Publications

Abstract

Background: There is an emerging evidence that pulmonary hypertension is associated with amino acid, carnitine, and thyroid hormone aberrations. We aimed to characterize metabolic profiles measured by the newborn screen (NBS) in infants with persistent pulmonary hypertension of the newborn (PPHN) Methods: Nested case–control study from population-based database. Cases were infants with ICD-9 code for PPHN receiving mechanical ventilation. Controls receiving mechanical ventilation were matched 2:1 for gestational age, sex, birth weight, parenteral nutrition administration, and age at NBS collection. Infants were divided into derivation and validation datasets. A multivariable logistic regression model was derived from candidate metabolites, and the area under the receiver operator characteristic curve (AUROC) was generated from the validation dataset. Results: We identified 1076 cases and 2152 controls. Four metabolites remained in the final model. Ornithine (OR 0.32, CI 0.26–0.41), tyrosine (OR 0.48, CI 0.40–0.58), and TSH 0.50 (0.45–0.55) were associated with decreased odds of PPHN; phenylalanine was associated with increased odds of PPHN (OR 4.74, CI 3.25–6.90). The AUROC was 0.772 (CI 0.737–0.807). Conclusions: In a large, population-based dataset, infants with PPHN have distinct, early metabolic profiles. These data provide insight into the pathophysiology of PPHN, identifying potential therapeutic targets and novel biomarkers to assess the response.

Abstract

In the current healthcare environment, ambulatory care nursing is increasingly recognized as an efficient and effective way of collaborating with clients to improve health outcomes and to focus on prevention. Nursing skills in ambulatory care are both valuable and necessary. However, few undergraduate nursing programs provide content on ambulatory care or significant clinical experience outside the context of an acute care setting. To meet this gap in education, a baccalaureate undergraduate course in ambulatory care nursing was created to address the growing need for RNs in this field. In collaboration with affiliated healthcare systems, this course provides the knowledge and skills needed to enable new RNs to enter this challenging and rapidly changing specialty.

Abstract

Introduction: Nearly 40% of US women of childbearing age are obese. Obesity during pregnancy is associated with multiple risks for both the woman and fetus, yet clinicians often feel unprepared to provide optimal antepartum care for this group of women. We collected and reviewed current evidence concerning antepartum care of women who are obese during pregnancy. Methods: We conducted a systematic review using PRISMA guidelines. Current evidence relating to the pregnancy care of women with a prepregnancy body mass index of 30kg/m2 or higher was identified using MEDLINE databases via PubMed, Embase, and Web of Science Core Collection between January 2012 and February 2018. Results: A total of 354 records were located after database searches, of which 63 met inclusion criteria. Topic areas for of included studies were: pregnancy risk and outcomes related to obesity, communication between women and health care providers, gestational weight gain and activity/diet, diabetic disorders, hypertensive disorders, obstructive sleep apnea, mental health, pregnancy imaging and measurement, late antepartum care, and preparation for labor and birth. Discussion: Midwives and other health care providers can provide better antepartum care to women who are obese during pregnancy by incorporating evidence from the most current clinical investigations.

Abstract

Background: Care at the end of life is increasingly fragmented and is characterized by multiple hospitalizations, even among patients enrolled with hospice. Objective: To determine whether hospice spending on direct patient care (including the cost of home visits, drugs, equipment, and counseling) is associated with hospital utilization and Medicare expenditures of hospice enrollees. Design: Longitudinal, observational cohort study (2008-2010). Setting/Subjects: Medicare beneficiaries (N = 101,261) enrolled in a national random sample of freestanding hospices (N = 355). Measurements: We used Medicare Hospice Cost reports to estimate hospice spending on direct patient care and Medicare claim data to estimate rates of hospitalization and Medicare expenditures. Results: Hospice mean direct patient care costs were $86 per patient day, the largest component being patient visits by hospice staff (e.g., nurse, physician, and counselor visits). After case-mix adjustment, hospices spending the most on direct patient care had patients with 5.2% fewer hospital admissions, 6.3% fewer emergency department visits, 1.6% fewer intensive care unit stays, and $1,700 less in nonhospice Medicare expenditures per patient compared with hospices spending the least on direct patient care (p < 0.01 for each comparison). Ninety percent of hospices with the lowest spending on direct patient care and highest rates of hospital use were for-profit hospices. Conclusions: Patients cared for by hospices with lower direct patient care costs had higher hospitalization rates and were overrepresented by for-profit hospices. Greater investment by hospices in direct patient care may help Centers for Medicare and Medicaid Services avoid high-cost hospital care for patients at the end of life.

