Publications
Publications
The Aging Physician
Merlo, G. (2021). In Principles of Medical Professionalism (1–). Oxford University Press. 10.1093/med/9780197506226.003.0015
Abstract
After decades of working in the medical field, physicians have gathered an extensive knowledge of human pathology as well as effective courses of treatment for illnesses. However, aging may also bring about cognitive deterioration, which may compromise the quality of care physicians provide to their patients. In 2015, 23 percent of physicians were above the age of 65. An estimated 25,000 to 50,000 active physicians are expected to suffer from mild cognitive impairment and up to 25,000 from dementia. Currently, physicians are not held to a mandatory retirement age and are not subject to oversight of their cognitive abilities and physical health as they age. However, the current system of self-regulation for cognitive impairment is insufficient for protecting patient safety; on the other hand, mandatory retirement or screening of aging physicians may be ethically or legally problematic. An optimal solution would balance the safety of patients and the dignity of aging physicians. It is likely to be multipronged and multifactorial, involving multiple screening steps and continued development to assess the quality of validation. Adoption of healthy lifestyle practices and financial literacy, as well as providing opportunities for retired physicians to stay involved with the medical profession, may encourage successful aging among physicians and ease the transition to retirement.
The association between preterm birth and postpartum mental healthcare utilization among California birthing people
Calthorpe, L. M., Baer, R. J., Chambers, B. D., Steurer, M. A., Shannon, M. T., Oltman, S. P., Karvonen, K. L., Rogers, E. E., Rand, L. I., Jelliffe-Pawlowski, L. L., & Pantell, M. S. (2021). American Journal of Obstetrics and Gynecology MFM, 3(4). 10.1016/j.ajogmf.2021.100380
Abstract
BACKGROUND: While mental health conditions such as postpartum depression are common, little is known about how mental healthcare utilization varies after term versus preterm delivery. OBJECTIVE: This study aimed to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization. STUDY DESIGN: The study sample was obtained from a database of live-born neonates delivered in California between the years of 2011 and 2017. The sample included all people giving birth to singleton infants between the gestational age of 20 and 44 weeks. Preterm birth was defined as <37 weeks’ gestation. Emergency department visits and hospitalizations with a mental health diagnosis within 1 year after birth were identified using International Classification of Diseases codes. Logistic regression was used to compare relative risks of healthcare utilization among people giving birth to preterm infants vs term infants, adjusting for the following covariates: age, race or ethnicity, parity, previous preterm birth, body mass index, tobacco use, alcohol or drug use, hypertension, diabetes mellitus, adequacy of prenatal care, education, insurance payer, and the presence of a mental health diagnosis before birth. Results were then stratified by mental health diagnosis before birth to determine whether associations varied based on mental health history. RESULTS: Of our sample of 3,067,069 births, 6.7% were preterm. In fully adjusted models, compared with people giving birth to term infants, people giving birth to preterm infants had a 1.5 times (relative risk; 95% confidence interval, 1.4–1.7) and 1.3 times (relative risk; 95% confidence interval, 1.2–1.4) increased risk of being hospitalized with a mental health diagnosis within 3 months and 1 year after delivery, respectively. People giving birth to preterm infants also had 1.4 times (95% confidence interval, 1.3–1.5) and 1.3 times (95% confidence interval, 1.2–1.4) increased risk of visiting the emergency department for a mental health diagnosis within 3 months and 1 year after birth, respectively. Stratifying by preexisting mental health diagnosis, preterm birth was associated with an elevated risk of mental healthcare utilization for people with and without a previous mental health diagnosis. CONCLUSION: We found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. Our findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.
