Conectar
by Gabriella Lillsunde Larsson, Jessica Carlsson, Gisela Helenius, Lovisa Bergengren
ObjectiveTo improve human papilloma virus (HPV) screening, more effective triage methods for HPV-positive samples need development and validation. Cytology, the most common triage method today, is subjective and can only be applied to professionally collected samples. Methylation status has been shown to be informative, as genes are highly methylated in HPV-induced cervical dysplasia and cancer. This study aimed to assess whether triaging HPV-positive samples using molecular methods, such as methylation and genotyping for high-risk HPV types, could be as effective as cytology in cervical screening.
MethodsA retrospective biobank study was conducted on HPV-positive samples collected in 2017–2018, analyzing FAM19A4/MiR-124-2 hypermethylation and HPV genotyping for types 16, 18, 31, 33, 45, 52, and/or 59, comparing these results to cytology triage for detecting histologically confirmed high-grade squamous intraepithelial lesions (HSIL) and cancer.
ResultsResults from 1915 positive screening samples were analyzed, including 1052 follow-up biopsies with 402 HSIL or cancer cases. Genotyping showed slightly higher sensitivity than cytology but lower specificity, while methylation had higher specificity but much lower sensitivity. Cytology’s positive predictive value (PPV) was 36%, with lower PPVs for the molecular methods. Combining molecular methods increased the PPV but significantly reduced sensitivity.
ConclusionsBased on these findings with molecular methods reducing sensitivity, we do not recommend adopting the molecular triage methods evaluated in this study in the Swedish setting. The trade-off between sensitivity and specificity does not support a change from the current cytology-based triage approach.
To predict nurses' turnover intention using machine learning techniques and identify the most influential psychosocial, organisational and demographic predictors across three countries.
A cross-sectional, multinational survey design.
Data were collected from 1625 nurses in the United States, Türkiye and Malta between June and September 2023 via an online survey. Twenty variables were assessed, including job satisfaction, psychological safety, depression, presenteeism, person-group fit and work engagement. Turnover intention was transformed into a binary variable using unsupervised machine learning (k-means clustering). Six supervised algorithms—logistic regression, random forest, XGBoost, decision tree, support vector machine and artificial neural networks—were employed. Model performance was evaluated using accuracy, precision, recall, F1 score and Area Under the Curve (AUC). Feature importance was examined using logistic regression (coefficients), XGBoost (gain) and random forest (mean decrease accuracy).
Logistic regression achieved the best predictive performance (accuracy = 0.829, f1 = 0.851, AUC = 0.890) followed closely by support vector machine (polynomial kernel) (accuracy = 0.805, f1 0.830, AUC = 0.864) and random forest (accuracy = 0.791, f1 = 0.820, AUC = 0.859). In the feature importance analysis, job satisfaction consistently emerged as the most influential predictor across all models. Other key predictors identified in the logistic regression model included country (USA), work experience (6–10 years), depression and psychological safety. XGBoost and random forest additionally emphasised the roles of work engagement, group-level authenticity and person–group fit. Job-stress-related presenteeism was uniquely significant in XGBoost, while depression ranked among the top predictors in both logistic regression and random forest models.
Machine learning can effectively predict turnover intention using multidimensional predictors. This methodology can support data-driven decision-making in clinical retention strategies.
This study provides a data-driven framework to identify nurses at risk of turnover. By integrating machine learning into workforce planning, healthcare leaders can develop targeted, evidence-based strategies to enhance retention and improve organisational stability.
This study adhered to STROBE reporting guideline.
This study did not include patient or public involvement in its design, conduct or reporting.
To determine the association between patient characteristics, techniques, and technologies with first-time peripheral intravenous catheter insertion in paediatric acute care.
Single-centre, prospective cohort study.
Data on patient, provider, and peripheral intravenous catheter insertion characteristics were collected at a large quaternary paediatric hospital in Queensland, Australia. Inpatients aged 0 to ≤ 18 years requiring a peripheral intravenous catheter or who had one inserted in the last 24 h, were eligible. Proportionate stratified random sampling was used. Generalised linear regression with modified Poisson regression assessed associations between patient variables (e.g., age) and first-time insertion success, along with technique (e.g., inserting clinician) and technology (e.g., ultrasound) variables. Models were adjusted for confounding variables identified through direct acyclic graphs.
