Publications

Abstract

Distal sensory peripheral neuropathy (HIV-DSP) affects upwards of 50% of people living with HIV. Causing often debilitating symptoms of tingling, numbness and burning, HIV-DSP can result in disability, unemployment and low quality of life. Comorbidities further complicate nursing care, heightening risk of polypharmacy and symptom exacerbation. Therefore, a neurological sensory assessment, combined with the patient's self-report of symptoms, can help nurse practitioners visualize, quantify and understand symptoms. Common pharmacological interventions include antiepileptics, antidepressants, analgesics and medical marijuana. The complexity of care for individuals with HIV-DSP merits a comprehensive approach. Implications for practice include interdisciplinary management with neurologists, podiatrists, mental health providers, and nurse-led counseling inclusive of patient safety teaching.

Abstract

Background: Cognitive decline is common after stroke. The influence of early cognitive impairment on midterm functional outcomes among Chinese acute ischemic stroke (AIS) patients has not been fully studied. The aim of the study was to assess the association between early cognitive impairment and midterm functional outcomes among Chinese AIS patients. Methods: A longitudinal survey focusing on Chinese AIS patients was conducted in three stroke centers in Shanghai, China (July to December 2016). A total of 185 eligible patients were interviewed at acute stage and at 1, 3, and 6 months after onset. Patients' functional outcomes were measured by modified Rankin Scale (mRS) and Barthel Index (BI) at each time point. Cognitive function was assessed using Montreal Cognitive Assessment, Changsha version (MoCA-CS), within 7 days after stroke onset. Covariates included patient's demographic characteristics, socioeconomic status, clinical characteristics of stroke, vascular risk factors, receiving rehabilitation after discharge from acute hospital, and recurrence. Generalized linear mixed models and general linear mixed models were applied. Results: The prevalence of cognitive impairment at acute stage of stroke among these patients was 88.1%. The risk of disability (mRS 2–5) of all patients after stroke decreased over time (OR = 0.491, 95% CI = 0.401–0.603). The risk of disability among those with cognitive impairment increased compared with those with normal cognition (OR = 7.384, 95% CI = 1.041–52.407). The BI score of all patients increased over time after controlling for covariates (β = 1.51, p < 0.01). The BI score of those with cognitive impairment was lower than that with normal cognition over the follow-up period after controlling for other covariates (β = −8.11, p < 0.05). Conclusions: This study showed that early cognitive impairment was associated with higher risk of disability and poor activity of daily living (ADL) among Chinese AIS patients. Further studies are needed to examine the linkage between multi-domain cognitive impairment and long-term disability and ADL among stroke survivors by using neuropsychological test batteries.

Abstract

BACKGROUND: Global immune activation and HLA alleles are each associated with the pathogenesis of human immunodeficiency virus (HIV) and hepatitis C virus .METHODS: We evaluated the relationship between 44 HLA class I and 28 class II alleles and percentages of activated CD8 (CD8+CD38+DR+) and CD4 (CD4+CD38+DR+) T cells in 586 women who were naive to highly active antiretroviral therapy. We used linear generalized estimating equation regression models, adjusting for race/ethnicity, age, HIV load, and hepatitis C virus infection and controlling for multiplicity using a false discovery rate threshold of 0.10.RESULTS: Ten HLA alleles were associated with CD8 and/or CD4 T-cell activation. Lower percentages of activated CD8 and/or CD4 T cells were associated with protective alleles B*57:03 (CD8 T cells, -6.6% [P = .002]; CD4 T cells, -2.7% [P = .007]), C*18:01 (CD8 T cells, -6.6%; P < .0008) and DRB1*13:01 (CD4 T cells, -2.7%; P < .0004), and higher percentages were found with B*18:01 (CD8 T cells, 6.2%; P < .0003), a detrimental allele. Other alleles/allele groups associated with activation included C*12:03, group DQA1*01:00, DQB1*03:01, DQB1*03:02, DQB1*06:02, and DQB1*06:03.CONCLUSION: These findings suggest that a person's HLA type may play a role in modulating T-cell activation independent of viral load and sheds light on the relationship between HLA, T-cell activation, immune control, and HIV pathogenesis.

