Publications

Abstract

Sexual and gender minority (lesbian, gay, bisexual, and transgnder: LGBT) adults experience heightened social discrimination and minority stress throughout their lives because of their minority identities. LGBT older adults are particularly vulnerable to the impact of minority stress as they are more likely to live alone and to be estranged from their families of origin. To cope, many LGBT older adults have developed social networks that include chosen families and non-biological relatives who care for one another as if they are family. The chosen family resilience strategy renegotiates what it means to do family and is worthy of theoretical examination. We apply the convoy model of social relations as an interdisciplinary framework for examining LGBT older adults' social networks and chosen families. We discuss points of convergence between the model and what is known about LGBT social networks, and we extend the model to account for chosen families and online social connections.

Abstract

Inner strength, one's internal process of moving through challenging circumstances, has not been described in persons living with mild cognitive impairment (MCI). This qualitative study used the Listening Guide methodology to explore experiences of inner strength in persons newly diagnosed with MCI. We analyzed 36 joint and individual semi-structured interviews with nine participants with MCI and nine care partners. Analytic poems represented three themes explaining inner strength experiences. In the foundational theme, Me with MCI, participants reconfigured their sense of self. The theme Vacillating between Seeking Relief and Dwelling in Challenge illustrated adjusting to life with MCI. The theme You Get through It characterized inner strengths including perseverance, optimism, accepting MCI, and seeking help. Each participant's inner strength profile was unique and impacted by cognitive impairment, and therefore benefitted from support. Though limited by homogeneity, this study highlights Listening Guide utility and has implications for strengths-based interventions and nursing practice.

Abstract

Introduction: Nursing faces numerous challenges amidst broader socio-political transitions in many countries. Despite efforts to establish formal nursing education and legislative frameworks, the profession’s status remains relatively low within some healthcare systems. This study aims to examine the factors influencing nursing professionalism and provide insights into strategies for its enhancement. Aim: The study seeks to summarize the existing literature on nursing professionalism, assess methodological quality, and derive recommendations for future research. Through a systematic review, the study explores various factors shaping nursing professionalism, including communication skills, resilience, education, and cultural perceptions. Methods: A systematic search was conducted across multiple electronic databases from 2014 to 2024 to identify relevant studies on nursing professionalism. The search strategy encompassed elements of professionalism, nursing, and exclusion criteria. Selected studies underwent methodological quality assessment using the Critical Appraisal Skills Programme Qualitative Checklist. Results: The review identified 421 records, yielding 72 eligible studies after screening and eliminating duplicates. Fourteen studies met the inclusion criteria, revealing a complex framework of factors influencing nursing professionalism. The key determinants include communication skills, resilience, education, and cultural perceptions. Studies emphasized the importance of effective communication, resilience in crisis management, quality education, and understanding psychological and cultural influences on professionalism. Conclusions: Nursing professionalism is influenced by multifaceted factors, including communication skills, resilience, education, and cultural perceptions. Recognizing these factors is vital for promoting high-quality nursing practice and ensuring patient safety. Addressing these elements can inform targeted interventions to enhance nursing professionalism and support nurses in delivering optimal healthcare. This study underscores the importance of investing in nursing education, fostering resilience, and considering cultural nuances to cultivate a culture of excellence and professionalism within healthcare systems.

Abstract

Introduction: Racial and ethnic minorities experience a disproportionate burden of the type 2 diabetes (T2D) and are at a 2 to 5 times higher risk of developing macrovascular disease. The purpose of the study was to describe the perspectives of Haitian American immigrants’ challenges to effective T2D self-management. Methods: Utilizing a descriptive qualitative approach, purposive sampling was employed to recruit a subgroup of adult Haitian American immigrants from a parent cross-sectional study. Content analysis was used to identify themes describing participant perspectives. Lincoln and Guba’s four criteria to assess the trustworthiness and ensure the rigor of the study were applied. Results: A total of 36 participants were enrolled, with 54% being male, and age ranged from 34 to 63 years. The majority were married, and 77% reported using metformin. Three facilitators and two barriers to their T2D self-management were found. Facilitators included (1) family and social support, (2) optimism and hope, and (3) novel devices. Barriers included (1) psychosocial and (2) environmental factors. Discussion: The facilitators underscore the pivotal role of close familial relationships, communal influence, and the potential utility of innovative devices like continuous glucose monitoring in enhancing T2D management, whereas the barriers delineate the unique challenges posed by discrimination, lack of provider/client decision-making and communication, the compounding effects of COVID-19, concerns about safety, mistrust in healthcare systems, and financial constraints, which collectively exacerbate the complexities of ineffective T2D management. Collaboration between clinicians, clients, and policymakers is imperative to emphasize the urgent necessity for a multifaceted approach in addressing the complex healthcare landscape of Haitian American immigrants managing T2D in the United States.

