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Article ; Online: Is everything really okay?: Using ecological momentary assessment to evaluate daily co-fluctuations in anxiety and reassurance seeking.

Meyer, Allison E / Silva, Susan G / Curry, John F

2023 Volume 171, Page(s) 104429

Abstract: Objective: Reassurance seeking, a behavior prominent in anxiety disorders and depression, is associated with poorer quality of interpersonal relationships and acts as a mechanism of stress generation. However, little research has elucidated momentary ... ...

Abstract	Objective: Reassurance seeking, a behavior prominent in anxiety disorders and depression, is associated with poorer quality of interpersonal relationships and acts as a mechanism of stress generation. However, little research has elucidated momentary associations between state anxiety and reassurance seeking behaviors. Method: In a sample of 104 university-affiliated young adults, we sought to replicate cross-sectional associations of reassurance seeking with trait anxiety (Aim 1) and intolerance of uncertainty (Aim 2). We then used ecological momentary assessment (EMA) to evaluate concurrent fluctuations in daily anxiety and reassurance seeking across 14 consecutive days (Aim 3). Hierarchical multi-level models for intensive longitudinal data were used to evaluate the relationship between state anxiety and daily reassurance seeking. Results: In baseline analyses, trait anxiety and intolerance of uncertainty were significantly associated with greater trait reassurance seeking, controlling for depression. Analyses of the EMA data showed that daily reassurance seeking behaviors fluctuated concurrently with daily anxiety during the 14 days, while controlling for trait anxiety and depression. Conclusion: Given evidence of concurrent fluctuations between state anxiety and reassurance seeking, the behavior should be considered as a potential target in treatment for anxiety disorders.
MeSH term(s)	Young Adult ; Humans ; Ecological Momentary Assessment ; Cross-Sectional Studies ; Anxiety Disorders/therapy ; Anxiety/therapy ; Interpersonal Relations
Language	English
Publishing date	2023-11-10
Publishing country	England
Document type	Journal Article
ZDB-ID	211997-3
ISSN	1873-622X ; 0005-7967
ISSN (online)	1873-622X
ISSN	0005-7967
DOI	10.1016/j.brat.2023.104429
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Article ; Online: Nurse practitioner satisfaction with in-person versus telehealth chronic care delivery.

Ibemere, Stephanie O / Silva, Susan G / Affronti, Mary Lou / Masese, Rita / Tanabe, Paula

Journal of the American Association of Nurse Practitioners

2024 Volume 36, Issue 3, Page(s) 160–170

Abstract: Background: The widespread use of telehealth and regulatory changes that enhanced nurse practitioner (NP) practice authority because of the SARS-CoV-2 pandemic offers an opportunity to assess postpandemic NP satisfaction with telehealth care delivery ... ...

Abstract	Background: The widespread use of telehealth and regulatory changes that enhanced nurse practitioner (NP) practice authority because of the SARS-CoV-2 pandemic offers an opportunity to assess postpandemic NP satisfaction with telehealth care delivery and perceptions of its feasibility compared with in-person visits. Purpose: Outpatient chronic care delivery satisfaction and preference were compared among NPs who provide care to adults through in-person and/or telehealth visits and examined NP demographic and clinical characteristics associated with overall satisfaction by care delivery type. Methodology: Data were collected using a cross-sectional, descriptive design through online dissemination of The Care Delivery Satisfaction Survey to a nationally representative sample of 586 NPs. Results: Compared with NPs using both visit types to deliver care, NPs delivering care in-person only had significantly lower satisfaction scores for interpersonal manner ( p = .0076) and communication ( p = .0108). NPs using telehealth only had significantly higher overall satisfaction and satisfaction subscale scores (all p < .01) compared with NPs using both visit types. Overall, 77% of NPs using both visit types preferred in-person delivery. Conclusions/implications: NPs delivering telehealth care only were more satisfied with chronic care delivery than NPs using both delivery types. NPs using both types were more satisfied with interpersonal manner and communication compared with NPs delivering in-person care only. Most NPs using both types preferred in-person care delivery. Given increased telehealth use, health systems, academic institutions, and insurance companies can use these study findings to inform policy on telehealth resources and infrastructure.
MeSH term(s)	Adult ; Humans ; Cross-Sectional Studies ; Delivery of Health Care ; Telemedicine ; Surveys and Questionnaires ; Nurse Practitioners
Language	English
Publishing date	2024-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2716317-9
ISSN	2327-6924 ; 1745-7599 ; 2327-6886 ; 1041-2972
ISSN (online)	2327-6924 ; 1745-7599
ISSN	2327-6886 ; 1041-2972
DOI	10.1097/JXX.0000000000000964
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Zs.A 2909: Show issues

