Connecting Gender, Race, Class, and Immigration Status to Disease Management

Objective: Chronic diseases are the leading causes of death in the United States. Chronic disease management occurs within all aspects of an individual’s life, including the workplace. Though the social constructs of gender, race, class, and immigration status within the workplace have been considered, their connection to disease management among workers has been less explicitly explored. Using a sample of immigrant hotel housekeepers, we explored the connections between these four social constructs and hypertension management. Methods: This qualitative research study was guided by critical ethnography methodology. Twenty-seven hotel room cleaners and four housemen were recruited (N = 31) and invited to discuss their experiences with hypertension and hypertension management within the context of their work environments. Results: Being a woman worker within the hotel industry was perceived to negatively influence participants’ experience with hypertension and hypertension management. In contrast, being a woman played a protective role outside the workplace. Being an immigrant played both a positive and a negative role in hypertension and its management. Being black and from a low socioeconomic class had only adverse influences on participants’ experience with hypertension and its management. Conclusion: Being a woman, black, lower class, and an immigrant simultaneously contribute to immigrant hotel housekeepers’ health and their ability to effectively manage their hypertension. The connection between these four constructs (gender, race, class, and immigration status) and disease management must be considered during care provision. Hotel employers and policy stakeholders need to consider those constructs and how they impact workers’ well-being. More studies are needed to identify what mitigates the associations between the intersectionality of these constructs and immigrant workers’ health and disease management within their work environment. Keywords: Gender, Race, Class, Immigration, Disease Management, Hospitalit

Research Brief: Technology and Health Education: An Exploratory Study of Older Chinese Immigrants

Technology advances, especially in the Internet, provide new tools to deliver health education to limited English proficient immigrants. This paper presents the findings of a qualitative descriptive study of older limited English proficient Chinese immigrants’ perspectives regarding computer-based health education. The sample consisted of 33 foreign-born Chinese recruited in Seattle, Washington. Data were generated through six focus groups and an 18-item demographic questionnaire. The analyses revealed that the majority was not skillful in computer use and Internet browsing, and the Internet was not a common health information source. Nevertheless, participants were supportive of having computer-based health information designed for Chinese immigrants. Interface designs, interface features, and content for the computer-based health education were discussed. The results support developing more computer-based programs requiring minimal computer, English language, and health literacy for immigrants, as well as investigations of cultural influence on the suitability and cost-effectiveness of computer-based health education for Chinese immigrants

Glycated hemoglobin vs fasting plasma glucose as a predictor of left ventricular dysfunction after st-elevation myocardial infarction

The World Health Organization and the American Diabetes Association recommend a level of glycated hemoglobin (HbA1c) ≥ 6.5% as diagnostic for diabetes. However, concordance between fasting plasma glucose (FPG) and HbA1c levels in acutely unwell patients is unknown. Furthermore, the prognostic value of HbA1c for left ventricular (LV) dysfunction is unclear. This study aimed to evaluate the concordance between HbA1c levels and FPG in consecutive patients with acute ST-elevation MI (STEMI) and compare their prognostic value in predicting LV dysfunction and elevated filling pressures on echocardiography.A total of 142 patients with a first incidence of STEMI were prospectively recruited. LV diastolic function was defined as mean septal and lateral early diastolic velocities (average e'); filling pressure was the ratio of transmitral E velocity to average e' (average E/e').Mean FPG and HbA1c levels were 7.7 ± 2.8 mmol/L and 6.5% ± 1.6%, respectively. Of 109 patients without previous diabetes, HbA1c levels identified an additional 18 patients (16.5%) as having diabetes, and the concordance with FPG was poor. Between diabetic and nondiabetic patients, there were no differences in LV end-diastolic volume (116 ± 37 vs 118 ± 43 mL; P = 0.78), end-systolic volume (69 ± 33 vs 68 ± 35 mL; P = 0.93), and ejection fraction (42 ± 12 vs 44 ± 11%; P = 0.49). On multivariable analyses, average e' was independently associated with HbA1c (β = -0.161; P = 0.045) but not FPG (P = 0.82). Similarly, average E/e' was independently associated with HbA1c (β = 0.168; P = 0.04) but not FPG (P = 0.32). Receiver operating characteristic curve analysis showed that an HbA1c cutoff of 6.4% (area under the curve, 0.68; P = 0.002) was associated with an elevated LV filling pressure.Only HbA1c was independently associated with impaired LV diastolic function and increased filling pressures after STEMI

Low-cost cell-based production platform for seasonal and pandemic influenza vaccines

Influenza-related illnesses have caused an estimated over million cases of severe illness, and it has about hundred thousands of deaths worldwide annually. Traditionally these vaccines are produced in embryonated chicken eggs. However, in the case of a pandemic outbreak, this egg-based production system may not be quickly enough to meet the surging demand. The efficacy associated with egg-based vaccines are low in recently years. The raising concerns with egg-derived vaccines is resulting in the spurred exploration of alternatives. MDCK cells are becoming as an alternative host to embryonated eggs for influenza virus propagation. Although MDCK cells were considered to be a suitable host for the virus production, their inability to grow in suspension still limits the process of scale-up and their production capability. Please click Additional Files below to see the full abstract

