Food Insecurity Status and Health Care Utilization Among COPD Patients: A Retrospective Study.

BACKGROUND: Government programs-targeting chronic disease patients with high health care costs-focus on clinical conditions, factors internal to the health care system, and individual patient education, not on addressing modifiable social determinants of health to reduce health care utilization. OBJECTIVE: To evaluate differences in sociodemographic variables and health care utilization between patients with chronic obstructive pulmonary disease (COPD) who reported food insecurity and those who did not. METHODS: This descriptive retrospective cross-sectional study used data from the electronic health records of a convenience sample of 854 participants with a discharge diagnosis of COPD or COPD with acute exacerbation, admitted via the emergency department of participating hospitals in Southern California. Chi-square (or Fisher's exact) tests and t tests were used to evaluate group differences, and multivariate (or Firth) logistic regression to identify factors that increased the odds of emergency department visits and hospitalizations. RESULTS: Significant differences between groups were identified for food insecurity (sometimes or often vs never insecure) and age (P < .001), race (P = .022), medical insurance (P < .001), zip code (P = .022), homeless status (P < .001), smoking status (P < .001), and emergency department visits (P = .033). No significant differences were found for food insecurity and hospitalizations (P = .592). CONCLUSION: This study contributes to the growing body of research supporting the association of upstream social factors (food insecurity, homelessness, zip code) and downstream health outcomes (repeated emergency room visits), and how existing programs can be effectively utilized to impact downstream health outcomes such as health care utilization.

Oncology Nurse Navigator Effect on Emergency Department Visits and Hospital Admissions of Adults With Cancer Post-Outpatient Chemotherapy.

OBJECTIVES: To examine the effect of oncology nurse navigators (ONNs) on the number of emergency department (ED) visits and hospital admissions (HAs) of adults with cancer post-outpatient chemotherapy. SAMPLE & SETTING: 1,370 patients with cancer between January 1, 2018, and December 31, 2019, in a comprehensive community cancer center in southern California. METHODS & VARIABLES: A descriptive cross-sectional study was conducted using retrospective electronic health records. Primary analysis included bivariate and multiple linear regression to identify correlates of ED visits and HAs in terms of ONN involvement. RESULTS: About 35% of patients had an ED visit or HA. Anemia, dehydration, and pain were common diagnoses. No significant differences were found in ED visits and HAs by ONN group. Medicare and chemotherapy administration location contributed to the likelihood of ED visits; nausea, pain, and pneumonia contributed to the likelihood of HAs. IMPLICATIONS FOR NURSING: ED visits and HAs are not appropriate clinical outcomes to measure ONNs' efficacy. Further research is needed to understand the long-term fiscal and operational outcomes of ONNs.

Pain and Spiritual Distress at End of Life: A Correlational Study.

Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.

Opioid Use Treatment and Recovery Services During Pregnancy.

BACKGROUND: The maternal and neonatal consequences of not receiving treatment for opioid use disorders (OUDs) is well known. To prevent adverse outcomes and provide appropriate treatment and services, it is imperative to understand factors influencing pregnant women with OUDs to seek treatment. OBJECTIVES: The purpose of this study is to identify barriers and facilitators related to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids. METHOD: Retrospective analysis of data from the National Survey on Drug Use and Health (NSDUH), using 2016, 2017, and 2018 NSDUH data. Sample included 122 pregnant and 3,305 nonpregnant women who misused opioids. RESULTS: Significant associations were noted among women who misused opioids (n = 3,427); age (χ2 = 25.406, p < .001), race/ethnicity (likelihood ratio [LR] = 17.721, p < .007), geographic location (χ2 = 7.585, p < .023), health insurance (LR = 13.909, p < .016), tobacco use within the past year (χ2 = 7.058, p = .008), and alcohol use within the past month (χ2 = 76.783, p < 0.001), 3.3% pregnant and 1.8% nonpregnant women who misuse opioids perceive a need to obtain treatment; 10.7% pregnant and 6.5% nonpregnant women currently receiving treatment for opioid misuse. The Strengthening the Reporting of Observational studies in Epidemiology checklist was used to develop the study. CONCLUSIONS: It is our responsibility to equally focus efforts on understanding the construct of perceived need and help seeking behaviors among pregnant women, as well as, deploy known techniques to engage them in recovery. Further research is necessary to explore the construct of perceived need in this population, as well as, strategies to increase engagement.

