Colorectal cancer screening disparities in Asian Americans: the influences of patient-provider communication and social media use.

PURPOSE: We examined the role of patient-provider communication (PPC) during in-person visits and via electronic communication and social media use on colorectal cancer (CRC) screening among Asian Americans (AAs) and Non-Hispanic Whites (NHWs) aged 50 and older. METHODS: Health Information National Trends Survey 2017-2020 data were analyzed. RESULTS: AAs tended to evaluate the quality of PPC during their in-person visits to a health care provider lower than NHWs. AAs' CRC screening rate was lower than the rate of NHWs (78.8% vs. 84.4%). After adjusting for sociodemographics, healthcare access, and health status, the quality of PPC was the only significant predictor associated with a lower probability of CRC screening among AAs (Adjusted OR 0.74; 95% CI 0.56, 0.96); while the Internet to communicate with a health care provider was the only significant predictor of CRC screening among NHWs (Adjusted OR 1.76; CI 1.11, 2.79). AAs were more likely to use YouTube to watch a health-related video than NHWs (43.5% vs, 24%). However, social media use was not associated with CRC screening in both AAs and NHWs. CONCLUSION: Use of electronic communication technology may contribute to improve health information literacy and reduce the disparity. On-line communication may empower the culturally and linguistically diverse AAs by improving their confidence in communication with health care providers. Thus, communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities. Online communication technologies may reduce the disparities in PPC related to cancer screening and cancer burden experienced by AAs.

A Technology-Enhanced Physical Activity Intervention: A Feasibility Study.

Using a single-group, pre-posttest design, we evaluated feasibility and acceptability of a technology-enhanced physical activity intervention in 43 midlife (aged 35-64) first-generation Korean American adults who were physically inactive. The intervention consisted of bi-weekly education sessions for 4 weeks, monthly small group walks for the following 8 weeks, and weekly reminder text messages during the entire intervention period. A 100% retention rate, 93% adherence, and 88.4% satisfaction supported the feasibility and acceptability of the intervention. Paired t-tests revealed the intervention was successful and effective as demonstrating a significant increase in self-efficacy and moderate physical activity and improved cardiometabolic health. This easy and motivation enhancing intervention has a wide potential applicability for other ethnic groups. Further intervention research is suggested in a large sample, multisite, for a longer-term with a randomized controlled trial design, which may lead us to narrow the gap in physical activity engagement and cardiometabolic health disparities.

Examining the Potential Effect of a Salt Sensitivity Biomarker in Korean American Immigrants: A Pilot Study.

The genetic factors involved with salt sensitivity (SS) have been studied using a genetic approach to identify individuals at high risk for developing hypertension and could benefit from a low sodium diet intervention, but this has not been well-studied in Korean American immigrants (KAIs). The purpose of this pilot study was to investigate the influence of SS that moderates blood pressure (BP) in KAIs (n = 34). KAIs were recruited from local communities and completed a blood draw, a 8-day food log, and BP testing. The dietary sodium intake was measured using the Fitbit mobile app, and an SS biomarker was assessed using targeted genotyping. out of five GNAI2 single nucleotide polymorphisms (SNPs) tested, rs4547694 significantly moderated the relationship of dietary sodium intake on BP in KAIs. Conclusions: Further studies are warranted to test the effect of a reduced sodium diet on BP while accounting for the moderating influence of an SS genotype.

The Relationship Between Lower Urinary Tract Symptoms and Osteoarthritis Symptoms Among Vendors in a Conventional Market.

PURPOSE: This study aimed to investigate lower urinary tract symptoms (LUTS) and the correlation between LUTS and osteoarthritis (OA) symptoms in the vendors working in a conventional market. METHODS: This cross-sectional study was conducted on 153 vendors aged 40 and over from August 10th to September 8th, 2020, in a conventional market. Data were collected via the self-reported questionnaires. We assessed LUTS by International Prostate Symptom Score (IPSS) and OA symptoms by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: The mean age of 153 subjects was 61.31±9.92 years old. The mean score of IPSS and WOMAC was 5.37±5.68 (range, 0-35) and 16.89±19.61 (range, 0-96). Fifty-one percent of subjects had urinary incontinence at least monthly. Twenty-four point two percent of subjects had moderate-to-severe LUTS which were defined as a score of IPSS ≥8. LUTS were positively correlated with OA symptoms (r=0.41, P<0.001). CONCLUSION: The results showed that LUTS were associated with OA symptoms, and it also emphasized the need for vendors to be provided with a health education program to manage and prevent their LUTS and OA symptoms.

