Publications

Abstract

Background: The use of mobile health (mHealth), including smartphone apps, can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, the mHealth platform has the potential to open new frontiers for HIV prevention efforts. However, little guidance is available to inform researchers about privacy and confidentiality concerns unique to the development and implementation of app-based HIV prevention programs. Objective: Given the lack of empirical data in this area, we aim to understand the privacy and confidentiality concerns associated with participation in a hypothetical app-based research study for HIV prevention efforts. Methods: A cross-sectional, web-based survey was conducted between June and July 2020 among 355 Malaysian MSM. The survey included demographic and sexual health questions and a series of short videos describing a hypothetical app-based HIV prevention program, followed by questions related to privacy and confidentiality concerns in each step of the app-based program (ie, recruitment, clinical interaction, risk assessment, and weekly reminder). Multivariable logistic regression models were used to identify the correlates of willingness to use such an app-based program. Results: Most of the participants (266/355, 74.9%) indicated their willingness to participate in a hypothetical mHealth app–based HIV prevention program. Participants expressed concerns about privacy, confidentiality, data security, and risks and benefits of participating in all stages of the app-based HIV research process. Multivariate analyses indicated that participants who had a higher degree of perceived participation benefits (adjusted odds ratio [aOR] 1.873; 95% CI 1.274-2.755; P=.001) were more willing to participate. In contrast, participants who had increased concerns about app-based clinical interaction and e-prescription (aOR 0.610; 95% CI 0.445-0.838; P=.002) and those who had a higher degree of perceived risks of participating (aOR 0.731; 95% CI 0.594-0.899; P=.003) were less willing to participate. Conclusions: Overall, our results indicate that mHealth app–based HIV prevention programs are acceptable for future research on Malaysian MSM. The findings further highlighted the role of privacy and confidentiality, as well as the associated risks and benefits associated with participation in such a program. Given the ever-evolving nature of such technological platforms and the complex ethical–legal landscape, such platforms must be safe and secure to ensure widespread public trust and uptake.

Abstract

The relationship between physicians and patients is unlike any other personal or working relationship in modern society. The patients must put their utmost trust in the abilities and intentions of their physicians, and in return, physicians must put the needs of patients above their own (described as a physician’s fiduciary duty). Often, the physician-–patient relationship crosses over boundaries that are present in other aspects of our lives. These so-called professional boundaries must be observed to avoid potential ethical or legal problems. Physicians ought to abide by the most conservative guidelines for professional boundaries established by their institution, state, and medical organization. Increased use of digital technology in medicine is blurring the lines of these boundaries. Physicians’ use of social media, email, and telemedicine all offer potential benefits as well drawbacks that should be considered before social media is incorporated into their practice.

Abstract

Background: Almost half of Veterans with localized prostate cancer receive inappropriate, wasteful staging imaging. Our team has explored the barriers and facilitators of guideline-concordant prostate cancer imaging and found that (1) patients with newly diagnosed prostate cancer have little concern for radiographic staging but rather focus on treatment and (2) physicians trust imaging guidelines but are apt to follow their own intuition, fear medico-legal consequences, and succumb to influence from imaging-avid colleagues. We used a theory-based approach to design a multi-level intervention strategy to promote guideline-concordant imaging to stage incident prostate cancer. Methods: We designed the Prostate Cancer Imaging Stewardship (PCIS) intervention: a multi-site, stepped wedge, cluster-randomized trial to determine the effect of a physician-focused behavioral intervention on Veterans Health Administration (VHA) prostate cancer imaging use. The multi-level intervention, developed according to the Theoretical Domains Framework (TDF) and Behavior Change Wheel, combines traditional physician behavior change methods with novel methods of communication and data collection. The intervention consists of three components: (1) a system of audit and feedback to clinicians informing individual clinicians and their sites about how their behavior compares to their peers’ and to published guidelines, (2) a program of academic detailing with the goal to educate providers about prostate cancer imaging, and (3) a CPRS Clinical Order Check for potentially guideline-discordant imaging orders. The intervention will be introduced to 10 participating geographically distributed study sites. Discussion: This study is a significant contribution to implementation science, providing VHA an opportunity to ensure delivery of high-quality care at the lowest cost using a theory-based approach. The study is ongoing. Preliminary data collection and recruitment have started; analysis has yet to be performed. Trial registration: CliniclTrials.gov NCT03445559.

