Publications by authors named "Sally H Rankin"

39 Publications

A 14-day follow-up of adult non-malarial fever patients seen by mobile clinics in rural Malawi.

Malawi Med J 2020 03;32(1):31-36

Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA.

Background: While health providers consistently use malaria rapid diagnostic tests to rule out malaria, they often lack tools to guide treatment for those febrile patients who test negative. Without the tools to provide an alternative diagnosis, providers may prescribe unnecessary antibiotics or miss a more serious condition, potentially contributing to antibiotic resistance and/or poor patient outcomes.

Methods: This study ascertained which diagnoses and treatments might be associated with poor outcomes in adults who test negative for malaria. Adult patients for rapid diagnostic test of malaria seen in mobile health clinics in Mulanje and Phalombe districts were followed for 14 days. Participants were interviewed on sociodemographic characteristics, health-seeking behaviour, diagnosis, treatment and access to care. Mobile clinic medical charts were reviewed. Two weeks (±2 days) following clinic visit, follow-up interviews were conducted to assess whether symptoms had resolved.

Results: Initially, 115 adult patients were enrolled and 1 (0.88%) was lost to follow-up. Of the 114 adult patients remaining in the study, 55 (48%) were seen during the dry season and 59 (52%) during the wet season. Symptoms resolved in 90 (80%) patients at the 14-day follow-up visit (n=90) with the rest (n=24) reporting no change in symptoms. None of the patients in the study died or were referred for further care. Almost all patients received some type of medication during their clinic visit (98.2%). Antibiotics were given to 38.6% of patients, and virtually all patients received pain or fever relief (96.5%). However, no anti-malarials were prescribed.

Conclusions: Mobile clinics provide important health care where access to care is limited. Although rapid tests have guided appropriate treatment, challenges remain when a patient's presenting complaint is less well defined. In rural areas of southern Malawi, simple diagnostics are needed to guide treatment decisions.
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March 2020

Predictors of HIV Risk Reduction in Adolescent Girls.

MCN Am J Matern Child Nurs 2019 May/Jun;44(3):150-156

Ellen R. Long-Middleton is an Associate Professor, College of Nursing and Health Sciences, University of Vermont, Burlington, VT. The author can be reached via email at Pamela J. Burke is a Clinical Professor & PhD Program Director, School of Nursing, Northeastern University, Bouvé College of Health Sciences; Faculty, LEAH Program (Leadership Education in Adolescent Health), Boston Children's Hospital, Division of Adolescent Medicine, Boston, MA. Sally H. Rankin is a Professor Emerita and MacArthur Foundation Chair for Global Health Nursing, School of Nursing, University of California San Francisco, San Francisco, CA.

Purpose: The purpose of the study was to explore the associations among mastery, self-esteem, and HIV risk reduction behaviors in a culturally diverse group of adolescent girls. It is important to identify and assess psychological determinants of HIV risk reduction behaviors such as mastery and self-esteem so that healthcare interventions may be tailored to maximize an adolescent's preventive efforts.

Study Design And Methods: Black, Latina, and White adolescent girls were recruited from an urban primary care setting in a tertiary care center. A descriptive, correlational design was used. Measures included the Pearlin Mastery Scale, Rosenberg Self-Esteem Scale, and the Adolescent Problem Severity Index. Data were collected through written surveys completed anonymously. Data were analyzed using multiple regression analysis.

Results: There were 224 participants. Mastery and self-esteem, variables that commonly explain health-enhancing behaviors, were not associated with HIV risk reduction behaviors either in the entire sample or cultural subgroups. There was an inverse relationship between age and HIV risk reduction behaviors in all cultural groups. There were no significant differences in HIV risk reduction behaviors among the three cultural groups.

Clinical Nursing Implications: Findings suggest HIV prevention efforts by nurses should be universal regardless of an adolescent girl's presumed level of mastery and self-esteem, and that these efforts need to intensify as they age.
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August 2019

A discrete choice experiment to determine facility-based delivery services desired by women and men in rural Ethiopia.

BMJ Open 2018 04 3;8(4):e016853. Epub 2018 Apr 3.

Family Health Care Nursing, School of Nursing, University of California, San Francisco, California, USA.

Objectives: Despite global efforts to increase facility-based delivery (FBD), 90% of women in rural Ethiopia deliver at home without a skilled birth attendant. Men have an important role in increasing FBD due to their decision-making power, but this is largely unexplored. This study aimed to determine the FBD care attributes preferred by women and men, and whether poverty or household decision-making are associated with choice to deliver in a facility.

Setting And Participants: We conducted a cross-sectional discrete choice experiment in 109 randomly selected households in rural Ethiopia in September-October 2015. We interviewed women who were pregnant or who had a child <2 years old and their male partners.

