Critical consciousness of public health nurses: A descriptive,comparative survey

Background

Public Health Nurses (PHN) caring for vulnerable populations amid systemic inequality must navigate complex situations, and consequently they may experience serious moral distress known to be detrimental to PHN wellbeing.

Objective

Given PHN awareness of social inequities, the study aimed to determine if PHNs were motivated to enact social change and engage in social and political action to address inequality.

Design and sample

A survey of 173 PHNs was conducted in fall 2022. The convenience sample was mainly female (96.5%), White (85%), had associate/bachelor's degrees (71.7%), and worked in governmental public health settings (70.7%).

Measure

The study employed the Short Critical Consciousness Scales’ subscales: Critical Reflection, Critical Motivation, and Critical Action.

Results

PHNs were highly motivated to address inequities (Critical Motivation = 20.83; SD = 3.16), with similarly high awareness (Critical Reflection = 17.89; SD = 5.18). However, social and political action scores were much lower (Critical Action = 7.13; SD = 2.63). A subgroup of PHNs with strong agreement regarding the impact of poverty were more likely to be younger (p = .039) and work in a community setting (p = .003); with higher scores across subscales (p < .001).

Conclusions

High critical reflection and motivation among PHNs aligned with literature. Lower Critical Action scores warrant investigation into validity for PHNs, and possible role constraints.     

The relationship between health and housing in low-income older adults: A secondary analysis of survey data

Objective

To examine the health-housing relationship in low-income older adults, and differences by income and receipt of housing assistance.

Design

Secondary analysis of longitudinal survey data.

Sample

About 10,858 adults aged 62+ who completed at least one wave of the 2014 Survey of Income and Program Participation (SIPP) (n = 37,333 observations).

Measurements

SIPP variables representing demographics and housing quality, affordability, stability, and neighborhood were analyzed. Low-income and higher-income participants were differentiated by the household income-to-poverty ratio.

Results

Low-income participants were significantly more likely to be in poor health and report problems with housing quality, affordability, and neighborhood safety compared to higher-income participants (p < .001). Increased household size and problems with housing quality and neighborhood safety were associated with poor health in both groups (p < .05). Low-income participants who received housing assistance were significantly poorer, less healthy, and food insecure than participants not receiving assistance (p < .001); however, the health-housing relationship was not different in the two groups.

Conclusions

Results provide additional support for housing as a social determinant of older adult health. Though housing assistance programs reached a subset of low-income older adults, the results suggest a housing assistance shortfall. Implications for public health nurses and researchers are explored.     

Climate,Health, and Nursing Tool (CHANT): A confirmatory factor analysis

Objective

To confirm the factor structure of the Climate, Health, and Nursing Tool (CHANT) tool via confirmatory factor analysis.

Design and sample

This is a cross-sectional analysis of voluntary, anonymous responses collected online in 2019, from a non-representative sample of 489 nurses from 12 nations with 95% of the respondents from the United States.

Measurements

A confirmatory factor analysis (CFA) was conducted to test a five-factor measurement model of the 22-item CHANT. Reliability was examined via Cronbach's α coefficient.

Results

The five CHANT subscales demonstrated acceptable reliability with Cronbach's α ranging from 0.67 to 0.91. The five-factor model of CHANT demonstrated good fit, x²(199) = 582.747, p < .001, CFI = 0.94, RMSEA = 0.06, and SRMR = 0.04 with statistically significant item-factor loadings.

Conclusion

CHANT is a reliable and robust instrument to measure nurses’ awareness, concern, motivation, and home and work behaviors regarding climate change and health, and is ready to be utilized in research, policy, professional settings, and among educators.     

Joint effects of prothrombotic genotypes and body height on the risk of venous thromboembolism: the Tromsø study

Essentials

• Body height and prothrombotic genotypes are associated with risk of venous thromboembolism (VTE).
• The joint effect of prothrombotic genotypes and tall stature on VTE risk is scarcely investigated.
• We investigated the joint effect of prothrombotic genotypes and tall stature on VTE risk.
• Prothrombotic genotypes did not yield excess risk of VTE in subjects with a tall stature.

Summary

Background

Studies have reported synergistic effects of prothrombotic single‐nucleotide polymorphisms (SNPs) and obesity on the risk of venous thromboembolism (VTE). Tall stature is associated with an increased VTE risk, but the joint effect of prothrombotic genotypes and tall stature on the VTE risk is unknown.

