Hepatitis B knowledge and preventive practices of Chinese American immigrants in Southern California.

PURPOSE: Chinese American immigrants have higher rates of chronic hepatitis B virus (HBV) infections and consequently higher rates of liver cancer compared to the general U.S. POPULATION: The need to assess this vulnerable population's knowledge and health practices is important to prevent HBV infections and improve outcomes. The purpose of this study was to describe HBV knowledge and preventive practices among Chinese American immigrants in Southern California. DATA SOURCES: Convenience sample of 179 Chinese American immigrants age ≥18 years from Los Angeles County (CA) participated in the study by completing a modified version of the B Free CEED's Hepatitis B Needs Assessment survey. CONCLUSIONS: Most participants were knowledgeable of HBV (91.6%) or HBV vaccination (70.5%), yet screening and vaccination for the virus were low (36.9% and 26.3%, respectively). Low knowledge was also found regarding modes of disease transmission. Barriers to engage preventive practices included: "feeling well/no health problems" and "not suggested by a doctor." These findings suggest the need for further education. IMPLICATIONS FOR PRACTICE: Nurse practitioners can play a significant role in assessing risk and implementing programs that are community focused, culturally sensitive, and evidence based to improve knowledge, screening, and preventive behaviors on HBV infections for this vulnerable population.

HFE-associated hereditary hemochromatosis: overview of genetics and clinical implications for nurse practitioners in primary care settings.

PURPOSE: HFE-hemochromatosis is one of the most common genetic disorders in the United States among Caucasians of Northern European ancestry. The purpose of this article is to discuss HFE-associated hereditary hemochromatosis (HH), including the genetics, pathophysiology, phenotype and genotype, diagnostics, and management utilizing a case-based format as an exemplar. DATA SOURCES: Online genetic resources; professional guidelines; review; and scientific articles. CONCLUSION: HFE-HH is an autosomal recessive disorder and two major genes C282Y and H63D are associated with HH (iron overload) susceptibility particularly C282Y/C282Y mutations. It has a variable penetrance and expression. Individuals who develop iron overload may develop broad symptoms, including joint discomfort, fatigue, decreased libido, and abdominal pain; and if left untreated, HFE-HH has the potential of developing end-organ disease including liver fibrosis, cirrhosis, and cancer; cardiac arrhythmias or heart failure; and diabetes. Suspicion of the disorder begins with personal and family history, transferrin saturation, and ferritin levels, and if high, genotyping to confirm the disorder. Management consists of correcting iron overload to prevent/delay end-organ damage often consisting of intermittent phlebotomy. IMPLICATIONS FOR PRACTICE: Knowledge of HFE-HH is essential so that nurse practitioners can identify individuals at risk and to provide appropriate management of care and referral.

5-years later - have faculty integrated medical genetics into nurse practitioner curriculum?

Abstract Many genetic/genomic educational opportunities are available to assist nursing faculty in their knowledge and understanding of genetic/genomics. This study was conducted to assess advance practice nursing faculty members' current knowledge of medical genetics/genomics, their integration of genetics/genomics content into advance practice nursing curricula, any prior formal training/education in genetics/genomics, and their comfort level in teaching genetics/genomic content. A secondary aim was to conduct a comparative analysis of the 2010 data to a previous study conducted in 2005, to determine changes that have taken place during that time period. During a national nurse practitioner faculty conference, 85 nurse practitioner faculty voluntarily completed surveys. Approximately 70% of the 2010 faculty felt comfortable teaching basic genetic/genomic concepts compared to 50% in 2005. However, there continue to be education gaps in the genetic/genomic content taught to advance practice nursing students. If nurses are going to be a crucial member of the health-care team, they must achieve the requisite competencies to deliver the increasingly complex care patients require.

Integration of genomics in cancer care.

PURPOSE: The article aims to introduce nurses to how genetics-genomics is currently integrated into cancer care from prevention to treatment and influencing oncology nursing practice. ORGANIZING CONSTRUCT: An overview of genetics-genomics is described as it relates to cancer etiology, hereditary cancer syndromes, epigenetics factors, and management of care considerations. METHODS: Peer-reviewed literature and expert professional guidelines were reviewed to address concepts of genetics-genomics in cancer care. FINDINGS: Cancer is now known to be heterogeneous at the molecular level, with genetic and genomic factors underlying the etiology of all cancers. Understanding how these factors contribute to the development and treatment of both sporadic and hereditary cancers is important in cancer risk assessment, prevention, diagnosis, treatment, and long-term management and surveillance. CONCLUSIONS: Rapidly developing advances in genetics-genomics are changing all aspects of cancer care, with implications for nursing practice. CLINICAL RELEVANCE: Nurses can educate cancer patients and their families about genetic-genomic advances and advocate for use of evidence-based genetic-genomic practice guidelines to reduce cancer risk and improve outcomes in cancer management.

