcultural applicability.

Abstract

Background: Advanced practice registered nurses (APRNs) are essential to care for the growing number of individuals with advanced illness given the shortage of palliative care clinicians. Problem: Graduate education for specialty practice palliative APRNs lacks consistency in structure, content, and standardization of specialty palliative APRN education. Approach: A workgroup of expert palliative APRNs and graduate faculty conducted focused discussions and a literature review to develop consensus recommendations based on national palliative APRN competencies and aligned with the 8 core concepts of the AACN Essentials. Outcome: Recommendations include: (a) definition of core concepts; (b) associated skills; (c) andragogical approaches; (d) evaluation methods; and (e) references for curricular development. Conclusion: The Recommendations for Specialty Palliative APRN Education is a first step toward the standardization of quality advanced practice specialty palliative nursing education. These recommendations provide the foundation for a comprehensive curriculum for palliative APRNs.

Abstract

Introduction: Psychedelic science is re-emerging to address mental health conditions, of which certain populations in the United States experience disparities. However, the perspectives of registered nurses (RNs), who have important roles within mental health care, towards psychedelics are largely unknown. Aim/Question: To assess attitudes, knowledge, and beliefs of a large, state-wide sample of RNs towards psychedelics in healthcare settings. Method: RNs were randomly selected from a statewide directory to participate in a cross-sectional, multi-method online survey. Results: 793 RNs completed all items, with generally positive attitudes towards psychedelics but mixed opinions regarding the legal landscape, including decriminalisation. Few (12.7%) reported psychedelic content in their training, and most expressed low confidence in their knowledge. Discussion: Findings generally align with previous research regarding provider attitudes towards psychedelics. Participants in this study had slightly more favourable attitudes and higher knowledge scores. Limitations: The study has potential selection bias, lacks a priori power analysis, and is limited to one state. Implications: As psychedelic science emerges as a potential treatment option for several mental health conditions, RNs must be prepared to support individuals and communities. Recommendations: Additional education in this emerging area of mental health nursing is warranted to ensure RN competence and confidence.

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Background: Cesarean birth increases risk of maternal morbidity and mortality. Purpose: Examine the relationship between labor and delivery staffing and hospital cesarean and vaginal birth after cesarean (VBAC) rates. Methods: Survey of U.S. labor nurses in 2018 and 2019 on adherence to AWHONN nurse staffing standards with data linked to American Hospital Association Survey data, patient discharge data, and cesarean birth and VBAC rates. Findings: In total, 2,786 nurses from 193 hospitals in 23 states were included. Mean cesarean rate was 27.3% (SD 5.9, range 11.7%–47.2%); median VBAC rate 11.1% (IQR 1.78%–20.2%; range 0%–40.1%). There was relatively high adherence to staffing standards (mean, 3.12 of possible 1–4 score). After adjusting for hospital characteristics, nurse staffing was an independent predictor of hospital-level cesarean and VBAC rates (IRR 0.89, 95% CI 0.84–0.95 and IRR 1.58, 95% CI 1.25–1.99, respectively). Discussion: Better nurse staffing predicted lower cesarean birth rates and higher VBAC rates. Conclusion: Hospitals should be accountable for providing adequate nurse staffing during childbirth.

Abstract

Although healthcare workers may be aware of the risks of physical inactivity, their levels of physical activity (PA) are similar to those of all US adults, with less than half engaging in sufficient PA. The purpose of this health promotion was to encourage daily PA among employees in a large academic healthcare system. We also tested whether individualized progress updates further influenced PA. This 10-week program was available to all employees of NYU Langone Health. Employees could sync their phone or accelerometer via app or web browser to count.it – the vendor chosen to monitor and manage step counts. Participants were asked to voluntarily provide basic information (age, sex, job role, work location) and complete the Physical Activity Vital Sign (minutes/week and intensity of PA) at enrollment and 10 weeks. For 10 weeks, participants were sent a message through their employee ‘MyChart’ portal with a link to information on the benefits of PA, and a reminder of that week’s step-count challenge. Those meeting criteria for weekly challenges were included in gift card raffles. Participants were randomized 1:1 to receive the standard message ± additional emails detailing their progress. 3528 employees registered to participate (8% of all employees) although active users diminished over time (1225 at week 10). Average daily steps remained stable throughout (7319 + 4540 in week 1, 7229 + 5010 in week 10). Although there was no difference in any individual week, receipt of personalized feedback was associated with significantly higher average step counts throughout the 10-wk intervention as a whole (P = 0.01). Age and an urban work location were positively associated with steps, while female sex and a clerical job role were negatively associated with steps counts (all P < 0.005). Our findings provide important insight for workplace interventions to promote PA. They further suggest specific groups that may benefit from targeted efforts.

