Effects of Prenatal Breastfeeding Education on Breastfeeding Duration Beyond 12 Weeks: A Systematic Review.

The proportion of infants in the United States who are breastfed at 1 year remains well below the Healthy People 2030 target. The health implications of suboptimal breastfeeding durations are significant, including increased risk of childhood leukemia and maternal Type 2 diabetes. Prenatal breastfeeding education provides an opportunity to improve breastfeeding self-efficacy among pregnant individuals and to establish their coping skills in case future breastfeeding problems arise. Although prenatal breastfeeding education is known to improve breastfeeding self-efficacy, characteristics of prenatal breastfeeding education interventions that are successful at increasing breastfeeding duration have not been well defined. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Health Action Process Approach, we conducted a systematic review of the literature examining the impact of prenatal breastfeeding education interventions on breastfeeding duration measured at least 12 weeks postpartum. Twenty-one studies were identified. Prenatal breastfeeding education was most likely to increase breastfeeding duration when education interventions integrated psychological components (Health Action Process Approach coping planning) or were paired with in-person postpartum breastfeeding support. Additional research is needed to examine the role of psychological components in breastfeeding education interventions in diverse populations and to determine the specific psychological intervention components with the greatest impact on breastfeeding duration.

Validation of Self-Reported Attachment Classification Among Racially and Ethnically Diverse Parents of Young Children.

BACKGROUND: The Attachment Style Questionnaire (ASQ) was developed to measure individual differences in insecure adult attachment and was suitable for populations that may have minimal or no experience in romantic relationships. The measure was previously validated on homogenous populations. OBJECTIVES: The purpose of this study was to verify construct validity and internal consistency of the ASQ among an ethnically and racially diverse sample of caregivers of young children ages birth to 3 years. METHODS: Using a cross-sectional design, we examined the psychometric properties of the ASQ. A racially and ethnically diverse sample of caregivers of young children (birth to 3 years old) completed the 40-item measure. Factor analyses and internal consistency analyses were conducted. RESULTS: Confirmatory factor analyses showed that the previously published factor structures were not a good fit for this diverse sample. Exploratory factor analysis with promax rotation revealed a four-factor solution among 16 items, including relationship anxiety, relationships as secondary, discomfort with closeness, and relationship distrust. Adequate internal consistency was noted for the factors, and structural invariance was confirmed across Hispanic and non-Hispanic ethnicities. DISCUSSION: Nurse scientists and practitioners should take caution when using or developing indices based on previous research. There should be consideration of structural stability and replication across the intended population.

Symptom and Illness Experience for English and Spanish-Speaking Children with Advanced Cancer: Child and Parent Perspective.

Understanding the symptom and illness experience of children with advanced cancer facilitates quality care; yet, obtaining this understanding is complicated by the child's developmental level and physical and psychological health factors that affect communication. The purpose of this study was to describe the symptom and illness experience of English- and Spanish-speaking children with advanced cancer as described by the child and parent. We conducted hermeneutic phenomenological, descriptive, and interpretive interviews with eligible children and parents. The interdisciplinary research team analyzed transcripts hermeneutically until consensus on theme labels was reached. Four themes and associated subthemes were identified from the interviews of the 10 child-parent dyads: 1. symptoms disrupt life (path to diagnosis, life is disrupted), 2. isolation (lack of understanding, family separations/relationships), 3. protection, and 4. death is not for children. Children and parents readily described the impact symptoms and cancer treatment had on their lives and relationships. These findings underscore the salient aspects of daily life disrupted by cancer. With a deeper understanding of symptom burden and its interference, relationship and communication implications, and anticipatory grief, the treating team may better optimize care for children and their families living with advanced cancer.

Posting With a Purpose: Improving Social Media Strategies to Communicate With Younger Generations.

The presence of four generations in the workplace and professional associations, paired with the advent of social media outlets as a dominant form of communication, suggests opportunities for improving communication strategies to better appeal to younger generations. This process improvement initiative sought to improve communication processes within a local chapter of the Oncology Nursing Society by using more diverse posting strategies that would speak to members' professional needs and included strategies encouraging members to view and engage with posts.

