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College of Nursing > Faculty Funded Research
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Coronary heart disease (CHD) afflicts nearly 7 million US women annually and remains their leading morbidity and mortality threat. Of these, 2.7 million have a history of myocardial infarction (MI), and an estimated 262,000 women are hospitalized annually with an acute coronary syndrome (ACS). Within a year of a first MI more women than men will die. Compared with men, women with ACS and those after coronary revascularization have longer hospitalizations and higher in-hospital mortality and endure up to 30% more readmissions within 30 days after the index hospitalization. Cardiac rehabilitation (CR) is an essential component of comprehensive care after ACS, is internationally endorsed, is integrated in evidence based guidelines for women and reveals incontrovertible morbidity and mortality benefits. Although referral to CR is designated as a performance measure of healthcare quality after ACS, CR has failed to reach over 80% of eligible women in the last 3 decades. Patient-oriented, medical and healthcare system barriers variably account for poor CR attendance among women. Without health insurance, CR costs about $6000 and even with health insurance, women can endure co-insurance payments of up to $50 for each of the 36 CR sessions ($1800). With an increasing ageing population and increasingly more women living with symptomatic CHD, the effectiveness and accessibility of secondary prevention (SP) health services for these women have never been more important. Alternatives to center-based CR programs are nonexistent. Thus, after hospital discharge women struggle with disease self-management without the knowledge or behavioral skills to effectively improve their risk factors for a subsequent cardiac event. Mobile health (mHealth) technology can deliver evidence-based health information and behavior theory based behavior change strategies to help women engage in self-care to manage their risk factors. A mobile application (app), “HerHeart” is an innovative SP intervention for improving reach, reducing cost and time, and improving health outcomes for women with CHD wherever they live. Empowering women with tailored information, intuitive self-monitoring, and personalized goal setting and feedback will transform SP from a 3-month center-based program to a paradigm of life-long engagement in healthy behaviors.
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MICROBIOME AS POTENTIAL MEDIATOR IN PRETERM INFANT NEURODEVELOPMENT
Tentative Start Date unknown
Tentative End Date unkown
Preterm infants account for 12% of births, but disproportionately account for 40% of children who have cerebral palsy (CP), 25% of children with hearing impairment and 35% of those with vision impairment. Thus optimizing neurodevelopmental outcomes for preterm patients would have significant impact on outcome numbers for all children. Neurodevelopmental potential of the preterm infant is influenced by (i) Gestational age (GA), (ii) events in the neonatal intensive care unit, and (iii) care in the home environment after NICU discharge. This proposal will focus on understanding events that increase or decrease the risk of developmental impairment after an infant has been born preterm at a given gestational age, not on the prior exposures of prenatal and social factors that may have increased the risk of preterm birth. For a given infant, factors that caused preterm delivery are complete and fixed. Our goal is to instead focus on factors that are prospectively modifiable from the time of birth through early childhood in order to optimize a given infant’s neurodevelopmental potential. We will follow infants in two environments through two epochs – the neonatal intensive care unit (NICU) hospital course from birth to discharge and the home environment from NICU discharge through school readiness evaluation at four to six years of age. We will investigate the microbiome as a potential biologic effector of clinical and environmental factors associated with neurodevelopmental outcome in these epochs.
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