Impact of patient health literacy on surgical treatment of breast cancer.

Little is known about the role of low health literacy (LHL) among breast surgical oncology patients. We initiated a prospective health literacy assessment to determine the relationship between health literacy and surgical treatment. Among 512 patients, univariate analysis revealed no statistical significance in the relationship of health literacy to breast surgery type, contralateral prophylactic mastectomy, or reconstruction following mastectomy. In a multivariate analysis, women with LHL were less likely to undergo reconstruction (aOR 0.81, 95% CI 0.69-0.94, P value = .006). Tailored interventions are needed to combat disparities in cancer treatment associated with LHL, with focus on reconstruction following mastectomy.

Paroxysmal Sympathetic Hyperactivity in Children: An Exploratory Evaluation of Nursing Interventions.

BACKGROUND: Paroxysmal sympathetic hyperactivity (PSH) produces symptoms of autonomic instability and muscle over-activity; however, the majority of nursing interventions used in clinical practice are anecdotal and not evidenced based. OBJECTIVE: The primary objective was to report nursing documentation of PSH events, and to describe the clinical nursing interventions and care provided to children who have suffered a severe brain injury and are exhibiting PSH. The secondary objective was to demonstrate how the Symptom Management Theory (SMT) can serve as a framework for research related to brain injury and PSH. METHODOLOGY: The study consisted of a retrospective chart review of nursing progress notes using direct content analysis. The nested sample of ten randomly selected charts was chosen from a larger quantitative study of 83 children who had suffered severe brain injuries with and without PSH. Textual analysis of verbatim nursing progress notes was used to describe nursing interventions that were used and documented for this patient population. RESULTS: The priority nursing interventions to manage these symptoms included medication administration, facilitation of family presence, and strategies to target auditory, tactile, and visual stimuli. The sample received different individual interventions for PSH. Additionally, individual subjects demonstrated different patterns of interventions. IMPLICATIONS: While tactile interventions were documented most frequently, there was not a uniform approach to interventions. The SMT can be useful to provide a framework that organizes and tests clinical care and management of PSH strategies.

Using Twitter to Understand Public Perceptions Regarding the #HPV Vaccine: Opportunities for Public Health Nurses to Engage in Social Marketing.

OBJECTIVES: Given the degree of public mistrust and provider hesitation regarding the human papillomavirus (HPV) vaccine, it is important to explore how information regarding the vaccine is shared online via social media outlets. The purpose of this study was to evaluate the content of messaging regarding the HPV vaccine on the social media and microblogging site Twitter, and describe the sentiment of those messages. DESIGN AND SAMPLE: This study utilized a cross-sectional descriptive approach. Over a 2-week period, Twitter content was searched hourly using key terms "#HPV and #Gardasil," which yielded 1,794 Twitter posts for analysis. Each post was then analyzed individually using an a priori coding strategy and directed content analysis. RESULTS: The majority of Twitter posts were written by lay consumers and were sharing commentary about a media source. However, when actual URLs were shared, the most common form of share was linking back to a blog post written by lay users. The vast majority of content was presented as polarizing (either as a positive or negative tweet), with 51% of the Tweets representing a positive viewpoint. CONCLUSIONS: Using Twitter to understand public sentiment offers a novel perspective to explore the context of health communication surrounding certain controversial issues.

Paroxysmal sympathetic hyperactivity: Autonomic instability and muscle over-activity following severe brain injury.

BACKGROUND: Children who suffer from moderate-to-severe brain injury can develop a complicating phenomenon known as paroxysmal sympathetic hyperactivity (PSH), characterized by autonomic instability and identified clinically as a cluster of symptoms that can include recurrent fever without a source of infection, hypertension, tachycardia, tachypnea, agitation, diaphoresis and dystonia. Studies with adults have demonstrated that this cluster of symptoms is associated with poorer clinical outcomes (prolonged hospitalizations, poorer cognitive and motor function). However, there have been limited studies in children with PSH. OBJECTIVE: To present a literature review regarding PSH following severe brain injury and highlight research needs in children with PSH. METHODOLOGY: Electronic databases (CINAHL, Ovid Medline, Web of Science and Google Scholar) were searched. RESULTS: Thirty-one research articles met the criteria for inclusion. Several themes emerged regarding the phenomenon of interest during the review: nomenclature, symptoms, management and differences between children and adults. IMPLICATIONS: The majority of the research regarding PSH following severe brain injury has been descriptive in nature. Few studies, however, have explored PSH in children with brain injury; therefore, little is known about whether the outcomes of children with PSH are different and, if so, in what ways.