Abstract

The ongoing regional nursing shortages in the United States, exacerbated by the COVID-19 pandemic, compromise patient safety and quality. Additionally, an aging workforce coupled with an aging population requiring more nursing care services limits organizations’ ability to adequately staff their facilities. Nurses’ turnover from the profession has been studied less than organizational turnover, thus, the purpose of this integrative review is to identify factors associated with intention to leave the nursing profession in the United States. Using Whittemore and Knafl's (2005) guidelines for integrative review methods, we conducted systematic searches in CINAHL, PubMed, and Web of Science in July 2024. There were 39 peer-reviewed studies that met inclusion criteria. Synthesis of findings resulted in four individual and four work-level themes associated with intent to leave the nursing profession. Individual themes included individual beliefs, health and wellbeing, individual work experiences, and career stability. Work-level themes included job characteristics, job demands/workload, resources and support, and work environment. Notably, job-level factors (i.e., workload, work environment, and support) were associated with professional turnover intention, which suggests that nurses do not believe their experiences will improve at another nursing job. Gaps in the literature include studies with nationally representative samples, studies using validated measures of health, and qualitative studies conducted with the aim of understanding why nurses want to leave the profession. To promote retention of nurses at the professional and organizational level, organizations should measure and modify relevant job-level factors, and the protection of nurses’ wellness should be a top organizational priority.

Abstract

In Brazil, research indicates that primary family members are the main source of support for individuals with chronic conditions such as hypertension (HTN). The burden of caregiving not only hinders effective HTN management but can also cause stress and anxiety, potentially leading to HTN in caregivers. Despite this, few studies have explored the impact of caregiving on these family members. Aims of the study were to: (1) Describe the prevalence of blood pressure (BP) control in family members of individuals with HTN; (2) identify family member perspectives on facilitators and barriers to HTN management; and (3) identify influences that help or interfere with family member functioning (levels of stress, quality of life [QOL], and caregiver burden). This descriptive, cross-sectional study included 213 family members randomly selected from 3 Family Health Strategy units. Family members were largely female (n = 143; 67.1%); the mean age was 60.1 years (SD ± 17.02) and 42.6% (n = 96) had less than a high school education. The three most important facilitators and barriers were related to medication, medical visits, healthy eating, physical activity, and stress. The mean systolic BP was 132.7 (SD ± 21.9) mmHg and a diastolic BP of 85.9 (SD ± 18.1) mmHg with 120 (56.3%) of family members classified as having normal BP. In regard to family member contributions to the self-care of the individual with HTN, family members displayed low levels of self-care maintenance (n = 148; 69.4%) and management (n = 47; 71.2%) support, while a slight majority (n = 114; 53.5%) had adequate levels of self-care confidence in supporting the individual with HTN. Family members (n = 189; 88.8%) showed moderate-to-high levels of perceived stress, but good physical (n = 189; 88.7%) and mental QOL (n = 196; 92%) and low levels of caregiver burden (n = 113; 53.1%). A variety of contextual sociocultural influences were associated with the outcomes under study. Family-based interventions are urgently needed to address the inadequate management of HTN.