Results: Both women and men preferred health facilities where medications and supplies were available (OR=3.08; 95% CI 2.03 to 4.67 and OR=2.68; 95% CI 1.79 to 4.02, respectively), a support person was allowed in the delivery room (OR=1.69; 95% CI 1.37 to 2.07 and OR=1.74; 95% CI 1.42 to 2.14, respectively) and delivery cost was low (OR=1.15 95% CI 1.12 to 1.18 and OR=1.14; 95% CI 1.11 to 1.17, respectively). Women valued free ambulance service (OR=1.37; 95% CI 1.09 to 1.70), while men favoured nearby facilities (OR=1.09; 95% CI 1.06 to 1.13) with friendly providers (OR=1.30; 95% CI 1.03 to 1.64). Provider preferences were complex. Neither women nor men preferred female doctors to health extension workers (HEW) (OR=0.92; 95% CI 0.59 to 1.42 and OR=0.74; 95% CI 0.47 to 1.14, respectively), male doctors to HEW (OR=1.33; 95% CI 0.89 to 1.99 and OR=0.75; 95% CI 0.50 to 1.12, respectively) or female over male nurses (OR=0.68; 95% CI 0.94 to 1.71 and OR=1.03; 95% CI 0.77 to 2.94, respectively). While both women and men preferred male nurses to HEW (OR=1.86; 95% CI 1.23 to 2.80 and OR=1.95; 95% CI 1.30 to 2.95, respectively), men (OR=1.89; 95% CI 1.29 to 2.78), but not women (OR=1.47; 95% CI 1.00 to 2.13) preferred HEW to female nurses. Both women and men preferred female doctors to male nurses (OR=1.71; 95% CI 1.27 to 2.29 and OR=1.44; 95% CI 1.07 to 1.92, respectively), male doctors to female nurses (OR=1.95; 95% CI 1.44 to 2.62 and OR=1.41; 95% CI 1.05 to 1.90, respectively) and male doctors to male nurses (OR=2.47; 95% CI 1.84 to 3.32 and OR=1.46; 95% CI 1.09 to 1.95, respectively), while only women preferred male doctors to female doctors (OR=1.45; 95% CI 1.09 to 1.93 and OR=1.01; 95% CI 0.76 to 1.35, respectively) and only men preferred female nurses to female doctors (OR=1.34; 95% CI 0.98 to 1.84 and OR=1.39; 95% CI 1.02 to 1.89, respectively). Men were disproportionately involved in making household decisions ( (1, n=216)=72.18, p<0.001), including decisions to seek healthcare ( (1, n=216)=55.39, p<0.001), yet men were often unaware of their partners' prenatal care attendance ( (1, n=215)=82.59, p<0.001).

Conclusion: Women's and men's preferences may influence delivery service choices. Considering these choices is one way the Ethiopian government and health facilities may encourage FBD in rural areas.
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April 2018

Depressive Symptom and Related Factors: A Cross-Sectional Study of Korean Female Workers Working at Traditional Markets.

Int J Environ Res Public Health 2017 11 27;14(12). Epub 2017 Nov 27.

MacArthur Foundation Chair for Global Health Nursing, School of Nursing, University of California, N411Y, Box 0606, 2 Koret Way, San Francisco, CA 94143, USA.

Background: Depression is one of the psychiatric diseases with a high prevalence rate, globally, and reportedly more prevalent among women than among men. Especially, women workers working at traditional markets are in depressive conditions without occupational health services. The purpose of this study is to investigate factors having a significant effect on the depressive symptoms of women workers at traditional markets in South Korea.

Methods: A cross-sectional study was used and subjects for the present study were 500 female workers in three selected representative traditional marketplaces in South Korea.

Results: The results of hierarchical regression analysis indicated that increased BMI (β = 0.297, = 0.017), poor nutritional status (β = 0.596, < 0.001), street vendor status (β = 2.589, = 0.001), job stress (β = 0.491, < 0.001), lower back pain (β = 0.377, = 0.011), lower self-efficacy (β = -0.368, = 0.002) and diminished family function (β = -0.633, = 0.001) affected workers' depressive symptoms. The explanatory power of these variables was 38.5%.

Conclusions: Based on these results, future research should focus on incorporating theses significant factors into effective interventions designed to decrease depressive symptoms in this population. Moreover, this study will increase interest in occupational health nursing, particularly in relation to vulnerable social groups, and expand the scope of practice in the field.
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November 2017

Sources of Social Capital for Malawi People Living With HIV.

Glob Qual Nurs Res 2016 Jan-Dec;3:2333393616676432. Epub 2016 Nov 22.

Rutgers University, Newark, New Jersey, USA.

With one of the highest rates of poverty and HIV in the world, Malawi faith-based organizations (FBOs), non-governmental organizations (NGOs), and community-based organizations (CBOs) are expected to provide tangible and emotional support to people living with HIV (PLWH). Using Lin's social capital theoretical approach, we examine the perspective of PLWH regarding the adequacy of support responses. Forty-six rural Malawi HIV+ adults provided interviews that were recorded digitally, translated, and transcribed by Malawi research assistants. Atlas.ti was used to organize the data and to aid in the analytic process. Participants expressed disappointment in the lack of resources that could be accessed through the FBOs although their expectations may have been unrealistic. Outcomes from accessing and mobilizing the FBO network were negative in terms of stigmatization by FBO leaders and members, whereas outcomes related to CBOs and NGOs were generally positive in terms of empowerment through HIV information and attendance at support groups.
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November 2016

Depression and Self-Rated Health Among Rural Women Who Experienced Adolescent Dating Abuse: A Mixed Methods Study.

J Interpers Violence 2016 Mar 11;31(5):920-41. Epub 2014 Nov 11.

Duke University, Durham, NC, USA.