199 children required 250 peripheral intravenous catheters (July 2022–September 2023). In the adjusted model, each year of age increase and every 5-kg increase in weight were associated with higher first-time insertion success. Children with a history of prematurity had an increased risk of first-time insertion failure. Vascular access specialists were more likely to succeed on the first attempt, as was ultrasound-guidance when adjusted for difficult intravenous access risk.
We identified techniques (expert clinicians) and technologies (ultrasound guidance) that improve first-time insertion success in paediatric patients.
A multi-faceted approach combining technique (clinician), technology (ultrasound guidance), and standardised policy can improve first-time peripheral intravenous catheter insertion. These strategies minimise patient discomfort, trauma, and emotional distress, enhancing the overall healthcare experience for children and their families.
This study emphasises the need to standardise healthcare policies and training, incorporating clinician expertise and ultrasound guidance to improve first-time insertion success, particularly for high-risk patients.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).
No Patient or Public Contribution.
Australia New Zealand Clinical Trials Registry, ACTRN12622000034730
This scoping review investigates the use of point-of-care infrared thermography devices for assessing various wound types. A comprehensive search across four databases yielded 76 studies published between 2010 and 2024 that met the inclusion criteria. The review highlights thermography applications in burns, surgical wounds, diabetic foot ulcers, pressure injuries, and other lower limb wounds. Key findings indicate its effectiveness in detecting early signs of inflammation and healing delays, facilitating timely interventions. The technology shows promise in accurately predicting wound healing trajectories and assessing treatment outcomes. Recent advancements have made thermographic devices more affordable and user-friendly, expanding their clinical potential. However, challenges persist, including reimbursement, training requirements, and integration with electronic medical records (EMRs), with EMR integration identified as a critical barrier to widespread adoption. While preliminary findings are promising, the current evidence base is constrained by small sample sizes, retrospective study designs, and limited consideration of skin tone variability. Large, prospective studies are essential to validate the clinical utility of thermography in wound care and to inform the development of standardised protocols that support equitable, bias-reduced assessment across diverse populations. Addressing these gaps is critical for advancing research, enhancing clinician training, and improving patient outcomes in wound care. Overall, point-of-care thermography demonstrates significant potential to enhance wound assessment and monitoring, thereby elevating care quality and patient outcomes.
To address the gap in existing postpartum care literature by gaining an in-depth understanding of Australian child and family health nurses' experiences of providing postpartum contraceptive care.
A qualitative exploratory study design, using semi-structured interviews.
Convenience and snowballing sampling methods were employed to recruit child and family health nurses currently practising in Australia. Semi-structured interviews were conducted with 15 nurses in July 2023, and data were analysed using reflexive thematic analysis as outlined by Braun and Clarke. The consolidated criteria for Reporting Qualitative research checklist were used to support the research process.
Despite their frequent contact with postpartum women and acknowledging the importance of postpartum contraceptive care, most participants did not commonly discuss contraception or family planning with mothers and did not feel it was part of their role to do so. Participants cited role ambiguity, limited knowledge of postpartum contraception, lack of clinical practice guidance, time constraints, and competing priorities as contributing to inconsistencies in postpartum contraceptive care provision.
This study highlights critical gaps in the provision of postpartum contraceptive care by child and family health nurses in Australia and underscores the need for systemic changes to promote postpartum contraceptive care as a key component of routine maternal health services.
This study provides actionable evidence for improving the delivery of postpartum contraceptive care, ensuring women are provided with accurate information about their options, and supporting contraceptive uptake to reduce the incidence of short interpregnancy intervals.
Our findings provide practical guidance relevant for healthcare policy and practice, emphasising the need to enhance child and family health nurses training in reproductive health, develop clear clinical practice guidelines, and address systemic barriers such as time constraints to improve the provision of postpartum contraceptive care and support women's reproductive health needs.
Standards for reporting qualitative research (SRQR).
No patient or public contribution.
To evaluate the effectiveness of multidisciplinary transitional care interventions on functional status, quality of life and readmission rates of stroke patients.
Quantitative systematic review and meta-analysis.
Studies with interventions to ease the hospital-to-home transition of stroke patients that were delivered by multidisciplinary teams consisting of registered healthcare professionals from at least two disciplines were included. Cochrane Risk of Bias tool was used for quality appraisal.