Abstract

Objective: This study evaluates Black and AIAN individuals’ self-reported history of being screened for firearm access by healthcare providers, and identifies factors that influence screening. Methods: A cross-sectional, nationally representative survey of included 3015 Black and 527 AIAN adults in the US. Participants were recruited via probability-based sampling. Results: Among Black participants, 13.1% and among AIAN participants, 18.4% reported being screened for firearm access. Of the participants who reported being screened, most have been by mental healthcare providers or primary care physicians. Factors associated with higher screening odds in Black adults included history of suicidal ideation or mental health treatment, current firearm access, younger age, and having children at home. For AIAN participants, a lifetime history of mental health treatment or identifying as female increased screening odds. Conclusion: Black adults report infrequently being screened for firearm access by healthcare providers. Identifying screening barriers and fostering discussions on firearm safety in healthcare settings are important next steps for firearm injury prevention efforts.

Abstract

Aim: Heart failure is a leading cause of hospitalisation and often coexists with seven comorbid conditions on average. This study aimed to examine the gender differences in disease burden, symptom burden, and quality of life among older adults with heart failure and multimorbidity. Design: Cross-sectional study. Methods: This study utilised a baseline survey from an ongoing cohort study in 2022–2023. Adults aged ≥ 50 years with heart failure and more than one chronic condition were recruited from a university-affiliated hospital using an electronic patient portal. Disease burden was measured using a modified Disease Burden Impact Scale. The Edmonton Symptom Assessment Scale and EuroQoL-5D-5L assessed symptom burden and quality of life. Gender differences in baseline outcomes were examined using Pearson's Chi-square tests, Welch's t-tests, and multiple linear regressions. Results: Among 353 participants who completed the baseline survey, the mean (±SD) age was 70 (±9.5) years, and 50.1% were women (mean age: 67 ± 9 vs. men: 72 ± 10). In adjusted models, women had 4.9 points higher disease burden (p = 0.003) and reported higher symptom scores of pain (p = 0.018), tiredness (p = 0.021), nausea (p = 0.007), and loss of appetite compared to men (p = 0.036). Women had significantly more moderate/severe problems in usual activities and pain/discomfort and 0.07 points lower EuroQoL index than men (p = 0.010). Conclusions: There were gender differences in disease/symptom burdens and quality of life. Women living with heart failure and multimorbidity had higher burdens but lower quality of life. Impact: Identifying gender differences among people with heart failure and multimorbidity can be the first step to explaining health disparities. Research should take more inclusive and equitable approaches to address these differences. Healthcare providers, including nurses, should implement targeted strategies for effective multimorbidity management by considering these differences and disparities in clinical settings. Reporting Method: STROBE checklist, cross-sectional. Patient or Public Contribution: No patient or public contribution.

Abstract

Objectives: Periodontitis is linked with many health conditions, but its genetic basis is not yet understood. This genome-wide association study (GWAS) aimed to investigate the genetic variants associated with periodontitis. Materials and methods: This study utilised UK Biobank participants of European descent. Individuals were categorised as “having periodontitis” if they self-reported having ‘painful gums’, ‘bleeding gums’ or ‘loose teeth’ (n = 68,482), or as “controls” for those without these symptoms (n = 307,342). We conducted GWAS of this binary periodontitis phenotype using logistic regression models with PLINK2.0 adjusting for age, sex and the first 15 principal components to account for population stratification. Results: There were 376,611 participants (mean baseline age = 57 ± 7.9 SD) included in the GWAS, and four significant loci were identified: rs775476621 on chromosome 11 (Odds Ratio, OR[T]: 3.08, p = 1.01 × 10− 8), rs751014048 on chromosome 11 (OR[G]: 3.07, p = 1.04 × 10− 8), rs149922301 on chromosome 4 near gene RP11-61G19.1 (OR[A]: 1.18, p = 2.71 × 10− 8) and rs368467810 on chromosome 6 near gene HIST1H3L (OR[TTTA]: 0.96, p = 3.88 × 10− 8). Conclusions: Within the current limitations, such as self-reported phenotype and older age of the study population, four loci were detected for periodontitis that have not previously been linked with this condition. Further exploration of the function of these loci may contribute to improved understanding of periodontitis aetiology and subsequent drug development. Clinical relevance: These findings offer new targets for future research to investigate the genetic impact on periodontitis and aid the future understanding of periodontitis pathology and the disease’s progression.