Abstract

Chronic psychiatric disorders are associated with a significant burden of morbidity and disability and tend to be underdiagnosed in the population. Furthermore, gender appears to be a significant determinant of psychiatric disorders, yet the literature does not make a gendered distinction regarding the prevention and adjuvant treatment of psychiatric disorders. A gendered perspective of psychiatry holds great promise for more effectively preventing and treating psychiatric disorders in women, and it may be useful to view women’s mental health across the lifespan in order to do so. As of now, lifestyle interventions focused on nutrition, exercise, tobacco use cessation, stress management, healthy relationships, and sleep are evidenced-based modalities that are likely to be useful for reducing the prevalence and morbidity of psychiatric disorders.

Abstract

Objectives: This study investigated whether older adults with better relationships with their adult children have better subjective and objective sleep quality than older adults with less-positive relationships with their children. We also examined whether depressive symptoms and loneliness mediated the association between parent-child relationships and sleep among older adults. Methods: Data were used from the second wave of the National Social life, Health, and Aging Project, in which 548 respondents (aged 62-90) participated in the sleep survey to measure their actigraph sleep activity for three consecutive days. Respondents also reported sleep quality (i.e., sleep duration and insomnia symptoms), contact frequency, and emotional closeness with their children. Results: Results from structural equation modeling showed that greater emotional closeness with children was directly associated with better objective sleep characteristics (i.e., sleep fragmentation and amount of sleep). Also, more frequent contact with children was directly related to fewer insomnia symptoms among older adults. Moreover, emotional closeness with children was indirectly linked to insomnia symptoms via depressive symptoms among older adults. Discussion: This study provided evidence for psychological pathways linking parent-child relationships and older parents' subjective sleep. The findings have implications for health professionals and family counselors who help people with sleep problems and relationship difficulties.

Abstract

Purpose: To determine psychometric properties of the Caring Behaviors Inventory-24 (CBI-24) among Korean clinical nurses. Methods: A methodological design was used. Data were collected from 408 clinical nurses. Construct validity analysis was performed, including factorial, convergent, and discriminant validity. Internal consistency was tested by Cronbach's α coefficients, inter-item correlation, and corrected item-total correlation. Results: Exploratory factor analysis produced three factors: 'empathy and supporting', 'knowledge and skills', and 'providing comfort'. In confirmatory factor analysis results, model fit indices were acceptable (x2/df=3.50, RMR=.05, RMSEA=.08, CFI=.90). The values obtained for the AVE ranged from .53 to .68, and for the CR ranged from .53 to .68. Convergent validity coefficients were noticeably greater in magnitude than discriminant validity coefficients: .53 (AVE1 value) and .68 (AVE2 value)≥.45 (r12 2 value) and .68 (AVE2 value) and .63 (AVE3 value)≥.61 (r23 2 value). Internal consistency (Cronbach's α) of CBI-K was .95. Conclusion: The CBI-K was shown to have acceptable construct validity and good internal consistency. Study findings imply that CBI-K could be a useful instrument for clinical administrators and nursing researchers to assess caring behaviors among Korean clinical nurses. Utilization of CBI-K might contribute to the building of empirical knowledge and the understanding of caring behaviors from nurses' perspectives.

