Publications
Publications
General Screening Recommendations for Chronic Disease and Risk Factors in Older Adults: Try This: Best Practices in Nursing Care to Older Adults
Taub, L.-F. (2018). Online: Try This Series.
A Genome-Wide Association Study Identifies a Candidate Gene Associated With Atazanavir Exposure Measured in Hair
Tamraz, B., Huang, Y., French, A. L., Kassaye, S., Anastos, K., Nowicki, M. J., Gange, S., Gustafson, D. R., Bacchetti, P., Greenblatt, R. M., Hysi, P. G., & Aouizerat, B. E. (2018). Clinical Pharmacology and Therapeutics, 104(5), 949-956. 10.1002/cpt.1014
Abstract
Hair provides a direct measure of long-term exposure of atazanavir (ATV). We report the results of the first genome-wide association study (GWAS) of ATV exposure measured in hair in an observational cohort representative of US women living with HIV; the Women's Interagency HIV Study. Approximately 14.1 million single nucleotide polymorphisms (SNPs) were analyzed in linear regression-based GWAS, with replication, adjusted for nongenetic predictors collected under conditions of actual use of ATV in 398 participants. Lastly, the PharmGKB database was used to identify pharmacogene associations with ATV exposure. The rs73208473, within intron 1 of SORCS2, resulted in a 0.46-fold decrease in ATV exposure, with the strongest association (P = 1.71×10−8) in GWAS. A priori pharmacogene screening did not identify additional variants statistically significantly associated with ATV exposure, including those previously published in ATV plasma candidate pharmacogene studies. The findings demonstrate the potential value of pharmacogenomic GWAS in ethnically diverse populations under conditions of actual use.
A genome-wide association study identifies only two ancestry specific variants associated with spontaneous preterm birth
Rappoport, N., Toung, J., Hadley, D., Wong, R. J., Fujioka, K., Reuter, J., Abbott, C. W., Oh, S., Hu, D., Eng, C., Huntsman, S., Bodian, D. L., Niederhuber, J. E., Hong, X., Zhang, G., Sikora-Wohfeld, W., Gignoux, C. R., Wang, H., Oehlert, J., … Sirota, M. (2018). Scientific Reports, 8(1). 10.1038/s41598-017-18246-5
Abstract
Preterm birth (PTB), or the delivery prior to 37 weeks of gestation, is a significant cause of infant morbidity and mortality. Although twin studies estimate that maternal genetic contributions account for approximately 30% of the incidence of PTB, and other studies reported fetal gene polymorphism association, to date no consistent associations have been identified. In this study, we performed the largest reported genome-wide association study analysis on 1,349 cases of PTB and 12,595 ancestry-matched controls from the focusing on genomic fetal signals. We tested over 2 million single nucleotide polymorphisms (SNPs) for associations with PTB across five subpopulations: African (AFR), the Americas (AMR), European, South Asian, and East Asian. We identified only two intergenic loci associated with PTB at a genome-wide level of significance: rs17591250 (P = 4.55E-09) on chromosome 1 in the AFR population and rs1979081 (P = 3.72E-08) on chromosome 8 in the AMR group. We have queried several existing replication cohorts and found no support of these associations. We conclude that the fetal genetic contribution to PTB is unlikely due to single common genetic variant, but could be explained by interactions of multiple common variants, or of rare variants affected by environmental influences, all not detectable using a GWAS alone.
Geriatric Interdisciplinary Team Training 2.0: A collaborative team-based approach to delivering care
Giuliante, M. M., Greenberg, S. A., McDonald, M. V., Squires, A., Moore, R., & Cortes, T. A. (2018). Journal of Interprofessional Care, 32(5), 1-5. 10.1080/13561820.2018.1457630
Abstract
Interprofessional collaborative education and practice has become a cornerstone of optimal person-centered management in the current complex health care climate. This is especially important when working with older adults, many with multiple chronic conditions and challenging health care needs. This paper describes a feasibility study of the Geriatric Interdisciplinary Team Training 2.0 (GITT 2.0) program focused on providing interprofessional care to complex and frail older adults with multiple chronic conditions. A concurrent triangulation mixed-methods design facilitated program implementation and evaluation. Over three years (2013-2016), 65 graduate students from nursing, midwifery, social work, and pharmacy participated along with 25 preceptors. Participants were surveyed on their attitudes toward interprofessional collaboration pre and post-intervention and participated in focus groups. While attitudes toward interprofessional collaboration did not change quantitatively, focus groups revealed changes in language and enhanced perspectives of participants. Based on the evaluation data, the GITT 2.0 Toolkit was refined for use in interprofessional education and practice activities related to quality initiatives.