Abstract

This secondary analysis of the National Youth Risk Behavior Survey (years 2015-2019) examines associations between school-based protective factors (i.e., safe school environments and academic achievement) and HIV risk behaviors among sexually experienced adolescent gay and bisexual men (n = 644), a population with the highest prevalence of undiagnosed HIV infections. Demographics included Hispanics/Latinos (25%, n = 158), Other race/ethnicity (14%, n = 88), and non-Hispanic Blacks/African Americans (13%, n = 81). Adjusted models showed that protective factors reduced odds for early sexual debut, multiple sexual partners, sex under the influence of drugs/alcohol, and condomless sex, with an additive effect demonstrated when two protective factors were present. Hispanics/Latinos had greater odds of reporting multiple sexual partners and HIV testing, indicating opportunities for school-based HIV prevention and further research. Our findings provide support for school-based programs that aim to improve social and structural determinants of health and ultimately reduce adolescent HIV burdens.

Abstract

Background Women with a history of gestational diabetes mellitus (GDM) have an elevated risk for cardiometabolic diseases. Chinese American immigrants are disproportionately affected by GDM, yet their cardiometabolic risk factors are understudied. Little is known about physical activity (PA) of this understudied high-risk minority group. Objective The purpose of this study was to describe self-reported PA and the facilitators of and barriers to PA in Chinese American immigrants with a history of GDM. Methods We conducted an exploratory multimethod study between 2020 and 2021 among 106 Chinese American immigrant women. PA was self-reported using the International Physical Activity Questionnaire - Long form. Four domains of PA (work, transportation, housework, and leisure time) and daily sitting time were recorded. Open-ended questions were asked about the facilitators of and barriers to PA. Results Participants' mean age was 34.3 ± 3.7 years, and body mass index was 21.7 ± 2.6 kg/m2. Approximately 25% had low PA. Over half (N = 56, 53%) reported no leisure-time moderate-to-vigorous PA. Walking and housework were the most common types of PA. Barriers to PA included being busy with life, physical health issues (eg, sleep and postpartum health issues), low motivation or not enjoying PA, COVID-related barriers, and an unfavorable environment for PA. Conclusions Strategies are needed to increase leisure-time moderate-to-vigorous PA in this population. Modifiable factors include providing convenient PA programs (eg, technology or home-based) and addressing postpartum health issues (eg, sleep). Increasing providers' awareness of barriers to PA and cardiometabolic disease risk in this hard-to-reach, high-risk group may improve assessment and referral for high-risk women. Future research is needed to further explore opportunities for PA that Chinese American immigrant women would be open to at this stage in their life.

Abstract

Background: An estimated 44.1 million US citizens are living with disabilities. People with disabilities are at higher risk for health problems, affecting their overall quality of life and care experience. Simulation-based learning (SBL) enables students to apply cognitive, affective, and psychomotor competencies through simulated experiential activities in realistic environments. Research is limited on the integration of disability into SBL nursing education. Aim: To appraise and synthesize extant literature on the integration of disability in SBL in prelicensure nursing programs. Methods: This review identified and synthesized 18 research articles describing the implementation of disability SBL in prelicensure nursing programs. Results: Four themes were identified substantiating the importance of integrating disability into SBL: knowledge and understanding, communication confidence, empathy, and enlightened attitudes. Conclusions: Disability SBL strategies are integral to achieving learning outcomes related to patient-centered care. Large well-designed studies are needed to measure its effectiveness.

Abstract

Background: Previous research has shown poor oral health and neighborhood environment are both risk factors for cognitive decline among older adults. Little research has assessed the synergistic effects of poor oral health and neighborhood environment on cognitive health. This study examined whether neighborhood environment moderates the relationship between edentulism and cognitive function over time. Methods: Using data from the Health and Retirement Study, we analyzed 9,994 adults aged 60 and older with 39,976 person-wave observations over 14 years (2006–2020). Cognitive function was measured using the modified Telephone Interview for Cognitive Status. Edentulism status was self-reported complete tooth loss. Neighborhood environment included perceived neighborhood cohesion and disorder. We used linear mixed-effect models to examine the moderation effect of neighborhood environment on the association between edentulism and cognitive function over time. Results: Edentulous participants (22.4 %) showed an accelerated decline over time in cognitive function compared to dentate participants (β = -0.57, 95 % CI: -0.98, -0.16). The analysis revealed that neighborhood cohesion moderated the relationship between edentulism and cognitive function over time (β = 0.08, 95 % CI: 0.01, 0.15). Specifically, among individuals reporting higher neighborhood cohesion, the negative effect of edentulism on cognitive decline was attenuated. Neighborhood disorder had no significant associations with cognitive function. Conclusions: This study demonstrates the relationship between edentulism and cognitive function varies by levels of neighborhood cohesion. The findings highlight the significance of neighborhood context in understanding the relationship between oral health and cognitive aging and suggest interventions addressing community environment may be particularly relevant for older adults with oral health challenges.