Abstract

In this updated Self-care of Hypertension Inventory Version 3.0 (SC-HI v3.0), items were added to better reflect the Theory of Self-care of Chronic Illness and revised based on recent research. The reorganized and expanded SC-HI now reflects the theoretical concepts of self-care maintenance, monitoring, and management. Objective To evaluate the psychometric properties of the SC-HI v3.0, we conducted exploratory factor analyses. Here, we report on its reliability and construct validity. Methods A sample of 200 adults with chronic hypertension completed a sociodemographic survey and the SC-HI v3.0. Exploratory factor analyses were conducted on item sets using principal factor method for analyzing the correlation matrix. Reliability was calculated using common factor coefficient of determinacy for multidimensional scales, for which values greater than 0.80 are considered adequate. Results The sample was 83.4% non-Hispanic White; 56% were women, with a mean age of 62.2 ± 12.5 years. The self-care maintenance scale (mean, 75.9 ± 13.6) had adequate reliability (ρ = 0.81, 0.80) for a 2-dimensional model of self-care maintenance identified as autonomous and consultative behaviors. The new self-care monitoring scale (mean score, 58.5 ± 21.99) had a single-factor solution with very good reliability (ρ = 0.94). The self-care management scale (mean score, 64.5 ± 19.5) had a single-factor solution, with moderate to strong factor loadings (0.22-0.68) and acceptable reliability (ρ = 0.84). Conclusions Initial testing suggests that the SC-HI v3.0 is a sound measure of the essential elements of self-care for adults with chronic hypertension. With the new self-care monitoring scale, the SC-HI v3.0 is a valid reflection of the theory on which it is based.

Abstract

Frontline workers are at great risk of significant mental health challenges as a result of responding to large-scale disasters. We conducted a mixed-methods study to identify the challenges experienced and the resources nurses drew upon during this first phase of the COVID-19 pandemic in the spring of 2020 in New York City (NYC). The qualitative data presented here are on 591 nurse participants in the qualitative arm of the study. Responses to qualitative questions were reviewed by one of the investigators to identify emerging themes. Two qualitative researchers used both deductive (guided by the Resilience Theory) and inductive approaches to analysis. Challenges identi fied by nurses included concerns about well-being and health risk; mental health symptoms such as depres sion, anxiety, and difficulty sleeping; fears about the ability to care for patients with severe life-threatening symptoms; and home-work challenges such as risk to family and friends; and lack of availability of institutional resources, particularly, personal protec tive equipment (PPE). Facilitators of resilience were institutional resources and support available; social support from coworkers, friends, and family; and positive professional identity. Recommendations for promoting resilience in future disaster/pandemic responses included clarification of disaster-related professional responsibilities, integration of disaster preparedness into professional education, and engage ment of nurses/frontline workers in preparation plan ning for disasters.

Abstract

Objectives: To investigate racial/ethnic differences in rehospitalization and mortality rates among premature infants over the first year of life. Study design: A retrospective cohort study of infants born in California from 2011 to 2017 (n = 3,448,707) abstracted from a California Office of Statewide Health Planning and Development database. Unadjusted Kaplan–Meier tables and logistic regression controlling for health and sociodemographic characteristics were used to predict outcomes by race/ethnicity. Results: Compared to White infants, Hispanic and Black early preterm infants were more likely to be readmitted; Black late/moderate preterm (LMPT) infants were more likely to be readmitted and to die after discharge; Hispanic and Black early preterm infants with BPD were more likely to be readmitted; Black LMPT infants with RDS were more likely to be readmitted and die after discharge. Conclusions: Racial/ethnic disparities in readmission and mortality rates exist for premature infants across several co-morbidities. Future studies are needed to improve equitability of outcomes.