Prevention Strategies for Neonatal Skin Injury in the NICU.

PURPOSE: The purpose of this article was to determine specific skin injury prevention interventions for neonates in the NICU. DESIGN: The design was a systematic review. SAMPLE: PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, and Scopus were systematically searched to identify quantitative studies identifying skin injury preventions for neonates in the NICU. OUTCOMES: The outcomes included skin integrity or skin condition. RESULTS: Nineteen studies were included in the review. Twelve studies included a randomized design. Barriers were the main interventions for the prevention of pressure injury, medical adhesive skin injury, diaper dermatitis, and general skin condition. The types of barriers included hydrocolloids, polyurethane-based dressings, film-forming skin protectant, or emollients. Nonbarrier interventions included rotation between a mask and nasal continuous positive airway pressure (NCPAP) interfaces, utilization of prescribed guidelines to decrease pressure injuries, and use of a lower concentration of chlorhexidine gluconate as a disinfectant.

Hispanic Parental Beliefs and Practices in the Management of Common Childhood Illnesses: A Review of the Literature.

Introduction: Hispanic parents are more likely to perceive common childhood illnesses as serious and needing immediate attention compared with other groups. The purpose of this review is to describe the factors that influence Hispanic parental management of common childhood illnesses. Method: A systematic search of PubMed, PsycINFO, and Cumulative Index of Nursing and Allied Health Literature was conducted. Studies were screened and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: Fifteen studies met the inclusion criteria for synthesis. Key findings include the following: (a) parental fears around common illnesses, (b) belief in folk illnesses, (c) use of traditional healers and remedies, (d) family members as a source of health information, (e) medical pluralism, and (f) barriers to care. Conclusion: Hispanic parents simultaneously engage both biomedical and folk spheres of treatment. More current research is needed to understand Hispanic beliefs and practices and to formulate culturally sensitive interventions in this population.

Beyond silos: An interprofessional, campus-wide ethics education program.

BACKGROUND: Ethics education is essential to the education of all healthcare professionals. The purpose of this study was to evaluate an interprofessional approach to ethics education to all students across an academic health science center. RESEARCH OBJECTIVES: The objectives were to (1) compare student perception of ethics education before and after the implementation of the campus-wide ethics program and (2) determine changes in student ethical decision-making skills following implementation of a campus-wide ethics program. RESEARCH DESIGN: This study was a quasi-experimental design with seniors graduating prior to the intervention serving as the control group. PARTICIPANTS AND RESEARCH CONTEXT: The setting was a comprehensive health science center in the southwestern United States. All students enrolled in the university participated in the intervention; however, 976 graduating students were used for evaluation of the intervention. ETHICAL CONSIDERATIONS: Study materials for each survey were submitted to the university's IRB, and the project was approved as exempt by the Committee for the Protection of Human Subjects. Student participation in the surveys was voluntary. No names or other identifying information were collected, and responses to the survey questions were kept confidential. FINDINGS: Students' perception of the adequacy of time spent on the ethics content in course instruction and practical training decreased from the baseline to the fifth-year survey. Students' overall comfort level with their abilities to deal with ethical issues increased from the baseline to the fifth year. Student ethical decision-making skills were higher at the third-year evaluation for all indicators. For the fifth-year survey, responses were also higher scoring on all four indicators. DISCUSSION: After participation in an interprofessional campus-wide effort on health professions ethics, students demonstrated higher ethical decision-making scores according to the Health Professional Ethics Rubric. However, their scores still did not reach the proficiency level identified in the rubric. CONCLUSION: Examination of the effectiveness of each part of the intervention is needed.

A Systematic Review of Physical Activity and Exercise on Physiological and Biochemical Outcomes in Children and Adolescents With Type 1 Diabetes.