Determinants of Human Papillomavirus Vaccination Among U.S. Navy Personnel.

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection, with at least half of sexually active people contracting the virus-a leading etiology for genital warts and anal, cervical, laryngeal, penile, vaginal, and vulvar cancers. Research suggests HPV is higher among U.S. military personnel than in U.S. civilian populations and can result in significant morbidity or complications and limit U.S. military's duties or deployable status. OBJECTIVES: The aim of the study was to identify determinants of HPV vaccination among U.S. Navy personnel. METHODS: Participants (N = 233) recruited from both active duty and activated reservists, attached to Commander, Naval Surface Force, U.S. Pacific Fleet (COMNAVSURFPAC), located in Japan and the United States, completed an anonymous online survey between June and October 2015. Bivariate analysis was used to examine relationships between sociodemographic, psychological factors, and HPV vaccination. Logistic regression was utilized to identify factors that increase odds for HPV vaccination. RESULTS: HPV vaccination was associated with gender; having deployed in the past 3 years; having heard of HPV, HPV testing, and HPV vaccine; HPV self-rating knowledge; where one heard about the vaccine; belief the chain of command recommends the vaccine; and HPV general knowledge, testing knowledge, and vaccine knowledge (p < .05). The regression model was statistically significant, χ(19) = 97.216, p < .001; four variables contributed to the model. DISCUSSION: Determinants of HPV vaccination were female gender; hearing about HPV vaccine from a healthcare provider, media, or Internet; belief the chain of command recommends the HPV vaccine; and greater HPV vaccine knowledge. Results augment healthcare professionals' and policy makers' existing evidence-based knowledge of the determinants of HPV vaccination to help develop effective HPV immunization policies and programs.

Pilot Evaluation of Auricular Acupressure in End-Stage Lung Cancer Patients.

BACKGROUND: Dyspnea is a common symptom in end-stage lung cancer patients and is only infrequently controlled. Currently, the use of complimentary therapies using traditional Chinese medicine (TCM), including auricular application of Vaccaria segetalis (a small seed), is understudied. Acupressure using auricular Vaccaria segetalis application has been reported as effective in reducing dyspnea when applied to a specific area of the ear associated with lung function in the TCM paradigm. OBJECTIVE: The purpose of this feasibility study was to evaluate the effects of standardized auricular acupressure therapy using Vaccaria segetalis on dyspnea intensity and distress and oxygen saturation in end-stage lung cancer patients. METHODS: The experimental design was three conditions with eight measurement points in time. Patients were randomly assigned to one of three treatment conditions: (1) Standard Care (SC); (2) SC with Vaccaria segetalis taped to random auricular locations (placebo); and (3) SC with Vaccaria segetalis taped to the auricular location deemed specific to lung function in TCM. Subjects were 11 hospice patients with advanced lung cancer and dyspnea. Dyspnea intensity and distress were measured by the Cancer Dyspnea Scale (CDS) and oxygen saturation was measured by pulse oximeter at eight time points. RESULTS: Non-parametric statistical analyses suggest the presence of acupressure effects with medium to large effects and significant effect for dyspnea effort. CONCLUSIONS: This pilot information suggests the need for further study of auricular acupressure using Vaccaria segetalis in the dyspneic advanced lung cancer population.

Adolescent Obesity Risk Knowledge (AORK): Let the Discussion Begin.

