Publications

Abstract

Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.

Abstract

Health care-associated infections are a leading cause of morbidity and mortality in US nursing home residents. Ongoing training of nursing home staff is vital to the implementation of infection prevention and control processes. Our aim was to describe associations between methods, frequency, and timing of staff infection prevention and control training and infection-related quality measures. In this national survey of nursing homes, timing of staff infection prevention and control training was associated with reduced indwelling urinary catheter use.

Abstract

Irritable bowel syndrome (IBS) is a common, chronic gastrointestinal (GI) condition characterized by disturbances in bowel habits and abdominal pain in the absence of known organic pathology. IBS reduces quality of life and is costly to treat. It is diagnosed using the symptom-based Rome criteria for functional GI disorders, which was recently updated and released as Rome IV. Both physiologic and psychological variables play a role in the etiology of IBS and perpetuate symptoms. Although research has shed light on IBS pathophysiology, therapeutic interventions remain symptom driven, employing both pharmacologic and nonpharmacologic approaches. Here, the authors review the epidemiology and pathophysiology of IBS, summarize diagnostic and treatment strategies, and discuss implications for nursing practice.

Abstract

Objectives To examine the distribution of birth weight in children with nonalcoholic fatty liver disease (NAFLD) compared with the general US population, and to investigate the relationship between birth weight and severity of NAFLD. Study design A multicenter, cross-sectional study of children with biopsy-proven NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network Database. Birth weight was categorized as low birth weight (LBW), normal birth weight (NBW), or high birth weight (HBW) and compared with the birth weight distribution in the general US population. The severity of liver histology was assessed by birth weight category. Results Children with NAFLD (n = 538) had overrepresentation of both LBW and HBW compared with the general US population (LBW, 9.3%; NBW, 75.8%; HBW, 14.9% vs LBW, 6.1%; NBW, 83.5%; HBW 10.5%; P <.0001). Children with HBW had significantly greater odds of having more severe steatosis (OR, 1.82, 95% CI. 1.15-2.88) and nonalcoholic steatohepatitis (OR, 2.03; 95% CI, 1.21-3.40) compared with children with NBW. In addition, children with NAFLD and LBW had significantly greater odds of having advanced fibrosis (OR, 2.23; 95% CI, 1.08-4.62). Conclusion Birth weight involves maternal and in utero factors that may have long-lasting consequences. Children with both LBW and HBW may be at increased risk for developing NAFLD. Among children with NAFLD, those with LBW or HBW appear to be at increased risk for more severe disease.

Abstract

Objective: We tested the feasibility and acceptability of a psycho-educational self-management intervention, Managing Cancer Care: A Personal Guide (MCC), to improve knowledge of care options (curative, palliative, and hospice care) among a range of breast cancer self-management skills. Methods: We conducted a one-group, pre-post-test study among women with non-metastatic breast cancer (n = 105). We gave participants the printed, self-guided, seven-module intervention following enrollment. At baseline and 2 months, we measured knowledge of care options, desired and actual role in self-management, medical communication skills, experience and management of transitions, anxiety, depression, uncertainty, and self-efficacy. We conducted interviews to obtain module ratings and qualitative data on strengths and limitations of MCC. Results: Knowledge of care options (δ = 0.40 (1.11), p = 0.0005) and desired role in self-management (δ = −0.28 (1.08), p = 0.0177) significantly improved. Less skilled medical communicators significantly improved their communication (δ = 3.47, standard deviation = 6.58, p = 0.0449). Multivariate modeling showed that changes in our primary outcomes of medical communication and management of transitions seemed to drive positive changes in our secondary outcomes of anxiety, depression, uncertainty, and self-efficacy. Participants highly rated MCC and reported the importance of understanding care options despite non-metastatic disease. Conclusions: MCC is a feasible and acceptable means of improving knowledge of care options and other aspects of breast cancer self-management. The combination of modules offered in MCC appears to have beneficial interactive effects. We are currently testing MCC more rigorously in a randomized controlled trial to explore mediating and moderating relationships.

Abstract

Persons receiving treatment for weight loss often demonstrate heterogeneity in lifestyle behaviors and health outcomes over time. Traditional repeated measures approaches focus on the estimation and testing of an average temporal pattern, ignoring the interindividual variability about the trajectory. An alternate person-centered approach, group-based trajectory modeling, can be used to identify distinct latent classes of individuals following similar trajectories of behavior or outcome change as a function of age or time and can be expanded to include time-invariant and time-dependent covariates and outcomes. Another latent class method, growth mixture modeling, builds on group-based trajectory modeling to investigate heterogeneity within the distinct trajectory classes. In this applied methodologic study, group-based trajectory modeling for analyzing changes in behaviors or outcomes is described and contrasted with growth mixture modeling. An illustration of group-based trajectory modeling is provided using calorie intake data from a single-group, single-center prospective study for weight loss in adults who are either overweight or obese.

Abstract

Nurses are often recognized for their volunteer efforts following disasters and international humanitarian crises. However, little attention is paid to the activities of nurses who promote a culture of health in their communities through local volunteer work. In this article, we describe nurses’ perceptions of how they promote health in their communities through formal and informal volunteer work. Using 315 written responses to an open-ended question included in a 2016 survey of the career patterns of nurses in the U.S., we utilized conventional content analysis methods to code and thematically synthesize responses. Two broad categories of nurse involvement in volunteer activities arose from the participants’ responses to the open-ended question, “Please tell us what you have done in the past year to improve the health of your community”: 17% identified job-related activities, and 74% identified non-job-related activities. 9% of respondents indicated they do not participate in volunteer work. Job-related activities included patient education, educating colleagues, and “other” job-related activities. Non-job-related activities included health-related community volunteering, volunteering related to a specific population or disease, family-related volunteering, church activities, health fairs, raising or donating money, and travelling abroad for volunteer work. Nurses are committed to promoting a culture of health in their communities both at work and in their daily lives. Leveraging nurses’ interest in volunteer work could improve the way nurses engage with their communities, expand the role of nurses as public health professionals, and foster the social desirability of healthful living.