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Article ; Online: Psychosocial stressors associated with frailty in community-dwelling older adults in the United States.

Shakya, Shamatree / Silva, Susan G / McConnell, Eleanor S / McLaughlin, Sara J / Cary, Michael P

Journal of the American Geriatrics Society

2024 Volume 72, Issue 4, Page(s) 1088–1099

Abstract: Background: Frailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocial ... ...

Abstract	Background: Frailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocial stressors, determine psychosocial stressors contributing to frailty, and explore the mediating psychosocial stressors pathway. Methods: This cross-sectional study involved 7679 community-dwelling older adults (≥65) from the Health and Retirement Study (2006 and 2008 waves). Psychosocial stressors such as loneliness, low subjective social status, financial strain, poor neighborhood cohesion, everyday discrimination, and traumatic life events were measured. Frailty was defined by the Fried phenotype measure. Multivariable logistic regressions were used to examine the association of gender, race/ethnicity, and education with psychosocial stressors, psychosocial stressors associated with frailty, and the mediating psychosocial stressors pathway. Results: Females experienced greater financial strain but lower discrimination (both p < 0.05). Older adults who identified as Hispanic, Black, and racially or ethnically minoritized experienced low subjective social status, high financial strain, low neighborhood cohesion, and high discrimination than their White counterparts (all p < 0.05). Those with lower education experienced high loneliness, low subjective social status, high financial strain, low neighborhood cohesion but lower traumatic life events (all p < 0.05). Psychosocial stressors: High loneliness, low subjective social status, high financial strain, and low neighborhood cohesion (all p < 0.05) independently increased the odds of frailty. The mediating pathway of psychosocial stressors was not significant. CONCLUSION: Disparities exist in exposure to psychosocial stressors associated with frailty. Multilevel interventions are needed to reduce the influence of psychosocial stressors on frailty.
MeSH term(s)	Female ; Humans ; United States/epidemiology ; Aged ; Frailty ; Independent Living ; Cross-Sectional Studies ; Residence Characteristics ; Ethnicity
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18821
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Article: Measure of perceived social support from family, friends, and healthcare providers for Korean adolescents and young adults with cancer.

Son, Heeyeon / Hong, Sungsil / Hong, Michin / Silva, Susan G

Asia-Pacific journal of oncology nursing

2023 Volume 10, Issue 7, Page(s) 100244

Abstract: Objective: Assessing the perceived social support (PSS) that adolescents and young adults (AYAs) with cancer receive from family, friends, and healthcare providers is critical to promoting their adjustment. This study developed a reliable and ... ...

