Recent Research Publications and Funding

  •  | February 1, 2013 5:00AM

    Background: Compared to same age healthy adults, stroke survivors experience 7 times as many falls annually. Such falls often cause hip or other fractures, loss of mobility, and increased fear of falling resulting in social isolation and/or dependence. Effective interventions for preventing falls among stroke survivors are critically needed. Tai Chi exercise has been shown to significantly reduce the number of falls in healthy older adults.

    Purpose: To examine the effect of a 12-week Yang-style Tai Chi (TC) intervention on fall rates among stroke survivors compared to SilverSneakers® (SS) and Usual Care (UC) groups.

    Methods: A randomized prospective clinical trial was conducted among stroke survivors (n=89), aged ≥ 50 years, and at ≥ 3 months post-stroke (TC, n=30; SS, n=31; or UC, n=28). TC and SS groups attended a 1-hour class 3 times/week for 12 weeks. The UC group received a weekly phone call along with written materials for participating in community-based physical activity. All subjects were interviewed weekly to ascertain fall data over the 12 weeks. Falls were defined as: “events in which subjects end up on the floor or ground when they did not expect to.” Data were analyzed using χ2 statistics with Yate’s continuity correction.

    Results: Subjects (46% women) were on average 70±10 years old. The majority reported an ischemic stroke (80%), were White/European-American (79%), married/partnered (60%), college-educated (79%), and retired/unemployed (93%). Over the 12-week trial, a total of 34 falls occurred; all happened at home, yet only 4 subjects sought medical attention for the fall. Most falls happened because subjects slipped or tripped (21%). The TC group had fewer falls (n=5 falls) than SS (n=14 falls) or UC (n=15 falls) groups (χ2=5.60, p=0.06). Post-hoc tests indicated that TC had significantly fewer falls than UC (χ2=4.29, p=0.04); while there was no significant difference between TC and SS (χ2=2.61, p=0.11), or SS and UC (χ2=0.29, p=0.59) groups.

    Conclusion: Our data suggest that a 12-week Yang-style TC intervention decreases fall rates among stroke survivors. Future studies examining the effectiveness of TC as a fall prevention strategy are recommended.

  •  | February 1, 2013 5:00AM

    Background: Stroke survivors fall up to seven times more annually than healthy adults of a similar age. The inability to recover balance from slipping, tripping, or rapid ambulation accounts for the majority of falls, while balance control can prevent falls. An examination of the triggers for falls and balance recovery strategies for near falls is crucial for fall prevention in stroke survivors.

    Purpose: To examine the self-reported triggers for falls and balance recovery strategies for near falls among community-dwelling stroke survivors.

    Methods: Descriptive study examining fall-related data from stroke survivors (n=89) aged ≥ 50 years, at ≥ 3 months post-stroke, participating in a 12-week exercise intervention study. All subjects were interviewed weekly to ascertain fall/near fall data over the 12 weeks. Falls were defined as: “events in which subjects end up on the floor or ground when they did not expect to.” Near falls were defined as: “events in which subjects recovered their balance without falling.”

    Results: Subjects (46% women) were on average 70±10 years old. The majority reported an ischemic stroke (80%), were White/European-American (79%), married/partnered (60%), college-educated (79%), and retired/unemployed (93%). Over the 12-week trial, there were a total of 124 fall-related events (n=34 falls, n=90 near falls); all events happened at home. Most falls happened due to slipping or tripping (21%) or rapid ambulation (18%). Other reported fall triggers included: legs or knees giving way (12%), bathroom related incidents such as incontinence (12%), reaching or leaning (6%), and vertigo or syncope (3%). Subjects most commonly recovered their balance without falling by grabbing onto or leaning against something (62%). A total of 29 (23%) fall-related events resulted in an injury, though only 8% of those events were evaluated by a healthcare provider.

    Conclusion: Our data suggests that stroke survivors fall most frequently as a result of slipping, tripping or rapid ambulation. Future studies investigating the effects of fall prevention strategies on these fall triggers are recommended. Since balance recovery was aided by grabbing onto or leaning against something, post-stroke home safety evaluation is essential in preventing falls.

  •  | January 24, 2013 5:00AM

    Providing help or support to others buffers the associations between stress and physical health. We examined the function of the neurohormone oxytocin as a biological mechanism for this stress-buffering phenomenon. Participants in a longitudinal study completed a measure of charitable behavior, and over the next two years provided assessments of stressful life events and physician-diagnosed physical ailments. Results indicated that charitable behavior buffered the associations between stressful events and new-onset ailments among individuals with the AA/AG genotypes of oxytocin receptor gene (OXTR) variant rs53576, but not among those with the GG genotype. These results suggest that oxytocin function may significantly affect health and may help explain the associations between prosocial behavior and health. More broadly, these findings are consistent with a role for the caregiving behavioral system in health and well-being.

