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Maternal Role Attainment


The current ANS featured article is titled “The Evolution of Maternal Role Attainment: A Theory Analysis” authored by Bridget J. Frese, PhD, RN, CNM, CNL and My Hanh (Theresa) Nguyen, PhD, PMHNP-BC. This article is available to be downloaded at no cost while it is featured, and there are Continuing Education (Professional Development) units available if you complete the CE test! We also welcome your comments about this article here! The authors have provided the following background about their work, and a slide set presenting the main points of the article.

Brenda Frese
My Hanh (Theresa) Nguyen

I am a certified nurse-midwife and my co-author, My Hanh (Theresa) Nguyen, is a psychiatric mental health nurse practitioner.  Although in different nursing disciplines, our passion overlaps in supporting the mental health of new parents with a focus on maternal mental health.  Underlying this passion is the recognition and understanding of the joys and challenges that happen with the transition of becoming a mother.  Our article is a theory analysis of Reva Rubin’s theory of maternal role attainment (1967) which was updated by Ramona Mercer, who changed the name to the theory of becoming a mother (2004).  Using the theory analysis developed by Walker and Avant (2011), Dr. Nguyen and I highlight the strengths of this important theory as well as offer suggestions to update concepts and language that are inclusive of all people and families. In addition, we offer novel visualizations of Rubin’s and Mercer’s theories as they evolved over time.  The theory of maternal role attainment and becoming a mother is relevant to any nurse who works with patients or clients during this exciting time of growth, development, and transition for families.  This not only includes labor and delivery nurses and midwives, but also prenatal, postpartum, neonatal, pediatric, community health, and psychiatric nurses.  As we continue to learn more and grow our nursing profession, it is important to remember those nurses who have come before us, such as Rubin and Mercer, and continue to keep their work alive and relevant.

Caption: Mercer’s “Becoming a Mother”

  1. Pregnancy: commitment, attachment, and preparation
  2. Birth to 2-6 weeks postpartum: acquaintance, learning, and physical restoration
  3. 2 weeks to 4 months postpartum: moving toward a new normal
  4. Around 4 months: Achievement of the maternal identity
    The process of becoming a mother involves an initial four stages that overlap and move in a linear fashion. The four stages lay a foundation for the continual evolution that continues after the achievement of maternal identity. This process happens in the context of family and friends, who are situated in the larger community, which is situated in society.

Conceptual and methodological Issues in Symptom Cluster Research


The current ANS featured article is titled “Advances in Conceptual and Methodological Issues in
Symptom Cluster Research: A 20-Year Perspective
” authored by Carolyn S. Harris, BSN, RN; Marylin Dodd, PhD, RN; Kord M. Kober, PhD; Anand A. Dhruva, MD; Marilyn J. Hammer, PhD, RN; Yvette P. Conley, PhD; and Christine A. Miaskowski, PhD, RN. The article is available for free download here while it is featured, and we welcome you to read the article and share your comments here. Carolyn Harris shared this message about her work for ANS readers:

Carolyn Harris

My program of research is centered on the identification of phenotypic characteristics and molecular markers that place patients with cancer at increased risk for a higher symptom burden. This research is informed by several years of experience as an oncology nurse where I witnessed firsthand the complexity of effective symptom management. For example, while patients with cancer often report multiple, co-occurring symptoms, these symptoms are often assessed and treated one-by-one. In addition, the symptom experience of these patients is highly variable: with some patients reporting several severe and distressing symptoms and others reporting a lower number of symptoms with lower severity. As described in this paper, symptom cluster research has the potential to address these important clinical issues and improve the symptom experience of patients with a variety of chronic conditions. This paper provides conceptual clarity for the application of two analytical approaches to symptom cluster research and describes novel methods that have recently emerged to facilitate our understanding of symptom clusters.

COP27 Climate Change Conference: Urgent action needed for Africa and the world


This Commentary is being published simultaneously in multiple journals.
See the full list of journals here.  

Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change

The 2022 report of the Intergovernmental Panel on Climate Change (IPCC) paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction, and climate hazards such as heatwaves and floods (1). These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to less than 1.5oC compared with pre-industrial levels.

