I will like you to work on this paper 2 for evidence base in nursing program. I have attched copy of paper 1, article 1, article 2, guide line,and outline to assist in writing the paper 2.The majorit

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I will like you to work on this paper 2 for evidence base in nursing program. I have attched copy of paper 1, article 1, article 2,  guide line,and outline to assist in writing the paper 2.The majority of the work should be base on article 1 (quantitative). I do not want plagiarism . I will pay $20 for the paper and will like it back by Friday night 4/5/2019 before midnight. Thanks

I will like you to work on this paper 2 for evidence base in nursing program. I have attched copy of paper 1, article 1, article 2, guide line,and outline to assist in writing the paper 2.The majorit
Running head: T OPIC SEARCH STRATEGY -TYPE 2 DIABETES 1 Topic Search Strategy : Type 2 Diabetes among African American Tutor copy Paper 1 Evidence -Based Practice March 2 2, 2019 TOPIC SEARCH STRATEGY -TYPE 2 DIABETES 2 Type 2 Diabet es Diabet es is a chronic condition where the body’s ability to handle glucose is affected leading to a higher than usual rise in the levels of glucose. The most common type is the type 2 diabetics where the body resists the production of insulin. The condition was in itially more common to adults, but with time it has been diagnosed with children who are obese. Type 2 diabet es do not have a cure but can be managed with oral hypoglycemic, insulin th erapy , exercise , healthy diet , smoking cessation, and avoiding intake of alcohol. The purpose of this study is to briefly describe a search strategy when identifying two articles that pertain to an evidence -based practice regarding type 2 diabetes among African American. Clinical Que stions The study focus on how social economic status can have an impact on type 2 diabet es among African American between age s of 21 to 94 in the United States. Different statistics document s had indicated that type 2 diabetes is a problem that should be w ell managed as it can result in serious health implications. The medical research council and the Diabetes care center in the United States are some of the resources where one can obtain more knowledge on this type of disease. The research shows that individual with the condition should work hard to control their blood sugar level s; and f ailure to do so would result in severe complications . T he implications from type 2 diabetes include kidney disease, hypoglycemia, hyperosmolar hyperglycemic nonketotic syndrome, diabetes retinopathy, and macrovascular disease. PICO is an evidenced -based method that assist in framing good research questions and recognize major concept. it indicates elements of proper quantitative question (Houser, 2018). TOPIC SEARCH STRATEGY -TYPE 2 DIABETES 3 The letter P stand for Population , letter I is for the i ntervention , letter C for comparison and letter O for outcome. The issue may sometimes have a T which st ands for the time frame (Houser, 2018). P: 486 African American men and women between the ages of 21 -94 with diabetes in the United States I: Social economic position C: Incidence rate of type 2 diabetes O: at increased risk of type 2 diabetes during the 3 life stages from childhood to adult PICO Question – In 486 African American men and women between the ages of 21 -94 with type 2 diabetes in the United States, how does social economic position compared with the incident rate of type 2 diabetes at increased risk of type 2 diabetes during the three life stages from childhood to adult? The independent variable in the above question is social economic position in 486 African American men and women between the ages of 21 -94 with diabetes in the Unit ed States . The dependent variable is increased risk of type 2 diabetes during the 3 life stages from childhood to adult . The study is to describe the search strategy of two articles about type 2 diabetes. The two chosen articles to be discussed include a qua ntitative study by student A and a qua litative study by student B . Levels of Evidence In the research, student A has used etiology for the type of PICO question to identify increase risk of type 2 diabetes. Quantitative research uses measurement of variables and statistic data to determine the effects of interventions, actions, risk factors, or events. The goal is to identify relationship among variable and deter mine differences in time ( Houser, 2018). TOPIC SEARCH STRATEGY -TYPE 2 DIABETES 4 Student A ’s article is quantitative because it includes numerical data as well as systematic, well -organized , and accurate information . In medicine , there are different levels of evidence ranked according to the strength of the result experimented through clinical trials or research study. The ranking helps in organizing the different evidence -based research practice with five levels. The first level involves a random tr ial that produces high -quality research through the examination of previous diagnostic. The second level is of a lesser quality prospective study done on consecutive patients for diagnostic criteria. The third one is based on therapy an d prognostic studies where it is carried out with nonconsecutive patients and is based on limited alternatives