Abstract

Perinatal care in the United States is in crisis. U.S. childbearing women are dying at higher rates than in comparable economically developed countries, despite the fact that four of every five perinatal deaths are preventable. The crisis disproportionately affects Black and American Indian and Alaska Native women, who are dying at two to three times the rate of their White counterparts. These disparities have been linked to systemic and structural racism and lack of access to care. A perinatal care workforce that reflects and meets the needs of a racially and ethnically diverse U.S. population is warranted to increase the likelihood of equitable care and decrease perinatal disparities. Using a health equity lens, this paper provides policy recommendations for a system-wide approach to growing and diversifying the perinatal nursing workforce as part of the solution to decrease disparities in perinatal outcomes.

Abstract

Background: The rapid spread and severity of COVID-19 brought major health challenges and dealt a heavy blow to key health services and daily life in Africa, including Malawi. Purpose: To explore and examine the impact of the COVID-19 pandemic on cervical cancer (CC) prevention behavior in Malawi through a decolonized lens. Methods: A qualitative descriptive study informed by a decolonized perspective was conducted during the COVID-19 pandemic. A purposive sampling was taken from 17 key informant interviews, including, seven Malawian women living with HIV infection (WLWHIV). Results: Themes explored were that COVID-19 was indiscriminate towards not only health deterioration but also a social crisis and health was no longer an individual problem but a public and global issue across borders. Conclusion: To uproot global health inequities, templates revolved around Western ways of knowing over national and global health need to be reexamined and methods reinvented to be relevant to local ways of knowing.

Abstract

Background: Low awareness and misconceptions surrounding mild cognitive impairment highlight the urgent need for effective health education. Reluctance to seek intervention and poor adherence to management strategies make behavior-oriented health education essential. Objective: To assess the effectiveness and clinical significance of a trans-theoretical model-based health education program on cognitive-behavioral outcomes in older adults with mild cognitive impairment. Design: A two-arm and assessor-blinded randomized controlled trial. Settings and participants: 100 community-dwelling older adults with mild cognitive impairment in Huzhou, China. Methods: Participants were randomly assigned to a trans-theoretical model-based health education program (weekly 45–60 min sessions for 8 weeks, followed by 12 weeks of unsupervised practice) or a wait-list control group receiving standard health education. Disease knowledge, behavioral stage, and adherence to health management behaviors were assessed at baseline, 8-week, and 20-week. Effects were evaluated at the group level via generalized estimating equation and at the individual level using reliable and clinically significant change. Results: The trans-theoretical model-based health education program demonstrated significant effects over the wait-listed control. Generalized estimating equation analyses showed statistically significant effects on behavioral stage (β8-week = 1.04, 95%CI = 0.34–1.75; β20-week = 1.72, 95%CI = 0.95–2.49), disease knowledge (β8-week = 1.14, 95%CI = 0.26–2.02; β20-week = 1.78, 95%CI = 0.87–2.69), and adherence to health management behaviors (β8-week = 6.20, 95%CI = 2.03–10.37; β20-week = 10.74, 95%CI = 6.47–15.01) at both measured intervals. Additionally, global cognitive function (β8-week = 0.60, 95%CI = − 0.18–1.38; β20-week = 2.42, 95%CI = 1.64–3.20), Purdue Pegboard Test Assembly and Bimanual Tasks (β8-week = 0.16/0.38, 95%CI = − 0.21–0.53/− 0.18–0.94; β20-week = 0.96/1.80, 95%CI = 0.57–1.35/1.17–2.43) improved significantly over time. Reliable and clinically significant change analyses at 8 weeks indicated significant improvements in the intervention group: 57 % of participants improved in disease knowledge (22 % clinically significant), 90 % in adherence to health management behaviors (17 % clinically significant), and 61 % in global cognitive function (10 % clinically significant). By 20 weeks, these rates increased to 63 % (29 %), 100 % (25 %), and 78 % (27 %). However, non-significant improvements in depression symptoms and sleep quality were found at individual-level assessment. Conclusions: This study shows that the trans-theoretical model-based health education program effectively enhances cognitive-behavioral health outcomes in older adults with mild cognitive impairment, with benefits persisting for 12 weeks. Future research should further explore the potential mechanisms underlying the cognition and behavior-enhancing effects of this program. Registration number: ChiCTR1900028351.

