The Affordable Care Act and child asthma: Lowering health care barriers by raising our voices.

BACKGROUND: This policy discussion addresses the provisions of the Affordable Care Act (ACA) that impact children with asthma. PURPOSE: The purpose of this policy paper is to inform health care professionals and lawmakers about ACA provisions affecting pediatric asthma care and provide recommendations for policy changes that can improve equitable care for children with asthma. METHODS: The issues addressed involve discrimination, Medicaid policy oversight, quality improvement stategy, data collection, school-based health care funding, accountable care organization reimbursement, and the extension of dependent coverage. DISCUSSION: Health care policy development that focuses on human rights, and not market valuation, could reduce health inequity among children with asthma. CONCLUSION: Policy recommendations are presented to improve asthma care for a population that is largely vulnerable due to age, socioeconomic status, and discrimination.

Enrollment and Completion Characteristics for Novel Remote Delivery Modes of the Self-management Programs During the COVID-19 Pandemic: Exploratory Analysis.

BACKGROUND: In-person, evidence-based, peer-facilitated chronic disease self-management programs have been shown to be effective for individuals from a variety of backgrounds, including rural and minority populations and those with lower socioeconomic status. Based in social learning theory, these programs use group processes to help participants better manage their chronic disease symptoms and improve their quality of life. During the pandemic, these in-person programs were forced to rapidly transition to remote delivery platforms, and it was unclear whether doing so increased disparities within our rural population. OBJECTIVE: The objectives of this analysis were to ascertain self-management program enrollment and completion characteristics between 2 remote delivery platforms, as well as determine the individual level characteristics that drove enrollment and completion across delivery modes. METHODS: We analyzed enrollment and completion characteristics of 183 individuals who either enrolled in a self-management workshop delivered through a web-based videoconference (VC) system or through a traditional, audio-only conference call (CC) offered by our health care network between April and December 2020. Chi-square tests of association were used to describe the characteristics of and differences between groups. Logistic regression analysis was used to determine significant predictors of enrollment and completion. RESULTS: Those who enrolled in the VC platform were significantly likelier to be younger and college educated than those who enrolled in the CC platform. Those who completed a program, regardless of delivery mode, were likelier to be older and college educated than those who did not complete a program. Multivariate analyses indicated that of those enrolled in the CC platform, completers were likelier to not be enrolled in Medicaid. Among those enrolled in the VC platform, completers were older, college graduates, female, and likelier to have reported poorer health than those who did not complete the program. CONCLUSIONS: The transition of self-management programs to remote delivery modes, particularly to those that rely on VC platforms, revealed that certain demographic groups may no longer be able or willing to access the service. Efforts need to be made to increase engagement in remote self-management workshops. In addition, equivalent quality services that do not rely on a digital platform must continue to be offered in order to promote health equity.

Global policies to reduce pandemic intensified violence against women.

Violence against women (VAW) worsened globally during the Covid-19 pandemic lockdowns. For example, a woman in France was killed every 3 days during lockdown. At the same time in South Africa, a woman was killed every 3 h. This paper presents and analyzes the risk factors that have worsened during the Covid-19 pandemic lockdowns and the subsequent economic consequences of mitigation policies. The purpose of this paper is twofold: (a) to conduct a critical review of international extant literature regarding government policies related to VAW since the beginning of the worldwide Covid-19 pandemic lockdowns that began in early 2020, and (b) to suggest opportunities for nurses to influence health policy development and social norms related to VAW. Thematic synthesis of the findings present interventions that helped to mitigate VAW during Covid-19 and is followed by a discussion of findings in relation to social determinants of health and human rights. A gender-based policy approach that focuses on the human right to be free of all forms of violence must be a leading strategy as governments reallocate resources and rebuild economies in the wake of this pandemic.

Validity and reliability of Turkish version of the Food-Mood Questionnaire for university students.

OBJECTIVE: This study aims to evaluate the validity and reliability of the Turkish version of the Food-Mood Questionnaire (FMQ) for university students. DESIGN: The original questionnaire developed by Begdache et al. (2019) was modified and translated into Turkish. The content validation ratio (CVR) and the content validity index (CVI) were used for content validity assessment. The construct validity was assessed by exploratory factor analysis and confirmatory factor analysis (CFA) on data collected on university students who completed the survey online. Pearson's correlation coefficients and Cronbach's α were used to assess reliability and validity (P < 0·05). SETTING: This study was conducted at five different universities in Turkey. PARTICIPANTS: A total of 251 (67 males and 184 females) undergraduate students participated in the study. Of these, seventy-five students completed a pre- and post-test assessment. RESULTS: In the current study, 251 university students with a mean age of 21·9 ± 4·1 years participated. The mean CVR and CVI were 0·96 and 0·98, respectively. Factor loadings ranged from 0·341 to 0·863, and item total score correlations ranged from 0·142 to 0·749. Cronbach's α coefficient was 0·633 for the whole scale. Five factors were extracted that had a good fit in CFA (χ2/DF = 1·37, root mean error of approximation: 0·039, goodness-of-fit index: 0·911 and comparative fit index: 0·933). CONCLUSIONS: The Turkish FMQ is a valid and a reliable tool for university students. FMQ can be used by clinicians or researchers to examine the mental distress and dietary patterns of university students. Further testing of the FMQ is required for validation in the general population.

