Caregivers' Knowledge and Food Accessibility Contributes to Childhood Malnutrition: A Case Study of Dora Nginza Hospital, South Africa.

Amongst the problems facing South Africa today are malnutrition and food insecurity, and there is a need for interventions and innovative strategies to address these. The aim of the study was to determine the contribution of caregivers' knowledge of nutrition and household food security among children aged 0 to 60 months. A cross-sectional study design was applied using a quantitative approach. A convenience sample (n = 184) of caregiver-child pairs (for children 0 to 60 months) from the Dora Nginza Hospital Paediatric Outpatient Department was used. A structured questionnaire was applied to collect data on socio-economic factors, health status, household food security, and caregivers' knowledge. In addition, interviews were conducted, and anthropometric measurements of children were taken to determine their nutritional status. The results indicate that most caregivers were female, and more than half completed high school, yet almost 75% were unemployed. Most of the caregivers (58.2%) were either overweight or obese. The results also show that only 33.2% of households were food secure, 29.3% were at risk of hunger, and 37.5% experienced hunger. The prevalence of stunting, underweight, and wasting among children in the study was high. A significant, slightly positive correlation was found between the body mass index of the caregiver and height for age. Poor socio-economic status and food inaccessibility were identified as possible underlying contributing factors to malnutrition, contributing to food insecurity and therefore poor dietary intake.

Nursing: Forever Changed by a Pandemic.

The paper consists of reflections on the corona pandemic and nursing knowledge as practice. Nurses have been so appreciated by the public during this time that they are referred to as heroes. The moral injustice of taking nurses who come so willing to serve and not provide protective gear for their practice is addressed.

NurseTRUST: A Leadership Model for Advancing Population Health.

An interview with one of the current leaders for NurseTRUST tells the story of a newly formed organization to advance nursing leadership to address population health. The vision has always been to prepare nurse leaders for advanced positions in senior leadership roles in healthcare. The RWJ-Nurse Executive Fellowship created national leaders to influence population health. The postprogram Fellows are leveraging this design for the next generation of leaders through the NurseTRUST organization. The network of trusted colleagues can address emerging issues with their national colleagues who are leaders in their field while mentoring the next generation of nurse leaders.

Nursing Theory Informs Dressage.

Application of nursing theory in daily life by applying elements of Parse's paradigm allowed for a more expansive view of the dressage experience by focusing on the paradox of visible-invisible in the unique rhythmic-patterns of the horse-rider team. The study of classical nursing theory has diminished in a similar pattern as classical dressage. The importance of studying the classics in any field is emphasized along with concerns about the future of nursing and healthcare.

Open or Conventional Access: Integrity in the Process.

A wave of new publishing options has opened for nursing. This dialogue examines factors, such as quality and cost, that may influence new authors. There are numerous options for young scientists with many new journal titles and promises of a quick review and guaranteed publication. Choices between Open Access and conventional journals can be difficult since higher cost to the author does not correlate with higher quality.

Paradoxes in Healthcare Leadership: Being-Nonbeing.

The paradox of being-nonbeing is explored from the perspective of the Vice President of Nursing and Clinical Services for a large rural integrated healthcare system in the United States. Being-nonbeing for the nurse leader is experienced daily. Being-nonbeing is experienced with self and others as she provides vision, leadership, and courageous support to the workplace and care environment.

Deep interarytenoid notch in young children managed with systematic thickener wean and injection laryngoplasty.

OBJECTIVES: Deep interarytenoid notch (DIN) is a congenital variation of the larynx often associated with dysphagia and aspiration (DA) in young children. Feeding therapy with thickeners and surgical management with injection larygoplasty (IL) are used with various efficacies. Thickeners address the functional domain and IL addresses the anatomical domain of treatment. Our objective was to evaluate DIN patients managed with both interventions. METHODS: We conducted a retrospective pilot descriptive study of DIN patients with DA aged 1-3 years receiving thickeners and IL. Patients received a systematic weekly reduction of thickeners, referred to as the Thickener Weaning Protocol (TWP), based on clinical signs and symptoms of DA. The outcomes were assessed by the rate of thickener level reduction and DA-related sign/symptom frequency achieved at 6 months post-treatment. RESULTS: Thirteen patients with DIN associated DA were analyzed. The TWP was initiated within 2 months in 77% of patients, and within 4 months in 100% of patients. Thickener scores improved from an average of 5.76 (3/4 honey) to 2.15 (thin) (p = 0.001). DA-related signs/symptoms frequency improved from an average of 3.3 to 0.84 (p = 0.05). CONCLUSIONS: These findings suggest that treatment of DIN associated DA with a combination of thickeners and IL results in significant clinical improvements in young children.

