The Impact of COVID-19 on Body Mass Index Among Hispanic Children Accessing a Primary Care Clinic in Central Texas: An Epidemic Amidst a Pandemic.

INTRODUCTION: The COVID-19 pandemic led to lifestyle disruptions that increased the risk for pediatric obesity and health disparities among Hispanic children. This study aimed to assess weight and body mass index (BMI) trends longitudinally, pre- and intra-COVID-19 pandemic, among Hispanic children. METHOD: A retrospective chart review included Hispanic children (n = 88) accessing a Federally Qualified Health Center, including six pediatric primary care clinics 6 months prepandemic and 6-, 12- and 18-month intrapandemic intervals. Descriptive statistical analyses included paired t tests, repeated-measures analysis of variance, and correlations for weight and BMI percentiles comparisons at prepandemic and intrapandemic intervals. RESULTS: Comparison of prepandemic and 6-month intrapandemic intervals did not identify differences in BMI percentiles. A significant difference in BMI percentiles was found in comparisons of prepandemic and 12- and 18-month intrapandemic intervals, with no differences identified by age or sex. DISCUSSION: Hispanic children experienced a significant increase in BMI percentiles throughout the pandemic. Addressing this social determinant of health among Hispanic children presenting with anomalous weight gain is imperative to promote health equity by focusing on the pediatric obesity epidemic.

The Moderating Role of Insecure Attachments on the Relationship between Controlling Behaviors and Violence Perpetration in Intimate Relationships.

This study sought to examine the association between male-to-female physical, psychological, and sexual violence and controlling behaviors of male partners. Further, the moderating effect of insecure attachment style on this association was examined in the context of South Korea. Existing national data collected from a representative Korean sample of 2,000 unmarried men was utilized. Findings indicated controlling behaviors among men were positively and negatively associated with psychological and physical violence, respectively, and no association was observed with sexual violence against female partners. Anxious attachment moderated the relationship between control over partner and psychological abuse. The avoidant attachment was identified as a quasi and pure moderator for the associations between control over the partner and physical and sexual violence, respectively.

Identification of provider and patient characteristics associated with antibiotic prescription in the treatment of acute sinusitis.

BACKGROUND: Inappropriate antibiotic use contributes to the development of antibiotic resistance. Sinusitis is the fifth most common diagnosis responsible for antibiotic use. Appropriate antibiotic prescribing for acute sinusitis treatment is crucial to mitigate antibiotic resistance threats. PURPOSE: The purpose of this study was to identify patient and provider characteristics associated with antibiotic prescription and to assess provider adherence to antibiotic prescribing guidelines for acute sinusitis treatment. METHODOLOGY: Retrospective chart review including acute sinusitis cases diagnosed over 12 months, at two express care clinics in the Southwestern United States. Data extraction identified 371 cases meeting inclusion criteria (age >18 years). Descriptive statistical data analyses included Chi square tests. RESULTS: A majority of cases received antibiotic prescriptions (90.8%, n = 337). Sociodemographic characteristics significantly associated with antibiotic prescription ( p < .05) included race, ethnicity, insurance type, and smoking status. Patient-reported nature of symptoms, sinus tenderness, and erythema/edema nasal turbinates were also significantly associated with antibiotic prescription ( p < .05). Antibiotic prescription and watchful waiting for acute sinusitis treatment were significantly associated with provider types ( p < .05). CONCLUSIONS: A gap exists between current guidelines and clinical practice for acute sinusitis treatment in outpatient settings. Antibiotic prescription occurred, although not indicated, along with incorrect antibiotic choice, dose, and duration of therapy. IMPLICATIONS: Outpatient antimicrobial stewardship programs for acute sinusitis treatment with a focus on educational interventions for providers may reduce antibiotic overprescribing for acute sinusitis.

Stories of Hope and Health: Wisdom From Older Mexican-American Women Who Broke Free From the Entangled Web of Love and Violence.

This interpretive qualitative study explores the lived experience of intimate partner violence (IPV) among 12 older Mexican-American women aged 55-85 with past experiences of IPV to understand how it shaped their lives. Sociocultural factors that influenced the IPV experience and sustained health amidst adversity were explored. Denzin's interpretive interactionism along with Antonovsky's salutogenic theory guided this study. These women survived IPV and discovered ways to foster health and thrive in later years. They all vowed to break the cycle of violence for future generations. Their wisdom offers hope and has implications for healthcare professionals, future research, and advocacy efforts.

