Publications

Abstract

Purpose: This study explored to develop a situation-specific theory explaining the healthy life of Korean patients with chronic kidney failure undergoing hemodialysis. Background: Chronic kidney failure (CKF) patients have to reorganize their lives around their hemodialysis sessions for their survival. Nursing interventions based on specific theories may promote their health-related behaviors and outcomes. However, few theoretical frameworks or theories are available to guide hemodialysis patients on how to construct their lives under various constraints, while considering their experiences and sociocultural contexts. Methods: An integrated approach was used to develop the situation-specific theory based on the network episode model (NEM), a review of related literature, and four of the authors' studies on hemodialysis patients' lives. Results: The major concepts in the proposed theory include sociocultural context, social networks, individual-level factors, illness experiences, health-related behaviors, and health outcomes. Each major concept includes several relevant subconcepts. Conclusions: We used this theory to identify factors involved in shaping the illness experiences, health-related behaviors, and outcomes of Korean CKF patients undergoing hemodialysis. By exploring the links between these factors, we explained the healthy life that considers the uniqueness of Korean patients' sociocultural context, social network, and individual-level factors. Nurse and other healthcare professionals could integrate the proposed situation-specific theory into the development of nursing interventions based on this theory to promote health-related behaviors and outcomes of Korean CKF patients undergoing hemodialysis.

Abstract

Objective China has seen an increasing number of international students in recent years, mostly from Africa and Asia. However, little is known about these students' HIV knowledge, sexual practices and potential HIV risk. This study aimed to describe HIV-related risk among international students. Design An online cross-sectional survey. Setting 10 universities situated in one province of China. Participants 617 international students filled out the questionnaire and 607 international students were included in this study. Primary and secondary outcome measures Socio-demographic and programme-related characteristics, HIV-related knowledge, sexual practices and other HIV/sexually transmitted infection-related variables. Logistic regression analyses were performed to examine factors associated with inconsistent condom use among international students. Result The results showed that in total, only 51.6% (313/607) of international students had adequate HIV-related knowledge, and 64.9% (394/607) reported not receiving any HIV related education or training while studying in China. Moreover, 32.3% (196/607) reported having penetrative sex including oral, vaginal and anal sex during the period in which they studied in China and among them. The proportions of inconsistent condom use in vaginal and oral intercourse while studying in China were 52.6% (50/95) and 79.5% (35/44), respectively, with casual partners, and 60% (80/129) and 91.2% (52/57) with regular partners, respectively. Female gender, being married and having multiple sexual partners were associated with inconsistent condom use. Conclusion The present study indicated that international students in one province of China have suboptimal HIV-related knowledge, significant unprotected sex, less HIV testing and less safe sex education, which highlights an urgent need to provide HIV education and related health services to international students in China.

Abstract

Background: Hospice care was initially designed for seriously ill individuals with cancer. Thus, the model and clinicians were geared toward caring for this population. Despite the proportion of persons living with dementia (PLWD) receiving hospice care substantially increased over the past 10 years, and their longer lengths of stay, established hospice interventions for this population are scarce. No systematic review has previously evaluated those interventions that do exist. We synthesized hospice intervention studies for PLWD, their families, and hospice professionals by describing the types of interventions, participants, outcomes, and results; assessing study quality; and identifying promising intervention strategies. Methods: A systematic review was conducted using a comprehensive search of five databases through March 2021 and follow-up hand searches. Included studies were peer-reviewed, available in English, and focused on hospice interventions for persons with dementia, and/or care partners, and clinicians. Using pre-determined inclusion and exclusion criteria, data was extracted guided by the Cochrane Checklist, and quality was assessed using a 26-item Consolidated Standards of Reporting Trials (CONSORT) Checklist. Results: The search identified 3235 unique studies in total, of which 10 studies met inclusion criteria. The search revealed three types of interventions: clinical education and training, usual care plus care add-on services, and “other” delivered to 707 participants (mostly clinicians). Five studies included underrepresented racial and ethnic groups. Outcomes measured knowledge and skills, psychosocial and health outcomes, feasibility, and acceptability, with significant improvements in six studies. Study quality was reflective of early-stage research with clinical education and training strategies showing deliberate progression towards real-world efficacy testing. Implications: Hospice interventions for PLWD are sparse and in early-phase research. More research is needed with rigorous designs, diverse samples, and outcomes considering the concordance of care.