Abstract

OBJECTIVE The aim of this study was to examine the impact of nurse shift patterns on nurses' collaboration with nurses and physicians in US acute care hospital units. BACKGROUND Collaboration between nurses and other healthcare providers is critical for ensuring quality patient care. Nurses perform collaboration during their shift work; thus, nurse shift patterns may influence collaboration. However, there is a dearth of empirical evidence of the relationship between nurse shift patterns and collaboration of nurses with other healthcare providers. METHODS This is a cross-sectional study using data from 957 units in 168 acute care hospitals. Measures of collaboration include nurse-nurse collaboration and nurse-physician collaboration. Measures of shift patterns included shift length and overtime. Multilevel linear regressions were conducted at the unit level, controlling unit and hospital characteristics. RESULTS Overtime (more nurses working overtime or longer overtime hours) was associated with lower collaboration at the unit level; however, shift length was not. CONCLUSIONS Working overtime may negatively influence nurses' collaboration with other healthcare providers.

Abstract

Background: The aim of this study was to understand the associations between acculturation and oral health among older Chinese immigrants in the United States. Method: We used data from the PINE study, which included the foreign-born older Chinese immigrants (N = 3,128). We measured acculturation by measuring participants’ length of stay and behavioral acculturation. Participants’ tooth and gum symptoms were the outcome variables. Results: Longer stay in the United States was significantly associated with fewer gum symptoms but not with tooth symptoms. Behavioral acculturation was not significantly associated with either tooth or gum symptoms. The middle tertile of behavioral acculturation, compared with its upper and lower tertiles, deemed to be a more significant risk factor of tooth/gum symptoms. In addition, older immigrants with more social interactions with the Americans were more likely to have tooth symptoms. Discussion: In the future, we will conduct a study using longitudinal data to help us better understand the relationship between acculturation and oral health in Chinese American population.

Abstract

Background. High parental self-efficacy (PSE) has been associated with healthy diets and higher levels of physical activity (PA) in children; however, data on PSE in relation to body weight and body composition are scarce. The objective of this study was to investigate associations of PSE with measures of diet, PA, body composition, and physical fitness in early childhood. Method. We used baseline data from the MINISTOP trial in healthy Swedish children (n = 301; 4.5 ± 0.15 years). PSE was assessed using a questionnaire, dietary data were collected using a mobile technology–assisted methodology, and PA was obtained (sedentary behavior and moderate-to-vigorous) by accelerometry. Body composition was measured using the pediatric option for BodPod and cardiorespiratory fitness by the 20 m shuttle run. Linear regression was conducted to evaluate cross-sectional associations of the outcomes in relation to total PSE and scores computed for the individual PSE factors: (1) diet, (2) limit setting of unhealthful behaviors, and (3) PA. Results. Higher scores of total PSE and the diet factor were associated with higher fruit intake (β = 0.82 g/point and 1.99 g/point; p =.014 and.009, respectively) and lower consumption of unhealthy snacks (β = −0.42 g/point and −0.89 g/point; p =.012 and.020, respectively) after adjustment for parental body mass index and education, respondent, and child’s sex and age. No associations were observed between PSE and PA, body composition, or cardiorespiratory fitness. Conclusions. Our study noted that PSE should be considered in conjunction with other strategies for a sustainable impact on childhood obesity.