A qualitative thematic analysis of mentorship for new psychiatric-mental health nurse practitioners.

BACKGROUND: A volume of literature reflects that mentorship is key in producing quality nurse practitioners. Mentoring leads to increased confidence, role clarity, and other benefits improving practice. However, there is little to no research focusing specifically on the impact of mentoring in psychiatric nurse mental health nurse practitioners (PMHNPs). PURPOSE: To explore process of acquiring mentorship and mentoring experiences of newly graduated PMHNPs, all of whom obtained their respective degrees partially or completely online. The study also seeks to describe perceptions of mentoring in PMHNP leaders. METHODS: Nine new graduate PMHNPs and 10 PMHNP leaders were recruited from membership rosters of professional organizations in the Southwestern United States. Informants participated in semi-structured interviews with questions sourced from an interview guide. Interviews were conducted via videoconference or telephone from informants' homes. Data were coded via an in vivo approach and analyzed by thematic methods. RESULTS: New graduates reported that mentoring was dependent on four themes: connectivity, educational stewardship, practice confidence, and luck. Mentor access via work, institutions, or schools was inconsistent. Leaders were concerned about limited educational and professional investment in mentorship because this process is an important component of professional development. CONCLUSION: Mentorship for new graduates is based on a variety of factors, some of which are out of their control. Lack of mentoring may affect practice, which affects patient care. Dialogue between educators, professionals, and organizations may improve mentoring stewardship. IMPLICATIONS: Enhanced communication between educational institutions and professional organizations to create a more fluid process from graduate to mentorship is needed.

Translation of novel antiemetic to sub-Saharan Africa using diffusion of innovation framework.

OBJECTIVE: Studies indicate inhaled isopropyl alcohol (IIA) is effective or superior to ondansetron for adult patients. Although quick-acting and low cost, it cannot be assumed this remedy is suitable for adoption in all settings. We explored how an innovative antiemetic remedy studied in the United States translates to a sub-Saharan Africa clinic/hospital setting using Rogers' Diffusion of Innovation Framework. DESIGN: Qualitative design with purposive sampling. SAMPLE: Health care staff (n = 11) providing and community members (n = 22) accessing health care services in a sub-Saharan Africa clinic/hospital. MEASUREMENTS: Semi-structured interviews with coding and identification of themes via deductive content analysis using Rogers' Diffusion of Innovation Framework. RESULTS: Nausea and vomiting was a common complaint, with malaria the most common etiology. Participants emphasized treatment of etiology over symptomatic treatment and described previous aromatherapy use. IIA advantages included administration route, quick-acting, self-administration, portable, available, and easy trialability. Participants expressed concerns regarding use of term "alcohol" as potentially offensive to others. CONCLUSION: Use of Rogers' Diffusion of Innovation framework identified barriers and facilitators to translation of a novel antiemetic remedy for sub-Saharan Africa clinic/hospital settings. Evaluating clinical innovations from perspectives of relative advantage, compatibility, complexity, trialability, and observability enhances adoption of innovations within clinical settings.

The Embodiment of Traditional Partería in the Colombian Pacific Region.

A Traditional Partera refers to a woman who assists, by traditional practices, women during gestation, birth, and reproductive life, aside of the formal health care system. Their practice, Traditional Partería, is considered a key ancestral cultural component in marginalized communities in Colombia. A comprehensive description of the essence of Colombian Traditional Partería is currently missing, and this practice is facing the loss of its body of knowledge. Here, we describe the essence of being a Colombian Traditional Partera. Eight Traditional Parteras participated in phenomenological interviews and body maps focused on their embodied conscious experience of being a Traditional Partera in Colombia. Seventeen general meaning units were identified and grouped in three embodied components (Head, Heart, and Hands) related to practice, knowledge, feelings, perceptions, context, and culture. We discuss philosophical reflections and implications of knowing other's world perspectives, describing a sensitive triad central in the Traditional Partería practice.

