Increasing diversity in the nursing workforce has been cited as key to decreasing long-standing health disparities in the United States. [1][2][3] Yet, Black, Hispanic/ Latinx, Native American, and Asian American nurses remain inadequately represented in the health care workforce. 4 Most recent data from the 2018 National Sample Survey of Registered Nurses (RNs) show that White, non-Hispanic RNs accounted for 73.3% of the RN workforce, followed by Hispanic/Latinx (10.2%), Black non-Hispanic/Latinx (7.8%), Asian non-Hispanic/Latinx (5.2%), and American Indian or Alaska Native non-Hispanic/Latinx (0.3%) RNs. 5 Although the number of underrepresented minority (URM) nurses in the US workforce has increased over time, these figures are not reflective of the demographic characteristics of the US population. 4,6,7 Mounting evidence shows that nursing workforce diversity is essential to the provision of high-quality care and culturally effective care. 1,8,9 This is particularly important in light of the coronavirus disease-2019 (COVID-19) pandemic, which has disproportionately impacted Black, Hispanic/Latinx, and Native American communities-further magnifying existing health disparities among these groups. 5,[10][11][12] Therefore, assessing factors associated with success for URM students in nursing is an essential step toward removing barriers that hinder nursing workforce diversity and developing interventions that enhance successful academic outcomes (eg, retention) for this group.Graham et al 13 conducted an integrative literature review from 1985 to 2015 that focused on examining facilitators and barriers to success among URMs and highlighted academic factors that may affect retention in the nursing program. The authors identified specific barriers to students' success, including faculty practices and interaction with peers. To expand on this body of literature, our systematic review sought to appraise the current literature to provide a more current understanding of barriers and facilitators to

ObjectiveThe study objective was to examine predictors of sleep disturbance and strain among caregivers of persons living with dementia (PLWD).MethodsThis cross-sectional study utilized a sample of community-dwelling older adults and their family caregivers drawn from the 2017 National Health and Aging Trends Study and National Study of Caregiving. Multivariable logistic regression was used to assess the association between caregiver and PLWD characteristics and a composite measure of caregiving strain. High caregiving strain was defined as a total score of ≥ 5 on the 6 caregiving strain items (e.g., emotional difficulty, no time for self). We used multivariable proportional odds models to examine predictors of caregiver sleep-related outcomes (trouble falling back to sleep and interrupted sleep), after adjusting for other caregiver and PLWD factors.ResultsOf the 1,142 family caregivers, 65.2% were female, 15% were Black, and 14% were Hispanic. Average age was 60 years old. Female caregivers were more likely to report high level of strain compared to male caregivers (OR: 2.61, 95% CI = 1.56, 4.39). Compared to non-Hispanic Whites, non-Hispanic Black and Hispanic caregivers had reduced odds of reporting greater trouble falling back asleep [OR = 0.55, CI (0.36, 0.82) and OR = 0.56, CI (0.34, 0.91), respectively]. The odds of reporting greater trouble falling back asleep was significantly greater among caregivers with high blood pressure vs. caregivers without high blood pressure [OR = 1.62, CI (1.12, 2.33)].ConclusionIn this cross-sectional study, caregivers with greater sleep difficulty (trouble falling back asleep) were more likely to report having high blood pressure. We found no racial/ethnic differences in interrupted sleep among caregivers to PLWD. These results suggest that interventions to improve sleep among caregivers to PLWD may decrease poor cardiovascular outcomes in this group.

BackgroundThe World Health Organisation (WHO) recommends skin-to-skin contact at birth as part of the essential newborn care processes that can help improve breastfeeding behaviours in new mothers. In 2019 Nigeria had the highest number of infant mortalities (270,000 infant deaths), second only to India (522,000 infant deaths). Consequently, the possible benefits of skin-to-skin contact and healthy breastfeeding behaviours to both mother and child cannot be overemphasised. This study seeks to understand the rate of skin-to-skin contact post-birth and how this affects early breastfeeding initiation, breastfeeding duration, and exclusive breastfeeding among Nigerian women. It also seeks to understand if the place of delivery or internet access affects the associations between skin-to-skin contact and breastfeeding behaviours. MethodsData from the Demographic and Health Survey (2018) on Nigerian women were analyzed, and 19,328 women were included in this study. The association between skin-to-skin contact post-birth (independent variable) and breastfeeding initiation, exclusive breastfeeding, and breastfeeding duration (dependent variables) were analyzed with multivariable logistic regression models adjusted for known confounders. The modifying effects of place of delivery and internet use were also assessed. ResultsNearly 13% of Nigerian women experienced skin-to-skin contact post-birth. The odds of exclusive breastfeeding were higher for women who experienced skin-to-skin contact with their newborns, compared to those that did not (odds ratio, OR=1.24, 95% confidence interval, CI=1.13-1.36). Conversely, the odds of initiating breastfeeding within the first hour of birth (OR=0.87, 95% CI=0.79-0.96) were lower in women who experienced skin-to-skin contact post-birth. There was no association between skin-to-skin contact and breastfeeding duration. Delivering their baby in private hospitals modified the association between skin-to-skin contact and early breastfeeding initiation (OR=3.27, 95% CI=2.33-4.60, P<0.001), as well as the association between skin-to-skin contact and breastfeeding duration (OR=1.56, 95% CI=1.14-2.15, P=0.008) more strongly than delivering their baby in public hospitals. ConclusionsIn Nigerian women, skin-to-skin contact post-birth is associated with some breastfeeding behaviours (early initiation and exclusive breastfeeding). However, associations between skin-to-skin contact and breastfeeding behaviours of early breastfeeding initiation and breastfeeding duration may be modified by the place of delivery. Therefore, health interventions to increase skin-to-skin contact practices should target skilled health providers, particularly in public hospitals.Placing a newborn baby on its mother's bare chest immediately after birth, 1 for an hour or till their first feed (skinto-skin contact), 2 is classified as an early essential newborn care by the World health Organisation (WHO). 3 It is also part of the WHO's 'Ten steps to successful breastfeeding' found in the 'Baby-Friendly Hospital Initiative' 2...