and costs. The fourth is the diagnostic study and the fifth being the experts’ opinion (Houser, 2018). The level of evidence for student A ar ticle is level three because it is based on etiology questions to identify increase risk factors or cause s of type 2 diabetes and examining the effective intervention in improving the outcome. The study mainly relies on the quantitative study and a little on the qua litative research in obtaining the required evidence. Search Strategies Obtaining an article that is relevant to the searched topic may deem difficult since different authors have numerous writings on the same issue. Student A had search ed on different engines, carefully evaluating each result to ensure best -fit evidence. The online Library at the Chamberlain University was very helpful, which had made search strategies to be less complicated. The database that was is EBSCOhost and many overwhelming results with more than a thousand articles and books . Student A has narrowed do wn the search by looking for those that specifically talked about the type two diabetes and intended populations such as African Americans. Student A searched for type 2 diabetes and the result was 80,241 articles . TOPIC SEARCH STRATEGY -TYPE 2 DIABETES 5 Student A had added African American to the search and the result was 849 articles . Student A added quantitative research or study to the search and the result was 600 articles. Student A narrowed the search by changing the publish date from 2014 to 2019 and the result was 209 articles. Student A continued to be narrowed with peer reviewed and the result was 206. Finally, student A narrowed down by adding male and female to the search and the result was 7 articles. The two chosen articles include qua ntitative study by s tudent A , and qua litative study by student B . The quantitative article shows statistic data on how socioeconomic position can increase the risk of type 2 diabetes among African American. The qualitative article focused on African American beliefs on type 2 diabetes. There was no limit on the number of articles to be used, but student A and B decided to pick on the two materials as it would be easier to go deep on its details and easy to understand. The other articles might have a high probability of confl icting ideas, and it would be difficult to make strong evidence. The two articles have provided the required information that was in line with the PICO question. The two articles both focused on Africa n American perspective of type 2 diabetes on its socioeconomic position and incidents rate for adults. (See appendix for search strategy). Conclusion Type 2 diabetes is a common condition with many Africa n Americans, and many writers have found it an excellent topic to base their writings. The tw o articles provided above would be a good starting point in analyzing the different etiology or prognosis questions and understanding more about the condition. The next step is to compare and contrast researcher A and B to review and demonstrate quantitati ve and qualitative articles. TOPIC SEARCH STRATEGY -TYPE 2 DIABETES 6 References Beckles, G. L., McKeever, K. B., Saydah, S., Imperatore, G., Loustalot, F., & Correa, A. (2019). Life course socioeconomic position, allostatic load, and incidence of type 2 diabetes among African American adults: The Jackson heart study, 2000 -04 to 2012. Ethnicity & disease , 29 (1), 39 -46. Retrieved from https://eds -a-ebscohost -com .chamberlainuniversity. idm.oclc.org/eds/detail/detail?vid=1&sid=817b0c12 -4855 -47af -81d7 -4558ad9a6 04a%40 sessionmgr4009&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN =134240622&db=s3h Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Burlington, MA: Jones & Bartlett Learning. Shiyanbola, O. O., Ward, E. C., & Brown, C. M. (2018). Utilizing the common -sense model to explore African Americans’ perception of type 2 diabetes: A qualitative study. Plos One , 13 (11), pp. e0207692. Retrieved from: https://eds -a-ebscohost -com .chamberlai n university.idm.oclc.org/eds/pdfviewer pdfviewer?vid=1&sid=2308ae98 -b5a2 -4848 -bc82 – b19a400c1e8d%40sdc -v-sessmgr06 TOPIC SEARCH STRATEGY -TYPE 2 DIABETES 7 Appendix TOPIC SEARCH STRATEGY -TYPE 2 DIABETES 8 Hint: PICO Question for article 2 – qualitative (stu dent B) How do 40 African American women and men, between ages 45 -60 from different communities in two cities in the United States , with a diagno sis of type 2 diabetes, perceive d factor s and cultural beliefs contributed to the development of type 2 diabetes? P- 40 African American women and men, between ages 45 -60 from different communities in two cities in the United States , with a diagno sis of type 2 diabetes I – perceive d factor s and cultural beliefs C- none O- contributed to the development of type 2 diabetes
I will like you to work on this paper 2 for evidence base in nursing program. I have attched copy of paper 1, article 1, article 2, guide line,and outline to assist in writing the paper 2.The majorit
