African-Americans Have a Higher Propensity for Death from COVID-19: Rationale and Causation.

The purpose of this article is to provide an understanding about the mechanisms that contribute to the proliferation of COVID-19 morbidity and mortality among high-risk populations, and especially African-Americans. African-Americans are succumbing to novel SARS-CoV-2 (COVID-19) at an alarming rate. Current data indicate that while African-Americans represent less than 13.4% of the United States' population, they account for one-third of more than 4.77 million persons with verified COVID-19 infections. Currently, more than 50,258 African-Americans have succumbed to the disease. African-Americans are disproportionately impacted by COVID-19 to an extent unobserved in other racial/ethnic subgroups. In addition, this article describes the physiological event inflammation-mediation storming (cytokine storming). Social determinants of health such as income, education, and employment are hypothesized to impact cogent health care delivery for African-Americans. Included in this article are data on clinical outcomes that highlight the role of pre-existing (health disparities) conditions like diabetes, hypertension, cardiovascular disease, obesity, and lung disease, as barriers to optimal outcomes among African-Americans who are hospitalized with COVID-19. Also explored in this article is causation for vascular complications. A further aim of this article is to provide insight into cause and effect rationales for COVID-19 and health disparities, from both biosocial and health inequality perspectives. Linkages between these selected health disparities and COVID-19 are examined to determine possible deteriorating effects of COVID-19. Finally, techniques are offered to render culturally competent care to African-Americans diagnosed with COVID-19 who present concomitantly with health disparities.

Chloroquine and Hydroxychloroquine for the Treatment of COVID-19: Review and Appraisal of Current Evidence.

Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and associated coronavirus disease 19 (COVID-19) began ravaging most of the globe in November 2019. In the United States more than 25 million people have been infected with SARS-CoV-2. To date, COVID-19 has killed close to 400,000 U.S. citizens. In the face of limited pharmacotherapies, the current burden of SARS-CoV-2 and COVID-19 signals overwhelming sickness and trillions in healthcare costs ahead. The need to expeditiously identify safe and efficacious prophylaxis and treatment options is critical. Drug repositioning may be a promising strategy toward mitigating the impact of SARS-CoV-2 and COVID-19. This rapid review appraises available evidence on the viability of vintage antimalarial drugs chloroquine (CHQ) and its analog hydroxychloroquine (HCQ) repositioned for SARS-CoV-2 prophylaxis and COVID-19 treatment. Findings suggest neither the use of CHQ nor HCQ singularly, or concomitantly, with azithromycin and/or zinc provide definitive benefits for use against SARS-CoV-2 infection or COVID-19 illness. Moreover, administration of these medications was linked to significant and sometimes fatal complications.

Mothers, Fathers, Sons, and Human Papillomavirus Immunization Practices.

Despite the fact that human papillomavirus (HPV) infection and HPV-related cancers are on the rise in men, male HPV vaccine series completion is less than 10% in many areas. This study examined parental knowledge of the HPV vaccine and intent to vaccinate their sons. A cross-sectional study of 341 parents of boys was conducted in school settings in rural southeastern Georgia. Mothers were 2.07 times more likely than fathers to vaccinate their sons. Future research directions should include strategies to increase HPV vaccination in both genders and focus on parents' perceived severity and vulnerability of their sons to HPV infection.

Adherence to intravenous chemotherapy in African American and white women with early-stage breast cancer.

BACKGROUND: Adherence to intravenous chemotherapy offers survival and recurrence-free benefits for women diagnosed with early-stage breast cancer. However, previous studies have found that African American women are more likely to discontinue intravenous chemotherapy early, thus shortening their survival. Yet the existence of racial differences and predictors of adherence to chemotherapy treatment between African American and white women are largely understudied or inconsistent. OBJECTIVE: The purposes of this study were to examine factors that influence the decision to adhere to chemotherapy in African American and white women diagnosed with early-stage breast cancer and to test for racial differences that may exist in this sample. INTERVENTIONS/METHODS: The study recruited a convenience sample of 99 African American and white women. Factors examined were sociodemographic variables (age, race, access to healthcare), social support, religious coping, chemotherapy adverse effects, depression, breast cancer knowledge, health beliefs, cancer fatalism, and days from diagnosis to treatment. Data analyses included logistic regression modeling. RESULTS: No racial differences in adherence to intravenous chemotherapy between African American and white women were found (χ = 2.627, P = .10). Days to treatment (odds ratio [OR], 0.982, P = .058), health insurance (OR, 0.121; P = .016), change in depression (OR, 0.935; P = .118), and symptom severity (OR, 0.950; P = .038) were independently associated with nonadherence to chemotherapy. CONCLUSIONS: This study provides emerging evidence of factors that may be potentially modified with interventions at the clinical setting. IMPLICATIONS FOR PRACTICE: The findings can be used to spearhead future intervention studies that improve treatment decision making to chemotherapy adherence.