Abstract

Objective: To explore attitudes toward immigrants and refugees living in Ecuador. Design and Measures: A transnationalism framework informed this qualitative study, which utilized a semi-structured interview guide to elicit responses from participants about their attitudes toward immigrants and refugees. Interviews were conducted in Spanish, audio-taped, transcribed, coded, and analyzed in Spanish to identify emergent themes. Demographic data were analyzed using SPSS. Sample: Participants (n = 50) were recruited from five sectors that interact with refugees: health care, the press, the police, nongovernmental organizations, and education. Fifty interviews were conducted with adults in Quito, Ecuador, in 2017. Results: Participants reported concerns about the health and well-being of immigrants and refugees, expressed a willingness to assist them, but within limits, noted discrimination and bias against refugees, and cited social policies and human rights as factors that influenced their attitudes. Conclusions: Our findings indicate that immigrants and refugees face challenges which impact their health and well-being, according to participants in the study. Social policies can influence attitudes, but are also affected by rapidly shifting immigration patterns. Migration flows in South America is an under-studied area of research, with opportunity for further public health nursing inquiry.

Abstract

Background: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses' attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe. Methods: A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania. Results: Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient's spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient's relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement. Conclusions: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

Abstract

Objective: HealthyHearts NYC was a stepped wedge randomized control trial that tested the effectiveness of practice facilitation on the adoption of cardiovascular disease guidelines in small primary care practices. The objective of this study was to identify was to identify attributes of small practices that signaled they would perform well in a practice facilitation intervention implementation. Methods: A mixed methods multiple-case study design was used. Six small practices were selected representing 3 variations in meeting the practice-level benchmark of >70% of hypertensive patients having controlled blood pressure. Inductive and deductive approaches were used to identify themes and assign case ratings. Cross-case rating comparison was used to identify attributes of high performing practices. Results: Our first key finding is that the high-performing and improved practices in our study looked and acted similarly during the intervention implementation. The second key finding is that 3 attributes emerged in our analysis of determinants of high performance in small practices: (1) advanced use of the EHR; (2) dedicated resources and commitment to quality improvement; and (3) actively engaged lead clinician and office manager. Conclusions: These attributes may be important determinants of high performance, indicating not only a small practice’s capability to engage in an intervention but possibly also its readiness to change. We recommend developing tools to assess readiness to change, specifically for small primary care practices, which may help external agents, like practice facilitators, better translate intervention implementations to context.

Abstract

Introduction: Cervical cancer is the second leading cause of cancer death among women in the Dominican Republic, and high rates persist despite existing Pap smear screening programs. The purpose of this study was to explore Dominican women’s knowledge and attitudes regarding human papillomavirus (HPV) and cervical cancer, cervical cancer screening practices, and perceived barriers and facilitators to early detection of cervical cancer. Method: Six focus groups (N = 64) were conducted in Spanish in urban, suburban, and rural locations, in private and public school settings, community and workplace settings, in or near Santo Domingo, as part of a larger study on barriers and facilitators to HPV vaccine implementation. Audio recordings were transcribed verbatim and translated from Spanish to English. Qualitative data analysis used inductive and deductive approaches. Results: Knowledge regarding HPV and cervical cancer varied across groups, but all agreed there was significant stigma and fear regarding HPV. Most women reported having Pap screening at least yearly. Follow-up of abnormal Pap testing was less consistent, with cost and uncertainty about provider recommendations identified as barriers. Discussion: Broader examination of provider-level and health system barriers and facilitators to cervical cancer prevention in the Dominican Republic is essential, in order to inform interventions to improve the effectiveness of cervical cancer screening and treatment programs and reduce preventable deaths.

