Browsing by Author "Wierenga, Kelly L."

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    Adapting to Uncertainty: Nursing Responsiveness to COVID-19
    (Wolters Kluwer, 2020-07) Wierenga, Kelly L.; Moore, Scott Emory; School of Nursing
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    Adapting to Uncertainty: Nursing Responsiveness to COVID-19
    (Wolters Kluwer, 2021-05-07) Wierenga, Kelly L.; Moore, Scott Emory; School of Nursing
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    African American Race Is Associated With Poorer Outcomes in Heart Failure Patients
    (Sage, 2017-04) Wierenga, Kelly L.; Dekker, Rebecca L.; Lennie, Terry A.; Chung, Misook L.; Dracup, Kathleen; School of Nursing
    Health care disparities associated with African American race may influence event-free survival in patients with heart failure (HF). A secondary data analysis included 863 outpatients enrolled in a multicenter HF registry. Cox regression was used to determine whether African American race was associated with shorter HF event-free survival after controlling for covariates. The multivariable-adjusted hazard ratios (95% confidence intervals [CI]) of older age (1.03, 95% CI = [1.01, 1.04]), New York Heart Association (NYHA) functional class (1.73, 95% CI = [1.29, 2.31]), depressive symptoms (1.05, 95% CI = [1.02, 1.07]), and African American race (1.64, 95% CI = [1.01, 2.68]) were predictors of shorter event-free survival (all ps < .05). Comparisons showed that NYHA functional class was predictive of shorter event-free survival in Caucasians (1.81, 95% CI = [1.33, 2.46]) but not in African Americans (1.24, 95% CI = [.40, 3.81]). African Americans with HF experienced a disparate risk of shorter event-free survival not explained by a variety of risk factors.
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    Associations between COVID-19 perceptions, anxiety, and depressive symptoms among adults living in the United States
    (2021-09) Wierenga, Kelly L.; Moore, Scott E.; Pressler, Susan; Hacker, Eileen; Perkins, Susan
    Background: Associations among illness perceptions of viruses, anxiety and depression symptoms, and self-management decisions, such as mask-wearing, are critical to informing public health practices to mitigate the short- and long-term consequences of the SARS-CoV-2 viral pandemic. Purpose: Guided by the common-sense model of self-regulation, this observational study examined associations among illness perceptions of COVID-19, anxiety, and depression symptoms among community-dwelling adults. Method: Data were collected from 1380 adults living in the United States early in the pandemic (03-23-2020 to 06-02-2020). Participants completed online surveys. Analyses were conducted using descriptive statistics and correlations. Findings: While increased anxiety symptoms were associated with less perceived personal control, greater concern, and higher emotional responsiveness, increased depression symptoms were related to lower concern as well as greater emotional responsiveness and perceived consequences of the pandemic. Discussion: Associations among illness perceptions, anxiety, and depression symptoms may impact viral spread mitigation behavior adoption.
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    Differences among physical activity actigraphy algorithms in three chronic illness populations
    (2022) Alder, Megan L.; Still, Carolyn H.; Wierenga, Kelly L.; Pignatiello, Grant A.; Moore, Shirley M.
    Objectives: In three chronic illness populations and in a combined sample, we assessed differences in two algorithms to determine wear time (WT%) and four algorithms to determine: Kilocalories, light physical activity (PA), moderate-to-vigorous PA (MVPA), and metabolic equivalents (METs). Methods: Data were collected from 29 people living with HIV (PLHIV), 27 participants recovering from a cardiac event, and 15 participants with hypertension (HTN). Participants wore the ActiGraphTM wGT3X-BT for > 3 days on their hip. Analysis of variance (ANOVA) was used to assess differences among the algorithms. Results: No differences were found between the two algorithms to assess WT% or among the four algorithms to assess kilocalories in each of the chronic illness populations or in the combined sample. Significant differences were found among the four algorithms for light PA (p < .001) and METs (p < .001) in each chronic illness population and in the combined sample. MVPA was significantly different among the four algorithms in the PLHIV (p=.007) and in the combined sample (p < .001), but not in the cardiac (p=.064) or HTN samples (p=.200). Discussion: Our findings indicate that the choice of algorithm does make a difference in PA determination. Differences in algorithms should be considered when comparing PA across different chronic illness populations.
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    Disproportionate Impact of the COVID-19 Pandemic on Perceived Social Support, Mental Health and Somatic Symptoms in Sexual and Gender Minority Populations
    (Taylor & Francis, 2021-01) Moore, Scott Emory; Wierenga, Kelly L.; Prince, Dana M.; Gillani, Braveheart; Mintz, Laura Janine; School of Nursing
    Deaths from COVID-19 continue to rise, and this virus has asymmetric impacts on marginalized communities though specific impacts on sexual and gender minority communities are not well understood. From March 23 to June 20, 2020, in an online cross-sectional survey among 1380 US adults, we assessed physical symptoms, psychological symptoms, rumination, and perceived social support in order to describe differences between sexual and gender minority (n = 290) and cisgender heterosexual (n = 1090) respondents. Sexual and gender minority respondents had more frequent COVID-19-associated physical symptoms and depression and anxiety symptoms. Sexual and gender minorities had a significantly higher proportion of depression and anxiety scores exceeding the clinical concern threshold. Longitudinal studies on the physical and psychological impacts of COVID-19 among sexual and gender minority communities are needed to inform interventions to eliminate these disparities.