Parental Human Papillomavirus Vaccine Survey (PHPVS): nurse-led instrument development and psychometric testing for use in research and primary care screening.

BACKGROUND AND PURPOSE: Human papillomavirus (HPV) vaccine was approved for girls aged 9-24 years in 2006 to prevent HPV infection and cervical cancer. The Parental Human Papillomavirus Survey (PHPVS) was framed on theoretical constructs of the health belief model (HBM) and developed to survey parents regarding their HPV knowledge, attitudes, and intent to vaccinate. METHODS: We evaluated the psychometric properties of the PHPVS using classical item analysis and exploratory factor analysis (EFA) among a sample of 200 parents/caregivers. RESULTS: The EFA yielded a 4-factor unidimensional model that explained between 62% and 68% of the total variance depending on the extraction method used. The estimated Cronbach's alpha for the PHPVS was .96. CONCLUSIONS: The PHPVS is a reliable measure of HPV knowledge, attitudes, and intent to vaccinate.

Transfusion-related necrotizing enterocolitis: a conceptual framework.

Necrotizing enterocolitis (NEC) is a disease primarily of prematurity characterized by partial or entire gut necrosis and is associated with significant mortality and morbidity. Recent studies report that approximately 25% to 35% of very low-birth-weight infants less than 1500 g receiving packed red blood cell transfusions develop temporally associated NEC, known as transfusion-related NEC (TR-NEC). Although there are many known risk factors for NEC, this article focuses on 3 contributing factors: packed red blood cell transfusions, enteral feedings, and gastrointestinal immaturity. Previous data suggest that these factors may interact to affect neonatal intestinal tissue oxygenation, which may lead to tissue ischemia, resulting in intestinal injury. This article presents a conceptual framework that combines current theoretical perspectives for TR-NEC, and reviews previous research examining related variables and how their interaction may increase the risk for TR-NEC development. In addition, incorporation of the proposed framework to guide future research and nursing care in this area is discussed.

Red blood cell transfusion-related necrotizing enterocolitis in very-low-birthweight infants: a near-infrared spectroscopy investigation.

BACKGROUND: Recent evidence suggests that antecedent red blood cell (RBC) transfusions increase the risk for necrotizing enterocolitis (NEC), the most common gastrointestinal emergency encountered by very-low-birthweight (VLBW) infants. The underlying mechanism for this association is unknown. Altered oxygenation of the mesenteric vasculature during RBC transfusion has been hypothesized to contribute to NEC development and was investigated in this study. STUDY DESIGN AND METHODS: Oxygenation patterns among four VLBW infants who developed transfusion-related NEC (TR-NEC) were compared to four VLBW infants with similar gestational age who were transfused but did not develop NEC (non-NEC). Cerebral and mesenteric patterns were recorded before, during, and 48 hours after RBC transfusion using near-infrared spectroscopy (NIRS) technology. Percentage change from mean baseline regional oxygen saturation values and cerebrosplanchnic oxygenation ratios were analyzed. RESULTS: All TR-NEC infants (24-29 weeks' gestation; 705-1080 g) demonstrated greater variation in mesenteric oxygenation patterns surrounding transfusions than non-NEC infants (27.6-30 weeks' gestation; 980-1210 g). TR-NEC infants received larger mean volumes of total blood (27.75 ± 8.77 mL/kg) than non-NEC infants (15.25 ± 0.5 mL/kg). CONCLUSION: Wide fluctuation and decreases in mesenteric oxygenation patterns are more pronounced in TR-NEC infants, especially before TR-NEC onset, compared to non-NEC infants. Greater total volume of infused blood was associated with TR-NEC in preterm infants. Using NIRS, larger prospective studies are needed to further evaluate potential risk factors for NEC in this high-risk population.

An opportunity for cancer prevention during preadolescence and adolescence: stopping human papillomavirus (HPV)-related cancer through HPV vaccination.

