Use of Electronic Health-Related Datasets in Nursing and Health-Related Research.

Datasets of gigabyte size are common in medical sciences. There is increasing consensus that significant untapped knowledge lies hidden in these large datasets. This review article aims to discuss Electronic Health-Related Datasets (EHRDs) in terms of types, features, advantages, limitations, and possible use in nursing and health-related research. Major scientific databases, MEDLINE, ScienceDirect, and Scopus, were searched for studies or review articles regarding using EHRDs in research. A total number of 442 articles were located. After application of study inclusion criteria, 113 articles were included in the final review. EHRDs were categorized into Electronic Administrative Health-Related Datasets and Electronic Clinical Health-Related Datasets. Subcategories of each major category were identified. EHRDs are invaluable assets for nursing the health-related research. Advanced research skills such as using analytical softwares, advanced statistical procedures, dealing with missing data and missing variables will maximize the efficient utilization of EHRDs in research.

Community outreach and engagement strategies from the Wisconsin Study Center of the National Children's Study.

The purpose of this methods article was to describe and evaluate outreach and engagement strategies designed to initially build county-wide awareness and support for the National Children's Study (NCS or the study) and subsequently to target the segment communities where recruitment for the study occurred. Selected principles from community outreach, social marketing, and health care system and personal referral formed the foundation for the strategies. The strategies included a celebration event, community advisory board, community needs assessment, building relationships with health care providers and systems, eliciting a network of study supporters, newsletters, appearances at local young family-oriented events (health fairs, parades), presentations to local community leaders, community forums, "branding" with assistance from a women-owned local marketing firm, and mailings including an oversized, second-touch postcard. Six months after study launch, approximately 4,600 study-eligible women were asked in a door-to-door survey if and how they became aware of the study. On average, 40% of eligible women reported being aware of the study. The most frequently cited strategy to cultivate their awareness was study-specific mailings. Awareness of the NCS increased by 7.5% among those receiving a second-touch postcard relative to controls (95% CIs [4.9, 10.7] z = 5.347, p < 0.0000, d = 0.16). Community outreach and engagement strategies, in particular the oversized postcard as a second-touch effort, may be used effectively by researchers for participant recruitment and by public health nurses for delivery of important population-focused messages.

Laboratory-confirmed, health care-associated bloodstream infections in Jordan: a matched cost and length of stay study.

BACKGROUND: No studies have been carried out in Jordan to examine length of stay (LOS) and extra cost associated with health care-associated bloodstream infections (HCABSIs). This study aims to estimate the extra LOS and cost associated with HCABSIs among adult hospitalized Jordanian patients. METHODS: Five-year data were retrieved from 1 large university-affiliated hospital in Jordan. Matched case-control design was used in this study. Cases were determined based on confirmed positive blood culture after 48 hours of admission. Matching criteria were age (±5 years), gender, admission diagnosis, and LOS in comparison group equal to the LOS (±5%) before blood culture for the case group. RESULTS: Of the total 445 infected patients 125 (28.1%) were matched with uninfected patients. The mean LOS after infection for cases was 12.1 days (standard deviation [SD] = 17.2) compared with 8.3 (SD = 7.9) days for the controls (P = .02). The total mean inflation-adjusted charges for cases was M (mean) = US $7,426, SD = $7,252 compared with M = $3,274, SD = $4,209 for controls, P < .001. Using multiple regression modeling, LOS after acquiring HCABSIs, admission to critical care units, and being infected with HCABSIs were significant predictors of patients' total charges. CONCLUSION: Figures generated from this can be used to inform health care researchers, policy makers, and professionals about the impact of HCABSIs.

Length of stay and charges associated with health care-acquired bloodstream infections.