This study used mixed methods to examine the experiences and health of rural, young adult women (N = 100) who self-reported past experience of physical, emotional and verbal, sexual, and relational abuse in adolescent dating relationships. Few studies have examined the lasting health ramifications of adolescent dating abuse adolescent dating abuse in rural populations, and almost no mixed methods studies have explored adolescent dating abuse. Participants completed questionnaires on demographics, relationship behaviors, and mental health symptoms. A subsample (n = 10) of participants also completed semi-structured, in-depth interviews with the primary investigator. Results suggest that depressive symptoms and self-rating of health in these women are associated with particular kinds and severity of abusive experiences, and that adolescent dating abuse has ramifications for health and development beyond the duration of the original relationship. Self-rated health (SRH) was inversely associated with abusive behaviors in the relationship, whereas depressive symptoms were positively correlated with such behaviors. Self-rated health was also negatively correlated with depressive symptoms. The results of this study represent an important step toward establishing lifetime health risks posed by adolescent dating abuse.
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March 2016

Psychiatric boarding incidence, duration, and associated factors in United States emergency departments.

J Emerg Nurs 2015 Jan 14;41(1):57-64. Epub 2014 Jul 14.

San Francisco, CA.

Introduction: Boarding, especially among psychiatric patients, has been characterized as a significant cause of ED crowding, but no quantitative analysis has described boarding nationally. This study determines the incidence, duration, and factors associated with ED boarding in the United States.

Methods: 2008 National Hospital Ambulatory Medical Care Survey ED data were stratified by visit type (psychiatric vs. non-psychiatric), boarding status, and patient and hospital characteristics. Boarding was defined as a visit with an ED length of stay >6 hours, and boarding time as ED length of stay minus 6 hours. Pearson's chi-square tests describe hospital and patient characteristics stratified by boarding status. Multilevel multivariable logistic and linear regressions determine associations with boarding and boarding time.

Results: While 11% of all ED patients boarded, 21.5% of all psychiatric ED patients boarded. Boarding was also more prolonged for psychiatric ED patients. Controlling for confounders, odds of boarding for psychiatric patients were 4.78 (2.63-8.66) times higher than non-psychiatric, and psychiatric patients boarded 2.78 (1.91-3.64) hours longer than non-psychiatric.

Discussion: US EDs experienced high proportions and durations of boarding with psychiatric patients disproportionately affected. Additional research concerning mental health care services and legislation may be required to address ED psychiatric patient boarding.
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January 2015

Predictors of health-promoting behavior associated with cardiovascular diseases among Korean blue-collar workers.

Asia Pac J Public Health 2015 Mar 4;27(2):NP691-702. Epub 2013 Oct 4.

University of California San Francisco, San Francisco, CA, USA.

The aim of this study was to investigate the contribution of actual cardiovascular disease (CVD) risks, psychosocial and work-related factors as predictors of health behavior. A sample of 234 Korean blue-collar workers, who worked in small companies, was included in this cross-sectional study. Data collection included a survey; anthropometric and blood pressure measures; and blood sampling. Multiple regression analyses showed that the model explained 30% of the variance in health behavior of blue-collar workers. The significant predictors for health behavior included education level, perceived general health, greater family function, higher social support, decision latitude, and non-shift work. Future research should focus on incorporating these significant predictors into effective behavioral interventions designed to promote cardiovascular health in this population.
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March 2015

How community trust was gained by an NGO in Malawi, Central Africa, to mitigate the impact of HIV/AIDS.

J Transcult Nurs 2013 Jul 22;24(3):263-70. Epub 2013 Apr 22.

University of California, San Francisco, CA 94143-0608, USA.

Trust is valuable social capital that is essential for effective partnerships to improve a community's health. Yet, how to establish trust in culturally diverse communities is elusive for many researchers, practitioners, and agencies. The purpose of this qualitative study was to obtain perspectives of individuals working for a nongovernmental organization (NGO) about gaining community trust in Malawi in order to mitigate the impact of HIV/AIDS. Twenty-six interviews were conducted over 12 months. Content analysis revealed the relationship between NGO staff and the community is crucial to gaining community trust. Gender, social context, and religious factors influence the establishment of trust within the relationship, but NGO assumptions about the community can erode community trust. Nurses and other health professionals working with the NGOs can help create conditions to build trust in an ethically and culturally sensitive manner whereby communities can develop processes to address their own health concerns.
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July 2013

Understanding motivations for abstinence among adolescent young women: insights into effective sexual risk reduction strategies.

J Pediatr Health Care 2013 Sep-Oct;27(5):342-50. Epub 2012 Apr 21.

School of Nursing, MGH Institute of Health Professions, Boston, MA, USA.

Introduction: Pregnancy and sexually transmitted infections pose a significant threat to the health and well-being of adolescent women. Abstinence, when practiced, provides the most effective means of preventing these problems, yet the perspective of abstinent young women is not well understood. The purpose of this investigation was to characterize female adolescents' motivations for abstinence.

Method: As part of a larger, cross-sectional quantitative study investigating predictors of HIV risk reduction behaviors, qualitative responses from study participants who never had intercourse were analyzed in a consensus-based process using content analysis and frequency counts. An urban primary care site in a tertiary care center served as the setting, with adolescent young women ages 15-19 years included in the sample.

Results: Five broad topic categories emerged from the data that characterized motivations for abstinence in this sample: personal readiness, fear, beliefs and values, partner worthiness, and lack of opportunity.

Discussion: A better understanding of the motivations for abstinence may serve to guide the development of interventions to delay intercourse.
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April 2014

Relationships and betrayal among young women: theoretical perspectives on adolescent dating abuse.

J Adv Nurs 2011 Jun 24;67(6):1393-405. Epub 2011 Jan 24.

Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, USA.

Aims: Adolescent dating abuse is not specifically described by any current nursing theory, and this article presents discussion of some existing theories that could inform a nursing theory of adolescent dating abuse. To account for the effects of gender, this discussion is limited to young women.