Seven electronic databases (PubMed, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Scopus and Web of Science) were searched for randomised controlled trials delivering transitional care interventions to hospitalised stroke patients.
Thirty-one randomised controlled trials were included in the final review. The studies featured multidisciplinary teams of two to nine professionals, most commonly nurses, physicians and physiotherapists. Although multidisciplinary care improved functional status and quality of life scores, the impact on readmission rates was inconclusive. Meta-analysis revealed significant improvements in functional status when care involved physicians, care coordinators (often nurses) or had teams of more than two healthcare professionals. Significant improvement in quality of life was also reported when care involved physicians or in teams with more than two healthcare professionals.
Multidisciplinary transitional care interventions show promise in improving functional status and quality of life after stroke. Their effectiveness depends on team composition and coordination, particularly the inclusion of physicians and care coordinators. Future research should address reporting gaps and evaluate broader strategies to reduce hospital readmissions.
Impact (Addressing)
What problem did the study address? ○
The effectiveness of multidisciplinary transitional care interventions for stroke patients.
○Evaluated the role of various healthcare professionals within these teams.
What were the main findings? ○
Multidisciplinary transitional care interventions significantly enhance stroke patients' functional status, especially within the first 3 months.
○Teams with care coordinators (often nurses) and supportive physicians improve functional outcomes, with effective communication being crucial despite underreporting of specific practices.
○Teams comprising of more than two health professionals can significantly improve stroke patients' functional status.
Where and on whom will the research have an impact? ○
Healthcare institutions and providers: The findings can guide healthcare institutions in developing and implementing effective transitional care services for stroke patients.
○Stroke patients: Patients receiving multidisciplinary transitional care are likely to experience enhanced functional recovery and improved ability to perform daily activities.
○Policymakers and researchers: The study highlights the need for more detailed reporting and research on communication practices within multidisciplinary teams and the importance of evaluating underreported outcomes like readmission rates.
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist.
No Patient or Public Contribution.
Background
In hospitals that serve disproportionately patients of Black race, here termed Black-serving hospitals (BSH), nurse staffing is worse, mortality rates are higher, and nursing-sensitive indicators may be worse than in other hospitals, but this evidence has not been compiled.
Objective
The study objective was to examine whether nursing-sensitive indicators, which measure changes in patient health status directly affected by nursing care, differ in hospitals where Black patients predominantly access their care, as compared to other hospitals.
Methods
To fulfill the objective, a cross-sectional design using publicly available 2019 to 2022 Hospital Compare, 2019 Medicare Provider Analysis and Review (MEDPAR), and case mix index (CMI) file databases were used. Four nursing-sensitive indicators were evaluated: pressure ulcer, postoperative sepsis, perioperative pulmonary embolus/deep vein thrombosis, and death rate among surgical inpatients with serious treatable complications (“failure to rescue”) in hospitals classified into high, medium, and low BSHs according to the percentage of patients of Black race in the MEDPAR data. Mean outcome differences across BSH categories were assessed through analyses of variance and regression models, which controlled for hospital CMI.
Results
The 3,101 hospitals were predominantly urban nonteaching hospitals in metropolitan areas. Although 12% of hospitals had Magnet designation, BSHs were disproportionately Magnet (14%). The outcome rates were 0.59 for pressure ulcers, 3.38 for perioperative pulmonary embolus/deep vein thrombosis, 143.58 for failure to rescue, and 4.12 for sepsis. Rates were significantly higher for pressure ulcers, perioperative pulmonary embolus/deep vein thrombosis, and sepsis in high BSHs. The mean failure to rescue rate was similar across low-to-high BSHs and did not show significant differences. These results were unchanged in models adjusting for CMI.
Discussion
The evidence suggests that several nursing-sensitive indicators are worse in high BSHs. Research linking nursing-sensitive indicators to nursing resources such as staffing is needed to explicate the mechanism underlying these findings. Poorer nursing-sensitive indicators in combination with poorer nurse staffing in high BSHs presents a priority for policy and management intervention. Sudden unexpected infant death (SUID) is a leading cause of infant mortality in the United States. Hospitals have implemented infant safe sleep programs with varying measures and degrees of success, but few have demonstrated improvements in hospital-based and home safe sleep practices with nurse subject matter experts (SMEs) and community SUID prevention campaigns.