Abstract

Background:: evidence suggests a reciprocal relationship between cognitive function (CF) and oral health (OH), but no study has demonstrated this inter-relationship in a longitudinal population. Objective:: to investigate the bidirectional relationship between CF and OH in an ageing cohort. Design:: cohort study. Setting:: general community. Subjects:: participants from the English Longitudinal Study of Ageing. Methods:: OH, measured by teeth status, self-reported OH and OH-related quality of life (OHRQoL), and CFs were collected at three time points in 2006/07, 2010/11 and 2014/15. Cross-lagged structural equation models were used to investigate the association between CF and OH, adjusted for potential confounding factors. Results:: 5477 individuals (56.4% women) were included (mean age = 63.1 years at 2006/07, 67.2 at 2010/11 and 70.4 at 2014/15, SD = 8.9) in analyses. The average CF score was 46.5(SD = 12.3) at baseline and 41.2 (SD = 13.4) at follow-up. 3350 (61.2%) participants had natural teeth only and 622 (11.2%) were edentulous. In the fully adjusted model, better cognition at baseline was associated with better OH at follow-up (beta coefficient = 0.02, 95% CI: 0.01–0.03); conversely better OH at baseline predicted better cognition (beta coefficient = 0.12, 95% CI: 0.06–0.18). Similar magnitude and direction of the reciprocal association was evident between cognition and OHRQoL. Conclusions:: This is the first longitudinal study to demonstrate the positive reciprocal association between CF and OH. The findings suggest the importance of maintaining both good CF and OH in old age.

Abstract

Sixteen million caregivers currently provide care to more than 5 million persons living with dementia (PLWD) in the United States. Although this population is growing and highly complex, evidence-based management remains poorly integrated within healthcare systems. Therefore, the National Institute on Aging IMPACT Collaboratory was formed to build the nation's ability to conduct embedded pragmatic clinical trials (ePCTs) for PLWD and their caregivers. The pilot core of the IMPACT Collaboratory seeks to provide funds for upward of 40 pilots for ePCTs to accelerate the testing of nonpharmacologic interventions with the goal that these pilots lead to full-scale ePCTs and eventually the embedding of evidence-based care into healthcare systems. The first two challenges for the pilot core in building the pilot study program were (1) to develop a transparent, ethical, and open nationwide process for soliciting, reviewing, and selecting pilot studies; and (2) to begin the process of describing the necessary components of a pilot study for an ePCT. During our initial funding cycle, we received 35 letters of intent, of which 17 were accepted for a full proposal and 14 were submitted. From this process we learned that investigators lack knowledge in ePCTs, many interventions lack readiness for an ePCT pilot study, and many proposed studies lack key pragmatic design elements. We therefore have set three key criteria that future pilot studies must meet at a minimum to be considered viable. We additionally discuss key design decisions investigators should consider in designing a pilot study for an ePCT. J Am Geriatr Soc 68:S14–S20, 2020.

Abstract

Abstract corporal punishment (CP) is associated with negative short-term and long-term children outcomes. However, many caregivers continue to administer spankings and other forms of CP. Pediatric nurse practitioners are in a unique position to affect change in parental behavior related to CP use and other parenting practices. This article will summarize the research on the dangers of CP and the corresponding benefits of positive parenting. It defines positive parenting and offers resources pediatric health care providers, including pediatric nurse practitioners, can use to educate both themselves and caregivers about specific discipline techniques appropriate to each developmental stage. Finally, it suggests practice strategies pediatric nurse practitioners can use to help caregivers replace CP and other harsh parenting practices with positive parenting to build a safe and healthy America.