While the Paris Agreement of 2015 outlines a global action framework that incorporates providing climate finance to developing countries, this support has yet to materialise (2). COP27 is the fifth Conference of the Parties (COP) to be organised in Africa since its inception in 1995. Ahead of this meeting, we—as health journal editors from across the continent—call for urgent action to ensure it is the COP that finally delivers climate justice for Africa and vulnerable countries. This is essential not just for the health of those countries, but for the health of the whole world.

Africa has suffered disproportionately although it has done little to cause the crisis

The climate crisis has had an impact on the environmental and social determinants of health across Africa, leading to devastating health effects (3). Impacts on health can result directly from environmental shocks and indirectly through socially mediated effects (4). Climate change-related risks in Africa include flooding, drought, heatwaves, reduced food production, and reduced labour productivity (5). 

Droughts in sub-Saharan Africa have tripled between 1970-79 and 2010-2019 (6). In 2018, devastating cyclones impacted three million people in Malawi, Mozambique and Zimbabwe (6). In west and central Africa, severe flooding resulted in mortality and forced migration from loss of shelter, cultivated land, and livestock (7). Changes in vector ecology brought about by floods and damage to environmental hygiene have led to increases in diseases across sub-Saharan Africa, with rises in malaria, dengue fever, Lassa fever, Rift Valley fever, Lyme disease, Ebola virus, West Nile virus and other infections (8, 9). Rising sea levels reduce water quality, leading to water-borne diseases, including diarrhoeal diseases, a leading cause of mortality in Africa (8). Extreme weather damages water and food supply, increasing food insecurity and malnutrition, which causes 1.7 million deaths annually in Africa (10). According to the Food and Agriculture Organization of the United Nations, malnutrition has increased by almost 50% since 2012, owing to the central role agriculture plays in African economies (11). Environmental shocks and their knock-on effects also cause severe harm to mental health (12). In all, it is estimated that the climate crisis has destroyed a fifth of the gross domestic product (GDP) of the countries most vulnerable to climate shocks (13). 

The damage to Africa should be of supreme concern to all nations. This is partly for moral reasons. It is highly unjust that the most impacted nations have contributed the least to global cumulative emissions, which are driving the climate crisis and its increasingly severe effects. North America and Europe have contributed 62% of carbon dioxide emissions since the Industrial Revolution, whereas Africa has contributed only 3% (14). 

The fight against the climate crisis needs all hands on deck

Yet it is not just for moral reasons that all nations should be concerned for Africa. The acute and chronic impacts of the climate crisis create problems like poverty, infectious disease, forced migration, and conflict that spread through globalised systems (6, 15). These knock-on impacts affect all nations. COVID-19 served as a wake-up call to these global dynamics and it is no coincidence that health professionals have been active in identifying and responding to the consequences of growing systemic risks to health. But the lessons of the COVID-19 pandemic should not be limited to pandemic risk (16, 17). Instead, it is imperative that the suffering of frontline nations, including those in Africa, be the core consideration at COP27: in an interconnected world, leaving countries to the mercy of environmental shocks creates instability that has severe consequences for all nations. 

The primary focus of climate summits remains to rapidly reduce emissions so that global temperature rises are kept to below 1.5 °C. This will limit the harm. But, for Africa and other vulnerable regions, this harm is already severe. Achieving the promised target of providing $100bn of climate finance a year is now globally critical if we are to forestall the systemic risks of leaving societies in crisis. This can be done by ensuring these resources focus on increasing resilience to the existing and inevitable future impacts of the climate crisis, as well as on supporting vulnerable nations to reduce their greenhouse gas emissions: a parity of esteem between adaptation and mitigation. These resources should come through grants not loans, and be urgently scaled up before the current review period of 2025. They must put health system resilience at the forefront, as the compounding crises caused by the climate crisis often manifest in acute health problems. Financing adaptation will be more cost-effective than relying on disaster relief.

