Risk Assessment Score and Chi-Square Automatic Interaction Detection Algorithm for Hypertension Among Africans: Models From the SIREN Study.

BACKGROUND: This study aimed to develop a risk-scoring model for hypertension among Africans. METHODS: In this study, 4413 stroke-free controls were used to develop the risk-scoring model for hypertension. Logistic regression models were applied to 13 risk factors. We randomly split the dataset into training and testing data at a ratio of 80:20. Constant and standardized weights were assigned to factors significantly associated with hypertension in the regression model to develop a probability risk score on a scale of 0 to 1 using a logistic regression model. The model accuracy was assessed to estimate the cutoff score for discriminating hypertensives. RESULTS: Mean age was 59.9±13.3 years, 56.0% were hypertensives, and 8 factors, including diabetes, age ≥65 years, higher waist circumference, (BMI) ≥30 kg/m2, lack of formal education, living in urban residence, family history of cardiovascular diseases, and dyslipidemia use were associated with hypertension. Cohen κ was maximal at ≥0.28, and a total probability risk score of ≥0.60 was adopted for both statistical weighting for risk quantification of hypertension in both datasets. The probability risk score presented a good performance-receiver operating characteristic: 64% (95% CI, 61.0-68.0), a sensitivity of 55.1%, specificity of 71.5%, positive predicted value of 70.9%, and negative predicted value of 55.8%, in the test dataset. Similarly, decision tree had a predictive accuracy of 67.7% (95% CI, 66.1-69.3) for the training set and 64.6% (95% CI, 61.0-68.0) for the testing dataset. CONCLUSIONS: The novel risk-scoring model discriminated hypertensives with good accuracy and will be helpful in the early identification of community-based Africans vulnerable to hypertension for its primary prevention.

Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users: A qualitative socio-ecological approach.

BACKGROUND AND PURPOSE: Nurse practitioners (NPs), as well as all healthcare clinicians, have a legal and ethical responsibility to provide health care for deaf American Sign Language (ASL) users equal to that of other patients, including effective communication, autonomy, and confidentiality. However, very little is known about the feasibility to provide equitable health care. The purpose of this study was to examine NP perceptions of barriers and facilitators in providing health care for deaf ASL users. DATA SOURCES: Semistructured interviews in a qualitative design using a socio-ecological model (SEM). CONCLUSIONS: Barriers were identified at all levels of the SEM. NPs preferred interpreters to facilitate the visit, but were unaware of their role in assuring effective communication is achieved. A professional sign language interpreter was considered a last resort when all other means of communication failed. Gesturing, note-writing, lip-reading, and use of a familial interpreter were all considered facilitators. IMPLICATIONS FOR PRACTICE: Interventions are needed at all levels of the SEM. Resources are needed to provide awareness of deaf communication issues and legal requirements for caring for deaf signers for practicing and student NPs. Protocols need to be developed and present in all healthcare facilities for hiring interpreters as well as quick access to contact information for these interpreters.

Conceptual Model of Weight Management in Overweight and Obese African-American Females.

PROBLEM: Weight management of overweight and obese (OWO) African-American females (AAFs) is a poorly defined concept, leading to ineffective treatment of overweight and obesity, prevention of health sequelae, and risk reduction. METHODS: A conceptual model of the phenomenon of weight management in OWO AAFs was developed through dimensional analysis of the literature. Constructs were identified and sorted into the dimensions of perspective, context, conditions, process, and consequences and integrated into an explanatory matrix. FINDINGS: Through dimensional analysis, weight management in OWO AAFs was characterized as a multidimensional concept, defined from the perspective of weight loss in community-dwelling AAFs. Behaviors associated with weight management are strongly influenced by intrinsic factors and extrinsic conditions, which influence engagement in the processes and consequences of weight management. CONCLUSIONS: The resulting conceptual model of weight management in OWO AAFs provides a framework for research interventions applicable in a variety of settings.

South Carolina guidelines for diabetes care 2013.