BACKGROUND: Although many studies have examined outcomes of health care-associated bloodstream infections (HCABSIs), population-based estimates of length of stay (LOS) and costs have seldom been reported. OBJECTIVES: Our objective was to generate US national estimates of LOS and costs associated with HCABSIs using the 2003 National Inpatient Sample (NIS). METHODS: This study utilized a matched case-control design to estimate LOS and costs associated with HCABSIs based on the 2003 (NIS). A special set of ICD-9-CM codes was used to identify cases. A 1:1 matching procedure was used in which HCABSIs in patients were matched with uninfected patients based on age, sex, and admission diagnosis. We performed weighted analysis to construct population estimates and their standard deviations for LOS and total charges. RESULTS: After applying the case finding criteria, 113,436 HCABSI cases were identified. The weighted mean LOS for HCABSIs cases was 16.0 days compared with 5.4 days for the control group (P < .001). The weighted mean total charges for patients with HCABSIs were $85,813 ($110,183 US in 2010) compared with $22,821 ($29,302 US in 2010) for uninfected patients (P < .001). We estimated that, in 2003, HCABSIs potentially cost the US economy nearly $29 billion ($37.24 billion US in 2010). CONCLUSION: This study estimated the economic burden of HCABSIs on the US national economy. With some modifications, the annually published NIS data could be useful as a national surveillance tool for health care adverse events including HCABSIs.

Laboratory confirmed health care-associated bloodstream infections: A Jordanian study.

BACKGROUND: Few studies have been conducted in Jordan related to health care associated bloodstream infections (HCABSIs). This study aims to examine epidemiology of HCABSIs among hospitalized adult patients in Jordan. METHODS: A cohort study (N=570; 445 confirmed HCABSIs, 125 uninfected patients) with a nested 1:1 matched case-control design (n=125 in each group) was used based on data from one large referral hospital in Jordan over a period of 5 years. HCABSI cases were determined based on confirmed positive blood culture after 48h of admission. The case-control analyses (n=250 per group) matched on gender, age, same admission month and unit. RESULTS: The overall incidence and mortality rates were 8.1 and 5.8 per 1000 admissions, respectively. Four-variable and three-variable multivariate models were proposed to explain the risk of HCABSIs in the matched analyses .The four-variable model consists of blood product (OR=24.5), invasive procedures (OR=4.3), renal failure (OR=9.2), and presence of other infections (OR=21.6). The three-variable model consists of recipient of blood product (OR=19.7), invasive procedures (OR=4.5), and renal failure (OR=9.4). CONCLUSIONS: This study is a pioneer study that examined risk factors, the associated HCABSIs in Jordan. Results from this study can be used to influence infection control plans in Jordan.

Environment and obesity in the National Children's Study.

We describe the approach taken by the National Children's Study (NCS) to understanding the role of environmental factors in the development of obesity. We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including gene-environment and gene-obesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.

Environment and Obesity in the National Children's Study / Ambiente e obesidade no National Children's Study

We describe the approach taken by the National Children's Study (NCS) to understanding the role of environmental factors in the development of obesity. We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including geneenvironment and geneobesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.

Descrevemos a abordagem do National Children's Study (NCS) para entender o papel dos fatores ambientais no desenvolvimento da obesidade. Revisamos a literatura a respeito de duas hipóteses principais no NCS que se relacionam a origens ambientais da obesidade e descrevem estratégias que serão utilizadas para testar cada hipótese. Apesar de estar claro que a obesidade em um indivíduo é resultado de um desequilíbrio entre consumo e gasto de energia, o controle da epidemia de obesidade requer o entendimento de fatores no ambiente moderno e exposições químicas que podem ter a capacidade de interromper a ligação entre o consumo e gasto de energia. Através da aceitação da abordagem do curso de vida a epidemiologia, o NCS será capaz de estudar as origens da obesidade da preconcepção ao final da adolescência, incluindo fatores que vão da herança genética a comportamentos individuais, passando pelo ambiente social, construído e natural e exposições químicas. O estudo terá poder estatístico suficiente para examinar as interações entre essas influências múltiplas, incluindo interações entre gene-ambiente e gene-obesidade. Um benefício secundário importante será derivado do banco de espécime para análise futura.

Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003.

BACKGROUND: Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported. OBJECTIVE: The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample. METHODS: This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and case-fatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI. RESULTS: The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6%. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical ventilation (OR, 4.97), trauma (OR, 1.98), hemodialysis (OR, 4.83), and malnutrition (OR, 2.50). The total maximum rescaled R(2) was 0.22. CONCLUSIONS: The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.

Environment and obesity in the National Children's Study.

OBJECTIVE: In this review we describe the approach taken by the National Children's Study (NCS), a 21-year prospective study of 100,000 American children, to understanding the role of environmental factors in the development of obesity. DATA SOURCES AND EXTRACTION: We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. DATA SYNTHESIS: Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. The NCS is the largest prospective birth cohort study ever undertaken in the United States that is explicitly designed to seek information on the environmental causes of pediatric disease. CONCLUSIONS: Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including gene-environment and gene-obesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.

Addressing childhood overweight: strategies learned from one Latino community.

The purpose of this study is to understand one Latino community's perspective about childhood overweight within this high-risk ethnic group. Three focus groups, consisting of 12 mothers, 12 fathers, and 8 boys and 4 girls ages 10-12, participated. Transcripts of interviews were coded using N-VIVO and analyzed thematically. Several themes emerge: parents' demanding work schedules, lack of time, transportation issues, opportunities for physical activities, and lack of meal preparation. Participants knew good nutrition and exercise help prevent obesity. Nursing interventions must address multiple challenges with childhood obesity at the family and community levels.

Childhood obesity: the infancy connection.

The prevalence of overweight has risen to 19% in children aged 6 to 11 years and 17% in adolescents aged 12 to 19 years. This paper examines gestational and infancy factors that influence the risk of overweight in childhood. Important factors to eliminate the infancy connection to childhood obesity include the following: (a) maternal lifestyle patterns, (b) infant feeding transitions, and (c) environmental factors. Prevention efforts need to focus on practice, research, and public policy.

Challenges and successes of infusing environmental health content in a nursing program.

Environmental health has received minimal attention in nursing curricula over the past decade, despite efforts by the Institute of Medicine (1995) and others to advance the environmental health agenda in nursing education, practice, and research. This paper describes an initiative that was first funded as a part of the Environmental Health Scholars Program in 2000 to incorporate environmental health into master's and undergraduate nursing programs at one university. Evaluation of this initiative highlights the challenges and successes experienced in this academic setting. A number of recommendations based on this experience and the literature are offered. There is a perceived need to define the critical body of knowledge and skills in environmental health and to develop tools to enable educators and practitioners to apply this knowledge in public health nursing and other specialty practices. In tandem, opportunities and incentives are needed to encourage faculty development and the infusion of environmental health into existing curricula. Changes are also needed across practice settings to proactively address environmental health issues so that environmental health becomes and remains an integral part of nursing.

Using a site visit to a contaminated location as a focus for environmental health education for academic and public health nurses.

We describe a conference initiative that is distinguished by the use of a "community case study" to increase the knowledge and skills of nursing faculty and public health nurses in environmental health and to provide networking support to facilitate infusion of environmental health into nursing curricula and public health nursing practice. The Institute of Medicine's (1995) general environmental health competencies for nurses provided the conference framework. Woburn, Massachusetts, a Superfund site, served as the community case study to illustrate a complex environmental health problem. Over an extended period of time, Woburn was contaminated with multiple chemicals that eventually contaminated the drinking water supply; a cluster of childhood leukemia cases was linked subsequently to the Superfund site contaminants. A 6-hr interpreted walking and bus tour of the Superfund site enabled us to visit the premises of responsible parties, the vapor extraction fields, the capped Well H in the wooded wetlands, and to tour the affected neighborhood. This intensive, hands-on approach to learning environmental health content and skills that incorporated multiple learning strategies serves as a model for developing future conferences for public health nurses and nursing faculty.