Some progress has been made on adaptation in Africa and around the world, including early warning systems and infrastructure to defend against extremes. But frontline nations are not compensated for impacts from a crisis they did not cause. This is not only unfair, but also drives the spiral of global destabilisation, as nations pour money into responding to disasters, but can no longer afford to pay for greater resilience or to reduce the root problem through emissions reductions. A financing facility for loss and damage must now be introduced, providing additional resources beyond those given for mitigation and adaptation. This must go beyond the failures of COP26 where the suggestion of such a facility was downgraded to “a dialogue” (18). 

The climate crisis is a product of global inaction, and comes at great cost not only to disproportionately impacted African countries, but to the whole world. Africa is united with other frontline regions in urging wealthy nations to finally step up, if for no other reason than that the crises in Africa will sooner rather than later spread and engulf all corners of the globe, by which time it may be too late to effectively respond. If so far they have failed to be persuaded by moral arguments, then hopefully their self-interest will now prevail.

Lukoye Atwoli, Editor-in-Chief, East African Medical Journal; Gregory E. Erhabor, Editor-in-Chief, West African Journal of Medicine; Aiah A. Gbakima, Editor-in-Chief, Sierra Leone Journal of Biomedical Research; Abraham Haileamlak, Editor-in-Chief, Ethiopian Journal of Health Sciences; Jean-Marie Kayembe Ntumba, Chief Editor, Annales Africaines de Medecine ; James Kigera, Editor-in-Chief, Annals of African Surgery; Laurie Laybourn-Langton, University of Exeter; Bob Mash, Editor-in-Chief, African Journal of Primary Health Care & Family Medicine; Joy Muhia, London School of Medicine and Tropical Hygiene; Fhumulani Mavis Mulaudzi, Editor-in-Chief, Curationis; David Ofori-Adjei, Editor-in-Chief, Ghana Medical Journal; Friday Okonofua, Editor-in-Chief, African Journal of Reproductive Health; Arash Rashidian, Executive Editor, and Maha El-Adawy, Director of Health Promotion, Eastern Mediterranean Health Journal; Siaka Sidibé, Director of Publication, Mali Médical; Abdelmadjid Snouber, Managing Editor, Journal de la Faculté de Médecine d’Oran; James Tumwine, Editor-in-Chief, African Health Sciences; Mohammad Sahar Yassien, Editor-in-Chief, Evidence-Based Nursing Research; Paul Yonga, Managing Editor, East African Medical Journal; Lilia Zakhama, Editor-in-Chief, La Tunisie Médicale; Chris Zielinski, University of Winchester.