Aims

To investigate the joint effects of prothrombotic genotypes and tall stature on the VTE risk.

Methods

Cases with incident VTE (n = 676) and a randomly selected age‐weighted subcohort (n = 1842) were sampled from the Tromsø study (cohort follow‐up: 1994–2012). DNA was genotyped for rs6025 (factor V Leiden), rs1799963 (FII), rs8176719 (ABO blood group), rs2066865 (fibrinogen‐γ), and rs2036914 (FIX). Age‐adjusted and sex‐adjusted hazard ratios (HRs) of VTE were calculated by categories of risk alleles (de Haan 5‐SNP score: 0–1, 2–3, and ≥ 4) and body height (< 40th, 40th–80th and > 80th percentiles).

Results

The VTE risk increased by increasing category of body height, and subjects with height ≥ 178 cm had a two‐fold higher VTE risk (HR 2.03; 95% confidence interval [CI] 1.51–2.73) than those with height ≤ 165 cm. The VTE risk also increased across categories of risk alleles. However, the combination of a tall stature and risk alleles, either individual SNPs or risk score, did not result in an excess VTE risk. Subjects with four or more risk alleles and height ≥ 178 cm had a two‐fold (HR 2.08; 95% CI 1.24–3.52) higher VTE risk than subjects ≤ 165 cm with no risk allele or one risk allele.

Conclusions

In contrast to obesity, the presence of prothrombotic genotypes did not result in an excess VTE risk in subjects with a tall stature.     

Living with relapsed myeloma: Symptoms and self‐care strategies

Aims and Objectives

To explore which symptoms relapsed myeloma patients experience and what self‐care strategies are used.

Methods

This was a qualitative study utilising focus group interviews (n = 4) with relapsed myeloma patients (n = 15) and carers (n = 9). The focus groups were analysed and guided by thematic analysis.

Results

Three major themes with subthemes were identified following analysis of the interview data: “difficult symptoms; “self‐care” and “feeling vulnerable.” These findings indicate the challenges relapsed myeloma patients experience with ongoing symptoms and highlight the importance of continuity of care.

Conclusions

Symptom management for myeloma patients remains complex due to the array of treatments given. These patients require holistic care and thorough regular assessments to help them cope with the adverse effects on their physical and psychological health. For patients with a long‐term diagnosis of myeloma, self‐management workshops and regular education sessions may be of benefit.

Relevance to clinical practice

This study highlights the key role of healthcare professionals in going beyond assessment of symptoms to offering advice and support to assist relapsed myeloma patients in managing their symptoms.     

Plasma CXCL1 levels and TRAF3IP2 variants in patients with myocardial infarction

Background

IL‐17A plays an important role in inflammatory responses in myocardial infarction (MI). IL‐17A signals through its receptor, for which, Act1 (TRAF3IP2) functions as a key upstream adaptor in the pathway.

Aim

To compare frequencies of functional polymorphisms of TRAF3IP2 (rs13210247, rs33980500) between patients with MI and healthy controls.

Methods

The selected SNPs were studied in 201 Iranian MI patients and 201 healthy blood donors from Fars Province by PCR‐RFLP in association with clinicopathologic criteria of patients. CXCL1 plasma levels in 126 MI patients and 50 normal subjects were measured by ELISA.

Results

A significant increase in the mutant (T) allele of TRAF3IP2 rs33980500 in patients with diastolic dysfunction of the heart (P = .01) was observed. The highest correlation, however, was observed between the TRAF3IP2 rs33980500 TT genotype and T allele with left main coronary artery stenosis (P = .01, P < .001; OR = 31.03). T allele of TRAF3IP2 rs33980500 was also associated with female gender, family history of cardiovascular disease, and mechanical complications of heart (P = .04, P = .02, and P = .01, respectively). Moreover, TRAF3IP2 rs13210247 (G) correlated with mechanical complications of the heart (P = .01). A significant increase in the plasma levels of CXCL1 chemokine in patients (P = .0006) associated with TT genotype of TRAF3IP2 (rs33980500) was observed (P = .04).

Conclusion

The gene variants of Act1 adaptor are associated with correlates of poor outcome in patients with MI and plasma CXCL1 levels.