Pre- and postassessment of nurse practitioners' knowledge of hereditary colorectal cancer.

PURPOSE: This study was part of an educational program conducted to describe nurse practitioners' (NPs') knowledge and perceived comfort level regarding the identification of hereditary colorectal cancer (CRC), specifically Lynch syndrome, also referred to as hereditary nonpolyposis CRC. DATA SOURCES: A 3-h workshop was developed that included a pretest to evaluate NPs' knowledge of hereditary CRC syndromes, educational program focusing on Lynch syndrome, and a posttest knowledge evaluation. Knowledge of hereditary CRC syndromes was assessed via a nine-item multiple choice self-report survey. Forty-two NPs participated in the study. CONCLUSION: Few NPs (39%) reported "comfortable" in identifying red flags "suspect" for Lynch syndrome. Percentage of NPs who responded correctly on each of the pretest items ranged from 17.0% to 57.1% (M = 26.2%; SD = 13.5%; 95% confidence intervals [CI] 14.9%, -37.5%). NPs who responded correctly to the same items after the educational program (posttest) ranged from 53.8% to 95% (M = 80.5%; SD = 15.3%; 95% CI 67.8%, -93.4%). IMPLICATIONS FOR PRACTICE: Genetic testing is widely available for Lynch syndrome. It is important that NPs are cognizant of the syndrome and identify patients at risk for hereditary cancer syndromes so appropriate referral and management can be instituted.

Pre- and posttest evaluation of a breast cancer risk assessment program for nurse practitioners.

PURPOSE: Numerous studies have shown that healthcare providers, including nurse practitioners (NPs) fail to provide breast cancer risk assessment (BrCRA) in primary care settings. A potential barrier to the use of BrCRA is insufficient knowledge or training of risk assessment. The purpose of this study was to analyze the outcome of a BrCRA program developed to enhance NPs' knowledge of risk assessment and use of empiric risk assessment models. DATA SOURCES: Thirty-five NPs participated in a before-after (pretest-posttest design) study evaluating the effectiveness of a BrCRA education program conducted at a national NP conference. Demographics, pre/post knowledge, and course satisfaction measures were all examined as a part of this pilot study. CONCLUSION: Continuing education through the implementation of a BrCRA program significantly increased NPs knowledge in assessing breast cancer risk and the use of empiric risk assessment models. IMPLICATIONS FOR PRACTICE: Many healthcare providers, including NPs, are inadequately prepared to assess a woman's risk for breast cancer. Understanding breast cancer risk assessment is essential if NPs are to provide appropriate counseling, management, and referral strategies needed to reduce a woman's risk for developing the disease. Continuing education provides one means to enhance NP's knowledge of BrCRA.

Patterns of regular use of mammography--body weight and ethnicity: the Multiethnic Cohort.

PURPOSE: To describe the association between body mass index (BMI) and frequency of regular mammography over an approximate 6-year period after controlling for the influence of demographic factors, behavioral factors, and medical history. This association was examined overall and by race/ethnicity in a multiethnic cohort of women including African American, Japanese American, Hispanic, Native Hawaiian, and non-Hispanic White women. DATA SOURCE: Analysis of 81,722 women from the Hawaii and Los Angeles Multiethnic Cohort (MEC) using unconditional logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs) for the association between BMI and regular annual or biennial (every 1-2 years) mammography overall and by race/ethnicity. RESULTS: Overall, 36% of MEC women reported regular annual mammography over an approximate 6-year period of follow-up. African American, Hispanic, and Native Hawaiian women had significantly lower annual and biennial mammography use compared to White women even after controlling for age, education, family history, BMI, menopausal status, and hormone therapy. Women who were overweight (OR = 0.96; 95% CI 0.92-1.01) or obese (OR = 0.88; 95% CI 0.84-0.93) were less likely to have regular annual mammography compared to women of normal weight. Similar findings were noted among women who had mammograms every 1-2 years (biennial). CONCLUSIONS: BMI is associated with the frequency of regular annual and biennial mammography in multiethnic women, especially among women who are overweight and obese. IMPLICATIONS FOR PRACTICE: Culturally sensitive educational strategies that promote healthy behaviors toward regular mammography and maintenance of normal BMI are warranted.