OBJECTIVE: We conducted a descriptive study of the correlates of refusal and acceptance of human papillomavirus (HPV) vaccination by rural parents of preadolescent and adolescent children. We hypothesized that the correlates of parents who allow their children aged 9 to 13 years to get the HPV vaccine and those of parents who do not allow vaccination would differ significantly. METHODS: This cross-sectional study was implemented during the school years 2009-2011 in the elementary and middle schools of three rural counties in Georgia. Parents were recruited at school functions to complete an anonymous validated survey. RESULTS: Parents who chose to vaccinate their children or intended to vaccinate were twice as likely to be from a race other than African American and 2.7 times more likely to have a religion other than Baptist. Using stepwise logistic regression and after adjustment for race and religion, we found that parents who had vaccinated or intended to vaccinate had significantly higher scores on perceived barriers (1.02 times more likely to vaccinate) and lower scores on perceived benefits (1.01 times more likely to vaccinate) (model p < .001). CONCLUSIONS: The results suggest that healthcare providers in rural areas can increase HPV vaccine uptake and reduce HPV-related cancers by using a multifaceted approach to educating their patients within the context of the patients' cultural values, geographic location, and economic situation. Such an approach could dispel misinformation and increase vaccine uptake.

Rural African American parents' knowledge and decisions about human papillomavirus vaccination.

PURPOSE: To identify predictors of human papillomavirus (HPV) vaccination among rural African American families. DESIGN: Cross-sectional descriptive study in schools in three rural counties in southeastern United States. The sample consisted of African American parents or caregivers with children 9 to 13 years of age who attended elementary or middle school in 2010-2011. METHODS: Using an anonymous, 26-item survey, we collected descriptive data during parent-teacher events from African American parents with children in elementary or middle school. The main outcome was measured as a response of "yes" to the statement "I have or will vaccinate my child with the HPV vaccine." In addition, composite scores of knowledge and positive attitudes and beliefs were compared. No interventions were conducted. FINDINGS: We identified predictors of HPV vaccination and found that religious affiliation had a correlation with vaccinating or planning to vaccinate a child. CONCLUSIONS: Results indicate a need for further research on the role of local culture, including religion and faith, in rural African Americans' decisions about giving their children the HPV vaccination. CLINICAL RELEVANCE: This study emphasizes the importance of understanding rural African American parents' knowledge, attitudes, and spiritual beliefs when designing health education programs and public health interventions to increase HPV vaccination uptake among African American boys and girls living in rural areas.

Issues in community-based care among homeless minorities.

Homelessness is an increasing major public health problem in the United States. The homeless population consists of men, women, youth and families who live on the streets or in shelters. Minorities, especially African-Americans and Hispanics, are particularly at risk for homelessness due to their high rates of poverty. Homelessness predisposes persons to poor health, including a variety of acute and chronic physical and psychological diseases for which they often have difficulty obtaining healthcare. This article discusses common issues and challenges that homeless minorities and their health-care providers face in obtaining community-based healthcare, including issues in caring for homeless men and women, fragmentation of healthcare, perceived discrimination and provider bias, provider-patient trust issues, lack of access to care, and health literacy issues. Two programs designed to provide community-based experiential learning for nursing students to address these issues and the health-care needs of the homeless are described, i.e., the Men Achieving Self Health (MASH) and Women Inspired Self Health (WISH) Outreach Programs. Approaches used by faculty and students who are engaged in providing health-care services to the homeless via the MASH and WISH Programs are discussed.

Symptom clusters and health-related quality of life in people with chronic stable angina.

AIM: This paper reports findings of a study to examine the independent contribution of chest pain, fatigue and dyspnoea to health-related quality of life in people with chronic stable angina. BACKGROUND: People with chronic stable angina experience poorer quality of life in multiple areas including physical and emotional health. Emerging evidence suggests the presence of concomitant symptoms yet there are no systematic studies examining the impact of symptom clusters on quality of life in people with chronic angina. METHOD: Outpatients (n = 134), recruited over a 16-month period in 2000 and 2001, with confirmed coronary heart disease and chronic angina completed reliable and valid questionnaires measuring chest pain frequency, fatigue, dyspnoea and quality of life. The data have contemporary relevance because despite changes in treatment of coronary heart disease, chronic angina remains prevalent worldwide. Hierarchical multiple linear regression was used to examine the symptom cluster of chest pain frequency, fatigue and dyspnoea in predicting quality of life. RESULTS: The sample was predominantly white (74·6%), men (59·7%) with a mean age of 63·4 (sd 12·12) years. Controlling for age, gender, social status and co-morbidities, the symptom cluster of chest pain frequency, dyspnoea and fatigue accounted for a statistically significant increase in unadjusted R² (F of Δ, P < 0·05) for the models predicting physical limitation (R² Δ 24·1%), disease perception (R² Δ 24·6%), Short Form-36 Physical Component Score (R² Δ 24·3%) and Mental Component Score (R² Δ 07·0%). CONCLUSION: Symptom assessment and management of people with chronic stable angina should involve multiple symptoms. Greater fatigue predicted poorer quality of life in multiple areas. As a possible indicator of depression, it warrants further assessment and follow-up.