Background: Adolescent dating abuse is an important and understudied international issue for nursing. Theoretical frameworks can support development of nursing scholarship for such issues. No single theory yet exists in nursing to explain the experiences and health ramifications of dating abuse among young women.

Data Sources: A summary table of theories is provided. Literature was gathered via database search and bibliographic snowballing from reference lists of relevant articles. Included literature dates from 1982 through 2010.

Discussion: Theories of relationship formation and function are discussed, including attachment, investment, feminist and gender role conflict theories. Betrayal trauma theory is considered as a mechanism of injury following an abusive dating experience.

Implications For Nursing: Gender, relationship and adolescence combine in a complex developmental moment for young women. To improve nursing care for those at risk for or in the throes of abusive relationships, it is critical to develop specific nursing approaches to understanding these relationships.

Conclusion: Existing theories related to relationship and traumatic experiences can be combined in the development of a nursing theory of adolescent dating abuse among young women.
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June 2011

The Know & Go! program improves knowledge for patients with coronary heart disease in pilot testing.

Heart Lung 2010 Nov-Dec;39(6 Suppl):S23-33

Betty Irene Moore School of Nursing, University of California, Davis Health System, Sacramento, California 95817, USA.

Objective: To determine if patients hospitalized for angioplasty could learn about symptoms, risk factors, and care-seeking behaviors before and after discharge and to assess patient acceptability of the intervention.

Methods: Thirty-two women and 32 men were randomly assigned to groups and completed an intervention pretest. The experimental group viewed the Know & Go! slide presentation at baseline and 2 and 4 months after discharge. A satisfaction survey was mailed to patients in the experimental group.

Results: There were no significant differences between groups in clinical or sociodemographic characteristics. The experimental group scored significantly higher on an intervention posttest at study completion (F = 15.21; P < .001). Patients were highly satisfied with the program and computer technology (range 0-12, M = 9.57 ± 1.83).

Conclusion: The Know & Go! intervention was safe, effective, and acceptable to patients in pilot testing. Results support refinement and further testing of the intervention for patients diagnosed with coronary heart disease.
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March 2011

Classifying subgroups of patients with symptoms of acute coronary syndromes: A cluster analysis.

Res Nurs Health 2010 Oct;33(5):386-97

Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA 95817, USA.

The purpose of the study was to identify subgroups of patients presenting with acute coronary syndromes based on symptom clusters. Two hundred fifty-six patients completed a symptom assessment in their hospital rooms. Latent class cluster analysis and analysis of variance were used to classify subgroups of patients according to selected clinical characteristics. Four subgroups were identified and labeled as Heavy Symptom Burden, Chest Pain Only, Sweating and Weak, and Short of Breath and Weak (model fit χ(2) [130,891, n = 256] = 867.5, p = 1.00). The largest group of patients experienced classic symptoms of chest pain and shortness of breath but not sweating. Younger patients were more likely to cluster in the Heavy Symptom Burden group (F = 5.08, p = .002). Interpretation of the clinical significance of these groupings requires further study.
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October 2010

The condom divide: disenfranchisement of Malawi women by church and state.

J Obstet Gynecol Neonatal Nurs 2008 Sep-Oct;37(5):596-604; quiz 604-6

University of California, San Francisco, CA 94143, USA.

Objective: To examine the impact of 2 mitigating social institutions, religious organizations, and the state, on Malawi women's vulnerability to HIV.

Design: In-depth interviews with a purposive sample of 40 central leaders from 5 faith-based organizations in Malawi were recorded and transcribed as part of an on-going larger study. Qualitative description was used to identify themes and categories.

Setting: Primarily urban and periurban areas of south-central Malawi.

Participants: A minimum of 6 leaders from each faith-based organization were interviewed; the mean age of the primarily male (68%) participants was 44 years (range 26-74).

Results: Analysis of religious leaders' messages about HIV produced an overarching theme, the condom divide, which conceptualized the divergence between faith-based organizations and the state's prevention messages related to HIV prevention strategies.

Conclusion: Faith-based organizations have "demonized" state messages about condoms as promoting sin. The faith-based organizations' insistence on abstinence and faithfulness leaves women with few options to protect themselves. As socially conscious citizens of the world, nurses can increase the responsiveness to the disparate levels of suffering and death in countries like Malawi.
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December 2008

School-based drama interventions in health promotion for children and adolescents: systematic review.

J Adv Nurs 2008 Jul;63(2):116-31

Department of Nursing Science, University of Tampere, Tampere, Finland.

Aim: The paper is a report of a review of the literature on the effects of school-based drama interventions in health promotion for school-aged children and adolescents.

Background: Drama, theatre and role-playing methods are commonly used in health promotion programmes, but evidence of their effectiveness is limited. The educational drama approach and social cognitive theory is share the assumption that learning is based on self-reflection and interaction between environment and person. However, educational drama also emphasizes learning through the dialectics between actual and fictional contexts.

Data Sources: A search was carried out using 10 databases and hand searching for the period January 1990 to October 2006.

Methods: A Cochrane systematic review was conducted.

Results: Nine studies met the criteria for inclusion. Their topics included health behaviour (five studies), mental health (two) and social health (two). Actor-performed drama or theatre play followed by group activities was the intervention in five studies, and classroom drama in four studies. Four of the studies were randomized controlled trials and five were non-randomized controlled studies. Four reports gave the theory on which the intervention was based, and in eight studies at least some positive effects or changes were reported, mostly concerning knowledge and attitudes related to health behaviour. The diversity of designs and instruments limited comparisons.

