January 22, 2013,
Volume 59, No. 18
Hiring Extra Temporary Travel Nurses May Save Lives
To reduce the shortage of available staff nurses, hospitals have hired temporary “travel” nurses without fully knowing the effect on patient outcomes. However, a new study has concluded hiring extra nurses may actually save lives.
After examining data from more than 1.3 million patients and 40,000 nurses in more than 600 hospitals, researchers from Penn Nursing have concluded that the use of such supplemental nurses “does not appear to have deleterious consequences for patient mortality.”
The study authors concluded that poor patient outcomes thought associated with hospital hiring of temporary nurses are more likely the result of poor working conditions within the hospitals themselves than with the nurses hired to alleviate shortages.
“Hospital executives and managers who employ large numbers of supplemental nurses should evaluate whether deficiencies in work environments in their institutions are adversely impacting the success in attracting and retaining qualified permanent nurses, as well as possibly adversely affecting patient outcomes,” said Dr. Linda H. Aiken, lead author and professor of sociology and nursing and director of the Center for Health Outcomes and Policy Research (CHOPR). CHOPR has long established a link between adding patients to a nurse’s workload (above four patients) and potential risk of mortality to the patient. Extending hospital shifts has also been associated with nurse burnout.
Mountains Are Only Minor Contributors to Sediment Erosion and Climate Regulation
Though churning smokestacks, cud-chewing cows and gasoline-burning vehicles are contributing constantly to greenhouse gas emissions, there are also many processes that do the reverse, pulling molecules like carbon dioxide out of the atmosphere. One of these is chemical weathering, which occurs when rock turns into soil. Carbon dioxide molecules and rain combine to dissolve rock, and the weathering products, including sediment, eventually make their way through waterways to the ocean where some become trapped on the ocean bottom and in coral reefs and seashells.
For years, geologists believed that mountains, due to their steep slopes and high rates of erosion, were large contributors to this “carbon draw down” effect. But a study led by Dr. Jane Willenbring suggests that mountains do not play a significant role in this activity. The findings are published in the January issue of the journal, Geology.
Dr. Willenbring, an assistant professor in the department of earth and environmental science in Penn’s School of Arts & Sciences, led the research, working with Dr. Alexandru Codilean of the GFZ German Research Center for Geosciences and Dr. Brandon McElroy of the University of Wyoming.
“These small mountain streams are packing a big punch for their size,” Dr. Willenbring said. “But even though they have a lot of erosion going on, the amount of the Earth covered by mountain ranges is too small to produce the amount of sediment that less steeply sloped areas produce.”
The previous studies lacked access to a new investigative technique that was developed relatively recently. The method involves an examination of cosmogenic nuclides, which are rare forms of chemical elements produced only when supernovas explode, sending high-energy radiation to Earth and breaking up other atoms. Counting these chemical isotopes allows researchers to determine how long sediment has remained in a particular watershed over long time periods.
The researchers analyzed published data on cosmogenic nuclide concentrations from around the world to determine the levels of sediment flux over a time frame of thousands to hundreds of thousands of years.
Given these findings, geologists interested in understanding the contribution of erosion to climate fluctuations may want to spend less time on mountaintops and more time in big, lower-lying rivers like the Mississippi and the Amazon, Dr. Willenbring said.
Black and Hispanic Patients Less Likely to Complete Substance Abuse Treatment
Roughly half of all Black and Hispanic patients who enter publicly funded alcohol treatment programs complete treatment, compared to 62 percent of White patients, according to a study from a team of researchers including the Perelman School of Medicine at the University of Pennsylvania. Comparable disparities were also identified for drug treatment program completion rates. The study, published in Health Affairs, shows that completion disparities among racial groups are likely related to differences in socioeconomic status and, in particular, greater unemployment and housing instability for Black and Hispanic patients. The researchers suggest that funding for integrated services and increased Medicaid coverage under the Affordable Care Act (ACA) could help to improve access to treatment programs for minorities.
According to researchers, the statistical differences roughly translate to 13,000 fewer completed episodes of drug treatment for Black patients and 8,000 fewer for Hispanic patients, compared to White patients. Other minority groups, including Native Americans, also showed lower completion rates than White patients. Only Asian American patients fared better than White patients for both drug and alcohol treatment completion.
According to the data from the Substance Abuse and Mental Health Services Administration (SAMHSA)’s 2007 Treatment Episode Data Set, reasons for incomplete treatment included leaving against professional advice, incarceration, or having treatment terminated by the facility because of noncompliance.
“Patients living in poverty may be more likely to receive treatment in an environment with high social distress, weak social support, or few economic opportunities,” said Dr. Brendan Saloner, a health services researcher at the Perelman School of Medicine and a Robert Wood Johnson Foundation Health and Society Scholar at Penn. Also, external factors could undermine individual engagement with treatment or create competing demands, leading to higher dropout rates from treatment.
“Unfortunately, it’s possible that funding for treatment programs may be limited in the future as states and the federal government look for ways to trim spending on public programs. However, in the long run, these reductions in spending on treatment programs may lead to increased spending for corrections and emergency department admissions.”
The researchers suggest that steps to broaden Medicaid funding in the Affordable Care Act could dramatically improve access. To be particularly effective, the policies should focus on points in the treatment process where vulnerable groups—particularly minorities—are likely to drop out of treatment. Broadened access to supported housing and vocational training could be two cost-effective ways of improving overall substance-addiction treatment results and reducing treatment outcome disparities, in addition to addressing significant public policy problems.
Dr. Saloner’s co-investigator on the study was Dr. Benjamin Lê Cook from Harvard Medical School.
Homelessness and Academic Achievement
One million American school children are homeless each year, and many more are thought to move frequently. A researcher from Penn’s School of Social Policy & Practice (SP2) is the lead author on a new longitudinal study linking homelessness and frequent moving with children’s achievement. The study appears in the October 30 issue of Child Development.
“This is the first study that has looked at academic achievement data for homeless and highly mobile students over many years,” said Dr. J. J. Cutuli, research director for Intelligence for Social Policy in SP2.
“Past studies on this topic have been able to produce snapshots in time, but now we’re able to see that gains in math achievement among these students slow down during periods of homelessness or high mobility, compared to their own achievement and growth during the years when they were not homeless or did not move as often.”
Conducted through a university-community partnership between the University of Minnesota and the Minneapolis Public Schools, the study examined the performance of more than 26,000 students in the city’s public education system.
The study used administrative data, such as test scores, attendance and eligibility for certain programs, to examine the academic achievement of students in grades 3-8. Student achievement was measured through their performance on annual standardized reading and math tests.
The research team found that students who were homeless at some point during the study or students who moved three or more times in one year had persistently lower levels of reading and math achievement, when compared to other low-income students and their more advantaged peers. These achievement gaps either stayed the same or worsened as students approached high school.
But the study also revealed great variation among the homeless and mobile students, with a substantial number showing resilience. Despite their unstable housing circumstances, 45 percent scored within the average range or better in math and reading.
“Understanding their successes may offer clues for strategies to address achievement problems in their peers,” Dr. Cutuli said. “Addressing short-term risks tied to homelessness or moving frequently, as well as long-term risks associated with chronic poverty and disadvantage, will help lead to solutions for these youth. One starting point may be to understand the protective influences that keep many of these children on track academically.”
Co-authors on this project were Ann S. Masten, Christopher D. Desjardins and Janette E. Herbers from the University of Minnesota; Jeffrey D. Long of the University of Iowa; David Heistad and Elizabeth Hinz from the Minneapolis Public Schools; and Chi-Keung A. Chan, who is now at Hong Kong Shue Yan University.