Abstract

Research recruitment, eligibility, and who chooses to participate shape the resulting data and knowledge, which together inform interventions, treatment, and programming. Patterns of research participation are particularly salient at this moment given emerging biomedical prevention paradigms. This paper explores the perspectives of Black and Latino young men who have sex with men (BL-YMSM) regarding research recruitment and eligibility criteria, how their experiences influence willingness to enroll in a given study, and implications for the veracity and representativeness of resulting data. We examine inclusion and recruitment as a complex assemblage, which should not be reduced to its parts. From April to July 2018, we conducted in-depth interviews with 30 BL-YMSM, ages 18–29, in New York City. Interviews were recorded, transcribed, and analyzed using the constant comparative method. Black and Latino YMSM’s responses unveiled tensions between researchers’, recruiters’, and participants’ expectations, particularly regarding eligibility criteria (e.g. age, sex frequency), assumptions about ‘risky behaviors,’ and the ‘target’ community. Men preferred peer-to-peer recruitment, noting that most approaches miss key population segments. Findings highlight the need to critically examine the selected ‘target’ community, who sees themselves as participants, and implications for data comprehensiveness and veracity. Study eligibility criteria and recruitment approaches are methodological issues that shape knowledge production and the policies and programs deployed into communities. These findings can inform how future research studies frame recruitment and eligibility in order to better meet the needs of participants and ensure future research engagement.

Abstract

Background: Lesbian, gay, bisexual, transgender and queer (LGBTQ) people, also commonly referred to as sexual and gender minorities (SGMs), live in every part of the United States and encompass all races and/or ethnicities, religions, and social classes. Major reports from various sources document higher rates of health issues (e.g., substance abuse, depression, suicidality, cardiovascular disease) among SGMs than heterosexuals. Chronic stress related to marginalization and discrimination is a key contributor to these disparities. The nursing profession has paid relatively little attention to SGM health issues. Purpose and Methods: To address these gaps, the first National Nursing LGBTQ Health Summit brought together nursing deans, leaders of national nursing organizations, and other participants from across the United States. Findings: Participants agreed that increasing SGM-specific content in nursing curricula, practice guidelines, faculty development, and research is necessary to improve the health of SGM people. Discussion: The Summit ended with a call to action for the nursing profession to prioritize SGM health through innovations in education, research, and practice.

Abstract

Objective: Hypertension during pregnancy can adversely affect maternal and fetal health. This study assessed whether diagnosis of leukemia or lymphoma prior to pregnancy is associated with hypertensive disorders of pregnancy including gestational hypertension, preeclampsia and eclampsia. Study design: A cross-sectional study used two statewide population-based datasets that linked birth certificates with sources of maternal medical history: hospital discharges in California and Surveillance, Epidemiology, and End Results (SEER) cancer registry data in Iowa. Birth years included 2007–2012 in California and 1989–2018 in Iowa. Main outcome measures: Primary outcome measure was hypertension in pregnancy measured from combined birth certificate and hospital diagnoses in California (for gestational hypertension, preeclampsia, or eclampsia) and birth certificate information (gestational hypertension or eclampsia) in Iowa. Results: After adjusting for maternal age, race, education, smoking, and plurality, those with a history of leukemia/lymphoma were at increased risk of hypertensive disorders of pregnancy in Iowa (odds ratio (OR) = 1.86; 95% CI 1.07–3.23), but not in California (OR = 1.12; 95% CI 0.87–1.43). In sensitivity analysis restricting to more severe forms of hypertension in pregnancy (preeclampsia and eclampsia) in the California cohort, the effect estimate increased (OR = 1.29; 95% CI 0.96–1.74). Conclusion: In a population-based linked cancer registry-birth certificate study, an increased risk of hypertensive disorders of pregnancy was observed among leukemia or lymphoma survivors. Findings were consistent but non-significant in a second, more ethnically diverse study population with less precise cancer history data. Improved monitoring and surveillance may be warranted for leukemia or lymphoma survivors throughout their pregnancies.