Transcriptional regulation of copper metabolism genes in the liver of fetal and neonatal control and iron-deficient rats.

Copper and iron metabolism have been known to interact for many years. We have previously shown, during pregnancy, that copper levels in the maternal liver rise as a consequence of iron deficiency, but that levels in the fetal liver decrease. In this paper, we measure expression of genes involved in copper metabolism in fetal and postnatal liver, to test whether alterations can explain this observation. Additionally, we study the extent to which gene expression changes in the latter stages of pregnancy and in the perinatal period. Ctr1 expression levels dropped to term, rising again thereafter. There was no difference in gene expression between control and iron deficient animals. Atox1 expression remained approximately stable until term, and then there was a rise to a maximum at about Day 8. Atp7a expression levels remained constant, except for a brief drop at term. Atp7b levels, in contrast, decreased from a maximum early in gestation to low levels in the term and post-natal livers. Ceruloplasmin expression appeared to be diametrically opposite to Atp7b. The other two metallochaperones showed the same pattern of expression as Atox1, with a decrease to term, a rise at Day 1, or a rise after birth followed by a brief decrease at about Day 3. None of the genes were significantly affected by iron deficiency, suggesting that changes in expression cannot explain the altered copper levels in the fetal and neonatal liver.

Parent/caregiver health literacy among children with special health care needs: a systematic review of the literature.

BACKGROUND: Children with special health care needs (CSHCN) are children with medical or behavioral diagnoses that require services beyond those generally needed by pediatric populations. They account for a significant portion of pediatric health care expenditures and often have complicated treatment regiments. Health literacy has recently been recognized as a key indicator of quality chronic disease self-management and parental/caregiver health literacy of CSHCN is an understudied area. The purpose of this systematic review was to assess the available evidence of studies investigating parent/caregiver health literacy of CSHCN. METHODS: Databases were searched to retrieve relevant articles for inclusion (dating from 1998 to 2014). Only studies that assessed the relationship between parent/caregiver health literacy on outcomes pertinent to CSHCN were included. Because of the limited number of studies, there were no restrictions placed on type of outcome. RESULTS: Thirteen studies were included in the final review with a range of health literacy assessments and outcome ascertainment. The majority of studies; (1) focused on the relationship between parental/caregiver health literacy and asthma outcomes, (2) were cross-sectional study designs, and (3) included samples recruited from pediatric clinics in academic medical settings. CONCLUSIONS: There were several gaps in the literature where future research is needed including; (1) direct assessment of child/adolescent health literacy, (2) inclusion of children with co-morbid conditions, (3) further assessment of the relationship between health literacy and health care utilization and cost, and (4) assessment of parental/caregiver health literacy in the inpatient care setting.

Acute rheumatic fever in First Nations communities in northwestern Ontario: Social determinants of health "bite the heart".

OBJECTIVE: To document a case series of 8 young First Nations patients diagnosed with acute rheumatic fever (ARF), a preventable disease that resulted in the death of 2 patients, in northwestern Ontario in the context of late diagnosis, overcrowded housing, and inadequate public health response. DESIGN: Retrospective case series over an 18-month period. SETTING: Remote First Nations communities in northwestern Ontario. PARTICIPANTS: Eight patients with ARF. MAIN OUTCOME MEASURES: Incidence, mortality, residual rheumatic heart disease, time to diagnosis, barriers to diagnosis and treatment, housing situation of patients, patient demographic characteristics (age, sex), and investigation results. RESULTS: The incidence of ARF in this population was 21.3 per 100,000, which is 75 times greater than the overall Canadian estimated incidence. The average patient age was 9.4 years. Most cases developed joint findings, and 5 of the surviving patients had rheumatic heart disease when they received echocardiography. The average time to diagnosis was 88 days. Two 4-year-old children died from ARF. Most patients lived in inadequate and crowded housing. CONCLUSION: This rare disease still exists in remote First Nations communities. These communities demonstrate an incidence equal to that in aboriginal communities in Australia and New Zealand, which have among the highest international incidence of ARF. Primordial prevention, including improved on-reserve housing, is urgently needed. Case detection and ongoing surveillance for primary and secondary prophylaxis requires a well resourced regional strategy.

Susceptibility to childhood-onset rheumatoid arthritis: investigation of a weighted genetic risk score that integrates cumulative effects of variants at five genetic loci.

