Publications

Abstract

The years 2020–21, designated by WHO as the International Year of the Nurse and Midwife, are characterised by unprecedented global efforts to contain and mitigate the COVID-19 pandemic. Lessons learned from successful pandemic response efforts in the past and present have implications for future efforts to leverage the global health-care workforce in response to outbreaks of emerging infectious diseases such as COVID-19. Given its scale, reach, and effectiveness, the response to the HIV/AIDS pandemic provides one such valuable example, particularly with respect to the pivotal, although largely overlooked, contributions of nurses and midwives. This Personal View argues that impressive achievements in the global fight against HIV/AIDS would not have been attained without the contributions of nurses. We discuss how these contributions uniquely position nurses to improve the scale, reach, and effectiveness of response efforts to emerging infectious diseases with pandemic potential; provide examples from the responses to COVID-19, Zika virus disease, and Ebola virus disease; and discuss implications for current and future efforts to strengthen pandemic preparedness and response.

Abstract

Aims: To explore nurses' experience and describe how they manage various contextual factors affecting the nurse-to-nurse handoff at change of shift. Design: Qualitative descriptive study. Methods: A convenience sample of 51 nurses from four medical and surgical care units at a university-affiliated hospital in Montreal, Canada, participated in one of the 19 focus group interviews from November 2017 to January 2018. Data were analysed through a continuous and iterative process of thematic analysis. Results: Analysis of the data generated a core theme of ‘sharing accountability for knowing and safeguarding the patient’ that is achieved through actions related to nurses' role in the exchange. Specifically, the outgoing nurse takes actions to ensure continuity of care when letting go, and the incoming nurse takes actions to provide seamless care when taking over. In both roles, nurses navigate each handoff juncture by mutually adjusting, ensuring attentiveness, managing judgements, keeping on track, and venting and debriefing. Handoff is also shaped by contextual conditions related to handoff norms and practices, the nursing environment, individual nurse attributes and patient characteristics. Conclusions: This study generated a conceptualization of nurses' roles and experience that details the relationship among the elements and conditions that shape nurse-to-nurse handoffs. Impact: Nursing handoff involves the communication of patient information and relational behaviours that support the exchange. Although many factors are known to influence handoffs, little was known about nurses' experience of dealing with these at the point of care. This study contributed a comprehensive conceptualization of nursing handoff that could be useful in identifying areas for quality improvement and guiding future educational efforts.

Abstract

The present study identified and compared the attitudes of nursing students from North and South American countries towards alcohol, alcohol use disorders and persons with alcohol use disorders (AUDs). A cross-sectional design and survey approach were used. The sample consisted of 327 nursing students recruited from four nursing schools in metropolitan regions of North and South America. The questionnaire contained questions about sex, age, marital status, home country and other questions about training in substance use disorders during nursing education and previous experiences with substance use disorder patients. To identify nursing students’ attitudes, validated English, Spanish and Portuguese versions of the attitudes scale for alcohol, alcoholism and persons with AUDs (EAFAA) were applied. Comparison of the four groups suggested that nursing students in the United States demonstrated more positive attitudes than students from Colombia, Mexico and Brazil. Similar positive attitudes were observed towards individuals with AUDs. Results of the attitudes towards the aetiology of AUDs showed positive attitudes in all samples, suggesting a contemporary understanding of AUDs. Nursing students’ attitudes were associated with home country and training in substance use disorders during nursing education. Nursing students’ attitudes were generally positive across countries. Idiosyncratic cultural and educational aspects in these countries and world regions likely significantly influenced the attitudes of nursing students towards alcohol and associated issues.

