Search

To evaluate whether patients with HIV enrolled in Linkage to Care (hospital-based only) or Linkage to Care Plus (nurse-led hospital-to-community transitional care) programmes fare better on clinical outcomes; and to investigate how factors such as substance use, mental health or health-related social needs contribute to these outcomes.Social determinants of health contribute to poor HIV outcomes such that only 57% of people living with HIV have achieved the goal of viral suppression nationally, and 50% are retained in clinical care. The programmes evaluated here aimed to increase HIV appointment attendance, retention in care, viral suppression and decrease acute care utilization and mitigate social needs via hospital-to-community transitional support.A retrospective observational cohort study.We conducted a retrospective patient chart review abstracting data over three time periods between 2017 and 2020 to conduct this longitudinal programme evaluation.Both programmes had meaningful effects on increasing HIV appointment attendance and viral suppression; Linkage to Care Plus experienced the largest gains. Older age was associated with viral suppression, and housing insecurity and mental health conditions were associated with increased emergency department utilization.Hospital-only and nurse-led hospital-to-community transitional care programmes can positively influence HIV care outcomes. There is a need for enhanced attention and accountability related to health-related social needs, especially housing, and mental and behavioural health, to end the HIV epidemic.Globally, we are striving to end the HIV epidemic with evidence-informed interventions. The nurse-led hospital-to-community and the hospital-only interventions evaluated here improved HIV outcomes with most gains realized by the nurse-led transitional care model. Integrating lessons from these programmes, with increased attention and accountability for addressing social needs, can improve practice and policies to achieve programmatic and national goals related to HIV and other diseases, and more critically, to meet the goals of the people we serve.Patients, staff and leadership at the University of Maryland Institute of Human Virology JACQUES Initiative and University of Maryland Medical Center THRIVE clinic contributed to the design and implementation of the programmes and informed the programme evaluation study.

Background and ObjectivesPet ownership or human–animal interaction has been associated with better health outcomes in individuals with disease or disability. We hypothesized that pet ownership, as well as dog ownership and cat ownership separately, are associated with maintaining physical function, and leisure time physical activity and that among dog owners, dog walking is associated with maintaining these outcomes for generally healthy community-dwelling older adults participating in the Baltimore Longitudinal Study of Aging.Research Design and MethodsA total of 637 men (44.1%) and women aged 50–100 years (M = 68.3, standard deviation [SD] = 9.6) completed a comprehensive pet ownership questionnaire that ascertained pet ownership history 10–13 years and had serial assessments of physical function every 1–4 years prior. Linear or generalized linear mixed models with time varying pet ownership were used to examine change in physical function over a mean of 7.5 years (range 1–13, SD = 3.6) according to pet ownership.ResultsPet owners (n = 185) were significantly younger (p < .001) and had fewer comorbidities (p = .03) than nonowners; thus, age and comorbidities were included as covariates in the longitudinal analyses. Physical function and leisure time physical activity declined with aging across all outcomes (p < .001); the decline was slower among pet owners in overall physical performance (p < .001), rapid gait speed (p = .03), usual gait speed (p = .032), cardiorespiratory fitness (p < .001), and physical well-being (p = .002) controlling for age and comorbidities. Changes in leisure time physical activities with aging did not differ between pet owners and nonowners. Dog walking was not independently related to the maintenance of physical function or leisure time physical activity with aging.Discussion and ImplicationsThis study provides the first longitudinal evidence that pet ownership is associated with maintained physical function among community-dwelling generally healthy older adults.

Human–animal interaction (HAI) such a dog walking is used as an intervention to decrease stress in individuals with Post-traumatic Stress Disorder (PTSD). However, it is important to know whether P...

Increasingly, health care institutions are called on to address social determinants of health (SDH) given the connection to morbidity and mortality across populations. However, widespread implementation of screening for health-related social conditions (HRSC) is lagging. It is estimated that half of patients who have such needs may be missed by failure to screen routinely. Health care institutions face gaps in information related to screening tools. A review of tools that screen for HRSC at the individual level is needed to share readily available and applicable tools for integration in various settings, to communicate how tools are typically administered, and to assess whether tools capture domains corresponding with Institute of Medicine (IOM) core measures. To address these gaps, an unsystematic rapid review of the literature was conducted. In addition to peer-reviewed literature, Google, PubMed, and CINAHL databases and grey literature were searched with a focus on lead agencies or scholars in the field. English language publications from 2008-2018 with content related to SDH or health-related social condition screening tools were included. Nine commonly applied tools were selected and reviewed for content, setting, and method of administration. Fifteen common domains were identified and assessed for alignment with IOM recommendations and correspondence with the construct of social stability. This review consolidates essential information about HRSC screening tools in 1 place and provides practice, policy, and research recommendations to improve HRSC screening. This review is a practice brief that can help health care institutions and clinicians implement screening and interventions related to HRSC.