     

Frailty risk in hospitalised older adults with and without diabetes mellitus

Background

Research indicates that diabetes mellitus (DM) may be a risk factor for frailty and individuals with DM are more likely to be frail than individuals without DM; however, there is limited research in hospitalised older adults.

Objectives

To determine the extent of frailty in hospitalised older adults with and without DM using a 16‐item Frailty Risk Score (FRS) and assess the role of frailty in predicting 30‐day rehospitalisation, discharge to an institution and in‐hospital mortality.

Methods

The study was a retrospective, cohort, correlational design and secondary analysis of a data set consisting of electronic health record data. The sample was older adults hospitalised on medicine units. Logistic regression was performed for 30‐day rehospitalisation and discharge location. Cox proportional hazards regression was used to analyse time to in‐hospital death and weighted using propensity scores.

Results

Of 278 hospitalised older adults, 49% had DM, and the mean FRS was not significantly different by DM status (9.6 vs. 9.1, p = 0.07). For 30‐day rehospitalisation, increased FRS was associated with significantly increased odds of rehospitalisation (AOR = 1.24, 95% CI [1.01, 1.51], p = 0.04). Although 81% were admitted from home, 57% were discharged home and 43% to an institution. An increased FRS was associated with increased odds of discharge to an institution (AOR = 1.48, 95% CI [1.26, 1.74], p < 0.001). The FRS was not significantly associated with increased risk of in‐hospital death (p = 0.17), but DM was associated with a 484% increase in the instantaneous risk of death (AHR = 5.84, 95% CI [1.71, 19.9], p = 0.005).

Conclusion

Diabetes mellitus and frailty were highly prevalent; the mean FRS was not significantly different by DM status. Although increased frailty was significantly associated with rehospitalisation and discharge to an institution, only DM was significantly associated with in‐hospital mortality.

Relevance to clinical practice

Frailty assessment may augment clinical assessment and facilitate tailoring care and determining optimal outcomes in patients with and without DM.     

Predictors of organizational commitment among Chinese nurses during the COVID-19 pandemic

Aim

To investigate organizational commitment among Chinese nurses and analyze factors influencing organizational commitment during COVID-19.

Background

Organizational commitment is the most important link between nurses and the organization because it is effective in work retention and the motivation of nurses, especially when addressing the COVID-19 crisis. However, there has been no empirical study conducted to predict organizational commitment in the field of nursing by combining work values with professional practice environments.

Methods

A cross-sectional predictive study was done with 362 nurses recruited from two tertiary hospitals in China. The Organizational Commitment Questionnaire, the Work Values Scale, and the Practice Environment Scale of the Nursing Work Index were used to collect data. Two factors related to the organizational commitment of nurses were investigated by using binary logistic regression analyses.

Results

Increased work values and a professional practice environment were associated with an increased likelihood of higher organizational commitment.

Discussion

The COVID-19 crisis became the utmost challenge to global healthcare systems and professional organizational commitment. Nurses’ organizational commitment was directly influenced by the professional practice environment and work values, especially intrinsic work values, in which the spirit of collectivism was consequential.

Conclusion and implications for the field of nursing and health policy

Study results provide information for global hospital administrators to promote these organizational commitment predictive factors, including work values and a professional practice environment in nursing practice. This helped foster a stronger organizational commitment among nurses to reduce nurse resource flow during COVID-19.     

Effect of Baduanjin on physical functioning and balance in adults with mild-to-moderate intellectual disabilities: A comparative study

Background

Adults with intellectual disabilities often experience mobility limitations. Baduanjin, a mindfulness-based exercise intervention, can exert positive effects on functional mobility and balance. This study examined the impact of Baduanjin on physical functioning and balance of adults with intellectual disabilities.

Method

Twenty-nine adults with intellectual disabilities participated in the study. Eighteen received a Baduanjin intervention for 9-months; 11 participants did not receive any intervention (comparison group). Physical functioning and balance were assessed using the short physical performance battery (SPPB) and stabilometry.

Results

Participants in the Baduanjin group experienced significant changes in the SPPB walking test (p = .042), chair stand test (p = .015), and SPPB summary score (p = .010). No significant changes between groups were observed in any of the variables assessed at the end of the intervention.

