Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care.

The U.S. population is plagued by physical inactivity, lack of cardiorespiratory fitness, and sedentary lifestyles, all of which are strongly associated with the emerging epidemic of chronic disease. The time is right to incorporate physical activity assessment and promotion into health care in a manner that engages clinicians and patients. In April 2015, the American College of Sports Medicine and Kaiser Permanente convened a joint consensus meeting of subject matter experts from stakeholder organizations to discuss the development and implementation of a physical activity vital sign (PAVS) to be obtained and recorded at every medical visit for every patient. This statement represents a summary of the discussion, recommendations, and next steps developed during the consensus meeting. Foremost, it is a "call to action" for current and future clinicians and the health care community to implement a PAVS in daily practice with every patient.

Global cardiovascular disease prevention: a call to action for nursing executive summary.

The global epidemic of cardiovascular disease (CVD) calls for multidisciplinary and multiprofessional approaches to the management of this condition, with strategic emphasis on prevention, treatment, and control. In addition, there is increasing recognition that effective prevention and management of CVD requires a diverse workforce skilled in the social, environmental, and policy determinants of health. Nowhere are these approaches and strategies brought together and more closely aligned than in the field of preventive cardiovascular nursing. This executive summary of "Global Cardiovascular Prevention: A Call to Action for Nursing" includes key points from the 6 papers written by the Preventive Cardiovascular Nurses Association and published in July-August 2011 as a supplement to the Journal of Cardiovascular Nursing and the European Journal of Cardiovascular Nursing. This supplement addresses innovative efforts to stem the current global epidemic of CVD and emphasizes the need for effective team-based interventions for lifestyle and behavior changes across the life span. Social solutions, strategies for working with key players to develop interactive models, as well as coordinated multilevel policies, partnerships, and programs that are culturally relevant and context specific are examined. Such approaches are urgently needed to reduce death and disability from CVD in the United States and globally. Nurse leaders and other members of the healthcare team are well positioned internationally to meet these challenges.

Association of summer temperatures with hospital admissions for renal diseases in New York State: a case-crossover study.

This study assessed the association between high temperatures and increased odds of hospitalization for renal diseases that, to date, has been examined in only a small number of studies. A case-crossover design was used to study 147,885 hospital admissions with renal diagnoses during July and August, 1991-2004, in New York State. Regional temperature, humidity, and barometric pressure data from automated monitors were used as exposure indicators. By use of time-stratified referent selection and conditional logistic regression analysis, an overall 9% increase in odds of hospitalization for acute renal failure per 5°F (2.78°C) was found for mean temperature at a 1-day lag (odds ratio = 1.09, 95% confidence interval: 1.07, 1.12). The results suggest increased susceptibility to hospitalization for acute renal failure for blacks, Hispanics, people aged 25-44 years, and those in the lowest income quartile. The odds varied geographically with the largest associations found in the more urban regions. Increased odds of hospitalization were also found for urinary tract infections, renal calculi, lower urinary calculi, and other lower urinary tract disorders. The findings can help to identify vulnerable subpopulations and to inform decisions and policies regarding adaptation strategies and heat-warning systems.

Health impact in New York City during the Northeastern blackout of 2003.

OBJECTIVE: This study assessed the health effects of the 2003 Northeastern blackout, the largest one in history, on mortality and hospital admissions due to respiratory, cardiovascular, and renal diseases in New York City (NYC), and compared the disease patterns and sociodemographic profiles of cases during the blackout with those on control days. METHOD: We investigated the effects of the blackout on health using incidence rate ratios to compare the disease on blackout days (August 14 and 15, 2003) with those on normal and comparably hot days (controls). Normal days were defined as summer days (June-August) between the 25th and 75th percentiles of maximum temperature during 1991-2004. Comparably hot days were days with maximum temperatures in the same range as that of the blackout days. We evaluated the interactive effects of demographics and the blackout using a case-only design. RESULTS: We found that mortality and respiratory hospital admissions in NYC increased significantly (two- to eightfold) during the blackout, but cardiovascular and renal hospitalizations did not. The most striking increases occurred among elderly, female, and chronic bronchitis admissions. We identified stronger effects during the blackout than on comparably hot days. In contrast to the pattern observed for comparably hot days, higher socioeconomic status groups were more likely to be hospitalized during the blackout. CONCLUSIONS: This study suggests that power outages may have important health impacts, even stronger than the effects of heat alone. The findings provide some direction for future emergency planning and public health preparedness.