Global Perspectives: A new look at international nursing
Newland, J. A. (2018). Nurse Practitioner, 43(12). 10.1097/01.NPR.0000547555.79012.7d
Group-based trajectory analysis of physical activity change in a US weight loss intervention
Imes, C. C., Zheng, Y., Mendez, D. D., Rockette-Wagner, B. J., Mattos, M. K., Goode, R. W., Sereika, S. M., & Burke, L. E. (2018). Journal of Physical Activity and Health, 15(11), 840-846. 10.1123/jpah.2017-0484
Abstract
BACKGROUND: The obesity epidemic is a global concern. Standard behavioral treatment including increased physical activity, reduced energy intake, and behavioral change counseling is an effective lifestyle intervention for weight loss.PURPOSE: To identify distinct step count patterns among weight loss intervention participants, examine weight loss differences by trajectory group, and examine baseline factors associated with trajectory group membership.METHODS: Both groups received group-based standard behavioral treatment while the experimental group received up to 30 additional, one-on-one self-efficacy enhancement sessions. Data were analyzed using group-based trajectory modeling, analysis of variance, chi-square tests, and multinomial logistic regression.RESULTS: Participants (N = 120) were mostly female (81.8%) and white (73.6%) with a mean (SD) body mass index of 33.2 (3.8) kg/m
2. Four step count trajectory groups were identified: active (>10,000 steps/day; 11.7%), somewhat active (7500-10,000 steps/day; 28.3%), low active (5000-7500 steps/day; 27.5%), and sedentary (<5000 steps/day; 32.5%). Percent weight loss at 12 months increased incrementally by trajectory group (5.1% [5.7%], 7.8% [6.9%], 8.0% [7.4%], and 13.63% [7.0%], respectively; P = .001). At baseline, lower body mass index and higher perceived health predicted membership in the better performing trajectory groups.
CONCLUSIONS: Within a larger group of adults in a weight loss intervention, 4 distinct trajectory groups were identified and group membership was associated with differential weight loss.
The growth and development of gerontological nurse leaders in policy
Perez, G. A., Mason, D. J., Harden, J. T., & Cortes, T. A. (2018). Nursing Outlook, 66(2), 168-179. 10.1016/j.outlook.2017.10.005
Abstract
Background: The National Hartford Center of Gerontological Nursing Excellence (NHCGNE) Scholars/Fellows Award Program was designed to promote the growth and development of nurse scientists, educators, and leaders in aging. Purpose: McBride's conceptual framework of the growth and development of nurse leaders was used to examine the NHCGNE impact on health and aging policy work among scholars/fellows, including barriers, facilitators, and resources. Methods: A multimethod two-phased approach included an online survey (phase I) focused on research and policy impact at local, state, or national level. Telephone interviews (phase II) were conducted to further understand the nature, depth, and focus of respondents’ policy work. Discussion: Based on our findings, we propose multilevel recommendations for advancing nurse scientists’ capacity to be leaders in shaping policy. Keen research skills are influential in policy advancement but not sufficient to advance policy. Preparing nurse scientists with competencies in translating research into policy can ultimately transform health and health care for older adults.
Hakuna matata: Our experiences as invited international nurse practitioner consultants in Dar es Salaam, Tanzania
Herrmann, L. L., & Brennan, M. (2018). Journal of the American Association of Nurse Practitioners, 30(10), 546-547. 10.1097/JXX.0000000000000102
Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association
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Abstract
Abstract
Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
Health professional training and capacity strengthening through international academic partnerships: The first five years of the human resources for health program in rwanda
Cancedda, C., Cotton, P., Shema, J., Rulisa, S., Riviello, R., Adams, L. V., Farmer, P. E., Kagwiza, J. N., Kyamanywa, P., Mukamana, D., Mumena, C., Tumusiime, D. K., Mukashyaka, L., Ndenga, E., Twagirumugabe, T., Mukara, K. B., Dusabejambo, V., Walker, T. D., Nkusi, E., … Binagwaho, A. (2018). International Journal of Health Policy and Management, 7(11), 1024-1039. 10.15171/ijhpm.2018.61
Abstract
Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
The health related quality of life of Puerto Ricans during cancer treatments; a pilot study
Gonzalez, V. J., McMillan, S., Pedro, E., Tirado-Gomez, M., & Saligan, L. N. (2018). Puerto Rico Health Sciences Journal, 37(1), 46-51.