Abstract

Adolescents and young adults (AYAs) are at increased risk for negative opioid-related outcomes, including misuse and overdose. High-quality cancer care requires adequate pain management and often includes opioids for tumor- and/or treatment-related pain. Little is known about opioid use and misuse in children and AYAs with cancer, and we therefore conducted a systematic review of the literature using PRISMA guidelines to identify all relevant studies that evaluated opioid use and/or misuse among this population. Eleven studies were identified that met our inclusion criteria. The range of opioid use among the studies was 12–97%, and among the five studies that reported opioid misuse or aberrant behaviors, 7–90% of patients met criteria. Few studies reported factors associated with opioid misuse but included prior mental health and/or substance use disorders, and prior opioid use. In summary, opioid use is highly variable among children and AYAs with cancer; however, the range of use varies widely depending on the study population, such as survivors or end-of-life cancer patients. Few studies have examined opioid misuse and/or aberrant behaviors, and future research is needed to better understand opioid use and misuse among children and AYAs with cancer, specifically those who will be cured of their cancer and may subsequently experience adverse opioid-related outcomes.

Abstract

Background: The HPV vaccination is effective and safe for preventing HPV infection and HPV attributable cancers. Despite this fact, the uptake rate of the vaccination in the United States has remained below the national target of 80%. Health policy focused on allocating resources and creating vaccine-promoting environments can influence HPV vaccination coverage rates. There is a scarcity of information about the HPV vaccination-related health policy and its impact on the outcome of vaccine uptake. Method: We conducted a comprehensive review of HPV vaccination-related health policies at the federal, state, and professional organization levels and examined their impact on population health by reviewing national data on HPV vaccination uptake rates. Results: The review revealed that (a) HPV vaccination recommendations, which serve as the federal-level HPV vaccination policy, have changed frequently in terms of gender, age criteria, and dosing schedule, and (b) the frequent changes of the policy have resulted in low uptake rates among male and young adult populations. Discussion: The uptake rate should be continuously followed to evaluate the impact of recent changes to the federal-level HPV vaccination policy. State-level policies and healthcare professionals, including nurses, are important to the promotion of HPV vaccinations and decreasing HPV vaccination disparities.

Abstract

A review of the literature indicates that there are many benefits of palliative care consultations for patients in the intensive care unit (ICU). Patients who received palliative care treatment were found to have a better emotional state, received less invasive procedures, and had a shorter ICU length of stay. It is noted that patients who could benefit from palliative care treatments may not be identified due to failures to meet the criteria for palliative care consultations. A culture change is needed to improve palliative services, and to standardize when and how it is used.

Abstract

Background:Eosinophilic esophagitis is an increasingly common inflammatory disease of the esophagus. Diagnosis and management are based on the histological presence of eosinophils in the esophageal mucosa, often requiring multiple endoscopies with sedation. Unsedated transnasal endoscopy (TNE), an alternative method of assessing the mucosa without the risks of sedation, is now being performed in the pediatric population. This is the first qualitative study on pediatric patients' and parents' experiences with TNE.Objective:The objective of the study was to describe pediatric patients' and parents' experiences of TNE with the goal of refining TNE protocols to improve the clinical experience.Methods:We used a qualitative descriptive approach that included in-depth, semistructured interviews with patients and parents following completion of TNE. Interviews continued until we reached thematic saturation. We analyzed data using qualitative content analysis.Results:A total of 21 interviews were completed. We identified 4 themes: Appeal of TNE; Expectations and Preparation for TNE; Tolerance of TNE; and Evaluation of TNE. Perceived positive aspects of TNE were no exposure to intravenous anesthesia; helpful and clear preparation for the procedure with a demonstration video and physician phone call; distraction during TNE with virtual reality goggles and a stress ball; parent able to accompany the patient; and TNE requiring less time than an esophagogastroduodenoscopy. Negative aspects included patient stress before TNE, patient dislike of nasal spray taste and sensation, and discomfort during the TNE procedure.Conclusion:The overall perception of TNE among our participants was positive. Study data will allow pediatric gastroenterologists the opportunity to improve both preparation for and comfort during TNE.