The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California
Karasek, D., Baer, R. J., McLemore, M. R., Bell, A. J., Blebu, B. E., Casey, J. A., Coleman-Phox, K., Costello, J. M., Felder, J. N., Flowers, E., Fuchs, J. D., Gomez, A. M., Karvonen, K., Kuppermann, M., Liang, L., McKenzie-Sampson, S., McCulloch, C. E., Oltman, S. P., Pantell, M. S., … Jelliffe-Pawlowski, L. L. (2021). The Lancet Regional Health - Americas, 2. 10.1016/j.lana.2021.100027
Abstract
Introduction: Our understanding of the association between coronavirus disease 19 (COVID-19) and preterm or early term birth among racially and ethnically diverse populations and people with chronic medical conditions is limited. Methods: We determined the association between COVID-19 and preterm (PTB) birth among live births documented by California Vital Statistics birth certificates between July 2020 and January 2021 (n=240,147). We used best obstetric estimate of gestational age to classify births as very preterm (VPTB, <32 weeks), PTB (< 37 weeks), early term (37 and 38 weeks), and term (39-44 weeks), as each confer independent risks to infant health and development. Separately, we calculated the joint effects of COVID-19 diagnosis, hypertension, diabetes, and obesity on PTB and VPTB. Findings: COVID-19 diagnoses on birth certificates increased for all racial/ethnic groups between July 2020 and January 2021 and were highest for American Indian/Alaska Native (12.9%), Native Hawaiian/Pacific Islander (11.4%), and Latinx (10.3%) birthing people. COVID-19 diagnosis was associated with an increased risk of VPTB (aRR 1.6, 95% CI [1.4, 1.9]), PTB (aRR 1.4, 95% CI [1.3, 1.4]), and early term birth (aRR 1.1, 95% CI [1.1, 1.2]). There was no effect modification of the overall association by race/ethnicity or insurance status. COVID-19 diagnosis was associated with elevated risk of PTB in people with hypertension, diabetes, and/or obesity. Interpretation: In a large population-based study, COVID-19 diagnosis increased the risk of VPTB, PTB, and early term birth, particularly among people with medical comorbidities. Considering increased circulation of COVID-19 variants, preventative measures, including vaccination, should be prioritized for birthing persons. Funding: UCSF-Kaiser Department of Research Building Interdisciplinary Research Careers in Women's Health Program (BIRCWH) National Institute of Child Health and Human Development (NICHD) and the Office of Research on Women's Health (ORWH) [K12 HD052163] and the California Preterm Birth Initiative, funded by Marc and Lynn Benioff.
The common denominator: Public health
Newland, J. A. (2021). Nurse Practitioner, 46(8), 11. 10.1097/01.NPR.0000757112.98829.25
The Compliance of End-of-Life Care Preferences Among Older Adults and Its Facilitators and Barriers: A Scoping Review
Master, J. F., Wu, B., Ni, P., & Mao, J. (2021). Journal of the American Medical Directors Association, 22(11), 2273-2280.e2. 10.1016/j.jamda.2021.05.007
Abstract
Objectives: To explore the compliance of end-of-life (EOL) care preferences, and the facilitators and barriers of promoting quality of EOL care among older adults. Design: A scoping review was used to identify key themes in the compliance of EOL care preferences among older adults. Setting and participants: Studies published between 2009 and 2020 were identified from the Medline and Cochrane libraries. Eligible articles containing components related to the compliance of EOL care preferences among older adults were selected. Measures: The eligible articles were thematically synthesized. Factors that affected the compliance of EOL care preferences among older adults were identified from the key components. Results: In total, 35 articles were included to identify the key components in the compliance of EOL care preferences: (1) supportive policy, (2) supportive environment, (3) cultural characteristics, (4) advance care planning (ACP), (5) the concordance of EOL care preferences between patients and surrogate decision makers, (6) prognosis awareness, and (7) patient's health status and the type of disease. Facilitators for the compliance of EOL care preferences included enactment of relevant policy, sufficient care institutions, the utilization of ACP, and poor health status. Barriers included lack of supportive policy, different culture, and low utilization of ACP. Conclusions/Implications: The compliance of EOL care preferences was low among older adults. The compliance of EOL care preferences can be improved through relevant policy development and the utilization of ACP.