Abstract
Objective: To examine the health related quality of life (HRQOL) experienced by 79 Puerto Rican adults during cancer treatments. Methods: This study used a descriptive, cross-sectional design. Participants completed a demographics form and the Functional Assessment of Cancer Therapy-General QOL questionnaire (FACT-G). Descriptive statistics were generated. Results: Participants were ages 28-78; most of the participants had breast (38.0%), prostate (14.0%) and cervical and ovarian cancers (10.1%) treated with chemotherapy (45.6%). The participants had a mean total score on the FACT-G of 75.2 (SD = 18.9). As a group, the functional well-being was the most affected (mean 17.2, SD 6.8), and the Social/Familial was the least affected (mean 20.7, SD 6.0). Conclusion: Cancer is the leading cause of death in the island of Puerto Rico. Female Puerto Rican cancer patients in this study sample had increased risk for experiencing worse: overall HRQOL, physical well-being and emotional well-being compared to males. Given that the Hispanic oncology population does not always report symptoms, risking under-assessment and under-management, this suggests there may be a greater need for HRQOL surveillance for this population.
Healthcare professionals perceptions of neglect of older people in Mexico: A qualitative secondary analysis
Caceres, B. A., Bub, L., Negrete, M., Giraldo Rodríguez, L., & Squires, A. (2018). International Journal of Older People Nursing, 13(1), e12168. 10.1111/opn.12168
Abstract
Aims and objectives: To describe healthcare professionals’ perceptions of neglect of older people in Mexico. Background: Mistreatment of older people, particularly neglect, has emerged as a significant public health concern worldwide. However, few studies have been conducted to examine neglect of older people in low- and middle-income countries. Most research has focused on estimating the prevalence of neglect in older populations with little emphasis on the perceptions of healthcare professionals and their role in addressing neglect of older people. Design: Qualitative secondary analysis. Methods: The parent study consisted of nine focus groups conducted with healthcare professionals at five public hospitals in Mexico. The purpose of the parent study was to perform a needs assessment to determine the feasibility of adapting the Nurses Improving Care for Healthsystem Elders programme to Mexico. A qualitative secondary analysis with directed content analysis approach was used to extract data related to neglect of older people. Results: A total of 89 participants representing healthcare professionals from several disciplines were interviewed. Three themes emerged: (i) The main point is not here; (ii) We feel hopeless; and (iii) We need preparation. Participants reported distress and hopelessness related to neglect of older people. Lack of community-based resources was noted as contributing to neglect. Increased education regarding care of older people for both caregivers and healthcare professionals and greater interdisciplinary collaboration were identified as potential solutions to combat neglect. Conclusions: Community-based services and resource allocation need to be re-evaluated to improve the care of older Mexicans. Interdisciplinary models of care should be developed to address concerns related to neglect of older people. Implications for practice: Neglect negatively impacts healthcare professionals’ ability to adequately care for older patients. There is a need to invest in community-based services and models of care to address these concerns.
Heavy Alcohol Use Among Migrant and Non-Migrant Male Sex Workers in Thailand: A Neglected HIV/STI Vulnerability
Guadamuz, T. E., Clatts, M. C., & Goldsamt, L. A. (2018). Substance Use and Misuse, 53(11), 1907-1914. 10.1080/10826084.2018.1436564
Abstract
Background: There is scarce research on male sex workers in the context of alcohol use. While heavy alcohol use has been established as a risk factor for HIV and STI infections among men who have sex with men (MSM), men who engage in sex work with other men, particularly from the Global South, have not been included in these studies. Moreover, studies among male sex workers in Asia often do not explore migration contexts of these men. Objectives: The objective of this exploratory study is to examine the prevalence and correlates of heavy alcohol use among migrant and non-migrant male sex workers in Bangkok and Pattaya, Central Thailand. Methods: Between August and October 2015, 18–24 year-old migrant and non-migrant male sex workers (n = 212) were recruited from various male sex work-identified venues (bars, clubs, massage parlors, and go-go bars) to take an interviewer-administered cross-sectional survey in Bangkok and Pattaya, Thailand. Measures were adapted from previous studies in similar populations and included structured questions across four domains, including demographic characteristics, alcohol use, stimulant use, and sexual behaviors. Multivariable logistic regression assessed the independent associations between heavy alcohol use (heavy versus not heavy) and demographic characteristics, stimulant use and sexual behavior. Results: Heavy alcohol use was prevalent among one-third of participants. Heavy alcohol use was positively associated with male sex workers who were non-migrant and Thai, currently using stimulants, having 15 or more male clients in the past month and having first consumed alcohol at age 15 years or younger. Conclusions: Current HIV prevention efforts should consider subpopulations of MSM, including male sex workers and migrants, as well as other risk behaviors like alcohol, as important contexts for HIV and STI risks.