Conclusion: There is a need for well-designed and theory-based studies that address drama interventions in health promotion for children and families. The challenge is to find or develop a theory, which combines educational, drama and health theories with valid and reliable measurements to examine the effects of the intervention.
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July 2008

An exploration of lifetime trauma exposure in pregnant low-income African American women.

Matern Child Health J 2011 Apr 6;15(3):410-8. Epub 2008 Feb 6.

Family, Maternal & Child Health Programs, Department of Public Health, Contra Costa Health Services, 597 Center Avenue, Martinez, CA, USA.

Objectives: The objective of this study was to describe the occurrence of lifetime trauma exposure in relation to perinatal health outcomes in low-income African American women.

Methods: One hundred and sixteen pregnant African American women recruited from two public prenatal clinics participated in this exploratory study. Information was obtained about psychological symptoms, medical conditions, prenatal care utilization, and health behaviors. To measure lifetime trauma exposure, women completed the Trauma History Questionnaire. Maternal and infant outcome data were obtained from the medical records following delivery.

Results: The occurrence of trauma exposure was high, with 87% of the women reporting at least one traumatic event. Their mean age was 25 years, 21% were primiparas, and they reported a mean of 4.3 ± 3.5 (median = 3) traumatic events during their lifetime. Crime-related experiences were common and included incidents of family or friends being murdered or killed (40%), robberies (23%), home burglaries (14%), attacks with weapons (13%), and muggings (12%). Lifetime trauma exposure was significantly associated with depressive symptoms, anxiety, and generalized stress. Women with greater lifetime trauma exposure had a higher rate of tobacco use, higher rate of premature rupture of membranes, and longer maternal hospital stay.

Conclusion: Low-income African American women in this sample experienced a variety of traumatic events. Lifetime trauma exposure was associated with adverse perinatal health. Findings suggest the need to further investigate trauma across the lifespan to better understand the impact of these experiences on the reproductive health and well-being of women and their infants.
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April 2011

Cluster analysis of elderly cardiac patients' prehospital symptomatology.

Nurs Res 2008 Jan-Feb;57(1):14-23

University of California, San Francisco, CA 94143-0606, USA.

Background: Chest pain routinely brings patients into the healthcare system, and elderly patients may present with more complex symptoms presaging ischemic heart changes than do younger patients.

Objective: To examine, using cluster analysis, how elderly patients experiencing an ischemic coronary heart disease cluster based on presenting symptoms in the week before hospitalization and how they vary in terms of their general physical and mental health, mood states, and quality of life.

Methods: Elderly (age >or=65 years), unpartnered patients (N = 247) admitted with ischemic coronary heart disease to one of five university medical centers were inducted into a clinical trial; only baseline data are reported. Interviews assessed cardiac symptoms, medical history, general physical and mental health, mood states, and quality of life. Patients were clustered (grouped) using squared Euclidean distances and weighted average linkage. Characteristics of patients were examined using analysis of variance and chi-squared analyses.

Results: Three clusters (groups) were identified: (a) Classic Acute Coronary Syndrome (severe ischemic pain; 22%), (b) Weary (severe fatigue, sleep disturbance, and shortness of breath; 29%), and (c) Diffuse Symptoms (mild symptomatology; 49%). Post hoc tests revealed that the Weary group was more likely to have a history of heart failure; they also exhibited significantly more psychological distress and lower quality of life than the other subgroups.

Conclusion: Cluster analysis proved useful in grouping patients based on their symptom experience, but further research is needed to clarify the relationships among identified symptoms, psychological distress, and health outcomes; develop interventions for Weary patients; and extend the findings of this study.
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January 2008

Systematic bias in self-reported annual household incomes among unpartnered elderly cardiac patients.

Appl Nurs Res 2007 Nov;20(4):205-9

Department of Physiological Nursing, University of California-San Francisco, San Francisco, CA 94143, USA.

The purpose of this exploratory study was to examine whether specific patient characteristics were associated with not reporting individual incomes among elderly unpartnered cardiac patients. Two hundred forty-seven unpartnered patients (age, >/=65 years) who were admitted with coronary artery disease to one of five university medical centers were interviewed during their hospitalization. Their average age was 76 years (SD = 6.3 years, range = 65-101 years). Of the sample, approximately 34% were men, 92% were Caucasian, 19% had less than 12 years of education, and 55% had at least 12 years (but not more than 16 years) of education. Approximately 13% of the patients did not report their annual household income. In a logistic regression analysis, higher education and greater social and economic satisfaction were significantly related to refusal to self-report income after controlling for age and sex (p < .05). The interaction between education and sex was not significant in the model (p > .05). Our findings indicate that there was a potential systematic bias regarding self-reporting of annual household income. Thus, this systematic bias needs to be examined before performing a multivariate analysis that includes income as a covariate.
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November 2007

Cluster analysis: a useful technique to identify elderly cardiac patients at risk for poor quality of life.

Qual Life Res 2007 Dec 23;16(10):1655-63. Epub 2007 Oct 23.

School of Nursing, University of California San Francisco, San Francisco, CA 94143, USA.

Objective: The purposes of this study are (1) to examine the frequency of cardiac symptoms in elderly people one year after acute myocardial infarction (AMI) and/or coronary artery bypass surgery (CABG); (2) to identify patient subgroups (cluster solutions) based on cardiac symptoms after cardiac events and (3) to determine if these subgroups vary based on health related quality of life and psychological distress.