Abstract	Objective: Assessing the perceived social support (PSS) that adolescents and young adults (AYAs) with cancer receive from family, friends, and healthcare providers is critical to promoting their adjustment. This study developed a reliable and comprehensive self-report PSS assessment tool that measures various aspects of social support by translating existing measurements into Korean. Methods: The translation was completed in accordance with international guidelines. To focus on cultural adaptation, the main ideas associated with items were translated to reflect the differences between Western and Eastern culture. In total, 144 Korean AYAs with cancer (mean age: 17 years; 46% female) completed the translated version. A separate principal component analysis (PCA) with an orthogonal quartimax rotation, a minimum eigenvalue of 1.0, and minimum factor loadings of 0.50 was used for each subscale. Cronbach's alpha coefficients were calculated for each PCA-derived subscale. Results: Four subscales with 46 items were identified. Two subscales represented perceived emotional support within the family (PSS-ESF, 14 items) and the AYA's perceived helpfulness within the family (PSS-HWF, 3 items). The third scale represented the perceived support of friends (PSS-Friends, 14 items). The final scale represented the perceived support of healthcare providers (PSS-HCPs, 15 items). Excellent reliability per subscale was demonstrated (Cronbach's alpha: 0.93 for PSS-ESF, 0.73 for PSS-HWF, and 0.92 each for PSS-Friends and PSS-HCPs). Conclusions: A culturally adapted and reliable Korean version questionnaire with four independent subscales was developed. Further assessment of the Korean PSS is required and will contribute to the development of culturally adapted and tailored interventions.
Language	English
Publishing date	2023-05-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2984639-0
ISSN	2349-6673 ; 2347-5625
ISSN (online)	2349-6673
ISSN	2347-5625
DOI	10.1016/j.apjon.2023.100244
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Article ; Online: Patient demographics and clinical characteristics influence opioid and nonopioid pain management prescriptions of primary care NPs, PAs, and physicians.

Nikpour, Jacqueline / Broome, Marion / Silva, Susan / Allen, Kelli D

Journal of the American Association of Nurse Practitioners

2022 Volume 34, Issue 7, Page(s) 883–890

Abstract: Background: Evidence exists on racial and gender disparities in chronic pain management among veterans. Most literature has described physicians' disparate opioid prescribing patterns, although it is unknown if prescribing disparities exist among nurse ... ...

Abstract	Background: Evidence exists on racial and gender disparities in chronic pain management among veterans. Most literature has described physicians' disparate opioid prescribing patterns, although it is unknown if prescribing disparities exist among nurse practitioners (NPs) and physician assistants (PAs) or among prescription of nonopioid analgesic strategies. Purpose: To identify patient characteristics associated with opioid and nonopioid prescriptions among Veterans Affairs (VA) chronic pain patients by primary care physicians, NPs, and PAs. Methodology: We used data from the VA's Survey of Health care Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Outcomes included opioid and nonopioid analgesic prescriptions. Patient characteristics included race/ethnicity, gender, education level, age, and clinical characteristics (comorbidities, self-reported health, and self-reported mental health). Logistic regression was performed to test for associations of patient characteristics with outcomes. Results: Patients who were White, male, age 41-64 years, and with no postsecondary education had higher odds of receiving an opioid prescription (all p -values ≤ .01), whereas patients who were Black, female, and <65 years old had higher odds of a nonopioid prescription (all p -values < .01). Having 5+ comorbidities and fair/poor self-reported health increased the odds of opioid and nonopioid prescriptions (all p -values < .01). Conclusions: Disparities in race, gender, and educational level significantly affect how primary care NPs, PAs, and physicians manage chronic pain. Implications: NPs and other primary care providers should pursue training opportunities to identify and mitigate potential biases that may affect their practice. Future research should take an intersectional lens in examining the source of chronic pain disparities.
MeSH term(s)	Adult ; Aged ; Analgesics, Non-Narcotic ; Analgesics, Opioid/therapeutic use ; Chronic Pain/drug therapy ; Drug Prescriptions ; Ethnicity ; Female ; Humans ; Male ; Middle Aged ; Pain Management ; Physicians ; Practice Patterns, Physicians' ; Prescriptions ; Primary Health Care
Chemical Substances	Analgesics, Non-Narcotic ; Analgesics, Opioid
Language	English
Publishing date	2022-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2716317-9
ISSN	2327-6924 ; 1745-7599 ; 2327-6886 ; 1041-2972
ISSN (online)	2327-6924 ; 1745-7599
ISSN	2327-6886 ; 1041-2972
DOI	10.1097/JXX.0000000000000728
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Zs.A 2909: Show issues

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Article ; Online: Does cumulative psychosocial stress explain frailty disparities in community-dwelling older adults?