Limited longitudinal studies have hindered the understanding of family adaptation after loss of a loved one in an intensive care unit (ICU). Based on the Double ABCX Model, this study examined changes in adaptation to bereavement for family members in the first year after the ICU death, with special attention to the effects of race/ethnicity. A repeated-measures design was used to conduct the investigation using 3 time points (1-3, 6, and 12 months) after the ICU death. Data were analyzed using linear mixed modeling. Family members (n = 30) consisted of 60% non-Hispanic Whites and 40% African Americans (AAs). During the first 1 to 3 months, moderate to severe symptoms of posttraumatic stress disorder, depression, anxiety, and stress were found (60%, 40%, 30%, and 26.7%, respectively). Initially, non-Hispanic Whites had higher depression scores than African Americans. The change in depression and posttraumatic stress disorder symptoms over 1 year differed by race/ethnicity. Many family members tended to be at risk of psychological sequelae in the early months after a patient's death in an ICU. Racial/ethnic differences in bereavement process need further exploration to understand the broader context within family members grieve and effectively offer support over the course of the first year.

When military veterans return from service many are in a state of reintegration from military to civilian life, a transition that can be difficult and stressful. Recent literature supports ...

Pet ownership (PO) or human-animal interaction (HAI) has been associated with better physical and mental health in individuals with existing disease or disability. In experimental studies, HAI improves some aspects of cognitive function. No research addresses HAI and longitudinal changes in cognitive function in older adults. We examined the relationship of PO to maintaining executive function (EF) within generally healthy community-dwelling older adults in the Baltimore Longitudinal Study of Aging (BLSA). We hypothesized less EF deterioration among pet owners than non-owners; and less deterioration among dog-walkers than owners who don’t walk their dogs. 637 women (55.9%) and men aged 50–100 years (M=68.3, SD=9.6) completed a PO questionnaire which ascertained ownership history and comprehensive examination every 1–4 years over 1–13 years (M=7.5, SD=3.6). Linear mixed models with time varying PO examined changes in EF according to PO. Pet owners (n=185) were younger (p < 0.001) and healthier (p=0.030) than non-owners; thus, age and comorbidities were included as covariates in the longitudinal analyses. EF, assessed using the Trail-Making Test (TMT), deteriorated with age (p’s < 0.001). Deterioration was less severe among pet owners than non-owners (TMT A: p < 0.001; B: p < 0.001; difference: p=0.042) and dog owners than non-owners (TMT A: p=0.025; B: p=0.009; difference: p=0.076), but not among cat owners than non-owners. Among dog owners (n=73), dog walkers experienced less deterioration than non-walkers (TMT A: p=0.156; B: p=0.001; difference: p < 0.001). This study provides the first longitudinal evidence that PO may contribute to maintaining EF among community-dwelling generally healthy older adults as they age.

Successful aging depends on avoiding disease and disability, maintaining high physical and cognitive function, and psychological adaptation. Research examining the relationship of pet ownership (PO) or human-animal interaction (HAI) to human health supports contributions to these successful ag-ing-related outcomes at some point in the life-cycle, mostly in populations with diseases or disabili-ties. We examine the contributions of PO to maintaining physical capacity among generally healthy community-dwelling older participants in the Baltimore Longitudinal Study of Aging (BLSA). Partici-pants’ [N=637, mean age=68.3 years (SD=9.6), pet owners N=149] completed a standardized physi-cal function test battery (among other measures) every 1-4 years and a ten-year PO history. Linear mixed, or generalized linear mixed, models with time varying PO were used to examine change in successful aging-related outcomes over up to 13 years [mean=7.5, (SD=3.6)] according to PO. Physi-cal function declined across all domains examined, but was observed to be less severe with PO in overall physical performance (p

BACKGROUND Intervention studies are used widely in nursing research to explore the efficacy of intervention programs for changing targeted health outcomes. However, the analyses of such studies have focused predominantly on their main intervention effects; most studies ignore the mechanisms underlying how the intervention programs work partly because of lack of application details of the longitudinal mediation analysis techniques. OBJECTIVES The aim of this study was to illustrate an application of parallel process latent growth curve modeling (PP-LGCM) to examine longitudinal moderated mediation effects. METHODS Longitudinal data from an online bone health intervention study were used to demonstrate the step-by-step application of PP-LGCM with Mplus statistical software. RESULTS With modification indices, we were able to achieve adequate model fit for PP-LGCM in our data. The mediation effects of self-efficacy on the intervention effects on exercise were nonsignificant for the entire sample. However, the conditional indirect effect showed the mediation effects were moderated by age group. DISCUSSION PP-LGCM provides an efficient way to analyze and explain the underlying mechanisms for the intervention effects in a trial, especially when the intervention program is guided by a theory.