OBJECTIVE: Children with childhood-onset rheumatoid arthritis (RA) include those with rheumatoid factor or anti-citrullinated protein antibody-positive juvenile idiopathic arthritis. To test the hypothesis that adult-onset RA-associated variants are also associated with childhood-onset RA, we investigated RA-associated variants at 5 loci in a cohort of patients with childhood-onset RA. We also assessed the cumulative association of these variants in susceptibility to childhood-onset RA using a weighted genetic risk score (wGRS). METHODS: A total of 155 children with childhood-onset RA and 684 healthy controls were genotyped for 5 variants in the PTPN22, TRAF1/C5, STAT4, and TNFAIP3 loci. High-resolution HLA-DRB1 genotypes were available for 149 cases and 373 controls. We tested each locus for association with childhood-onset RA via logistic regression. We also computed a wGRS for each subject, with weights based on the natural log of the published odds ratios (ORs) for the alleles investigated, and used logistic regression to test the wGRS for association with childhood-onset RA. RESULTS: Childhood-onset RA was associated with TNFAIP3 rs10499194 (OR 0.60 [95% confidence interval 0.44-0.83]), PTPN22 rs2476601 (OR 1.61 [95% confidence interval 1.11-2.31]), and STAT4 rs7574865 (OR 1.41 [95% confidence interval 1.06-1.87]) variants. The wGRS was significantly different between cases and controls (P < 2 × 10(-16) ). Individuals in the third to fifth quintiles of wGRS had a significantly increased disease risk compared to baseline (individuals in the first quintile). Higher wGRS was associated with increased risk of childhood-onset RA, especially among males. CONCLUSION: The magnitude and direction of the association between TNFAIP3, STAT4, and PTPN22 variants and childhood-onset RA are similar to those observed in RA, suggesting that adult-onset RA and childhood-onset RA share common genetic risk factors. Using a wGRS, we have demonstrated the cumulative association of RA-associated variants with susceptibility to childhood-onset RA.

Iron and copper in fetal development.

Copper and iron are both essential micronutrients. Because they can both accept and donate electrons, they are central to many energy dependent chemical reactions. For example, copper is a critical part of ferroxidase enzymes ceruloplasmin, hephaestin and zyklopen, as well as enzymes such as dopamine-ß-monoxygenase, while iron is part of the catalytic site of many cytochromes and enzymes involved in fatty acid desaturation. Unsurprisingly, therefore, copper and iron deficiency, especially during pregnancy, when cell proliferation and differentiation are very active, sub-optimal nutrient status can lead to serious consequences. These problems can persist into adulthood, with an increased risk of mental problems such as schizophrenia and, in animal models at least, hypertension and obesity. In this review, we consider what these problems are and how they may arise. We examine the role of copper and iron deficiencies separately during fetal development, in terms of birth outcome and then how problems with status in utero can have long term sequelae for the offspring. We examine several possible mechanisms of action, both direct and indirect. Direct causes include, for example, reduced enzyme activity, while indirect ones may result from changes in cytokine activity, reductions in cell number or increased apoptosis, to name but a few. We examine a very important area of nutrition-interactions between the micronutrients and conclude that, while we have made significant advances in understanding the relationship between micronutrient status and pregnancy outcome, there is still much to be learned.

Hierarchy of risk of childhood-onset rheumatoid arthritis conferred by HLA-DRB1 alleles encoding the shared epitope.

OBJECTIVE: Associations between shared epitope (SE)-encoding HLA-DRB1 alleles and rheumatoid arthritis (RA) are well established. However, only a limited number of studies have investigated these alleles in patients with childhood-onset RA, which is defined as rheumatoid factor- and/or anti-citrullinated protein antibody-positive juvenile idiopathic arthritis. The aims of this study were to investigate the largest cohort of patients with childhood-onset RA for association with SE alleles and to determine whether there is a hierarchy of risk based on the amino acid sequence of the SE. METHODS: High-resolution HLA-DRB1 genotypes were obtained for 204 patients with childhood-onset RA and 373 healthy control subjects. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for different SE-encoding HLA-DRB1 alleles. In addition, genotype ORs were calculated for combinations of SE alleles classified into S(2) , S(3P) , or L alleles, based on amino acid sequences in position 70-74 of the DRß1 chain, as proposed by Tezenas du Montcel et al. RESULTS: We confirmed associations between HLA-DRB1 SE alleles and childhood-onset RA (76% of patients carried 1 or 2 SE alleles compared with 46% of control subjects; OR 3.81, 95% CI 2.4-6.0, P < 1 × 10(-7) ). We also observed associations between individual SE alleles (HLA-DRB1*0101, *0401, *0404, *0405, *0408, and *1001) and childhood-onset RA. Genotype-specific risk estimates suggested a hierarchy of risk, with the highest risk among individuals heterozygous for S(2) /S(3P) (OR 22.3, 95% CI 9.9-50.5, P < 0.0001). CONCLUSION: We confirm the association between SE-encoding HLA-DRB1 alleles and susceptibility to childhood-onset RA. The excess risk conferred by carriage of the combination of S(2) and S(3P) risk alleles suggests that children with DRß1 chains containing the KRAA and QRRAA or RRRAA sequences are especially susceptible to RA.