Abstract

Objective  The aim of this study was to assess whether racial disparities in rates of and indications for cesarean delivery (CD) between non-Hispanic Black and non-Hispanic White birthing people in California changed from 2011 to 2017. Methods  This was a retrospective cohort study using a database of birth certificates linked to discharge records. Singleton term live births in nulliparous Black and White birthing people in California between 2011 and 2017 were included. Those with noncephalic presentation, placenta previa, and placenta accreta were excluded. CD rate and indication were obtained from birth certificate variables and International Classification of Diseases codes. Differences in CD rate and indication were calculated for Black versus White individuals using univariable and multivariable logistic regression and adjusted for potential confounders. Results  A total of 348,144 birthing people were included, 46,361 Black and 301,783 White. Overall, 30.9% of Black birthing people underwent CD compared with 25.3% of White (adjusted relative risk [aRR]: 1.2, 95% confidence interval [CI]: 1.2-1.3). From 2011 to 2017, the CD rate fell 11% (26.4-23.7%, p < 0.0001) for White birthing people and 1% for Black birthing people (30.4-30.1%, p = 0.037). Over the study period, Black birthing people had a persistent 1.2- to 1.3-fold higher risk of CD and were persistently more likely to undergo CD for fetal intolerance (aRR: 1.1, 95% CI: 1.1-1.2) and less likely for active phase arrest or arrest of descent (aRRs: 0.9 and 0.4; 95% CIs: 0.9-0.9 and 0.3-0.5). Conclusion  The CD rate decreased substantially for White birthing people and minimally for Black birthing people in our cohort over the study period. Meanwhile, disparities in CD rate and indications between the two groups persisted, despite controlling for confounders. Although care bundles for reducing CD may be effective among White birthing people, they are not associated with reduction in CD rates among Black birthing people nor improvements in racial disparities between Black and White birthing people. Precis  Despite increasing attention to racial inequities in obstetric outcomes, there were no changes in disparities in CD rates or indications in California from 2011 to 2017. Key Points Black birthing people are more likely to undergo CD than White despite controlling for confounders. There are unexplained differences in CD indication among Black and White birthing people. These disparities persisted from 2011 to 2017 despite increasing efforts to decrease CD rates in CA.

Abstract

Background: Black men are disproportionately affected by prostate cancer, the most common non-cutaneous malignancy among men in the USA. The United States Preventive Services Task Force (USPSTF) encourages prostate-specific antigen (PSA) testing decisions to be based on shared decision-making (SDM) clinician professional judgment, and patient preferences. However, evidence suggests that SDM is underutilized in clinical practice, especially among the most vulnerable patients. The purpose of this study is to evaluate the efficacy of a community health worker (CHW)-led decision-coaching program to facilitate SDM for prostate cancer screening among Black men in the primary care setting, with the ultimate aim of improving/optimizing decision quality. Methods: We proposed a CHW-led decision-coaching program to facilitate SDM for prostate cancer screening discussions in Black men at a primary care FQHC. This study enrolled Black men who were patients at the participating clinical site and up to 15 providers who cared for them. We estimated to recruit 228 participants, ages 40–69 to be randomized to either (1) a decision aid along with decision coaching on PSA screening from a CHW or (2) receiving a decision aid along with CHW-led interaction on modifying dietary and lifestyle to serve as an attention control. The independent randomization process was implemented within each provider and we controlled for age by dividing patients into two strata: 40–54 years and 55–69 years. This sample size sufficiently powered the detection differences in the primary study outcomes: knowledge, indicative of decision quality, and differences in PSA screening rates. Primary outcome measures for patients will be decision quality and decision regarding whether to undergo PSA screening. Primary outcome measures for providers will be acceptability and feasibility of the intervention. We will examine how decision coaching about prostate cancer screening impact patient-provider communication. These outcomes will be analyzed quantitatively through objective, validated scales and qualitatively through semi-structured, in-depth interviews, and thematic analysis of clinical encounters. Through a conceptual model combining elements of the Preventative Health Care Model (PHM) and Informed Decision-Making Model, we hypothesize that the prostate cancer screening decision coaching intervention will result in a preference-congruent decision and decisional satisfaction. We also hypothesize that this intervention will improve physician satisfaction with counseling patients about prostate cancer screening. Discussion: Decision coaching is an evidence-based approach to improve decision quality in many clinical contexts, but its efficacy is incompletely explored for PSA screening among Black men in primary care. Our proposal to evaluate a CHW-led decision-coaching program for PSA screening has high potential for scalability and public health impact. Our results will determine the efficacy, cost-effectiveness, and sustainability of a CHW intervention in a community clinic setting in order to inform subsequent widespread dissemination, a critical research area highlighted by USPSTF. Trial registration: The trial was registered prospectively with the National Institute of Health registry (www.clinicaltrials.gov), registration number NCT03726320, on October 31, 2018.

