Publications

Abstract

The NIDA funded Substance Abuse Education, Research and Training (SARET) Program addresses the compelling need for health professionals prepared to engage in substance use disorders (SUD) research. The goal of this interprofessional project, structured by an Executive Committee of co-investigators from the disciplines of medicine, nursing, social work and dentistry, is to increase the skills of students from each discipline for interprofessional research collaboration and early career-development opportunities in SUD research. The development of web-based modules, interprofessional seminars and a model mentorship program were designed as well, for dissemination and evaluation by other health professional schools. The educational format is 6 interactive web-based learning modules, providing an overview of core content on Substance Use Disorders (SUD), summer or year-long mentored research experiences with NIH-funded researchers and small interprofessional seminars and site visits. Assessment consists of self-reported annual student learning outcomes and external editorial and advisory board project and curricular materials review. These reviews encourages the updating of materials and provide flexibility for participating “champions” at other schools who use the modules. Quantitative and qualitative outcomes of student research activities and data on dissemination of modules support the fit between project content and interprofessional teaching modalities. The learning modules are available without charge to individuals, students, faculty or health professional programs from the project's website.

Abstract

Although coronary heart disease (CHD) requires a significant amount of self-care, there are no instruments available to measure self-care in this population. The purpose of this study was to test the psychometric properties of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI). Using the Self-Care of Chronic Illness theory, we developed a 22-item measure of maintenance, management, and confidence appropriate for persons with stable CHD and tested it in a convenience sample of 392 adults (62% male, mean age 61.4 ± 9.6 years). Factorial validity was tested with confirmatory factor analysis. Convergent validity was tested with the Medical Outcomes Study MOS-SAS Specific Adherence Scale and the Decision Making Competency Inventory (DMCI). Cronbach alpha and factor determinacy scores (FDS) were calculated to assess reliability. Two multidimensional self-care scales were confirmed: self-care maintenance included “consultative behaviors” (e.g., taking medicines as prescribed) and “autonomous behaviors” (e.g., exercising 30 minute/day; FDS =.87). The multidimensional self-care management scale included “early recognition and response” (e.g., recognizing symptoms) and “delayed response” (e.g., taking an aspirin; FDS =.76). A unidimensional confidence factor captured confidence in each self-care process (α =.84). All the self-care dimensions were associated with treatment adherence as measured by the MOS-SAS. Only self-care maintenance and confidence were associated with decision-making (DCMI). These findings support the conceptual basis of self-care in patients with CHD as a process of maintenance that includes both consultative and autonomous behaviors, and management with symptom awareness and response. The SC-CHDI confidence scale is promising as a measure of self-efficacy, an important factor influencing self-care.

Abstract

Background: Hypertension (HTN) is a global public health issue. Self-care is an essential component of HTN treatment, but no instruments are available with which to measure self-care of HTN. Objectives: The purpose of this study is to test the psychometric properties of the Self-care of Hypertension Inventory (SC-HI). Methods: Using the Self-care of Chronic Illness theory, we developed a 24-item measure of maintenance, monitoring, and management appropriate for persons with chronic HTN, tested it for content validity, and then tested it in a convenience sample of 193 adults. Exploratory factor analysis was used to identify measure structure. Cronbach's α and factor determinacy scores and were used to assess reliability. Validity was tested with the Medical Outcomes Study General Adherence Scale and the Decision Making Competency Inventory. Results: Seventy percent of the sample was female; mean age was 56.4 ± 13 years; mean duration of HTN was 11 ± 9 years. Removal of 1 item on alcohol consumption resulted in a unidimensional self-care maintenance factor with acceptable structure and internal consistency (α =.83). A multidimensional self-care management factor included "consultative" and "autonomous" factors (factor determinacy score = 0.75). A unidimensional confidence factor captured confidence in and persistence with each aspect of self-care (α =.83). All the self-care dimensions in the final 23-item instrument were associated with treatment adherence and several with decision making. Conclusion: These findings support the conceptual basis of self-care in patients with HTN as a process of maintenance, monitoring, and management. The SC-HI confidence scale is promising as a measure of self-efficacy in self-care.