BACKGROUND: There is a huge economic burden of diabetes in South Carolina. METHODS: The South Carolina Guidelines for Diabetes Care were based on the 2013 Standards of Medical Care from the American Diabetes Association. RESULTS: From a review of the Diabetes Quality Indicators in South Carolina 2007, Medicare claims data show: 65% of South Carolinians with diabetes insured by Medicare received 2 A1C test per year, 54% received an eye examination and 78% received a lipid panel. Only 42% of these individuals with diabetes had all 3 tests in the same year. In addition, only 50% of individuals with diabetes in South Carolina attended a diabetes self-management class. To improve the statistics and outcomes, the Diabetes Advisory Council provided the evidence-based South Carolina Guidelines for Diabetes Care. They are based on the 2013 Standards of Medical Care from the American Diabetes Association. These guidelines have been promoted at the continuing education programs sponsored by the Diabetes Initiative of South Carolina and the South Carolina Division of Diabetes Prevention and Control and distributed in the community sites by the Racial and Ethnic Approaches to Community Health coalition. CONCLUSIONS: The South Carolina Guidelines for Diabetes will provide evidence-based therapy and monitoring to minimize complications from diabetes and promote a higher quality of life for those with diabetes.

"It's a wild thing, waiting to get me": stance analysis of African Americans with diabetes.

PURPOSE: This mixed methods study uses a unique approach from social science and linguistics methodologies, a combination of positioning theory and stance analysis, to examine how 20 African Americans with type 2 diabetes make sense of the practices that led to recurrent emergency department visits to identify needs for more effective intervention. METHODS: In a purposive sample of postemergency department visit interviews with a same-race interviewer, people responded to open-ended questions reflecting on the decision to seek emergency department care. As applied to diabetes education, positioning theory explains that people use their language to position themselves toward their disease, their medications, and the changes in their lives. Transcriptions were coded using discourse analysis to categorize themes. As a form of triangulation, stance analysis measured language patterns using factor analysis to see when and how speakers revealed affect, attitude, and agentive choices for action. CONCLUSION: Final analysis revealed that one third of the sample exhibited high scores for positive agency or capacity for decision-making and self-management, while the rest expressed less control and more negative emotions and fears that may preclude self-management. This approach suggests a means to tailor diabetes education considering alternative approaches focused on communication for those facing barriers.

Measurement of students' perceptions of nursing as a career.

PURPOSE: Middle school has been identified as the prime age group to begin nursing recruitment efforts because students have malleable perceptions about nursing as a future career choice. The purpose of this integrative review is to present a brief overview of research processes related to middle school students' perceptions of nursing as a future career choice and to critically evaluate the current instruments used to measure middle and high school students' perceptions of nursing as a career choice. DESIGN: An integrative review of the years 1989 to 2009 was conducted searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine PubMed service (PubMed), and Ovid MEDLINE databases using the key words career, choice, future, ideal, nursing, and perception. Reference lists of retrieved studies were hand searched, yielding a total of 22 studies. METHODS: Inclusion criteria were (a) sample of middle school students, (b) sample of high school students, (c) mixed sample including middle or high school students, and (4) samples other than middle or high school students if the instrument was tested with middle or high school students in a separate study. Ten studies met these criteria. FINDINGS: Of the 10 studies, samples were 30% middle school students; 40% high school students; 10% mixed, including school-aged students; and 20% college students with an instrument tested in middle school students. Eighty percent of participants were White females. Overall, participants' socioeconomic status was not identified. A single study included a theoretical framework. Five instruments were identified and each could be completed in 15 to 30 min. The most commonly used instrument is available free of charge. Seventy percent of the studies used Cronbach's alpha to report instrument reliability (0.63 to 0.93), whereas 30% failed to report reliability. Fifty percent of the studies established validity via a "panel of experts," with three of those studies further describing the panel of experts. CONCLUSIONS: Samples of white females may hinder generalization. Socioeconomic status was not consistently reported and may be an important factor with regard to perceptions of nursing as a career choice. An overall absence of theoretical framework hinders empirical data from being applied to nursing theories that in turn may support nursing concepts. The reporting of reliability and validity may be improved by further defining panel of experts and expanding the number of experts (more than seven). More in-depth evaluation of the psychometric properties of the instruments with more diverse populations is needed. CLINICAL RELEVANCE: Rigorously tested instruments may be useful in determining middle school students' perceptions about nursing. Therefore, future researchers should consider testing existing instruments in the middle school population, adhering to theoretical frameworks, diversifying the sample population, and clearly reporting reliability and validity to gain knowledge about middle school students' perceptions about a nursing career.