Abstract

INTRODUCTION: Among US veterans, more than 78% have a body mass index (BMI) in the overweight (≥25 kg/m2) or obese range (≥30 kg/m2). Clinical guidelines recommend multicomponent lifestyle programmes to promote modest, clinically significant body mass (BM) loss. Primary care providers (PCPs) often lack time to counsel and refer patients to intensive programmes (≥6 sessions over 3 months). Using peer coaches to deliver obesity counselling in primary care may increase patient motivation, promote behavioural change and address the specific needs of veterans. We describe the rationale and design of a cluster-randomised controlled trial to test the efficacy of the Peer-Assisted Lifestyle (PAL) intervention compared with enhanced usual care (EUC) to improve BM loss, clinical and behavioural outcomes (aim 1); identify BM-loss predictors (aim 2); and increase PCP counselling (aim 3).METHODS AND ANALYSIS: We are recruiting 461 veterans aged 18-69 years with obesity or overweight with an obesity-associated condition under the care of a PCP at the Brooklyn campus of the Veterans Affairs NY Harbor Healthcare System. To deliver counselling, PAL uses in-person and telephone-based peer support, a tablet-delivered goal-setting tool and PCP training. Patients in the EUC arm receive non-tailored healthy living handouts. In-person data collection occurs at baseline, month 6 and month 12 for patients in both arms. Repeated measures modelling based on mixed models will compare mean BM loss (primary outcome) between study arms.ETHICS AND DISSEMINATION: The protocol has been approved by the Institutional Review Board and the Research and Development Committee at the VA NY Harbor Health Systems (#01607). We will disseminate the results via peer-reviewed publications, conference presentations and meetings with stakeholders.TRIAL REGISTRATION NUMBER: NCT03163264; Pre-results.

Abstract

Perceived discrimination is significantly associated with mental health symptoms among persons living with HIV (PLWH). However, little is known about the factors mediating this relationship. We aimed to examine the mediating role of social isolation and loneliness in the association between perceived discrimination and mental health symptoms among PLWH. A multicenter (Shanghai, Kunming, Nanning, Hengyang, and Changning in China) cross-sectional study was conducted in 2017. Data from 883 PLWH were used for statistical analysis. Perceived discrimination, mental health symptoms, loneliness and social isolation were assessed through self-report questionnaires. Structural equation modeling (SEM) showed a satisfactory model fit (CMIN/DF = 2.676, GFI = 0.998, CFI = 0.997, NFI = 0.995, TLI = 0.985, RMSEA = 0.044 [0.000, 0.090]) and a significant total indirect effect (β = 0.058, SE = 0.009, Z = 6.444, p < 0.01). Both loneliness (β = 0.042, SE = 0.008, Z = −5.250, p < 0.01) and social isolation (β = 0.016, SE = 0.004, Z = −4.000, p < 0.01) were determined to be significant mediators of the association between perceived discrimination and mental health symptoms. Interventions that combat loneliness and social isolation may help ameliorate the adverse consequences of perceived discrimination on mental health.

Abstract

Perceived discrimination is associated with symptoms of cognitive dysfunction (SOCD) among middle-age and older persons living with HIV (PLWH). We aimed to explore how the association between perceived discrimination and SOCD was mediated by mental health symptoms and social isolation. The sample included 321 PLWH, ages 45 years and older, for a multicenter cross-sectional study. Structural equation modeling showed an acceptable model fit and a significant total indirect effect between perceived discrimination and SOCD. All three indirect effect pathways were significant, suggesting that perceived discrimination could influence SOCD through mental health symptoms, through social isolation, or through mental health symptoms and then social isolation. Our study demonstrates that perceived discrimination is a concern for the management of cognitive function among middle-age and older PLWH. Both mental health symptoms and social isolation are critical elements in the design and evaluation of interventions for promoting cognitive health.