The National Children's Study and the children of Wisconsin.

Prospective, multi-year epidemiologic studies such as the Framingham Heart Study and the Nurses' Health Study have proven highly effective in identifying risk factors for chronic illness and in guiding disease prevention. Now, in order to identify environmental risk factors for chronic disease in children, the US Congress authorized a National Children's Study as part of the Children's Health Act of 2000. Enrollment of a nationally representative cohort of 100,000 children will begin in 2008, with follow-up to continue through age 21. Environmental assessment and examination of biomarkers collected at specified intervals during pregnancy and childhood will be a major component of the Study. Recruitment at 105 sites across the United States is planned, and will begin at 7 Vanguard Centers in 2008, including Waukesha County, Wis. The National Children's Study will provide information on preventable risk factors for such chronic diseases as asthma, certain birth defects, neurobehavioral syndromes, and obesity. In addition, the National Children's Study will provide training in pediatric environmental health for the next generation of researchers and practitioners.

The National Children's Study Waukesha County, Wisconsin Vanguard Center.

The National Children's Study (NCS) is a large, longterm study designed to detect environmental influences on the health and development of children. Waukesha County, Wisconsin, was selected as 1 of 7 "Vanguard Centers" currently funded to finalize and lead the implementation of the study protocol. The authors provide an overview of key design and planning processes that will be used at all NCS Vanguard locations, the specific approaches to be used in the NCS Waukesha County Vanguard Center, and information about how Wisconsin physicians and other health care professionals can become involved in working with the NCS.

Smoking-related health behaviors of employees and readiness to quit: basis for health promotion interventions.

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.

Identifying at risk nursing home residents using a polydipsia screening tool.

Persons diagnosed with schizophrenia are considered at risk for polydipsia, a potentially life-threatening condition characterized by excessive consumption of fluids. This study examined the demographic and health-related characteristics of nursing home residents with psychiatric diagnoses (N = 70) who reside in a 92-bed facility. The prevalence of polydipsia and behavioral characteristics and symptoms as measured by a 17-item polydipsia screening tool also were described. Patients who screened positive for polydipsia (36%) exhibited behaviors that included incontinence, smoking, frequent voiding, and preference for fluid over food. A polydipsia screening program could minimize morbidity and mortality associated with this fairly prevalent condition.

Assault of long-term care personnel.

The purpose of this study was to explore contributing factors, consequences, and solutions to assault of long-term care personnel. The study sample consisted of three focus groups composed of certified nursing assistants and administrators employed in long-term care facilities within a large Midwestern city. Using content analysis methodology, multiple themes emerged: worker attitude, vulnerability, work culture, job tasks, training, working short-staffed, financial concerns, changes in social values and health care, community crime, substance abuse, accepting assaults, coworker threats, issues of retaliation, professional withdrawal, and inability to share experiences. Preventive measures suggested by the participants are consistent with those recommended by the Occupational Safety and Health Administration. Implications for staff and administrators include both personal and workplace strategies. Recommendations include implementing more comprehensive violence prevention programs that includes conflict management and training tailored to the type of residents.

Workplace homicides in Chicago. Risk factors from 1965 to 1990.

Using data from police records, this study examined risk factors related to 940 workplace homicides occurring in Chicago between 1965 and 1990. Black men were predominantly both victims (49%) and offenders (75%). The median age for victims was 42 years, but only 25 years for offenders. Women (40%) were more likely than men (6%) to be killed by intimates. Firearms were involved in 83% of all homicides, and robbery was the primary motive (62%). Workplace homicides occurred most frequently in taverns (22%). Alcohol use by tavern workers was involved in 48% of the homicides. Wide disparity in the number of workplace homicides occurred in Chicago's 77 community areas. Strategies to deter robbery and alcohol use, as well as to prevent domestic violence in the workplace, need to be implemented and evaluated. Occupational health nurses play a pivotal role in effective violence prevention.