Application of the Toxic Stress Schema: An Exemplar for School Nurses.

For many children of color, the cumulative impact of pre-existing stressors, disparities, and pandemic-related losses has contributed to a toxic level of stress. Toxic stress can disrupt healthy brain development making children vulnerable to physical and mental health problems. School nurses are the primary health professionals who interact with children daily during the academic year, which positions them to identify risk factors within the social determinants of health that contribute to the development of toxic stress. The Toxic Stress Schema (TSS) provides a framework for assessment and care planning related to social determinants of health and potential sources of stress and/or buffering support for the physical and mental well-being of children. A case study approach is used to demonstrate the application of the TSS to school nursing and provide the basis for conceptualizing a plan of care and identifying resources to support the child's physical and mental health.

Parental Self-Efficacy in New Mothers Predicts Infant Growth Trajectories.

The purpose of this study was to examine whether parental self-efficacy (PSE) is associated with change in infant weight-for-length z score (WLZ) from age 3 to 12 months. Data were drawn from the Infant Care, Feeding, and Risk of Obesity study, conducted with low-income, African American mother-infant dyads (n = 127). PSE was measured at infant age of 3 months. Infant anthropometrics were measured at infant age of 3 and 12 months, WLZ change between these time points was calculated, and infants stratified into WLZ change categories (expected, excessive, or slow). To analyze the data, ANCOVA, multiple regression, and post hoc techniques were used. Controlling for infant birthweight, PSE at 3 months was associated with infant WLZ change (η2 = 0.05, p = .04). Mothers of infants who exhibited excessive growth had higher PSE than mothers of infants who exhibited slow growth (Tukey-adjusted p = .03). This finding suggests that infants of mothers with high PSE may have increased obesity risk, but more research is needed.

Decreasing Adverse Events in Pediatric Patients With End-Stage Renal Disease.

Children with end-stage renal disease (ESRD) are at a higher risk of adverse events when they live at a distance from a pediatric facility with specialty services specific to the disease process. At a children's hospital in the southeast, a dialysis unit provides care for 27 patients with chronic ESRD. Nineteen of the 27 patients live more than 1 hour away from the children's hospital. Over the past 3 years, adverse events have occurred in patients being treated at another hospital. These adverse events included sepsis, bacterial and fungal infections, and compromised residual glomerular filtration rate because of the administration of nephrotoxic medications. The purpose of this article is to describe the findings from an improvement effort aimed at decreasing adverse events in the pediatric patient population with ESRD who require urgent or emergent care using an emergency room dialysis card as a communication tool for patients, families, and providers.

Self-efficacy, infant feeding practices, and infant weight gain: An integrative review.

It has been suggested that self-efficacy specific to parenting or feeding may influence the decisions parents make regarding infant feeding; however, a review of this topic has not been conducted. The purpose of this integrative review is to synthesize the literature regarding the potential role of self-efficacy in infant feeding practices or infant weight gain. A total of 40 articles were used to guide this review, which were classified into three categories examining an association with self-efficacy (1) breastfeeding; (2) infant feeding practices such as parental feeding style and dietary quality; and (3) infant weight gain. Evidence regarding breastfeeding self-efficacy (BFSE) and breastfeeding is extensive; mothers with a higher sense of BFSE more often initiate breastfeeding and breastfeed for longer durations. The evidence regarding self-efficacy and the association with infant feeding practices other than breastfeeding is sparse. However, several studies report that mothers who have a higher sense of self-efficacy are more likely to follow infant feeding practices which align with recommendations. The authors have speculated an association between self-efficacy and infant weight gain; yet, to date, no study has found a significant association. More research is needed on the topic, particularly in diverse populations and with fathers and mothers.

Perceptions of Brain Health and Cognition in Older African Americans and Caucasians With HIV: A Focus Group Study.

As people age with HIV, cognitive problems may become more prevalent and severe, but lifestyle behaviors (i.e., physical activity) have been shown to protect brain health and cognition. We examined the perceptions that older adults living with HIV have about protecting and improving brain health and cognition through lifestyle behaviors. Qualitative data were analyzed from four focus groups (N = 30) of African Americans and Caucasians living with HIV and at least 50 years of age. An open-coding scheme using conventional content analysis was employed. Two results were found. First, many older adults with HIV in our study expressed a variety of cognitive complaints that interfered with daily function. Second, these participants reported few specific ideas about how such health behaviors were important to their own brain health and cognition. Education interventions may help older adults with HIV learn to improve and protect brain health and cognition as they age.