Methods: A sample of 206 elderly, unpartnered, patients (age > or = 65) were interviewed one year after AMI and/or CABG by telephone. Cardiac symptoms, SF-36, POMS, and QOL-I were measured. A hierarchical cluster analysis was used to identify patient subgroups based on cardiac symptoms, using a combination of dendrograms and stopping rules.

Results: Three subgroups were identified: (1) the Weary (19.4%), (2) the Diffuse symptom (68.4%), and (3) the Breathless groups (12.2%). The Weary group had significantly lower scores on all of SF-36 subscales (except for social functioning) and higher scores on all of POMS subscales (except for Anger/hostility and Confusion/Bewilderment) compared to the Diffuse symptom group.

Conclusions: The cluster analysis was useful to identify the subgroup with poorer recovery. Patients in the Weary group need more attention and intervention strategies to improve their health.
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December 2007

Sleep disturbance, fatigue, and stress among Chinese-American parents with ICU hospitalized infants.

Issues Ment Health Nurs 2007 Jun;28(6):593-605

Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia 30302-4019, USA.

The purpose of this study is to describe Chinese-American parents' sleep disturbances and fatigue in relation to their stress levels, resulting from the hospitalization of their infants in intensive care units (ICUs). Four sets of data were collected: (1) Parents' demographic data and infant's medical records; (2) Subjective sleep data gathered from the General Sleep Disturbance Scale, from sleep diary descriptions, and objective sleep data from wrist actigraphy recordings; (3) Fatigue severity from the Numerical Rating Scale-Fatigue; and (4) Data from the Parental Stressor Scale: Infant Hospitalization. A majority of the mothers (93%) and fathers (60%) experienced sleep problems after their infants were admitted to the ICU. Mothers reported greater sleep disturbances and more severe fatigue than did fathers. Actigraphy records showed that mothers experienced much more wakeful time during the night than did fathers. In both gender categories, less total sleep time was related to reports of higher parental stress, and higher morning fatigue was related to subjectively reported sleep disturbances. Findings from this preliminary study demonstrate significant relationships among parents' perceived stress, impaired sleep, and fatigue severity during the infant's hospitalization period. Findings suggest implications for education of both ICU parents and staffs. This study could be replicated with a bigger sample size to further examine the relationships between parental stress and well-being.
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June 2007

The effects of a collaborative peer advisor/advanced practice nurse intervention: cardiac rehabilitation participation and rehospitalization in older adults after a cardiac event.

J Cardiovasc Nurs 2007 Jul-Aug;22(4):313-9

Yvonne L. Munn Center for Nursing Research, Institute for Patient Care, Massachusetts General Hospital, Boston, MA 02114, USA.

Background: After the cardiovascular events of myocardial infarction (MI) and coronary artery bypass surgery (CABS), unpartnered older adults are a vulnerable group that may benefit from interventions to improve health outcomes. The purpose of this analysis is to determine if a community-based collaborative peer advisor/advanced practice nurse intervention increased participation in cardiac rehabilitation programs and reduced hospital readmissions after MI and CABS and determine whether the type of cardiovascular event influenced rehospitalization.

Subjects And Methods: This study was a randomized clinical trial that enrolled 247 unpartnered older adults who were single, widowed, or divorced. Subjects were randomized into 4 groups: standard of care group for MI and for CABS and standard of care plus the treatment groups for MI and for CABS, for 12 weeks after discharge. There were 163 women/84 men, with a mean age of 76.4 years, who were admitted for MI (n = 93) or CABS (n = 154) and who were enrolled from 5 academic medical centers. The treatment consisted of a community-based intervention of a home visit within 72 hours and telephone calls at 2, 6, and 10 weeks from an advanced practice nurse and 12 weekly telephone calls from a peer advisor. Participation in a cardiac rehabilitation program and rehospitalizations were collected at 6 weeks and 3, 6, and 12 months by telephone interview.

Results And Conclusions: There were significantly more participants in cardiac rehabilitation programs after 3 months in the treatment group, and this increase was seen up to 1 year after MI and CABS. There were no statistical differences, although there were fewer rehospitalizations between 3 and 6 months after MI and CABS in the treatment group compared with the standard of care group. Overall, the evidence from this study suggests that a community-based collaborative peer advisor/advanced practice nurse intervention can play a role in promoting active participation in cardiac rehabilitation programs and fewer rehospitalizations in unpartnered older adults after MI and CAGS.
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July 2007

Trajectory of prehospital delay in patients with acute myocardial infarction in the Japanese health care system.

Int J Cardiol 2006 Feb;107(2):188-93

School of Nursing, University of California San Francisco, 2 Koret Way, Room N611E, San Francisco, CA 94143-0604, USA.

Objective: The purpose of this study was to understand the trajectory of prehospital delay in patients with acute myocardial infarction (AMI) in the Japanese health care system, which offers patients a choice between seeking treatment in a neighborhood clinic/small hospital (clinic group) or a large hospital with comprehensive cardiac services, including a cardiac catheterization laboratory (hospital group).

Methods: In this cross sectional study, 155 consecutive patients admitted with AMI to one of 5 urban hospitals in Japan were interviewed within 7 days after admission.