Abstract

BACKGROUND: The overlapping human immunodeficiency virus (HIV) and hepatitis C virus (HCV) epidemics disproportionately affect people with substance use disorders. However, many people who use substances remain unaware of their infection(s).OBJECTIVE: The objective of this study was to examine the efficacy of an on-site bundled rapid HIV and HCV testing strategy in increasing receipt of both HIV and HCV test results.RESEARCH DESIGN: Two-armed randomized controlled trial in substance use disorder treatment programs (SUDTP) in New York City. Participants in the treatment arm were offered bundled rapid HIV and HCV tests with immediate results on-site. Participants in the control arm were offered the standard of care, that is, referrals to on-site or off-site laboratory-based HIV and HCV testing with delayed results.PARTICIPANTS: A total of 162 clients with unknown or negative HIV and HCV status.MEASURES: The primary outcome was the percentage of participants with self-reported receipt of HIV and HCV test results at 1-month postrandomization.RESULTS: Over half of participants were Hispanic (51.2%), with 25.3% being non-Hispanic black and 17.9% non-Hispanic white. Two thirds were male, and 54.9% reported injection as method of drug use. One hundred thirty-four participants (82.7%) completed the 1-month assessment. Participants in the treatment arm were more likely to report having received both test results than those in the control arm (69% vs. 19%, P<0.001). Seven participants in the treatment arm received a preliminary new HCV diagnosis, versus 1 in the control arm (P=0.029).CONCLUSION: Offering bundled rapid HIV and HCV testing with immediate results on-site in SUDTPs may increase awareness of HIV and HCV infection among people with substance use disorders.

Abstract

Background Cardiovascular disease (CVD) and intimate partner violence (IPV) are 2 major chronic problems that prevalently affect women's health and quality of life in the United States. However, whether female IPV survivors are at risk for developing adverse cardiovascular outcomes has not been clearly understood. Objective This integrative review was conducted to bridge the literature gap by examining cardiovascular health in female adults with a history of IPV experience. Methods Three electronic databases including PubMed, CINAHL, and Web of Science were used to search for studies published between 1998 and 2019. The search process followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Results Of the 229 records retrieved from the literature, 19 met the criteria for review. All included studies were quantitative research. Although the overall findings showed a mixed relationship between IPV and CVD, women who experienced abuse were more likely to engage in unhealthy behaviors, have higher levels of CVD biomarkers, experience cardiovascular symptoms, and exhibit long-term cardiovascular complications when compared with nonabused women. Conclusions Intimate partner violence is a stressor that directly and indirectly influences women's cardiovascular health. Therefore, it is essential for healthcare providers to routinely screen IPV status in clinical practice. Targeted interventions, such as assessing women's coping strategies and evaluating their cardiovascular health using a total risk factor approach, are recommended to prevent or reduce the deleterious effects of violence on this large, vulnerable group of women.

Abstract

The number of orthopedic surgeries performed in the United States has increased substantially over the past several years. The most recent data available from the Agency for Healthcare Research and Quality indicate that five of the 10 operative procedures most commonly performed during inpatient stays involve the musculoskeletal system. Cigarette smoking is one of the most prevalent and preventable risk factors for musculoskeletal disorders and orthopedic surgery complications. This article discusses the effects of smoking on bone health, the importance of smoking cessation among patients scheduled for or recovering from orthopedic surgery, and the vital role nurses play in supporting patient efforts to lead a tobacco-free life.

Abstract

Background: Mobile health (mHealth) and Web-based research methods are becoming more commonplace for researchers. However, there is a lack of mHealth and Web-based human papillomavirus (HPV) prevention experimental studies that discuss potential issues that may arise. Objective: This study aimed to assess the feasibility of research procedures and discuss the challenges and lessons learned from an mHealth and Web-based HPV prevention experimental study targeting female Korean American college students in the United States. Methods: A pilot randomized controlled trial (RCT) was conducted in an mHealth and Web-based platform with 104 female Korean American college students aged 18-26 years between September 2016 and December 2016. Participants were randomized to either the experimental group (a storytelling video intervention) or the comparison group (a nonnarrative, information-based intervention). Outcomes included the feasibility of research procedures (recruitment, eligibility, randomization, and retention). Results: From September 2016 to October 2016, we recorded 225 entries in our initial eligibility survey. The eligibility rate was 54.2% (122/225). This study demonstrated a high recruitment rate (95.6%, 111/122) and retention rate (83.7%, 87/104) at the 2-month follow-up. Conclusions: Findings from this study demonstrated sufficient feasibility in terms of research procedures to justify a full-scale RCT. Given the increased possibility of invalid or misrepresentative entries in mHealth and Web-based studies, strategies for detection and prevention are critical.