Abstract

Case-control studies suggest that higher whole grain and lower refined grain intakes are associated with reduced cancer risk, but longitudinal evidence is limited. The objective of this prospective cohort study is to evaluate associations between whole and refined grains and their food sources in relation to adiposity-related cancer risk. Participants were adults from the Framingham Offspring cohort (N = 3,184; ≥18 yr). Diet, measured using a food frequency questionnaire, medical and lifestyle data were collected at exam 5 (1991–95). Between 1991 and 2013, 565 adiposity-related cancers were ascertained using pathology reports. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations of whole and refined grains with risk of adiposity-related cancers combined and with risk of breast and prostate cancers in exploratory site-specific analyses. Null associations between whole and refined grains and combined incidence of adiposity-related cancers were observed in multivariable-adjusted models (HR: 0.94; 95% CI: 0.71–1.23 and HR: 0.98; 95% CI: 0.70–1.38, respectively). In exploratory analyses, higher intakes of whole grains (oz eq/day) and whole grain food sources (servings/day) were associated with 39% and 47% lower breast cancer risk (HR: 0.61; 95% CI: 0.38–0.98 and HR: 0.53; 95% CI: 0.33–0.86, respectively). In conclusion, whole and refined grains were not associated with adiposity-related cancer risk. Whole grains may protect against breast cancer, but findings require confirmation within a larger sample and in other ethnic groups.

Abstract

This book uses a developmental approach to behavioral health for the entire pediatric population. Each section of this book is dedicated to the traditional developmental ages. Each opening chapter within the specific developmental age provides information for pediatric primary care providers to assess, identify, and intercept potential behavioral health problems through the use of a developmental approach to behavioral health assessments (infants, toddlers, preschool-age children, school-age children, and adolescents,). Assessment, screening, intervention, and treatment strategies are provided through analysis of the best available evidence by experts in the field of pediatric practice. Cutting-edge topics written by experts in the fields of pediatric primary care and pediatric behavioral health are highlighted in this book and include: infant brain development and outcomes from ineffective parenting; social determinants of health and effect on behavioral health; building resiliency in children; infant depression; behavioral problems in children with inborn errors of metabolism; autism, global developmental delays, and genetic syndromes; attention deficit hyperactivity disorder and comorbidities. The topics also include bullying social media and behavioral health; eating disorders; the autistic adolescent in residential treatment facilities; child behaviors within military families; foster care; toxic stress; trauma-informed care; lesbian, gay, bisexual, and transgender adolescent; and holistic and integrative care, and holistic care, integrative medicine, and behavioral health. Within each developmental section, there are case studies that provide exemplary practices for assessing, diagnosing, and evaluating children presented with the particular behavioral health problem. Case studies include the following topics: failure to thrive in infancy; infant colic; toilet training; sleep disorders in children with autistic spectrum disorder and ADHD; toddler impulsive behaviors; nail biting; and adolescent substance abuse.

Abstract

Background In order to meet the demands of a dynamic and complex health care landscape, nursing education must develop and implement programming to produce a highly educated nursing workforce. Interprofessional honors education in nursing with targeted mentorship is one such model. Purpose To describe undergraduate nursing student and faculty perceptions and beliefs of mentorship in the context of interprofessional honors education, and compare and contrast the perceptions and beliefs about mentorship in interprofessional honors education between undergraduate nursing students and faculty. Methods The study used a cross-sectional, descriptive design. Data were collected at an urban university in the northeast US, using a researcher-developed electronic survey. The sample included 24 full-time nursing faculty, and 142 undergraduate nursing students. Results Perceptions and beliefs regarding mentorship in the context of interprofessional honors education were similar for faculty and students, with both ranking mentorship among the most important components of a successful honors program. Conclusions Honors education with a dedicated mentorship component may be implemented to improve the undergraduate education experience, facilitate advanced degree attainment, and develop future nursing leaders.