PURPOSE: In this systematic review we aimed to evaluate the effects of physical activity (PA) and exercise on biochemical and physiological outcomes in children and adolescents with type 1 diabetes (T1D). DESIGN: The review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS: The search of literature was performed using PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Library, Scopus, Medline, PsycINFO, the Nursing Reference Center, and Google Scholar. The search was limited to include peer-reviewed articles published in English from May 2012 to May 2018 and included adolescents <19 years of age with T1D. Twenty-seven studies met the inclusion criteria: 8 interventional and 19 observational studies. FINDINGS: Both observational and interventional studies showed considerable agreement that supervised regular moderate to vigorous physical activity (MVPA) is more effective on adiposity and cardiorespiratory fitness than habitual PA. Further, it was reported that PA of different intensities improves insulin sensitivity and decreases daily insulin dosage. Results of glycemic control were equivocal. Although observational studies reported improvement in glycemic control with PA of different intensities, most of the experimental studies revealed no significant associations. A consistent agreement among the studies revealed a considerable benefit of regular habitual PA of light to moderate intensity on blood glucose regulation and lipid profile. CONCLUSIONS: The reviewed studies showed that regular MVPA was associated with several health benefits in adolescents with T1D; however, additional studies are needed to fully understand the effect of PA on health outcomes. CLINICAL RELEVANCE: Regular MVPA (at least 4 hr per week) with good glycemic control is a promising option for adolescents with T1D when risk management of hypoglycemia is appropriately taken.

Ethnic/Racial Comparisons in Strategies Parents Use to Cope with Food Insecurity: A Systematic Review of Published Research.

Food insecurity in US affects African Americans, Hispanic, and American Indians disproportionately compared to Caucasians. Ethnicity/race may influence the strategies parents use to reduce the effects of food insecurity. The purpose of this review is to compare coping strategies for food insecurity used by parents of different ethnicities/race as reported in published literature. A systematic search on PubMed and Embase yielded 983 studies, of which 13 studies met inclusion criteria and were reviewed. All groups used public and private assistance, social networks, nutrition related, and financial-related strategies. The limited evidence suggests that there are differences in how parents of different ethnicities/race apply these coping strategies. Current evidence is insufficient to confidently determine the extent of these differences. This review is a starting point for exploration of cultural differences in how parents of various ethnicities/race cope with food insecurity and identifies specific areas for further research.

Treatment recidivism in adolescents with mental illness: A focused applied medical ethnography.

PROBLEM: Treatment recidivism, described as frequent unplanned relapse readmissions, is a national problem predominant in adolescents with mental illness. Because the main triggers of treatment recidivism are not fully understood, the purpose of this study was to explore treatment recidivism (i) to better understand treatment recidivism from the perspectives of recidivist adolescents with mental illness, (ii) to describe major factors that contribute to treatment recidivism and how best to minimize them from the perspectives of these adolescents, and (iii) to describe their interaction with the medical culture. METHODS: A focused applied medical ethnography was used to study 16 purposively selected adolescents. Interviews were conducted together with unobtrusive unit observation of the participants and collection of demographic and clinical information. FINDINGS: The participants were nearly unanimous in identifying the "additional stressors" of problematic parental relations and school bullying as the main triggers of treatment recidivism over and above their "routine stressors" of adolescence and mental illness. They had mixed perceptions of treatment recidivism and described their interaction with the medical culture as positive. CONCLUSION: Further research is needed to determine the impact of parental relations and school bullying on recidivism in adolescents with mental illness.

Symptom profiles in children with advanced cancer: Patient, family caregiver, and oncologist ratings.