Abstract

Background: Depression affects 33% of women with type 2 diabetes (T2D) and leads to increased risks of premature mortality. Fluctuation and variation of depressive presentations can hinder clinical identification. Purpose: We aimed to identify and examine subgroups characterized by distinct depressive symptom trajectories among women with T2D. Methods: This retrospective analysis leveraged the Women’s Interagency HIV Study data to identify depressive symptom trajectories based on the Center for Epidemiological Studies Depression scores (2014-2019) among women with and without HIV. Descriptive statistics characterized sample demographics (eg, age, race, income), clinical indices (eg, hemoglobin A1C [HbA1c], BMI, HIV status), and psychosocial experiences (eg, discrimination, social support, anxiety, pain). We used growth mixture modeling to identify groups defined by distinct depressive symptom trajectories and parametric and non-parametric tests to examine demographic, clinical, and psychosocial differences across subgroups. Results: Among the 630 women included, the mean age was 50.4 (SD = 8.3) years, 72.4% identified as Black and non-Hispanic, and 68.2% were living with HIV. Five subgroups were identified and distinguished by severity and symptom type. Participants with lower incomes (P = .01), lower employment (P < .0001), lower social support (P = .0001), and experiences of discrimination (P < .0001) showed greater membership in threshold, moderate, and severe depressive subgroups. Subgroup membership was not associated with metabolic indices (BMI, HbA1c) or HIV status. Anxiety, pain, and loneliness (all P = .0001) were worse in subgroups with higher depressive symptoms. Conclusions: Among women with T2D, depressive symptom trajectories differ across clinical and social contexts. This study advances precision by delineating subgroups within a broad clinical category.

Abstract

Background: Improving the oral health of older immigrants is an important public health priority in the United States, but the role of children’s support has received little attention. This study investigated the relationship between support from adult children and perceived oral health among foreign-born and U.S.-born Chinese Americans. We also examined the mediating role of resilience. Methods: Data were derived from a sample of 377 Chinese American older adults aged 55 or older in Honolulu, Hawai’i. Using a path analysis with structural equation models, we conducted a comparison of self-rated oral health and oral health problems between foreign-born and U.S.-born Chinese Americans. Results: For foreign-born participants, more emotional support from children was directly associated with better perceived oral health and indirectly linked to perceived oral health via resilience. For U.S.–born Chinese Americans, financial support from children was directly related to worse perceived oral health. Conclusions: This study provides evidence for resilience pathways linking social support from children and older immigrants’ oral health, which can help health professionals and family counselors develop culturally tailored interventions.

Abstract

Context: Chronic kidney disease (CKD) disproportionately impacts lower socioeconomic groups and is associated with many symptoms and complex decisions. Integration of Kidney Supportive Care (KSC) with CKD care can address these needs. To our knowledge, this approach has not been described in an underserved population. Objectives: We describe our adaptation of an ambulatory integrated KSC and CKD clinic for implementation in a safety net hospital. We report our utilization metrics; characteristics of the population served; and visit activities. Methods: We considered modifications from the perspectives of people with CKD, their providers, and the health system. Modifications were informed by meeting notes with key participants (hospital administrators [n = 5], funders [n = 1], and content experts [n = 2]), as well as literature on palliative care program building, safety net hospitals, and KSC. We extracted utilization data for the first 15 months of the clinic's operations, demographics, clinical characteristics, unmet health related social needs, and symptom burden, measured by the Integrated Palliative Outcome Scale-Renal (total Score, and sub-scores of physical, psychological, and practical impact of CKD) from the electronic health record. Results are reported using descriptive statistics. Results: Adaptions were proactive and done by clinical and administrative leaders. Meetings identified challenges of the safety net setting including people presenting with advanced disease and having several social needs. Modifications to our base model were made in staffing, data collection, and work flow. Show rate was approximately 68%, with a majority of people identifying as Black or Hispanic, and uninsured or on Medicaid. Symptom burden was lower than previous reports, driven by a better psychological sub-score. Conclusions: We describe a feasible ambulatory care model of KSC in a safety net setting that can serve as a framework for the development of other noncancer palliative care ambulatory clinics. Future work will optimize our model.

