Social Determinants of Health in the Lives of Urban-Dwelling, Pregnant Puerto Rican Women and Families: Nursing Implications From a Secondary Narrative Analysis.

Urban-dwelling childbearing Puerto Rican women and families on the U.S. mainland face a myriad of social determinants that affect pregnancy and overall health outcomes. Historically, Puerto Ricans have poorest pregnancy outcomes of all Hispanic women. Acknowledgment of the cyclic, structural barriers faced by this patient population is essential to providing wholistic care. Here, we discuss family nursing implications derived from narrative analysis of a parent study that investigated ecological systems affecting 21 pregnant Puerto Rican women residing in an impoverished and crime-ridden neighborhood in Philadelphia. Content analysis of interviews revealed interwoven social determinants of health embedded in participant narratives. Furthermore, we present case vignettes based on integration of participant interviews that encapsulate the everyday experiences of these women and their families and provide clinicians with guidance and strategies for interacting with and advocating for this population.

Systematic Review of Disparities in Kidney Transplantation Prior to Implementation of the Kidney Allocation System and Directions for Research.

Major changes were made to the U.S. kidney allocation system (KAS) on December 4, 2014, in the effort to address disparities in kidney transplantation (KT) and achieve equity in organ allocation. Research is necessary to examine whether KAS achieved its goal; first, a firm understanding of the disparities that existed prior to implementation of KAS is needed. This systematic review examined the literature on disparities in access to deceased donor KT (DDKT) after listing in the pre-KAS era and discussed mechanisms to explain these disparities. Thirty-two articles were included. Racial, gender, age, socioeconomic, physiologic, geographic, and health care system disparities existed in the pre-KAS era. Findings of this review will inform the agenda for future disparities research in the post-KAS era.

Engagement of Urban, Pregnant Puerto Rican Women in Health Disparities Research.

Persistent challenges surround the recruitment of minority women from marginalized communities in health disparities research. These challenges include lack of the following: interest in research participation, trust, positive relationships between researchers and participants/community, and principal investigators from minority groups. The purpose of this article is to describe successful recruitment strategies used in health disparities research with pregnant Puerto Rican women and to suggest ways to ensure the future success of studies on health disparities. Suggested strategies include creating trust, facilitating active participation of stakeholders, and strengthening the research pipeline with undergraduate and graduate nursing students.

Factors Related to International Travel for Transplantation Among U.S.-Listed Kidney Transplant Candidates.

Factors related to travel for transplantation were examined using data from the Scientific Registry for Transplant Recipients. Candidates who traveled abroad for a kidney transplant had higher odds of being male, Asian or Hispanic, college-educated, employed, privately insured, and a non-U.S. citizen/non-U.S. resident. Candidates with a body mass index greater than 30, a calculated panel reactive antibody (cPRA) greater than 80%, and a history of more than two years of hemodialysis or peritoneal dialysis had lower odds of traveling abroad for a kidney transplant. Geographically, candidates listed in the northeastern region of the United States (New York and Western Vermont) had the highest odds of traveling abroad for a kidney transplant. Findings of this study can be used to guide practice and education with transplant candidates, and to direct further investigation in this understudied but growing area of transplantation.