Breast cancer risk elements and nurse practitioners' knowledge, use, and perceived comfort level of breast cancer risk assessment.

PURPOSE: The purpose of this study was to describe nurse practitioners' (NPs') knowledge, use, and perceived comfort level in providing breast cancer risk assessment to women in clinical settings. DATA SOURCES: This descriptive study was part of a needs assessment to determine if education and training programs on breast cancer risk assessment are warranted for NPs. A convenience sample of 147 NPs completed surveys to assess their knowledge of breast cancer risk assessment and use of empiric breast cancer risk assessment tools, and to evaluate their perceived comfort level in assessing women's risk for developing breast cancer. CONCLUSIONS: Assessing women's risk for the development of breast cancer is important in providing primary and secondary preventive strategies such as chemoprevention, lifestyle changes, and enhanced surveillance that may reduce a woman's risk for developing the disease. Although 51.4% of NPs reported providing breast cancer risk assessment, few (37%) reported use of family history or the Gail model (6%) to determine their patients' breast cancer risk. NPs' knowledge of breast cancer risk assessment and use of empiric risk assessment models were low. The majority (71%) of NPs felt uncomfortable or a low level of comfort in conducting breast cancer risk assessment. IMPLICATIONS FOR PRACTICE: Excluding skin cancer, breast cancer is the leading cause of cancer and second leading cause of cancer death among women in the United States. Breast cancer risk assessment is important in identifying women who may be at high risk for developing the disease. At the front line in health care, NPs can play a vital role in assessing women's risk for breast cancer. These findings suggest that education and training may be warranted to enhance knowledge and use of empiric risk models to increase the comfort level of NPs in conducting breast cancer risk assessment to their patients.

Ethnic differences in the use of regular mammography: the multiethnic cohort.

Women's regular use of mammography over a 6 year interval was examined among women aged 45-75 in the Hawaii and Los Angeles Multiethnic Cohort (MEC). The analyses included 81,722 African American, Japanese, Latina, Native Hawaiian, and White females using self-reported mammography history from 1993 to 1998. Ninety-one percent of MEC women reported ever having a mammogram, however only 36% reported regular annual and 48% reported regular biennial mammography over the interval. Mammography was lowest among women who were obese, had a high school education or less, or who were aged 70 and over. Regular mammography use during follow-up was low compared to prior studies reporting on recent mammography. African American, Latina, and Native Hawaiian women had significantly lower annual and biennial mammography use compared to White women even after controlling for age, education, family history, body mass index and hormone therapy indicating that gaps exist in mammography that remain unexplained by known predictors of screening behavior.

Scoping the family history: assessment of Lynch syndrome (hereditary nonpolyposis colorectal cancer) in primary care settings--a primer for nurse practitioners.

PURPOSE: To describe and discuss the characteristic features and red flags of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, that warrants referral for genetic cancer risk assessment (GCRA). A focus on the nurse practitioner's (NP) role in familial risk assessment, physical examination, initiation of genetic referrals, and issues related to the genetic counseling process are also discussed. DATA SOURCES: A review and synopsis of professional guidelines, clinical articles, and research studies on Lynch syndrome and the genetics of inherited cancer syndromes associated with colorectal cancer. Online resources from the American Gastroenterological Association, American Medical Association, the American Nurses Association, the National Comprehensive Cancer Network, the National Cancer Institute, the National Cancer Institute-Physician Data Query, the National Coalition of Health Professional Education in Genetics, the National Human Genome Research Institute, the National Society of Genetic Counselors, International Society of Nurses in Genetics, and the Oncology Nursing Society. CONCLUSIONS: Approximately 5% of all colon cancers are because of a germ line mutation predisposing individuals and their family members to colorectal and other cancers. Although the efficacy of screening modalities is established, healthcare providers often fail to identify those at greatest risk for disease. The extended family history is the first step in recognition of individuals "suspect" for hereditary colon cancers such as Lynch syndrome. Early-age onset of Lynch syndrome-associated cancers, an autosomal-dominant pattern, multiple primary tumors in an individual or multiple family members with Lynch syndrome-associated cancers, characteristic pathological features of colon cancer, or a known germ line Lynch syndrome mutation in a family member are "red flags" that will aid NPs in identifying individuals who may benefit from GCRA. IMPLICATIONS FOR NURSE PRACTITIONER PRACTICE: The importance of enhanced surveillance for early diagnosis and prevention of disease is a critical part of primary care. Thus, it is imperative that NPs obtain a minimum of a three-generation pedigree, recognize hereditary cancer patterns, and provide referral counseling for consideration of genetic testing of individuals suspect for Lynch syndrome.