Abstract

Background: Neurodiverse and disabled individuals are underrepresented in nursing education, often facing marginalization, lack of support, and implicit bias. Purpose: This study assessed nursing faculty's preparedness to teach neurodiverse students by examining their knowledge and attitudes about neurodiversity. Methods: A convergent parallel mixed methods design was used, involving a survey emailed to 469 nursing faculty at 3 North American institutions. The survey included the Faculty Preparedness Questionnaire-Neurodiversity and open-ended questions. Results: The study found that faculty has moderate knowledge of neurodiversity but desire more training. Attitudes were generally positive, though some implicit biases were present. Qualitative analysis revealed themes of natural variation, acceptance, and the need for more support and training. Conclusion: Faculty members showed a willingness to learn and support neurodiverse students, but professional development is needed to reduce ableism and enhance inclusive teaching practices.

Abstract

Design thinking (DT) has evolved as a human-centered framework for solving problems in a number of industries including health care and education. Users of DT move through a multistep dynamic process involving five stages: empathy, problem identification, ideation, prototyping, and testing. This article highlights one program’s efforts to operationalize DT into the undergraduate nursing curriculum as a project-based learning strategy in a senior class. This educational innovation works to develop advanced critical thinking and problem-solving competencies for approximately 450 nursing students each academic year and has been taking place since 2019.

Abstract

BACKGROUND AND OBJECTIVES: Goal-concordant transition to hospice is an important facet of end-of-life care for people living with dementia. The objective of this integrative review was to appraise existing evidence and gaps focused on interventions and predictors of transition to hospice and end-of-life care for persons living with dementia across healthcare to inform future research.RESEARCH DESIGN AND METHODS: Using integrative review methodology by Whittemore and Knafl, five databases were searched (PubMed, CINAHL, Web of Science, Google Scholar, Cochrane Database for Systematic Reviews) for articles between 2000 and 2023. The search focused on dementia, hospice care, transitions, care management and/or coordination, and intervention studies.RESULTS: Fourteen articles met inclusion criteria after critical appraisal. Most were cross-sectional in design and conducted in nursing homes and hospitals in the U.S. persons living with dementia had multiple chronic conditions including cancer, diabetes, heart disease, and stroke. Interventions included components of hospice decision-making delivered through advance care planning, checklist-based care management for hospice transition, and palliative care for those with severe dementia. Predictors included increasing severity of illness including functional decline, organ failure, intensive care use, and the receipt of palliative care. Other predictors were related to insurance status, race and ethnicity, and caregiver burden. Overall, despite moderate to high-quality evidence, the studies were limited in scope and sample and lacked racial and ethnic diversity.DISCUSSION AND IMPLICATIONS: Prospective, multisite randomized trials and population-based analyses including larger and diverse samples are needed for improved end-of-life dementia illness counseling and hospice care transitions for persons living with dementia and their caregivers.

Abstract

Background and Objectives: Goal-concordant transition to hospice is an important facet of end-of-life care for people living with dementia. The objective of this integrative review was to appraise existing evidence and gaps focused on interventions and predictors of transition to hospice and end-of-life care for persons living with dementia across healthcare to inform future research. Research Design and Methods: Using integrative review methodology by Whittemore and Knafl, 5 databases were searched (PubMed, CINAHL, Web of Science, Google Scholar, and Cochrane Database for Systematic Reviews) for articles between 2000 and 2023. The search focused on dementia, hospice care, transitions, care management and/or coordination, and intervention studies. Results: Fourteen articles met inclusion criteria after critical appraisal. Most were cross-sectional in design and conducted in nursing homes and hospitals in the U.S. persons living with dementia had multiple chronic conditions including cancer, diabetes, heart disease, and stroke. Interventions included components of hospice decision-making delivered through advance care planning, checklist-based care management for hospice transition, and palliative care for those with severe dementia. Predictors included increasing severity of illness including functional decline, organ failure, intensive care use, and the receipt of palliative care. Other predictors were related to insurance status, race and ethnicity, and caregiver burden. Overall, despite moderate to high-quality evidence, the studies were limited in scope and sample and lacked racial and ethnic diversity. Discussion and Implications: Prospective, multisite randomized trials and population-based analyses including larger and diverse samples are needed for improved end-of-life dementia illness counseling and hospice care transitions for persons living with dementia and their caregivers.