Abstract

Health care education programs were faced with the need to quickly adapt to a new reality during the coronavirus disease 2019 pandemic. Students were temporarily suspended from campus and clinical sites, requiring prompt changes in structure to their didactic and clinical learning. This article describes the rapid adjustments that one midwifery and women's health nurse practitioner education program created using both synchronous and asynchronous simulation experiences to promote student learning and ongoing engagement. Flexibility and reflexivity were needed by faculty and students alike in the face of the multiple changes wrought by the pandemic. Curricular changes were made simultaneously in many courses. Objective structured clinical examinations simulate telehealth experiences that assess knowledge, clinical reasoning, and professional behaviors via a scripted scenario and an actor patient. On-call simulations mimic telephone triage and provide students the opportunity to build listening, assessment, and management skills for prenatal and intrapartum scenarios. Students are provided equipment and virtual instruction in an intrauterine device insertion session, which promotes skill acquisition and self-confidence. Trigger films are used to visualize real-life or scripted clinical encounters, leading to discussion and decision-making, particularly in the affective domain. Bilateral learning tools, similar to case studies, provide students an opportunity to demonstrate their knowledge and critical thinking with a mechanism for faculty feedback. Web-based virtual clinical encounter learning tools using patient avatars prompt additional student learning. Suturing skills introduced in live remote group sessions are augmented with video-guided individual practice. This article describes each of these adapted and innovative simulation methods and shares lessons learned during their development and implementation.

Abstract

Background: Lymphedema is a progressive and chronic illness. Early detection and treatment often lead to better clinical outcomes and improvement of patients' quality of life. Lymphedema symptoms can assist in detecting lymphedema. However, the use of patient-reported symptom evaluation is still limited in clinical practice. To address this gap in clinical practice, a metropolitan cancer center implemented an electronic patient evaluation of lymphedema symptoms (EPE-LE) to enable patients' real-time symptom report during patients' routine clinical visit while waiting to see their doctors in a waiting room. The purpose of this clinical project was to evaluate the usefulness of EPE-LE during patients' routine clinical visit. Methods: A cross-sectional design was used. Participants were outpatient post-surgical breast cancer patients and clinicians who were involved in the EPE-LE implementation at a metropolitan cancer center of US. Data were collected during the three-month EPE-LE implementation, including patients' report of lymphedema symptoms, patient and clinician satisfaction, and referral to lymphedema specialists. Descriptive statistics were used for data analysis. Results: During the three-month implementation, a total of 334 patients utilized the EPE-LE to report their lymphedema symptoms and 24 referrals to lymphedema specialists. Nearly all of the patients found that the EPE-LE was easy to use (91%) and that they were satisfied with the EPE-LE for reporting lymphedema symptoms (89%). The majority (70%) of patients reported that the EPE-LE helped them to learn about symptoms related to lymphedema and encouraged them to monitor their symptoms. All clinicians (100%) agreed that the use of the EPE-LE improved their lymphedema symptom assessment in post-surgical breast cancer patients; 75% reported that the EPE-LE increased their communication with patients related to lymphedema symptoms, 75% agreed they would recommend the EPE-LE for use at other cancer centers, and 75% reported that the information retrieved from the EPE-LE was helpful in evaluation of lymphedema. Conclusions: The use of EPE-LE enhanced patients' real-time report of lymphedema symptoms, improved patient education on lymphedema symptoms, and helped clinicians for evaluation of lymphedema. The use of EPE-LE is an example how to implement evidence-based research into clinical practice that provides benefits for both patients and clinicians.