39 Original Report: Cardiovascular Disease and Related Risk Factors IntroductIon In the United States, minority racial-ethnic and socioeconomically disadvantaged groups are dispropor – tionately affected by type 2 diabetes mellitus (t2DM). 1,2 As elsewhere, risks for t2DM increase with decreas – ing socioeconomic position (SEP). 3 Several conceptual models propose how SEP across the life course can influence health in adulthood. 4,5 The critical/sensitive period model speci – fies that, during specific periods of development adverse physical and so – cial exposures may have long-lasting effects on the structure and function of systems, organs, and tissues. The effect of this biological programming on risk may be modified by exposures in adulthood. The accumulation of risk model proposes that effects of exposures at different life stages may accumulate over time resulting in increasing cumulative damage to health. The pathways effects model proposes that early life socioeconomic circumstances track social trajectories into adulthood which, in turn, in – fluence health. Studies using the life course approach have shown that the timing (critical/sensitive periods), fre – quency and duration of exposure to social stressors influence incidence of t2DM. 6-13 To date, these models have been tested among White adults, and in three studies the relationships were demonstrated in women but not in men. 6-7, 9,12 One study reported that low childhood SEP increased t2DM incidence regardless of race but did not report interaction with sex. 13 Complementary to the accumula – tion of risk hypothesis is the concept of allostatic load (AL) or dysregu – lation of multiple physiologic sys – tems that may arise from repeated or chronic exposure to social stress – ors. 14 Compared with Whites, Afri – can Americans have higher levels of Life C ourse s o Cioe Conomi C P osition , A LLost Ati C L oAd , A nd i n Ciden Ce of t y Pe 2 d iA betes A mong A fri CAn A meri CAn A du Lts : the J AC kson h e A rt s tudy , 2000-04 to 2012 Gloria L. Beckles, MD, MSc 1; Kai McKeever Bullard, PhD, MPH 1; Sharon Saydah, PhD 1; Giuseppina Imperatore, MD, PhD 1; Fleetwood Loustalot, PhD, MPH 2; Adolfo Correa, MD, MPH 3 Objective: We examined whether life course socioeconomic position (SEP) was associated with incidence of type 2 diabetes (t2DM) among African Americans. Design: Secondary analysis of data from the Jackson Heart Study, 2000-04 to 2012, using Cox proportional hazard regression to estimate hazard ratios (HR) with 95% CI for t2DM incidence by measures of life course SEP. Participants: Sample of 4,012 nondiabetic adults aged 25-84 years at baseline. Outcome Measure: Incident t2DM identi – fied by self-report, hemoglobin A1c ≥6.5%, fasting plasma glucose ≥126 mg/dL, or use of diabetes medication. Results: During 7.9 years of follow-up, 486 participants developed t2DM (incidence rate 15.2/1000 person-years, 95% CI: 13.9-16.6). Among women, but not men, childhood SEP was inversely associated with t2DM incidence (HR=.97, 95% CI: .94-.99) but was no longer associated with adjust – ment for adult SEP or t2DM risk factors. Up – ward SEP mobility increased the hazard for t2DM incidence (adjusted HR=1.52, 95% CI: 1.05-2.21) among women only. Life course allostatic load (AL) did not explain the SEP-t2DM association in either sex. Conclusions: Childhood SEP and up – ward social mobility may influence t2DM incidence in African American women but not in men. Ethn Dis. 2019;29(1):39-46; doi:10.18865/ed.29.1.39 Keywords: Life Course Socioeconomic Position; Type 2 Diabetes; Allostatic Load; African Americans 1 Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 2 Division for Heart Disease & Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 3 University of Mississippi Medical Center, Jackson, MS Address correspondence to Gloria Beckles, MD, MSC; Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy NE, MS F-75, Atlanta, GA 30341; [email protected] Ethnicity & Disease, Volume 29, Number 1, Winter 2019 40 AL and are more likely to experience chronic exposure to socioeconomic stressors. 15 To our knowledge, no study has examined the contribution that AL may make to the life course SEP-t2DM association among Afri – can Americans. Therefore, we aimed to examine whether: 1) life course SEP was associated with t2DM in – cidence among African Americans; 2) the relationship was modified by sex; and 3) AL explained the life course SEP-t2DM association. 21-94 years who participated at base – line (2000-2004), we identified 4,012 participants aged 25 to 84 years with no evidence of diabetes who were fol – lowed through December 31, 2012. Variables Incident cases were identified during follow-up if a participant reported physician-diagnosed dia – betes, use of diabetes medication, or had a fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%. Life-course (SEP) was concep – tualized to represent three life stages during which individuals experienced different timing and levels of SEP exposure. 5 Childhood SEP (C-SEP) was measured using number of years of schooling or highest degree com – pleted by parents or most important caretakers when participant was up to age 16 years. Young adulthood SEP (YA-SEP) was measured by par – ticipants’ educational attainment at baseline (high school). Levels of C- SEP and YA-SEP exposures were cat – egorized as low (<12 years of school – ing or 12 years of schooling or >high school). 17 Mature adulthood SEP (MA-SEP) was measured using the Olin Wright social class typology which describes a managerial, super – visory and worker hierarchy based on job autonomy in the workplace. 