Abstract

OBJECTIVES: To examine racial/ethnic differences in type of SSB most frequently consumed and in correlates of youth sugar-sweetened beverage (SSB) intake.METHODS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES), 2011-2016, for children and adolescents aged 5-17 years (n = 6507). The main outcome was SSB consumption (i.e., sodas, sweetened fruit drinks, nectars, sports and energy drinks, sweetened coffees and teas, enhanced waters). Mean and proportions of SSB intake were estimated accounting for complex sampling strategy and weighting. Multivariable regression models were developed for each race/ethnicity and age group.RESULTS: Two-thirds of children and adolescents reported consuming SSB on a given day. Among consumers, mean SSB consumption was greatest for Black children and White adolescents and lowest for Asian American children and adolescents. The most popular type of SSB consumed was sweetened fruit drinks among children and soda among adolescents, except among White and Mexican American children for whom soda and Black adolescents for whom sweetened fruit drinks were most popular. Female sex and water intake were negatively associated with SSB consumption across most races/ethnicities. Screen time, dentist visits, nativity, and guardian education were associated with SSB intake among a subset of races/ethnicities.CONCLUSIONS: Associations between covariates and SSB intake as well as types of beverages preferred vary by race/ethnicity, as such chronic disease policies should not be 'one size fits all'. Targeted interventions for specific groups of vulnerable youths hold promise for further reducing SSB consumption, including directing efforts towards reducing sweetened fruit drinks for Black children.

Abstract

Phenomenon: Ageism is a significant social issue, especially in China. Ageism adversely affects willingness to consider a career in geriatric medicine. However, few studies have examined this topic among Chinese medical students. This study aimed to investigate attitudes toward older people among medical students in China, examine the factors related to these attitudes, and determine the relationships between attitudes and willingness to consider geriatric medicine as a career after graduation. Approach: Responses from 1,022 Chinese medical students were included in the analyses. Students provided demographic information and completed the Fraboni Scale of Ageism (FSA). The data were analyzed using the Statistical Package for Social Sciences, version 24.0 (IBM SPSS Corp). Findings: The mean score of the FSA was 64.42 ± 6.58. Multiple regression analysis showed that the significant predictors of ageism were being male, longer years of training in medical school, and no caregiving experiences with older adults during clinical practice (R 2 =.038, F = 13.520, p <.001). Students who had higher FSA scores were more unwilling to consider a career in geriatric medicine after graduation (t = 4.281, p <.001, Cohen’s d =.268). Insights: Chinese medical students have fewer positive attitudes toward older adults than what has been reported in other countries. Future studies should examine the determinants of ageism among medical students in various cultures to guide the development, implementation, and assessment of interventions designed to nurture a more positive attitude toward older adults and increase willingness to consider a career in geriatric medicine.

Abstract

The COVID-19 pandemic has disrupted clinical nursing and midwifery education. This disruption has long-term implications for the nursing and midwifery workforce and for future healthcare responses to pandemics. Solutions may include enhanced partnerships between schools of nursing and midwifery and health service providers and including schools of nursing and midwifery in preparedness planning. These suggestions notwithstanding, we call upon national and international nursing and midwifery bodies to study how to further the clinical education of nurses and midwives during pandemics and other times of crisis.

Abstract

Background: Chinese persons living with HIV (PLWH) suffer from prevalent mental health issues. We aimed to develop a tailored cognitive behavioral therapy (CBT), test its feasibility, acceptability, and preliminary effects (depression, anxiety, and medication adherence) for Chinese PLWH. Methods: Twenty PLWH were assigned randomly. Intervention participants learned skills in CBT and relaxation training in a tailored group-based weekly 10-session project. Each session lasted for two hours and was delivered by nurses and volunteers. Control participants only received laboratory tests and free antiretroviral therapy (ART) medication. Feasibility and acceptability were descriptively summarized. Depression, anxiety, and ART medication adherence data were collected at the baseline (T0), after the intervention (T1) and after 6 months of follow-up (T2). Results: The average CBT attendance rate for all sessions was 60%. No participants in the intervention group dropped out of the study. All participants in the intervention group agreed that they could benefit from the CBT. Participants in the intervention group showed a greater improvement in anxiety and self-reported ART medication adherence than those in the control group at T1. However, no preliminary intervention effect was found at T2. Limitations: The small sample size leads to a lack of representativeness in the study sample. We excluded participants with severe comorbidities, which may lead to an underestimate of the intervention effect of CBT among Chinese PLWH. Conclusions: CBT is feasible and acceptable, demonstrating promising preliminary effects on anxiety and ART medication adherence among Chinese PLWH. Additional research is needed to test the effectiveness of this approach.