The designation for change
Newland, J. A. (2021). Nurse Practitioner, 46(5), 14. 10.1097/01.NPR.0000742904.48440.fb
The development of a personalized symptom management mobile health application for persons living with hiv in China
Han, S., Pei, Y., Wang, L., Hu, Y., Qi, X., Zhao, R., Zhang, L., Sun, W., Zhu, Z., & Wu, B. (2021). Journal of Personalized Medicine, 11(5). 10.3390/jpm11050346
Abstract
Persons living with HIV (PLWH) continuously experience symptom burdens. Their symptom prevalence and severity are also quite different. Mobile health (mHealth) applications (apps) offer exceptional opportunities for using personalized interventions when and where PLWH are needed. This study aimed to demonstrate the development process of the symptom management (SM) app and the structure and content of it. Our research team systematically searched for evidence-based resources and summarized up-to-date evidence for symptom management and health education. Our multidisciplinary research team that included physicians, nurses, software engineers, and nursing professors, evaluated the structure and content of the drafted app. Both quantitative data and qualitative results were collected at a group discussion meeting. Quantitative data were scores of sufficient evidence, situational suitability, practicability, cost-effectiveness, and understandability (ranged from one to four) for 119 items of the app contents, including the health tracking module, the self-assessment module, coping strategies for 18 symptoms (80 items), medication management, complementary therapy, diet management, exercise, relaxation techniques, and the obtaining support module. The SM app was comprised of eight modules and provided several personalized symptom management functions, including assessing symptoms and receiving different symptom management strategies, tracking health indicators, and communicating with medical staff. The SM app was a promising and flexible tool for HIV symptom management. It provided PLWH with personalized symptom management strategies and facilitated the case management for medical staff. Future studies are needed to further test the app’s usability among PLWH users and its effects on symptom management.
The Effect of Body Mass Index on Brain Volume and Cognitive Function in Relapsing–Remitting Multiple sclerosis: A CombiRx Secondary Analysis
Ben-Zacharia, A. B., Janal, M. N., Brody, A. A., Wolinsky, J., Lublin, F., & Cutter, G. (2021). Journal of Central Nervous System Disease, 13. 10.1177/11795735211042173
Abstract
Background: Multiple sclerosis (MS) is an autoimmune disease leading to physical, emotional and cognitive disability. High body mass index (BMI) may impact cognitive function and brain volume in MS. Yet, there is paucity of evidence addressing the impact of BMI on cognitive function and brain volume in MS. Objectives: The purpose of this study was to examine the effects of BMI on normal appearing brain volume and cognitive function in patients with relapsing–remitting MS. Methods: A secondary data analysis of the NIH CombiRx study was conducted. Multivariate regression and mixed model analyses were executed to analyze the effect of BMI on brain volume and cognitive function. Results: The mean baseline age of the 768 participants was 38.2(SD = 9.4) years. 73% were female and 88.8% were Caucasian. The mean BMI was 28.8 kg/m2(SD = 6.7). The multivariate regression and mixed model analyses failed to show a clinical effect of BMI on brain volume and cognitive function. Conclusion: BMI did not show an effect on cognitive function and brain volume among MS patients. Although there is increased interest in the effects of modifiable factors on the course of MS, the effects of BMI on brain volume and cognitive function are debatable and warrant further research. ClinicalTrials.gov
The Effects of a Multifaceted Intervention to Improve Care Transitions Within an Accountable Care Organization: Results of a Stepped-Wedge Cluster-Randomized Trial
Schnipper, J. L., Samal, L., Nolido, N., Yoon, C., Dalal, A. K., Magny-Normilus, C., Bitton, A., Thompson, R., Labonville, S., & Crevensten, G. (2021). Journal of Hospital Medicine, 16(1), 15-22. 10.12788/jhm.3513
Abstract
BACKGROUND: Transitions from hospital to the ambulatory setting are high risk for patients in terms of adverse events, poor clinical outcomes, and readmission. OBJECTIVES: To develop, implement, and refine a multifaceted care transitions intervention and evaluate its effects on postdischarge adverse events. DESIGN, SETTING, AND PARTICIPANTS: Two-arm, single-blind (blinded outcomes assessor), stepped-wedge, cluster-randomized clinical trial. Participants were 1,679 adult patients who belonged to one of 17 primary care practices and were admitted to a medical or surgical service at either of two participating hospitals within a pioneer accountable care organization (ACO). INTERVENTIONS: Multicomponent intervention in the 30 days following hospitalization, including inpatient pharmacist-led medication reconciliation, coordination of care between an inpatient “discharge advocate” and a primary care “responsible outpatient clinician,” postdischarge phone calls, and postdischarge primary care visit. MAIN OUTCOMES AND MEASURES: The primary outcome was rate of postdischarge adverse events, as assessed by a 30-day postdischarge phone call and medical record review and adjudicated by two blinded physician reviewers. Secondary outcomes included preventable adverse events, new or worsening symptoms after discharge, and 30-day nonelective hospital readmission. RESULTS: Among patients included in the study, 692 were assigned to usual care and 987 to the intervention. Patients in the intervention arm had a 45% relative reduction in postdischarge adverse events (18 vs 23 events per 100 patients; adjusted incidence rate ratio, 0.55; 95% CI, 0.35-0.84). Significant reductions were also seen in preventable adverse events and in new or worsening symptoms, but there was no difference in readmission rates. CONCLUSION: A multifaceted intervention was associated with a significant reduction in postdischarge adverse events but no difference in 30-day readmission rates.