17 Participants were classified as manag – ers if they reported that in the work – place, they: a) made decisions about such things as the products or services offered, number of people employed, budgets; and b) supervised the work of other employees, had responsibil – ity for what work other employees did. Those who reported that they only supervised other employees were classified as supervisors. Otherwise, participants were classified as neither. Level of MA-SEP exposure was cat – egorized as low (neither), medium (supervisor), and high (manager). Based on a social mobility framework which recognizes that SEP may vary across the life span, 4 each SEP mea – sure was re-categorized as a binary variable (less than high, high) to de – fine 3 SEP trajectories: 1) stable if the level of SEP exposure in childhood remained the same in young adult – hood; 2) downward if the level of SEP exposure fell from high in childhood to less than high in young adulthood; 3) upward if the level of SEP expo – sure rose from less than high in child – hood to high in young adulthood. Trajectories from childhood to ma – ture adulthood were defined similarly. Traditional t2DM risk factors se – lected were age, sex, parental history of diabetes, physical activity and di – etary consumption (poor, interme – diate, ideal), 18 and smoking status (current, former, never); height was selected as a biological marker of cu – mulative nutritional, socioeconomic, and health deprivation. 19 (Table 1). Based on previous research and avail – ability in the JHS dataset, we selected a total of 11 biomarkers to reflect re – sponses to: a) the neuroendocrine sys – tem (serum cortisol); b) the cardiovas – cular system (systolic blood pressure, diastolic blood pressure, heart rate, homocysteine); c) the metabolic sys – tem (total cholesterol, HDL choles – terol, serum creatinine, waist circum – ference); and d) the immune system (high sensitivity C-reactive protein, We aimed to examine whether: 1) life course SEP was associated with t2DM incidence among African Americans; 2) the relationship was modified by sex; and 3) AL explained the life course SEP-t2DM association. M ethods Data Source and Study Population We used data from the Jackson Heart Study (JHS), a population- based prospective study of cardio – vascular disease among African American residents of Jackson, Mis – sissippi. 16 Of the 5,306 residents aged Ethnicity & Disease, Volume 29, Number 1, Winter 2019 Socioeconomic Position and Diabetes – Beckles et al 41 white blood cells). Biomarkers were stratified into quartiles and (except for HDL cholesterol) values above the 75th percentile of each biomarker were considered high risk; otherwise, values were not high risk. 13 For HDL cholesterol, values below the 25th percentile were considered high risk; otherwise, values were not high risk. Then, we calculated an AL global risk score for each participant by summing the total number of biomarkers with high risk levels; not high risk levels re – ceived a score=0 (overall range: 0-11). Statistical A nalyses We used the iterated chained equa – tions approach to perform multiple imputations of all variables needed for the analysis. 20 The mi impute chained and the mi estimate commands in Stata version 13 (StataCorp LP; Col – lege Station, Texas) were used to create 5 imputed datasets to calculate pooled estimates. 21 Descriptive analyses exam – ined the distributions of baseline co – variates. Behavioral covariates were re- categorized as binary variables (poor, not poor; current/former, never) for use in the regression analyses. Survival Table 1. Baseline characteristics of nondiabetic African Americans by sex—the Jackson Heart Study, 2000-2004 Characteristics Women, N = 2,518 Men, N = 1,494 % or mean 95% CI % or mean 95% CI Childhood SEP Mother’s educational attainment, % <12 years 62.7 (60.6-64.8) 52.8 (50.2-55.5) 12 years 17.8 (16.2-19.4) 23.4 (21.2-25.6) >12 years 19.5 (17.8-21.2) 23.8 (21.6-26.0) Father’s educational attainment, % <12 years 68.4 (66.1-70.8) 64.6 (61.7-67.7) 12 years 16.3 (14.8-17.9) 17.6 (15.0-20.3) >12 years 15.2 (13.1-17.4) 17.7 (15.1-20.4) Young adulthood SEP Own educational attainment, % Less than high school 17.0 (15.5-18.4) 19.1 (17.1-21.1) High school/GED 25.0 (23.3-26.7) 23.4 (21.3-25.6) More than high school 58.0 (56.1-60.0) 57.4 (54.9-60.0) Mature adulthood SEP Occupational social class, % Neither 54.7 (52.7-57.0) 40.7 (38.0-43.3) Supervisory 13.3 (11.9-14.7) 14.4 (12.5-16.3) Managerial 32.0 (30.1-33.9) 44.9 (42.2-47.7) t2DM risk factors Age, years, mean 54.7 (54.2-55.2) 53.6 (53.0-54.3) Height, cm, mean 164.0 (163.8-164.3) 177.5 (177.1-177.8) Family history of diabetes, % 35.5 (33.7-37.4) 30.5 (28.2-32.9) Physical activity, % Poor 47.8 (45.9-49.8) 45.3 (42.7-47.8) Intermediate 34.1 (32.3-36.0) 29.9 (27.5-32.2) Ideal 18.0 (16.5-19.5) 24.9 (22.7-27.1) Healthy diet, % Poor 61.6 (59.7-63.5) 68.5 (66.1-70.8) Intermediate 37.5 (35.6-39.3) 31.1 (28.7-33.4) Ideal .9 (.1-.8) .4 (.1-.8) Smoking status, % Current 10.9 (9.7-12.2) 19.2 (17.2-21.3) Former 1.2 (.7-1.6) 1.3 (.8-1.9) Never 87.9 (86.6-89.2) 79.4 (77.3-81.5) AL global risk score, mean 2.5 (2.5-2.6) 3.5 (3.5-3.6) SEP, socioeconomic position; AL, allostatic load.All percentages do not sum to 100 because of rounding . Ethnicity & Disease, Volume 29, Number 1, Winter 2019 Socioeconomic Position and Diabetes – Beckles et al 42 analysis was used to estimate time (in years) from baseline examination to first occurrence of t2DM, with sur – vival times censored at dates of death, loss to follow-up, or December 31, 2012. Incidence rates (cases per 1000 person-years) were calculated for each life course SEP measure. Cox propor – tional hazards regression models were fitted to estimate unadjusted and ad – justed hazard ratios for incident t2DM by life-course SEP measures. All analy – ses were stratified by sex. Differences were considered significant at P<.05. r esults Table 1 presents the characteris – tics of nondiabetic participants by sex at baseline examination. Participants reported more years of schooling for their mothers than fathers (men, 10.9 years vs 9.3 years; women, 10.2 years vs 8.9 years). We found no sex dif – ference in YA-SEP but for MA-SEP, more men than women were in the managerial class (44.9% vs 32.0%). Men and women were of similar age. Women were more likely than men to report a family history of diabetes but they were less likely to report ideal physical activity (18.0% vs 24.9%), a poor diet (61.6% vs 68.5%), or current smoking (10.9% vs 19.2%). Women also had a lower mean AL global risk score than men (2.6 vs 3.6). Association of Life Course SEP with T2DM Incidence During a mean follow-up of 7.9 years, 486 of the 4,012 nondiabetic participants developed t2DM: overall crude incidence rate was 15.2/1000 person-years (women 15.4/1000 person-years; men 14.8/1000 person- years) (Table 2). Because father’s years of schooling were not associated with t2DM incidence in either sex, C- SEP was measured by mother’s years of schooling in all further analyses (Table 3). C-SEP was inversely as – sociated with t2DM among women but not men. C-SEP was barely asso – ciated with t2DM (HR=.97; P=.05) in a model adjusted only for the tra – ditional risk factors and AL (Model 2). In the fully adjusted model, no SEP measures were associated with t2DM (Model 3). We repeated all analyses using the full sample and confirmed the sex interaction (P =.02) in the C-SEP-t2DM association. Table 2. Incidence rate of type 2 diabetes by life course socioeconomic position and sex—the Jackson Heart Study, 2000-04 to 2012 Women, N=2,518 Men, N=1,494 Person-years (p-y) Cases (n) Incidence rate per 1000 p-y (95% CI) Person-years (p-y) Cases (n) Incidence rate per 1000 p-y (95% CI) Total 20,378 314 15.4 (13.8-17.2) 11,590 172 14.8 (12.8-17.2) Childhood SEP Mother’s educational attainment <12 years 1281 216 16.9 (14.7-19.3) 6201 88 14.2 (11.5-17.5) 12 years 7553 55 15.5 (11.9-20.2) 2669 45 16.9 (12.6-22.6) >12 years 4008 43 10.7 ( 8.0-14.5) 2761 39 14.1 (10.3-19.3) Father’s educational attainment <12 years 14175 211 14.9 (13.0-17.0) 7580 103 13.6 (11.2-16.5) 12 years 3254 59 18.1 (14.0-23.4) 2049 45 22.0 (16.4-29.4) >12 years 2949 44 14.9 (11.1-20.1) 2002 24 12.0 (8.0-17.9) Young adulthood SEP Own educational attainment Less than high school 3366 58 17.2 (13.3-22.3) 2164 27 12.5 (8.6-18.2) High school/GED 5080 75 14.8 (11.8-18.5) 2670 37 13.9 (10.0-19.1) More than high school 11862 180 15.2 (13.1-17.6) 6756 108 16.0 (13.2-19.3) Mature adulthood SEP Occupational social class Neither 10141 167 16.5 (14.2-19.2) 4125 74 17.9 (14.3-22.5) Supervisory 2496 37 14.8 (10.7-20.5) 1517 24 15.8 (10.6-23.6) Managerial 6003 96 16.0 (13.1-19.5) 4696 65 13.8 (10.9-17.7) SEP, socioeconomic position. Ethnicity & Disease, Volume 29, Number 1, Winter 2019 Socioeconomic Position and Diabetes – Beckles et al 43 Table 3. Hazard ratios (95% CI) for incidence of type 2 diabetes by life course socioeconomic position and sex—the Jackson Heart Study, 2000-04 to 2012 Women, N=2,518 Men, N=1,494 Model 1 Model 2 Model 3 Model 1 Model 2 Model 3 Childhood SEP .97 (.94-.99) .97 (.94-1.00) .97 (.94-1.04) 1.02 (.98-1.06) 1.02 (.98-1.06) 1.02 (.98-1.06) Age, years .99 (.99-1.01) 1.00 (.99-1.01) 1.00 (.98-1.01) 1.00 (.98-1.02) Height, cm 1.02 (.99-1.02) 1.01 (.99-1.03) 1.02 (1.00-1.04) 1.02 (1.00-1.04) Family history of diabetes Ye s 1.43 (1.14-1.80) b1.40 (1.10-1.76) b 1.81 (1.33-2.45) c1.77 (1.29-2.41) b No (ref.) 1.00 1.00 1.00 1.00 Physical activity Poor 1.00 (.86-1.17) .97 (.83-1.10) .84 (.69-1.02) .81 (.66-.99) a Not poor (ref.) 1.00 1.00 1.00 1.00 Healthy diet Poor 1.17 (.94-1.45) 1.20 (.96-1.50) 1.25 (.91-1.71) 1.29 (.93-1.79) Not poor (ref.) 1.00 1.00 1.00 1.00 Smoking status Current or former 1.21 (.99-1.50) 1.19 (.96-1.47) 1.12 (.91-1.38) 1.07 (.86-1.34) Never (ref.) 1.00 1.00 1.00 1.00 AL global risk score 1.17 (1.10-1.25) c1.19 (1.11-1.28) c 1.16 (1.06-1.27) b1.16 (1.06-1.27) b High Not high Young adulthood SEP Less than high school (ref.) 1.00 1.00 High school or GED .91 (.63-1.31) 1.11 (.64-1.92) More than high school 1.02 (.72-1.44) 1.21 (.74-1.98) Mature adulthood SEP Manager .97 (.75-1.25) .75 (.54-1.06) Supervisor .91 (.64-1.30) .89 (.56-1.41) Neither (ref.) 1.00 1.00 SEP, socioeconomic position; AL, allostatic load.a. P<.05.b. P<.01.c. P<.001.Model 1 = unadjusted; Model 2 = controls for traditional diabetes risk f actors and AL global risk score; Model 3 = additional control for Young adulthood SEP and Mature adulthood SEP. Association of Life Course SEP Trajectories with Incidence of T2DM The SEP