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Utilization of hospice for end-of-life care is known to be lower among racial and ethnic minority groups than among White populations when controlling for other socioeconomic factors. Certain patient, provider, and community characteristics may influence home-hospice use. We sought to identify patient, provider, and community factors associated with home-hospice use. Our final analytic sample included 1,208,700 hospice patients who received home-hospice from 2,148 Medicare-certified hospice providers in 2016. We found that an increase in the proportion of hospice patients with a primary diagnosis of dementia decreased the odds that home-hospice was provided (OR = 1.42, 95% CI = 1.36-1.48). Patients who received hospice care from a provider with a higher proportion of dually enrolled patients were less likely to receive home-hospice (OR = 1.42, 95% CI = 1.36-1.48) and hospices located in ZIP-codes with higher proportion of Hispanic resident were less likely to provide home-hospice (OR = 1.00, 95% CI = 0.99-0.99). Additional research is needed to clarify the mechanisms underlying these associations.

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The end-of-life period of individuals with Alzheimer disease and related dementias receiving home health care (HHC) is understudied. We sought to describe characteristics of HHC patients with Alzheimer disease and related dementias at risk of death within a year, based on clinician assessment. We conducted a secondary data analysis of a 5% random sample of the Outcome and Assessment Information Set data set for the year 2017. We used Outcome and Assessment Information Set-C item M1034 to identify HHC patients with overall status of progressive condition leading to death within a year. Multivariable logistic regression model was used to examine the association between sociodemographic, functional, clinical, and caregiving factors and likelihood of decline leading to death within a year, as identified by HHC clinicians. Clinician perception of decline leading to death within a year was higher for Whites (vs Blacks or Hispanics) (odds ratio [OR], 0.74 [95% confidence interval (CI), 0.69-0.80], and OR, 0.63 [95% CI, 0.57-0.69], respectively). Factors associated with increased odds of decline leading to death within a year included daily pain (OR, 1.11 [95% CI, 1.06-1.17]), anxiety daily or more often (OR, 1.58 [95% CI, 1.49-1.67]), shortness of breath (OR, 1.45 [95% CI, 1.34-1.57]), use of oxygen (OR, 1.60 [95% CI, 1.52-1.69]), disruptive behavior (OR, 1.26 [95% CI, 1.20-1.31]), and feeding difficulty (OR, 2.25 [95% CI, 2.09-2.43]). High symptom burden exists among HHC patients with Alzheimer disease and related dementias identified to have a status of decline leading to death within a year.

BackgroundThere are important racial and geographic disparities linked with obesity and diabetes in the USA. Latinx residing in rural areas face a unique combination of factors that can exacerbate existing healthcare disparities, increasing the prevalence of diabetes. MethodsQualitative study using focus groups was carried out between November 2014 and February 2015. The six focus groups were evenly split between Miami (Miami-Dade) and Pensacola (Escambia County) both in Florida. A total of 57 Latinx, 40 years and older, were recruited for a 60-minute session. Baseline demographic and clinical information were collected using a questionnaire before starting the focus group. Open-ended questions recorded participants' perceptions about obesity and diabetes and barriers to health care. Theme analysis was conducted for each question and across the groups. ResultsWhile most Hispanics understood that diabetes is a serious disease, neither those in Miami nor Escambia understood the difference between type 1 and 2 diabetes. Those in Miami had more knowledge about its long-term effects and expressed less language, communication and cultural barriers compared to those in Escambia. ConclusionsThere is a need to promote culture-appropriate health education programs geared towards raising awareness about diabetes in both communities but especially in rural communities.