Abstract

Background: Preterm infants suffer from respiratory morbidity especially during the first year of life. Objective: To investigate the association of air quality and sociodemographic indicators on hospital admission rates for respiratory causes. Methods: This is a retrospective cohort study. We identified all live-born preterm infants in California from 2007 to 2012 in a population-based administrative data set and linked them to a data set measuring several air quality and sociodemographic indicators at the census tract level. All sociodemographic and air quality predictors were divided into quartiles (first quartile most favourable to the fourth quartile least favourable). Mixed effect logistic models to account for clustering at the census tract level were used to investigate associations between chronic air quality and sociodemographic indicators respiratory hospital admission during the first year of life. Results: Of 205 178 preterm infants, 5.9% (n = 12 033) were admitted to the hospital for respiratory causes during the first year. In the univariate analysis, comparing the first to the fourth quartile of chronic ozone (risk ratio [RR] 1.29, 95% confidence interval [CI] 1.21, 1.37), diesel (RR 1.10, 95% CI 1.02, 1.17) and particulate matter 2.5 (RR 1.07, 95% CI 1.01, 1.14) exposure were associated with hospital admission during the first year. Following adjustment for confounders, the risk ratios for hospital admission during the first year were 1.53 (95% CI 1.37, 1.72) in relation to educational attainment (per cent of the population over age 25 with less than a high school education) and 1.23 (95% CI 1.09, 1.38) for poverty (per cent of the population living below two times the federal poverty level). Conclusions: Among preterm infants, respiratory hospital admissions in the first year in California are associated with socioeconomic characteristics of the neighbourhood an individual is living in.

Abstract

Background: Epigenome-wide association studies (EWAS) have been widely applied to identify methylation CpG sites associated with human disease. To date, the Infinium MethylationEPIC array (EPIC) is commonly used for high-throughput DNA methylation profiling. However, the EPIC array covers only 30% of the human methylome. Methylation Capture bisulfite sequencing (MC-seq) captures target regions of methylome and has advantages of extensive coverage in the methylome at an affordable price. Methods: Epigenome-wide DNA methylation in four peripheral blood mononuclear cell samples was profiled by using SureSelectXT Methyl-Seq for MC-seq and EPIC platforms separately. CpG site-based reproducibility of MC-seq was assessed with DNA sample inputs ranging in quantity of high (> 1000 ng), medium (300–1000 ng), and low (150 ng–300 ng). To compare the performance of MC-seq and the EPIC arrays, we conducted a Pearson correlation and methylation value difference at each CpG site that was detected by both MC-seq and EPIC. We compared the percentage and counts in each CpG island and gene annotation between MC-seq and the EPIC array. Results: After quality control, an average of 3,708,550 CpG sites per sample were detected by MC-seq with DNA quantity > 1000 ng. Reproducibility of DNA methylation in MC-seq-detected CpG sites was high among samples with high, medium, and low DNA inputs (r > 0.96). The EPIC array captured an average of 846,464 CpG sites per sample. Compared with the EPIC array, MC-seq detected more CpGs in coding regions and CpG islands. Among the 472,540 CpG sites captured by both platforms, methylation of a majority of CpG sites was highly correlated in the same sample (r: 0.98–0.99). However, methylation for a small proportion of CpGs (N = 235) differed significantly between the two platforms, with differences in beta values of greater than 0.5. Conclusions: Our results show that MC-seq is an efficient and reliable platform for methylome profiling with a broader coverage of the methylome than the array-based platform. Although methylation measurements in majority of CpGs are highly correlated, a number of CpG sites show large discrepancy between the two platforms, which warrants further investigation and needs cautious interpretation.