trajectory from child – hood to adulthood was associated with incidence of t2DM among women but not among men (Table 4). Women exposed to low SEP in childhood and young adulthood ex – perienced a higher unadjusted hazard ratio incidence (HR=1.61) compared with women exposed to a stable high SEP. With adjustment, this effect was attenuated (HR=1.41) and the association was no longer significant. Among women whose SEP status rose from low/medium in childhood to high in young adulthood, the haz – ard was 1.64 times that for those with stable high SEP. With adjustment for traditional risk factors and AL the as – sociation was attenuated (HR=1.52) but remained significant. Decline in SEP status from high in childhood to low/medium in young adulthood was not associated with t2DM inci – dence (HR=1.68). Childhood to ma – ture adulthood SEP trajectories were not associated with t2DM incidence. Contribution of AL to the Life Course SEP-T2DM Association Adjustment for the AL global risk score did not reduce or com – pletely explain the association be – tween any life course SEP measure and t2DM incidence (Table 4). However, the score was positively associated with t2DM incidence in Ethnicity & Disease, Volume 29, Number 1, Winter 2019 Socioeconomic Position and Diabetes – Beckles et al 44 the C-SEP and SEP trajectory mod – els in both sexes [data not shown]. d Iscuss Ion In this study of African Ameri – can adults, we found that life course SEP may influence the development of t2DM in women but not in men. The risk of developing t2DM in later life was inversely related to the level of SEP exposure in childhood, but the association was not independent of either SEP or traditional t2DM risk factors in adulthood. We also found that women who experienced upward SEP mobility from child – hood to young adulthood compared with those with stable high SEP had an increased risk of developing t2DM, and that this association was independent of adult SEP and t2DM risk factors. However, AL did not explain the effect of life course SEP on t2DM incidence in either sex. Our finding that the critical/sen – sitive period hypothesis did not sup – port an effect of childhood SEP on incidence of t2DM among African American women in later life was consistent with results from studies conducted among White Americans and elsewhere. 8,10,11 However, the current result is not strictly com – parable for reasons such as differ – ences in the populations, duration of follow-up, measures of early-life SEP, t2DM risk factors and analytic methods. To date, only one study has reported race-specific results: at 34 years of follow-up of the Alameda County cohort, low childhood SEP increased t2DM incidence among Black and White participants but no sex interaction was reported. 7 With regard to social mobility across the life course, our findings are consistent with earlier research. 6,7,10 Studies in the United States and Unit – ed Kingdom all reported increased incidence with downward SEP mo – bility. In contrast, the current study found that increased incidence among African American women was not as – sociated with decline in SEP but was associated with upward SEP mobility. People who develop t2DM grow differently in early life from those who do not develop the disease. 22 Ex – posure to adverse environmental in – fluences during development is asso – ciated with slow growth in utero, low birthweights, small size throughout infancy, and rapid gain in weight and body mass when no longer exposed to the adverse influences. High rates of such adverse outcomes among African Americans are well-docu – mented. 23 Most members of the JHS Table 4. Hazard ratios (95% CI) for incidence of type 2 diabetes by change in socioeconomic position among women—the Jackson Heart Study, 2000-04 to 2012 Social mobility indicator Model 1 Model 2 Model 3 Model 4 OR 95% CI OR (95% CI) OR (95% CI) OR (95% CI) Stable low SEP 1.61 a (1.03-2.51) 1.46 (.90-2.37) 1.50 (.92-2.44) 1.45 (.89-2.36) Downward mobility 1.83 (.9-3.52) 1.72 (.88-3.35) 1.78 (.91-3.46) 1.68 (.86-3.26) Upward mobility 1.64 b (1.14-2.36) 1.56 a (1.08-2.27) 1.56 a (1.08-2.27) 1.52 a (1.05-2.20) Stable high SEP (ref.) 1.00 1.00 1.00 1.00 SEP, socioeconomic position.a. P<.05.b. P<.01.Model 1=unadjusted; Model 2= adjusted for demographic diabetes risk fact ors; Model 3= additional adjustment for behavioral diabetes risk factors;Model 4= additional adjustment for allostatic load global risk score. In this study of African American adults, we found that life course SEP may influence the development of t2DM in women but not in men. cohort were born before the middle of the 20th century; therefore, many of their mothers could have experi – enced the intergenerational economic and nutritional deprivation prevalent in the southern states until the late 1970s. 24,25 Research also shows that early life exposure to socioeconomic Ethnicity & Disease, Volume 29, number 1, winter 2019 Socioeconomic Position and Diabetes – Beckles et al 45 stressors may also set in motion long- term trajectories of metabolic risk fac – tors for t2DM but only in women. 26 Kaplan et al showed how, after 1964, Black women proved to be the greatest beneficiaries of the occupa – tional and economic improvements that increased in the southern states in response to Civil Rights policies. 