The influence of persistent pathogens on circulating levels of inflammatory markers: A cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis

Background: Systemic inflammation is linked to cardiovascular risk, but the influence of persistent pathogens, which are conventionally dichotomously categorized, on circulating levels of inflammatory markers is not clear. Antibody levels of pathogens have not been examined in relation to inflammation. Methods. Using data from a subsample of the Multi-Ethnic Study of Atherosclerosis, we examined circulating levels of interleukin-6 (IL-6), C-reactive protein (CRP) and fibrinogen in relation to five common persistent pathogens: cytomegalovirus, herpes simplex virus-1, Hepatitis A virus, Helicobacter pylori and Chlamydia pneumoniae. We tested the hypothesis that the number of seropositive pathogens (based on conventional cut-off points) would not be as sensitive a marker of inflammation as immune response measured by antibody levels to pathogens. Results. High antibody response to multiple pathogens showed graded and significant associations with IL-6 (p < 0.001), CRP (p = 0.04) and fibrinogen (p = 0.001), whereas seropositive pathogen burden did not. In multiple linear regression models, high antibody response to multiple pathogens maintained a positive association only with IL-6 (4.4% per pathogen exhibiting high antibody response, 95% CI 0.0-8.9). Conclusions. High antibody response to pathogens was a more consistent marker of inflammatory outcomes compared to seropositivity alone and high antibody response to multiple pathogens was a stronger marker compared to any single pathogen

Implementation research and Asian American/Pacific Islander health

Numerous barriers prevent the translation of research into practice, especially in settings with diverse populations. Nurses are in contact with diverse populations across settings and can be an important influence to further implementation research. This paper describes conceptual approaches and methodological issues pertinent to implementation research and implications for Asian American/Pacific Islander (AAPI) health research. The authors discussed the values of using theory to guide implementation research, levels of theory that are commonly used in interventions, and decisions for theory selection. They also articulated the shortcoming of randomized controlled trials, the gold standard for testing efficacy of interventions, and present quasi-experimental designs as a plausible alternative to randomized controlled trials when research is conducted in real-world settings. They examined three types of quasi-experimental designs, the unit of analysis, the choice of dependent variables, and measurement issues that influence whether research findings and evidence-based interventions are successfully translated into practice. Practicing nurses who are familiar with the AAPI population, as well as nurse researchers who have expertise in AAPI health can play critical roles in shaping future implementation research to advance AAPI health. Nurses can provide practice-based evidence for refining evidence-supported interventions for diverse, real-world settings and theory-based interventions that are socioculturally appropriate for AAPIs. Interdisciplinary, practice-based research networks that bring multiple agencies, organizations, communities, and academic institutions together can be a mechanism for advancing implementation research for AAPI health

Sin City Winds

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Associations of Dietary Long-Chain n-3 Polyunsaturated Fatty Acids and Fish With Biomarkers of Inflammation and Endothelial Activation (from the Multi-Ethnic Study of Atherosclerosis [MESA])

Cardioprotective effects of long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) and fish consumption have been observed. However, data on the specific associations of these dietary factors with inflammation and endothelial activation are sparse. We conducted a cross-sectional study of 5,677 men and women from the MESA cohort including African Americans, Caucasians, Chinese and Hispanics, aged 45-84 years, and free of clinical cardiovascular disease. Dietary information was collected by self-administered food frequency questionnaire. Multivariable linear regression analyses were used to examine relations between intake of LC n-3 PUFAs, non-fried fish and fried fish and biomarkers of inflammation and endothelial activation. LC n-3 PUFA intakes were inversely associated with plasma concentrations of interleukin-6 (IL-6, P=0.01) and matrix metalloproteinase-3 (MMP-3, P=0.03) independent of age, body mass index, physical activity, smoking, alcohol consumption and dietary variables. Non-fried fish consumption was found inversely related to C-reactive protein (CRP, P=0.045) and IL-6 (P<0.01); and fried fish was observed being inversely related to soluble intercellular adhesion molecules-1 (sICAM-1) (P<0.01) but not associated with other biomarkers after adjustment for potential confounders. In conclusion, this study suggests that dietary intakes of LC n-3 PUFAs and fish are inversely associated with concentrations of some biomarkers reflecting lower levels of inflammation and endothelial activation. These results may partially explain the cardioprotective effects of fish consumption

Model-Informed Drug Development:Steps Toward Harmonized Guidance

Global alignment of expectations is required to achieve consistency in the planning, conduct, reporting, and regulatory review of modelinformed drug development (MIDD) applications. An International Council for Harmonization (ICH) MIDD general principles guideline has been positioned to provide a common standard of practice including a framework for risk-based assessment of MIDD-derived evidence within the context of global regulatory decision-making. This perspective provides the background, our viewpoints, and the next steps in the development of this guideline