Abstract

Background: Disparities exist in the rates of preterm birth and infant mortality across different racial/ethnic groups. However, only a few studies have examined the impact of race/ethnicity on the outcomes of premature infants. Objective: To report the rates of mortality and severe neonatal morbidity among multiple gestational age (GA) groups stratified by race/ethnicity. Methods: A retrospective cohort study utilizing linked birth certificate, hospital discharge, readmission, and death records up to 1 year of life. Live-born infants ≤36 weeks born in the period 2007-2012 were included. Maternal self-identified race/ethnicity, as recorded on the birth certificate, was used. ICD-9 diagnostic and procedure codes captured neonatal morbidities (intraventricular hemorrhage, retinopathy of prematurity, periventricular leukomalacia, bronchopulmonary dysplasia, and necrotizing enterocolitis). Multiple logistic regression was performed to evaluate the impact of race/ethnicity on mortality and morbidity, adjusting for GA, birth weight, sex, and multiple gestation. Results: Our cohort totaled 245,242 preterm infants; 26% were white, 46% Hispanic, 8% black, and 12% Asian. At 22-25 weeks, black infants were less likely to die than white infants (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.62-0.94). However, black infants born at 32-34 weeks (OR 1.64; 95% CI 1.15-2.32) or 35-36 weeks (OR 1.57; 95% CI 1.00-2.24) were more likely to die. Hispanic infants born at 35-36 weeks were less likely to die than white infants (OR 0.66; 95% CI 0.50-0.87). Racial disparities at different GAs were also detected for severe morbidities. Conclusions: The impact of race/ethnicity on mortality and severe morbidity varied across GA categories in preterm infants. Disparities persisted even after adjusting for important potential confounders.

Abstract

Background: Despite a body of evidence on racial/ethnic minority enrollment and retention in research, literature specifically focused on recruiting racially/ethnically diverse older adults for social science studies is limited. There is a need for more rigorous research on methodological issues and the efficacy of recruitment methods. Cultural obstacles to recruitment of racial/ethnic minority older adults include language barriers, lack of cultural sensitivity of target communities on the part of researchers, and culturally inappropriate assessment tools. Methods: Guided by the Consolidated Framework for Implementation Research (CFIR), this study critically appraised the recruitment of racial/ethnic minority older adults for focus groups. The initial approach involved using the physical and social infrastructure of the ElderSmile network, a community-based initiative to promote oral and general health and conduct health screenings in places where older adults gather, to recruit racial/ethnic minority adults for a social science component of an interdisciplinary initiative. The process involved planning a recruitment strategy, engaging the individuals involved in its implementation (opinion leaders in senior centers, program staff as implementation leaders, senior community-based colleagues as champions, and motivated center directors as change agents), executing the recruitment plan, and reflecting on the process of implementation. Results: While the recruitment phase of the study was delayed by 6 months to allow for ongoing recruitment and filling of focus group slots, the flexibility of the recruitment plan, the expertise of the research team members, the perseverance of the recruitment staff, and the cultivation of change agents ultimately resulted in meeting the study targets for enrollment in terms of both numbers of focus group discussions (n = 24) and numbers of participants (n = 194). Conclusions: This study adds to the literature in two important ways. First, we leveraged the social and physical infrastructure of an existing program to recruit participants through community sites where older adults gather. Second, we used the CFIR to guide the appraisal of the recruitment process, which underscored important considerations for both reaching and engaging this underserved population. This was especially true in terms of understanding the disparate roles of the individuals involved in implementing and facilitating the recruitment plan.

Abstract

Objective:Examine the risk of preterm birth (PTB) among women who use drugs during pregnancy and have elevated-fetoprotein (AFP).Study Design:The sample included California singleton live births in 2005 to 2010 contained within a hospital discharge database linked to the Prenatal Screening Program. A selection of mothers who did not use drugs was selected at a ratio of 4:1. Risk of PTB was calculated using adjusted odds ratios and 95% confidence intervals (CIs) for women who did or did not use drugs by their AFP percentile.Results:We identified 7190 women who used drugs and selected 28 760 women who did not. Of women using cocaine with AFP ≥95th percentile, 43.8% delivered prematurely. Women using drugs with AFP ≥95th percentile were 11 to 35 times as likely to deliver <32 weeks.Conclusion:The combination of drug use and elevated AFP results in high rates of PTB. This combination results in an additive risk.

Abstract

There is well-established literature indicating change in partner as a risk for preeclampsia, yet the research on the risk of preterm birth after a change in partners has been sparse and inconsistent. Using a population of California live born singletons, we aimed to determine the risk of preterm birth after a change in partner between the first and second pregnancies. The risk of preterm and early term delivery in the second pregnancy was calculated for mothers who did or did not change partners between births with the referent group as women who delivered both pregnancies at term and did not change partners. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Relative to women who delivered at 39 weeks or later in the second pregnancy and did not change partners, preterm birth risks were somewhat lower for women who changed partners between the first and second pregnancies compared to those women who did not change partners. For example, 10.6% of women who did not change partners and delivered their second pregnancy before 34 weeks also delivered their first pregnancy before 34 weeks, while 8.5% of women who changed partners delivered before 34 weeks. Findings suggest partner change may alter the risk of preterm birth.