Hepatic Failure
Chen, L., & Lim, F. (2018). In Handbook of Clinical Nursing: Critical and Emergency Care Nursing (1–, pp. 153-157). Springer.
Hepatic Failure
Chen, L., & Lim, F. (2018). In A Guide to Mastery in Clinical Nursing: The Comprehensive Reference (1–, pp. 89-92). Springer.
HIV and other STIs in male sex workers: Findings from a sexual health promotion intervention in Vietnam
Goldsamt, L. A., Clatts, M. C., Giang, L. M., Le, B. Q., Colby, D. J., & Yu, G. (2018). International Journal of STD and AIDS, 29(6), 540-546. 10.1177/0956462417740291
Abstract
Male sex workers (MSWs) in Vietnam are at high risk for acquisition and transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), yet are extremely disengaged from the healthcare system. This contributes to large numbers of untreated or late-treated infections and increased secondary transmission. We enrolled 995 MSWs in Hanoi and Ho Chi Minh City (HCMC) in a Sexual Health Promotion intervention that included face-to-face delivery of seven content modules, a clinical examination and testing for HIV, syphilis, gonorrhea and Chlamydia. Onsite treatment was provided for STIs, and those who tested positive for HIV were referred to local treatment centers. While 64.6% of participants had never been to a health service and fewer than half (41.2%) had ever been tested for HIV, 67.1% returned for test results. This testing identified 109 (11.0%) participants who were HIV-positive and 312 (31.4%) who tested positive for at least one other STI. Substantive differences were seen in MSWs from different cities, with those from Hanoi more likely to have ever visited a health service (57.8% vs. 24.9%) and to have taken a prior HIV test (54.1% vs. 37.9%) than those in HCMC. Sexual health promotion is a promising approach to engaging MSWs in health services.
HIV and symptoms of depression are independently associated with impaired glucocorticoid signaling
Bekhbat, M., Mehta, C. C., Kelly, S. D., Vester, A., Ofotokun, I., Felger, J., Wingood, G., Anastos, K., Gustafson, D. R., Kassaye, S., Milam, J., Aouizerat, B., Weber, K., Golub, E. T., Moore, M. F., Diclemente, R., Fischl, M., Kempf, M. C., Maki, P., & Neigh, G. N. (2018). Psychoneuroendocrinology, 96, 118-125. 10.1016/j.psyneuen.2018.06.013
Abstract
Chronic inflammation caused by HIV infection may lead to deficient glucocorticoid (GC) signaling predisposing people living with HIV to depression and other psychiatric disorders linked to GC resistance. We hypothesized that comorbid HIV and depressive symptoms in women would synergistically associate with deficits in GC signaling. This cross-sectional study used samples obtained from the Women's Interagency HIV Study (WIHS). The Centers for Epidemiological Studies (CES-D) was used to define depression in four groups of women from the Women's Interagency HIV Study (WIHS): 1) HIV-negative, non-depressed (n = 37); 2) HIV-negative, depressed (n = 34); 3) HIV-positive, non-depressed (n = 38); and 4) HIV-positive, depressed (n = 38). To assess changes in GC signaling from peripheral blood mononuclear cells (PBMCs), we examined baseline and dexamethasone (Dex)-stimulated changes in the expression of the GC receptor (GR, gene: Nr3c1) and its negative regulator Fkbp5 via quantitative RT-PCR. GR sensitivity was evaluated in vitro by assessing the Dex inhibition of lipopolysaccharide (LPS)-stimulated IL-6 and TNF-α levels. Depressive symptoms and HIV serostatus were independently associated with elevated baseline expression of Fkbp5 and Nr3c1. Depressive symptoms, but not HIV status, was independently associated with reduced LPS-induced release of IL-6. Counter to predictions, there was no interactive association of depressive symptoms and HIV on any outcome. Comorbid depressive symptoms with HIV infection were associated with a gene expression and cytokine profile similar to that of healthy control women, a finding that may indicate further disruptions in disease adaptation.