25 However, the striving to escape persis – tent poverty could itself have proven to be a chronic stressor. Goal-striving stress, the discrepancy between socially derived aspiration and achievement, is associated with poor physical and men – tal health among adult Americans. 27,28 Specifically, among African Americans, this type of stress was strongly associ – ated with psychological distress, a con – dition more common and more severe among women than men. 28 Upward social mobility may also be strongly associated with reduced psychological well-being among African Americans, more so in women than men. 29 Recent evidence indicates that psychologi – cal distress is associated with incident t2DM independent of traditional be – havioral risk factors. 30 The studies cited above suggest plausible explanations for the unexpected effect of upward social mobility on t2DM observed among African American women. Limitations The current study is subject to several limitations. First, the JHS sample is not a nationally repre – sentative sample; consequently, the findings are not generalizable to the total adult African American popu – lation. Second, few studies have as – sessed the accuracy with which adults recall parental SEP. 31-33 One recent study found poor agreement between young African American women and their mothers about SEP in early (kappa=.14) and late childhood/ado – lescence (kappa=.20). 33 If such inac – curacy is typical, we may have un – derestimated the effect of C-SEP on t2DM in women. Third, the sample size for men could have resulted in the null findings we observed; how – ever, our findings are consistent with those from several earlier studies. 6,7,9,12 Finally, we used imputed models to reduce bias due to missing values but we are uncertain about the extent to which values were missing at random. c onclus Ions Despite the limitations, this study has several strengths. We ana – lyzed data from a large cohort and a prospective design which allowed examination of the effect of SEP on future risk of t2DM among African Americans. The life course approach yielded support for the social mobil – ity hypotheses suggesting that the duration of exposure to social stress – ors may influence t2DM incidence, at least, among African American women. Future research is necessary to ascertain replicability of our find – ings and provide further insights into how socioeconomic stressors increase risk for t2DM in later life. AcknowledgeMents The Jackson Heart Study is supported by contracts HHSN268201300046C, HH – SN268201300047C, HSN268201300048C, HHSN268201300049C, HH – SN268201300050C from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. The authors thank the participants and data collection staff of the Jackson Heart Study. All procedures were in accordance with the ethical standards of the responsible com – mittee on human experimentation (institu – tional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all participants included in the study. Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Preven – tion, or the US Department of Health and Human Services. Conflict of Interest No conflicts of interest to report. Autfor Contributions Research concept and design: Beckles, Bullard, Saydah, Imperatore, Correa; Acqui – sition of data: Beckles, Bullard, Imperatore, Correa; Data analysis and interpretation: Beckles, Bullard, Imperatore, Loustalot, Correa; Manuscript draft: Beckles, Saydah, Loustalot; Statistical expertise: Beckles, Bul – lard, Saydah, Correa; Acquisition of funding: Correa; Administrative: Beckles, Saydah, Loustalot; Supervision: Imperatore References1. CDC. National Diabetes Statistics Report, 2017. Atlanta, GA: U.S. Dept. of Health and Human Services; CDC, 2017. Last accessed October 11, 2018 from: https://www.cdc.gov/ diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf 2. Beckles GL, Zhu J, Moonesinghe R. Diabetes — United States, 2004 and 2008. MMWR . 2011;60(suppl):90-93. Last accessed October 11, 2018 from: https://www.cdc.gov/mmwr/ preview/mmwrhtml/su6001a20.htm 3. Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol . 2011;40(3):804-818. https://doi.org/10.1093/ ije/dyr029 PMID:21335614 4. Kuh D, Ben-Shlomo Y. A life course approach to chronic disease epidemiology. Oxford: Uni – versity Press; 1997. 5. Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epide – miol Community Health . 2003;57(10):778- 783. https://doi.org/10.1136/jech.57.10.778 PMID:14573579 6. Lidfeldt J, Li TY, Hu FB, Manson JE, Kawachi I. A prospective study of child – hood and adult socioeconomic status and incidence of type 2 diabetes in women. Am J Ethnicity & Disease, Volume 29, Number 1, Winter 2019 Socioeconomic Position and Diabetes – Beckles et al 46 Epidemiol . 2007;165(8):882-889. https://doi. org/10.1093/aje/kwk078 PMID:17284723 7. Maty SC, Lynch JW, Raghunathan TE, Kaplan GA. 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Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Associa – tion’s strategic Impact Goal through 2020 and beyond. Circulation . 2010;121(4):586- 613. https://doi.org/10.1161/CIRCULA – TIONAHA.109.192703 PMID:20089546 19. Perkins JM, Subramanian SV, Davey Smith G, Özaltin E. Adult height, nutrition, and population health. Nutr Rev . 