Abstract

Objectives: The current study aims to explore person-centered communication between health care professionals and COVID-19-infected older patients in acute care settings. Methods: The current qualitative study explored the communication between professionals and COVID-19-infected older adults in the acute care setting through 2 rounds of interviews with physicians and nurses who provided direct care and treatment for COVID-19-infected older patients in Wuhan, China. We explored the possibilities and significance of facilitating effective communication despite multiple challenges in the pandemic. Conventional content analysis was adopted to analyze the rich data collected from our participants. Results: It is possible and necessary to initiate and sustain person-centered communication despite multiple challenges brought by the pandemic. The achievement of person-centered communication can play significant roles in addressing challenges, building mutual trust, improving quality of care and relationships, and promoting treatment adherence and patients' psychological well-being. Discussion: It is challenging for health care professionals to provide care for COVID-19-infected older adults, especially for those with cognitive and sensory impairment, in acute care settings. Facilitating person-centered communication is a significant strategy in responding to the pandemic crisis and a core element of person-centered care.

Abstract

It is often difficult for medical students to understand the extent of the educational debt that they may incur. They often struggle with managing their finances during training and after they begin to practice medicine. Students make their choice of specialty without fully considering how their decision may affect their lifestyle and their ability to pay off their loans. This has led to a serious shortage in primary-care physicians. In addition, because physicians undergo an extensive training period, they are often late in planning for and funding for their retirement. Understanding the time-value of money and being able to make informed decisions regarding repaying loans versus meeting other financial obligations are important factors to addressing this problem. Financial literacy is not being taught in medical schools and residency programs, although there is a perceived need. Developing a financial plan that involves both paying off debt and saving for retirement is usually the best course of action.

Abstract

Physician burnout, as described in North America, is a multidimensional work-related syndrome that includes emotional exhaustion, depersonalization, and a low sense of accomplishment from work. More than 50% of physicians were reporting symptoms of burnout prior to the COVID-19 pandemic. This silent epidemic of burnout is bound to become less silent as the pandemic continues. Lifestyle medicine is an evidence-based discipline that describes how daily habits and health practices can affect overall health and well-being of individuals. Lifestyle Medicine can potentially play a significant role in preventing and ameliorating physician burnout. This article explores the burnout process, including the historical context, international definitions, symptoms, and imprecision of the clinical diagnosis. The systemic etiological issues are discussed, and the psychological underpinnings are explored, including physicians’ personal vulnerabilities contributing to burnout. The stress response and lifestyle medicine’s role in healthy coping are described. A prevention model for risk factor reduction is proposed, focusing on primordial, primary, secondary, and tertiary prevention. Lifestyle medicine clinicians’ role in prevention, treatment, and advocacy to ameliorate the potential for burnout is discussed along with specific recommendations.

Abstract

OBJECTIVE:  The aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy.STUDY DESIGN:  This population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n = 2,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg/m2) was classified as normal weight (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 (≥40). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race/ethnicity, education, health care payer, parity, plurality, and comorbidities.RESULTS:  The overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (n = 320). Unadjusted ORs were 1.32 (95% CI: 1.01-1.74) for women with overweight BMI and 2.03 (95% CI: 1.57-2.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95-1.66) for overweight women and 1.38 (95% CI: 1.04-1.84) for women with obesity. The ORs suggested a dose-response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00.CONCLUSION:  Pre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period.KEY POINTS: · Pre-pregnancy obesity affects maternal health.. · Effects may extend to peripartum cardiomyopathy.. · The risk includes peripartum cardiomyopathy that emerges postpartum..