Background: Childhood wheeze may be related to pesticide exposure, and diet and genetics (Paroxonase, PON1) may modify the effects of exposure. Methods: We analyzed data from the HOME Study, a prospective pregnancy and birth cohort, to examine the association of gestational urinary organophosphate (OP) and pyrethroid (3PBA) metabolite concentrations with child wheeze, forced expiratory volume in one second (FEV1) at ages 4 and 5 years, and wheeze trajectory patterns through age 8 years. Results: Among 367 singletons, the frequency of wheeze ranged from 10.6% to 24.1% at each measurement age. OP and 3PBA metabolite concentrations were not associated with wheeze at 8 years or from birth to 8 years, but there were three significant interactions: (1) maternal daily fruit and vegetable consumption (less than daily consumption and increasing 3PBA was associated with wheeze at age 8 years, OR = 1.40), (2) maternal PON1-108 allele (CT/TT genotypes and high DE was associated with wheeze at age 8 years, OR = 2.13, 2.74) and (3) PON1192 alleles (QR/RR genotypes with higher diethylphosphate (DE) and dialkyl phosphate (DAP) were associated with wheeze at age 8 years, OR = 3.84). Pesticide metabolites were not consistently related to FEV1 or wheeze trajectory. Conclusions: Gestational OP and 3PBA metabolites were associated with child respiratory outcomes in participants with maternal dietary and genetic susceptibility.

In recent research involving assisted-living residents with mild to moderate cognitive impairment, a structured 12-week Pet Assisted Living (PAL) intervention led to improved physical activity (PA)...

The distribution of violence, sexually transmitted infections, and substance use disorders is not random, but rather the product of disease, behavior, and social conditions that co-occur in synergistic ways (syndemics). Syndemics often disproportionately affect urban communities. Studies of syndemics, however, rarely apply consistent measures of social conditions. Here, the construct of social stability (SS) (housing, legal, residential, income, employment, and relationship stability) was evaluated as a consistent measure of social conditions related to sex, drug, and violence exposures in a new population in a Mid-Atlantic urban center. Lower SS predicted greater likelihood of any and combinations of risk. The magnitude varied based on specification: odds of sex-drug-violence exposure were greater for low vs. high latent SS class (OR = 6.25; 95%CI = 2.46, 15.96) compared with low vs. high SS category (OR = 2.64; 95%CI = 1.29, 5.39). A latent class characterized by residential instability was associated with greater likelihood of risk—a relationship that would have been missed with SS characterized only as an ordinal category. SS reliably captured social conditions associated with sexual, drug, and violence risks, and both quantity and quality of SS matter. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11524-020-00431-z) contains supplementary material, which is available to authorized users.

Aeromedical evacuation (AE) transports a military patients with a variety of medical conditions from foreign theaters back to the United States for medical treatment. Biological (e.g., alpha-amylas...

This study addresses whether asthma and/or hay fever predict fertility and impaired fecundity. The lifetime number of pregnancies (fertility) and spontaneous pregnancy losses (impaired fecundity) in 10,847 women representative of the U.S. population 15 to 44 years of age with histories of diagnosed asthma and/or hay fever are analyzed in the 1995 National Survey of Family Growth using multivariable Poisson regression with multiple covariates and adjustments for complex sampling. Smokers have significantly increased fertility compared to nonsmokers. Smokers with asthma only have significantly increased fertility compared to other smokers. Higher fertility is associated with impaired fecundity (ectopic pregnancy, miscarriage, stillbirth). Women with asthma (with and without hay fever) have significantly higher pregnancy losses than women without asthma. With increasing number of pregnancies, smokers have increased pregnancy losses compared to nonsmokers. Smokers, especially those with asthma only, have increased fertility and require special attention as to their family planning needs, reproductive health, and smoking cessation. Women with asthma, regardless of number of pregnancies, and smokers with higher numbers of pregnancies have high risk pregnancies that require optimal asthma/medical management prenatally and throughout pregnancy. Whether a proinflammatory asthma endotype underlies both the increased fertility and impaired fecundity associated with age and smoking is discussed.

Background Asthma is associated with adverse pregnancy outcomes. At the same time there is a worldwide increase in asthma and hay fever. Objective This study addresses whether asthma and/or hay fever adversely influence pregnancy outcomes. Methods Data from the 1995 National Survey of Family Growth that include a history of diagnosed asthma, hay fever, and adverse pregnancy outcomes in 10,847 women representative of the US population aged 15 to 44 years were analyzed. Results Women with the allergic phenotypes asthma and hay fever and hay fever only had no significant increase in adverse pregnancy outcomes (spontaneous pregnancy loss, preterm birth, infant low birth weight), whereas women with the nonatopic phenotype asthma only (without hay fever) did. The study did not evaluate endotypes. Conclusions This study provides new data that the allergic phenotypes, asthma and hay fever and hay fever only, are compatible with healthy pregnancy, whereas the nonatopic asthma phenotype, asthma only, adversely impacts pregnancy.