Feedback on a Multimodal Cognitive Intervention for Adults Aging With HIV: A Focus Group Study.

Nearly 50% of adult persons living with HIV (PLWH) experience HIV-associated neurocognitive disorder (HAND), which is associated with deteriorating brain health and cognitive functioning. Multimodal interventions that simultaneously improve physical activity, nutrition, and sleep hygiene may be of value for adult PLWH, especially as they age and become vulnerable to HAND. We used four focus groups of PLWH (N = 30; ages ≥ 50 years) to solicit feedback about Cognitive Prescriptions, a multimodal cognitive intervention. Lifestyle and health behaviors pertaining to Cognitive Prescriptions were assessed, including: (a) physical activity, (b) mental activity, (c) nutrition, (d) social engagement, (e) emotional health, (f) sleep hygiene, and (g) substance use. When presented a template of the intervention, participants expressed favorable opinions and remarked they would want to work with a clinician, paraprofessional, or peer to implement such a program into their own daily routines. From this, implications for practice and research are provided.

Never-pregnant African American adolescent girls' perceptions of adolescent pregnancy.

Despite the decrease in adolescent pregnancy rates, rates among African American girls remain higher than other racial/ethnic adolescent groups. This descriptive qualitative study explored never-pregnant African American adolescent girls' perceptions about adolescent pregnancy. Sixty-four participants participated in individual interviews and focus groups. Individual interviews examined beliefs about adolescent pregnancy and perceptions of life changes resulting from becoming pregnant during adolescence. Focus groups were held to validate findings from the interviews. Participants agreed that becoming pregnant during adolescence would negatively impact their education, family, and peers. Participants anticipated feelings of shame and embarrassment in the event that they became pregnant.

Early adolescent African American girls' perceptions of virginity and romantic relationships.

BACKGROUND: Nationally, African American (AA) girls aged 15 to 19 have the highest incidence of Chlamydia, gonorrhea, and syphilis compared to White and Hispanic girls of the same age group. To address this STI epidemic, it is imperative to target AA girls during early adolescence and before sexual debut. According to the 2011 National Youth Risk Behavior Survey, approximately 7% of AA girls initiate sex prior to age 13. The purpose of this descriptive, qualitative study was to explore AA girls', aged 12 to 14, perceptions about virginity and relationships and how those perceptions influence their decisions to engage in or abstain from sexual activity. METHODS: A convenience sample of 64 participants was recruited through community-based organizations in Alabama. Data were collected using individual interviews and focus groups. Individual interview focused on (1) values and beliefs about being a virgin, (2) choosing boyfriends, and (3) perceptions about good and bad relationships. Focus groups were held to validate findings from interviews. Verbatim transcripts of audiotapes, observation notes, and demographic data were primary data for analysis. Content analysis was used in analysis and interpretation of qualitative data to formulate meaningful categories, themes, and patterns. The qualitative research software, QSR N-Vivo®, was used to code and sort data into categories. The SPSS statistical software was used to conduct descriptive analyses to describe the study sample. RESULTS: Mean age of study sample was 12.9 years. Out of 64participants, 5 reported having engaged in sexual activity. Mean age of sexual debut was 13 years. Common themes that emerged included: respecting myself, ideal boyfriend, characteristics of a romantic relationship. CONCLUSIONS: Findings from this study suggest STI prevention programs should build upon the values related to virginity to promote delaying sexual activity. Furthermore, findings suggest the need for education about healthy relationships.

The moderating effect of sexual pressure on young urban women's condom use.

The purpose of this study was to examine whether women's experiences of sexual pressure moderated the relationship between sexual empowerment determinants and condom use in a sample of 100 high-risk women, ages 19-25. Five sexual empowerment determinants of condom use were identified from the literature: HIV knowledge, self-esteem, condom self-efficacy, positive attitudes toward condom use, and condom negotiation skills. Linear and logistic regression analyses revealed that positive attitudes toward condom use and condom negotiation skills were significant predictors of condom use. These relationships, however, were moderated by sexual pressure. Findings indicate that women's experiences with sexual pressure have the potential to decrease the likelihood of condom use, even though other sexually protective behaviors may be exhibited.