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Dickerson KJ. Prognostic uncertainty in multiple sclerosis: A concept analysis. J Clin Nurs 2023; 32:633-642. [PMID: 34643008 DOI: 10.1111/jocn.16069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 01/17/2023]
Abstract
AIM To report an analysis of the concept of prognostic uncertainty in patients with multiple sclerosis (MS). BACKGROUND The complexity and ambiguity involved in a diagnosis of MS lead to the occurrence of prognostic uncertainty among patients. A concept analysis is presented that analyses what prognostic uncertainty means to those experiencing the transition between relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis. DESIGN Concept analysis. DATA SOURCES PubMed, Ovid Medline, Cumulative Index for Nursing and Allied Health Literature databases were searched for literature published within the last 10 years using combinations of the terms prognostic and diagnostic uncertainty, and multiple sclerosis along with archival referencing. METHODS The Walker and Avant method was used to analyse the concept of prognostic uncertainty in patients with MS. RESULTS The defining attributes identified that provide additional context to prognostic uncertainty are illness uncertainty, intolerance of uncertainty and progressive dwindling. Related, contrary, model and borderline cases are presented to further discuss the application of the key attributes to the concept. CONCLUSION There are limited data on prognostic uncertainty and multiple sclerosis; however, patients and physicians express uncertainty in understanding one's disease trajectory and determining when a patient with relapsing-remitting multiple sclerosis has entered the secondary progressive multiple sclerosis disease course leading to ineffective communication and frustration. RELEVANCE TO CLINICAL PRACTICE Genetics and genomics have the potential to provide a prognostic factor for addressing the concept of uncertainty as it relates to persons with multiple sclerosis. Moving beyond the concept analysis, a case is made for nurse involvement in genetic and genomic research to conduct trials, translate, and apply these findings to clinical practice and nursing curricula, addressing the uncertainty experienced by those afflicted with chronic illnesses, such as multiple sclerosis.
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Affiliation(s)
- Kelly Jean Dickerson
- University of Missouri - Kansas City, Kansas City, MO, USA.,Children's Mercy, Kansas City, MO, USA
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Milner JJ, Zadinsky JK. Nursing Informatics and Epigenetics: An Interdisciplinary Approach to Patient-Focused Research. Comput Inform Nurs 2022; 40:515-520. [PMID: 35929740 PMCID: PMC9365264 DOI: 10.1097/cin.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- John J. Milner
- Author Affiliation: College of Nursing, Augusta University
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Lee JS, Jaini PA, Papa F. An Epigenetic Perspective on Lifestyle Medicine for Depression: Implications for Primary Care Practice. Am J Lifestyle Med 2022; 16:76-88. [PMID: 35185430 PMCID: PMC8848122 DOI: 10.1177/1559827620954779] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 06/16/2024] Open
Abstract
Depression is the most common presenting mental health disorder in primary care. It is also a major contributor to somatic complaints, worsening of chronic medical conditions, poor quality of life, and suicide. Current pharmacologic and psychotherapeutic approaches avert less than half of depression's cumulative burden on society. However, there is a growing body of research describing both how maladaptive lifestyle choices contribute to the development and worsening of depression and how lifestyle-oriented medical interventions can reduce the incidence and severity of depression. This research, largely derived from an emerging field called epigenetics, elucidates the interactions between our lifestyle choices and those epigenetic factors which mediate our tendencies toward either health, or the onset, if not worsening of disease. The present review highlights how lifestyle choices involving diet, physical activity, sleep, social relationships, and stress influence epigenetic processes positively or negatively, and thereby play a significant role in determining whether one does or does not suffer from depression. The authors propose that medical training programs consider and adopt lifestyle medicine oriented instructional initiatives that will enable tomorrow's primary care providers to more effectively identify and therapeutically intervene in the maladaptive choices contributing to their patients' depression.