Conclusions

Baduanjin practice may cause significant, albeit small, improvements in physical functioning of adults with intellectual disabilities.     

Predicting drug efficacy in chronic low back pain by quantitative sensory tests

Background

Drugs are prescribed for chronic low back pain without knowing in advance whether a patient will respond to them or not. Quantitative sensory tests (QST) can discriminate patients according to sensory phenotype, possibly reflecting underlying mechanisms of pain processing. QST may therefore be a screening tool to identify potential responders to a certain drug. The aim of this study was to investigate whether QST can predict analgesic effects of oxycodone, imipramine and clobazam in chronic low back pain.

Methods

Oxycodone 15 mg (n = 50), imipramine 75 mg (n = 50) and clobazam 20 mg (n = 49) were compared to active placebo tolterodine 1 mg in a randomized, double‐blinded, crossover fashion. Electrical, pressure and thermal QST were performed at baseline and after 1 and 2 h. Pain intensity was assessed on a 0–10 numeric rating scale every 30 min for up to 2 h. The ability of baseline QST to predict pain reduction after 2 h was analysed using linear mixed models. Genetic variants of drug‐metabolizing enzymes and genes affecting pain sensitivity were examined as covariables.

Results

No predictor of analgesic effect was found for oxycodone and clobazam. Thermal QST was associated with analgesic effect of imipramine: patients more sensitive to heat or cold were more likely to experience an effect of imipramine. Pharmacogenetic variants and pain‐related candidate genes were not associated with drug efficacy.

Conclusions

Thermal QST have the potential to predict imipramine effect in chronic low back pain. Oxycodone and clobazam effects could not be predicted by any of the selected QST or genetic variants.

Significance

Predicting drug efficacy in chronic low back pain remains difficult. There is some evidence that patients more sensitive to heat and cold pain respond better to imipramine.     

The impact of a structured preoperative protocol on day of surgery cancellations

Aims and objectives

To evaluate the impact of implementing an evidence‐based, structured preoperative protocol on day of surgery cancellations in 13 operative specialties.

Background

Surgery cancellations cause unnecessary harm for patients and organisations as many cancellations could be prevented. Preoperative care has developed in recent years, and several preoperative interventions have been introduced. However, the optimal model for organising preoperative care remains unknown. Cancellations are a commonly used indicator when evaluating the success of preoperative care.

Design

Observational study with two study phases: before and after.

Methods

The cancellation data were collected from the hospital register from 1 September 2013–31 May 2014 (n = 591) and from September 2015–May 2016 (n = 542). The compliance rate of the preoperative protocol was evaluated in group sessions (n = 13) during spring 2016 using the participation of preoperative healthcare professionals (n = 49). The data were analysed statistically.

Results

Cancellation rates varied between 1.6%–9.7% (in the first phase) and between 1.5%–7.7% (in the second phase). A remarkable decrease was found in patients who failed to attend their scheduled procedures. The mean of compliance to the preoperative protocol across all specialties was 82.3%. A correlation between the rate of cancellation and the rate of compliance with the preoperative protocol was found.

Conclusions

A preoperative protocol promotes the scheduled arrival of surgical patients to the hospital and therefore decreases cancellation rates.

Relevance to clinical practice

An evidence‐based preoperative care protocol should be introduced for all healthcare professionals working in preoperative care to ensure smooth, safe and high‐quality care for surgical patients.     

Droperidol versus ondansetron for nausea treatment within the emergency department

Objective

A randomised single-blind trial was undertaken in an adult ED population, comparing the effectiveness of droperidol 2.5 mg IV with ondansetron 8 mg IV for the treatment of nausea and vomiting.

Methods

Patients were randomly allocated to receive droperidol (n = 60) or ondansetron (n = 60). Patients rated their nausea severity on a Visual Analogue Scale (VAS) immediately before and 30 min after drug administration. The primary outcome was of symptom improvement, defined by a VAS change ≥−8 mm 30 min post-treatment. Mean VAS change and percentage experiencing desired effect were secondary outcomes compared.

Results

Of 120 study patients, 60 (50%) received droperidol or ondansetron. Symptom improvement occurred in 93% (56 of 60) and 87% (52 of 60), respectively (P = 0.362). Mean VAS change was −38 mm and −29 mm, respectively (P = 0.031). Percentage of patients indicating desired effect was 85% and 63%, respectively (P = 0.006). Additional antiemetics were required for 16% and 37% of subjects, respectively (P = 0.006).

