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Posted: 1/14/2009

The Thousand Natural Shocks: Do Environmental Stress, Money Woes, Hurt Older Women's Health? - Today's roller-coaster economy has led countless older adults to worry about making ends meet. Very likely, that financial stress is affecting their health and even shortening their lives. Johns Hopkins University School of Nursing (JHUSON) Assistant Professor Sarah L. Szanton, PhD, RN, and Professor and Associate Dean for Research Jerilyn K. Allen, ScD, RN, FAAN, report in the Journal of Gerontology: Social Sciences (November 2008) that, without regard to race, age, education, absolute income, insurance status and illness, older women expressing greater levels financial stress are 60% more likely to die within five years than their less-financially stressed counterparts. Their longitudinal analysis of 728 women between 70 and 79 years of age, titled "Effect of Financial Strain on Mortality in Community-Dwelling Older Women" also suggests that a woman's perception of financial strain may be a better predictor of mortality than actual income, particularly among African-American women. Szanton notes, "It seems clear that money worries can be a significant social determinant of ill health and even death in later life. If we can help address the sources of the financial strain for older adults, such as the monthly costs of medication and health care, we may be able to help reduce the toll economics takes on life and health."

Financial stress isn't the only cause of stress in older women. A host of social, psychological, and environmental stressors affect mind and body daily. A growing body of research suggests that how the body adjusts to those stresses, and the cumulative effect of a lifetime of those adjustments, can be measured in increased disability and illness in later life, a concept called an allostatic load. Working with the population from the same long-term study of women's health and aging, Szanton, Allen, and their colleagues report in the January 2009 Biological Research for Nursing that this lifetime of work by hormones and the immune system to reset the body to chemical balance in the face of stressful situations may contribute specifically to late-life frailty in older women. Critically, the researchers point out in Allostatic Load and Frailty in the Women's Health and Aging Studies that, while not causal in nature, the association between the allostatic loads lifetime of stressors and late-life frailty is independent of chronic disease, socioeconomic status, race, education, or other factors.
 
Take My Breath Away: Asthma and Urban Violence - Living in a violence-prone, urban neighborhood just might affect a child's asthma management according to JHUSON Associate Professor and public health sleuth Joan E. Kub, PhD, APHN, BC; Professor Arlene Butz, ScD, PNP; and colleagues at the JHU School of Medicine and the University of Maryland School of Pharmacy. Separately, violence and asthma pose risks for urban youth; together, they represent a considerable public health threat. African-American youngsters are 200% more likely to die from asthma than their white counterparts and homicide is the leading cause of death among these youth. Countless other youth and their families witness or fear neighborhood violence. In a 2008 Journal of Community Health article, "The Effect of Violence on Asthma: Are Our Children Facing a Doubled-edged Sword?," Kub and her colleagues examine family exposure to community violence and perceptions of feeling safe as well as children's asthma symptoms and treatments among 231 urban-dwelling caregivers and their children with moderate asthma.  Families with greater exposure to community violence reported more asthma symptoms for their children than families with less exposure, and children who saw violence were less likely to go to their primary care providers. Kub and Butz observed, "By finding ways to reduce environmental barriers to regular asthma care, we can help improve the quality of life and breath for urban young people with asthma and their families and practice better preventive care. The findings suggest that health care providers should evaluate potential violence exposure and tailor care and education accordingly."

When Women Are the Abusers - Most news stories of intimate partner violence (IPV) once termed domestic violence are about women who have been abused by male partners, dates, or friends. But the commission of intimate partner violence isn't just the province of men. According to former JHUSON doctoral student Jessica R. Williams, PhD (08), MPH, RN; JHUSON Associate Professor Joan E. Kub, PhD., APHN, BC; and JHU  Bloomberg School of Public Health doctoral candidate Reem Ghanour, MPA, women of all ages also perpetrate intimate partner violence, and in greater number than commonly believed. The issue simply has not been recognized, reported or studied as frequently or thoroughly as has male IPV. The researchers October 2008 Trauma, Violence and Abuse review article, "Female Perpetration of Violence in Heterosexual Intimate Relationships: Adolescence through Adulthood," combed the literature, evaluated 62 studies of female-initiated heterosexual intimate violence and confirmed that female perpetrated IPV is common among adolescents, college students, and adults. Emotional violence (such as verbal abuse) is most prevalent, followed by physical violence and sexual violence. Williams and Kub suggest some of the IPV may occur in response to victimization by a male partner, date, or friend but significant gaps still remain in our understanding of the factors associated with the use of violence by women. They urge that researchers and clinicians alike begin to assess a woman's role in violent intimate relationships and to design IPV prevention and intervention programs with that issue in mind.