BACKGROUND: Systematic symptom assessment is not routinely performed in pediatric oncology. The objectives of the current study were to characterize the symptoms of pediatric oncology outpatients and evaluate agreement between patient and proxy reports and the association between children's ratings and oncologists' treatment recommendations. METHODS: Two versions of the pediatric Memorial Symptom Assessment Scale (pMSAS) were translated into Spanish. An age-appropriate and language-appropriate pMSAS was administered independently before visits to the oncologist to patients and family caregivers (caregivers) and after visits to consenting oncologists. Statistical analysis included Spearman correlation coefficients and weighted kappa values. RESULTS: English and Spanish results were similar and were combined. A total of 60 children and their caregivers completed the pMSAS. The children had a median age of 10 years (range, 7-18 years); approximately 62% were male and 33% were Spanish-speaking. Fourteen oncologists completed the pMSAS for 25 patients. Nine patients (15%) had no symptoms and 38 patients (63%) reported ≥2 symptoms. The most common symptoms were fatigue (12 patients; 40%) and itch (9 patients; 30%) for the younger children and pain (15 patients; 50%) and lack of energy (13 patients; 45%) among the older children. Total and subscale score agreement varied by proxy type and subscale, ranging from fair to good for most comparisons. Agreement for individual symptoms between the patient and proxy ranged from a kappa of -0.30 (95% confidence interval, -0.43 to -0.01) to 0.91 (95% confidence interval, 0.75 to 1.00). Three of 51 symptomatic patients (6%) had treatment recommendations documented in the electronic health record. CONCLUSIONS: Symptoms are common and cross several functional domains. Proxy and child reports are often not congruent, possibly explaining apparent undertreatment among this group of patients.

The Brewsters: A new resource for interprofessional ethics education.

BACKGROUND: One of the barriers to interprofessional ethics education is a lack of resources that actively engage students in reflection on living an ethical professional life. This project implemented and evaluated an innovative resource for interprofessional ethics education. OBJECTIVES: The objective of this project was to create and evaluate an interprofessional learning activity on professionalism, clinical ethics, and research ethics. DESIGN: The Brewsters is a choose-your-own-adventure novel that addresses professionalism, clinical ethics, and research ethics. For the pilot of the book, a pre-test/post-test design was used. Once implemented across campus, a post-test was used to evaluate student learning in addition to a student satisfaction survey. PARTICIPANTS AND RESEARCH CONTEXT: A total of 755 students in six academic schools in a health science center completed the activity as part of orientation or in coursework. ETHICAL CONSIDERATIONS: The project was approved as exempt by the university's Committee for the Protection of Human Subjects. FINDINGS: The pilot study with 112 students demonstrated a significant increase in student knowledge. The 755 students who participated in the project had relatively high knowledge scores on the post-test and evaluated the activity positively. DISCUSSION: Students who read The Brewsters scored well on the post-test and had the highest scores on clinical ethics. Clinical ethics scores may indicate issues encountered in mass media. CONCLUSION: The Brewsters is an innovative resource for teaching interprofessional ethics and professionalism. Further work is needed to determine whether actual and long-term behavior is affected by the activity.

Symptoms and quality of life in diverse patients undergoing hematopoietic stem cell transplantation.

CONTEXT: Symptoms and quality of life (QOL) are critically important in hematopoietic stem cell transplantation (HSCT). However, few studies have examined these factors by transplant type among diverse cultures. OBJECTIVES: To identify and compare QOL and symptom severity and prevalence by transplant type in a diverse population having HSCT. METHODS: The M. D. Anderson Symptom Inventory Blood and Marrow Transplantation (MDASI-BMT) module measured symptom severity and its impact. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) measured QOL. RESULTS: Symptom data were collected from 164 patients at eight points (pretransplant to 100 days post-transplant) and QOL data at four times. Over time, symptom severity was significantly correlated with QOL and patients who had allogeneic transplants with myeloablative regimens showed more severe sleep disturbance and poorer QOL than patients having autologous transplants. Male patients reported less fatigue than female patients. However, ethnicity was not significant. Patients whose functional status was good had fewer of the five worst symptoms and higher QOL than patients with a poor functional status. Patients with acute graft-versus-host disease had more severe symptoms than those who did not. CONCLUSION: Type of transplant and preparative regimen are the most important aspects to consider when managing symptoms and QOL. This information is important for providing anticipatory guidance and support needed during the transplantation experience, to explore in future research the mechanisms involved in symptoms after HSCT, and to develop additional effective interventions.

Is acanthosis nigricans a reliable indicator for risk of type 2 diabetes in obese children and adolescents? A systematic review.