PURPOSE: This study aims to examine adolescent level of knowledge concerning obesity risk. DESIGN AND METHODS: Qualitative and quantitative data were collected using a staged process. Data collected with (a) Obesity Risk Knowledge Scale (ORK-10), (b) focus groups, (c) scientific advisory group input, and (d) the Adolescent Obesity Risk Knowledge Scale (AORK). RESULTS: The AORK is tailored from the ORK-10 (α = .53) to capture adolescents' knowledge of obesity complications and/or risks (α = .68). PRACTICE IMPLICATIONS: The AORK integrates questions for assisting practitioners to initiate discussions about obesity and lifestyle choices with adolescents and their families.

Call-shift fatigue and use of countermeasures and avoidance strategies by certified registered nurse anesthetists: a national survey.

This study surveyed Certified Registered Nurse Anesthetist (CRNA) members of the American Association of Nurse Anesthetists (AANA) on their frequency of call-shift fatigue, fatigue symptoms, medical errors associated with fatigue, and use of fatigue countermeasures and avoidance strategies. A secondary aim was to identify predictors of call-shift fatigue. An invitation to complete an anonymous electronic survey was sent to 2,500 randomly selected AANA members. Data were collected on CRNAs' fatigue experience, call-shift length and frequency, errors in patient care, and use of fatigue countermeasures and avoidance strategies. Analysis included descriptive and inferential statistics. Logistic regression was used to identify predictors of call-shift fatigue. Of 325 CRNAs who provided data, 82% reported experiencing call-shift fatigue, 87% used fatigue countermeasures, 77% used fatigue-avoidance strategies, and 28% reported committing a medical error because of fatigue. Predictors included hours to recovery from a call shift (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04-1.12), working 5 to 6 calls per month (OR = 3.78, CI = 1.17-12.23), working 7 or more calls per month (OR = 4.87, CI = 1.93-12.33), use of fatigue countermeasures (OR = 5.44, CI = 2.15-13.77), and fatigue symptoms (OR = 2.19, CI = 1.03-4.67). Call-shift fatigue is a common problem among CRNAs and is associated with medical errors and negative health consequences.

Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women.

BACKGROUND: The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women. METHOD: Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants. RESULTS: A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n=382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR]=1.81, p=0.005). Women reporting substance use problems (OR=2.37, p<0.0001) and IPV (OR=3.98, p<0.0001) had higher odds for depressive symptoms. CONCLUSION: In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues.

Exploring perceptions and experiences of maternal depression in Latinas: a qualitative study.

Understanding how depression is conceptualized is key to designing effective screening and treatment procedures. Of particular concern is maternal depression in Latinas, given the high Latina birthrate. We conducted two focus groups of pregnant Latinas to elicit their perceptions of and experiences with maternal depression. Women reported familiarity with the concept of maternal depression and that their experiences with depression were linked to social support from family and friends. Women also indicated that they felt responsible for coping and recovering from depression independently. How experiences with depression interact with traditional Latino idioms of distress, needs further investigation.

A model for maternal depression.

With the awareness of maternal depression as a prevalent public health issue and its important link to child physical and mental health, attention has turned to how healthcare providers can respond effectively. Intimate partner violence (IPV) and the use of alcohol, tobacco, and other drugs are strongly related to depression, particularly for low-income women. The American College of Obstetricians and Gynecologists (ACOG) recommends psychosocial screening of pregnant women at least once per trimester, yet screening is uncommonly done. Research suggests that a collaborative care approach improves identification, outcomes, and cost-effectiveness of care. This article presents The Perinatal Mental Health Model, a community-based model that developed screening and referral partnerships for use in community obstetric settings in order to specifically address the psychosocial needs of culturally diverse, low-income mothers.

Pediatric health care providers' self-reported practices in recognizing and treating maternal depression.

Screening for maternal depression with appropriate intervention has been emphasized through pediatric guidelines, but engaging providers to implement such procedures remains challenging. This study examined self-reported practice in recognizing and treating maternal depression in 98 pediatric health care providers. Over 85% agreed that recognizing maternal depression was their responsibility, yet only half reported confidence in their ability to do so. Fewer than 10% reported asking mothers about depression or using a screening tool. Clear differences in practice, treatment, and perceived barriers by confidence level were found. Implications for practice, research, and training are discussed.