The effects of obesity on lymphatic pain and swelling in breast cancer patients
Fu, M. R., Axelrod, D., Guth, A., McTernan, M. L., Qiu, J. M., Zhou, Z., Ko, E., Magny-Normilus, C., Scagliola, J., & Wang, Y. (2021). Biomedicines, 9(7). 10.3390/biomedicines9070818
Abstract
Abstract: BackgroundLymphatic pain and swelling due to lymph fluid accumulation are the most common and debilitating long-term adverse effects of cancer treatment. This study aimed to quantify the effects of obesity on lymphatic pain, arm, and truncal swelling. Methods: A sample of 554 breast cancer patients were enrolled in the study. Body mass index (BMI), body fat percentage, and body fat mass were measured using a bioimpedance device. Obesity was defined as a BMI ≥ 30 kg/m2 . The Breast Cancer and Lymphedema Symptom Experience Index was used to measure lymphatic pain, arm, and truncal swelling. Multivariable logistic regression models were used to estimate the odds ratio (OR) with 95% confidence interval (CI) to quantify the effects of obesity. Results: Controlling for clinical and demographic characteristics as well as body fat percentage, obesity had the greatest effects on lymphatic pain (OR 3.49, 95% CI 1.87–6.50; p < 0.001) and arm swelling (OR 3.98, 95% CI 1.82–4.43; p < 0.001). Conclusions: Obesity is a significant risk factor for lymphatic pain and arm swelling in breast cancer patients. Obesity, lymphatic pain, and swelling are inflammatory conditions. Future study should explore the inflammatory pathways and understand the molecular mechanisms to find a cure.
The epidemic of gun violence in America
Newland, J. A. (2021). Nurse Practitioner, 46(6), 10. 10.1097/01.NPR.0000751800.62349.8e
The HEAR-VA Pilot Study: Hearing Assistance Provided to Older Adults in the Emergency Department
Chodosh, J., Goldfeld, K., Weinstein, B. E., Radcliffe, K., Burlingame, M., Dickson, V., Grudzen, C., Sherman, S., Smilowitz, J., & Blustein, J. (2021). Journal of the American Geriatrics Society, 69(4), 1071-1078. 10.1111/jgs.17037
Abstract
BACKGROUND/OBJECTIVES: Poor communication is a barrier to care for people with hearing loss. We assessed the feasibility and potential benefit of providing a simple hearing assistance device during an emergency department (ED) visit, for people who reported difficulty hearing. DESIGN: Randomized controlled pilot study. SETTING: The ED of New York Harbor Manhattan Veterans Administration Medical Center. PARTICIPANTS: One hundred and thirty-three Veterans aged 60 and older, presenting to the ED, likely to be discharged to home, who either (1) said that they had difficulty hearing, or (2) scored 10 or greater (range 0–40) on the Hearing Handicap Inventory-Survey (HHI-S). INTERVENTION: Subjects were randomized (1:1), and intervention subjects received a personal amplifier (PA; Williams Sound Pocketalker 2.0) for use during their ED visit. MEASUREMENTS: Three survey instruments: (1) six-item Hearing and Understanding Questionnaire (HUQ); (2) three-item Care Transitions Measure; and (3) three-item Patient Understanding of Discharge Information. Post-ED visit phone calls to assess ED returns. RESULTS: Of the 133 subjects, 98.3% were male; mean age was 76.4 years (standard deviation (SD) = 9.2). Mean HHI-S score was 19.2 (SD = 8.3). Across all HUQ items, intervention subjects reported better in-ED experience than controls. Seventy-five percent of intervention subjects agreed or strongly agreed that ability to understand what was said was without effort versus 56% for controls. Seventy-five percent of intervention subjects versus 36% of controls said clinicians provided them with an explanation about presenting problems. Three percent of intervention subjects had an ED revisit within 3 days compared with 9.0% controls. CONCLUSION: Veterans with hearing difficulties reported improved in-ED experiences with use of PAs, and were less likely to return to the ED within 3 days. PAs may be an important adjunct to older patient ED care but require validation in a larger more definitive randomized controlled trial.