  • Fatigue in HIV and AIDS: An Analysis of Evidence
     | January 18, 2013 5:00AM

    HIV-related fatigue continues to be the most common complaint of infected people. No physiological factors have been consistent predictors for fatigue; psychosocial factors, particularly depression, have emerged more consistently in studies. While clinicians would want to rule out common causes of fatigue such as hypothyroidism, hypogonadism, or anemia, there is scant research for most interventions, which makes it difficult to make definitive recommendations for their use. Modafinil has the strongest research evidence to date, with multiple studies finding it effective in relieving fatigue. However, researchers must continue to pursue ways to ameliorate fatigue in HIV infection, given the high financial, personal, and social costs suffered by people experiencing it.

  •  | January 16, 2013 5:00AM

    Purpose: Human immunodeficiency virus (HIV)–related fatigue (HRF) is multicausal and potentially related to mitochondrial dysfunction caused by antiretroviral therapy with nucleoside reverse transcriptase inhibitors (NRTIs).

    Methodology: The authors compared gene expression profiles of CD14+ cells of low versus high fatigued, NRTI-treated HIV patients to healthy controls (n = 5/group). The authors identified 32 genes predictive of low versus high fatigue and 33 genes predictive of healthy versus HIV infection. The authors constructed genetic networks to further elucidate the possible biological pathways in which these genes are involved.

    Relevance for nursing practice: Genes including the actin cytoskeletal regulatory proteins Prokineticin 2 and Cofilin 2 along with mitochondrial inner membrane proteins are involved in multiple pathways and were predictors of fatigue status. Previously identified inflammatory and signaling genes were predictive of HIV status, clearly confirming our results and suggesting a possible further connection between mitochondrial function and HIV. Isolated CD14+ cells are easily accessible cells that could be used for further study of the connection between fatigue and mitochondrial function of HIV patients.

    Implication for Practice: The findings from this pilot study take us one step closer to identifying biomarker targets for fatigue status and mitochondrial dysfunction. Specific biomarkers will be pertinent to the development of methodologies to diagnosis, monitor, and treat fatigue and mitochondrial dysfunction.

  •  | January 7, 2013 5:00AM

    DNA methylation is an epigenomic modification that is essential to normal human development and biological processes. DNA methylation patterns are heritable and dynamic throughout the life span. Environmental exposures can alter DNA methylation patterns, contributing to the development of complex disease. Identification and modulation of environmental factors influencing disease susceptibility through alterations in DNA methylation are amenable to nursing intervention and form the basis for individualized patient care. Here we describe the evidence supporting the translation of DNA methylation analyses as a tool for screening, diagnosis, and treatment of complex disease in nursing research and practice. The ethical, legal, social, and economic considerations of advances in genomics are considered as a model for epigenomic policy. We conclude that contemporary and informed nurse scientists and clinicians are uniquely poised to apply innovations in epigenomic research to clinical populations and develop appropriate policies that guide equitable and ethical use of new strategies to improve patient care.

  •  | January 5, 2013 5:00AM

    The purpose of this study was to determine the relationship between hospital nursing; that is, nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia.  

  •  | January 1, 2013 5:00AM

    The prevalence of loneliness is reported to be as high as 20% for school-age children. The purpose of this paper is to present an integrative review of quantitative studies of loneliness in samples of school age children. Thirty-six articles are included. Three different scales were used to assess loneliness. Loneliness related to negative psychological problems such as anxiety and depression, and to poor academic achievement. The school environment and both peer and family relationships contributed to loneliness. Only one school-based intervention was identified as potentially successful for alleviating loneliness.

  • The Robert Wood Johnson Foundation Nurse Faculty Scholars Program: An opportunity for junior nurse faculty
     | December 26, 2012 5:00AM

    Members of the 2009 RWJF NFS Cohort write about the RWJF NFS experience and benefits for junior nursing faculty. This is a pre-print version of the article which is expected to be printed in April 2013.

  • Rural African Parents' Knowledge and Decisions About Human Papillomavirus Vaccination
     | December 11, 2012 5:00AM

    The purpose of this study is to identify predictors of human papillomavirus (HPV) vaccination among rural African American families.