Obesity and type 2 diabetes is becoming a major health problem affecting children and adolescents in the United States. This article reviews the current literature examining the association between the presence of acanthosis nigricans (AN) and risk for developing type 2 diabetes mellitus (T2DM) in obese children and adolescents. Ethnicity, family history of diabetes, and emergence of obesity are contributing factors for development of hyperinsulinemia, and insulin resistance, and ensuing visible changes on skin which is known as the AN. The purpose of this review was to assess the validity of AN as an early indicator of T2DM. Nineteen articles that were published from 1994 to 2010 were included for this review and reported an association between AN, hyperinsulinemia, and hyperglycemia. Nurses and advanced nurse practitioners working with children and adolescents have a tremendous role in identifying the risk factors, counseling, role modeling, and referring them to available community resources to promote healthy living. Early initiatives focusing on lifestyle changes may halt the progress, chronicity, and burden of T2DM in children and adolescents.

Family strategies for managing childhood cancer: using complementary and alternative medicine in Jordan.

AIM: This paper is a report of a study that examined the use of complementary and alternative medicine therapies among children with cancer in Jordan. BACKGROUND: Complementary and alternative medicine use by oncology patients has been gaining acceptance in the developed countries and developing countries. Healthcare professionals are becoming increasingly aware that patients use complementary and alternative medicine either covertly or overtly. METHODS: A descriptive cross-sectional design was used with parents of children with cancer under treatment and follow-up in a paediatric oncology department in Jordan between August 2007 and April 2008. RESULTS: Parents of 69 children with cancer in Jordan were surveyed for their use of complementary and alternative medicine with their children. A total of 65.2% of the sample had used at least one type of complementary and alternative medicine during the course of their child's treatment. The use of biological and nutritional complementary and alternative medicine was 70.5% among the users. Use of body and soul complementary and alternative medicine strategies was reported for 22.2% of the children using complementary and alternative medicine. Twenty per cent of the sample used body movement complementary and alternative medicine for their children. A total of 45.5% of complementary and alternative medicine users perceived benefits in using complementary and alternative medicine for their children with cancer. However, 40% of complementary and alternative medicine users had stopped using complementary and alternative medicine for multiple reasons. CONCLUSION: Parents used complementary and alternative medicine to support their children's medical treatment and to use all possible methods to cure their children. The reason for parents not using complementary and alternative medicine included not being aware of complementary and alternative medicine. Most of the patients have not discussed the issue of using complementary and alternative medicine with the medical staff.

Health promoting behavior among chronically ill Pacificans living with non-communicable disease in Fiji, Nauru, and Kiribati.

INTRODUCTION: Individuals in the developing world are quick to adopt patterns of behavior that mimic Western trends even when those trends have negative long term effects on health. In this study we relate survey results describing attitudes and perceptions toward individual health responsibility of people being treated for non-communicable diseases including diabetes, hypertension, and cardiovascular disease in order to improve public health interventions. METHODS: We conducted convenience sample surveys in both English and native languages at outpatient clinics and hospital centers in Fiji, Nauru, and Kiribati with people being treated for non-communicable diseases. We used the Health Promoting Lifestyle Profile in regression analyses to explore underlying factors explaining patient attitudes in managing their illnesses. RESULTS: Our results suggest that there exist attitudinal differences among afflicted populations with regard to stress, physical activity, nutrition, and health responsibility. One unifying theme is the lack of interest in conventional public health educational methods including printed material and public lectures. These similarities and differences must be recognized by government health ministries as well as international health organizations when developing public health interventions. CONCLUSION: Public health professionals and educators must develop ways to transmit the message of healthy lifestyles to populations in the South Pacific that do not give much attention to conventional public health education methods. The epidemic of non-communicable disease that is occurring in many of the Pacific Island nations will only be effectively addressed by new educational approaches.

An analysis of health promotion and risk behaviors of freshman college students in a rural southern setting.

This study described health promotion and risk behaviors of entering college students in a rural southern setting. A sample of 251 students completed the Health Promotion and Health Risk Survey during a testing period that included other academic surveys. Results indicated that participants believe they are in control of their health. In addition, participants reported that happiness and health were the most important personal values for them. When compared with the National College Health Risk Behavior data, participants in this study were significantly lower in many of the health risk behaviors.