Abstract

Objective: To examine the bidirectional relationship between weight change and obstructive sleep apnea (OSA) in the context of a behavioral weight loss intervention. Patients and Methods: Adults who were overweight or obese (N=114) participated in a 12-month behavioral weight loss intervention from April 17, 2012, through February 9, 2015. The apnea-hypopnea index (AHI), a marker of the presence and severity of OSA, was assessed at baseline, 6 months, and 12 months. Linear mixed models evaluated the effect of weight change on the AHI and the effect of OSA (AHI ≥5) on subsequent weight loss. Secondary analyses evaluated the effect of OSA on intervention attendance, meeting daily calorie goals, and accelerometer-measured physical activity. Results: At baseline, 51.8% of the sample (n=59) had OSA. Adults who achieved at least 5% weight loss had an AHI reduction that was 2.1±0.9 (adjusted mean ± SE) events/h greater than those with less than 5% weight loss (P<.05). Adults with OSA lost a mean ± SE of 2.2%±0.9% less weight during the subsequent 6-month interval compared with those without OSA (P=.02). Those with OSA were less adherent to daily calorie goals (mean ± SE: 25.2%±3.3% vs 34.8%±3.4% of days; P=.006) and had a smaller increase in daily activity (mean ± SE: 378.3±353.7 vs 1060.1±377.8 steps/d; P<.05) over 12 months than those without OSA. Conclusion: Behaviorally induced weight loss in overweight/obese adults was associated with significant AHI reduction. However, the presence of OSA was associated with blunted weight loss, potentially via reduced adherence to behaviors supporting weight loss. These results suggest that OSA screening before attempting weight loss may be helpful to identify who may benefit from additional behavioral counseling.

Abstract

This chapter provides an overview of behavioral issues in school settings. Major topics covers the explanations of why school settings can pose challenges for behavior; etiology, manifestations, and consequences of behavioral challenges in school settings; and bullying among children and youth as an example of a challenging behavior at school. The chapter discusses the behavioral problems with teachers and parents, it’s important for pediatric primary care providers (P-PCPs) to remember that descriptions of aggressive behaviors vary in severity, frequency, and seriousness of the acts themselves. Urge teachers and parents to observe and report the exact behaviors, their duration, possible catalysts, and impacts of the behaviors on the student, peers, and classroom learning. The chapter concludes with a summary of recommendations for P-PCPs who, with the correct knowledge about bullying behaviors, can intercept the problems while working with children who are affected by behavioral challenges at school.

Abstract

Background: In the United States, 16 million immigrants are 50 years and older, but little is known about their cardiometabolic health and how to best assess their cardiovascular disease (CVD) risk. Aging immigrants may therefore not be benefitting from advances in CVD prevention. Objective: In this study, we estimate and compare CVD risk in a nationally representative sample of aging immigrants using 3 different measures. Methods: This was a cross-sectional analysis using National Health and Nutrition Examination Survey data. Immigrants 50 years and older with no history of CVD were eligible. The Framingham Risk Score (FRS), the American College of Cardiology/American Heart Association Pooled Cohort Risk Equation, and presence of metabolic syndrome (MetS) were used to estimate risk. Bivariate statistics were analyzed using SPSS version 23.0 Complex Survey module to account for National Health and Nutrition Examination Survey unique weighting scheme. Results: The mean age of the sample was 61.3 years; 40% had hypertension, 17% had diabetes, 10% were smokers, and 95% did not meet the recommended physical activity guidelines. Proportions at an elevated CVD risk were as follows: American College of Cardiology/American Heart Association, 42% female and 76% male; FRS, 17.4% female and 76% male; and MetS, 22% female and 24% male. Conclusions: Immigrants had a lower overall risk using MetS and the American College of Cardiology/American Heart Association equation than has been found using these tools in similarly aged samples. The opposite was true for the FRS. The discrepancy between the proportion at risk and those being treated may reflect healthcare access gaps that warrant further investigation. A more holistic approach to risk measurement is needed that accounts for determinants of health that disproportionately affect immigrants, including language and socioeconomic status.