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Affiliation(s)
- Jenny Sunghyun Lee
- Jenny Sunghyun Lee, Department of Preventive Medicine, Loma Linda University Medical School, 24785 Stewart Street, Loma Linda, CA 92350; e-mail:
| | - Paresh Atu Jaini
- Department of Preventive Medicine, Loma Linda University Medical School, Loma Linda, California (JSL)
- Department of Psychiatry, John Peter Smith Hospital, Fort Worth, Texas (PAJ)
- Department of Medical Education, University of North Texas Health Science Center, Fort Worth, Texas (FP)
| | - Frank Papa
- Department of Preventive Medicine, Loma Linda University Medical School, Loma Linda, California (JSL)
- Department of Psychiatry, John Peter Smith Hospital, Fort Worth, Texas (PAJ)
- Department of Medical Education, University of North Texas Health Science Center, Fort Worth, Texas (FP)
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Aiello LB. Genomics Education: Knowledge of Nurses Across the Profession and Integration Into Practice. Clin J Oncol Nurs 2018; 21:747-753. [PMID: 29149120 DOI: 10.1188/17.cjon.747-753] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since the completion of the Human Genome Project in 2003, the implications of genetics and genomics for health and illness have become clearer. All nurses, at all levels and across all specialties, must have a basic understanding of genetics and genomics to provide appropriate care.
. OBJECTIVES This article provides an overview of the integration of genetics and genomics into nursing education, as well as continued barriers to nursing knowledge of genetics and genomics.
. METHODS A literature review was conducted using CINAHL®, PubMed, ProQuest, and Google Scholar. Databases were reviewed for literature published from January 1962 to November 2017.
. FINDINGS Although genetic and genomic education has been integrated into undergraduate and graduate nursing curricula, a gap exists in this knowledge among student nurses, practicing nurses, and nursing faculty.
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Parenting stress and DNA methylation among African Americans in the InterGEN Study. J Clin Transl Sci 2018; 1:328-333. [PMID: 29707254 PMCID: PMC5915805 DOI: 10.1017/cts.2018.3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/25/2017] [Accepted: 01/05/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction General life stress has been associated with altered DNA methylation in individuals of African Ancestry, although the relationship between parenting stress and DNA methylation has not been described. The purpose of this study was to examine the relationship between maternal parenting stress and DNA methylation among African Ancestry mother-child dyads. Methods We evaluated epigenome-wide DNA methylation relative to parenting stress in 74 mother-child dyads using linear mixed models. Results Significant variation in maternal DNA methylation at 95 CpG sites was associated with level of parenting stress. Notably, we identified a change in DNA methylation associated with poly (ADP-ribose) polymerase-1, which plays a key role in stress signaling. We did not identify any significant variation in child DNA methylation related to maternal parenting stress. Conclusions However, DNA methylation patterns observed in children mirrored patterns observed in their mothers. The results suggest that differential maternal DNA methylation is associated with higher levels of parenting stress.
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Taylor JY, Sun YV, Barcelona de Mendoza V, Ifatunji M, Rafferty J, Fox ER, Musani SK, Sims M, Jackson JS. The combined effects of genetic risk and perceived discrimination on blood pressure among African Americans in the Jackson Heart Study. Medicine (Baltimore) 2017; 96:e8369. [PMID: 29069027 PMCID: PMC5671860 DOI: 10.1097/md.0000000000008369] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Both genomics and environmental stressors play a significant role in increases in blood pressure (BP). In an attempt to further explain the hypertension (HTN) disparity among African Americans (AA), both genetic underpinnings (selected candidate genes) and stress due to perceived racial discrimination (as reported in the literature) have independently been linked to increased BP among AAs. Although Gene x Environment interactions on BP have been examined, the environmental component of these investigations has focused more on lifestyle behaviors such as smoking, diet, and physical activity, and less on psychosocial stressors such as perceived discrimination.The present study uses candidate gene analyses to identify the relationship between Everyday Discrimination (ED) and Major Life Discrimination (MLD) with increases in systolic BP (SBP) and diastolic BP (DBP) among AA in the Jackson Heart Study. Multiple linear regression models reveal no association between discrimination and BP after adjusting for age, sex, body mass index (BMI), antihypertensive medication use, and current smoking status.Subsequent candidate gene analysis identified 5 SNPs (rs7602215, rs3771724, rs1006502, rs1791926, and rs2258119) that interacted with perceived discrimination and SBP, and 3 SNPs (rs2034454, rs7602215, and rs3771724) that interacted with perceived discrimination and DBP. Most notably, there was a significant SNP × discrimination interaction for 2 SNPs on the SLC4A5 gene: rs3771724 (MLD: SBP P = .034, DBP P = .031; ED: DBP: P = .016) and rs1006502 (MLD: SBP P = .034, DBP P = .030; ED: DBP P = .015).This study supports the idea that SNP × discrimination interactions combine to influence clinically relevant traits such as BP. Replication with similar epidemiological samples is required to ascertain the role of genes and psychosocial stressors in the development and expression of high BP in this understudied population.