Abstract

Background: Autoimmune rheumatic diseases (ARDs) and bariatric surgery are each risk factors for adverse birth outcomes. To date, no study has investigated their combined impact on birth outcomes. Objectives: The objective of this study was to evaluate the impact of bariatric surgery on pregnancy outcomes in women with an ARD. As a secondary comparison, we assessed the risk of bariatric surgery on the same outcomes in women without an ARD. Setting: Records maintained by the California Office of Statewide Health Planning and Development. Methods: This cohort study included infants born between 20–44 weeks of gestation in California between 2011–2018. Risks of adverse pregnancy outcomes were evaluated for women with a history of bariatric surgery as compared to women without a history of bariatric surgery, stratified by ARD, using log-linear regression with a Poisson distribution. Results: The study included 3,574,165 infants, of whom 10,823 (0.3%) were born to women who had an ARD and 13,529 (0.38%) to women with a history of bariatric surgery. There were 155 infants born to women (0.0043%) with both an ARD and a history of bariatric surgery. In women with an ARD and without bariatric surgery, the prevalence of preterm births was 18%, compared to 17.4% in women with both ARD and bariatric surgery; in women without ARD but with prior bariatric surgery, the prevalence of preterm births was 13.7%, compared to 8.2% in women without bariatric surgery. Except for neonatal intensive care unit (NICU) admissions, women with an ARD and history of bariatric surgery were not at a statistically increased risk of having other adverse pregnancy outcomes as compared to women with an ARD and no history of bariatric surgery. Conclusion: Our study shows that women with ARD already have a high occurrence of several adverse birth outcomes, and this was not further increased by a history of bariatric surgery. The infants born to women with a history of ARD and bariatric surgery were admitted to the NICU significantly more than the infants born to women with an ARD and no history of bariatric surgery.

Abstract

Background Data on the prevalence and correlates of restless legs syndrome (RLS) in people with HIV are limited. This study sought to determine the prevalence of RLS, associated clinical correlates, and characterize sleep-related differences in men with and without HIV. Methods Sleep-related data were collected in men who have sex with men participating in the Multicenter AIDS Cohort Study (MACS). Demographic, health behaviors, HIV status, comorbidities, and serological data were obtained from the MACS visit coinciding with sleep assessments. Participants completed questionnaires, home polysomnography, and wrist actigraphy. RLS status was determined with the Cambridge-Hopkins RLS questionnaire. RLS prevalence was compared in men with and without HIV. Multinomial logistic regression was used to examine correlates of RLS among all participants and men with HIV alone. Sleep-related differences were examined in men with and without HIV by RLS status. Results The sample consisted of 942 men (56% HIV+; mean age 57 years; 69% white). The prevalence of definite RLS was comparable in men with and without HIV (9.1% vs 8.7%). In multinomial regression, HIV status was not associated with RLS prevalence. However, white race, anemia, depression, and antidepressant use were each independently associated with RLS. HIV disease duration was also associated with RLS. Men with HIV and RLS reported poorer sleep quality, greater sleepiness, and had worse objective sleep efficiency/ fragmentation than men without HIV/RLS. Conclusions The prevalence of RLS in men with and without HIV was similar. Screening for RLS may be considered among people with HIV with insomnia and with long-standing disease.