This study addresses whether asthma and/or hay fever predict fertility and impaired fecundity. The lifetime number of pregnancies (fertility) and spontaneous pregnancy losses (impaired fecundity) in 10,847 women representative of the U.S. population 15 to 44 years of age with histories of diagnosed asthma and/or hay fever are analyzed in the 1995 National Survey of Family Growth using multivariable Poisson regression with multiple covariates and adjustments for complex sampling. Smokers have significantly increased fertility compared to nonsmokers. Smokers with asthma only have significantly increased fertility compared to other smokers. Higher fertility is associated with impaired fecundity (ectopic pregnancy, miscarriage, stillbirth). Women with asthma (with and without hay fever) have significantly higher pregnancy losses than women without asthma. With increasing number of pregnancies, smokers have increased pregnancy losses compared to nonsmokers. Smokers, especially those with asthma only, have increased fertility and require special attention as to their family planning needs, reproductive health, and smoking cessation. Women with asthma, regardless of number of pregnancies, and smokers with higher numbers of pregnancies have high risk pregnancies that require optimal asthma/medical management prenatally and throughout pregnancy. Whether a proinflammatory asthma endotype underlies both the increased fertility and impaired fecundity associated with age and smoking is discussed.

Although fish and other aquatic species are popular privately-kept pets, little is known about the effects of watching live fish on the perceptions of arousal and the link between those perceptions and physiological measures of arousal. In two separate experiments, participants were asked to watch identically-equipped fish tanks for five minutes in each of three conditions: (1) Live fish, (2) plants and water, and (3) empty tank. Linear mixed models used across both experiments revealed similar results: Greater perceptions of relaxation and mood, and less anxiety during or after viewing the live fish condition, compared with the other conditions. Heart rate and heart rate variability responded to the arousal associated with a math task, but did not differ consistently across viewing conditions. These results suggest that the link between perceptions of arousal, and the physiological measures associated with arousal, may not be strong or immediate, or that heart rate and heart rate variability may not be appropriate measures for the test population. Implications of these results for the biophilia hypothesis and the biopsychosocial model are discussed.

Introduction Adolescent obesity is one of the most serious global public health challenges. Social networking sites are currently popular among adolescents. Therefore, the obesity prevention program for Korean American adolescents was developed on the most popular social networking site, Facebook. The purpose of this study was to evaluate the usability of a culturally tailored Facebook-based obesity prevention program for Korean American adolescents (Healthy Teens). Method An explorative descriptive design of usability testing was used. Usability testing employing one-on-one observation, the think-aloud method, audio taping, screen activity capture, and surveys was performed. Twenty participants were recruited from two Korean language schools (mean age, 15.40 ± 1.50 years). Recruitment and user testing was performed between February and April 2014. Content analysis, using the inductive coding approach, was performed by three coders to analyze transcriptions. Descriptive statistics were used to analyze quantitative data including demographic characteristics, perceived usability, eHealth literacy, and health behaviors. Results Testing revealed several usability issues in content, appearance, and navigation. Participants' comments regarding content were positive. Although the Facebook platform provided limited flexibility with respect to building the site, participants described the program's appearance as appropriate. Most participants did not experience difficulty in navigating the program. Discussion Our preliminary findings indicated that participants perceived the Healthy Teens program as usable and useful. This program could be used as a robust platform for the delivery of health education to adolescents. Further research is required to assess the effects of Facebook-based programs on adolescent obesity prevention.

Data from the Patients and Families Psychological Response to the Home Automated External Defibrillator Trial were used to examine the relationship between biopsychosocial variables and patients' coping strategies postmyocardial infarction. This study is the secondary data analysis of longitudinal observational study. A total of 460 patient-spouse pairs were recruited in January 2003 to October 2005. Hierarchical linear regression analysis examined biological/demographic, psychological and social variables regarding patients' coping scores using the Family Crisis Oriented Personal Evaluation Scale. Lower social support and social support satisfaction predicted lower total coping scores. Being younger, male gender and time since the myocardial infarction predicted lower positive coping strategy use. Higher anxiety and lower social support were related to fewer positive coping methods. Lower educational levels were related to increased use of negative coping strategies. Reduced social support predicted lower total coping scores and positive coping strategy use and greater passive coping style use. Social support from a broad network assisted with better coping; those living alone may need additional support. Social support and coping strategies should be taken into consideration for patients who have experienced a cardiac event.

Pet ownership (PO) has been linked to better health outcomes in older adults, particularly those with chronic health conditions. It is suggested that pets influence their owners lives both by encouraging social interaction and by interfering with owners’ willingness or ability to seek care for themselves. We use data from 6 questions about the positive and negative influence of pets on community dwelling older adults’ administered to pet owners (N=223, age >=50 years) in the Baltimore Longitudinal Study of Aging. We use principal components analysis (oblique rotation) to extract dimensions of owner’s perceptions of pet influences (PPI) and examine the relationship of these dimensions to owners’ cognitive, physical functional, and psychological status. Three dimensions of PPI include: fiscal/health challenges (F1: 3 items, alpha=0.70), wellness promotion (F2: 2 items, alpha=0.80); and reason for social/travel constraints (F3: 1 item). In regression analysis with all factors entered simultaneously, after controlling for age, higher magnitude of F1 significantly independently predicted poor physical quality of life (p=.0007), greater perceived stress (p=0.041), and lower happiness (p=0.014); F2 did not independently predict any health outcome; higher F3 significantly independently predicted lower emotional vitality (p=0.048). Controlling for age, all three factors were independent predictors of pet attachment (p’s=0.001, 0.010, 0.047, respectively). F1 and F3 were positively and F2 was negatively correlated with attachment. PPI was associated with owners’ physical and mental health. Perhaps older adults with higher attachment to pets are more likely to keep them despite higher challenges.