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Affiliation(s)
| | - Yan V. Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA
| | | | - Mosi Ifatunji
- Department of Sociology and Carolina Population Center, University of North Carolina, Chapel Hill, NC
| | - Jane Rafferty
- Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Ervin R. Fox
- Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS
| | - Solomon K. Musani
- Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS
| | - Mario Sims
- Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS
| | - James S. Jackson
- Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor, MI
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Aiello LB, Chiatti BD. Primer in Genetics and Genomics, Article 4—Inheritance Patterns. Biol Res Nurs 2017; 19:465-472. [DOI: 10.1177/1099800417708616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the completion of the Human Genome Project, much has been uncovered about inheritance of various illnesses and disorders. There are two main types of inheritance: Mendelian and non-Mendelian. Mendelian inheritance includes autosomal dominant, autosomal recessive, X-linked, and Y-linked inheritance. Non-Mendelian inheritance includes mitochondrial and multifactorial inheritance. Nurses must understand the types of inheritance in order to identify red flags that may indicate the possibility of a hereditary disorder in a patient or family.
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Affiliation(s)
- Lisa B. Aiello
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Lopes-Júnior LC, Carvalho Júnior PM, de Faria Ferraz VE, Nascimento LC, Van Riper M, Flória-Santos M. Genetic education, knowledge and experiences between nurses and physicians in primary care in Brazil: A cross-sectional study. Nurs Health Sci 2016; 19:66-74. [PMID: 27510609 DOI: 10.1111/nhs.12304] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/23/2016] [Accepted: 07/04/2016] [Indexed: 12/28/2022]
Abstract
Recent advances in genomics and related technologies have the potential to improve health care throughout the world. In this cross-sectional study, we examine genetics education, knowledge, and genetics-related experiences among the nurses and physicians who provide primary care in a Brazilian city. Fifty-four healthcare professionals from family health units participated in the study (response rate: 90%). Data were collected using a structured 36-item questionnaire divided into five axes: sociodemographic data and academic background; genetics education; genetics knowledge; genetics-related experiences in family practice; and knowledge regarding the National Policy for Comprehensive Care in Clinical Genetics in the Unified Health System. Although most participants (85.2%) acknowledged receiving some genetic content during their undergraduate education, the majority (77.8%) advised that they did not feel prepared to deliver genomics-based health care in primary care. The results suggest that nurses and physicians often lack the knowledge to provide genomics-based health care in primary care. Therefore, continuing education in genetics/genomics should be provided to primary healthcare professionals in order to enhance family practice and compliance with national policies.
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Affiliation(s)
- Luís Carlos Lopes-Júnior
- Who Collaborating Centre for Nursing Research Development, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Lucila Castanheira Nascimento
- Who Collaborating Centre for Nursing Research Development, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marcia Van Riper
- Chapel Hill School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Milena Flória-Santos
- Who Collaborating Centre for Nursing Research Development, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Lopes-Júnior LC, Olson K, de Omena Bomfim E, Pereira-da-Silva G, Nascimento LC, de Lima RAG. Translational research and symptom management in oncology nursing. ACTA ACUST UNITED AC 2016; 25:S12, S14, S16 passim. [PMID: 27231745 DOI: 10.12968/bjon.2016.25.10.s12] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In recent years, translational research (TR) has become a new approach for bridging basic research and clinical practice. This article examines studies in which the authors used TR to learn more about the underlying causes of selected symptoms, and to discuss these results in the context of cancer nursing and symptom management. A literature review was undertaken, plus critical analysis of the authors. TR conducted by cancer nursing scholars has been relatively limited in the past, but is becoming more common as nurses complete additional academic work in the basic sciences and develop research teams with colleagues of those areas of knowledge. The goal in these studies is to show how a set of variables explains differential interventional effects. The availability of TR provides new evidence for the management of symptoms experienced by individuals with cancer, which could lead to improvements in the care of cancer patients across the world.