A guide to developing a culturally competent organization.

The journey to organizational cultural competence for a health care organization, educational setting, freestanding clinic, or long-term-care organization is a process that requires the collaborative efforts from people at all levels in every department as well as external consumers such as public policy officials, students, and community leaders. Broadly speaking, four main but overlapping areas must be considered in institute activities and strategies to accomplish a comprehensive culturally competent organization. These four areas are (a) administration and governance, (b) orientation and education, (c) language, and (d) staff competencies. This article presents key content areas and activities to consider on the journey to cultural competence. Tables with suggested departmental responsibilities for implementation are included. In some cases, the journey may best be facilitated by a consultant who is well versed in cultural competence and organizational dynamics.

Challenges and strategies of dyad research: cardiovascular examples.

This article highlights challenges in recruitment, retention, attrition, data collection, and analysis when studying dyads in cardiovascular research. Including family members in studies is particularly important because family members often have a major role in treatment of patients with cardiovascular illness. The partnership of a patient-family member is referred to as a dyad and may include the cardiovascular patient and another relative, such as an adult child, sibling, spouse, son-in-law or daughter-in-law, or unmarried partner. Insights gained from previous research may facilitate and improve rigor when reviewing and conducting studies involving dyads with cardiovascular and other chronic diseases. Including patients and partners in descriptive and intervention studies will allow researchers to more fully explore family factors that may be salient in health outcomes.

Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans.

African Americans with high blood pressure (BP) can benefit greatly from therapeutic lifestyle changes (TLC) such as diet modification, physical activity, and weight management. However, they and their health care providers face many barriers in modifying health behaviors. A multidisciplinary panel synthesized the scientific data on TLC in African Americans for efficacy in improving BP control, barriers to behavioral change, and strategies to overcome those barriers. Therapeutic lifestyle change interventions should emphasize patient self-management, supported by providers, family, and the community. Interventions should be tailored to an individual's cultural heritage, beliefs, and behavioral norms. Simultaneously targeting multiple factors that impede BP control will maximize the likelihood of success. The panel cited limited progress with integrating the Dietary Approaches to Stop Hypertension (DASH) eating plan into the African American diet as an example of the need for more strategically developed interventions. Culturally sensitive instruments to assess impact will help guide improved provision of TLC in special populations. The challenge of improving BP control in African Americans and delivery of hypertension care requires changes at the health system and public policy levels. At the patient level, culturally sensitive interventions that apply the strategies described and optimize community involvement will advance TLC in African Americans with high BP.

Marginality and physical and sexual abuse in women.

We examine the role of marginality as a social determinant of physical and sexual abuse in women. In this study of a community sample of 568 women of reproductive age, and women with a history of physical and sexual abuse reported significantly more marginality than women without a prior history of abuse. An inverse relationship between socioeconomic status (SES) and marginality existed. Sexual abuse initially experienced in childhood had a more profound impact on marginality in women than when the abuse initially occurred in adolescence or adulthood. Early identification of abused women in clinical practice may help to prevent further marginality and adverse health outcomes.

Advancing nursing science in vulnerable populations: measurement issues.

This study examined measurement practices of researchers in relation to vulnerable population research published in four general nursing research journals in 2004. The purpose was to identify issues and imperatives in the measurement of research variables with vulnerable populations that warrant attention. A total of 133 articles were eligible for inclusion in the study, and 428 measurement instruments were used in the studies. A content analysis of the 133 eligible articles indicated that most samples included to a greater extent more Whites than predominantly minority populations, and more adults than children. Most of the articles did not specify socioeconomic status of samples. Of the 133 eligible articles, 83 (62.4%) included samples that were comprised of a majority of racial and ethnic minorities; however, percentages of studies that focused predominately on a specific minority group were below 10% in more than 80% of studies. Major findings related to measurement practices indicated inadequate specification of the measurement framework employed; lack of adequate specification of the conceptual base of measurement tools; and, a heavy reliance on the use of self-report data, attitudinal and perceptual measures, and the use of questionnaires and rating scales. There was also inadequate attention to the metric qualities of laboratory physiological measures, and to reliability and validity in general. It was concluded that inadequate attention is given to measurement practices by researchers when studying vulnerable populations.