Correspondence: chris.zielinski@ukhealthalliance.org

References

  1. IPCC. Climate Change 2022: Impacts, Adaptation and Vulnerability. Working Group II Contribution to the IPCC Sixth Assessment Report; 2022.
  2. UN. The Paris Agreement: United Nations; 2022 [Available from: https://www.un.org/en/climatechange/paris-agreement (accessed 12/9/2022)].
  3. Climate change and Health in Sub-saharan Africa: The Case of Uganda. Climate Investment Funds; 2020.
  4. WHO. Strengthening Health Resilience to Climate Change 2016.
  5. Trisos CH, I.O. Adelekan, E. Totin, A. Ayanlade, J. Efitre, A. Gemeda, et al. Africa. In: Climate Change 2022: Impacts, Adaptation, and Vulnerability. 2022 [Available from: https://www.ipcc.ch/report/ar6/wg2/  (accessed 26/9/2022)].
  6. Climate Change Adaptation and Economic Transformation in Sub-Saharan Africa. World Bank; 2021.
  7. Opoku SK, Leal Filho W, Hubert F, Adejumo O. Climate Change and Health Preparedness in Africa: Analysing Trends in Six African Countries. Int J Environ Res Public Health. 2021;18(9):4672.
  8. Evans M, Munslow B. Climate change, health, and conflict in Africa’s arc of instability. Perspectives in Public Health. 2021;141(6):338-41.
  9. S. P. Stawicki, T. J. Papadimos, S. C. Galwankar, A. C. Miller, Firstenberg MS. Reflections on Climate Change and Public Health in Africa in an Era of Global Pandemic.  Contemporary Developments and Perspectives in International Health Security. 2: Intechopen; 2021.
  10. Climate change and Health in Africa: Issues and Options: African Climate Policy Centre 2013 [Available from: https://archive.uneca.org/sites/default/files/PublicationFiles/policy_brief_12_climate_change_and_health_in_africa_issues_and_options.pdf (accessed 12/9/2022)].
  11. Climate change is an increasing threat to Africa2020. Available from: https://unfccc.int/news/climate-change-is-an-increasing-threat-to-africa (accessed 12/9/2022).
  12. Atwoli L, Muhia J, Merali Z. Mental health and climate change in Africa. BJPsych International. 2022:1-4 https://www.cambridge.org/core/journals/bjpsych-international/article/mental-health-and-climate-change-in-africa/65A414598BA1D620F4208A9177EED94B (accessed 26/9/22022).
  13. Climate Vulnerable Economies Loss report. Switzerland: Vulnerable twenty group; 2020.
  14. Ritchie H. Who has contributed most to global CO2 emissions? Our World in Data. https://ourworldindata.org/contributed-most-global-co2 (accessed 12/9/2022).
  15. Bilotta N, Botti F. Paving the Way for Greener Central Banks. Current Trends and Future Developments around the Globe. Rome: Edizioni Nuova Cultura for Istituto Affari Internazionali (IAI); 2022.
  16. WHO. COP26 special report on climate change and health: the health argument for climate action. . Geneva: World Health Organization; 2021.
  17. Al-Mandhari A; Al-Yousfi A; Malkawi M; El-Adawy M. “Our planet, our health”: saving lives, promoting health and attaining well-being by protecting the planet – the Eastern Mediterranean perspectives. East Mediterr Health J. 2022;28(4):247−248. https://doi.org/10.26719/2022.28.4.247 (accessed 26/9/2022)
  18. Simon Evans, Josh Gabbatiss, Robert McSweeney, Aruna Chandrasekhar, Ayesha Tandon, Giuliana Viglione, et al. COP26: Key outcomes agreed at the UN climate talks in Glasgow. Carbon Brief [Internet]. 2021. Available from: https://www.carbonbrief.org/cop26-key-outcomes-agreed-at-the-un-climate-talks-in-glasgow/ (accessed 12/9/2022).

Access to Care


The October – December 2022 issue of ANS (45:4) is just published! The first ANS featured article in this issue is titled “Access Denied: Nurses’ Perspectives of Access to Oncology Care Among Indigenous Peoples in Canada” authored by Tara C. Horrill, PhD, RN; Donna E. Martin, PhD, RN; Josée G. Lavoie, PhD; and Annette S. H. Schultz, PhD, RN. You can download and read this article at no cost while it is featured, and we welcome your comments about this work here! Dr. Horrill shared this information about this work for ANS readers:

Tara Horrill

My program of research centers on health and healthcare inequities in the cancer care sector. The research findings reported in “Access Denied…” represents one component of a multiple methods study that investigated issues of access to cancer care among Indigenous Peoples in Canada, and was the final component of my doctoral dissertation. My interest in issues of inequitable access to cancer care and Indigenous Peoples was born out of my experiences as a clinical oncology nurse, and repeatedly seeing Indigenous patients be diagnosed with advanced cancers, often cancers that we have the ability to detect early and treat. As I started to ask questions of clinicians around me as to why we were seeing these patterns, the responses I received often attributed these late diagnoses to “lifestyle” choices or increased cancer risk. Yet there seemed to be more to the picture that I wasn’t hearing, and I wondered about issues of accessibility, which formed the basis of my dissertation research. The findings reported in this article focus specifically on interviews with oncology nurses to understand their perspectives on the barriers to and facilitators of access to oncology care, which has not yet been explored in existing literature. We were particularly interested in nurses’ perspectives as they provide the bulk of clinical care, daily navigate the tensions between individual patient experiences of illness and suffering and the health system in which they work, and also have experiences of caring for Indigenous patients over time and various practice settings. Nurses provided important insights into many of the challenges surrounding access to oncology care and drew attention to the actual and potential work of oncology nurses in addressing these inequities. It seems the role of nurses is not often considered in relation to healthcare access, however these findings open space to not only see the valuable work being done by nurses, but to consider where and how we, as a profession, could better to confront inequities in access to oncology care for Indigenous Peoples by addressing healthcare access at all levels.