HIV Testing and Associated Factors Among Men Who Have Sex with Men in Changsha, China
Zhou, J., Chen, J., Goldsamt, L., Wang, H., Zhang, C., & Li, X. (2018). Journal of the Association of Nurses in AIDS Care, 29(6), 932-941. 10.1016/j.jana.2018.05.003
Abstract
Promoting HIV testing is an important strategy to end the HIV epidemic. HIV incidence among men who have sex with men (MSM) has increased rapidly in China in recent years, but HIV testing rates are still low. Our cross-sectional study investigated HIV testing rates and analyzed associated factors in 565 MSM in Changsha between April and December 2014. In the previous year, 37.7% of participants had not been tested, 38.2% had had one test, and 24.1% had had two or more tests. Those who initiated sexual debut at an older age, had known someone infected with HIV, or had been diagnosed with a sexually transmitted illness (STI) were more likely to have had an HIV test. HIV intervention programs in China should focus on sexually active young MSM, integrate HIV testing and counseling services in STI clinics, and describe real experiences of living with HIV to improve HIV testing in MSM.
Hospital's organizational culture and leadership style of health care professionals in the context of health care system in transition: cross sectional survey.
Blaževičiene, A., Newland, J. A., Bagdoniene, L., Juknelis, K., & Vanckaviciene, A. (2018). In J. Rakova & M. S. Soosova (Eds.), Aktualine poziadavky rozvoja profesie sestry (1–, p. 9). Pavol Jozef Safarik University.
How skilled do Israeli nurses perceive themselves to be in providing palliative care? Results of a national survey
Feder, S. L., Collett, D., Conley, S., Schulman-Green, D., Meron, T., & Cherny, N. (2018). International Journal of Palliative Nursing, 24(2), 56-63. 10.12968/ijpn.2018.24.2.56
Abstract
BACKGROUND: In Israel, palliative care (PC) services are limited. This study assessed Israeli nurses' perceived competencies and educational needs in providing PC.DESIGN: Online administration of the End-of-Life Professional Caregiver Survey (EPCS).SETTING/SUBJECTS: Oncology and PC nurses were identified through the Israel Ministry of Health and Oncology Nurses' Society.MEASUREMENTS: Demographic and practice data were analysed using analysis of variance tests to determine differences between nurse characteristics by EPCS domains.RESULTS: The sample (n=105) was 94% female, had a mean age of 48 years (SD=10.5) and 83% were Jewish Israeli. Thirty-nine percent reported PC training in nursing school and 42% felt their workplace provided little to no PC education and resources to nurses. Those with advanced degrees and those who received post-graduate PC training had higher mean scores across EPCS domains (p<0.05 for all).CONCLUSIONS: Nursing education and workplace support in PC for Israeli nurses are limited. It is hoped that these findings may inform future PC nursing education and policy in Israel.
Identification of diabetes risk in dental settings: Implications for physical and mental health
Rosedale, M. T., Strauss, S. M., Kaur, N., Danoff, A., & Malaspina, D. (2018). International Journal of Mental Health, 47(1), 64-73. 10.1080/00207411.2017.1377803
Abstract
The risk for diabetes is significantly elevated in persons who are older, overweight, and have serious mental illness. However, primary care practitioners (PCP) tend to underestimate this risk. Although there are few opportunities for early detection of diabetes, blood exuded during routine oral exams in dental settings can be used to assess glycated hemoglobin (HbA1c) levels. The current study sought to understand how primary care practitioners would react to patients who screened positive for elevated HbA1c, how they estimated risk, and whether they provided treatment recommendations or counseling. Semistructured telephone interviews were conducted on 61 subjects three months after demonstrating elevated HbA1c levels from dental screenings. Data were transcribed and analyzed using content analysis. Qualitative analyses revealed the following four themes according to patients: (1) “Being told I needed to make lifestyle changes” (41%); (2) Realizing I needed a new health care provider or medication change” (10%); (3) “Being told of the need for monitoring but no counseling/treatment change” (16%); and (4) “Being told everything is fine and there is nothing to worry about” (31%). Only half of the 61 cases reporting elevated HbA1c levels at screening experienced their PCP’s as responding with counseling or medication changes. Almost a third of cases perceived that their PCP’s dismissed the results, making no recommendations, and the rest perceived no counseling or interventions being proposed. Based on subjects’ perceptions of their PCP’s responses to their elevated HbA1c values, the impact of this intervention is substantially reduced over expectations.