Abstract

Background: Interprofessional education (IPE) is a curricular requirement for all healthcare professional education standards. To foster learning about, from and with each other, consistent with the Interprofessional Education Consortium’s Core Competencies, many graduate schools are integrating interprofessional (IP) simulation experiences throughout their educational curricula, providing multiple opportunities for health professional students to collaborate and practice together. High-fidelity, real-time simulations help students from diverse professional backgrounds to apply their classroom learning in realistic clinical situations, utilize mobile technology to access clinical decision support (CDS) software, and receive feedback in a safe setting, ensuring they are practice-ready upon graduation. Methods: New York University Rory Meyers College of Nursing (NYU) and Long Island University College of Pharmacy (LIU) partnered for two consecutive years to create, coordinate and implement two interprofessional educational simulations involving patients with chronic cardiovascular disease. A utilization-focused evaluation of high-fidelity, simulation-enhanced IPE (Sim-IPE) was implemented to assess students’ IP competencies before and after their participation in the IPE-simulation and their overall satisfaction with the experience. The Interprofessional Collaborative Competency Attainment Survey (ICCAS), a reliable instrument, was administered to both doctor of pharmacy students and primary care advanced practice nursing students before and after each simulation experience. Additionally, student satisfaction surveys were administered following the IPE-simulation. Results: Aggregated means revealed statistically significant improvements in each of the six domains including communication, collaboration, roles and responsibilities, collaborative patient/family approach, conflict resolution and team functioning. Student ratings revealed positive experiences with the IPE-simulations. Conclusions: High-fidelity, real-time IPE-simulation is a powerful pedagogy to help graduate students from different professional backgrounds practice applying IP competencies in simulated experiences. Quality improvement studies and research studies are needed to assess the impact of high-fidelity, real-time simulations throughout graduate curricula with different types of patients to improve coordinated, team approaches to treatment.

Abstract

Effective recruitment of research participants is essential for successful randomized controlled trials and remains one of the most challenging and labor-intensive aspects of conducting research. The purpose of this manuscript is to describe recruitment methods for this two-group, internet-based intervention trial and enrollment status in relation to recruitment methods, accounting for accrual rates and recruitment costs and to discuss our recruitment results and limitations informed by the Clinical Trials Transformation Initiative (CTTI) team's evidence and expert-based recommendations for recruitment. The primary study was a two-group randomized controlled trial designed to evaluate the efficacy of a virtual environment, Diabetes LIVE©, compared to a traditional website format to provide diabetes self-management education and support to adults with type 2 diabetes. Our recruitment experience was labor-intensive, multimodal, and required multiple iterations throughout the study to meet recruitment goals. To allow for more efficient and realistic budgets aligned with funding, researchers should engage stakeholders in recruitment planning and monitor and report personnel time and cost by recruitment methods. To allow for more efficient and effective recruitment into meaningful clinical trials and of interest to participants, researchers should use a participative approach during all study phases, including question development.

Abstract

BACKGROUND: Severe maternal morbidity (SMM) has increased in the United States by 45% in the last decade. While the recurrence of several adverse pregnancy outcomes from one pregnancy to the next has been established, the recurrence risk of SMM is unknown.OBJECTIVE: To determine whether women who have SMM in a first pregnancy are at increased risk of SMM in their second pregnancy, compared to women who did not have SMM in their first pregnancy.METHODS: This is a population-based study using linked vital statistics and hospital discharge records from the Office of Statewide Health Planning and Development in California from 1997 to 2012. The study population had their first two singleton births (live births or stillbirths) in California between 1997 and 2012 (n = 1 180 357). The primary exposure was SMM during the hospitalisation at first birth, and the primary outcome was SMM during the hospitalisation at second birth. Prevalence and risk ratios of SMM at second birth were computed for women who did and did not have SMM at first birth, as well as for certain specific indicators of SMM.RESULTS: Of the 1 180 357 women included in this analysis, 9088 (77 per 10 000 births) experienced SMM at first birth. Among these women, the prevalence of SMM at second birth was 470 per 10 000 births, compared to 68 per 10 000 births among women without SMM at first birth. This corresponded to an unadjusted risk ratio of 6.87 (95% CI 6.23, 7.57), which did not differ substantially when adjusted for factors known to be associated with SMM (6.42, 95% CI 5.86, 7.13).CONCLUSION: Women experiencing SMM in their first pregnancy were at an approximately sixfold increased risk of experiencing SMM in their second pregnancy.

