Low- and lower middle-income countries advanced practice nurses: an integrative review.

AIM: To review published literature descriptions of advanced practice nurses' roles in low- and lower middle-income countries. BACKGROUND: Advanced practice nurse roles have the potential to address insufficient healthcare resources in low- and lower middle-income countries. INTRODUCTION: This integrative review highlights advanced practice nurses' roles in the delivery of healthcare services in low- and lower middle-income countries. METHODS: Three electronic databases PubMed, CINAHL complete and ProQuest Health & Medicine were searched. No limits by year or language were set. The names for low- and lower middle-income countries and combinations 'related to advanced practice nurses' titles were used to identify papers. In addition, a review of publication type was performed. Themes found within the publications were assessed against the advanced practice nurses' International Council of Nurses' characteristics. An integrative review facilitated an appraisal of the papers identified. RESULTS: The initial search identified 5778 publications in 16 languages. This number was reduced to 23, from 18 low- and lower middle-income once exclusion criteria were applied. Six publications were from 1977 to 1999, and six between 2000 and 2010, with the remaining 11 from 2011 to 2018. Zambia had the most publications. Notably, 63 countries were not represented. Of those meeting inclusion criteria, the majority addressed education with a lesser extent focusing on practice and regulation of advanced practice nurse's roles. The majority were published during the last decade. DISCUSSION: This review of the published literature identified advanced practice nurses' roles and function within some healthcare systems. However, not all components were reported. Examination of the grey literature could provide additional information about the actual and potential benefits of advanced practice nurses' in low- and lower middle-income countries. CONCLUSION: The published literature that referred to advanced practice nurses' identified their contribution to positive impacts on health care over the last 40 years. However, with only 11 publications identified in the last 7 years, further review is required to understand the advanced practice nurses' roles in these countries. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: Further development of advanced practice nurses' in low- and lower middle-income countries is supported by the lack of published literature.

Prevalence of high-risk human papilloma virus among women with hepatitis C virus before liver transplantation.

BACKGROUND: We sought to assess the prevalence and risk factors for high-risk human papillomavirus (HPV) infection among female liver transplant (LT) candidates. Traditional health screening before LT listing has included Pap smear and is typically carried out by the patient's local provider. The prevalence of high-risk HPV in this population has not been studied. METHODS: With Institutional Review Board approval, 62 LT candidates received a liquid-based Pap smear with high-risk HPV testing as part of their pre-transplant evaluation by a single provider. Clinical variables included age, ethnicity, insurance status, prior Pap smear, and HPV results, HPV risk factors including age of first intercourse, number of lifetime partners, last sexual activity, smoking, birth control pill use, history of sexually transmitted infections, human immunodeficiency virus status, immunosuppressive medication, medical diagnoses, prescribed medications, and history of hepatitis A, B, C, or D. RESULTS: The 62 women had a median age of 56 years, and 39% had high-risk behavior known to be associated with HPV. Ten of 62 patients (16.1%) had high-risk HPV at baseline screening, 5 of whom had atypical cytology. All of the patients who were positive for high-risk HPV had an etiology of hepatitis C virus (HCV) as the underlying cause of liver disease, with the majority (90%) having no history of high-risk behavior for HPV. In contrast, all patients with high-risk behavior who were HCV negative were HPV negative. Fisher's exact test demonstrated a statistically significant relationship between HPV and HCV; odds ratio = 24.4, 95% confidence interval, 1.4, 438.7, P-value = 0.0013. None of the other potential risk factors were associated with HPV in this cohort. CONCLUSIONS: In this study, we provide evidence of a strong association between HCV and HPV in LT candidates, which has not been previously reported. HPV positivity was observed in non-sexually active women, suggesting a reactivation of dormant HPV. An association between hepatitis C and high-risk HPV could involve impairment of T-cell function by hepatitis C. These data support close surveillance in women's health screening for LT candidates. Further studies to characterize immune responses in these patients will be in order.