Abstract

Background: Accurately identifying patients with hypoglycemia is key to preventing adverse events and mortality. Natural language processing (NLP), a form of artificial intelligence, uses computational algorithms to extract information from text data. NLP is a scalable, efficient, and quick method to extract hypoglycemia-related information when using electronic health record data sources from a large population. Objective: The objective of this systematic review was to synthesize the literature on the application of NLP to extract hypoglycemia from electronic health record clinical notes. Methods: Literature searches were conducted electronically in PubMed, Web of Science Core Collection, CINAHL (EBSCO), PsycINFO (Ovid), IEEE Xplore, Google Scholar, and ACL Anthology. Keywords included hypoglycemia, low blood glucose, NLP, and machine learning. Inclusion criteria included studies that applied NLP to identify hypoglycemia, reported the outcomes related to hypoglycemia, and were published in English as full papers. Results: This review (n=8 studies) revealed heterogeneity of the reported results related to hypoglycemia. Of the 8 included studies, 4 (50%) reported that the prevalence rate of any level of hypoglycemia was 3.4% to 46.2%. The use of NLP to analyze clinical notes improved the capture of undocumented or missed hypoglycemic events using International Classification of Diseases, Ninth Revision (ICD-9), and International Classification of Diseases, Tenth Revision (ICD-10), and laboratory testing. The combination of NLP and ICD-9 or ICD-10 codes significantly increased the identification of hypoglycemic events compared with individual methods; for example, the prevalence rates of hypoglycemia were 12.4% for International Classification of Diseases codes, 25.1% for an NLP algorithm, and 32.2% for combined algorithms. All the reviewed studies applied rule-based NLP algorithms to identify hypoglycemia. Conclusions: The findings provided evidence that the application of NLP to analyze clinical notes improved the capture of hypoglycemic events, particularly when combined with the ICD-9 or ICD-10 codes and laboratory testing.

Abstract

Background: To address significant health inequities experienced by residents of public housing in East and Central Harlem compared to other New Yorkers, NYC Department of Health and Mental Health (DOHMH) collaborated with community and academic organizations and the New York City Housing Authority to develop a place-based initiative to address chronic diseases in five housing developments, including a community activation and mobilization component led by community health organizers (CHOs). Purpose: Guided by the Consolidated Framework for Implementation Research (CFIR), we evaluated the initial implementation of the community activation and mobilization component to systematically investigate factors that could influence the successful implementation of the intervention. Methods: Nineteen in-depth qualitative interviews were conducted with a purposive sample of CHOs, community members and leaders, collaborating agencies and DOHMH staff. Interviews were transcribed verbatim, and themes and codes were developed to identify theoretically important concepts of the CFIR and emergent analytic patterns. Results: Findings identified important facilitators to implementation: positive community perception of the program, CHO engagement and responsiveness to community needs, CHO norms and values and adaptability of DOHMH and CHOs to community needs. Challenges included the instability of the program in the first year, limited ability to address housing related issues, concerns about long term funding, competing community priorities, low expectations by the community for the program, time and labor intensity to build trust within the community, and the dual roles of CHOs as community advocates and DOHMH employees. Conclusions: Findings will guide future community activation and mobilization activities. The study demonstrates the value of integrating implementation science and health equity frameworks.

Abstract

Mental health problems are common among individuals suffering from chronic noncommunicable diseases (NCDs) such as type 2 diabetes mellitus and hypertension. Self-management is essential in preventing NCD progression. Mental health problems can impede the ability to self-manage one’s NCDs. The African Caribbean population in the United States suffers from a high burden of NCDs and has unique societal factors that alter disease management. This systematic review aimed to better understand the burden of mental health problems among African Caribbean adults with one or more NCDs and explore the association between mental health disorders and the level of control of NCDs. A literature search was conducted for original research documenting the prevalence of mental illnesses in individuals with NCDs. Data were descriptively summarized. Fourteen studies met inclusion criteria. Three themes emerged: (1) prevalence of comorbid mental health problems and chronic NCDs; (2) factors that mitigate or mediate the association between mental health problems and chronic NCDs—(a) factors influencing self-management; (b) association between mental health and NCD outcome studies focused on (b1) risk factors and (b2) protective factors; and (3) varied results. Chronic disease self-management and disease outcomes are influenced by mental problems and the association is mitigated by complex factors in the African Caribbean population.