Integrating genetics into advanced practice nursing curriculum: strategies for success.

Keeping up with the volume of new genetic information emerging from the human genome project is a challenge for almost all healthcare providers, but nurses who received little or no formal genetic training often find it particularly intimidating. Nursing faculty may be reluctant to add genetic content to existing courses, much less tackle the work of teaching an entire course in genetics. This article provides nursing faculty with some strategies and straightforward curriculum modifications to assist them in integrating genetic content into graduate-level nursing curriculum. Advanced Practice Nurses in particular should understand genetics well enough to be aware of and appreciate the wide variety of genetic conditions that might be encountered in a clinical setting. The authors offer practical suggestions for incorporating genetics into Advanced Practice Nursing curricula.

An overview of ethnicity and assessment of family history in primary care settings.

PURPOSE: To discuss the importance of and the nurse practitioner's (NP's) role in the assessment of ethnicity/family of origin in conducting a multigenerational family history in primary care settings. DATA SOURCES: A review of the literature on past research results addressing racial and ethnic disparities and current articles from scientific journals exploring the relationship between race and genetics. Web sites were from the National Institutes of Health, the Human Genome Research Institute, the National Cancer Institute, and the Health and Human Services Minority Health and Disparities report. CONCLUSIONS: The family history has received renewed interest due to the sequencing of the human genome. A multigenerational family history is an important first step in screening for a multitude of disorders impacted by genetic susceptibility, shared environments, and common behaviors. Assessment of the patient's ethnicity/family of origin is an integral part of the multigenerational family history, particularly in the diagnosis of chronic diseases and the assessment of risks for genetic disorders. The multigenerational family history is important in diagnosis, predictive genetic testing, disease prevention, and health promotion. Challenges facing NPs and the utilization of a multigenerational family history in the current U.S. health system include (a) training clinicians on the correct assessment and utilization of a multigenerational family history, (b) assessment of the subtleties of ethnicity and identifying multiple ethnic groups within a family, (c) collection of the family history in a manner that is sensitive to the cultural beliefs of individuals, and (d) avoidance of stereotyping. IMPLICATIONS FOR PRACTICE: Significant advances in genetics and genetic testing requires that NPs be well versed in collecting and interpreting a multigenerational family history to include assessment of the patient/family's ethnicity/family of origin. The ability to effectively conduct and evaluate the individual's and family's health risk through a multigenerational family history will be important in diagnosis, health promotion, disease prevention, and the determination for genetic counseling referral and predictive testing when appropriate. Assessment of risk and prevention of disease is also important in reducing health disparities.

Faculty members' perceptions of medical genetics and its integration into nurse practitioner curricula.

This study assessed faculty members' perceived knowledge of medical genetics concepts and conditions, the importance of integrating this content into NP curricula and how this was being done. During a national NP conference, 40 NP faculty voluntarily completed surveys. Participants' perceived knowledge of genetics varied; 35% noted low or very low knowledge, and only 5% reported high or very high knowledge. Most participants (95%) believed genetics is important, but only 10% reported having separate genetics courses in their NP programs. Approximately half of the participants reported personal involvement in genetics NP education, and 50% reported barriers to implementing it into their curricula. Most faculty indicated they did not feel comfortable teaching genetics, nor did they have formal training in the area. Advancing medical genetics into NP curricula will require ongoing faculty development and training to sustain and build genetics skills and competencies for advanced practice nurses.

Knowledge, perceptions, and attitudes of advanced practice nursing students regarding medical genetics.

PURPOSE: To describe the current medical genetic knowledge and perceptions of graduate advanced practice nursing (advanced practice nurse [APN]/nurse practitioner and nurse anesthetist) students using survey data for future integration of genetic topics, principles, and healthcare issues into curriculum. DATA SOURCES: Survey data of APNs' perceived knowledge of genetics and a review of the literature from past research studies of students and current articles from professional journals and organizations. Web sites were those of the National Coalition of Health Professions for Education in Genetics and National Institutes of Health, Human Genome Research Institute; professional organizations; and the authors' professional, clinical, and educational experiences. CONCLUSIONS: Most APN students perceived they had minimum knowledge and prior training regarding medical genetics. There is a need to integrate genetic concepts, principles, and medical conditions into advanced practice nursing curriculum and to provide clinical experiences in genetic conditions across the life span and throughout the health and illness spectrum. APN students have positive attitudes toward integrating genetics into graduate curricula. Potential methods for program integration include readings, small group discussion, standardized patients, and role-play as measures to increase information. IMPLICATIONS FOR PRACTICE: The National Coalition for Health Profession Education in Genetics, the American Nursing Association, and the American College of Nursing Education have recommended integration of genetics knowledge and skills into routine health care to provide effective interventions for individuals and families. However, previous research and data from this study have revealed that many nurses have minimal training in genetics. Advanced practice nurses must be knowledgeable on genetic principles, topics, and the ethical, legal, and social implications related to medical genetics to increase the ability to diagnose, prevent, and treat diseases and to provide effective care for individuals and families.