The impact of COVID-19 on opioid treatment programs in the United States
Goldsamt, L. A., Rosenblum, A., Appel, P., Paris, P., & Nazia, N. (2021). Drug and Alcohol Dependence, 228. 10.1016/j.drugalcdep.2021.109049
Abstract
Background: The COVID-19 pandemic had the potential to severely disrupt the delivery of methadone and buprenorphine, as social distancing and other public health regulations made in-person services difficult to maintain. Federal and state regulators changed requirements regarding the dispensing of medication and in-person counseling at opioid treatment programs. Understanding staff and patient reactions to these changes can help determine whether they should be maintained. Methods: We interviewed 25 directors of OTP programs located throughout the United States. Note takers wrote summaries of each interview which were coded for topics and themes covered in the interview guide, including changes to clinic practices, take-home medications, telehealth, patient and staff reactions to new COVID-related protocols, and financial concerns for programs. Results: Most programs rapidly incorporated new regulatory requirements, and directors were generally positive about the impact of increased take-home doses of medication and increased reliance on telehealth. Some directors voiced concerns about these changes, and some reported that patients missed the daily clinical contact with staff. Directors also suggested that more time was needed to assess the full impact of these changes. Financial impacts varied, although many directors were quick to point out that the ongoing opioid epidemic has delivered a steady stream of new patients, thus offsetting potential financial losses. Conclusions: Overall, this study demonstrated the generally positive view of OTP directors to the regulatory changes necessitated by the COVID-19 pandemic. More time is needed to fully evaluate the impact of these changes on clinical outcomes.
The Impact of COVID-19 on Social Isolation in Long-term Care Homes: Perspectives of Policies and Strategies from Six Countries
Chu, C. H., Wang, J., Fukui, C., Staudacher, S., A. Wachholz, P., & Wu, B. (2021). Journal of Aging and Social Policy, 33(4), 459-473. 10.1080/08959420.2021.1924346
Abstract
Preventing the spread of COVID-19 in long-term care homes is critical for the health of residents who live in these institutions. As a result, broad policies restricting visits to these facilities were put in place internationally. While well meaning, these policies have exacerbated the ongoing social isolation crisis present in long-term care homes prior to the COVID-19 pandemic. This perspective highlights the dominant COVID-19 LTC policies from six countries, and proposes five strategies to address or mitigate social isolation during the COVID-19 pandemic that can also be applied in a post-pandemic world.
The Impact of Long-Term Care Policy on the Percentage of Older Adults With Disabilities Cared for by Family Members in China: A System Dynamics Simulation
Peng, R., & Wu, B. (2021). Research on Aging, 43(3), 147-155. 10.1177/0164027520923567
Abstract
This study examined the impact of current and future long-term care (LTC) policies on the family caregiving burden in China. System dynamics (SD) methodology was used to construct an LTC delivery system model that simulates the demand of LTC, living options, and LTC service use for disabled older adults. The model was based on three policy variables including the proportion of payment from LTC insurance, the growth rate of beds in LTC institutions, and the time to adjusting the capacity of community-based care. Results showed that the percentage of older adults with disabilities cared for by family members was projected to increase from 92.6% in 2015 to 97.8% in 2035, assuming no policy changes; under the mixed policy scenario, this percentage would reduce significantly to 63.8% in 2035. These findings illustrate that changes in LTC policy and delivery system have a significant impact on family care.