Results: The median total prehospital delay time in the clinic group (n=84) was significantly longer than the hospital group (n=71) (6 h and 48 min vs 2 h and 9 min, p<.001). Patients with severe chest pain were significantly less likely to seek treatment at a clinic/small hospital than at a large hospital compared to patients with mild or moderate symptoms (OR 0.85, 95% CI: 0.75, 0.97). Patients who did not interpret their symptoms as cardiac in origin were significantly more likely to seek treatment at a clinic/small hospital than at a large hospital compared to patients who interpreted their symptoms as cardiac in origin (OR 3.32, 95% CI: 1.56, 7.10). After controlling for demographic and medical history, patients in the clinic group were 3.69 times (95% CI: 1.28, 10.66) less likely to receive any reperfusion therapy compared to patients in the hospital group.

Conclusions: Findings support the need for public education in Japan that focuses on the appropriate response to AMI symptoms. Moreover, regional AMI networks need to be instituted to provide for early transfer for PCI from clinic/small hospitals to tertiary centers.
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February 2006

Acculturation and stress in Chinese-American parents of infants cared for in the intensive care unit.

Adv Neonatal Care 2005 Dec;5(6):315-28

Byridine F. Lewis School of Nursing, College of Health and Human Science, Georgia State University, Atlanta 30302, USA.

Purpose: To describe the stressful experiences of Chinese-American parents who have an infant in the intensive care unit (ICU), and to assess the influence of acculturation, parents' characteristics, and social supports on parental stress.

Design: A cross-sectional, descriptive, correlational study.

Sample/setting: A convenience sample of 30 Chinese-American families (30 mothers, 25 fathers) who had an infant hospitalized in 3 ICU sites in the San Francisco area.

Methodology: Measures included: (1) Infant's health data from the medical records and parents' demographic data, and (2) Parental Stressor Scale: Infant Hospitalization, Suinn-Lew Asian Self-Identity Acculturation Scale, and Family Support Scale.

Main Outcome Measure: The dependent variable was mothers' and fathers' stress levels. Independent variables included personal/family characteristics, acculturation, uncertainty regarding infants' illness, and social supports.

Principal Results: The ICU stressors were ranked by both mothers and fathers in the following order: infant's appearance, parental role alteration, staff communication and behaviors, and ICU environment. The combined effects of uncertainty about their infant's illness and its future impact, a strong belief in Asian family values, and lack of support from healthcare providers accounted for 26% and 55% of the variance in parental stress for mothers and fathers, respectively.

Conclusions: Findings from this study suggest implications for the education of both families and the ICU staffs.
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December 2005

Implementation of efficacy enhancement nursing interventions with cardiac elders.

Rehabil Nurs 2005 Nov-Dec;30(6):221-9

Massachusetts General Hospital, Boston, USA.

Intervention strategies based on social cognitive theory and encompassing the bio-psycho-behavioral domains are proposed to enhance self-efficacy in men and women 65 years and older recovering from myocardial infarction and coronary artery bypass grafting. This paper describes a study in which the theory-based development of efficacy enhancement (EE) nursing interventions and their implementation and utilization with interventions from the Nursing Interventions Classification (NIC) were used with cardiac elders in the treatment group of the community-based randomized clinical, trial, "Improving Health Outcomes in Unpartnered Cardiac Elders." Advanced practice nurses (APNs) provided the nursing intervention to 110 participants (mean age = 76.2, SD = 6.0) for the first 12 weeks after discharge to home. After an initial introductory meeting in the acute-care setting, participant contacts by the APNs were made at a home visit and telephone calls at 2, 6, and 10 weeks. Results describe the number of participants receiving interventions at all contacts over 12 weeks, at specified contact points, and the intensity (nurse time) of the interventions. Verbal encouragement and mastery were EE interventions used with the greatest number of participants. Exercise promotion, energy management and active listening were NIC interventions used with the most participants. Variations in the use of interventions over 12 weeks and their intensities, suggest patterns of recovery in the elders. During rehabilitation EE interventions can be successfully implemented with men and women 65 years and older and individualized to the recovery trajectory. Nurses can integrate specific EE interventions with more general interventions from the bio-psycho-behavioral domains to enhance the recovery process for cardiac elders.
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January 2006

Comparing interventions in older unpartnered adults after myocardial infarction.

Eur J Cardiovasc Nurs 2006 Mar 26;5(1):83-9. Epub 2005 Oct 26.

Department of Nursing, GRB 1034, Massachusetts General Hospital, Boston, MA 02114, USA.

Background: Older adults after myocardial infarction (MI) are a vulnerable group who may benefit from interventions to improve health outcomes. The use of a peer advisor or an advanced practice nurse (APN) to provide a self-efficacy intervention is a promising method of improving health outcomes after MI.

Aims: The purpose of this paper was to compare the effect of two self-efficacy interventions, a peer advisor and an APN, to a group who received standard care after MI.

Methods: The study was a three-group randomized clinical trial with a peer advisor intervention group, an APN intervention group, and a standard care group. Outcome data were collected in the hospital after MI and by telephone at 12 weeks after hospital discharge, after the interventions were completed.

Results: At 12 weeks after MI, there were no significant differences between the 3 groups in health outcomes. There were similar changes in self-efficacy for performing recovery behaviors, the actual performance of recovery behavior, physical and mental health across both intervention groups and the standard care group.

Conclusions: Although the data did not validate the benefits of these self-efficacy interventions, future efforts at identifying changes in health outcomes may need to use more discrete measurements that are more sensitive to changes in the older unpartnered adult after an MI.
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March 2006

Malawi women and HIV: socio-cultural factors and barriers to prevention.

Women Health 2005 ;41(1):69-86

University of California, School of Nursing, 1409 43rd Ave, San Francisco, CA, 94122, USA.