This project evaluated the impact of a state-wide, evidence-based infant safe sleep program for birthing hospitals using nurse SMEs and a community awareness campaign on nurse knowledge, safe sleep environments, and trends in infant sleep-related deaths.
Between 2016 and 2021, a pre- and post-test quality improvement intervention-based design was used to enroll hospitals and train and embed SMEs to educate peers, conduct practice surveillance and audits, and address practice deviations. A website housed comprehensive resources, and a large-scale community-based social and print media campaign on safe sleep practices occurred. Nurse and practice data from 12 hospitals that fully implemented the program were compared pre- and post-implementation. State-wide survey data for key safe sleep indicators reported by parents were compared from our 12 birthing hospitals to other facilities.
Of trained nurses (N = 902), 83.4% reported making substantial or exceptional progress in being proactive in surveillance of safe sleep environments. Pre- and post-implementation environmental audits showed a significantly higher proportion of infants in safe sleep positions post-implementation (94.3%) than pre-implementation (89.6%) (p = 0.001). Statewide survey data from birth parents discharged from our program hospitals significantly outperformed those discharged from other state facilities. Multi-media campaigns resulted in over 1.4 million impressions on our website. Sleep-related deaths for infants born at four program hospitals dropped 16.1% from 31 in 2018 to 26 in 2021.
A safe sleep program improved hospital-based nurses' knowledge and practice and birth parent's knowledge and behaviors, and it was associated with a decrease in infant sleep-related deaths.
Background
In sub-Saharan Africa, the risk of obstetric complications remains high throughout the postpartum period.
Objective
We developed and tested a novel, integrated model of group postpartum care titled Focused-Postpartum Care (Focused-PPC) to improve outcomes. In this paper, we report clinical outcomes of participants in the intervention arm and differences in knowledge of postbirth warning signs among those in the intervention and control arms.
Methods
Focused-PPC encompassed recommended clinical assessments, targeted education, and peer support up to 1 year after birth. Focused-PPC was implemented as a parallel randomized controlled trial involving 192 postpartum women across four health centers in Tamale, Ghana, from February 2022 to August 2023. Eligible participants 18 years or older with a live birth were randomly assigned to either the Focused-PPC intervention arm or the control arm at a 1:1 allocation and were not blinded to their allocation. At each health center, 48 participants were allocated to either an intervention or control arm. Focused-PPC groups in the intervention arm consisted of eight participants per group. Participants in the intervention arm received the Focused-PPC integrated group model of care. Participants in the control arm received the standard of postnatal care already administered at each health center.
Results
Baseline analysis included 96 participants from the control arm and 91 participants from the intervention arm. We found that vital signs and clinical outcomes were relatively stable; however, incidences of hypertension substantially decreased among participants in the intervention arm. By 3 months postbirth, most participants in the intervention arm were able to identify all postbirth warning signs and retain this knowledge compared to the control arm. Those in the intervention arm were also knowledgeable of more warning signs at each time point compared to the control arm.
Discussion
An integrated, evidence-based approach to postpartum care, such as Focused-PPC, has potential to increase knowledge and improve clinical outcomes among mothers in Ghana. by Laurie M. Heller, Urszula Oszczapinska, Jessica M. Smith, Megan M. Julien
We conducted nine experiments to determine why a sound’s pleasantness can be altered by movies, abstract paintings, and words. In Expt. 1, unpleasant sounds, such as the sound of a person sniffing, were paired either with their original video track or with video tracks depicting neutral events that could plausibly have produced the sound, such as pulling tissues out of a tissue box. While the unpleasant sounds were mildly unpleasant to an unscreened population, these sounds were expected to be more unpleasant for people who have misophonia, a condition in which certain everyday sounds are unbearable. Consistent with past literature, neutral video tracks increased the sounds’ pleasantness for the non-misophonic and misophonic populations, by 0.98 and 1.59 points, respectively (on an 11-point scale). Movies rated as having better audio-visual matches produced greater changes in pleasantness, consistent with the hypothesis that source reassignment caused the changes. Expt. 2 found a consistent result when the video tracks were replaced with written event descriptions, although the effect size was reduced. Expt. 3 inverted Expt. 1 and found that unpleasant video tracks decreased the pleasantness of neutral sounds by 2.12 points, but better-matching movies did not produce greater changes in pleasantness. In Expts. 4–6, we sought an alternative to the source reassignment explanation by obtaining ratings of audio-visual synchrony, cross-modal agreement in symbolism, source plausibility, and sound identifiability. No complete explanation was found for the effect of unpleasant videos. Furthermore, pleasant abstract paintings increased the pleasantness of unpleasant sounds by 0.37 points, correlating with cross-modal agreement but not with audio-visual match. Taken together, different types and patterns of match ratings can help discern the causal mechanisms by which visual stimuli affect sound pleasantness (e.g., source reassignment, cross-modal agreement).To describe newly graduated nurses' experiences of reflection as a support for professional development during the initial months of their transition while caring for patients in a hospital setting.