Background: Risky behaviors are related to poor outcomes among young adolescents. This study piloted a mindfulness based intervention, Learning 2 Breath Mindfulness Curriculum, focusing on the feasibility of programming and intervention effects on coping, affect, and trait mindfulness among at-risk adolescents. Further, the mindfulness based intervention was compared to an attention intervention. Methods: Sixth-grade level female students in a boarding school for at-risk youth randomly allocated to either the mindfulness intervention (n = 12) or an attention intervention (n = 11) for six weeks. Outcomes (i.e., primary coping, positive affect, and trait mindfulness) were assessed before and after the interventions. Results: Intervention groups did not differ in demographics or outcomes at baseline. Twenty-two of 23 (95.7%) registered participants attended all of the sessions. Participants completed 86.4% of study tools. Separate repeated measures ANOVAs revealed no significant interactions among group and time for primary coping, positive affect, or mindfulness. However, positive affect did increase [F(1, 17) = 10.675, p = 0.005, partial η2 = 0.39] over time for both groups and there was a slight increase in trait mindfulness over time (although not statistically significant; p = 0.095, partial η2 = 0.155]). Primary coping did not change with time. Conclusion: The mindfulness intervention utilized in the present study exhibited feasibility in this population. Although preliminary, mindfulness based interventions may contribute to positive affect among at-risk youth in a boarding school. Limitations and future directions are discussed. Keywords: Adolescents, Mindfulness intervention, School-based programs, Coping, Affect

Background and objectives Most research on human-animal interaction (HAI) and human health focuses on one of three perspectives: (a) health effects of pet ownership; (b) health effects of contact with a companion animal; or (c) health effects of animal-assisted interventions including animal-assisted therapies, and animal-assisted activities. Methods We reviewed research methods used to address each perspective, within the context of human aging, and identified challenges associated with these methods. Results The complex challenges involved in designing studies to address all three perspectives and examples of research design elements that can be used to alleviate issues raised in each type of study are provided. Discussion and implications We suggest emerging methodologies that may be helpful for answering important questions from all three perspectives about the relationship of HAI to health outcomes for older adults.

We explore the association of PO and marital status to changes in health during aging. This secondary analysis uses 1992, 2004, and 2011 data from healthy participants (N=2,319) in the WLS. Health outcomes (symptoms, illnesses, days in bed due to illness, depression, and cognition) and demographic/ health variables (age, marital status, sex, smoking, BMI, engagement with friends/relatives). PO (ever owned a pet/dog/cat) was assessed in 2011. In linear mixed models, PO, dog ownership, and cat ownership (CO) independently predicted changes in health outcomes. Marital status moderated the association of CO to changes in cognition[F(1,012.85)=4.09,p=0.043]. Both marriage and CO were associated with increased cognition from ages 53 to 64; being unmarried without CO was associated with reduced cognition during aging with the lowest cognition by age 70. Results provide insight into how PO and social support influence healthy aging. Longitudinal PO and health/social data are necessary to better understand these relationships.

Diminishing cognitive and physical function, worsening psychological symptoms and increased mortality risk and morbidity typically accompany aging. Health needs of the aging population will continue to increase as the proportion of the population aged 50 years and older increases. Pet ownership (PO) has been linked to better health outcomes in older adults, particularly those with chronic health conditions. However, much of the evidence is weak with little known about the contribution of PO to successful aging in community living older adults. This study examines associations between PO and cognitive performance, physical functioning, and psychological status in community living older adults. Participants in the Baltimore Longitudinal Study of Aging (>50 years old, N=378) completed physical functioning, cognitive and psychological testing, and a ten-year PO history. Most participants (89%) had owned pets at some point and 24% currently have pets. Fourteen percent have 1-4 dogs, 12% have 1-4 cats, and 3% have others. PO was lower with older age (p