Conclusion

There was no statistically significant difference in the primary outcome of symptom improvement between droperidol and ondansetron. Secondary outcomes which favour droperidol warrant further exploration.     

Liraglutide relieves cardiac dilated function than DPP‐4 inhibitors

Introduction

Diabetes mellitus is a progressive disease with cardiovascular complications. This study evaluated the effects of liraglutide, a glucagon‐like peptide‐1 analogue and the dipeptidyl peptidase 4 inhibitors sitagliptin and linagliptin on cardiac function in type 2 diabetes patients with renal impairment.

Materials and Methods

A total of 139 patients who were referred because of suboptimal glycaemic control were randomly assigned to liraglutide 0.9 mg/d (n = 45), sitagliptin 50 mg/d, (n = 49) or linagliptin 5 mg/d (n = 45) at enrolment and were evaluated. Blood glucose, glycosylated haemoglobin and serum creatinine were assayed every 3 months for 48 months. Echocardiography was performed every 12 months for 48 months.

Results

Compared with baseline, fasting glucose, postprandial glucose, and systolic and diastolic pressure, but not estimated glomerular filtration rate, significantly decreased in all three groups. Albuminuria decreased from 24 to 48 months with liraglutide, but only from 24 to 30 months with sitagliptin and linagliptin. Diastolic function, assessed by E/e′ or left atrial dimension improved only with liraglutide.

Conclusions

Liraglutide was effective for glucose and blood pressure control, reduced albuminuria and improved diastolic function. Diastolic function was not improved by sitagliptin and linagliptin.     

Initial observations regarding free cortisol quantification logistics among critically ill children

Abstract  

     

Serum carbohydrate antigen 153 and renal function in patients with type 2 diabetes mellitus

Objective

The aim of our study was to investigate the correlation between serum carbohydrate antigen 153 (CA153) and renal function in patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 184 patients with T2DM were included, and renal function was assessed by the modification of diet in renal disease (MDRD) formula adjusted coefficient of the Chinese people.

Results

Serum CA153 concentrations were positively correlated with blood glucose (BG) and glycated hemoglobin (HbA1c) (r = .204, P = .005; r = .165, P = .025) in patients with T2DM. There was a negative correlation between serum CA153 and estimated glomerular filtration rate (GFR) (r = −.229, P = .002) in whole patients with T2DM; similarly, the correlations were observed in both women and men (r = −.228, P = .028 for women, r = −.231, P = .028 for men). Multiple linear regression analysis suggested that serum CA153 was still significantly correlated with estimated GFR (beta = −0.286, P < .001).

Conclusions

Serum CA153 is negatively correlated with estimated GFR in patients with T2DM, and serum CA153 may be a potentially useful clinical biomarker to assess renal function in the study population.

     

Correlation between neutrophil/lymphocyte ratio and Ranson score in acute pancreatitis

Background

Acute pancreatitis (AP) is characterized by inflammation of the pancreas, elevated pancreatic enzymes, and abdominal pain. The neutrophil to lymphocyte ratio (NLR) is used as a marker of inflammation. In this retrospective study, we aimed to investigate novel early prognostic predictors of AP, such as NLR and its correlation with the Ranson score.

Methods

A total 435 patients (Male: 152; 34.9%, Age: 63.53 ± 17.22 years) were included in the study. Data were collected by two clinicians scanning the registered hospital records.

Results

Classification of the patients according to the aetiologies revealed gallstone(s) 58.6% (n = 255), hyperlipidaemia 2.2% (n = 9), viruses 0.7% (n = 3), malignancies 0.5% (n = 2), and alcohol 0.2% (n = 1). No reason was discovered in 37.9% (n = 165) of patients. Age, duration in the intensive care unit, serum aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma‐glutamyl transferase (GGT), total bilirubin, direct bilirubin, lactate dehydrogenase (LDH), white blood cell (WBC) count, neutrophil count, lymphocyte count, and the NLR were greater in the group with a Ranson score ≥3 than the group with a Ranson score <3.

Discussion

Quick diagnosis is essential in AP. Current scoring systems for AP diagnosis are complicated, whereas NLP is a simple, practical, and effective marker.