The Impact of Nonpharmacological Interventions on Sleep Quality among Older Adult Patients in the Intensive Care Unit
Bae, G., & Lim, F. (2021). Critical Care Nursing Quarterly, 44(2), 214-229. 10.1097/CNQ.0000000000000355
Abstract
Sleep is a basic human need that is required for good health and overall well-being. Adequate sleep is critical for cognitive functioning, memory consolidation, and emotional regulation by rejuvenating the body. Sleep may not be of significant concern unless it becomes lacking or disturbed as it alters the immune function, neurological processes, and intellectual and decision making of individuals. Hospitalized older adults are particularly vulnerable for the negative impact of poor sleep due to reduced physiological reserve and comorbidities. The purpose of this review is to appraise current evidence on nonpharmacological sleep interventions to promote better sleep quality and overall health outcomes among the general adult and older patients in the intensive care unit compared with no intervention at all. The findings of this integrative review will be useful in designing and implementing interdisciplinary plans of care that promote the use of nonpharmacological sleep protocols within the hospital setting.
The impact of Severe Maternal Morbidity on probability of subsequent birth in a population-based study of women in California from 1997-2017
Bane, S., Carmichael, S. L., Snowden, J. M., Liu, C., Lyndon, A., & Wall-Wieler, E. (2021). Annals of Epidemiology, 64, 8-14. 10.1016/j.annepidem.2021.08.017
Abstract
Importance: Complications during pregnancy and birth can impact whether an individual has more children. Individuals experiencing SMM are at a higher risk of general and reproductive health issues after pregnancy, which could reduce the probability of a subsequent birth. Objective: To examine whether experiencing SMM during an individual's first birth affects their probability of having an additional birth, and whether this effect varies by maternal factors. Methods: This retrospective cohort study US linked vital records and maternal discharges from 1997 to 2017 to identify all California births. The exposure, Severe Maternal Morbidity (SMM) was identified using a Centers for Disease Control and Prevention index. Individuals whose first birth was a singleton live birth were followed until their second birth or December 31, 2017, whichever came first. Hazard ratios for having a subsequent birth were estimated using Cox proportional hazard regression models. This association was assessed overall and stratified by maternal factors of a priori interest: age, race/ethnicity, and payer. Results: Of the 3,916,413 individuals in our study, 51,872 (1.3%) experienced SMM at first birth. Compared to those who do not experience SMM, individuals who had SMM had a lower hazard, or instantaneous rate, of subsequent birth (adjusted HR 0.83, 95% CI: 0.82, 0.84); this association was observed in all levels of stratification (for example, adjusted HR range for known race/ethnicity: 0.78, 95% CI: 0.76, 0.80 for non-Hispanic White to 0.90, 95% CI: 0.88, 0.92 for Hispanic) and all indicators of SMM (0.24, 95% CI: 0.17, 0.35 for cardiac arrest/ventricular fibrillation to 0.84, 95% CI: 0.80, 0.87 for eclampsia). Conclusion and Relevance: Our findings suggest that individuals who experience SMM at the time of their first birth are less likely to have a subsequent birth as compared to those who do not experience SMM at the time of their first birth. While the reasons for these findings are unclear, they could inform reproductive life planning discussions for individuals experiencing SMM. Future directions include studies exploring the reasons for not having a subsequent birth.