Abstract

Objective: Sexual minority women (lesbian and bisexual) experience significant stigma, which may increase their cardiovascular disease (CVD) risk. The purpose of this study was to examine the prevalence of modifiable risk factors for CVD (including mental distress, health behaviors, blood pressure, glycosylated hemoglobin, and total cholesterol) and CVD in sexual minority women compared with their heterosexual peers. Materials and Methods: A secondary analysis of the National Health and Nutrition Examination Survey (2001-2012) was conducted. Multiple imputation with chained equations was performed. Logistic regression models adjusted for relevant covariates were run. Self-report (medical history and medication use) and biomarkers for hypertension, diabetes, and high total cholesterol were examined. Results: The final analytic sample consisted of 7,503 that included 346 sexual minority women (4.6%). Sexual minority women were more likely to be younger, single, have a lower income, and lack health insurance. After covariate adjustment, sexual minority women exhibited excess CVD risk related to higher rates of frequent mental distress (adjusted odds ratio [AOR], 2.05; 95% confidence interval [CI], 1.45–2.88), current tobacco use (AOR, 2.11; 95% CI, 1.53–2.91), and binge drinking (AOR, 1.66; 95% CI, 1.17–2.34). Sexual minority women were more likely to be obese (AOR, 1.61; 95% CI, 1.23–2.33) and have glycosylated hemoglobin consistent with prediabetes (AOR, 1.56; 95% CI, 1.04–2.34). No differences were observed for other outcomes. Conclusions: Sexual minority women demonstrated increased modifiable risk factors for CVD, but no difference in CVD diagnoses. Several emerging areas of research are highlighted, in particular, the need for CVD prevention efforts that target modifiable CVD risk in sexual minority women.

Abstract

Background: The American Heart Association's (AHA) Council on Cardiovascular and Stroke Nursing (CVSN) plays a critical role in advancing the mission of the AHA in the discovery of new scientific knowledge. The aim was to identify priority research topics that would promote and improve cardiovascular (CV) health, provide direction for the education of future nurse scientists, and serve as a resource and catalyst for federal and organizational funding priorities. Methods: A Qualtrics survey, which included 3 questions about priorities for CVSN nurse researchers, was sent to the CVSN Leadership Committee and all CVSN Fellows of the AHA (n = 208). Responses to the questions were reviewed for word repetitions, patterns, and concepts and were then organized into thematic areas. The thematic areas were reviewed within small groups at the November (2016) in-person CVSN leadership meeting. Results: Seventy-three surveys were completed. Five thematic areas were identified and included (1) developing and testing interventions, (2) assessment and monitoring, (3) precision CV nursing care, (4) translational and implementation science, and (5) big data. Topic areas noted were stroke, research methods, prevention of stroke and CV disease, self-management, and care and health disparities. Conclusion: Five thematic areas and 24 topic areas were identified as priorities for CV nursing research. These findings can provide a guide for CV nurse scientists and for federal and foundational funders to use in developing funding initiatives. We believe additional research and discovery in these thematic areas will help reduce the rising global burden of CV disease.

Abstract

This chapter discusses the case study of adolescent with a substance use disorder. Confidentiality is defined as an agreement between patient and provider that information discussed during the encounter will not be shared with other parties without patient permission. A confidentiality statement must be provided to adolescents at every healthcare visit. The confidentiality statement assures adolescents that information provided to the pediatric primary care provider (P-PCP) during the office visit is a standard of care that supports full disclosure and trust between the adolescent and the P-PCP, without punitive consequences for the adolescent. P-PCPs must be knowledgeable about the laws in the state in which they practice to provide accurate information to the adolescents with admitted substance use problems. The key to intercepting these behaviors is effective office-based screenings and an immediate intervention with prompt referral to treatment and interprofessional collaborative initiatives at the national, state, and local community levels.