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Open Access Publications from the University of California

Scholarly Works (65 results)

  • Article
  • Peer Reviewed
UC Irvine Previously Published Works (2008)
    Cover page: Understanding the Health Impact of the September 11th AttacksCreative Commons 'BY' version 4.0 license
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2015)
      Cover page: Psychological Distress and Susceptibility to Cardiovascular Disease Across the Lifespan Implications for Future Research and Clinical Practice∗
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (1990)
      Organizational and technological developments within the health care system have helped consolidate a power structure that dehumanizes clients and fosters defensiveness in professionals. Frequent exposure to death renders health professionals vulnerable to severe anxiety, which they may try to avoid through death denial, leaving them psychologically unable to support dying clients. Professional education, attitudes equating death with professional failure, organizational coping strategies among nurses, and staff burnout interact to perpetuate this atmosphere. As a model for learning, this article analyzes a pediatric case study to illuminate the manifestations of professional defensiveness. Finally, I consider three specific problem-solving strategies: improving morale, opening communication, and expanding professional education to include death studies and psychological study of the health organization. Bringing humanity back into the health care environment is possible to the extent that both the organization and its members are responsive and open to change.
        Cover page: Death and the health professional: Organization and defense in health careCreative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2012)
        Cardiovascular disorders (CVD) are associated with acute and posttraumatic stress responses, yet biological processes underlying this association are poorly understood. This study examined whether renin-angiotensin-aldosterone system activity, as indicated by a functional single nucleotide polymorphism (SNP) in the angiotensin converting enzyme (ACE) gene, is associated with both CVD and acute stress related to the September 11, 2001 (9/11) terrorist attacks. European-American respondents (N = 527) from a nationally representative longitudinal study of coping following 9/11 provided saliva for genotyping. Respondents had completed health surveys before 9/11 and annually for 3 years after, and acute stress assessments 9 to 23 days after 9/11. Respondents with rs4291 AA or TT genotypes reported high acute stress twice as often as those with the AT genotype. Individuals with the TT genotype were 43% more likely to report increased physician-diagnosed CVD over 3 years following 9/11, when the following variables were included in the model: (a) pre-9/11 CVD, mental health, and non-CVD ailments; (b) cardiac risk factors; (c) ongoing endocrine disorders; and (d) significant demographics. The ACE rs4291 TT genotype, which has been associated with HPA axis hyperactivity and higher levels of serum angiotensin converting enzyme (ACE), predicted acute stress response and reports of physician-diagnosed CVD in a national sample following collective stress. ACE gene function may be associated with both mental and physical health disorders following collective stress.
          Cover page: Acute Stress and Cardiovascular Health: Is There an ACE Gene Connection?Creative Commons 'BY' version 4.0 license
          • Peer Reviewed
          UC Irvine Previously Published Works (2017)
            Cover page: The Unintended Consequences of Disaster-Related Media Coverage
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2014)

            Objective

            Stressful life events experienced during childhood and as an adult negatively impact mental and physical health over the life span. This study examined polymorphisms from 2 hypothalamic-pituitary-adrenal axis-related genes previously associated with posttraumatic stress disorder-FKBP5 and CRHR1-as moderators of the impact of child abuse and adult stress on physical health.

            Method

            A national, community-based subsample of non-Hispanic European American respondents (n = 527) from a prospective longitudinal 3-year study of stress and coping (N = 2,729) provided saliva for genotyping.

            Results

            FKBP5 (rs1360780) and CRHR1 (rs12944712) polymorphisms significantly interacted with child abuse and adult stress to predict increases in physical health ailments over 3 years. Child abuse and adult stress were strongly related to physician-diagnosed physical ailments among individuals with the risk alleles of both single nucleotide polymorphisms. Individuals carrying the low-risk homozygotic genotypes were protected from the long-term negative health implications of experiencing both child abuse and adult stress.

            Conclusion

            Consistent with theories linking the hypothalamic-pituitary-adrenal axis with stress-related disease, hypothalamic-pituitary-adrenal axis polymorphism genotypes moderated the association between exposure to child abuse/adult stress and long-term physical health outcomes in a national sample.
              Cover page: FKBP5 and CRHR1 Polymorphisms Moderate the Stress–Physical Health Association in a National Sample
              • Thesis
              • Peer Reviewed
              UC Irvine Electronic Theses and Dissertations (2022)

              Lumbar spine disease accounts for half of all musculoskeletal complaints and is a major contributor to pain and disability. Surgical intervention is often used as the ultimate management modality among patients with complicated spine conditions. Evidence documents a high prevalence of anxiety among patients with this disease process, and patients with anxiety who receive surgical treatment for low back pathology demonstrate worse postoperative outcomes, including more severe pain, higher rates of postoperative delirium, and increased length of hospital stay when compared to those without anxiety. Despite these known disparities, University of California, San Diego – La Jolla (UCSD – La Jolla) does not screen elective lumbar spine surgical patients for anxiety in the postoperative setting, a time when pain and disability are at their most severe. In response, this project introduced anxiety screening among this patient population using the Anxiety domain of the Hospital Anxiety and Depression Scale (HADS-A) on postoperative day one. Those patients who screened positive for anxiety were referred for osteopathic manipulative treatment (OMT), a therapy which has been shown to effectively ameliorate postoperative pain among lumbar spine patients and postoperative anxiety. This project had three outcome measures: (1) participation rate, or the percentage of patients who accepted the screening protocol, (2) anxiety prevalence, or the percentage of patients who screened positive for anxiety on the HADS-A, and (3) OMT consult rate, or the percentage of patients who received OMT prior to discharge. We screened 20 patients over a period of two weeks. We observed a participation rate of 100%, as well as an OMT consult rate of 100%. Among the 20 patients screened, 35% screened positive for anxiety, and an additional 10% screened as borderline abnormal (or having some evidence of anxiety). When considering individual items on the HADS-A, we found that the item with the highest average score was the one that asked after somatic symptoms, which reinforces the role pain plays postoperatively among this patient population. While we cannot extrapolate the results observed in this project due to the limited sample size, the suggestion that a third of postoperative lumbar spine patients may experience anxiety should act as an impetus for ongoing screening.