The Lived Experience of Being Diagnosed With COVID-19 Among Black Patients: A Qualitative Study
Aliyu, S., Travers, J. L., Norful, A. A., Clarke, M., & Schroeder, K. (2021). Journal of Patient Experience, 8. 10.1177/2374373521996963
Abstract
Diagnosis and hospitalization for COVID-19 are disproportionately higher among black persons. The purpose of this study was to explore the lived experience of being diagnosed with COVID-19 among black patients. Semistructured one-on-one interviews with black patients diagnosed with COVID-19 were conducted. Data were analyzed using conventional content analysis and a directed content approach. Fifteen patients participated and 3 themes were identified: Panic amidst a COVID-19 diagnosis, Feeling the repercussion of the diagnosis, and Personal assessment of risks within one’s individual environment. Fear of dying, inadequate health benefits, financial issues, and worries about spreading the virus to loved ones were acknowledged by the patients as critical areas of concerns. Majority of the patients looked to God as the ultimate way of surviving COVID-19. However, none of the patients reported receiving support for spiritual needs from health care providers. This is the first study to investigate the lived experience of being diagnosed with COVID-19 among black patients. Our results highlight several factors that put this group at increased risk for COVID-19 and where additional strategies are needed to address these inadequacies. Integrating public health interventions to reduce socioeconomic barriers and integrating spirituality into clinical care could improve patient care delivery.
The Mediating Role of Coping Style: Associations Between Intimate Partner Violence and Suicide Risks Among Chinese Wives of Men Who Have Sex With Men
Wu, W., Zhang, Y., Goldsamt, L., Yan, F., Wang, H., & Li, X. (2021). Journal of Interpersonal Violence, 36(11), NP6304-NP6322. 10.1177/0886260518814264
Abstract
The wives of men who have sex with men, known as “Tongqi” in China, have increasingly attracted public attention due to their potential risks of suicide and sexually transmitted infections and HIV. However, few studies have explored the association between intimate partner violence (IPV) and suicide risk or the mediating effect of coping style on these associations among Tongqi in China. To describe these relationships, a cross-sectional online survey was conducted in China from February 2016 to February 2017. A questionnaire, which consisted of the Revised Conflict Tactics Scales, the Simplified Coping Style Questionnaire, the Beck Scale for Suicidal Ideation, and reports of suicide attempts, was completed by 178 Chinese Tongqi. Bootstrap tests were performed to determine the mediating role of coping styles on the association between IPV and suicide risks. The median IPV score was 14 (range: 0-50), with the domain of negotiation ranking highest. The average coping style score was.37±.73; 61.2% of Tongqi have had suicidal ideation, and 11.8% had attempted suicide. IPV was significantly correlated with suicidal ideation (rs =.19, p <.01) and suicide attempts (rs =.29, p <.001). Participants with a negative coping style had higher suicidal ideation (rs = –.39, p <.01) and suicide attempts (rs = –.22, p <.01). Coping style had a full mediating effect on the association between IPV and suicidal ideation and a partial mediating effect on suicide attempts. Chinese Tongqi experienced high level of IPV and suicide risks. IPV contributed to the suicide risks of Chinese Tongqi, but these associations were mediated by coping style. Therefore, interventions to improve mental health and prevent suicide risks of Chinese Tongqi should focus on helping them develop a positive coping style to achieve the goal of Healthy China in 2030.
The nurse workforce
Clarke, S. P. (2021). In Nurses Contributions to Quality Health Outcomes (1–, pp. 39-60). Springer International Publishing. 10.1007/978-3-030-69063-2_3
Abstract
The nurse workforce-the nurses available to provide care to a group of patients or a population and the characteristics of these nurses-provides a critical context for the Quality Health Outcomes Model (QHOM). This chapter begins with a brief consideration of workforce issues within the QHOM. Two forces at the heart of workforce analysis (supply and demand) and how these forces play out in various arenas for nursing practice are discussed. This chapter does not focus on managers' decisions regarding coverage of patient care responsibilities by nursing staff and nursing personnel qualifications, which fall within the realm of staffing (see Chaps. 4 and 13). Instead, it will focus on the size and composition of the body of nurses providing care, the forces that influence this body of nurses, and how workforce parameters act as an element of context for staffing, practice environments, and nursing care delivery. The chapter concludes with discussions of ongoing and emerging trends likely to influence the nurse workforce, especially in relation to healthcare quality and safety considerations.