Background Adoption of evidence-based practices (EBP) by registered nurses (RNs) and nurse leaders continues to be a challenge. Although multiple strategies and substantial resources are being invested to advance nursing practice based on evidence, little is known about the long-term impact of these interventions. Aims This study was undertaken to assess nurse leaders’ and clinical RNs’ beliefs to use EBP, perceptions about organizational readiness for EBP, and frequency of implementing EBP following implementation of multifaceted interventions to achieve and maintain Magnet designation. Methods This retrospective descriptive study compared data from two previously administered online surveys (2008 and 2012) at a mid-Atlantic Magnet-designated community hospital. Results Clinical RNs' self-reported attitudes toward EBP were more positive (2008: M = 53.85, standard error of the mean [SEM] = 0.65; 2012: M = 57.07,SEM = 0.58), as well as their perceptions of organizational readiness (2008: M = 50.72, SEM = 1.20; 2012: M = 81.09, SEM = 0.98), between the two survey years. Contrarily, although nurse leader scores were significantly higher for beliefs (2008: M = 61.15, SEM = 1.23; 2012: M = 60.60., SEM = 0.96), readiness (2008: M = 61.28, SEM = 2.16; 2012: M = 85.18, SEM = 1.64), and implementation (2008: M = 21.35, SEM = 1.72; 2012: M = 19.08, SEM = 1.43) little change was observed in the nurse leader scores between the two survey years compared with clinical RNs. Discussion Results from this study suggest that the multifaceted interventions have had a positive impact on clinical RNs’ beliefs and readiness for EBP, but not for nurse leaders. Albeit low, self-reported implementation of EBP by RNs and nurse leaders has been sustained, but has not improved. Linking Evidence to Action Leaders must see their role as not only facilitators of EBP but also as active participants practicing EBP. Actively engaging leaders in EBP by serving on interprofessional EBP teams and role modeling these behaviors to staff is critical to EBP implementation. Realistic expectations of RNs for EBP implementation and clear and accessible resources may enhance RNs’ willingness to implement. Going forward, it may be necessary to differentiate the expectations of RNs in EBP implementation by clarifying expectations in the process of identification and analysis of evidence from use of EBP in clinical practice.

Working memory (WM) plays a critical role in the execution of a wide variety of cognitive tasks and predicts academic success. This study was designed to compare the impact of the presence of a dog or a person, and physical contact with them, on the performance of a WM task. It also exam- ined whether the impact differed for two dogs, and whether these factors im- pacted arousal during the WM task. College students (n=31, aged 18–23 years) performed a WM task in five counterbalanced conditions; dog-touch, dog-no-touch, person-touch, person-no-touch, and alone. Participants were randomly assigned to one of two dogs; Miniature Poodle (n=16) or Border Collie (n=15). The WM task involved replicating increasingly complicated se- quences of colored lights by touching them on an iPad®. Linear mixed model analyses revealed there was a significant interaction between collaborator and touch (p=0.05); best WM scores occurred without touch with either the per- son or the dog present, and worst WM scores occur...

Ethnic minority groups are less engaged than Caucasian American adults in advance care planning (ACP). Knowledge deficits, language, and culture are barriers to ACP. Limited research exists on ACP and advance directives in the Chinese American adult population. Using a pre–posttest, repeated measures design, the current study explored the effectiveness of a nurseled, culturally sensitive ACP seminar for Chinese American adults on (a) knowledge, completion, and discussion of advance directives; and (b) the relationship between demographic variables, advance directive completion, and ACP discussions. A convenience sample of 72 urban, community-dwelling Chinese American adults (mean age = 61 years) was included. Knowledge, advance directive completion, and ACP discussions increased significantly after attending the nurse-led seminar ( p < 0.01). Increased age correlated with advance directive completion and ACP discussions; female gender correlated with ACP discussions. Nursing education in a community setting increased advance directive knowledge and ACP engagement in Chinese American adults. [ Journal of Gerontological Nursing, 41 (8), 17–21.]

Objective To conduct a systematic review of gender differences in stroke, mortality, and hospitalization for patients with atrial fibrillation and/or flutter (AF/Afl). Methods Full texts, published, peer-reviewed, English language articles from 1999 through July 2014 were examined. Articles with populations of patients with AF/Afl were included if they conducted longitudinal analysis of any of three outcomes: stroke, mortality, and hospitalization, and reported or compared at least one of the outcomes according to gender. Results Seventeen articles were included: sixteen on stroke, nine on mortality, and one on hospitalization. In nine articles women had more strokes (RRs 0.89–1.9). Findings about gender differences in mortality (RRs 0.69–2.8) and hospitalizations were equivocal. Conclusions Few articles examine differences in outcomes between men and women with AF/Afl. Given the prevalence of AF/Afl and health care costs it is vital to determine gender differences to evaluate appropriate therapies to decrease stroke, mortality, and hospitalizations.