Exploring cognitive dissonance in the correctional nursing experience.

OBJECTIVE: Correctional nurses navigate conflict between custody and caring. Balance is needed between healthcare and security priorities. This study explores the unique nature of nursing practice within correctional settings to inform interventions reducing stress, enhancing coping and mitigating cognitive dissonance among these nurses. DESIGN: Qualitative, semi-structured interviews. SAMPLE: Purposive sampling of nurses practicing in a correctional facility in the Southwestern United States. RESULTS: Thematic analyses identified six themes describing the experiences of nurses in the correctional facility. The themes, "We have a sense of purpose," "We don't trust each other," "We want respect," "We experience unique stress," "It changes who you are," and "We try to leave it all there," describe the need for interventions providing debriefing opportunities, strengthening of relationships with corrections personnel, reflection and stress reduction to ameliorate the potential for cognitive dissonance. CONCLUSIONS: Correctional nurses in this study perceived a strong sense of purpose and a desire for respect. They are challenged by relationships with both correctional staff and inmates and perceived a change in who they are due to practice in this challenging environment. Measurable, evidence-based stress relief interventions such as mindfulness practices, reflection interventions, physical activity, prayer and meditation are indicated to address these challenges.

Expanding the conceptualisation of the Art of Caring.

OBJECTIVE: To analyze the concept Art of Caring and expand its conceptualization in the Nursing discipline. METHODS: A conceptual analysis in Spanish and English was developed based on the steps proposed by Walker and Avant. FINDINGS: Five principal historical stages of development of the concept were identified. Attributes, antecedents, consequences, and cases are provided. An analogy is proposed to illustrate this concept through the representation of a four-dimensional figure (tesseract). CONCLUSIONS: Art of Caring embeds the core disciplinary nursing knowledge. Exploring this concept leads to a broad perspective of Nursing and the act of caring, with the potential of uniting the discipline globally. IMPLICATIONS FOR NURSING PRACTICE: With the increasing use of Nursing knowledge in different languages, the global understanding of its foundations is key for advancement of the discipline. This concept analysis provides tools to help nurses to understand and be understood regardless of linguistic differences.

Rural Dementia Caregivers in Southwest Texas: An Exploratory Study of Advance Directives and End-of-Life Proxy Decision Making.

For a growing number of persons with dementia (PWDs), advance care planning (ACP) can help families make important end-of-life (EOL) care decisions that reflect PWDs' values and preferences. The current exploratory study aimed to understand advance directive planning and decision making among PWDs and caregivers. A survey was conducted with a convenience sample of 47 ethnically diverse PWD caregivers recruited from rural health care facilities in Southwest Texas. Sixty-eight percent of PWDs and caregivers were Hispanic. The majority of PWDs had completed an advance directive (60%) and preferred equally shared decision making between family (including the PWD) and physicians (57%). Under a hypothetical EOL scenario for PWDs, caregivers chose comfort (40%) and palliative care treatment (55%) more than other goals and treatment options. In this scenario, Hispanic PWDs were less likely than non-Hispanic White counterparts to complete an advance directive (48% vs. 81%, p < 0.05) and to choose only pain and symptom management (46% vs. 81%, p < 0.05). Although the overall ACP rates among rural PWDs may be comparable to those for the general PWD population, ethnic differences exist. More culturally competent education efforts are needed to promote ACP among PWDs in culturally diverse rural communities. [Journal of Gerontological Nursing, 45(9), 11-17.].

Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium.

PROBLEM: Mycoplasma genitalium has been associated with male urethritis. We sought to relate M. genitalium to genitourinary signs and symptoms in women. METHOD OF STUDY: We compared 26 culture-positive women (group 1), 257 additional polymerase chain reaction-positive women (group 2), and 107 negative control women. We used logistic regression to evaluate signs and symptoms, controlling for co-infections, pregnancy, age, and intervention group assignment. RESULTS: Comparing group 1 with controls, we found significantly elevated odds ratios (ORs) for intermediate vaginal discharge (OR = 5.4; 95% confidence interval 1.01, 29.2) and action in response to discharge [3.9 (1.1, 13.5)]. Non-significant increases were observed for pathologic vaginal discharge [3.8 (0.78, 18.2)], pathologic dyspareunia [1.5 (0.25, 9.0)], vaginal odor [2.1 (0.75, 5.7)], and cervical mucopus [4.1 (0.74, 22.4)]. Group 2 results were similar, but showed no increase in cervical mucopus relative to controls. CONCLUSION: Infection with M. genitalium in women is independently related to increased genitourinary symptomatology.