Abstract

OBJECTIVE: Late preterm infants have an increased risk of morbidity relative to term infants. We sought to determine the rate, temporal trend, risk factors, and reasons for 30-day readmission. METHODS: This is a retrospective cohort study of infants born at 34 to 42 weeks’ gestation in California between January 1, 2011, and December 31, 2017. Birth certificates maintained by California Vital Statistics were linked to discharge records maintained by the California Office of Statewide Health Planning and Development. Multivariable logistic regression was used to identify risk factors and derive a predictive model. RESULTS: Late preterm infants represented 4.3% (n = 122 014) of the study cohort (n = 2 824 963), of which 5.9% (n = 7243) were readmitted within 30 days. Compared to term infants, late preterm infants had greater odds of readmission (odds ratio [OR]: 2.34 [95% confidence interval (CI): 2.28–2.40]). The temporal trend indicated increases in all-cause and jaundice-specific readmission infants (P < .001). The common diagnoses at readmission were jaundice (58.9%), infections (10.8%), and respiratory complications (3.5%). In the adjusted model, factors that were associated with greater odds of readmission included assisted vaginal birth, maternal age ≥34 years, diabetes, chorioamnionitis, and primiparity. The model had predictive ability of 60% (c-statistic 0.603 [95% CI: 0.596–0.610]) in late preterm infants who had <5 days length of stay at birth. CONCLUSION: The findings contribute important information on what factors increase or decrease the risk of readmission. Longitudinal studies are needed to examine promising hospital predischarge and follow-up care practices.

Abstract

Climate change is a global crisis with major impacts on planetary health and quality of life. Nurses are well positioned to recognize the major health consequences of climate change on health. Therefore, highlighting nurses’ active engagement in mitigating climate change impact and resilience efforts is essential. However, there is little evidence of climate change content in nursing curricula. Climate change/planetary health content could be integrated into existing Doctor of Nursing Practice programs so that graduates, as influential leaders, are equipped to meet the challenges ahead. The domains, competencies and sub-competencies outlined in the Essentials: Core competencies for professional nursing education (American Association of Colleges of Nursing (AACN), 2021) are proposed as a curricular scaffold to integrate climate change content in DNP curricula. Climate change content matched to the AACN domains and competencies could be included in many existing DNP courses. Climate change would become a consistent concept throughout all DNP curricular programs rather than a specified course addressing climate change. The curricular structure presented would provide a foundation for enhancing DNP students' knowledge, attitudes and skills related to climate change. These students and future graduates would be well prepared to introduce changes in practices and policies at the local, national, and global levels.

Abstract

Here we report three epigenome-wide association studies (EWAS) of DNA methylation on self-reported race, global genetic ancestry, and local genetic ancestry in admixed Americans from three sets of samples, including internal and external replications (Ntotal= 1224). Our EWAS on local ancestry (LA) identified the largest number of ancestry-associated DNA methylation sites and also featured the highest replication rate. Furthermore, by incorporating ancestry origins of genetic variations, we identified 36 methylation quantitative trait loci (meQTL) clumps for LA-associated CpGs that cannot be captured by a model that assumes identical genetic effects across ancestry origins. Lead SNPs at 152 meQTL clumps had significantly different genetic effects in the context of an African or European ancestry background. Local ancestry information enables superior capture of ancestry-associated methylation signatures and identification of ancestry-specific genetic effects on DNA methylation. These findings highlight the importance of incorporating local ancestry for EWAS in admixed samples from multi-ancestry cohorts.

Abstract

The evidence-based interconnection between mental health with lifestyle medicine practice is discussed. The extent to which physical health, and mental and behavioral health overlap are significant, and their interaction is seen in many ways. These bidirectional influences form a continuous thread through all lifestyle medicine pillars. The intersection of mental health and lifestyle should be considered and applied to provide optimal evidence-based lifestyle medicine for all patient populations who will benefit from the specific attention to diet, physical activity, relationships, stress, sleep, and substance use. Lifestyle medicine can be utilized to directly address and treat a range of mental health symptoms and disorders, and physical illnesses. In addition, behavior change skills and addressing the psychological factors contributing to barriers are crucial to helping patients reach their lifestyle medicine goals. Approaches to practice that attend to, and address, mental and behavioral health are relevant to and necessary for all types of providers who work within the lifestyle medicine framework.

Abstract

An applied epidemiology course for doctor of nursing practice students was revised to include a module on the impact of climate change on population health. The Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model of instructional design is a gold standard framework for creating course content and guided the module development. A nurse content expert discussed the environmental impacts of climate change on health using literature, actual clinical scenarios, and the application of epidemiologic data. Topics included safeguarding workers and vulnerable populations within the context of the coronavirus disease 2019 pandemic. Students posted reflections on their understanding of module content in response to structured prompts electronically in the learning management system for review by the faculty. Faculty evaluation of responses identified the need to further develop and integrate environmental epidemiology and climate change content more fully within the doctor of nursing practice curriculum.