Shakya, Shamatree / Silva, Susan G / McConnell, Eleanor S / McLaughlin, Sara J / Cary, Michael P

Archives of gerontology and geriatrics

2023 Volume 113, Page(s) 105055

Abstract: Objective: Frailty is a leading predictor of adverse outcomes in older adults. Although disparities in frailty are well-documented, it is unclear whether psychosocial stressors explain these disparities. This study aimed to examine the potential ... ...

Abstract	Objective: Frailty is a leading predictor of adverse outcomes in older adults. Although disparities in frailty are well-documented, it is unclear whether psychosocial stressors explain these disparities. This study aimed to examine the potential mediating role of psychosocial stress. Methods: This cross-sectional study included 7,679 community-dwelling older adults (≥ 65) from Health and Retirement Study in the US (2006 and 2008). We used six dichotomized psychosocial stressors: a) loneliness, b) discrimination, c) financial strain, d) low subjective status, e) poor neighborhood cohesion, and f) traumatic life events to compute cumulative psychosocial stress. The Fried frailty phenotype defined frailty based on three features: slowness, poor strength, weight loss, fatigue, and low physical activity. Multivariable regressions were used to examine the structural determinants (gender, education, race, and ethnicity) frailty relationship and test whether cumulative psychosocial stress has a mediating role. Results: The frailty prevalence was 22%. Females, Hispanics, Blacks, and those with less education had higher odds of frailty (p<.01). Race and ethnic minorities and non-college graduates experienced greater cumulative psychosocial stress relative to their White and college graduate counterparts (p<.05), respectively. Greater cumulative psychosocial stress was associated with increased odds of frailty (p < .001); however, it did not mediate the structural determinants and frailty relationship. Conclusion: Contrary to expectations, cumulative psychosocial stress did not mediate the relationship between structural determinants and frailty. Rather, high cumulative psychosocial stress was independently associated with frailty. Further research should examine other psychosocial mediators to inform interventions to prevent/delay frailty.
MeSH term(s)	Female ; Humans ; Aged ; Frailty/epidemiology ; Independent Living ; Cross-Sectional Studies ; Ethnicity ; Stress, Psychological/epidemiology ; Stress, Psychological/complications ; Frail Elderly/psychology ; Geriatric Assessment
Language	English
Publishing date	2023-05-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	603162-6
ISSN	1872-6976 ; 0167-4943
ISSN (online)	1872-6976
ISSN	0167-4943
DOI	10.1016/j.archger.2023.105055
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Article ; Online: Structural determinants and cardiometabolic typologies related to frailty in community-dwelling older adults.

Shakya, Shamatree / Silva, Susan G / McConnell, Eleanor S / McLaughlin, Sara J / Cary, Michael P

Archives of gerontology and geriatrics

2023 Volume 117, Page(s) 105171

Abstract: Frailty is a geriatric syndrome linked to adverse outcomes. Co-occurring cardiometabolic factors increase frailty risk; however, their distinct combinations (typologies) associated with frailty are unclear. We aimed to identify subgroups of older adults ... ...