2016;74(3):149- 165. https://doi.org/10.1093/nutrit/nuv105 PMID:26928678 20. van Buuren S, Boshuizen HC, Knook DL. Multiple imputation of missing blood pres – sure covariates in survival analysis. Stat Med . 1999;18(6):681-694. https://doi.org/10.1002/ (SICI)1097-0258(19990330)18:63.0.CO;2-R PMID:10204197 21. StataCorp. Stata Statistical Software: Release 13. College Station, TX: StataCorp. LP; 2013. 22. Barker DJP. Sir Richard Doll Lecture. Developmental origins of chronic disease. Public Health . 2012;126(3):185-189. https:// doi.org/10.1016/j.puhe.2011.11.014 PMID:22325676 23. Dominguez TP. 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The impact of goal-striving stress on physical health of white Americans, African Americans, and Caribbean blacks. Ethn Dis . 2012;22(1):21-28. PMID:22774305 28. Sellers SL, Neighbors HW. Effects of goal-striving stress on the mental health of black Americans. J Health Soc Be – hav . 2008;49(1):92-103. https://doi. org/10.1177/002214650804900107 PMID:18418987 29. Cole ER, Omari SR. Race, class and the dilemmas of upward mobility for African Americans. J Soc Issues . 2003;59(4):785- 802. https://doi.org/10.1046/j.0022- 4537.2003.00090.x 30. Virtanen M, Ferrie JE, Tabak AG, et al. Psychological distress and incidence of type 2 diabetes in high-risk and low-risk popula – tions: the Whitehall II Cohort Study. Diabetes Care . 2014;37(8):2091-2097. https://doi. org/10.2337/dc13-2725 PMID:24784831 31. Krieger N, Okamoto A, Selby JV. Adult female twins’ recall of childhood social class and father’s education: a validation study for public health research. Am J Epide – miol . 1998;147(7):704-708. https://doi. org/10.1093/oxfordjournals.aje.a009512 PMID:9554610 32. Batty GD, Lawlor DA, Macintyre S, Clark H, Leon DA. Accuracy of adults’ recall of child – hood social class: findings from the Aberdeen children of the 1950s study. J Epidemiol Community Health . 2005;59(10):898-903. https://doi.org/10.1136/jech.2004.030932 PMID:16166367 33. Straughen JK, Caldwell CH, Osypuk TL, Helmkamp L, Misra DP. Direct and proxy recall of childhood socio-economic posi – tion and health. Paediatr Perinat Epidemiol . 2013;27(3):294-302. https://doi.org/10.1111/ ppe.12045 PMID:23574418 Ethnicity & Disease, Volume 29, Number 1, Winter 2019 Socioeconomic Position and Diabetes – Beckles et al Copyright ofEthnicity &Disease isthe property ofEthnicity &Disease, Inc.anditscontent may notbecopied oremailed tomultiple sitesorposted toalistserv without thecopyright holder’s expresswrittenpermission. 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I will like you to work on this paper 2 for evidence base in nursing program. I have attched copy of paper 1, article 1, article 2, guide line,and outline to assist in writing the paper 2.The majorit
Chamberlain College of Nursing NR449 Evidence-Based Practice Evidence Matrix Table Article Reference Purpose Hypothesis Study Question Variables Independent(I) Dependent(D) Study Design Sample Size and Selection Data Collection Methods Major Findings 1 (sample not a real article) Smith, Lewis (2013), What should I eat? A focus for those living with diabetes. Journal of Nursing Education, 1 (4) 111-112. How do educational support groups effect dietary modifications in patients with diabetes? D-Dietary modifications I-Education Qualitative N- 18 Convenience sample-selected from local support group in Pittsburgh, PA Focus Groups Support and education improved compliance with dietary modifications. 1 2 3 4 5 NR449 Evidence Matric Table.docx Revised10/20/14 ns/cs
I will like you to work on this paper 2 for evidence base in nursing program. I have attched copy of paper 1, article 1, article 2, guide line,and outline to assist in writing the paper 2.The majorit
Title/Introduction (RUA #2) Introduction to paper /problem Problem Significance and Description of problem (from RUA 1 if no changes are needed) , Purpose of Paper (Last sentence) Description of Findings Concepts – from article , 2 paragraphs needed, 1 paragraph from each article Methods – from article , 2 paragraphs needed, 1 paragraph from each article Participants – from article , 2 paragraphs needed, 1 paragraph from each article Instruments – from article , 2 paragraphs needed, 1 paragraph from each article , also discuss reliability and validity (R/V) of each instrument. If the author does not discuss R/V, state that and conduct a brief internet search, discuss your findings. Evidence – answer to purpose question …did the article you chose answer the PICO question you wrote? You will need to mention each PICO and answer the above. Matrix Table – fill out for each art icle (only research article ). You may insert the table here at the end of the Description of Findings section or you may insert it as an appendix. See your APA book for appendixes. If it is not in the body of the paper an there is no statement telling me where to find it, then I will stop reading your paper at the references. Be sure you your Reference is in APA format and you state w hat type of clinical question (i.e. objective, aim, purpose, hypothesis, ect. This should not be made up, it should be retrieved from each article. Conclusion Write an appropriate conclusion , including major findings from each article and i dentify next step for group References (goes on new page)

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