What's cooking with garlic: is this complementary and alternative medicine for hypertension?

PURPOSE: To define complementary and alternative medicine (CAM); describe one type of CAM, garlic (Allium sativum L); and discuss its effects on blood pressure as a treatment for hypertension. DATA SOURCES: Literature review from professional journals, abstracts, natural therapy books, and the World Wide Web (Internet). Information from the following professional organizations and agencies: The World Health Organization, Agency of Healthcare Research and Quality, National Cancer Institute, National Center for Complementary and Alternative Medicine, American Botanical Council, and Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. CONCLUSION: Garlic is widely used throughout the world as a CAM. It is one of the most popular herbal products sold in the United States. However, while some studies have shown small positive effects in reducing blood pressure, there are insufficient scientific data to draw conclusions regarding its efficacy on clinical blood pressure outcomes. Thus, healthcare providers should be cautious in recommending this herbal product as an antihypertensive CAM. IMPLICATIONS FOR PRACTICE: CAMs may be used by clients for a variety of conditions including hypertension. Healthcare providers must be cognizant of the use, efficacy, adverse affects, and scientific evidence concerning CAM in order to provide safe and effective practice as well as appropriate and accurate information to their clients.

Assessing ethnicity in preconception counseling: genetics--what nurse practitioners need to know.

PURPOSE: To define and discuss five genetic disorders--Tay-Sachs, sickle cell anemia, Canavan's disease, thalassemia, and cystic fibrosis (CF)--and to explain the importance of the nurse practitioner's (NP's) assessment of clients' ethnicity during preconception counseling, which should address these genetic conditions. DATA SOURCES: Review of literature from professional journals, professional organizations' Web sites, guidelines from the American College of Obstetricians and Gynecologists, the National Institute of Health Consensus Statement, and the authors' professional clinical experience. CONCLUSIONS: The goal of preconception counseling is to identify potential or actual medical, psychological, or social conditions that may affect the mother or fetus. NPs are often the health care providers that initiate preconception counseling to women in varied primary care settings. NPs must be familiar with ethnicity-related inheritable conditions in order to provide appropriate client information and education and to implement testing and, when needed, referral for genetic counseling to individuals and families at risk for genetic disorders such as Tay-Sachs, Canavan's disease, CF, sickle cell anemia, and thalassemia. IMPLICATIONS FOR PRACTICE: NPs providing health care to women of child-bearing age should assess the client's use of contraception and intent for future pregnancy. Preconception counseling when indicated should be initiated to all women to increase their potential for healthy pregnancy outcomes. Although a comprehensive personal, family, medical, and psychosocial history and initiation of folic acid are the mainstays of preconception counseling, assessment for risk of ethnicity-related genetic conditions must also be included in prepregnancy health care.

Factors associated with breastfeeding intentions of African-American women at military health care facilities.

Studies have shown that 21% to 51% of African-American women (AAW) reported breastfeeding, lagging behind Caucasian (61%-71%) and Hispanic (67%-71%) women despite breastfeeding's health benefits. This study aimed to assess AAWs "intent" to breastfeed and describe the relationship among knowledge, age, education, parity, and selected factors of the theory of planned behavior with their intent. The theory of planned behavior assumes intentions are immediate antecedent of behavior. Voluntary surveys of 95 AAW who intended to breastfeed were collected at two U.S. military prenatal clinics. The results were that breastfeeding intent was related to AAW's age, education, and perceived subjective norms (social pressures) and behavioral control (success in breastfeeding); only age and perceived behavior-control best "predicted" breastfeeding intent. Healthy People 2010's objectives are to increase numbers to 75% of women who breastfeed. This study notes the importance of health care providers in promoting AAW to breastfeed by initiating culturally sensitive strategies that enhances AAW's social support and personal confidence toward breastfeeding success.