Health Literacy and Access to Care in Cancer Screening Among Korean Americans.

BACKGROUND: Health literacy and access to care are critical facilitators for preventive health behaviors. After the passage of the Affordable Care Act in March 2010, little has been studied about how improved health insurance coverage has impacted the use of preventive health services among Korean Americans. OBJECTIVE: The study assessed the impact of access to care, use of services, and health literacy on cancer screening among Korean Americans. METHODS: A descriptive cross-sectional study of 377 Korean Americans age 18 years and older was conducted with a survey and convenient sampling in Texas. KEY RESULTS: Although 79% of the sample had health insurance, 32% had never visited a health care provider, and 14% were delayed in care in the past 12 months. Only 11.6% were confident to complete medical forms, and 69.5% had limited levels of confidence. Cancer screening compliance rates were: mammography (50.4% at age 40-54 years; 46.6% at age 55 years and older), a Pap smear (29.4% at age 21-29 years; 78.4% at age 30-65 years; 72.2% at age 66 years and older), and colorectal cancer screening at age 45 years and older (stool tests 15.1%; sigmoidoscopy 27%; colonoscopy 51.3%). Multiple logistic regression analyses revealed that household income, gender, health insurance, and health literacy were significantly associated with self-reported cancer screening. CONCLUSIONS: Korean Americans who participated in this study are characterized by marginalized health literacy, underused health care services, and significantly lower cancer screening compliance than the goals of Healthy People 2020. The following interventions are suggested to improve health literacy and health insurance literacy on cancer screening: culturally sensitive and linguistically appropriate education for the guidelines concordant with cancer screening, effective communication skills with health care providers, support for navigating the health care system, and development of internet- or social media-based health education programs to meet the preferred communication methods of this population. [HLRP: Health Literacy Research and Practice. 2021;5(4):e310-e318.] Plain Language Summary: Despite having improved health insurance coverage, Korean Americans of this study have marginalized health literacy, limited health insurance literacy, low cancer screening compliance, and underused health care services. The results of this study suggest several strategies to improve health literacy and health insurance literacy for Korean Americans, which may also apply to other groups with similar barriers.

Integrating EBP into an undergraduate research methodology course using the Star Model of Knowledge Transformation: A mixed-method study.

BACKGROUND: Evidence-based practice (EBP) competence is essential for healthcare professionals. Before undergraduate nursing students become research producers, they should first be competent research consumers. OBJECTIVE: To assess the level of students' readiness for EBP and explore their learning experiences after a modified research methodology course integrated with an EBP model. DESIGN: A mixed-method study using a one-group posttest-only design was utilized. PARTICIPANTS AND SETTING: Participants were 146 third-year students of a nursing school in South Korea. METHODS: A 15-week research methodology course was modified based on the Star Model of Knowledge Transformation. The course consisted of lectures, group discussions, group reports, and student presentations. EBP readiness was measured using a Korean version of the EBP Readiness Inventory, and the students' reflective logs were analyzed. RESULTS: Most students reported that EBP education was necessary. The average scores of students' EBP self-efficacy and knowledge were 4.36 out of 6 and 7.65 out of 15, respectively. Of the students, 73% rated their own EBP knowledge at a beginner level. Analysis of the reflective logs revealed that students regarded evidence appraisal as the most critical content (26.3%), additional learning was necessary (21.1%), and evidence-based practice was perceived as difficult (49.4%). CONCLUSION: Through the integrated research methodology course, nursing students gained EBP self-efficacy while recognizing its importance. However, acquiring sufficient knowledge in a single course was difficult, and the students remarked on the difficulty of the course. Therefore, integrating EBP concepts and applications in core nursing courses should be considered, and various innovative learning strategies are required to improve students' knowledge and competencies.

Relationship between Acculturative Stress and Pain Catastrophizing in Korean Americans.

Acculturative stress is speculated to be a sociocultural factor contributing to pain since cultural beliefs and practices can influence the way patients perceive and respond to pain. However, the relationship between acculturative stress and pain catastrophizing remains poorly understood. Therefore, we examined the relationship between acculturative stress and pain catastrophizing in Korean Americans. We collected survey data from Korean American in Texas (N = 374). Acculturative stress was measured with the Acculturative Stress Scale, and pain catastrophizing was measured with the Pain Catastrophizing Scale. Participants' mean age was 46.89 years, and 63% were women. Bivariate and multivariate statistical analyses indicated that higher acculturative stress may contribute to higher pain catastrophizing (regression coefficient = 1.02, P = 0.04). These findings advance our understanding of sociocultural factors associated with pain in Korean Americans; additional research with a larger sample is warranted for cross-validation.