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    Emotion Regulation and Perceptions of Illness Coherence and Controllability on Regimen Adherence and Negative Cardiac Health Events in African American Women With Heart Failure
    (Wolters Kluwer, 2017) Wierenga, Kelly L.; Lehto, Rebecca H.; Given, Barbara; School of Nursing
    Background: African American women with heart failure (HF) have stressors that negatively impact HF self-management adherence and heighten the occurrence of negative cardiac health events. Perceptions of illness coherence and controllability and emotion regulation are known to facilitate self-management in the face of stressors. Objective: The aim of this study was to determine whether difficulties with emotion regulation and negative perceptions of illness coherence and controllability are detrimental to adherence and increase negative cardiac health events in this patient population. Methods: African American women (n = 54) with HF, aged 49 to 84 years, participated in this longitudinal descriptive correlational study. Using convenience sampling, we recruited patients from hospitals and HF clinics. They completed interviews at intake and 30 days, and their medical records were reviewed at 90 days. Linear and logistic regression models were used to assess predictors of general adherence and negative cardiac health events. Results: Of 54 patients who participated in the study, 28 experienced a negative health event during 90 days, and 57% of these events were cardiac related. The only clear predictor of these events was greater New York Heart Association functional classification (β = 1.47, P = .027). No associations were found between predictors (emotion regulation, controllability, coherence, age, education) and general adherence. Conclusions: Emotion regulation showed a possible greater impact on negative cardiac health events than on general adherence. Perceived illness coherence showed less impact on negative cardiac health events than on general adherence.
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    Emotion Regulation in Chronic Disease Populations: An Integrative Review
    (Springer, 2017) Wierenga, Kelly L.; Lehto, Rebecca H.; Given, Barbara; School of Nursing
    Background and Purpose: Emotion regulation, the experiencing, processing, and modulating of emotional response, is necessary to manage the emotional stressors common in patients with chronic illness. Overwhelming emotional demands deplete the resources needed for everyday self-care management of chronic disease, contributing to poor health outcomes. Emotion regulation is shown to impact behaviors in healthy individuals; yet, a review of literature examining evidence of associations in chronically ill populations is lacking. The purpose of this article is to examine the state of the science relative to the impact of emotion regulation on health outcomes in chronic illness populations. Methods: Articles were reviewed (N = 14) that focused on emotion regulation and outcomes of patients with chronic illness. Results: Indicate that most of the studies focused on these concepts are cross-sectional and measure emotion regulation using various surveys. Potential relationships exist with increased age, male gender, higher education, decreased stress, depressive, and anxiety symptoms being associated with more adaptive emotion regulation. Of primary importance to patients with chronic illnesses is the potential link between greater difficulties with emotion regulation and the presence of chronic disease as well as poorer physical function. Implications for Practice: Care should include attention to affective regulation as well as physiologic responses of chronic illness.
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    Evaluating Depressive Symptoms, BDNF Val66Met, and APOE-ε4 as Moderators of Response to Computerized Cognitive Training in Heart Failure
    (Elsevier, 2023) Pressler, Susan J.; Jung, Miyeon; Giordani, Bruno; Titler, Marita G.; Gradus-Pizlo, Irmina; Reid Lake, Kittie; Wierenga, Kelly L.; Clark, David G.; Perkins, Susan M.; Smith, Dean G.; Mocci, Evelina; Dorsey, Susan G.; School of Nursing
    Background: Depressive symptoms, brain-derived neurotrophic factor (BDNF) Val66Met, and apolipoprotein (APOE)-ε4 may moderate response to computerized cognitive training (CCT) interventions among patients with heart failure (HF). Objectives: The purpose of this study was to examine moderators of intervention response to CCT over 8 months among patients with HF enrolled in a 3-arm randomized controlled trial. Outcomes were memory, serum BDNF, working memory, instrumental activities of daily living (IADLs), and health-related quality of life (HRQL). Methods: 256 patients with HF were randomized to CCT, computerized crossword puzzles active control, and usual care control groups for 8 weeks. Data were collected at enrollment, baseline, 10 weeks, and 4 and 8 months. Mixed effects models were computed to evaluate moderators. Results: As previously reported, there were no statistically significant group by time effects in outcomes among the 3 groups over 8 months. Tests of moderation indicated that depressive symptoms and presence of BDNF Val66Met and APOE-ε4 were not statistically significant moderators of intervention response in outcomes of delayed recall memory, serum BDNF, working memory, IADLs, and HRQL. In post hoc analysis evaluating baseline global cognitive function, gender, age, and HF severity as moderators, no significant effects were found. HF severity was imbalanced among groups (P = .049) which may have influenced results. Conclusions: Studies are needed to elucidate biological mechanisms of cognitive dysfunction in HF and test novel interventions to improve memory, serum BDNF, working memory, IADLs and HRQL. Patients may need to be stratified or randomized by HF severity within intervention trials.
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    Factors Influencing the Impact of Depressive Symptoms on Physical Functional Capacity After Cardiac Rehabilitation
    (Wolters Kluwer, 2019-05) Wierenga, Kelly L.; Moore, Shirley M.; Liu, Jintao; Sattar, Abdus; School of Nursing
    Purpose This study aims to determine (1) if depressive symptoms in the year following completion of cardiac rehabilitation impact physical functional capacity and (2) if exercise, perceived benefits and barriers, self-efficacy, and social support moderate this relationship. Design This longitudinal correlational secondary data analysis included 379 cardiovascular rehabilitation patients. Methods Participants completed measures of depression and potential moderating variables at baseline, 2 months, 6 months, and 12 months and 6-minute work test at baseline and 12 months and wore heart rate monitors to measure exercise for 12 months. Findings Poorer physical functional capacity was predicted by depressed mood score. This relationship was moderated by the percentage of time exercising in target heart rate zone and family support of exercise, but not by perceived benefits and barriers or self-efficacy for exercise. Conclusions Depressive symptoms negatively impact physical functional capacity, and this relationship is moderated by family support and the percentage of time exercising in target heart rate zone.