Abstract

Background: To assess the extent of self-awareness of gum disease among adults in the United States. Methods: Data were from the 2009-2012 National Health and Nutrition Examination Survey. The outcome variable is self-awareness of gum disease. Multivariate logistic regression models were used to examine the relationship between self-awareness and clinically diagnosed periodontitis. The analytical sample included 6876 participants. Results: Among those participants (30 years or older) who were classified as having periodontitis, 27% (95% confidence interval [CI], 24.4-29.8) were self-aware of the disease (positive predicted value = 25%). Of those who self-reported having gum disease, 14.1% had a diagnosis of periodontitis (sensitivity = 75%). Older adults were less likely to be aware of gum disease (P <.05). Non-Hispanic blacks (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.53-0.85) were less likely to be aware of the disease than non-Hispanic whites. Adults with diabetes (AOR = 1.61; 95% CI, 1.25-2.06), or with lung disease (AOR = 1.61; 95% CI, 1.25-2.08), or current smokers (AOR = 1.72; 95% CI, 1.29-2.31) were more likely to be aware of the disease. Conclusion: The study showed that self-awareness of gum disease among adults was low. Our study findings suggest that there is a great need to improve oral health knowledge and awareness among the adult population in the United States.

Abstract

Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.

Abstract

Objectives: To investigate whether A) duration of ulcer before start of treatment in specialist health care, and B) severity of ulcer according to University of Texas classification system (UT) at start of treatment (baseline), are independent predictors of healing time. Methods: This retrospective cohort study, based on electronic medical record data, included 105 patients from two outpatient clinics in Western Norway with a new diabetic foot ulcer during 2009-2011. The associations of duration of ulcer and ulcer severity with healing time were assessed using cumulative incidence curves and subdistribution hazard ratio estimated using competing risk regression with adjustment for potential confounders. Results: Of the 105 participants, 45.7% achieved ulcer healing, 36.2% underwent amputations, 9.5% died before ulcer healing and 8.5% were lost to follow-up. Patients who were referred to specialist health care by a general practitioner ≥ 52 days after ulcer onset had a 58% (SHR 0.42, CI 0.18-0.98) decreased healing rate compared to patients who were referred earlier, in the adjusted model. High severity (grade 2/3, stage C/D) according to the UT classification system was associated with a decreased healing rate compared to low severity (grade1, stage A/B or grade 2, stage A) with SHR (95% CI) equal to 0.14 (0.05-0.43) after adjustment for referral time and other potential confounders. Conclusion: Early detection and referral by both the patient and general practitioner are crucial for optimal foot ulcer healing. Ulcer grade and severity are also important predictors for healing time, and early screening to assess the severity and initiation of prompt treatment is important.

Abstract

OBJECTIVE: To test the hypothesis that sleep disorder diagnosis would be associated with increased risk of preterm birth and to examine risk by gestational age, preterm birth type, and specific sleep disorder (insomnia, sleep apnea, movement disorder, and other). METHODS: In this observational study, participants were from a cohort of nearly 3 million women in California between 2007 and 2012. Inclusion criteria were women with singleton neonates liveborn between 20 and 44 weeks of gestation without chromosomal abnormalities or major structural birth defects linked to a hospital discharge database maintained by the California Office of Statewide Health Planning and Development and without mental illness during pregnancy. Sleep disorder was defined based on International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code (n=2,265). Propensity score matching was used to select a referent population at a one-to-one ratio. Odds of preterm birth were examined by gestational age (less than 34 weeks, 34-36 weeks, and less than 37 weeks of gestation) and type (spontaneous, indicated). RESULTS: Prevalence of preterm birth (before 37 weeks of gestation) was 10.9% in the referent group compared with 14.6% among women with a recorded sleep disorder diagnosis. Compared with the referent group, odds (95% CI, P value, percentage) of preterm birth were 1.3 (1.0-1.7, P=.023, 14.1%) for insomnia and 1.5 (1.2-1.8, P<.001, 15.5%) for sleep apnea. Risk varied by gestational age and preterm birth type. Odds of preterm birth were not significantly increased for sleep-related movement disorders or other sleep disorders. CONCLUSION: Insomnia and sleep apnea were associated with significantly increased risk of preterm birth. Considering the high prevalence of sleep disorders during pregnancy and availability of evidence-based nonpharmacologic interventions, current findings suggest that screening for severe presentations would be prudent.