Evolution of Experiential Learning Opportunities for Nursing Students After Natural Disaster.

BACKGROUND: Natural disasters, such as Hurricane Harvey, can provide unique hands-on learning experiences for nursing students. METHOD: The University of Texas Health Science Center at San Antonio School of Nursing deployed teams of faculty and students to Rockport, Texas, two to three times per week to provide post-disaster relief following Hurricane Harvey. Each team included a minimum of 10 students and two faculty to provide primary care, prevention, and door-to-door canvassing. Nursing students provided physical examinations, urgent care, vaccines, first aid training, and education. RESULTS: Across 6 months and more than 60 trips, over 200 students (supervised by 12 faculty) successfully delivered care to Rockport residents. This learning experience was invaluable for the nursing students, who expressed that "I felt like a real nurse" and "This is the best experience I have had since I decided to become a nurse." CONCLUSION: This intervention highlights the potential of disaster relief as a unique hands-on educational experience for nursing students. [J Nurs Educ. 2020;59(1):30-33.].

"We didn't forget" Utilizing a Community-Nurse Partnership to Promote Health in Rockport, Texas after Hurricane Harvey.

BACKGROUND: On August 25th 2017 Harvey, a category 4 hurricane, made landfall on the south coast of Texas with heavy winds and rain that severely damaged the seaside town of Rockport. The challenge facing healthcare providers following a natural disaster is timely assessments of community need and available resources. One week later, faculty at the University of Texas Health Science Center San Antonio, School of Nursing (SON) completed a community assessment and developed valuable partnerships. AIMS: Eighteen days after the initial assessment, faculty had secured support from The Children's Health Fund and operationalized strategies to provide disaster relief and experiential learning opportunities for the SON Population Focused Health undergraduate students. MATERIALS & METHODS: The community-as-partner model served as the framework to apply the nursing process to a community in crisis. As the focus shifted to recovery, the team prioritized the need to address long-term consequences for children after a natural disaster. RESULTS: Two educational sessions were designed using an interactive and instructional approach to discuss parental strategies to assess and support children as they navigated through loss after Harvey. DISCUSSION: This community-nurse partnership has endured, and the SON faculty and students continue to travel to Rockport to promote health and provide education to the community.

Hepatitis C virus double-stranded RNA is the predominant form in human liver and in interferon-treated cells.

Hepatitis C virus (HCV) is unique among RNA viruses in its ability to establish chronic infection in the majority of exposed adults. HCV persists in the liver despite interferon (IFN)-stimulated gene (ISG) induction; robust induction actually predicts treatment failure and viral persistence. It is unclear which forms of HCV RNA are associated with ISG induction and IFN resistance during natural infections. To thoroughly delineate HCV RNA populations, we developed conditions that fully separate the strands of long double-stranded RNA (dsRNA) and allow the released RNAs to be quantified in reverse transcription/polymerase chain reaction assays. These methods revealed that dsRNA, a pathogen-associated molecular pattern (PAMP), comprised 52% (standard deviation, 28%) of the HCV RNA in the livers of patients with chronic infection. HCV dsRNA was proportionally higher in patients with the unfavorable IL28B TT (rs12979860) genotype. Higher ratios of HCV double-stranded to single-stranded RNA (ssRNA) correlated positively with ISG induction. In Huh-7.5 cells, IFN treatment increased the total amount of HCV dsRNA through a process that required de novo viral RNA synthesis and shifted the ratio of viral dsRNA/ssRNA in favor of dsRNA. This shift was blocked by ribavirin (RBV), an antiviral drug that reduces relapse in HCV patients. Northern blotting established that HCV dsRNA contained genome-length minus strands. CONCLUSION: HCV dsRNA is the predominant form in the HCV-infected liver and has features of both a PAMP and a genomic reservoir. Interferon treatment increased rather than decreased HCV dsRNA. This unexpected finding suggests that HCV produces dsRNA in response to IFN, potentially to antagonize antiviral defenses. (Hepatology 2017;66:357-370).