Ruffled Feathers at Hubbard Poultry Company

This case has a labor law and product liability focus and is suited for a human resource, employment or business law class at the undergraduate level. This case is based on an actual incident; the names of the workers and company have been changed

Increasing Medication Adherence in Hypertensive Patients With Million Hearts® Health Literacy Program

Healthy People 2020 identified hypertension (HTN) as a controllable risk factor to prevent cardiovascular disease and stroke. Adhering to regular antihypertensive (AHT) medications improves outcomes in patients diagnosed with HTN by controlling blood pressure, reducing hospital visits, and promoting patient wellness. Medication adherence occurs when prescribed medicine regimens are utilized by the patient as directed to manage illness or disease, as evidenced by patients receiving medications at their pharmacy. The practice-focused question for this quality improvement project asked whether implementation of health literacy tools from Million Hearts® HTN Control: Action Steps for Clinicians, increased medication adherence as evidenced by regular medication pickups by adult hypertensive patients. Additionally, this project provided an assessment to identify the patient\u27s current health literacy level using the Newest Vital Sign. The purpose of this quality improvement project was to improve health literacy about AHT medications to increase medication adherence in adults diagnosed with HTN. The logic model allowed for communication of resources, activities, and guidance during project implementation. Data related to medication pickups from adult participants, 1 male and 4 females aged 21-76, were analyzed using descriptive statistics via percent difference pre-post program. Results showed an 80% rate of medication adherence, however increased medication adherence was not achieved. Results also revealed a knowledge deficit in 20% of participants indicating they were unaware they had been prescribed combination AHT medication to control their blood pressure, and not knowing their most recent blood pressure results, or how their specific AHT medication regimen worked at controlling their HTN needs. These findings could lead to exploring additional underlying factors that impede medication adherence such as income, medication cost, insurance cost, and transportation needs. This project supports the need for health literacy to be addressed to improve knowledge and understanding about HTN, and implied the need to address the problem of low health literacy in patients with HTN. Implications for nursing practice include health literacy tools for community-based ambulatory clinics to influence medication adherence and self-care management of adults with HTN. Positive social change was demonstrated by providing health literacy to adult HTN population to improve medication adherence thus reducing health risk

Evidence-based practice educational intervention studies: A systematic review of what is taught and how it is measured

Abstract Background Despite the established interest in evidence-based practice (EBP) as a core competence for clinicians, evidence for how best to teach and evaluate EBP remains weak. We sought to systematically assess coverage of the five EBP steps, review the outcome domains measured, and assess the properties of the instruments used in studies evaluating EBP educational interventions. Methods We conducted a systematic review of controlled studies (i.e. studies with a separate control group) which had investigated the effect of EBP educational interventions. We used citation analysis technique and tracked the forward and backward citations of the index articles (i.e. the systematic reviews and primary studies included in an overview of the effect of EBP teaching) using Web of Science until May 2017. We extracted information on intervention content (grouped into the five EBP steps), and the outcome domains assessed. We also searched the literature for published reliability and validity data of the EBP instruments used. Results Of 1831 records identified, 302 full-text articles were screened, and 85 included. Of these, 46 (54%) studies were randomised trials, 51 (60%) included postgraduate level participants, and 63 (75%) taught medical professionals. EBP Step 3 (critical appraisal) was the most frequently taught step (63 studies; 74%). Only 10 (12%) of the studies taught content which addressed all five EBP steps. Of the 85 studies, 52 (61%) evaluated EBP skills, 39 (46%) knowledge, 35 (41%) attitudes, 19 (22%) behaviours, 15 (18%) self-efficacy, and 7 (8%) measured reactions to EBP teaching delivery. Of the 24 instruments used in the included studies, 6 were high-quality (achieved ≥3 types of established validity evidence) and these were used in 14 (29%) of the 52 studies that measured EBP skills; 14 (41%) of the 39 studies that measured EBP knowledge; and 8 (26%) of the 35 studies that measured EBP attitude. Conclusions Most EBP educational interventions which have been evaluated in controlled studies focus on teaching only some of the EBP steps (predominantly critically appraisal of evidence) and did not use high-quality instruments to measure outcomes. Educational packages and instruments which address all EBP steps are needed to improve EBP teaching

Community-Level Resources Bolstering Resilience to HIV/AIDS: Perspectives of Middle-Aged and Older Men Who Have Sex with Men Living with HIV/AIDS

Most prior research on resilience to HIV/AIDS has utilized quantitative tools (e.g., scales and surveys) to examine individual-level assets (e.g., self-efficacy, hope, optimism) that researchers believe represent or approximate resilience to HIV/AIDS with minimal consideration for the perspectives of men who have sex with men (MSM), the population that has remained at greatest risk of, and the most impacted by HIV/AIDS in North America since the 1980s. The aim of this qualitative study is to identify community-level resources that bolster resilience to HIV/AIDS based specifically on the perspectives and lived experiences of middle-aged and older (MAO) MSM living with HIV/AIDS. Employing a Community-Based Participatory Research (CBPR) approach involving the meaningful and active engagement of MSM at multiple levels (i.e., as research team members, peer researchers, Community Advisory Board representatives, community partners, and study participants), forty-one MAO MSM living with HIV/AIDS from Ontario, Canada, were included in the study’s semi-structured interviews. Utilizing thematic analysis, four major themes were identified from the interview data: (a) the 2SLGBTQ+ community; (b) community-based not-for-profit organizations; (c) public health services; and (d) neighbourhood support programs. This article discusses the value of community-level resources as important additions to individual-level assets for bolstering resilience to HIV/AIDS, as well as the implications of the study’s findings and limitations for future HIV/AIDS services and research