Abstract	Frailty is a geriatric syndrome linked to adverse outcomes. Co-occurring cardiometabolic factors increase frailty risk; however, their distinct combinations (typologies) associated with frailty are unclear. We aimed to identify subgroups of older adults with distinct cardiometabolic typologies and characterize their relationship with structural determinants and frailty to inform tailored approaches to prevent and delay frailty. This study was cross-sectional design and included 7984 community-dwelling older adults (65+ years) enrolled in the Health and Retirement Study (2006 and 2008). Latent class analysis was performed using seven cardiometabolic indicators (abdominal obesity, obesity, low high-density lipoprotein; and elevated blood pressure, blood sugar, total cholesterol, C-reactive protein). Frailty was indicated by ≥3 features (weakness, slowness, fatigue, low physical activity, unintentional weight loss). Logistic regression was used to examine the relationship between structural determinants (gender, race/ethnicity, and education), cardiometabolic typologies, and frailty. Three cardiometabolic subgroups were identified: insulin-resistant (n = 3547), hypertensive dyslipidemia (n = 1246), and hypertensive (n = 3191). Insulin-resistant subgroup members were more likely to be female, non-Hispanic Black, and college non-graduates; hypertensive dyslipidemia subgroup members were more likely to be non-Hispanic Others and report high school education; and hypertensive subgroup members were more likely to be male and college educated (p≤.05). Frailty risk was higher for females, Hispanic or Non-Hispanic Black older adults, and those with lower education (p≤.001). Frailty risk was greater in the insulin-resistant compared to the other subgroups (both aOR=2.0, both p<.001). Findings highlight a need to design tailored interventions targeting cardiometabolic typologies to prevent and delay frailty.
MeSH term(s)	Humans ; Male ; Female ; Aged ; Frailty/epidemiology ; Independent Living ; Frail Elderly ; Cross-Sectional Studies ; Obesity ; Hypertension ; Dyslipidemias ; Insulins ; Geriatric Assessment
Chemical Substances	Insulins
Language	English
Publishing date	2023-08-28
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	603162-6
ISSN	1872-6976 ; 0167-4943
ISSN (online)	1872-6976
ISSN	0167-4943
DOI	10.1016/j.archger.2023.105171
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Article: Influence of Primary Care Provider Type on Chronic Pain Management Among Veterans.

Nikpour, Jacqueline / Broome, Marion / Silva, Susan / Allen, Kelli D

Journal of nursing regulation

2022 Volume 13, Issue 1, Page(s) 35–44

Abstract: Background: Chronic pain disproportionately impacts veterans and is often treated in primary care, where physician shortages in the Veterans Health Administration (VHA) healthcare system are well documented. Nurse practitioners (NPs) may represent a ... ...

Abstract	Background: Chronic pain disproportionately impacts veterans and is often treated in primary care, where physician shortages in the Veterans Health Administration (VHA) healthcare system are well documented. Nurse practitioners (NPs) may represent a solution to the care shortage; however, concerns of NP opioid overprescribing have led to NP practice and prescribing restrictions in individual VHA facilities and at the state level. Little is known regarding the prescribing patterns of NPs and physician assistants (PAs) for veterans with chronic pain in the VHA. Purpose: The purpose of this study was to compare opioid and non-opioid prescribing patterns of physicians, NPs, and PAs for chronic pain patients at VHA centers. Methods: We used data from the U.S. Department of Veterans Affairs Survey of Healthcare Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Patient medical records for the year were analyzed by provider type (physician, NP, or PA) for differences in providers' rates of prescribing opioid and non-opioid medications, as well as characteristics of the opioid prescriptions (e.g., high daily morphine milligram equivalent [90 MME/day] dose, long-term opioid therapy [90 days]). Results: Medical records of a total of 39,936 patients were included. In FY 2016, 55% of patients received one opioid prescription, whereas 83.8% received one non-opioid prescription. Compared to patients of NPs and PAs, patients of physicians had higher odds of receiving opioid (vs. NPs: OR = 1.13, Conclusion: In a national sample of veterans with chronic pain, NPs and PAs did not have higher odds of opioid prescribing. Concerns of NP or PA opioid overprescribing may be addressed by considering evidence that patients of these providers are not at higher odds of receiving an opioid prescription.
Language	English
Publishing date	2022-04-17
Publishing country	United States
Document type	Journal Article
ISSN	2155-8256
ISSN	2155-8256
DOI	10.1016/s2155-8256(22)00032-1
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Article ; Online: Assessing Practice Patterns and Influential Factors for Nurse Practitioners Who Manage Chronic Pain.