Rethinking Cheating on Written Exams


The current ANS featured article is titled “Redefining Cheating on Written Exams: A Shift Toward Authentic Assessment to Promote Universal Design for Learning in the Context of Critical Caring Pedagogy” authored by Laura A. Killam, MScN, RN; Marian Luctkar-Flude, PhD, RN, CCSNE; Sara Brune, MA, RN; and Pilar Camargo-Plazas, PhD, RN. Please visit the ANS website to download this article at no cost while it is featured, and share our comments about this article here! Laura Killam shared this message about their work:

Nurse educators have a responsibility to prepare students for ethical and safe client care, which is why significant efforts are put into preserving the academic integrity in assessments. We believe that authentic open-book take-home exams are a tool that can be structured and delivered in a way that minimizes cheating possibilities. This article explores how to enact Critical Caring Pedagogy by role modeling integrity during value-based dialogue. In addition we discuss why students may cheat and how educators can design their exams in a way that prevents cheating possibilities (see Figure). We hope that this discussion stimulates discussion and debate around how to create (nearly) cheat-proof authentic exams.

A Student-Centered Approach to Authentic Written Exams

“Sex” and “Gender” in Research Reports in Nursing Journals


The current featured ANS article is titled “An Analysis of the Use of the Terms Sex and Gender in
Research Reported in Nursing Journals
” authored by John R. Blakeman, PhD, RN, PCCN-K and Valentina M. Fillman, PhD, RN. This article is available to download at no cost while it is featured, and we welcome your discussion about the issues raised here on the blog! Dr. Blakeman shared the background related to this work here:

John Blakeman

I learned a tremendous amount of information during my PhD coursework. I can still remember sitting in my Theoretical Basis of Nursing Research course, discussing the importance of defining variables precisely and transparently. My classmates and I agreed that if variables were imprecisely defined, operationalized, or reported, trusting the findings of a particular study is more difficult and muddies the science. It was during this time that I began to think more carefully about the common variables used in research reports. Certain fundamental demographic variables, such as sex and gender, are among the most used variables in all research reports.

At the time, many questions circled my mind, including (but not limited to):

  • Do researchers carefully decide whether they will use sex, gender, or both as variables in their studies?
  • How precisely are sex and gender defined and operationalized in nursing research?
  • How much ambiguity exists in the way that sex and gender are described in research reports?
  • Do researchers understand the difference between sex and gender?

Simultaneously, I was beginning to think about my dissertation study – what variables I would include and how I would define and operationalize these variables. Notably, my dissertation work focused on women’s experience of prodromal myocardial infarction symptoms – those symptoms that occur in the days, weeks, and months before myocardial infarction. Thus, it was especially important for me to think about what I truly meant by women’s experiences… Did I mean biologically female (at least as assigned at birth, based on genitalia)? Did I mean woman, as in a person who identified as a woman, even if their sex assigned at birth was not female? Or did I mean something else?

As a first step in answering the many questions that I had about sex and gender, I undertook a comprehensive literature review, ultimately penning an article titled “Words Matter: Sex and Gender as Unique Variables in Research,” also published in Advances in Nursing Science. This initial paper helped me focus my thinking regarding these two variables, and upon completion of my PhD, I decided to more fully explore how sex and gender were used in the research published in nursing journals.

I collaborated with Dr. Valentina Fillman to conduct the present study. She and I had long discussions about what research questions to include and how best to capture what was “happening” in the nursing literature. Ultimately, we decided that we needed to start at a basic level, given that limited information has been published about how sex and gender are specifically used/reported in research published in nursing journals. We felt that this initial work could point us in new directions moving forward – highlighting areas requiring additional focus or attention.

While I will let the article speak for itself, so to speak, the bottom line is that we found a large amount of ambiguity in the way that sex and gender were defined, used, and reported across the articles included in our study. It is important to note that in some cases it was difficult to know how authors defined or used sex and/or gender, given that reporting was limited. However, even when sex and/or gender were more clearly reported, issues of ambiguity or imprecision were common. In some cases, sex and gender were used interchangeably, and it was difficult to know which of these variables the authors truly measured.