Weigh the Risks and the Needs Before Beginning Campus STD Screening - College students are at particular risk for sexually transmitted diseases (STDs) such as genital herpes (HVS-2), for which rates exceed 10 percent in 10-29 year olds. But should campus health services routinely offer student screening for the often silent HVS-2? Two separately published Journal of American College Health articles (November/December 2008) by JHUSON Assistant Professor Hayley D. Mark, PhD, MPH, RN; recent JHUSON PhD graduate Jessica R. Williams, PhD (08), MPH, RN; and colleagues at the JHU schools of medicine and public health clarify that a screening program demands more than an advertising flier, a site, and a blood draw. In "Serologic Screening for Herpes Simplex Virus Among University Students: A Pilot Study," they report on HVS-2 screening among a convenience sample of 100 sexually active students on a college campus. They found that screen accuracy is a key issue, since false positives were greater than anticipated using a common test, requiring additional more costly tests to ensure accurate results. Further, given the finding of psychosocial problems (social break-ups, depression, and anxiety) and the need for short-term counseling among students testing positive, Mark and her colleagues urge schools to be prepared to provide immediate and follow-up counseling. Their second article, "Recruitment Strategies and Motivations for Sexually Transmitted Disease Testing Among College Students," suggests that outreach for STD screening should neither adopt nor even suggest that individuals are being targeted for screening.  Screening information instead should be transmitted broadly, be both nonjudgmental and informative, and be disseminated by a trusted source, such as the student health center. Mark notes, "If a school wants to undertake screening, it needs to be built on a foundation of student trust in the health care system and the assurance of full confidentiality. Used with caution, our findings can help inform decisions about screening and improve the effectiveness of counseling and follow-up."

Lowering High Blood Pressure Can Make a World of Change - In developing nations pressed for health care funding and resources, diagnosis and treatment of high blood pressure often take a back seat to more immediate health care needs, including HIV/AIDS treatment. In South Africa, where the rate of hypertension is roughly 25% among urban black men and women, that approach may be penny wise and pound foolish, according to JHUSON Dean and Professor of Nursing, Public Health, and Medicine Martha N. Hill, PhD, RN, FAAN; Associate Professor Cheryl R. Dennison, PhD, RN, ANP; and their South African co-researchers. Their study, "Determinants of Target Organ Damage in Black Hypertensive Patients Attending Primary Health Care Services in Cape Town: The Hi-Hi Study" (American Journal of Hypertension, 2008), one of the first of its kind, examines the prevalence of heart and kidney problems among urban black men and women in ongoing treatment for high blood pressure in South Africa. Dennison and Hill discovered that among the study population of individuals already in hypertension treatment, a frightening 61% continue to have uncontrolled high blood pressure; as a result, rates of heart and kidney disease are marked. The reasons? Too many patients seek hypertension treatment only after damage already has accrued; some patients don't comply with recommended treatment regimens over time. Further, overtaxed primary care providers, who focus more on infectious disease such as HIV/AIDS than on chronic noninfectious illness, may not titrate medications adequately or communicate clearly with hypertension patients. Because high blood pressure primarily affects younger black South African men at the height of their earning capacity, the implications of these findings are chilling from both economic and chronic care perspectives. And if this is the best care available for those already diagnosed with hypertension, the future for those with undiagnosed high blood pressure who remain outside the health care system is even more bleak.  "The time is now to attack and treat high blood pressure with the same urgency as HIV/AIDS in South Africa and elsewhere in developing nations," Hill and Dennison urge. "Not only will it benefit millions today and over the long term, but it also can save precious health care dollars in today's challenging and challenged global economy."

Combining Nursing and Health Connectivity for the Greater Good - The rapid expansion of information and communications technology (ICT) around the globe has opened new avenues for nurses to reach out to isolated, medically underserved communities around the world, according to JHUSON Assistant Professor Patricia A. Abbott, PhD, RN, FAAN, FACMI. In "Globalization and Advances in Information Communication Technologies: The Impact on Nursing and Health" (Nursing Outlook, September/October 2008) Abbott and a colleague describe how nurses must seize the opportunity to work on the frontlines of global health technology. They describe specific ways in which the combination of ITC and nursing can make a difference in primary care with the growing use of smart phones and texting for health in frontier areas, and the increasing influence of both electronic health records and telehealth. Abbott notes, ITC can help us provide health information and desperately needed health services to very remote areas around the world, from refugee camps in Sub-Saharan Africa to Inuit outposts in the Arctic Circle. In the hands of skilled nurses, ICT is helping us save lives by closing the gap between what we know and what we do by speeding delivery of vital health information into the hands of those who care. Given President-elect Obama's strong advocacy for digitized health care, nursing has a remarkable opportunity to serve the greater good by using ICT to improve both health and health care at home and around the world.