Heterosexually transmitted HIV/AIDS continues to devastate the health and economy of sub-Saharan African countries. In Malawi, 15.4% of 15-49 year olds are infected with HIV and 18-26% of pregnant women are living with HIV. Research has shown that sociocultural factors, especially gender roles and relationships, play a significant role in the transmission of HIV in Africa but little is known about Malawi women's perspective on HIV/AIDS. What do Malawi women say about the impact of HIV/AIDS on their lives, their role in prevention, and the barriers they face in trying to stem the spread of the disease? To answer these questions, three focus groups with Malawi women were conducted and analyzed for themes. The purpose of this paper is to describe one emergent theme captured in the statement, "We are just vessels for our husbands." This theme is explicated through discussions of women's and men's images, women's roles, gender/power relationships, disempowerment, role models and empowerment. Evident in this theme are interrelated messages for those involved in HIV/AIDS prevention. Health education alone is insufficient to stem the tide of HIV in Malawi. A multidisciplinary, systematic approach that includes women's education and economic empowerment as well as modifying legal and social structures that contribute to the spread of HIV/AIDS in Malawi is suggested as necessary additions to HIV and AIDS intervention programs. Only through forging partnerships between health, education, women's development groups, and political and social leaders will we be able to reduce the impact of HIV/AIDS in Malawi.
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October 2005

The stigma of being HIV-positive in Africa.

PLoS Med 2005 Aug 19;2(8):e247. Epub 2005 Jul 19.

Global AIDS Interfaith Alliance, San Francisco, California, USA.

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August 2005

FAMISHED for support: recovering elders after cardiac events.

Clin Nurse Spec 2005 May-Jun;19(3):142-9

School of Nursing, University of California at San Francisco, USA.

Background: Heart disease causes disproportionately heavy burdens on unpartnered elders (widowed, divorced, never married) who have limited social resources to contend with recovery demands and complications resulting from acute myocardial infarction (AMI) or coronary artery bypass graft (CABG) surgery. Research suggests that the availability of social support improves recovery after AMI and CABG, yet functional support expressly designed to modify health and stimulate recovery remains unspecified. Advanced practice nurses (APNs) in the clinical nurse specialist (CNS) role who provide social support to recovering elders may be able to improve health outcomes for this vulnerable group.

Aims: The investigators' aims are to (1) quantify the duration and frequency of nurse contact with unpartnered elders recovering from cardiac events and (2) describe the functional support provided by the CNS to the unpartnered recovering elder.

Methods: Forty narrative accounts comprising 670 entries by interventional CNS APNs were examined using thematic analytic techniques.

Results: Over a 14-week period, CNS APNs contacted recovering elders 16 times, with a total of 4.5 hours spent per elder, or 13 minutes per phone call and 80 minutes per home visit. Analysis of 670 entries demonstrated functional and emotional support that was captured in the acronym, FAMISHED.

Conclusions: Functional and emotional support from the CNS may enhance self-efficacy for recovery from cardiac events for unpartnered elders.
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June 2005

Donkey work: women, religion, and HIV/AIDS in Malawi.

Health Care Women Int 2005 Jan;26(1):4-16

University of California-San Francisco, San Francisco, California 94143, USA.

Addressed in this article are the familial, cultural and religious influences on Malawi women that contribute to HIV/AIDS. Thirty-nine adult Malawi women representing voluntary assistance groups, religious groups, and university women participated in 3 focus groups in Malawi. Interview data were taped, transcribed, and analyzed using qualitative descriptive analysis. Findings revealed that multiple burdens in the lives of Malawi women resulting from poverty and responsibility for family members are made more onerous by religious institutions, sexual practices, and cultural beliefs. In conclusion, women's "donkey work" may result in at-risk sexual behavior as a means of survival, thus increasing the incidence of HIV/AIDS. Alleviating the burdens involves efforts from religious groups and restructuring of belief systems.
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January 2005

Prehospital delay and independent/interdependent construal of self among Japanese patients with acute myocardial infarction.

Soc Sci Med 2005 May 20;60(9):2025-34. Epub 2004 Dec 20.

Department of Physiological Nursing, University of California, 2 Koret Way, BOX 0604, San Francisco, CA 94143-0604, USA.

Reducing the time from symptom onset to reperfusion therapy is an important approach to minimizing myocardial damage and to preventing death from acute myocardial infarction (AMI). Previous studies suggest that certain ethnic or national groups, such as the Japanese, are more likely to delay in accessing care than other groups. The aims of this paper were the following; (1) to examine whether culture (defined as independent and interdependent construal of self) is associated with delay in accessing medical care in Japanese patients experiencing symptoms of AMI; (2) to determine if the relationship between independent and interdependent construal of self and prehospital delay time is mediated by cognitive responses and/or emotional responses; and (3) to determine if independent and interdependent construal of self independently predicts choice of treatment site (clinic vs. hospital). A cross-sectional study was conducted at hospitals in urban areas in Japan. One hundred and forty-five consecutive patients who were admitted with AMI within 72 h of the onset of symptoms were interviewed using the modified response to symptoms questionnaire and the independent and interdependent construal of self scale. The interdependent construal of self scores were significantly associated with prehospital delay time, controlling for demographics, medical history, and symptoms (p<.001). However, the relationship between independent and interdependent self and prehospital delay times was not mediated by cognitive or emotional responses. In multiple logistic regression analysis, patients with high independent construal of self were more likely to seek care at a hospital rather than a clinic compared to those with lower independent construal of self. In conclusion, cultural variation within this Japanese group was observed and was associated with prehospital delay time.
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May 2005