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Affiliation(s)
- Luis Carlos Lopes-Júnior
- Oncology Nurse Expert and PhD candidate, Ribeirão Preto College of Nursing - PAHO/WHO Collaborating Centre for Nursing Research Development, University of São Paulo, Brazil
| | - Karin Olson
- Professor, Faculty of Nursing, University of Alberta, Canada
| | | | - Gabriela Pereira-da-Silva
- Associate Professor, Ribeirão Preto College of Nursing and Graduate Program in Basic and Applied Immunology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Lucila Castanheira Nascimento
- Associate Professor, of the Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, Brazil - PAHO/WHO Collaborating Centre for Nursing Research Development, University of São Paulo, Brazil
| | - Regina Aparecida Garcia de Lima
- Full Professor, Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing - PAHO/WHO Collaborating Centre for Nursing Research Development, University of São Paulo, Brazil
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Leach V, Tonkin E, Lancastle D, Kirk M. A strategy for implementing genomics into nursing practice informed by three behaviour change theories. Int J Nurs Pract 2016; 22:307-15. [DOI: 10.1111/ijn.12431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/08/2016] [Accepted: 02/28/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Verity Leach
- PhD Student, Genomics Policy Unit; Faculty of Life Sciences and Education, University of South Wales; Pontypridd Wales UK
| | - Emma Tonkin
- Senior Research Fellow, Genomics Policy Unit; Faculty of Life Sciences and Education, University of South Wales; Pontypridd Wales UK
| | - Deborah Lancastle
- Registered Psychologist, Senior Lecturer in Psychology, School of Psychology, Early Years and Therapeutic Studies; University of South Wales; Pontypridd Wales UK
| | - Maggie Kirk
- Upsilon Xi at large, Professor, Genomics Policy Unit, Past President, International Society of Nurses in Genomics, Faculty of Life Sciences and Education; University of South Wales; Pontypridd Wales UK
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Introduction. Semin Oncol Nurs 2016; 32:1-2. [DOI: 10.1016/j.soncn.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dahlen HG, Downe S, Wright ML, Kennedy HP, Taylor JY. Childbirth and consequent atopic disease: emerging evidence on epigenetic effects based on the hygiene and EPIIC hypotheses. BMC Pregnancy Childbirth 2016; 16:4. [PMID: 26762406 PMCID: PMC4712556 DOI: 10.1186/s12884-015-0768-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/02/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In most high and middle income countries across the world, at least 1:4 women give birth by cesarean section. Rates of labour induction and augmentation are rising steeply; and in some countries up to 50% of laboring women and newborns are given antibiotics. Governments and international agencies are increasingly concerned about the clinical, economic and psychosocial effects of these interventions. DISCUSSION There is emerging evidence that certain intrapartum and early neonatal interventions might affect the neonatal immune response in the longer term, and perhaps trans-generationally. Two theories lead the debate in this area. Those aligned with the hygiene (or 'Old Friends') hypothesis have examined the effect of gut microbiome colonization secondary to mode of birth and intrapartum/neonatal pharmacological interventions on immune response and epigenetic phenomena. Those working with the EPIIC (Epigenetic Impact of Childbirth) hypothesis are concerned with the effects of eustress and dys-stress on the epigenome, secondary to mode of birth and labour interventions. This paper examines the current and emerging findings relating to childbirth and atopic/autoimmune disease from the perspective of both theories, and proposes an alliance of research effort. This is likely to accelerate the discovery of important findings arising from both approaches, and to maximize the timely understanding of the longer-term consequences of childbirth practices.
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Affiliation(s)
- H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751, NSW, Australia.
| | - S Downe
- University of Central Lancashire, Preston, PR3 2LE, Lancashire, UK.
| | - M L Wright
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA.
| | - H P Kennedy
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA.
| | - J Y Taylor
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA.
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Mapping the human genome: Implications for practice. Nursing 2016. [PMID: 26226114 DOI: 10.1097/01.nurse.0000470413.71567.fd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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