Nursing research activities in New York state are alive and well: a survey of selected acute care facilities and schools of nursing.

This survey was conducted to assess the nature and extent of nursing research activities in acute care facilities and schools of nursing in New York state. A questionnaire was mailed to 269 acute care facilities and 42 schools of nursing with a response rate of 29%. Sixty-seven percent of acute facilities and 100% of schools responding reported participating in nursing research activities. Sixty-eight percent of the acute care facilities and 67% of the schools of nursing that participated in research activities reported that nursing research was included in staff job descriptions. The findings revealed that the organizational environment in schools was more supportive of research activities than in acute care facilities. Despite changes in health care, including overall downsizing and deletion of nursing research positions, acute care facilities and schools of nursing reported an increase in quality and quantity of research from 1992-1996 compared to 1988-1991.

Perceptions of the importance placed on religion and folk medicine by non-Mexican-American Hispanic adults with diabetes.

The high incidence of diabetes and diabetes-related complications in Hispanic adults in the United States continues to be of concern among healthcare providers. The underutilization of screening services and early treatment centers by Hispanic adults seems to contribute to the problem. This survey examined whether religious, spiritual, and folk medicine beliefs play a role in the participants' view of diabetes and treatment choices. One hundred four non-Mexican-American Hispanic adults with diabetes were surveyed using a self-report questionnaire. Results showed that 78% of patients believed they had diabetes because it was God's will; 17% of patients reported using herbs to treat their diabetes. This survey demonstrates the importance of addressing religion and spirituality when dealing with the issues of disease and health in this population.

Composition of weight loss in severely obese women: a new look at old methods.

Seven severely obese, outpatient dieters lost weight (mean +/- SEM, 14 +/- 1 kg), and the composition of weight lost was determined by six different models. Total body water (TBW), total body potassium (TBK), and body density, bone mineral content, and fat as determined by dual photon absorptiometry (DPA) were measured while subjects were weight-stable, before and after weight loss. Fat loss was calculated by three two-compartment models (2C-TBW, 2C-TBK, and hydrodensitometry [2C-HD]), one three-compartment model (HD with correction for water content of fat-free mass [FFM], 3C), and one four-compartment model (HD with correction for water and mineral content of FFM, 4C), and was measured directly by DPA. Mean composition of weight loss was similar for all models (mean weight lost as fat: 89% for DPA, 91.5% for 4C, 89% for 3C, 88.6% for 2C-HD, and 87% for 2C-TBW) except 2C-TBK (weight lost as fat, 66%). There was a much wider range of individual values for the 2C-TBW and 2C-TBK models (17% to 138% and 18% to 93%, respectively) than for the multicompartment models (63% to 112%) and DPA (76% to 107%). Almost opposite results were obtained for the same individual when using the 2C-TBK and 2C-TBW models. The discrepancy between these models was due to the inverse relationship between changes in TBW and TBK in the group as a whole (r = -.34, NS). In addition, TBK loss was found to be dependent on the initial level of hyperinsulinemia, calculated as the area under the 2-hour oral glucose tolerance curve.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of diabetic patients' home urine glucose testing technique and ability to interpret results.

The attention of diabetes educators has focused on home blood glucose monitoring, with little attention being given to the educational needs of patients who choose to perform home urine glucose monitoring. This study assessed patients' urine glucose testing technique and ability to interpret test results. A questionnaire was developed and administered by clinic nurses to 100 adults with diabetes who perform home urine glucose monitoring. Patients selected the urine testing product they used at home and demonstrated the technique using a prepared glucose solution. The nurse recorded whether patients correctly performed each step in the procedure according to product instructions. Results indicated that 61% of patients did not perform the procedure correctly. Patients had difficulty reading package insert instructions, could not correctly read a clock, did not wait the correct amount of time before reading test results, and did not routinely keep written result diaries. This study demonstrates the importance of routine review of home urine glucose testing with the product used at home.