Civic Engagement in Nursing: Measuring Participation, Reflecting on Influences, and Harnessing Momentum.

This study explored civic engagement and related variables among registered nurses and non-nurses. Historical influences that have shifted engagement are discussed. This was a cross-sectional, observational study. Data was collected in a convenience sample (n = 727) of registered nurses (n = 232) and non-nurses (n = 495) and was analyzed using descriptive and ANOVA statistics. Nurses were more engaged than non-nurses (p = .000). Age, education, and field of practice were significant variables among nurses. Nurses are positioned to answer the call to civically engage for health-related issues. Findings underscore ways to elevate and harness civic engagement among nurses.

Spatial dynamics of access to primary care for the medicaid population.

Primary care (PC) has always been underestimated and underinvested by the United States health system. Our goal was to investigate the effect of Medicaid expansion and the Affordable Care Act (ACA) provisions on PC access in Broome County, NY, a county that includes both rural and urban areas, and can serve as a benchmark for other regions. We developed a spatial system dynamics model to capture different stages of PC access for the Medicaid population by using the health belief model constructs and simulate the effect of several hypothetical interventions on PC utilisation. The government data portals used as data sources for calibrating our model include the New York State Department of Health, the Medicaid Delivery System Reform Incentive Payment (DSRIP) dashboards, and the US census. In our unique approach, we integrated the simulation results within Geographical Information System (GIS) maps, to assess the influence of geospatial factors on PC access. Our results identify hot spot demographic areas that have poor access to PC service facilities due to transportation constraints and a shortage in PC providers. Our decision support tool informs policymakers about programmes with the strongest impact on improving access to care, considering spatial and temporal characteristics of a region.

Reducing Hospital Readmissions in Upstate New York: Teasing Out the Effective Programs.

PURPOSE OF STUDY: The study's purpose was to identify hospital programs, organizational characteristics, and levels of nursing involvement in hospital programs that contribute significantly to reductions in readmission rates and reimbursement penalties for hospital systems in upstate New York. PRIMARY PRACTICE SETTING: Hospitals located in upstate New York. METHODOLOGY AND SAMPLE: No sampling technique was employed because the cohort included hospitals located in upstate New York. Hospitals in upstate New York were selected (N = 94), representing 53 counties ranging between metropolitan and rural status. Using an ex post facto design within the framework of the ecological and synergy models, organizational characteristics of hospital systems and educational levels of nursing involvement in hospital programs were analyzed and coded. Independent-samples t tests, analysis of variance, and Pearson correlation tests were conducted. RESULTS: Organizational programs that reduce various hospital readmission rates and reimbursement penalties for hospitals in upstate New York are (1) certified home health agencies; (2) telehealth; (3) house calls; (4) advanced practice nurses on care management interdisciplinary discharge teams; and (4) increasing the number of hospital readmission reduction programs (HRRPs) utilized. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Hospitals should.

Undergraduate nursing students and the elderly: An assessment of attitudes in a Turkish university.

At times when populations are aging and nursing services for elders are needed, gerontology as a nursing specialty is not a highly sought career choice. The purposes of this study were to assess the overall attitudes of nursing students at a Turkish university toward the elderly and to identify the effects of demographic and social factors on attitudes. Using a non-experimental design, the Turkish version of the Kogan's Attitudes towards Old People (KAOP) Scale was given to undergraduate nursing students. Significant findings demonstrated that the older the student, the worse the attitude and that students willing to work with elders had significantly better total KAOP and better positive item scores than those not willing to work with elders. The findings support educational preparation as a major factor in shaping student attitudes. Geriatric education should be integral to nursing education to help ensure sustainability of nursing services for the elderly population.

Cognitive stimulation for apathy in probable early-stage Alzheimer's.

We studied changes in apathy among 77 community-dwelling older persons with mild memory loss in a randomized clinical trial comparing two nonpharmacological interventions over four weeks. The study used a pre-post design with randomization by site to avoid contamination and diffusion of effect. Interventions were offered twice weekly after baseline evaluations were completed. The treatment group received classroom style mentally stimulating activities (MSAs) while the control group received a structured early-stage social support (SS) group. The results showed that the MSA group had significantly lower levels of apathy (P < .001) and significantly lower symptoms of depression (P < .001). While both groups improved on quality of life, the MSA group was significantly better (P = .02) than the SS group. Executive function was not significantly different for the two groups at four weeks, but general cognition improved for the MSA group and declined slightly for the SS group which produced a significant posttest difference (P < .001). Recruitment and retention of SS group members was difficult in this project, especially in senior center locations, while this was not the case for the MSA group. The examination of the data at this four-week time point shows promising results that the MSA intervention may provide a much needed method of reducing apathy and depressive symptoms, while motivating participation and increasing quality of life.

Health risk behaviors among adolescents attending rural, suburban, and urban schools: a comparative study.

This study describes differences in health risk behaviors among 2,017 adolescents attending rural, suburban, and urban school districts in upstate New York. Differences in risk behaviors regarding use of tobacco, alcohol, and illegal substances; sexual activity; and carrying weapons were analyzed. A consistent pattern emerged from the analysis of the data, with rural students at most risk. The findings reinforce the need to focus on the relationship between residence and health risk behaviors, so that intervention programs specific to the needs of rural, suburban, and urban adolescents can be developed.