Exploring the Interface of Genetics, Genomics, and Older Adults

This dissertation addresses the interface of genetics, genomics, and older adults through a collection of three manuscripts that examine genetic and genomic testing and decision-making across age groups. The dissertation offers evaluations of a new lens for decision-making in genetics and genomics, a contextualization of the differences and similarities of perceptions and beliefs that exist among age groups engaging in direct-to-consumer personal genetic testing (DTC PGT), an identification of two factors that influence the decision to engage in DTC PGT, and an expansion of the current applications of Protection Motivation Theory to include disclosure, finance, and advance directive-management behaviors related to DTC PGT results. Together these three manuscripts support and expand on previous understandings about older adults and decision-making in genetics and genomics. The dissertation findings identify many unique qualities of the 60+year old age group while also finding similarities that span age groups. These findings support the need for further examination of both age-group differences and the phenomenon of genetic or genomic decision-making. The differences and similarities among age groups will provide initial findings on which future work in decision-making and decision-support can be built. The dissertation’s focus on context as a key component of decision-making is both timely and forward looking. The need to create unique and informed decision-support interventions is growing as the personalized medicine movement begins to bring in more genetic information. Consumer-driven healthcare demands consumer-sensitive approaches. The use of behavioral economics and the Protection Motivation Theory as guides will help healthcare professionals to address the age-group differences and the individual contexts that shape the genetic decision-making process

Social Activity Restriction and Psychological Health Among Caregivers of Older Adults With and Without Dementia

Objectives: We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups. Methods: Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers’ age, gender, race, education, relationship to care recipient, and self-rated health. Results: Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting friends and family was associated with higher distress and lower well-being in non-dementia caregivers. Any activity restriction had stronger association with distress for caregivers of older adults with versus without dementia. Discussion: Findings highlight the need for tailored interventions based on caregivers’ perceptions of meaningful social activities and dementia-friendly communities to promote social participation

Historic Redlining and Health Outcomes: A Systematic Review

Objective: The purpose of this systematic review was to synthesize the existing literature on the associations between historic redlining and modern-day health outcomes across the lifespan. Method: This review searched PubMed and CINAHL for peer-reviewed, data-based articles examining the relationship between historic redlining and any health outcome. Articles were appraised using the JBI critical appraisal checklist. The results were synthesized using a narrative summary approach. Results: Thirty-six articles were included and focused on various health outcomes, including cardiovascular outcomes, breast cancer incidence and mortality, firearm injury or death, birth-related outcomes, and asthma outcomes. Most of the included articles (n = 31; 86%) found significant associations between historic redlining and adverse health outcomes such as increased cardiovascular disease, higher rates of preterm births, increased cancer incidence, reduced survival time after breast cancer diagnosis, and increased firearm injury incidence. Discussion: This review demonstrates the persistent effect of historic redlining on individuals’ health. Public health nurses should recognize redlining as a form of structural racism when caring for affected communities and should advocate for policies and programs that advance health equity. Nurse researchers should develop and test multilevel interventions to address systemic racism and improve health outcomes in communities affected by redlining

Adapting to Uncertainty: Nursing Responsiveness to COVID-19

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic

Exploring mHealth as a New Route to Bridging the Nursing Theory-Practice Gap

The purpose of this poster is to discuss the use of mHealth as a tool for research and development of nursing theories. Mobile health (mHealth) is one of the most promising new advances in healthcare technology. mHealth is defined as the use of mobile technology in the provision of healthcare delivery or health promotion (Qiang, Yamamichi, Hausman, & Altman, 2011). The need for innovative and effective interventions for the prevention and management of chronic illness is evident. The use of mHealth interventions in the treatment and monitoring of chronic illness is still young but shows great promise. Currently the public health and psychological sciences are using their theories to guide interventional studies by operationalizing concepts through mHealth’s multi-faceted capabilities for patient interaction. Outcomes measures from chronic illness-mHealth studies are thematically evaluated by using theoretical nursing outcome-related concepts of Meleis’ Transitions theory and Mishel’s Uncertainty in Illness theory. Despite a small number of articles available for review, there are strong themes of activation and engagement of the patient through mHealth. The application of nursing theory in mHealth offers a new method to operationalize theoretical concepts, test theory-based interventions, and gain new contextual insight into the health-illness patient experience