Abstract

In today's fast-paced health care delivery system, new evidence for practice emerges on a daily basis, and research results are quickly disseminated. Nurse practitioners are challenged to evaluate the relevance of the evidence to their patient populations and whether clinical practice should be changed on the basis of the presenting evidence. Nurse researchers also need to report study findings in a relevant, organized, and scholarly manner using reporting guidelines. This paper discusses both critical appraisal checklists and reporting guidelines providing exemplars for using each of the available tools.

Abstract

The Geriatric Emergency Care Applied Research (GEAR) Network (1) conducted a scoping review of the current literature on the identification of and interventions to address elder abuse among patients receiving care in emergency departments and (2) used this review to prioritize research questions for knowledge development. Two questions guided the scoping review: What is the effect of universal emergency department screening compared to targeted screening or usual practice on cases of elder abuse identified, safety outcomes, and health care utilization?; and What is the safety, health, legal, and psychosocial impact of emergency department-based interventions vs. usual care for patients experiencing elder abuse? We searched five article databases. Additional material was located through reference lists of identified publications, PsychInfo, and Google Scholar. The results were discussed in a consensus conference; and stakeholders voted to prioritize research questions. No studies were identified that directly addressed the first question regarding assessment strategies, but four instruments used for elder abuse screening in the emergency department were identified. For the second question, we located six articles on interventions for elder abuse in the emergency department; however, none directly addressed the question of comparative effectiveness. Based on these findings, GEAR participants identified five questions as priorities for future research–two related to screening, two related to intervention, and one encompassed both. In sum, research to identify best practices for elder abuse assessment and intervention in emergency departments is still needed. Although there are practical and ethical challenges, rigorous experimental studies are needed.

Abstract

Emerging adulthood (18–25 years) represents a window of opportunity to modify the trajectory of cardiometabolic disease risk into older adulthood. Not known is the extent to which rest-activity rhythms (RAR) may be related to biomarkers of cardiometabolic health in this population. In this cross-sectional, observational study, 52 healthy emerging adults wore wrist accelerometers (14 consecutive days; 24 h/day) for assessment of nonparametric RAR metrics, including interdaily stability (IS; day-to-day RAR consistency), intradaily variability (IV; within-day RAR fragmentation), and relative amplitude (RA; robustness of RAR), as well as autocorrelation (correlation of rest/activity levels at 24-h lag-times). Cardiometabolic biomarkers, including body mass index (BMI), body fat percentage, blood pressure (BP), fasting lipids, glucose, and C-reactive protein (CRP) were assessed. Additional measures including physical activity, sleep duration, and habitual caffeine and alcohol consumption were also evaluated. A series of multivariable regression models of cardiometabolic biomarkers were used to quantify associations with RAR metrics. On average, participants were 20 ± 1 years of age (21 males, 31 females), non-obese, and non-hypertensive. All were nonsmokers and free of major diseases or conditions. In separate models, which adjusted for sex, BMI, moderate-vigorous physical activity, sleep duration, caffeine, and alcohol consumption, IS was inversely associated with total cholesterol (p ≤ 0.01) and non-HDL cholesterol (p < .05), IV was positively associated with CRP (p < .05), and autocorrelation was inversely associated with total cholesterol (p < .05) and CRP (p < .05). Conversely, associations between RA and cardiometabolic biomarkers were nonsignificant after adjustment for BMI, alcohol, and caffeine consumption. In conclusion, RAR metrics, namely, a higher IS, lower IV, and higher autocorrelation, emerged as novel biomarkers associated with more favorable indices of cardiometabolic health in this sample of apparently healthy emerging adults.