Abstract

Greater exposure to racial/ethnic discrimination among pregnant Black American women is associated with elevated prenatal depressive symptomatology, poorer prenatal sleep quality, and poorer child health outcomes. Given the transdiagnostic importance of early childhood sleep health, we examined associations between pregnant women’s lifetime exposure to racial/ethnic discrimination and their two-year-old children’s sleep health. We also examined women’s gendered racial stress as a predictor variable. In exploratory analyses, we examined prenatal sleep quality and prenatal depressive symptoms as potential mediators of the prior associations. We utilized data from a sample of Black American women and children (n = 205). Women self-reported their lifetime experiences of discrimination during early pregnancy, their sleep quality and depressive symptoms during mid-pregnancy, and their children’s sleep health at age two. Hierarchical linear multiple regression models were fit to examine direct associations between women’s experiences of discrimination and children’s sleep health. We tested our mediation hypotheses using a parallel mediator model. Higher levels of gendered racial stress, but not racial/ethnic discrimination, were directly associated with poorer sleep health in children. Higher levels of racial/ethnic discrimination were indirectly associated with poorer sleep health in children, via women’s prenatal depressive symptomatology, but not prenatal sleep quality. Clinical efforts to mitigate the effects of discrimination on Black American women may benefit women’s prenatal mental health and their children’s sleep health.

Abstract

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

Abstract

Background: Conflict between clinicians is prevalent within intensive care units (ICUs) and may hinder optimal delivery of care. However, little is known about the sources of interpersonal conflict and how it manifests within the context of palliative and end-of-life care delivery in ICUs. Objective: To characterize interpersonal conflict in the delivery of palliative care within ICUs. Design: Secondary thematic analysis using a deductive-inductive approach. We analyzed existing qualitative data that conducted semistructured interviews to examine factors associated with variable adoption of specialty palliative care in ICUs. Settings/Subjects: In the parent study, 36 participants were recruited from two urban academic medical centers in the United States, including ICU attendings (n = 17), ICU nurses (n = 11), ICU social workers (n = 1), and palliative care providers (n = 7). Measurements: Coders applied an existing framework of interpersonal conflict to guide initial coding and analysis, combined with a flexible inductive approach allowing new codes to emerge. Results: We characterized three properties of interpersonal conflict: disagreement, interference, and negative emotion. In the context of delivering palliative and end-of-life care for critically ill patients, "disagreement" centered around whether patients were appropriate for palliative care, which care plans should be prioritized, and how care should be delivered. "Interference" involved preventing palliative care consultation or goals-of-care discussions and hindering patient care. "Negative emotion" included occurrences of silencing or scolding, rudeness, anger, regret, ethical conflict, and grief. Conclusions: Our findings provide an in-depth understanding of interpersonal conflict within palliative and end-of-life care for critically ill patients. Further study is needed to understand how to prevent and resolve such conflicts.

Abstract

Introduction: Previous studies that used traditional multivariable and sibling matched analyses to investigate interpregnancy interval (IPI) and birth outcomes have reached mixed conclusions about a minimum recommended IPI, raising concerns about confounding. Our objective was to isolate the contribution of interpregnancy interval to the risk for adverse birth outcomes using propensity score matching. Methods: For this retrospective cohort study, data were drawn from a California Department of Health Care Access and Information database with linked vital records and hospital discharge records (2007–2012). We compared short IPIs of < 6, 6–11, and 12–17 months to a referent IPI of 18–23 months using 1:1 exact propensity score matching on 13 maternal sociodemographic and clinical factors. We used logistic regression to calculate the odds of preterm birth, early-term birth, and small for gestational age (SGA). Results: Of 144,733 women, 73.6% had IPIs < 18 months, 5.5% delivered preterm, 27.0% delivered early-term, and 6.0% had SGA infants. In the propensity matched sample (n = 83,788), odds of preterm birth were increased among women with IPI < 6 and 6–11 months (OR 1.89, 95% CI 1.71–2.0; OR 1.22, 95% CI 1.13–1.31, respectively) and not with IPI 12–17 months (OR 1.01, 95% CI 0.94–1.09); a similar pattern emerged for early-term birth. The odds of SGA were slightly elevated only for intervals < 6 months (OR 1.10, 95% CI 1.00–1.20, p <.05). Discussion: This study demonstrates a dose response association between short IPI and adverse birth outcomes, with no increased risk beyond 12 months. Findings suggest that longer IPI recommendations may be overly proscriptive.