                Cover page: Anxiety among Adults Undergoing Elective Lumbar Spine Surgery at University of California – San Diego Medical Center – La Jolla
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (1994)
                This paper offers an environmental psychological analysis of child sexual abuse, a pervasive and disruptive societal problem. Earlier analyses of child sexual abuse have emphasized clinical, social, and developmental concepts and methodologies, while neglecting the environmental context of the problem. The proposed conceptualization of child sexual abuse suggests that a broader understanding of the etiology and psychosocial consequences of this problem can be achieved by integrating theoretical constructs drawn from clinical, social, developmental, and environmental psychology. First, some of the key findings and analytical perspectives from earlier studies of child sexual abuse are reviewed and then those findings are linked to a broader analysis of people-environment transactions. This transactional approach emphasizes contextual influences on the etiology and psychosocial outcomes of child sexual abuse, and suggests both clinical and environmental design strategies to reduce the prevalence and disruptive impacts of this problem. © 1994 Academic Press Limited.
                  Cover page: The environmental psychology of child sexual abuseCreative Commons 'BY' version 4.0 license
                  • Thesis
                  • Peer Reviewed
                  UC Irvine Electronic Theses and Dissertations (2022)

                  Background: To optimize patient outcomes and conserve limited inpatient bedspace, the University of California, Irvine Medical Center Emergency Department (UCIMC ED) developed the COVID Observation Protocol, designed to decompress ED overcrowding, inpatient hospital admissions, and 30-day ED revisitations by discharging patients home on home-oxygen therapy. Methods: A retrospective program evaluation was conducted to assess whether the COVID Observation Protocol reduced 30-day ED readmissions and hospital admissions. Data from the electronic health record (EHR) compared patients presenting to the UCIMC ED pre-and post-implementation. Chi-square tests were utilized to compare inpatient hospitalizations, 30-day ED revisitations, and discharge home with home-oxygen therapy. A thematic analysis was conducted based upon an anonymous online survey to assess the role NPs played during the implementation process. Results: 4,049 patients presented to the ED, 48% before December 29, 2020, and 52% after. Thematic analysis yielded four themes: (1) significant issues with overcrowding in the ED; (2) lack of evidence-based research to support the newly implemented protocol; (3) a general lack of resources; and (4) needing coping skills to manage patients during a pandemic. Inpatient hospitalizations and 30-day ED revisitations were lower before implementation, and more patients were discharged home with home-oxygen therapy before protocol implementation. 30-day revisitations were lower among those discharged home on home-oxygen therapy after protocol implementation. Discussion: The goal of this protocol was to decrease and decompress inpatient admissions and reduce 30-day ED revisitations by discharging them home on home-oxygen therapy. While it was hypothesized that the protocol would reduce the number of inpatient hospitalizations after implementation, this project demonstrated the opposite; however, those patients who were discharged on home-oxygen therapy were significantly less likely to return to the ED within a 30-day timeframe. Analysis of the NP interviews demonstrated a stressful environment in which decisions had to be made to prioritize the sickest of patients with access to limited resources and a challenging practice environment in the mobile field hospital. Conclusion: While, on the surface, it appears that the protocol was not successful, a closer examination of the cohort discharged home on home-oxygen therapy after December 29, 2020, demonstrated a significant reduction in 30-day ED revisitations. Despite the number of confounding items, this scholarly project has demonstrated that the updated protocol was successful in reducing revisitation rates and warrants further analysis.

                    Cover page: The COVID Observation Protocol: Evaluating a nurse practitioner implementation in an Emergency Department Observation Unit
                    • Article
                    • Peer Reviewed
                    UC Irvine Previously Published Works (2013)
                    We examined whether the oxytocin receptor gene (OXTR) single nucleotide polymorphism (SNP) rs53576 genotype buffers the combined impact of negative social environments (e.g., interpersonal conflict/constraint) and economic stress on post-traumatic stress (PTS) symptoms and impaired daily functioning following collective stress (September 11th terrorist attacks). Saliva was collected by mail and used to genotype 704 respondents. Participants completed Web-based assessments of pre-9/11 mental health, acute stress 9-23 days after 9/11, the quality of social environments 1 year post-9/11, economic stress 18 months post-9/11, and PTS symptoms and impaired functioning 2 and 3 years post-9/11. Interactions between negative social environments and economic stress were examined separately based on OXTR rs53576 genotype (GG vs. any A allele). For individuals with an A allele, a negative social environment significantly increased PTS symptoms without regard to the level of economic stress experienced. However, for respondents with a GG genotype, negative social environments predicted elevated PTS symptoms only for those also experiencing high economic stress. Gender moderated associations between negative social environments, economic stress, and impaired functioning. The functioning of females was most affected by negative social environments regardless of genotype and economic stress, whereas the functioning of males was differentially susceptible to economic stress depending on OXTR genotype and negative social environments. These findings suggest that it is important to consider the combined impact of gender and ongoing stress in different domains as moderators of genetic vulnerability following collective stress.
                      Cover page: Environmental stress, oxytocin receptor gene (OXTR) polymorphism, and mental health following collective stressCreative Commons 'BY' version 4.0 license
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