A qualitative descriptive design.
Four focus groups with 20 newly graduated nurses participating in a professional development programme at aregion in Sweden were conducted in 2023. The data were analysed using qualitative content analysis.
The analysis identified one main category: Reflection supports newly graduated nurses' professional development during their transition. This main category includes three generic categories: (1) Reflection with peers in a regularly structured dialogue group strengthens the professional role; (2) reflection with experienced healthcare instructors in learning activities enhances the mastery of care tasks; and (3) reflection with experienced colleagues in the workplace enhances task performance. Structured reflection in dialogue groups and interactive learning activities within the Professional Development Programme facilitated deeper reflections on caring experiences.
Newly graduated nurses reported that regularly structured reflection, adequate space, and established trust were essential to their professional development. While the professional development programme provided opportunities, variations in the workplace environment led to unequal conditions for reflective practice.
Addressing the need for reflection among newly graduated nurses is crucial for organisations to facilitate their transition. Establishing structures for reflection on caring experiences within introduction programmes can support their professional development.
Reflective practice in complex and challenging hospital settings can support the professional development of newly graduated nurses.
The Consolidated Criteria for Reporting Qualitative Research (COREQ) was adhered to.
No patient or public contributions.
Background
Tongue-tie is associated with nipple pain and early breastfeeding cessation. To date, research has been limited by small sample sizes and a dearth of evidence on the effects of tongue-tie on infant feeding symptoms and physiologic breastfeeding mechanics.
Objectives
In this article, we describe the protocol for our study exploring infant feeding, negative breastfeeding symptoms, maternal anatomy, and physiologic sucking data between infants with and without tongue-tie.
Methods
A prospective cohort study design is being employed. Over 8 weeks, three visits will be conducted with a sample of mothers and their infants without tongue-tie and a sample of mothers and their infants diagnosed with tongue-tie undergoing treatment via frenotomy. The aims of the study were to compare breastfeeding symptoms, breast anatomy, infant feeding symptoms, feeding efficiency, and nutritive sucking parameters between infants with and without tongue-tie, further comparing these metrics pretreatment and posttreatment via frenotomy with the non-tongue-tied age-matched counterparts.
Results
This study is currently ongoing.
Discussion
Tongue-tie is an everyday problem; clear guidelines are needed to decide whether to treat it. This novel, innovative, and multidisciplinary research study aims to fill critical gaps in understanding the physiological and functional effects of tongue-tie on breastfeeding, offering evidence to inform better clinical decisions and support effective interventions. Introducción: En la atención del parto es primordial brindar cuidado humanizado a la madre, garantizando de esta forma el respeto a su dignidad, bienestar y cultura. Objetivo: Describir la atención y cuidados que brinda el personal de enfermería durante el parto a mujeres hablantes de lengua náhuatl y comparla con la percepción de las y los enfermeros. Materiales y método: Investigación cualitativa, con ocho mujeres hablantes de la lengua náhuatl de Uxtuapan, a quienes se les realizó una entrevista semiestructurada mediante grupo focal y una segunda entrevista individualizada en domicilio. También se entrevistaron a 11 profesionales de enfermería con grabadora de voz. Se transcribieron las entrevistas, se identificaron unidades de significado, se recategorizó y se describieron los resultados a través de la conformación de categorías: Cuidado, Entorno, Cultura, Relación ayuda-confianza. Se respetó la confidencialidad de los datos. Resultados: La falta de comunicación, tiempo e interacción en la relación enfermera-paciente favorece una percepción errónea de las pacientes ante su cuidado, denotando maltrato, soledad, falta de empatía. Conclusión: Para asegurar el cuidado humanizado en la atención del parto, se requiere mantener una conexión con las mujeres y cuidadores, donde se respeta su cultura y se favorece la seguridad de la vida humana.