Abstract

This cross-sectional study aimed to determine the prevalence of the co-occurrence of physical frailty and cognitive impairment and to identify its associated demographic, psychosocial and behavioural factors. Participants were recruited from 32 neighbourhoods using multistage sampling method in Xuhui District, Shanghai, China. A total of 1585 older adults were included who lived in community, were 75 years or older and without a clinical diagnosis of dementia. Based on the presences of frailty (using the modified frailty phenotype criteria) and/or cognitive impairment (using Chinese version Mini-Mental Status Examination stratified by educational level), the participants were classified into four groups: normal, cognitive impairment alone, frailty alone and co-occurrence. Multinomial logistic regression analyses were conducted to identify the demographic, psychosocial (depression, social participation and social support) and behavioural (sedentary lifestyle and sleep problems) characteristics associated with the co-occurrence of physical frailty and cognitive impairment. The prevalence of frailty alone, cognitive impairment alone and the co-occurrence of physical frailty and cognitive impairment in the study sample were 7%, 26.94% and 7.19% respectively. The results of multinomial logistic regression show the following characteristics significantly associated with the co-occurrence of physical frailty and cognitive impairment: advanced age (81–85 years old, Odds Ratio, OR = 1.99, 95% CI = 1.10–3.59; 86 years or older, OR = 6.43, 95% CI = 3.66–11.29), number of co-morbidities (OR = 1.34, 95% CI = 1.01–1.77), depression (OR = 3.88, 95% CI = 2.39–6.29), social participation (OR = 0.61, 95% CI = 0.39–0.96), sedentary lifestyle (OR = 2.69, 95% CI = 1.66–4.34) and sleep problems (insomnia occasionally, OR = 1.84, 95% CI = 1.07–3.17; insomnia every day, OR = 2.38, 95% CI = 1.33–4.26). The co-occurrence of physical frailty and cognitive impairment is a prevalent health issue in oldest old community-dwelling older adults. Advanced age, co-morbidity, depression, sedentary lifestyle and sleep problems are risk factors for cognitive frailty while good social participation may have a protective effect on it.

Abstract

Objectives:This study describes prevention behavior and psychosocial health among people living with HIV (PLHIV) and HIV-negative people during the early wave of the coronavirus disease 2019 (COVID-19) pandemic in the United States. We assessed differences by HIV status and associations between social disruption and psychosocial health.Design:A cross-sectional telephone/videoconference administered survey of 3411 PLHIV and HIV-negative participants in the Multicenter AIDS Cohort Study/WIHS Combined Cohort Study (MWCCS).Methods:An instrument combining new and validated measures was developed to assess COVID-19 prevention efforts, social disruptions (loss of employment, childcare, health insurance, and financial supports), experiences of abuse, and psychosocial health. Interviews were performed between April and June 2020. Associations between social disruptions and psychosocial health were explored using multivariable logistic regression, adjusting for sociodemographics and HIV status.Results:Almost all (97.4%) participants reported COVID-19 prevention behavior; 40.1% participants reported social disruptions, and 34.3% reported health care appointment disruption. Men living with HIV were more likely than HIV-negative men to experience social disruptions (40.6% vs. 32.9%; P < 0.01), whereas HIV-negative women were more likely than women with HIV to experience social disruptions (51.1% vs. 39.8%, P < 0.001). Participants who experienced ≥2 social disruptions had significantly higher odds of depression symptoms [aOR = 1.32; 95% confidence interval (CI): 1.12 to 1.56], anxiety (aOR = 1.63; 95% CI: 1.17 to 2.27), and social support dissatisfaction (aOR = 1.81; 95% CI: 1.26 to 2.60).Conclusions:This study builds on emerging literature demonstrating the psychosocial health impact related to the COVID-19 pandemic by providing context specific to PLHIV. The ongoing pandemic requires structural and social interventions to decrease social disruption and address psychosocial health needs among the most vulnerable populations.

Abstract

Objective: The purpose of this study was to understand the physical and psychological impact of high stress clinical environments and contributory factors of burnout in multidisciplinary healthcare workforce during the initial outbreak of COVID-19. Method: In-person qualitative interviews informed by an adaptation of Karasek's Job Demand-control model were conducted with a convenience sample of healthcare workforce from March to April 2020. Results: Themes emerging from interviews coalesced around three main areas: fear of uncertainty, physical and psychological manifestations of stress, and resilience building. Shifting information, a lack of PPE, and fear of infecting others prompted worry for those working with Covid-infected patients. Participants reported that stress manifested more psychologically than physically. Individualized stress mitigation efforts, social media and organizational transparency were reported by healthcare workers to be effective against rising stressors. Conclusion: COVID-19 has presented healthcare workforce with unprecedented challenges in their work environment. With attention to understanding stressors and supporting clinicians during healthcare emergencies, more research is necessary in order to effectively promote healthcare workforce well-being.