Nikpour, Jacqueline / Broome, Marion / Silva, Susan

Pain management nursing : official journal of the American Society of Pain Management Nurses

2021 Volume 22, Issue 3, Page(s) 312–318

Abstract: Introduction: Challenges exist in caring for chronic pain patients, such as preventing opioid-related adverse events, a lack of available non-pharmacologic alternatives, and limitations in prescriptive authority. Nurse practitioners are well-suited to ... ...

Abstract	Introduction: Challenges exist in caring for chronic pain patients, such as preventing opioid-related adverse events, a lack of available non-pharmacologic alternatives, and limitations in prescriptive authority. Nurse practitioners are well-suited to manage chronic pain due to their holistic approach to care and growing numbers in primary care. Yet little is known about the chronic pain care given by NPs. As such, the purpose of this study was to understand the experiences of NPs who manage chronic pain, and to examine how these experiences impact NP prescribing patterns in chronic pain management. Methods: We developed the 31-item NP Chronic Pain Prescribing Practices survey. We collected data from N = 128 NPs at the American Association of Nurse Practitioners (AANP) conference. Pearson chi-square and Fisher's exact tests were utilized for statistical analysis. Results: NPs reported high levels of agreement with nearly all the presented challenges. MSN-prepared NPs were more likely than DNP-prepared NPs to report difficulty in managing pain (x 2 = 4.2, p = .04). There were no differences in prescription of chronic pain therapies between NPs of varying practice authority statuses. NPs in specialty care settings were more likely to utilize opioids (x 2 = 13.6, p < .01), while primary care NPs were significantly more likely to use NSAIDs (x 2 = 13.5, p < .01) and Tylenol (x 2 = 3.9, p = .05). Conclusions: Our findings demonstrate significant challenges NPs face in chronic pain management. More research is needed to better understand the complexities associated with chronic pain care given by NPs in order to effectively manage chronic pain while still preventing opioid-related adverse events.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Chronic Pain/drug therapy ; Humans ; Nurse Practitioners ; Practice Patterns, Physicians' ; Primary Health Care ; Surveys and Questionnaires
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-03-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2213260-0
ISSN	1532-8635 ; 1524-9042
ISSN (online)	1532-8635
ISSN	1524-9042
DOI	10.1016/j.pmn.2021.01.001
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Article: Are There Differences in Marital-Role Quality between Women and Their Male Partners Who Conceived Via IVF and Those Who Did Not?

Cebert, Morine / Silva, Susan / Stevenson, Eleanor L

Journal of best practices in health professions diversity : research, education and policy

2020 Volume 11, Issue 2, Page(s) 135–149

Abstract: Objectives: Marital-role quality (MRQ) is a predictor of mental well-being, sexual intimacy, and maternal attachment. Data on differences in MRQ during pregnancy between women and their male partners who conceived spontaneously or via IVF are ... ...

Abstract	Objectives: Marital-role quality (MRQ) is a predictor of mental well-being, sexual intimacy, and maternal attachment. Data on differences in MRQ during pregnancy between women and their male partners who conceived spontaneously or via IVF are inconclusive. This study compared MRQ across pregnancy in these two groups. Methods: The sample's two groups: (a) 26 women and 26 male partners who conceived via IVF; and (b) 25 women and 20 male partners who conceived spontaneously. All 97 participants completed a MRQ scale during each trimester of pregnancy. Trajectory analyses were conducted to test for between-group differences in the changes in subscales across pregnancy within dyads. Results: Scores did not reveal any significant differences in subscales in those who conceived via IVF compared to non-IVF groups across the three trimesters in each dyad. The observed effect sizes were small, with exception that males in the non-IVF comparison group had greater concerns during the first trimester than did males in the IVF group (Cohen d= 0.51, moderate effect size). Conclusions: Though the IVF population perceives pregnancy differently and experiences more anxiety than those who conceive spontaneously, their marital-role quality during pregnancy does not seem to be affected. Their perceptions before conception and in early parenting are worthy of investigation.
Language	English
Publishing date	2020-07-21
Publishing country	United States
Document type	Journal Article
ISSN	2475-2843
ISSN	2475-2843
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