To assess the acceptability and perceived feasibility of integrating a co-designed nurse-led model of contraception and medication abortion care within rural and regional general practices.
Qualitative exploratory design utilising Sidani and Braden's indicators of acceptability and feasibility.
We conducted semi-structured interviews with 12 practice nurses, 8 general practitioners and 3 practice managers who currently or previously worked in rural, regional or remote general practice. Participants were recruited purposively through social media, partner organisation newsletters and snowballing. During the interview, participants were presented with an overview of the co-designed model of care and asked specific questions to gain feedback on its acceptability and perceived feasibility. Data were analysed in NVivo using template analysis and iterative categorisation. Findings were mapped according to Sidani and Braden's indicators of acceptability and feasibility.
Three overarching themes were identified: nurses are acceptable providers, factors influencing the feasibility of the model and factors supporting greater feasibility of the model. Participants found the nurse-led model acceptable, describing nurses as suitable and sometimes preferred providers of long-acting reversible contraception and abortion care in rural and regional settings. They also perceived the model as feasible, citing similarities to existing care processes such as infant immunisations and chronic disease management, contributing to its feasibility. However, contextual factors such as the need to adapt the model to each clinic and patient's unique needs, foster strong general practitioner–practice nurse professional relationships and ensure that staff have shared values and adequate training for contraception and abortion provision were described as critical for feasibility.
Overall, participants found the nurse-led model of care to be acceptable and feasible for implementation in rural and regional general practices. This perception carries important implications for policy and practice, highlighting the need for supportive policies to enhance the effectiveness of such models across Australian general practice.
Our findings emphasise the need for initiatives aimed at addressing inadequate funding for nurse-led care, improving documentation of this care, enhancing understanding among general practitioners and nurses regarding the scope of practice for practice nurses, and overcoming training barriers specific to rural areas. These measures are essential for enabling nurse-led models of contraception and medication abortion to function effectively in practice.
This paper is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidelines.
Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.
by Hossein Mansourizadeh, Mohammad Reza Bakhtiarizadeh, Luciana Correia de Almeida Regitano, Jennifer Jessica Bruscadin
Different sheep breeds show distinct phenotypic plasticity in fat deposition in the tails. The genetic background underlying fat deposition in the tail of sheep is complex, multifactorial, and may involve allele-specific expression (ASE) mechanism to modulate allelic expression. ASE is a common phenomenon in mammals and refers to allelic imbalanced expression modified by cis-regulatory genetic variants that can be observed at heterozygous loci. Therefore, regulatory processes behind the fat-tail formation in sheep may be to some extent explained by cis- regulatory variants, through ASE mechanism, which was investigated in the present study. An RNA-Seq-based variant calling was applied to perform genome-wide survey of ASE genes using 45 samples from seven independent studies comparing the transcriptome of fat-tail tissue between fat- and thin-tailed sheep breeds. Using a rigorous computational pipeline, 115 differential ASE genes were identified, which were narrowed down to four genes (LPL, SOD3, TCP1 and LRPAP1) for being detected in at least two studies. Functional analysis revealed that the ASE genes were mainly involved in fat metabolism. Of these, LPL was of greater importance, as 1) observed in five studies, 2) reported as ASE gene in the previous studies and 3) with a known role in fat deposition. Our findings implied that complex physiological traits, like fat-tail formation, can be better explained by considering various genetic mechanisms, which can be more finely mapped through ASE analyses. The insights gained in this study indicate that biallelic expression may not be a common mechanism in sheep fat-tail development. Hence, allelic imbalance of the fat deposition-related genes can be considered a novel layer of information for future research on genetic improvement and increased efficiency in sheep breeding programs.by Andrew D. Shelton, Jessica L. Allen, Vicki S. Mercer, Jeremy R. Crenshaw, Jason R. Franz
Rehabilitation to prevent falls should not only directly address intrinsic and extrinsic factors, but also the neuropsychology of falls to promote safe and independent mobility in our aging population. The purpose of this study was to determine the relation between falls self-efficacy and objective responses to a series of walking balance perturbations. 29 healthy younger adults and 28 older adults completed four experimental trials, including unperturbed walking and walking while responding to three perturbations: mediolateral optical flow, treadmill-induced slips, and lateral waist-pulls; and three self-reported questionnaires: Activity-specific Balance Confidence, Falls Efficacy Scale, and the Fear of Falling Questionnaire-Revised. We quantified stabilizing responses as a change in margin of stability from unperturbed walking. Older adults generally exhibited larger instability than younger adults in response to walking balance perturbations. Only the Fear of Falls Questionnaire-Revised showed an increase in perceived falls risk for older adults. We found no significant correlations for older adults between any balance perturbation response and questionnaires of self-perception. Given the disconnect between self-perceived falls risk and responses to walking balance perturbations, rehabilitation to prevent falls while maintaining mobility and independence will likely require personalized techniques that combine neuromuscular training with approaches for neurophysiological reeducation.Background
Patients in hospitals that serve disproportionately patients of Black race have worse outcomes than patients in other hospitals, but the modifiable nursing factors that may contribute to such disparities have not been explored.