Asian American adolescents' willingness to donate organs and engage in family discussion about organ donation and transplantation.

CONTEXT: Despite the growing need for organ donation among Asian Americans, studies suggest that they are reluctant to donate. OBJECTIVE: To examine the association of attitudes and knowledge about organ donation and transplantation with willingness to donate and willingness to engage in family discussion about organ donation among Asian American adolescents. DESIGN: A cross-sectional study. SETTING: The Big Island of Hawaii. PARTICIPANTS: Self-identified Asian American adolescents (Japanese, Chinese, Filipino, Korean), ages 16 to 17 years old, and each adolescent's parent or guardian. MAIN OUTCOME MEASURES: Asian American adolescents provided demographic information and completed the Modified Organ Donation Attitude Survey, the Organ Donation and Transplantation Knowledge Survey, and the Suinn-Lew Asian Self-Identity Acculturation Scale. A parent or guardian also provided demographic information. Linear regression analyses were used to examine the associations with willingness to donate and to engage in family discussion about organ discussion. RESULTS: Willingness to donate was associated with positive knowledge related to general aspects about organ donation and cultural limitations in receiving an organ transplant, a high level of acculturation, and a low level of negative attitudes (R2 = 0.402, F = 18.86, P = .005). Asian American adolescents with approving or positive attitudes were likely to engage in family discussion about organ donation (R2 = 0.195, F = 27.93, P = .005). To reinforce and maintain high levels of knowledge and positive attitudes, organ donation education is most likely needed in high schools.

One step entry to P,O- and P,N-type heterocyclic tertiary phosphine ligands and application in Suzuki-Miyaura cross-coupling reactions.

A direct synthesis of conformationally mobile P,O- and P,N-type heterocyclic phosphine ligands is described involving radical-mediated addition of diisobutylphosphine to olefinic-heterocycles. Palladium complexes of the P,N-ligand were determined to be highly active in the Suzuki-Miyaura cross-coupling reactions, including deactivated aryl chlorides.

An evaluation of the factors that affect the health-related quality of life of children following myelosuppressive chemotherapy.

PURPOSE: The purposes of this study, in children who were assessed 1 week after the administration of myelosuppressive chemotherapy were: to compare the total and subscale scores on a generic measure of health-related quality of life (HRQOL) to normative data from healthy children and describe the relationships between demographic, clinical, and symptom characteristics of children with cancer and generic and disease-specific dimensions of HRQOL. METHODS: Patients (n = 61) were predominantly male (52.5%), minority (63.9%), and 14.7 years of age. Children completed the Memorial Symptom Assessment Scale for 10- to 18-year olds, the PedsQL™ Generic and Cancer Modules, and the Karnofsky Performance Status (KPS) scale 1 week after the start of a chemotherapy cycle. RESULTS: The mean number of symptoms per patient was 10.6. Compared with the normative sample, children with cancer reported significantly lower scores for the total scale and all of the subscales except emotional and social functioning. No significant differences were found between any demographic characteristics and total or subscale scores on the generic or disease-specific measures of HRQOL. Lower KPS scores were associated with poorer generic and disease-specific HRQOL scores. In addition, a higher number of symptoms was associated with poorer generic and disease-specific HRQOL scores. Finally, higher symptom distress scores were associated with poorer generic and disease-specific HRQOL scores. CONCLUSION: Among the demographic, clinical, and symptom characteristics studied, poorer functional status and higher symptom burden were associated with significant decreases in HRQOL in children who received myelosuppressive chemotherapy.

Update on physical activity including special needs populations.

PURPOSE OF REVIEW: Childhood obesity rates remain high, especially among adolescents, minorities, and children with disabilities. The American Academy of Pediatrics and American Medical Association have released recommendations for childhood obesity treatment and prevention which include interventions related to physical and sedentary activity. This review explores recent updates in the area of physical activity and sedentary behavior related to these recommendations as well as emerging evidence relevant to physical activity among children with disabilities. RECENT FINDINGS: Safety and access are among some of the environmental barriers to children's participation in extracurricular physical activity that need to be addressed. Analyses of the relationship between physical activity and sedentary screen time continue to show inconsistent results, although evidence in support of active video games is increasing. Children with disabilities are a special subpopulation for whom physical activity should particularly be encouraged. SUMMARY: Increased physical activity and decreased sedentary behaviors are essential components of obesity management in children with and without disabilities. Pediatric providers are encouraged to address barriers to physical activity with all families and act as advocates for changes in the local community that support access to physical activity for all children.