Normal establishment of virus-specific memory CD8 T cell pool following primary infection during pregnancy.

Suppression of cell-mediated immunity has been proposed as a mechanism that promotes maternal tolerance of the fetus but also contributes to increased occurrence and severity of certain infections during pregnancy. Despite decades of research examining the effect of pregnancy on Ag-specific T cell responses, many questions remain. In particular, quantitative examination of memory CD8 T cell generation following infection during pregnancy remains largely unknown. To examine this issue, we evaluated the generation of protective immunity following infection during pregnancy with a nonpersistent strain of lymphocytic choriomeningitis virus (LCMV) in mice. The CD8 T cell response to LCMV occurred normally in pregnant mice compared with the nonpregnant cohort with rapid viral clearance in all tissues tested except for the placenta. Despite significant infiltration of CD8 T cells to the maternal-fetal interface, virus persisted in the placenta until delivery. Live pups were not infected and generated normal primary immune responses when challenged as adults. Memory CD8 T cell development in mice that were pregnant during primary infection was normal with regards to the proliferative capacity, number of Ag-specific cells, cytokine production upon re-stimulation, and the ability to protect from re-infection. These data suggest that virus-specific adaptive memory is normally generated in mice during pregnancy.

The relationships among stress, coping, social support, and weight class in premenopausal African American women at risk for coronary heart disease.

The purpose of this study was to determine the nature of the relationships among stress, coping, social support, and weight class in premenopausal African American women as risk factors for coronary heart disease. Overweight and obesity are significant problems for African American women who are at an increased risk of weight-related diseases, such as diabetes, hypertension, cardiovascular disease, and cancer. Of these women, those who are premenopausal have a significantly higher coronary heart disease mortality rate than their white counterparts. There are gaps in current knowledge concerning the role that stress and other psychosocial factors play in weight control of premenopausal African American women. Data were obtained from 178 women with eligible data sets from a larger study of 236 subjects (Genetic Predictors of Coronary Heart Disease in Premenopausal African American Women). The measures for stress, coping, and social support included the Perceived Stress Scale, the Norbeck Social Support Questionnaire, and the Jalowiec Coping Scale. The weight class of the women was determined as: normal weight-body mass index (BMI) of 18.5-24.9 kg/m, overweight-BMI of 25-29.9 kg/m, or obese-BMI > or = 30 kg/m. Statistical analysis conducted included Spearman's rho, Chi-square, and regression analysis. Confrontive coping was shown to be used more often to a "high" degree in normal-weight African American women than in overweight and obese African American women (chi = 24.024; P = .0001). Confrontive coping was the only independent predictor of weight class in a regression model that included perceived stress, life events, social support, and optimistic, self-reliant, and evasive coping strategies. Therefore, African American women who use confrontive coping to a high degree were more likely to confront problems, such as weight control issues, than those who use this coping strategy to a low or medium degree.

American Academy of Nursing Expert Panel report: developing cultural competence to eliminate health disparities in ethnic minorities and other vulnerable populations.

The members of the Expert Panel on Cultural Competence of the American Academy of Nursing (AAN) envisioned this article to serve as a catalyst to action by the Academy to take the lead in ensuring that measurable outcomes be achieved that reduce or eliminate health disparities commonly found among racial, ethnic, uninsured, underserved, and underrepresented populations residing throughout the United States. The purposes of this article are to (a) assess current issues related to closing the gap in health disparities and achieving cultural competence, (b) discuss a beginning plan of action from the Expert Panel on Cultural Competence for future endeavors and continued work in these areas beyond the 2002 annual conference on Closing the Gap in Health Disparities, and (c) provide clearly delineated recommendations to assist the Academy to plan strategies and to step forward in taking the lead in reshaping health care policies to eliminate health care and health disparities.

Relationship of adolescent physical and sexual abuse to perimenstrual symptoms (PMS) in adulthood.

Research is lacking regarding adolescent physical and sexual abuse and perimenstrual symptoms (PMS). This study examined the relationship between adolescent physical and sexual abuse and PMS in adult women. Secondary data analysis of a longitudinal study of a community sample of 568 women (35% underrepresented ethnicities), using the database "Nursing Assessment of PMS: Neurometric Indices," was performed. History of both adolescent physical abuse and sexual abuse was significantly associated with PMS in adulthood. Women with a history of adolescent physical and sexual abuse had significantly more severe PMS patterns with more dysphoria than women without abuse.