Systematic Neighborhood Observations at High Spatial Resolution: Methodology and Assessment of Potential Benefits

There is a growing body of public health research documenting how characteristics of neighborhoods are associated with differences in the health status of residents. However, little is known about how the spatial resolution of neighborhood observational data or community audits affects the identification of neighborhood differences in health. We developed a systematic neighborhood observation instrument for collecting data at very high spatial resolution (we observe each parcel independently) and used it to collect data in a low-income minority neighborhood in Dallas, TX. In addition, we collected data on the health status of individuals residing in this neighborhood. We then assessed the inter-rater reliability of the instrument and compared the costs and benefits of using data at this high spatial resolution. Our instrument provides a reliable and cost-effect method for collecting neighborhood observational data at high spatial resolution, which then allows researchers to explore the impact of varying geographic aggregations. Furthermore, these data facilitate a demonstration of the predictive accuracy of self-reported health status. We find that ordered logit models of health status using observational data at different spatial resolution produce different results. This implies a need to analyze the variation in correlative relationships at different geographic resolutions when there is no solid theoretical rational for choosing a particular resolution. We argue that neighborhood data at high spatial resolution greatly facilitates the evaluation of alternative geographic specifications in studies of neighborhood and health

Mitigating Risks and Building Resilience to HIV/AIDS: Perspectives of HIV-Negative, Middle-Aged and Older Men Who Have Sex with Men

Purpose: Although ample research has been conducted on resilience to HIV/AIDS, most studies have utilized quantitative methods and focused almost exclusively on people living with HIV/AIDS. A relatively untapped source of knowledge is the perspectives of HIV-negative, middle-aged and older men who have sex with men (MSM) who have been navigating risks and building resilience to HIV/AIDS since the 1980s. Our qualitative, community-based participatory research study examined the perspectives of HIV-negative, middle-aged and older MSM on factors that helped mitigate the risks of and build resilience to HIV/AIDS. Methods: In collaboration with community-based organizations, fourteen participants were recruited for in-depth interviews. Participants were aged 40 or older, identified as HIV-negative MSM, and resided in Ontario, Canada. Thematic analysis of interviews revealed salient themes. Results: Three themes were identified: (1) individual attributes (e.g., self-awareness/control), (2) protective relational factors (e.g., meaningful sexual relationships), and (3) community-based resources (e.g., competent healthcare/service providers). Conclusion: HIV-negative, middle-aged and older MSM recognized factors that helped mitigate risks of contracting and build resilience to HIV/AIDS based on their own lived experiences. Some of these factors have not been explicitly identified or extensively discussed in extant academic literature, and are worth considering in the development of community-based HIV/AIDS prevention and intervention programs

Population stratification may bias analysis of PGC-1α as a modifier of age at Huntington disease motor onset

Huntington’s disease (HD) is an inherited neurodegenerative disorder characterized by motor, cognitive and behavioral disturbances, caused by the expansion of a CAG trinucleotide repeat in the HD gene. The CAG allele size is the major determinant of age at onset (AO) of motor symptoms, although the remaining variance in AO is highly heritable. The rs7665116 SNP in PPARGC1A, encoding the mitochondrial regulator PGC-1α, has been reported to be a significant modifier of AO in three European HD cohorts, perhaps due to affected cases from Italy. We attempted to replicate these findings in a large collection of (1,727) HD patient DNA samples of European origin. In the entire cohort, rs7665116 showed a significant effect in the dominant model (p value = 0.008) and the additive model (p value = 0.009). However, when examined by origin, cases of Southern European origin had an increased rs7665116 minor allele frequency (MAF), consistent with this being an ancestry-tagging SNP. The Southern European cases, despite similar mean CAG allele size, had a significantly older mean AO (p < 0.001), suggesting population-dependent phenotype stratification. When the generalized estimating equations models were adjusted for ancestry, the effect of the rs7665116 genotype on AO decreased dramatically. Our results do not support rs7665116 as a modifier of AO of motor symptoms, as we found evidence for a dramatic effect of phenotypic (AO) and genotypic (MAF) stratification among European cohorts that was not considered in previously reported association studies. A significantly older AO in Southern Europe may reflect population differences in genetic or environmental factors that warrant further investigation

Candidate glutamatergic and dopaminergic pathway gene variants do not influence Huntington’s disease motor onset

Huntington’s disease (HD) is a neurodegenerative disorder characterized by motor, cognitive, and behavioral disturbances. It is caused by the expansion of the HTT CAG repeat, which is the major determinant of age at onset (AO) of motor symptoms. Aberrant function of N-methyl-D-aspartate receptors and/or overexposure to dopamine has been suggested to cause significant neurotoxicity, contributing to HD pathogenesis. We used genetic association analysis in 1,628 HD patients to evaluate candidate polymorphisms in N-methyl-D-aspartate receptor subtype genes (GRIN2A rs4998386 and rs2650427, and GRIN2B rs1806201) and functional polymorphisms in genes in the dopamine pathway (DAT1 3′ UTR 40-bp variable number tandem repeat (VNTR), DRD4 exon 3 48-bp VNTR, DRD2 rs1800497, and COMT rs4608) as potential modifiers of the disease process. None of the seven polymorphisms tested was found to be associated with significant modification of motor AO, either in a dominant or additive model, after adjusting for ancestry. The results of this candidate-genetic study therefore do not provide strong evidence to support a modulatory role for these variations within glutamatergic and dopaminergic genes in the AO of HD motor manifestations