The nurturing intent of nature
Newland, J. A. (2021). Nurse Practitioner, 46(10), 9. 10.1097/01.NPR.0000790512.02956.ef
The patterns of caregiving activities for family caregivers of older adults in hong kong: An exploratory latent class analysis
Huang, J., Chau, P. H., Choi, E. P. H., Wu, B., & Lou, V. W. (2021). Journals of Gerontology - Series B Psychological Sciences and Social Sciences, 76(8), 1605-1616. 10.1093/geronb/gbaa203
Abstract
Objectives: This study identified the classes (i.e., patterns) of caregivers' activities, based on their engagements in caregiving activities, and explored the characteristics and the caregiver burden of these classes. Methods: This study was a secondary analysis of a cross-sectional survey on the profiles of family caregivers of older adults in Hong Kong. A latent class analysis approach was adopted to classify family caregivers (N = 932) according to their routine involvements in 17 daily caregiving activities: 6 activities of daily living (ADLs) and 8 instrumental activities of daily living activities (IADLs) in addition to emotional support, decision making, and financial support. Multinomial logistic regression and multiple linear regression illuminated the characteristics of the classes and compared their levels of caregiver burden. Results: The family caregivers fell into 5 classes: All-Round Care (High Demand, 19.5%), All-Round Care (Moderate Demand, 8.2%), Predominant IADLs Care (High Demand, 23.8%), Predominant IADLs Care (Moderate Demand, 32.5%), and Minimal ADLs and IADLs Care (Low Demand, 16.0%). These classes exhibited different characteristics in terms of care recipients' cognitive statuses and caregiver backgrounds. The levels of caregiver burden differed across classes; the All-Round Care (High Demand) class experienced the highest levels of caregiver burden. Discussion: This study contributes to existing scholarship by turning away from a predefined category of care tasks to explore the patterns of caregiving activities. By identifying caregiving activity patterns and understanding their associated characteristics and caregiver burden, prioritizing and targeting caregiver support interventions better is possible.
The powder keg: Lessons learned about clinical staff preparedness during the early phase of the COVID-19 pandemic
Aliyu, S., Norful, A. A., Schroeder, K., Odlum, M., Glica, B., & Travers, J. L. (2021). American Journal of Infection Control, 49(4), 478-483. 10.1016/j.ajic.2020.10.014
Abstract
Background: Little is known about clinical staff's perspectives on preparedness for a pandemic. The purpose of this study was to obtain various clinical staff perspectives about preparedness to meet the demands for care during the early phase of the SARS-CoV-2 (COVID-19) pandemic. Methods: We conducted a qualitative study using semistructured in-person interviews from March 2020 to April 2020 at a large tertiary academic urban hospital center. Interview guides were informed by the Resilience Framework for Public Health Emergency Preparedness and analyzed using a directed content analysis approach. Results: Fifty-five clinical staff participated in the study. Three themes emerged from the data (1) Risk assessment and planning: “The powder keg,” (2) Innovative evolution of roles and responsibilities, and (3) Pandemic response and capacity. In the early phases of the pandemic, participants reported varying levels of risks for dying. However, most participants adapted to practice changes and became innovative in their roles over time. Hierarchies were less relevant during care delivery, whereas team collaboration became crucial in managing workforce capacity. Discussion: As the pandemic progressed, staff preparedness evolved through a trial-and-error approach. Conclusions: The pandemic is evolving as is clinical staff preparedness to meet the demands of a pandemic. In order to get a grasp on the crisis, clinical staff relied on each other and resorted to new workarounds.
The presidential partnership: leaving a trail
White, K., & Sullivan-Marx, E. (2021). Nursing Outlook, 69(6), 935-936. 10.1016/j.outlook.2021.10.001
The psychosocial impact on frontline nurses of caring for patients with COVID-19 during the first wave of the pandemic in New York City.
Kovner, C., Raveis, V. H., Van Devanter, N., Yu, G., Glassman, K., & Jean-Ridge, L. (2021). Nursing Outlook, 69(5), 744-754. 10.1016/j.outlook.2021.03.019
Abstract
Infectious disease pandemics, such as COVID-19, have dramatically increased in the last several decades.