Abstract

Federal law requires school health leaders to ensure meaningful access to language resources to promote optimal health and education outcomes. This paper aims to inform all stakeholders, including decision-makers, about the importance of developing language access plans and policies. Multiple sources and legal guidelines provide a comprehensive overview of the issue. Including an examination of current practices and challenges that school nurses encounter, specifically regarding language resources, guidance is offered to elucidate meaningful language access policies that ensure equitable access to school health services. Supporting meaningful language access includes providing school nurses with qualified interpretation and translation services to care for those who do not speak, read, or write in English or have limitations with the English language. Additionally, local and state agencies may implement language access services requirements and enforce compliance with a language access plan to meet federal funding requirements.

Abstract

Menopause is a complex life stage that affects millions. This article helps nurses understand its symptoms, treatment options, and how to better support patients through the transition.

Abstract

Addressing disparities related to Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) is a priority for policymakers, practitioners, and researchers. In this perspective, we highlight important gaps and opportunities presented during Session 4: Disparities in Health Care Access, Utilization, and Quality, of the 2023 National Research Summit on Care, Services, and Supports for Persons Living with Dementia and Their Care Partners/Caregivers. We call attention to three areas: (1) increased data availability and linkages across local, state, and federal levels; (2) health information technology use and related care access, quality, and costs; and (3) diverse health insurance models used to enable access to medical care, long-term services and supports, and address care quality. Recommendations present considerations for future research and opportunities to strengthen policies related to the care of persons living with AD/ADRD. Highlights: Disparities related to AD/ADRD negatively impact diverse populations. Limited data on underrepresented groups make it difficult to assess the full scope of disparities. Increasing access to health information technology is necessary for reducing disparities. More information is needed to understand the impact of payment models on addressing disparities.

Abstract

Objectives: Examine relationships between arts participation in high school and later life, cognition, and cognitive change among older adults in the United States. Design: Longitudinal retrospective Setting: Health and Retirement Survey (HRS) including the Life History Mail Surveys (LHMS) and Consumption and Activities Mail Survey (CAMS). Participants: A sample of HRS respondents with cognition data from Wave 3 (1996) through Wave 14 (2018). We merged LHMS and CAMS responses (2017 and 2019) about high school arts participation, eliminating respondents < 50 years of age, without cognitive data in the last three waves, or with normal cognition following previously reported dementia. Measurements: Respondents were categorized into 4 groups for musical and for visual arts): (1) lifelong learners; (2) high school learners; (3) current learners; and (4) no interest. Cognitive function was measured as a continuous summary score on a 27-point cognitive battery of items in the Langa-Weir Classification total Telephone Interview for Cognitive Status, TICS. Results: Musical arts participation at time of the survey was associated with a slower rate of cognitive decline in the entire sample (3505 participants in musical and 3507 in visual arts) and the War Babies cohort. Those who participated in musical arts at the time of the survey and while in high school experienced a slower rate of cognitive decline in the AHEAD-CODA cohort only. No relationships were found between cognition and times of visual arts participation. Conclusions: Some types of arts participation at different periods of life may benefit cognition later in life.

Abstract

Pregnancy is a vital period affecting both maternal and fetal health, with impacts on maternal metabolism, fetal growth, and long-term development. While the maternal metabolome undergoes significant changes during pregnancy, longitudinal shifts in maternal urine have been largely unexplored. In this study, we applied liquid chromatography–mass spectrometry-based untargeted metabolomics to analyze 346 maternal urine samples collected throughout pregnancy from 36 women with diverse backgrounds and clinical profiles. Key metabolite changes included glucocorticoids, lipids, and amino acid derivatives, indicating systematic pathway alterations. We also developed a machine learning model to accurately predict gestational age using urine metabolites, offering a non-invasive pregnancy dating method. Additionally, we demonstrated the ability of the urine metabolome to predict time-to-delivery, providing a complementary tool for prenatal care and delivery planning. This study highlights the clinical potential of urine untargeted metabolomics in obstetric care.