Antiplatelet therapy in acute coronary syndromes: implications for nursing practice.

The care of cardiovascular patients experiencing a myocardial infarction (MI) has evolved from simple bed rest and relief of pain to complex interventions and multiple medications that target both the short- and long-term risks associated with atherosclerosis and ischemia. Even the terminology has changed, from MI to acute coronary syndromes (ACSs). The term, acute coronary syndrome, refers to the clinical symptoms resulting from acute myocardial ischemia; it encompasses unstable angina, non-ST-elevation MI, and ST-elevation MI. Antiplatelet therapies are critically important in the management of patients with ACS. Antiplatelet therapies interfere with platelet aggregation and platelet activation both acutely and chronically and thus impact the development of acute MI. Thus, they are prescribed for millions of patients with ACS. As a result of this progress in treatment, nursing management of persons with ACS has also evolved. This article reviews the pathophysiology of ACS, the role of antiplatelet therapies, their effects on platelet adhesion, and the role of the nurse in caring for patients with ACS who are prescribed these important therapies.

Global cardiovascular disease prevention: a call to action for nursing: community-based and public health prevention initiatives.

Policy changes are necessary to promote cardiovascular disease prevention. These will involve community-based and public health initiatives for primary and secondary prevention of cardiovascular disease. In this article, we discuss such interventions, community-based participatory research that has been conducted in this area, and implications for capacity building in genetics research. Finally, areas for future research in this area will be identified.

Trajectories of fatigue in family caregivers of patients undergoing radiation therapy for prostate cancer.

Predictors of and trajectories for evening and morning fatigue were evaluated in family caregivers of oncology patients using hierarchical linear modeling. Evening fatigue trajectory fit a quadratic model. Predictors included baseline sleep disturbances in family caregivers and baseline evening fatigue in patients. Morning fatigue trajectory fit a linear model. Predictors were baseline trait anxiety, levels of perceived family support, and baseline morning fatigue in patients. Findings suggest considerable inter-individual variability in the trajectories of evening and morning fatigue. Evaluating family caregivers for sleep disturbance, anxiety, and poor family support, as well as high levels of patient fatigue, could identify those family caregivers at highest risk for sustained fatigue trajectories.

Understanding Functional Communication in Head and Neck Cancer Survivors Using a Mixed Methods Design.

BACKGROUND: Functional communication, defined as everyday communication with family and friends, at work, and in the community, is an important but understudied concept in the head and neck cancer (HNC) survivor population. OBJECTIVE: The aim of this study was to better understand functional communication by using a mixed methods approach. METHODS: Head and neck cancer survivors participated in semistructured interviews and completed self-report questionnaires assessing multiple aspects of well-being and health-related quality of life (HRQOL). These qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated. RESULTS: Survivors' perceptions of functional communication ranged from "Communication is good" to "Communication has changed" to "Communication is difficult." Using these qualitative results, survivors were categorized into 3 mutually exclusive groups. Clinically meaningful cut points were exceeded on measures of depressive symptoms (18%), state (40%) and trait (54%) anxiety, and pain (18%). Health-related quality of life scores were moderate to high for the sample as a whole. Statistically significant group differences were found only on the HNC-specific measure of HRQOL. A surprising finding was that the lowest mean score on social function was in the "Communication has changed" group. This group perceived changes in speech and voice that bothered them when communicating in social situations, although their speech was clear to a listener. CONCLUSION: An underrecognized subpopulation of HNC survivors may exist, whose day-to-day functional communication has changed in ways that impact their relationships and sense of self. IMPLICATIONS FOR PRACTICE: Clinical identification of this subpopulation and provision of appropriate interventions are essential to facilitate optimal HRQOL after HNC treatment.

