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.

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.

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.

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.

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.

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.

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 experiences of midlife women with migraines.

PURPOSE: To describe the experiences of midlife women with migraines. DESIGN AND METHODS: Qualitative data were collected in two consecutive studies, using open-ended interviews, focus groups, and online discussion boards. Interpretive methods were used for analysis. FINDINGS: Three patterns were identified: Changing Headache Patterns; Predicting, Preventing, and Controlling Headaches; and Keeping on the Move. These patterns indicated how women's headaches changed over time, how headaches were envisioned within the context of their lives, what strategies were used to meet work and home responsibilities, and how women controlled their headaches while maintaining a sense of perspective. CONCLUSIONS: Many midlife women with migraines receive inadequate or inappropriate treatment, and better dissemination of current diagnostic and treatment guidelines is necessary. Ongoing research is needed to increase understanding of how this problem affects midlife women's lives and of what interventions might prevent or alleviate migraine discomfort.

Genetic predictors of coronary heart disease risk factors in premenopausal African-American women.

PURPOSE: This study examined polymorphisms at the loci HLA-DQB1, HLA-DRB1, TNFa microsatellite, and D6S89, all which lie within or telomeric to the major histocompatibility complex (MHC) and the apolipoprotein E (APOE) and THO-1 loci in premenopausal African-American women (AAW) for their association with known coronary heart disease (CHD) risk factors. The sample, drawn from community and military sources, included premenopausal AAW (mean age=34.18) who were at low risk (n=117) and high risk (n=173) for CHD. METHODS: In this case- (high risk) control (low risk) study, venous blood was used for DNA extraction. Polymorphisms were assessed by using a variety of standard polymerase chain reaction (PCR) methods. Allelic controls were used in all reactions, and two individuals sized and concurred on allele assignment in each analysis. Vertical auto profile (VAPI), glucose challenge tests, measurement of insulin levels, blood pressure, body mass index (BMI), and waist-hip ratio (WHR) assessments were conducted by using standardized procedures. Pearson's correlation coefficients and assessment of allele distributions via relative frequency and frequency variance were conducted in relation to military status, risk group, and risk factors by using exact P values and likelihood ratio chi-squared (Irchi2) statistic. The significance level was set at .05. RESULTS: Of the 237 women (low and high risk), 116 of the women in the sample were in Stage I obesity or heavier. Of 237 women (low and high risk), 85 (36%) of the women in this sample were insulin resistant. The frequency of D6589 allele 185, D6S89 allele 191, TNFa allele 97, and TNFa allele 103 alleles were higher in the high-risk than the low-risk group; and the D6S89 195 allele was higher in the low-risk group. Elevated systolic blood pressure (SBP) was associated with HLA-DRB1*09 and TNFa 117 alleles. APOE*4, TNFa 109, and DRB1*107 alleles were associated with increased relative risk for elevated total cholesterol to high-density lipoprotein (HDL) ratios. APOE*4 and D6589 193 alleles were associated with an elevated risk for low-density lipoprotein (LDL) or LDL sub-fraction levels. APOE*2 was associated with a lower relative risk for total cholesterol to HDL ratios. Metabolic syndrome was identified in 26.6% of the sample and was associated with the presence of DRB1*09, DRB1*12, and DRB1*15 alleles. Lp(a) levels were positively associated with risks for HDL, HDL2, HDL3, LDL, and total cholesterol. Lp(a) was negatively associated with risks for very low-density lipoprotein (VLDL), triglyceride, fasting blood sugar (FBS), insulin resistance, SBP, weight, and WHR. CONCLUSION: The association of APOE, DRB1, D6589 and TNFa alleles with risk of CHD suggest that these are candidate genes or linked to genes for CHD in this cohort of AAW. Our data supported elevated plasma Lp(a) as a potential risk factor in AAW; however, its role is still unclear. The premenopausal AAW in this sample had a higher than expected rate of metabolic syndrome, which was associated with DRB1 alleles.

Online Data Collection in Women's Health Research: A Study of Perimenopausal Women with Migraines.

An estimated 17 to 18 percent of all women, and six percent of men, experience migraines. Hormonal shifts may cause migraines to recur, worsen, or even begin during the perimenopause and are a significant cause of discomfort and disability. However, very little research has explored the experience of migraines in this population. The purpose of this study was to describe the experiences of perimenopausal women with migraines, via online questionnaires and discussion boards, and to evaluate the feasibility of collecting women's health data via the Internet. In an earlier study, we found that midlife women had difficulty attending focus groups due to other time commitments. This study was designed to increase accessibility to the research via the Internet. Of the 43 women recruited into the study, 21 were also interviewed in "real-time" qualitative interviews; all received passwords to complete online questionnaires and participate in three- to four-week discussion boards on the study Web site. Quantitative data were imported into SPSS; narrative qualitative data from discussion boards were transferred to a software package for analysis. Online questionnaires and discussion boards were found to be feasible methods for data collection for this population. Qualitative data analysis revealed themes related to women's efforts to predict and control their headaches, the relationship of headaches to women's menses and menopausal symptoms, and the effects of migraines on their lives. In this paper we describe the process of using the Internet, feminist issues related to this innovative methodology, and also discuss the results of a major study theme, the experience of headaches in relationship to the menstrual cycle.