Abstract

Induction of labor is increasingly a common component of the intrapartum care. Knowledge of the current evidence on methods of labor induction is an essential component of shared decision-making to determine which induction method meets an individual's health needs and personal preferences. This article provides a review of the current research evidence on labor induction methods, including cervical ripening techniques, and contraction stimulation techniques. Current evidence about expected duration of labor following induction, use of the Bishop score to guide induction, and guidance on the use of combination methods for labor induction are reviewed.

Abstract

This project examines risk and protective factors for preterm birth (PTB) among Black women in Oakland, California. Women with singleton births in 2011–2017 (n = 6199) were included. Risk and protective factors for PTB and independent risk groups were identified using logistic regression and recursive partitioning. Having less than 3 prenatal care visits was associated with highest PTB risk. Hypertension (preexisting, gestational), previous PTB, and unknown Women, Infant, Children (WIC) program participation were associated with a two-fold increased risk for PTB. Maternal birth outside of the USA and participation in WIC were protective. Broad differences in rates, risks, and protective factors for PTB were observed.

Abstract

Objective The aim of the study is to evaluate the risk of preterm birth (PTB, <37 weeks) and early term (37 and 38 weeks) birth among women with an emergency department (ED) visit or hospitalization with a urinary tract infection (UTI) by trimester of pregnancy. Methods The primary sample was selected from births in California between 2011 and 2017. UTIs were identified from the ED or hospital discharge records. Risk of PTB, by subtype, and early term birth were evaluated by trimester of pregnancy and by type of visit using log-linear regression. Risk ratios were adjusted for maternal factors. Antibiotic usage was examined in a population of privately insured women from Iowa. Results Women with a UTI during pregnancy were at elevated risk of a birth <32 weeks, 32 to 36 weeks, and 37 to 38 weeks (adjusted risk ratios [aRRs] 1.1-1.4). Of the women with a diagnostic code for multiple bacterial species, 28.8% had a PTB. A UTI diagnosis elevated risk of PTB regardless of antibiotic treatment (aRR 1.4 for treated, aRR 1.5 for untreated). Conclusion UTIs are associated with early birth. This association is present regardless of the trimester of pregnancy, type of PTB, and antibiotic treatment.

Abstract

In 2019, 10 to 20 million school-aged youth were identified as having a chronic health condition or disability. However, little is known about U.S. school district policies on school nurses’ participation in Individualized Educational Program (IEP) and Section 504 teams to support these youth. Using nationally representative district-level data from the 2016 School Health Policies and Practices Study, we examined whether U.S. school districts have policies on school nurse participation in IEP and 504 development. In addition, we examined the relationship between having such policies and policies on (a) creating and maintaining school teams to assist students with disabilities and (b) the participation of other essential school staff in IEP and 504 development. Among districts with policies regarding school nurse participation in IEP development versus those that did not, a significantly greater proportion had policies on student support teams and counselors’ participation on IEP teams (79.2% vs. 44.4%, p <.001, and 98.7% vs. 56.2%, p <.001, respectively). In addition, among districts with policies on school nurse participation in 504 development versus those that did not, a significantly greater proportion also had policies on support teams and counselors’ participation on 504 teams (77.5% vs. 43.1%, p <.001, and 97.2% vs. 50.7%, p <.001, respectively). We also examine regional and locale differences in these policies. Findings encourage discussion on student support teams’ role in school districts for students with chronic health conditions and disabilities, how school nurses can be essential team members, and better coordination of student care to promote children who are engaged, healthy, and supported within the school community.