BACKGROUND Families of critically ill patients often make difficult decisions related to end-of-life (EOL) care including the withdrawal of life-sustaining therapies. OBJECTIVES This study explored patient and proxy decisions related to mechanical ventilator withdrawal in scenarios characterizing 3 distinct disease trajectories (cancer, stroke, and heart failure [HF]) with different prognoses. The relationship between patient directives, modification of directives, prognosis, trust, and EOL decisions were examined. METHODS This secondary analysis of data obtained in the "Contracts, Covenants, and Advance Care Planning" study included a sample of 110 subjects with 50 patient-proxy pairs. Patient and proxy agreement was assessed in response to questions regarding mechanical ventilator withdrawal while considering directives or modification of directives in 3 different scenarios. RESULTS Patient and proxy agreement ranged from 48% (n = 24 pairs) to 94% (n = 47 pairs). Agreement was lowest in HF (uncertain prognosis) when the directive indicated "do nothing" or "did not indicate any preference." Modified directives yielded 48% (n = 24 pairs) to 84% (n = 42 pairs) agreement. Changing directives from "do nothing" to "more hopeful" in HF (uncertain prognosis) had the highest agreement among modified scenarios. Despite wide variability in agreement, patients reported a high level of trust in their proxies' decisions. DISCUSSION This study highlighted differences in patient and proxy agreement about withdrawal of mechanical ventilation. Critical care nurses provide a key role in supporting EOL decisions. Encouraging ongoing communication about preferences and understanding the role of disease process and prognosis in decision making are paramount. Future research needs to explore factors that may improve patient and proxy agreement in EOL decisions and ways critical care nurses can support patients and proxies in these decisions, ultimately improving EOL care.

BACKGROUND The health-related quality of life (HRQoL) of patients with atrial fibrillation (AF) and atrial flutter (AFL) is an important issue in cardiovascular health management. Determinants of poor HRQoL of AF/AFL patients require further elucidation. OBJECTIVES The purpose of this study was to evaluate the influencing factors related to the HRQoL of AF/AFL patients. METHODS In 150 consecutively recruited patients in a multicenter, cross-sectional study from April 2010 to February 2011, depression and anxiety were measured with the Beck Depression Inventory II and the State Trait Anxiety Inventory, respectively, whereas HRQoL was assessed with the generic Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Linear regression modeling was performed to determine predictors of HRQoL among variables, including the patients' age, gender, race, marital status, type of AF/AFL, frequency of AF/AFL symptoms, time since diagnosis, and anxiety and depression symptoms. RESULTS Female patients with AF/AFL reported poorer physical HRQoL than male patients did (P < .001, R² = 0.391). Symptoms of depression and anxiety were found to be associated with poorer HRQoL (P < .001, R² = 0.482). Anxiety was the strongest predictor of the mental component of the Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Younger patients had worse AF/AFL-related symptoms and severity than older patients did (P < .001, R² = 0.302). Increased frequency of symptomatic episodes was associated with worse AF/AFL-related symptoms and severity. CONCLUSION In conclusion, depression and anxiety symptoms and female gender emerged as clear indicators of poor HRQoL in AF/AFL patients. These risk factors should be used to identify patients who may require additional evaluation and treatment efforts to manage their cardiac conditions or HRQoL. Interventions to improve HRQoL in these individuals require further investigation.

Adolescents with cardiac diagnoses face unique challenges that can cause psychosocial distress. This study compares a Mindfulness-Based Stress Reduction (MBSR) program to a video online support group for adolescents with cardiac diagnoses. MBSR is a structured psycho-educational program which includes yoga, meditation, cognitive restructuring, and group support. A published feasibility study by our group showed significant reduction in anxiety following this intervention. Participants were randomized to MBSR or video online support group, and completed measures of anxiety, depression, illness-related stress, and coping pre- and post-6-session interventions. Qualitative data were obtained from post-intervention interviews. A total of 46 teens participated (mean 14.8 years; 63% female). Participants had congenital heart disease and/or cardiac device (52%), or postural orthostatic tachycardia syndrome (48%). Illness-related stress significantly decreased in both groups. Greater use of coping skills predicted lower levels of depression in both groups post-study completion. Higher baseline anxiety/depression scores predicted improved anxiety/depression scores in both groups. Each group reported the benefits of social support. The MBSR group further expressed benefits of learning specific techniques, strategies, and skills that they applied in real-life situations to relieve distress. Both the MBSR intervention and video support group were effective in reducing distress in this sample. Qualitative data elucidated the added benefits of using MBSR techniques to manage stress and symptoms. The video group format is useful for teens that cannot meet in person but can benefit from group support. Psychosocial interventions with stress management techniques and/or group support can reduce distress in adolescents with cardiac diagnoses.

Adolescents with implantable cardioverter defibrillators (ICDs) or pacemakers (PMs) face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac devices and could potentially impact adolescents’ adjustment to these devices. Mindfulness Based Stress Reduction (MBSR) is a structured psycho-educational program that includes meditation, yoga, and group support and has been studied extensively among adults. This study examined the feasibility of the MBSR program for adolescents with ICDs/PMs, a population previously unexamined in the research literature. The participants completed measures of anxiety and depression (Hospital Anxiety and Depression Scale) and coping (Responses to Stress Questionnaire) at baseline and after the six-session MBSR intervention. Mean age of the cohort (n = 10) was 15 ± 3 years, 6 were male, 6 had a PM, and 4 had an ICD. Feasibility was demonstrated by successful recruitment of 10 participants, 100 % participation and completion. Anxiety decreased significantly following the intervention, with a large effect size, t[9] = 3.67, p