Objective
The study objective was to examine whether nurse staffing differs in hospitals that serve predominantly patients of Black race (Black-serving hospitals) as compared to other hospitals.
Methods
A cross-sectional correlational design using a nurse survey in a national hospital sample was used to fulfill the study objective. Nurse staffing was measured as the maximum number of patients cared for on the last shift from the 2015 annual registered nurse survey conducted in National Database of Nursing Quality Indicators hospitals. Hospitals were classified into subgroups of low, medium, and high percentages of patients of Black race using the 2019 Medicare Provider Analysis and Review database.
Results
In survey data from 179,336 registered nurses in 574 hospitals, nurse staffing was significantly worse in high-Black-serving hospitals as compared to medium- and low-Black-serving hospitals. In Poisson regression models that adjusted for nursing unit type and hospital characteristics, nurses in high-Black-serving hospitals and medium-Black-serving hospitals had more patients-per-nurse than did nurses in low-Black-serving hospitals.
Discussion
Small, statistically significant differences in nurse staffing that are worse in hospitals where Black patients disproportionately access their care were found using nurse survey data accounting for nursing unit type. The poorer nurse staffing in Black-serving hospitals may compromise the care and outcomes of the seven in 10 hospitalized Black older adults who receive care in Black-serving hospitals. The consequences for patient outcome disparities of poorer nurse staffing in Black-serving hospitals deserve investigation. Policies to increase nurse staffing in hospitals serving a higher proportion of patients of Black race are needed to contribute to efforts to reduce health disparities. Background
In the United States, Black adults have the highest prevalence of obesity and hypertension, increasing their risk of morbidity and mortality. Caregivers of persons with dementia are also at increased risk of morbidity and mortality due to the demands of providing care. Thus, Black caregivers—who are the second largest group of caregivers of persons with dementia in the United States—have the highest risks for poor health outcomes among all caregivers. However, the physiological changes associated with multiple chronic conditions in Black caregivers are poorly understood.
Objectives
In this study, metabolomics were compared to the metabolic profiles of Black caregivers with obesity, with or without hypertension. Our goal was to identify metabolites and metabolic pathways that could be targeted to reduce obesity and hypertension rates in this group.
Methods
High-resolution, untargeted metabolomic assays were performed on plasma samples from 26 self-identified Black caregivers with obesity, 18 of whom had hypertension. Logistic regression and pathway analyses were employed to identify metabolites and metabolic pathways differentiating caregivers with obesity only and caregivers with both obesity and hypertension.
Results
Key metabolic pathways discriminating caregivers with obesity only and caregivers with obesity and hypertension were butanoate and glutamate metabolism, fatty acid activation/biosynthesis, and the carnitine shuttle pathway. Metabolites related to glutamate metabolism in the butanoate metabolism pathway were more abundant in caregivers with hypertension, while metabolites identified as butyric acid/butanoate and R-(3)-hydroxybutanoate were less abundant. Caregivers with hypertension also had lower levels of several unsaturated fatty acids.
Discussion
In Black caregivers with obesity, multiple metabolic features and pathways differentiated among caregivers with and without hypertension. If confirmed in future studies, these findings would support ongoing clinical monitoring and culturally tailored interventions focused on nutrition (particularly polyunsaturated fats and animal protein), exercise, and stress management to reduce the risk of hypertension in Black caregivers with obesity. 
FreshRSS 