A Salutogenic Framework to Understand Disparity in Breast Cancer Screening Behavior in African American Women

African American women (AAW) have the highest breast cancer mortality rate than any other racial or ethnic group. Limited access to care reduces mammography screening for AAW. Despite barriers, some AAW engage in breast cancer screening (BCS) behaviors like mammography. The salutogenic theory of health focuses on positive health behaviors and offers a framework to understand personal factors which allow some AAW to overcome adversity and engage in BCS. Sense of coherence (SOC) is central to salutogenic theory. Individuals with greater SOC utilize available resources to attain optimal health. This study: 1) Evaluated the contribution of SOC, social support and spirituality to BCS motivation and behaviors in AAW, and 2) Determined whether there are differences in SOC, health perception, spirituality, and social support among AAW who utilize free mammography programs compared to AAW who do not. A 2-group cross-sectional design was used. Participants completed self-report questionnaires. Findings revealed that SOC was directly correlated with social support, spirituality, health perception and BCS motivation. Social support moderated the effect of SOC on BCS behaviors, in that low social support increased BCS behaviors in women with high SOC. Moreover, spirituality significantly predicted greater BCS motivation. Logistic regression demonstrated that women enrolled in the Illinois Breast and Cervical Cancer Program (IBCCP) reported a greater incidence of performing and intent to perform breast self-exam and to obtain clinical breast-exam and mammograms. Women in the IBCCP program were more likely to be compliant with BCS guidelines than women not enrolled in IBCCP. In conclusion, SOC, social support and spirituality influence BCS behaviors and motivation in AAW. Also, free mammogram programs, like IBCCP, promote greater BCS behaviors and compliance with BCS guidelines in AAW. The findings can guide the development of cultural-specific salutogenic programs to motivate and improve compliance of AAW with breast cancer screening guidelines

Demonstrating the value of the RN in ambulatory care

During 2003, an estimated 906 million visits were made to physician offices in the United States (Hing, Cherry, & Woodwell, 2005). Overall, 42% of visits to outpatient settings were attended by a registered nurse (Middleton & Hing, 2005). Despite ambulatory care being the fastest growing site for care, it is the least studied. The purpose of this article is to provide an overview of the role of the RN in ambulatory care and describe the direct and indirect economic value of RNs in ambulatory care settings

Optimizing Strategies for Care Coordination and Transition Management: Recommendations for Nursing Education

The purpose of this descriptive qualitative study was to explore nurse and healthcare leaders\u27 experiences and perceptions of care coordination and transition management (CCTM®). Four barriers emerged that added insight into the lack of adopting and integrating CCTM knowledge, skills, and attitudes in nursing education in the following categories: curriculum redesign, silos of care settings and care providers, knowledge gap, and faculty development/resistance. Recommendations and implications for education, for both nursing students and practicing nurses, are described

Developing a Business Case for the Care Coordination and Transition Management Model: Needs, Methods, and Measures

In this descriptive qualitative study, nurse and healthcare leaders\u27 experiences, perceptions of care coordination and transition management (CCTM®), and insights as to how to foster adoption of the CCTM RN role in nursing education, practice across the continuum, and policy were explored. Twenty-five barriers to recognition and adoption of CCTM RN practice across the continuum were identified and categorized. Implications of these findings, recommendations for adoption of CCTM RN practice across the care continuum, and strategies for reimbursement policies are discussed

Developing a Business Case for the Care Coordination and Transition Management Model: Need, Metrics, and Measures

In this descriptive qualitative study, nurse and healthcare leaders\u27 experiences, perceptions of care coordination and transition management (CCTM®), and insights as to how to foster adoption of the CCTM RN role in nursing education, practice across the continuum, and policy were explored. Twenty-five barriers to recognition and adoption of CCTM RN practice across the continuum were identified and categorized. Implications of these findings, recommendations for adoption of CCTM RN practice across the care continuum, and strategies for reimbursement policies are discussed

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Influence of Sense of Coherence, Spirituality, Social Support and Health Perception on Breast Cancer Screening Motivation and Behaviors in African American Women

Despite formidable barriers, some African American women (AAW) engage in breast cancer screening (BCS) behaviors. Understanding individual characteristics that allow AAW to overcome barriers to BCS is critical to reduce breast cancer mortality among AAW. A salutogenic model of health was used to evaluate the influence of sense of coherence, social support, spirituality and health perception on BCS motivation and behaviors in AAW, and to determine differences in these factors in AAW who participate in free BCS programs compared to AAW who do not. Findings revealed that greater levels of spirituality were significantly associated with greater motivation to practice BCS. Further, women who utilized free BCS programs reported significantly greater rates of both performing and of intent to perform breast self examinations (BSE) in the future, obtaining clinical breast exams and mammograms. Findings can inform the development of culturally specific programs to improve the utilization of BCS programs by AAW

Making It All Work

The greater prevalence of type 2 diabetes is a critical issue among the U.S. Hispanic population. This study examined the struggles of Hispanic adults managing type 2 diabetes with limited resources. Ten Hispanic adults (enrolled in a larger study to determine the effects of diabetes self-management intervention), 25 to 80 years of age and living in a rural West Texas county in the United States, were selected. Three categories of challenges emerged: (a) diabetes self-care behaviors and challenges, (b) challenges with limited resources, and (c) challenges with support mechanisms. “Making it all work” was the overarching theme that tied all the categories together. This study offers lessons for health care providers and policymakers on how to maximize the availability of resources for Hispanic individuals with type 2 diabetes living within the constraints of limited resources