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Posted: 5/11/2011

And the Beat Goes On: Promoting Heart Health
Annually, over 1.5 million people die from heart disease in the U.S., many of low income with high blood pressure, high cholesterol, or diabetes.  Despite decades of education, as many as 70% of us don't manage our blood pressure; as many as 80% aren't lowering our cholesterol- or diabetes-related risks, either. What can be done? Nursing research leaders hope the Community Outreach and Cardiovascular Health research study, COACH, will provide badly needed answers. Writing in Contemporary Clinical Trials [May 2011], professor and associate dean for research Jerilyn K. Allen, ScD, RN, FAAN; associate professor Cheryl R. Dennison Himmelfarb, PhD, RN, ANP; assistant professor Sarah L. Szanton, PhD, CRNP; professor and JHSON dean Martha N. Hill, PhD, RN, FAAN, describe the design and rationale for an NIH-funded clinical trial of 525 low-income patients at federally funded health centers. Undertaken with community involvement, the COACH program is a comprehensive, individualized heart disease risk-reduction intervention delivered by a nurse practitioner/community health worker team. The study will determine if the program improves risk factor status among high-risk patients.  In an era of dwindling resources and a shifting health care landscape, the interventions cost effectiveness and sustainability are other hoped-for outcomes. As Allen notes, "By engaging the community and heath centers from the start, this program, if proven clinically and economically effective, can be sustained over time. Nurse practitioners are in a pivotal position to assure safe, effective, patient-centered health care, like that being undertaken in the COACH study. Ultimately, this and other research by faculty of the Johns Hopkins University School of Nursing (JHSON) can make a difference in lowering not only heart disease risk, but also the risks for other chronic illnesses" ["COACH trial: A randomized controlled trial of nurse practitioner/health worker cardiovascular risk reduction in urban community health centers: Rationale and design."]

One Is Not Enough: Combining Strategies Improves Minority Pap Use
The Pap test - the best known way to detect early cervical cancer - saves lives. Yet, Asian American women are among the least likely to have had a recent test. Cervical cancer rates among Vietnamese and Korean American women are the highest in the nation; diagnosis and treatment most often come later, when patients are sicker. Yet, as JHSON associate professor Hae-Ra Han, PhD, RN; professor Miyong T. Kim, PhD, RN, FAAN; and colleagues have found little has been done to improve screening rates for these at-risk women. Their recent meta-analysis, reported in Psycho-Oncology [April 2011], shows that of 750 studies published between 1984 and 2009 and identified for review, only 18 focused on the promotion of Pap tests among significant numbers of ethnic minority women. Close examination of those studies disclosed that the most beneficial interventions are those which open doors - access-enhancing interventions - since many ethnic, minority women lack health insurance. In contrast, mass media educational approaches were not particularly successful. What works best is  implementing multiple strategies, beginning with access. In addition, according to Han, "it seems that culture matters.  Integrating the preferences and values of a particular population into the intervention, perhaps through the use of peer navigators, can help them really hear and heed the Pap test message."  However, she cautions, it will take more research to determine the best package of interventions to help reduce the cervical cancer threat among Asian American women. ["Interventions that increase use of Pap tests among ethnic minority women: A meta-analysis."]

Dad's Behavior Counts in Caregiving, Too
Faced with the same difficult experiences and stresses, some children - resilient children - sail right through; in contrast, others experience serious problems that extend into later life. Working with a multi-site team, JHSON Professor Douglas A. Granger, PhD, Director of the School's Center for Interdisciplinary Salivary Bioscience Research, explored how the psychobiology of stress - evidenced by increases in the stress hormone cortisol- may be implicated in these differences. The team followed a large group of children from birth for more than seven years, exploring parent-child relationships, particularly early adversity and stress in that relationship, on child development and wellbeing. Through their observations, they sought to understand the factors that contribute to individual children's risk or resilience status. While much has been written about the impact of mother's caregiving on child stress and behavior, writing in Developmental Psychology [March 2011], Granger and his team present one of the very first reports on the impact of fathers' parenting style on the development of very young children. Using cortisol levels as a measure of stress and adaptation, they found that like mothers, more involved, engaged fathers make a difference in a child's capacity for resilience. According to Granger, "The capacity for resilience is all about the interplay of the environment, biology, behavior, and relationships. And we've found that nurturing by fathers, as well as by mothers, influences how a child responds to adversity or stress. In turn, those biological responses, may predict a child's risk or resilience in later life."  ["Father Contributions to Cortisol Responses in Infancy and Toddlerhood."]

In Other Nursing Research News
With the growing emphasis on electronic health records in clinical care and practice, JHSON associate professor Patricia Abbott, PhD, RN, BC, FACMI, FAAN, Johns Hopkins Hospital nursing administrator Stephanie S. Poe, DNP, RN, and colleagues report on how peer coaches can help build clinical and technical EHR capacity by front-line nurses. ["Building Nursing Intellectual Capacity for Safe Use of Information Technology." Journal of Nursing Care and Quality, April/June 2011.]  JHSON assistant professor Sarah L. Szanton, PhD, MSN, CRNP, and colleagues have found that lower education is predictive of increased mobility difficulties in older women, a discovery with important outreach and prevention implications. ["Education Predicts Incidence of Preclinical Mobility Disability in Initially High-Functioning Older Women. The Womens Health and Aging Study II," Journal of Gerontology: Medical Sciences, May 2011.]  To help guide expenditure of the Affordable Care Acts Community Living Assistance Services and Supports Plan (CLASS) funds, Szanton joined JHSON professor Laura N. Gitlin, PhD, and others to delineate a series best practices in services, technologies, and  environment to support independent, home-based living for individuals with disabilities. CLASS provides funds to enable people who become disabled get the help they need to remain in their homes and part of their communities. ["Supporting Individuals with Disability Across the Lifespan at Home: Social Services, Technologies and the Built Environment, ACA CLASS Program Technical Assistance Brief," Spring 2001, downloadable at www.theSCANFoundation.org.]