Ultimately, the findings of this study led me to the conclusion that all researchers need to decide with more care a) whether they will use sex, gender, or both as variables in their research, b) how they will define and operationalize these variables, and c) how they will clearly report these variables. As researchers, I think that we sometimes become so focused on defining and measuring outcome variables that we take the demographic or independent variables in a study for granted. Perhaps these demographic variables have become so familiar that we do not give them additional thought. However, I hope that this paper serves to remind us all of the importance of carefully measuring and reporting sex and gender in research.

Visions: The Journal of the society of Rogerian Scholars, to become part of Advances in Nursing Science


Unique Collaboration will Expand Nursing Knowledge Globally 

Advances in Nursing Science (ANS), long recognized as a leader in disseminating nursing knowledge through scholarly publication, will incorporate Visions: The Journal of Rogerian Nursing Science within its pages beginning with the January-March 2023 issue (volume 46, issue 1). This new partnership will immediately provide Visions with increased exposure and reach to an international audience of nurse scholars. Within ANS, the section will be called Visions: Scholarship of Rogerian Nursing Science. It will be branded with a custom logo that will be featured on the title page of the article in each issue. Visions will have a place of pride in ANS as the last article in the issue, long known as one of the first articles that readers turn to in any journal. 

By virtue of this collaboration, articles published in Visions: Scholarship of Rogerian Nursing Science will be indexed in MEDLINE, Scopus, Ovid, and CINAHL. For promotional purposes, Visions: Scholarship of Rogerian Nursing Science can identify the Journal Impact Factor of ANS (currently 2.147) as well as membership in COPE: the Committee on Publication Ethics. Lippincott/Wolters Kluwer will be the publisher of record for Visions: Scholarship of Rogerian Nursing Science. The ISSN for ANS is 0161-9268 (print) and 1550-5014 (online). 

Visions: The Journal of Rogerian Nursing Science was established as the official journal of the Society of Rogerian Scholars in 1993, providing readers with essential knowledge about Martha E. Rogers’ Science of Unitary Human Beings. Visions was founded by Violet M. Malinski, RN; PhD and Sheila Cheema, RN; PhD. The journal has always aimed to assist scholars who are interested in discovering, understanding, and disseminating nursing knowledge related to Rogers’ theory. Advances in Nursing Science has been published since 1978 with a mission to lead scholarly discourse in nursing. Peggy L. Chinn, PhD, RN, FAAN is the founding editor. 

Visions: Scholarship of Rogerian Nursing Science will continue to have its own editor, editorial board, and panel of peer reviewers. These experts in the Science of Unitary Human Beings will ensure that only the most current and comprehensive manuscripts that help improve the understanding of Rogerian science are published in Visions: Scholarship of Rogerian Nursing Science in ANS. 

Manuscripts submitted to Visions: Scholarship of Rogerian Nursing Science should be papers that contribute significantly to a unitary transformative perspective based on Martha E. Rogers’ Science of Unitary Human Beings. Research reports, concept analyses, reviews, and theoretical or philosophic discussion papers are welcome. Guidelines for ANS articles regarding style, presentation, length, formatting, references, tables, figures, supplemental digital content, originality, and permissions apply to articles submitted for Visions: Scholarship of Rogerian Nursing Science. Detailed guidelines for authors are at the ANS website

Revisioning Obesity


The current ANS featured article is titled “Revisioning Obesity in Health Care Practice and Research: New Perspectives on the Role of Body Temperature” authored by Mary Madeline Rogge, PhD, RN, FNP, BC; and Bibha Gautam, PhD, RN, CNE. While it is featured you can download the article at no cost! Here is some background that Dr. Rogge shared for ANS readers:

Mary Madeline Rogge

Our area of interest is obesity, especially the problem of obesity recidivism.  Intensive efforts to promote healthy eating and higher physical activity, alone or in conjunction with pharmacologic agents or surgical interventions, have failed to quell obesity prevalence. Furthermore, decades of research have shown weight loss produced by a negative energy balance, or caloric intake below energy expenditure, is attended by a reduction in the basal metabolic rate that suppresses further weight loss and promotes fat recovery.  This annoying but consistent outcome suggests to us that obesity may serve a functional, protective function.  Furthermore, if excess fat serves a functional purpose, losing weight in obesity that does not resolve the underlying environmental stimulus may exacerbate the biological drive to gain more fat.  Based on this framework, we surveyed the literature in search of antecedents or precursors of weight gain, adipogenesis, or increased fat mass that could explain intractable obesity.