Abstract

Background: Limited research is available on the relationship between social support, social strain, and cognitive function among community-dwelling U.S. Chinese older adults. This study aims to examine the associations between social support/strain and cognitive outcomes. Methods: Data were drawn from the Population-Based Study of Chinese Elderly (N = 3,159). Cognitive function was measured by a battery of tests including the East Boston Memory Test, the Digit Span Backwards assessment, and the Symbol Digit Modalities Test. Social support and strain were measured by the scales drawn from the Health and Retirement study. Multiple regression analyses were conducted. Results: Social support was significantly associated with global cognitive function (β = .11, SE = .02, p < .001), episodic memory (β = .11, SE = .03, p < .001), working memory (β = .18, SE = .08, p < .05), and executive function (β = 1.44, SE = .37, p < .001). Social strain was significantly associated with global cognitive function (β = .23, SE = .05, p < .001), episodic memory (β = .27, SE = .07, p < .001), working memory (β = .34, SE = .17, p < .05), and executive function (β = 2.75, SE = .85, p < .01). In terms of sources of social support/strain, higher support from friends was significantly associated with higher global cognitive function (β = .04, SE = .02, p < .05), higher episodic memory (β = .05, SE = .02, p < .05), and higher executive function (β = .71, SE = .29, p < .05). Higher strain from spouse was significantly associated with higher global cognitive function (β = .10, SE = .03, p < .01), higher episodic memory (β = .11, SE = .04, p < .01), and higher executive function (β = 1.28, SE = .49, p < .01). Higher strain from friends was significantly associated with higher executive function (β = 3.59, SE = 1.17, p < .01). Conclusions: Social support and strain were associated with cognitive outcomes. Future longitudinal studies should be conducted.

Abstract

Purpose During the toddler years, temper tantrums and impulsive behaviors are the norm. These behaviors can frustrate even the most experienced mothers. Design and Methods A prospective, double blind, randomized controlled trial using pre-test/post-test experimental design was used to examine the effectiveness of an office-based educational program to improve maternal confidence and the social-emotional development of toddlers. The Toddler Care Questionnaire (TCQ) was administered to all mothers as a pre and post intervention test. The treatment intervention was a videotaped (DVD) parenting skills intervention on the social-emotional development of toddlers and on maternal confidence in caring for toddlers. Results Sixty mothers and 60 toddlers entered the study with 29 mothertoddler dyads randomized to the treatment group and 31 to the control group. Twenty-six (26) mother-toddler dyads in the treatment and 25 mother-toddler dyads in the control group completed the study. Pairwise comparisons of adjusted means showed significant improvements for both toddler groups on the Brigance toddler screen, and no statistically significant difference in gains between the groups. The mixed model results for the TCQ showed an overall significant improvement from preto post-test, and a non-significant interaction between group and time indicting no significant difference in gains seen by treatment groups. Conclusions Brief educational programs on DVD's are an efficient way to offer information to mothers while in the office waiting area. Practice Implications: Pediatric nurses who encounter mothers who struggle with caring for their toddlers may find brief-office based interventions a valuable tool for educating parents.

Abstract

Study Objectives: Sudden unexpected death during sleep (SUDS) is the most common cause of death in patients with familial dysautonomia (FD), an autosomal recessive disease characterized by sensory and autonomic dysfunction. It remains unknown what causes SUDS in these patients and who is at highest risk. We tested the hypothesis that SUDS in FD is linked to sleep-disordered breathing. Methods: We retrospectively identified patients with FD who died suddenly and unexpectedly during sleep and had undergone polysomnography within the 18-month period before death. For each case, we sampled one age-matched surviving subject with FD that had also undergone polysomnography within the 18-month period before study. Data on polysomnography, EKG, ambulatory blood pressure monitoring, arterial blood gases, blood count, and metabolic panel were analyzed. Results: Thirty-two deceased cases and 31 surviving controls were included. Autopsy was available in six cases. Compared with controls, participants with SUDS were more likely to be receiving treatment with fludrocortisone (odds ratio [OR]; 95% confidence interval) (OR 29.7; 4.1-213.4), have untreated obstructive sleep apnea (OR 17.4; 1.5-193), and plasma potassium levels <4 mEq/L (OR 19.5; 2.36-161) but less likely to use noninvasive ventilation at night (OR 0.19; 0.06-0.61). Conclusions: Initiation of noninvasive ventilation when required and discontinuation of fludrocortisone treatment may reduce the high incidence rate of SUDS in patients with FD. Our findings contribute to the understanding of the link between autonomic, cardiovascular, and respiratory risk factors in SUDS.

Abstract

Background: Prostate cancer is the most frequently diagnosed cancer in men in Puerto Rico, and external beam radiation therapy (EBRT) is a popular treatment. Although symptom management is a clinical priority of comprehensive oncology care, symptom assessment at the time of primary or adjuvant EBRT has received limited attention. Objectives: This article examines the prevalence and severity of symptoms experienced by 54 Puerto Rican men prior to EBRT. Methods: Participants completed a demographic form and the MD Anderson Symptom Inventory. Descriptive statistics were generated. Findings: Most participants had received hormonal treatment, and about a third had received no treatment prior to EBRT. About a third of those who received hormonal treatment reported experiencing side effects before EBRT, and disturbed sleep, numbness and tingling, fatigue, and dry mouth were the most severe. Puerto Rican men with prostate cancer who receive hormonal treatment are at increased risk for experiencing symptom burden prior to EBRT. Greater need for symptom surveillance, treatment, and control may be needed among this population.

Abstract

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.