Development of composite symptom variables for quantitative analysis of genitourinary symptomatology in women.

Gonorrhoea and chlamydia infections in women are often regarded as asymptomatic. Syndromic management of sexually transmitted disease (STDs), however, is partially based on vaginal symptoms. We sought to better identify STD-associated symptoms in women by development of composite genitourinary symptom constructs. Standard symptoms were stratified, based on their descriptors (amount, frequency, severity, etc.), into pathological (likely to be STD-associated) and intermediate (unlikely to be STD-related). Simple symptoms and composite symptom constructs were significantly more common in women with STD infections (chlamydia, gonorrhoea and/or trichomonas) than those without infection (six months later). Logistic regression confirmed the association of each pathological symptom construct individually with gonorrhoea, chlamydia and trichomonas. Composite symptom constructs improve the specificity for detecting STD infections in women.

Reduction in sexual risk behaviors and infection rates among African Americans and Mexican Americans.

BACKGROUND: Project SAFE, a gender- and culture-specific cognitive-behavioral intervention, was one of the few interventions to have demonstrated a significant reduction in sexually transmitted infections in a randomized, controlled trial. GOAL: We evaluated intervention efficacy in 379 Mexican Americans and 170 African Americans; and in a subset of 477 women, explored ethnic differences in the relationships over time between attitudes/beliefs about relationships, reported sexual behavior, and infection. STUDY DESIGN: Women were questioned intensively at baseline, 6, and 12 months. We used stratified analyses and multivariate regression to evaluate ethnic differences and the role of behavior in explaining ethnic differences in infection. RESULTS: African Americans had higher overall infection rates (29.0% vs. 18.3%) than Mexican Americans, but the intervention efficacy was similar (odds ratios, 0.58 and 0.54, respectively). African Americans reported more douching after sex, less mutual monogamy, and more rapid partner turnover. However, Mexican Americans appeared slightly more likely to have sex with an untreated partner, and there was no difference in risky sex. African Americans reported greater difficulty finding partners and reported attitudes more compatible with nonmonogamy. CONCLUSIONS: Despite substantial ethnic differences in attitudes/beliefs, behaviors, and infection rates, the intervention had a comparable impact on both Mexican American and African American.

Behaviors changed by intervention are associated with reduced STD recurrence: the importance of context in measurement.

BACKGROUND: Evaluations of STD/HIV interventions incorporating behavioral and biologic outcomes have not reported strong correspondence. GOAL: The goal of the study was to demonstrate that behaviors, measured comprehensively, are associated with infection and to delineate the behaviors responsible for reduced infection rates in Project SAFE (Sexual Awareness For Everyone). STUDY DESIGN: Follow-up data from an intervention trial were analyzed to determine: (1) study versus control differences in complex risk behaviors and (2) the overall relationship between these behaviors and infection status (chlamydia and/or gonorrhea), with use of multiple logistic regression. RESULTS: Lower infection rates among 249 women who received intervention (compared with 228 controls) were explained by reduced-risk status in 5 modifiable behaviors. The 0 to 12-month logistic regression model (including sex with untreated partner [OR = 5.6], lack of mutual monogamy [OR = 2.4], unsafe sex [OR = 1.9], rapid partner turnover [OR = 2.7], and douching after sex [OR = 1.9]) correctly predicted infection status for 75.3% of participants (71.8% of infected, 76.2% of uninfected). Women in nonmutually monogamous unions who had sex with partners who were untreated or incompletely treated were 13 times more likely to be infected than those who were monogamous and avoided sex with an untreated/incompletely treated partner. CONCLUSION: This intervention reduced infection rates by maintaining low-risk behaviors and changing high-risk behaviors. We elucidated the complex relationship between behavior and infection by incorporating context into variable conceptualization and considering several behaviors simultaneously.