Abstract

Objectives: We investigated the association between maternal leukocyte telomere length (LTL) in the immediate postpartum period and moderate to late preterm birth (32– < 37 weeks) among Latinas, a population at high risk for preterm birth. Methods: Maternal LTL was measured using quantitative polymerase chain reaction at delivery in a prospective San Francisco primarily Latina birth cohort. Logistic regression models were used to investigate the association between postpartum maternal LTL and preterm birth. Maternal LTL was analyzed as a continuous predictor. Results: Out of 194 participants, 23 (11.9%) had preterm delivery. Longer postnatal maternal LTL was associated with preterm birth (crude OR 4.68; 95% confidence interval (CI) 1.07, 20.6, p = 0.039; adjusted OR 12.8, 95% CI 1.83, 99.9, p = 0.010). Age-stratified analysis showed that being under 35 years increased the effect size of the association between maternal LTL and preterm birth (adjusted OR 32.5, 95% CI 2.58, 597, p < 0.01). Conclusions for Practice: Latina mothers with moderate to late preterm infants had longer LTL in the immediate postpartum period compared to those with term infants. This association was stronger for mothers under the age of 35 years. LTL may serve as a biomarker to better understand the pathophysiology and risk of preterm birth and could inform targeted interventions for prevention and early detection. Future studies are needed to understand physiological changes in maternal LTL from the prenatal to postnatal period in relation to birth outcomes.

Abstract

Purpose: Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system. Methods: This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study’s primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato Results: The study population consisted of 357 patients with median age of 59 years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17–0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01–1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use. Conclusions: The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.

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This study examines how coping strategies and social support mediate the relationship between type D personality and psychological distress in COPD patients. A sample of 351 patients completed surveys on demographics, psychological distress (Kessler Psychological Distress Scale), social support (Social Support Self-Rating Scale), coping strategies (Chinese version of Medical Coping Modes Questionnaire), and type D personality (Type D Personality Scale). Using structural equation modeling (SEM) via AMOS 23.0 and SPSS, results showed that confrontation and acceptance-resignation coping strategies, as well as type D personality, were positively correlated with psychological distress, while social support was negatively correlated. SEM estimates revealed a chain mediating effect of social support and coping strategies between type D personality and psychological distress. Enhancing social support and coping strategies is crucial for reducing psychological distress, especially in COPD patients with type D personality.

Abstract

Background: The prevalence of hypertension (HTN) is high in Brazil, and control rates are low. Little is known about the factors that contribute to HTN control from a family-based perspective. Objectives: Guided by the Family Management Style Framework, specific aims were to (1) describe the prevalence of adequate blood pressure (BP) control in individuals cared for the Family Health Strategy, (2) identify facilitators and barriers to HTN management, and (3) identify individual contextual sociocultural influences (sociocultural context and social and Family Health Strategy support), definition of the situation, and management behaviors that help or interfere with individual functioning (BP control in the individual with HTN). Methods: This descriptive, cross-sectional study included 213 individuals with HTN randomly selected from 3 Family Health Strategy units from July 2016 until July 2017. Results: Most of the individuals were female (n = 139, 65.3%), retired (n = 129, 60.5%), and White (n = 129, 60.2%) and had less than a high school education (n = 123, 57.6%). Family income (n = 166, 77.8%) was less than 5500 reals (US $1117/month). Mean (SD) systolic BP was 137.1 (±24.1) mm Hg, and mean (SD) diastolic BP was 83.8 (±18.6) mm Hg, with 47.9% (n = 102) having uncontrolled BP. In the multivariate logistic model, only high levels of perceived social support were significantly associated (odds ratio, 3.29; 95% confidence interval, 1.44–7.5; P = .005) with controlled BP. Conclusions: Social support is strongly associated with BP control. Optimizing support may play an important role in BP control and preventing HTN-related complications.

Abstract

Preceptors are essential in the clinical education of prelicensure registered nursing and advanced practice registered nursing students. However, there is a growing scarcity of preceptors available to provide clinical education. Additionally, preceptors have not uniformly received professional development in the practice of teaching that is essential in delivering high quality clinical education, and clinical education in nursing is an unfunded mandate. This article reviews the current state of preceptors, the importance and challenges of preceptors in clinical education, the lack of funding for clinical education by preceptors, and proposed solutions.

Abstract

The field of psychiatry has evolved over the past 2500 years. Between dynamic psychotherapy and psychopharmacology, lifestyle psychiatry holds a different space. This approach capitalizes on the lifestyle medicine movement, as it promotes change within 6 domains of activity. Apart from incorporating these lifestyle pillars as adjunctive therapy for either psychodynamic therapy or psychotropic medication regimens, lifestyle psychiatry is on the frontier similar to the other growing fields of precision psychiatry, advanced learning in psychiatry, psychedelics in psychiatry, digital mental health, and psychiatric genetics. Any disruption into the historical practice of psychiatry, particularly with the prescription of medications, can be met with scrutiny. We encourage the field of psychiatry to keep an open mind as our field continues to evolve. What makes lifestyle psychiatry particularly powerful and unique in its ability to assess and evaluate internal and external factors that contribute to individual behaviors, and may impact the ability to incorporate healthy lifestyle actions. Internal factors include: emotional regulation, internalized trauma, cognitive factors, and personality traits. On the other hand, external factors include environmental barriers and work-related burnout.