Changes in childhood risk taking and safety behavior after a peer group media intervention.

BACKGROUND: Risk taking is a significant health-compromising behavior among children that often is portrayed unrealistically in the media as consequence-free. Physical risk taking can lead to injury, and injury is a leading cause of hospitalization and death during childhood. OBJECTIVE: The aim of this study was to examine the effectiveness of a 4-week program for school-age children in reducing risk-taking behaviors and increasing safety behaviors. METHODS: A two-group, experimental, repeated-measures design was used to compare 122 White and Latino children randomly assigned to an intervention group or a wait-list group at baseline and at 1, 3, and 6 months after intervention. Children received a behaviorally based intervention delivered in four 2-hour segments conducted over consecutive weeks. The thematic concept of each week (choices, media, personal risk taking, and peer group risk taking) moved from the general to the specific, focusing on knowledge and awareness, the acquisition of new skills and behaviors, and the supportive practice and application of skills. RESULTS: Participants increased their safety behaviors (p = .006), but risk-taking behaviors remained unchanged. Families in the intervention group increased their consistent use of media rules (p = .022), but decreases in media alternatives suggest difficulty in taking up other habits and activities. Coping effectiveness was predictive of safety behaviors (p = .005) at 6 months, and coping effectiveness plus television watching was predictive of risk taking (p = .03). CONCLUSIONS: Findings from this study suggest that interventions that influence children's media experiences help enhance safety behaviors and that strategies to aid parents in finding media alternatives are relevant to explore.

Altered iron metabolism in children with human immunodeficiency virus disease.

BACKGROUND: Despite the high prevalence of altered iron metabolism in children with human immunodeficiency virus (HIV) disease, these alterations have not been well studied. PROCEDURES: Twenty-six children with HIV disease underwent laboratory evaluation to determine the presence of anemia, and to classify the anemia as iron-deficiency anemia or anemia of chronic disease. RESULTS: Half of the children had an alteration in iron metabolism: 6 were iron deficient, 4 had hyperferritinemia, and 3 demonstrated hyperferritinemia with iron deficiency. CONCLUSIONS: These data indicate that alterations in iron metabolism are common even in the HAART era and warrant further study to identify individuals at risk for these alterations.

Translating research on healthy lifestyles for children: meeting the needs of diverse populations.

This article provides two examples of approaches nursing can take to reach diverse populations of children and their families to enhance health lifestyles. First, a descriptive summary of a brief after-school intervention program aimed at influencing 8- and 9-year-old children's media habits and the prevention of negative health behaviors is presented. Design consideration for translating health lifestyles research findings into a nurse-managed inner city primary care practice is reviewed in the second example.

A Comprehensive Approach to Undergraduate Nursing Students' Research Experiences.

BACKGROUND: As the demands for high-quality nursing care increase and organizations are held accountable for patient outcomes, health care must be driven by research and evidence-based practice (EBP). Historically, prelicensure nursing students have expressed little interest in these topics as they focus on establishing the clinical skills necessary to provide care and have found that courses on nursing research are not clinically relevant. METHOD: This article presents one institution's approach to undergraduate nursing research education by three initiatives: (a) a summer research program, (b) a distinguished major program, and (c) an EBP approach in the undergraduate nursing research course. RESULTS: The results of these initiatives have demonstrated positive outcomes in three areas: practice improvements, knowledge dissemination, and student interest in research and further professional development. CONCLUSION: These programs have proven to be clinically beneficial, while increasing student interest in research and further nursing education. [J Nurs Educ. 2018;57(1):58-62.].

A retrospective analysis of paroxysmal sympathetic hyperactivity following severe pediatric brain injury.

BACKGROUND: There are several gaps in the literature related to the prognosis and care of children who have experienced a brain injury then develop paroxysmal sympathetic hyperactivity (PSH). OBJECTIVE: The objective of the present study was to explore the characteristics and prognosis of children who have experienced severe brain injury and developed PSH. METHODOLOGY: A secondary analysis was conducted using an established clinical dataset of children who had experienced severe brain injury and were admitted to an academic children's rehabilitation center (n= 83). RESULTS: Those children with PSH had a significantly longer acute care length of stay (p= 0.024) and total length of stay (p= 0.034) compared with those without PSH. There was no significant difference in cognitive and motor function or transition to rehabilitation between those with and those without PSH after controlling for age and etiology of injury. IMPLICATIONS: The findings from the present study reveal factors regarding the elusive phenomenon of PSH among children.