Perceived Self-Efficacy: A Concept Analysis for Symptom Management in Patients With Cancer
.

BACKGROUND: Perceived self-efficacy (PSE) for symptom management plays a key role in outcomes for patients with cancer, such as quality of life, functional status, symptom distress, and healthcare use. Definition of the concept is necessary for use in research and to guide the development of interventions to facilitate PSE for symptom management in patients with cancer.
. OBJECTIVES: This analysis will describe the concept of PSE for symptom management in patients with cancer.
. METHODS: A database search was performed for related publications from 2006-2016. Landmark publications published prior to 2006 that informed the concept analysis were included.
. FINDINGS: Greater PSE for symptom management predicts improved performance outcomes, including functional health status, cognitive function, and disease status. Clarification of the concept of PSE for symptom management will accelerate the progress of self-management research and allow for comparison of research data and intervention development.

Managing abnormal blood lipids: a collaborative approach.

Current data and guidelines recommend treating abnormal blood lipids (ABL) to goal. This is a complex process and requires involvement from various healthcare professionals with a wide range of expertise. The model of a multidisciplinary case management approach for patients with ABL is well documented and described. This collaborative approach encompasses primary and secondary prevention across the lifespan, incorporates nutritional and exercise management as a significant component, defines the importance and indications for pharmacological therapy, and emphasizes the importance of adherence. Use of this collaborative approach for the treatment of ABL ultimately will improve cardiovascular and cerebrovascular morbidity and mortality.

Genetics and genomics of osteoclast differentiation: integrating cell signaling pathways and gene networks.

The regulation of osteoclast differentiation in the bone microenvironment is critical for normal bone remodeling, as well as for various human bone diseases. Over the last decade, our knowledge of how osteoclast differentiation occurs has progressed rapidly. We highlight some of the major advances in understanding how cell signaling and transcription are integrated to direct the differentiation of this cell type. These studies used genetic, molecular, and biochemical approaches. Additionally, we summarize data obtained from studies of osteoclast differentiation that used the functional genomic approach of global gene profiling applied to osteoclast differentiation. This genomic data confirms results from studies using the classical experimental approaches and also may suggest new modes by which osteoclast differentiation and function can be modulated. Two conclusions that emerge are that osteoclast differentiation depends on a combination of fairly ubiquitously expressed transcription factors rather than unique osteoclast factors, and that the overlay of cell signaling pathways on this set of transcription factors provides a powerful mechanism to fine tune the differentiation program in response to the local bone microenvironment.

Coronary risk factors in adult children of parents with coronary heart disease: a comparison survey of southeastern Brazil and southeastern United States.

A survey was performed in southeastern Brazil and in the southeastern United States to: 1) compare coronary risk factors in adult children (>18 years old) of parents with coronary heart disease enrolled in cardiac rehabilitation programs in countries with different geographic, social, and economic factors; and 2) to assess the influence of coronary heart disease of parents on alteration of lifestyle in these adult children. There were 286 biological children available for the survey (135 Brazil, 151 United States). Of those, 142 completed the survey (78 Brazil, 64 United States) for an overall compliance rate of 50% (58% Brazil, 42% United States). The following differences were noted: blood pressure > 159/90 mm Hg (23% Brazil, 15% United States [nonsignificant]); total cholesterol > 181 mg/dL (5% Brazil, 30% United States [p < 0.001]); HDL-C < 35 mg/dL (95% Brazil, 21% United States [p < 0.001]); low-fat diet (29% Brazil, 64% United States [p < 0.001]); smoke/ever (41% Brazil, 34% United States [nonsignificant]); currently smoke (72% Brazil, 18% United States [p < 0.001]); any exercise [44% Brazil, 82% United States [p < 0.001]); exercise > 90 minute/week (18% Brazil, 20% United States [nonsignificant]); improved lifestyle habits (39% Brazil, 79% United States [p < 0.001]); improved lifestyle habits related to parent's coronary heart disease (66% Brazil, 35% United States [p < 0.05]). Such differences may reflect geographic, social, and/or economic factors.