Community Engagement: Transformation for Health Framework.

The dialogue with Dr. Christine Esperat is about her project working with people in the community to establish transformation. She shares her vision and the process of developing a community-based health program.

The plasma biomarker soluble SIGLEC-1 is associated with the type I interferon transcriptional signature, ethnic background and renal disease in systemic lupus erythematosus.

BACKGROUND: The molecular heterogeneity of autoimmune and inflammatory diseases has been one of the main obstacles to the development of safe and specific therapeutic options. Here, we evaluated the diagnostic and clinical value of a robust, inexpensive, immunoassay detecting the circulating soluble form of the monocyte-specific surface receptor sialic acid binding Ig-like lectin 1 (sSIGLEC-1). METHODS: We developed an immunoassay to measure sSIGLEC-1 in small volumes of plasma/serum from systemic lupus erythematosus (SLE) patients (n = 75) and healthy donors (n = 504). Samples from systemic sclerosis patients (n = 99) were studied as an autoimmune control. We investigated the correlation between sSIGLEC-1 and both monocyte surface SIGLEC-1 and type I interferon-regulated gene (IRG) expression. Associations of sSIGLEC-1 with clinical features were evaluated in an independent cohort of SLE patients (n = 656). RESULTS: Plasma concentrations of sSIGLEC-1 strongly correlated with expression of SIGLEC-1 on the surface of blood monocytes and with IRG expression in SLE patients. We found ancestry-related differences in sSIGLEC-1 concentrations in SLE patients, with patients of non-European ancestry showing higher levels compared to patients of European ancestry. Higher sSIGLEC-1 concentrations were associated with lower serum complement component 3 and increased frequency of renal complications in European patients, but not with the SLE Disease Activity Index clinical score. CONCLUSIONS: Our sSIGLEC-1 immunoassay provides a specific and easily assayed marker for monocyte-macrophage activation, and interferonopathy in SLE and other diseases. Further studies can extend its clinical associations and its potential use to stratify patients and as a secondary endpoint in clinical trials.

Transformative Relationships: Humans and Animals.

This column focuses on the transformative nature of human-animal relationships. In the context of nursing, these relationships are clearly therapeutic for veterans recovering from trauma. The time is right to begin to explore the science behind such unique healing relationships and the potential connection to nursing science.

Holistic Leadership-Nursing's Unique Contribution to Healthcare.

This dialogue is focused on holistic leadership from the perspective of a well-known leader in nursing. He frames the changing healthcare environment and nursing's unique contribution on the interprofessional team.

Thoughts About Nursing Curricula: Dark Clouds and Bright Lights.

In this essay, several nurse scholars who are particularly concerned about the contemporary state of nursing science present their concerns about the inclusion of nursing conceptual models and theories in the curricula of nursing programs (dark clouds) and ways in which the concerns have been addressed (bright lights). This essay is the second of two essays that were catalyzed by Barrett's paper, "Again, What Is Nursing Science?" The first essay was published in the previous issue of Nursing Science Quarterly.

Public Dialogue in Nursing and Healthcare.

Dialogue between two scholars on the importance of engagement with consumers as well as professionals. Social media is emphasized as a critical mode of communication.

An Aerodigestive Approach to Laryngeal Clefts and Dysphagia Using Injection Laryngoplasty in Young Children.

PURPOSE OF REVIEW: Our objective is to summarize the presentation, diagnosis, and management of mild laryngeal clefts in children. We focus on deep interarytenoid notches (DIN), a subclassification of type 1 laryngeal clefts (LC1), and review the literature and our multidisciplinary experience utilizing injection laryngoplasty (IL). RECENT FINDINGS: DIN is a mild form of LC1 and is considered a normal anatomical variant. Recent cohort studies demonstrate IL to be a safe, low-risk, and efficacious treatment of LC1, but few studies focus on DIN. We present results from two aerodigestive clinic (ADC) pilot studies at our institution, in patients 1-3 years old, with DIN-related dysphagia and aspiration (DA). Feeding, respiratory-related symptom scores, and aspiration/penetration assessed on modified barium swallow (MBS) significantly improved following combined IL and feeding therapy using a thickener weaning protocol (TWP). Subgroup analysis reveals combined IL and TWP to be particularly effective in patients with severe baseline DA. Multidisciplinary aerodigestive evaluation and management with IL and feeding therapy focused on weaning levels of thickener is emerging as a novel and effective approach for treatment of DIN-related DA in young children. Further comparative, prospective trials investigating effects of IL and feeding therapy are required to validate results.

Transitions and Transformations in Nursing Leadership.

The dialogue with Dr. Melanie Dreher focuses on a time of transition and her reflections on her career as a dean. Dr. Dreher shares from a personal and professional perspective.