Identifying and intercepting behavioral health problems in infancy
Hallas, D. (2018). In Behavioral Pediatric Healthcare for Nurse Practitioners (1–, pp. 69-81). Springer Publishing Company. 10.1891/9780826116819.0006
Abstract
Infancy is a wonderful time for healthy parents and healthy infants to grow together within healthy home and community environments that support the social-emotional development of infants, thus establishing the foundation for lifelong behavioral and mental health. Pediatric primary care providers (P-PCPs) must acknowledge the paradigm shift to attain behavioral health for all by viewing behavioral health as beginning at the moment of conception and existing on a continuum throughout the life span, delicately balancing between behavioral/mental health and well-being versus behavioral health disorders/mental illness and malady. This chapter examines, analyzes, and evaluates the best available evidence to identify and intercept behavioral health problems prior to conception, post-delivery, and during the first year of life. P-PCPs must assess the mother-infant bonding and attachment relationship, maternal nurturing behaviors, and maternal responses to the infant, as well as the infant’s social-emotional developmental patterns, at every primary care encounter.
Immunizations for Older Adults: Try this: Best Practices in Nursing Care to Older Adults
Taub, L.-F. (2018). Online: Try This Series.
Implementation of Online Opioid Prevention, Recognition and Response Trainings for Laypeople: Year 1 Survey Results
Simmons, J., Rajan, S., Goldsamt, L. A., & Elliott, L. (2018). Substance Use and Misuse, 53(12), 1997-2002. 10.1080/10826084.2018.1451891
Abstract
Background: This article reports on the first implementation of an online opioid-overdose prevention, recognition and response training for laypeople. The training was disseminated nationally in November 2014. Between 2000 and 2014, U.S. opioid deaths increased by 200%. The importance of complementary approaches to reduce opioid overdose deaths, such as online training, cannot be overstated. Objectives: A retrospective evaluation was conducted to assess perceived knowledge, skills to intervene in an overdose, confidence to intervene, and satisfaction with the training. Measurements: Descriptive statistics were used to report sample characteristics, compare experiences with overdose and/or naloxone between subgroups, and describe participants’ satisfaction with the trainings. Z-ratios were used to compare independent proportions, and paired t-tests were used to compare participant responses to items pre- and posttraining, including perceived confidence to intervene and perceived knowledge and skills to intervene successfully. Results: Between January and October 2015, 2,450 laypeople took the online training; 1,464 (59.8%) agreed to be contacted. Of these, 311 (21.2% of those contacted) completed the survey. Over 80% reported high satisfaction with content, format and mode of delivery and high satisfaction with items related to confidence and overdose reversal preparedness. Notably, 89.0% of participants felt they had the knowledge and skills to intervene successfully posttraining compared to 20.3% pretraining (z = −17.2, p <.001). Similarly, posttraining, 87.8% of participants felt confident they could successfully intervene compared to 24.4% pretraining (z = −15.9, p <.001). Conclusions: This study demonstrates the effectiveness of the GetNaloxoneNow.org online training for laypeople.
In Children With Nonalcoholic Fatty Liver Disease, Zone 1 Steatosis Is Associated With Advanced Fibrosis
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Abstract
Abstract
Background & Aims: Focal zone 1 steatosis, although rare in adults with nonalcoholic fatty liver disease (NAFLD), does occur in children with NAFLD. We investigated whether focal zone 1 steatosis and focal zone 3 steatosis are distinct subphenotypes of pediatric NAFLD. We aimed to determine associations between the zonality of steatosis and demographic, clinical, and histologic features in children with NAFLD. Methods: We performed a cross-sectional study of baseline data from 813 children (age <18 years; mean age, 12.8 ± 2.7 years). The subjects had biopsy-proven NAFLD and were enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network. Liver histology was reviewed using the Nonalcoholic Steatohepatitis Clinical Research Network scoring system. Results: Zone 1 steatosis was present in 18% of children with NAFLD (n = 146) and zone 3 steatosis was present in 32% (n = 244). Children with zone 1 steatosis were significantly younger (10 vs 14 years; P <.001) and a significantly higher proportion had any fibrosis (81% vs 51%; P <.001) or advanced fibrosis (13% vs 5%; P <.001) compared with children with zone 3 steatosis. In contrast, children with zone 3 steatosis were significantly more likely to have steatohepatitis (30% vs 6% in children with zone 1 steatosis; P <.001). Conclusions: Children with zone 1 or zone 3 distribution of steatosis have an important subphenotype of pediatric NAFLD. Children with zone 1 steatosis are more likely to have advanced fibrosis and children with zone 3 steatosis are more likely to have steatohepatitis. To achieve a comprehensive understanding of pediatric NAFLD, studies of pathophysiology, natural history, and response to treatment should account for the zonality of steatosis.