Detrital chromite concentrations, nearshore Port au Port Bay, Newfoundland

A nearshore sediment sampling program was undertaken in Port au Port Bay, western Newfoundland. The -objectives of the program were to map the distribution of detrital chromite in the seabed sediments and to evaluate the paleoenvironmental evolution of chromite-bearing sedimentary facies. Bottom sediments were found to be enriched in detrital chromite in an area adjacent to and parallel to the east shore of the bay, south of the mouth of the Fox Island River. During glaciation, chromite from the Lewis Hills ophiolite complex was incorporated in glacial materials. Post-glacial reworking of chromite-bearing sediments by fluvial and marine processes is observed in a number of sedimentary facies: fluvial sediments of the Fox Island River, a large outwash plain and marine-limit delta occurring near the mouth of Fox Island River, an erosional lag blanketing the outwash delta, and emergent and submergent beach terraces bordering a small coastal embayment south of Fox Island River, The relatively low wave energy of the Port au Port Bay area appears, however, to have precluded extensive placer development in all sedimentary facies. RÉSUMÉ Un programme d'éhantillonage des sédiments côtiers fut entrepris dans la baie de Port-au-Port, dans l'ouest de Terre-Neuve. Les buts de ce programme étaient de cartographier la distribution de la chromite détritique dans les sédiments de fonds marin et d'évaluer l’évolution paléo-environnementale des faciès sédimentaires porteurs de chromite. Les sédiments de fond se sont révèles être enrichis en chromite détriiique dans une zone adjacente et parallèle à la côte est de la baie, au sud de l’embouchure de la rivière de file Fox. Pendant la glaciation, la chromite du complexe ophiolitique de Lewis Hills fut incorporée dans les matériaux glaciaires. Le remaniement post-glaciaire des sédiments porteurs de chromite par des processus fluviaux et marins est observé dans un certain nombre de faciès sédimentaires: les sédiments fluviaux de la rivière de Tile Fox, unsandur étenductun delta de contact glaciaire situe près de l'embouchure de la rivière de Tile Fox, un gravier résiduel qui recouvre le sandur et des terrasses marines émergentes et submerges bordant une anse située au sud de la rivière de l'ile Fox. L'énergie relativement basse des vagues de la région de Port-au-Port semble toutefois avoir empêché la formation de placers étendus dans tous les faciès sédiment aires. [Traduit par le journal

Mapping the Dynamic Complexity of Sexual and Gender Minority Healthcare Disparities: A Systems Thinking Approach

Sexual and gender minority (SGM) populations experience extensive health disparities compared to their straight and cisgender counterparts. The importance of addressing these disparities is paramount, as SGM groups often encounter significant barriers to accessing comprehensive healthcare, including societal stigma, provider bias, and financial constraints. This study utilizes a community-based system dynamics approach to understand and visualize the barriers to and facilitators of healthcare engagement for SGM groups across their life course. It aims to identify core constructs, relationships, and dynamic feedback mechanisms related to the experiences of connection/disconnection with physical, mental, and dental healthcare of SGM individuals. Barriers to access, such as discriminatory practices and the limited availability of SGM-informed healthcare professionals, exacerbate these disparities, underscoring the urgency of developing targeted interventions. System dynamics, a complex systems science (CSS) methodology, was used for this research. Group model building sessions were conducted with diverse SGM groups, including youth, older adults, and trans and gender-expansive community members. Causal loop diagrams were developed according to an iterative process, and a meta-model of their collective experiences was created. The study revealed extensive, dynamic, and shifting structural barriers for SGM community members accessing healthcare. Societal and structural stigma, provider bias, and pathologization were identified as significant barriers throughout their life course. Community-led interventions and SGM-focused holistic healthcare were identified as critical facilitators of SGM healthcare connection. The findings highlight the need for SGM-affirming and culturally responsive healthcare settings. This paper calls for a concerted effort from SGM health researchers to use CSS in developing interventions to reduce SGM health disparities

A systematic review of US nursing faculty's knowledge, awareness, inclusion, and perceived importance of sexual and gender minority-related content in nursing curricula

•First systematic review of nursing faculty perceptions and curricular inclusion of LGBTQ+ content in US nursing programs•Despite numerous calls for nursing education to address the issue the evidence base is small and limited to descriptive empirical literature•Measurement is an area of great need in this area with most studies using investigator developed surveys or dated instruments.•The nursing profession must invest the same amount of energy in inclusive curriculum as it is in competency-based education•US nursing faculty deserve evidence-based SGM health education preparedness programs. In the US, sexual and gender minority (SGM) individuals continue to experience health inequities, and nursing curricula content and nursing faculty with SGM health expertise in the US remain limited. Addressing health disparities begins with the preparation of future nurses—US nursing faculty must be supported to meet these growing needs. To describe, appraise, and synthesize research from 2000-2020 on US nursing faculty knowledge, awareness, inclusion, and perceived importance of SGM health content. Following PRISMA 2020 guidelines, we registered a systematic review and appraisal protocol in PROSPERO, and then executed the protocol and synthesized the literature. We found an empirical evidence base surrounding US nursing faculty and SGM health much more limited than expected. Only four cross-sectional, descriptive empirical articles fit the a priori inclusion criteria. The studies were of moderate quality at best and often relied on unvalidated or older measures. In general, the studies focused on examining characteristics of nursing programs, faculty comfort with content, faculty perceptions of content importance, and hours dedicated to content. Since the close of the review, new commentaries and editorials expanding the call for change in the US were published—the time for commentary has passed. It remains unclear whether US nursing faculty are adequately prepared to educate future nurses about SGM health issues—and an unprepared healthcare workforce is yet another barrier to SGM health equity. The evidence base supporting US nursing faculty development desperately needs more studies using rigorous methodologies