Animal-assisted invention (AAI) in gaining attention as a therapeutic modality; however, the effect of it has not been well studied in the child welfare system. The purpose of this study was to examine the effects of AAI on stress indicators (as measured by salivary alpha-amylase (sAA), immunoglobulin A (IgA), and heart rate) in children undergoing forensic interviews for alleged sexual abuse. A repeated measures design was used in this study. Upon receiving signed, informed consents and assents, children were enrolled in the study. Children (n = 42), whose ages ranged from 5 to 14 years (M = 8.91, SD = 2.33), were assigned to either the intervention condition (n = 19; AAI during forensic interview) or the control condition (n = 23; standard practice forensic interview). Each child's parent/guardian completed a demographic form, and saliva samples and heart rate measures were obtained from each child before and after the forensic interview. Mixed linear models were tested, with the level of signif...

The presence of a dog has been associated with reduced responses to stressors in several, but not all, previous studies. The presence of a dog has also been related to improved performance on some ...

The relationship of burnout (BO), compassion fatigue (CF), compassion satisfaction (CS), and secondary traumatic stress (STS) to personal/environmental characteristics, coping mechanisms, and exposure to traumatic events was explored in 128 trauma nurses. Of this sample, 35.9% had scores consistent with BO, 27.3% reported CF, 7% reported STS, and 78.9% had high CS scores. High BO and high CF scores predicted STS. Common characteristics correlating with BO, CF, and STS were negative coworker relationships, use of medicinals, and higher number of hours worked per shift. High CS correlated with greater strength of supports, higher participation in exercise, use of meditation, and positive coworker relationships. Caring for trauma patients may lead to BO, CF, and STS; identifying predictors of these can inform the development of interventions to mitigate or minimize BO, CF, and STS in trauma nurses.

Migration is a major life event that alters the functioning of individuals, often leading to the disruption of families and other social networks. When adaptation and coping fail, psychological distress may result. The purpose of this study is to examine the prevalence of psychological distress and to identify risk factors associated with the development of psychological distress symptoms in Chinese immigrants. A cross-sectional survey was conducted in a Chinese community in Maryland, USA. A total of 247 people completed the survey. Descriptive statistics were used to describe demographic and prevalence data. Differences in means of psychological distress scores by group were examined with t-tests and analysis of variance. Multiple regression analysis was used to test multiple predictors of psychological distress scores. The prevalence of psychological distress among Chinese immigrants in this study was 22.3%, double the expected frequency in the general US population. Being younger, self-reported with po...

BACKGROUND Heart failure (HF) is a major health problem in the United States, affecting 5.7 million American adults. Psychosocial distress, in particular depression, contributes to morbidity and mortality in patients with HF. Little is known about the interrelationship among disease severity, social support, and depression. OBJECTIVE The aim of this study was to examine the contributions of social support and disease severity to longitudinal changes in depression and anxiety of outpatients with HF. METHODS Patients (N = 108) enrolled in the Psychosocial Factors Outcome Study completed the Beck Depression Inventory-II, the State Trait Anxiety Inventory, and the Social Support Questionnaire-6 at study entry and every 6 months for up to 2 years. RESULTS At baseline, 30% of the patients were depressed and 42% were anxious. Social support amount contributed to changes in depression (P = .044) but not anxiety (P = .856). Depression increased over time for patients who had lower initial social support amount. Depression did not increase for those with higher initial social support amount. Neither New York Heart Association class nor treatment group (placebo or implantable cardioverter defibrillator) interacted with time to predict depression, which indicates that changes in depression were parallel for patients with New York Heart Association class II and class III HF and for those who received implantable cardioverter defibrillators and those who did not. Assessment of patients with HF should include depression and social support. Interventions to enhance social support among patients with HF who have low social support may help alleviate the development of depression. CONCLUSIONS Reducing psychological distress and increasing social support may improve health outcomes among HF outpatients. It is important for studies of HF to include assessment of depression, anxiety, and social support and evaluate their contributions to health outcomes.

As the population ages the number of older adults living with hypertension (HTN) is rising dramatically. Uncontrolled HTN increases cardiovascular and renal mortality. Ambulatory (A) blood pressure (BP) is a better predictor of HTN-related morbidity and mortality than office BP. Lower BP is the most important therapeutic goal in treating HTN. Any reduction in BP has significant benefits for older adults. The current study was designed to evaluate the impact of the presence of pet dogs and cats on ABP during the daily lives of independently living, older pet owners with pre- to mild HTN. A repeated measures observational study of ABP of 32 pet owners (21 dogs, 8 cats, 3 cat and dog; 29 women) aged 50–83 years with BP 120–150/80–100 mmHg or < 150/100 with anti-hypertensive medication was conducted. Owner's ABPs were recorded every 20 minutes for one day during waking hours at study entry, one month, and three months. Activity monitors and diaries were used to obtain information about activity, mood,...