Our research revealed that a major function of adipose tissue is maintenance of core body temperature, and the body’s temperature regulation is highly integrated with body mass and energy expenditure.  White adipose tissue reduces heat loss through the skin, while brown adipose tissue dissipates or disperses heat.  Increasing body temperature activates temperature-sensitive hypothalamic receptors to reduce food intake and simultaneously stimulates brown adipose tissue energy dispersal.  Hypothalamic detection of cooler body temperature stimulates food consumption and lowers energy expenditure.

Other research shows normal body temperature in Americans has declined in men and women over the past century, which could explain the concomitant rise in the population’s adiposity.  Increased exposure to air-conditioning also corresponds to the acceleration of obesity rates during the same time frame.  We also found research that demonstrates exposure to whole-body warm ambient temperature is associated with fat loss in human subjects.

We conclude declining core body temperature and lower ambient temperature may be an important contributor to intractable obesity.  Revisioning clinical obesity as a problem of adaptation to pervasive low ambient temperature offers a new perspective for obesity research and management. 

Prenatal Primary Nursing Care in a Context of Vulnerability


Our current featured ANS article is titled “The Prenatal Primary Nursing Care Experience of Pregnant
Women in Contexts of Vulnerability: A Systematic Review With Thematic Synthesis
” authored by Émilie Hudon, MSc, RN; Catherine Hudon, MD, PhD; Maud-Christine Chouinard, PhD, RN; Sarah Lafontaine, PhD, RN; Louise Catherine de Jordy, MSc, RN; and Édith Ellefsen, PhD, RN. The article is “open access” and available to download on the ANS website. Émilie Hudon shares this background about her work:

Émilie Hudon

My research interests focus primarily on pregnant women in vulnerable contexts and prenatal nursing care. Soon, I will be submitting my doctoral dissertation, a descriptive and interpretative qualitative study aimed at better understanding the prenatal nursing care experience of pregnant women in vulnerable contexts. The experience of prenatal nursing follow-up has a significant influence on women’s use of health services. The nurse’s pregnancy follow-up can contribute to preventing health complications for both the mother and the fetus. In my doctoral project, I identified the factors influencing the experience of prenatal nursing care for these women, the way in which the relationship between the pregnant women and the nurse influences the experience of prenatal nursing care, as well as avenues for improving the prenatal nursing care experience of pregnant women in vulnerable contexts.

Living with HIV/AIDS & Diabetes during COVID-19


The current ANS featured article is titled “Self-management of the Dual Diagnosis of HIV/AIDS and Diabetes During COVID-19: A Qualitative Study” by Julie A. Zuñiga, PhD; Heather E. Cuevas, PhD; Kristian Jones, PhD; Kristine Adiele; Lauren Cebulske; Livia Frost; Siddhaparna Sannigrahi, BS; Alexandra A. García, PhD, RN, FAAN; and Elizabeth M. Heitkemper, PhD, RN. The article is free to download while it is featured and we welcome your comments and responses here! Dr. Zuñiga sent this message about her work for ANS readers:

Julie A. Zuñiga

My area of research is HIV self-management and HIV prevention in under-represented communities. I recently completed an NIH-funded mixed methods study of people with the dual diagnosis of HIV and diabetes to explore self-management barriers and facilitators for both conditions.  From the findings, we extrapolated that social determinants of health were more influential in this population than in people living with HIV only. In the context of Covid, it became easier for some people to engage in some diabetes management behaviors during the lock down period. With the stigma of blood and HIV, it can be uncomfortable for people with the dual diagnosis of HIV and diabetes to test blood sugar outside of their homes or around others. My current study continues the stigma and discrimination research umbrella with a focus on barriers, facilitators, and preferences for HIV prevention in the transgender and gender expansive community.

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