Publications

Abstract

Background: Negative beliefs can be a barrier to provide quality nursing care for persons living with mental health conditions. This international SP simulation study explored nursing students’ beliefs toward persons with mental health conditions in the United States (US) and Turkey before and after participating in a mental health standardized patient simulation. Methods: A quasi-experimental study design was used in two settings in two countries. Measures included a socio- demographic survey and the Beliefs toward Mental Illness scale. Results were analyzed using paired sample t-test, independent t-test, and chi-square tests. Results: Students in the US had significantly lessened negative attitudes toward persons with mental health conditions when compared to the Turkey group. Conclusion: SP simulation may offer opportunities to improve nursing students’ beliefs toward persons with mental health conditions.

Abstract

Mental health and lifestyle are dynamically interconnected. Current global trends in the prevalence of mental illnesses and chronic disease indicate the need for a transdiagnostic approach to public health that addresses symptomatology, social determinants of health, and individual lifestyle factors to improve health outcomes on individual- and population-level scales. Lifestyle psychiatry is a relatively new but rapidly expanding evidence-based field of medicine that targets health behavior change and patient well-being through the lens of the biopsychosocial model of health. Lifestyle psychiatry may serve as a timely vessel through which lifestyle medicine clinicians can utilize a patient-centered approach to healthcare that enhances mental health, physical health, and overall well-being. Clinical applications of lifestyle psychiatry integrate the foundations of lifestyle medicine, neuroscience related to personality and individual factors, cognitive-behavioral approaches, positive psychology, psychopathology, neurobiology, and health neuroscience.

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Objective: The objective of the study was to explore factors associated with oral health-related quality of life (OHRQoL) in patients with ischaemic stroke in China, guided by the theory of planned behaviour (TPB) and Andersen’s oral health outcome model. Background: Recent studies have reported that the prevalence of stroke is increasing and that stroke patients are facing many oral health related problems. This study provided insights into the role of TPB in the OHRQoL among patients with ischaemic stroke. Materials and methods: Three hundred eight patients with ischaemic stroke from the Department of Neurology of a third-grade class-A hospital in Xuzhou, China, were enrolled in this cross-sectional study between June and September 2020. They completed a questionnaire that included information on socio-demographic characteristics and health behaviours, the Montreal Cognitive Assessment Scale, the Modified Rankin Scale and the Chinese version of the Oral Health Impact Profile-14 scale (OHIP-14). Structural equation modelling (SEM) was used to examine the association among the selected variables based on the TPB and Andersen’s oral health outcome model. Results: Among the participants (mean age 65.6), most (57.5%) were male. Their mean OHIP-14 score was 13.3 ± 7.6. Based on the SEM path diagram, behavioural attitude, subjective norms and perceived behavioural control of oral health were positively associated with intention; intention was associated with OHRQoL. The degree of disability was negatively associated with intention. Cognitive function was positively associated with OHRQoL. Conclusion: The OHRQoL of hospitalised patients with ischaemic stroke in China is fair to poor and affected by their oral health behaviours. Improved oral health behavioural attitude, subjective norms and perceived behavioural control might help them form good intentions and improve their OHRQoL.

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Aim: To assess the effect of cognition on the loss of functional dentition. Materials and Methods: We used data from the three waves of the Panel on Health and Ageing of Singaporean Elderly study (n = 4990 at baseline, 774 complete cases analysed) over 6 years (2009–2015). The outcome was the loss of functional dentition (<21 teeth). The exposure was cognitive impairment, while baseline confounders included age, sex, education, and ethnicity. Time-varying confounders included income, living arrangements, smoking, diabetes, depressive symptoms, cardiovascular disease, and body mass index. We used marginal structural mean models with inverse probability treatment weighted. Results: The mean age of the participants was 70.2 years at baseline. The proportion of participants with loss of functional dentition increased from 74.6% to 89.9% over 6 years. Women, ethnic Chinese, less educated, smokers, people with diabetes, and individuals with depression had a higher proportion of loss of functional dentition than their counterparts. Loss of functional dentition was 1.8 times higher (odds ratio 1.80; 95% confidence interval 0.88–3.69) among those with cognitive impairment after taking well-known confounders into account. Conclusions: After accounting for the time-varying exposure and confounding evidence, the association between cognition and functional dentition among the elderly in Singapore remains uncertain.

Abstract

This manuscript guides school nurses in addressing the unique needs of U.S. school-aged students and families with limited English proficiency (LEP). Owing to the increasing ethnic and racial diversity in U.S. K–12 schools, school nurses will likely encounter children and families with LEP. Students with LEP may be part of a family which immigrated to this country as permanent residents, are refugees, or asylum seekers. Some may be from migrant families who move throughout the region or country for work. School health services, including nursing services, may be the first and only health resource to which these children have consistent access. The availability and importance of language access services are highlighted, as well as tips for school nurses to advocate for language access resources, training for effective communication, understanding the legal landscape, and addressing cultural beliefs that influence health behaviors. Advocacy toward identifying the distinctive needs of families with LEP aims to help school nurses target equitable health outcomes.

Abstract

Background Depression is a growing global problem with significant individual and societal costs. Despite their consequences, depressive symptoms are poorly recognized and undertreated because wide variation in symptom presentation limits clinical identification - particularly among African American (AA) women - an understudied population at an increased risk of health inequity. Objectives The aims of this study were to explore depressive symptom phenotypes among AA women and examine associations with epigenetic, cardiometabolic, and psychosocial factors. Methods This cross-sectional, retrospective analysis included self-reported Black/AA mothers from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study (data collected in 2015-2020). Clinical phenotypes were identified using latent class analysis. Bivariate logistic regression examined epigenetic age, cardiometabolic traits (i.e., body mass index ≥ 30 kg/m2, hypertension, or diabetes), and psychosocial variables as predictors of class membership. Results All participants were Black/AA and predominantly non-Hispanic. Over half of the sample had one or more cardiometabolic traits. Two latent classes were identified (low vs. moderate depressive symptoms). Somatic and self-critical symptoms characterized the moderate symptom class. Higher stress overload scores significantly predicted moderate-symptom class membership. Discussion In this sample of AA women with increased cardiometabolic burden, increased stress was associated with depressive symptoms that standard screening tools may not capture. Research examining the effect of specific stressors and the efficacy of tools to identify at-risk AA women are urgently needed to address disparities and mental health burdens.

Abstract

Background: Given the importance of self-management in type 2 diabetes mellitus (T2DM), a major aspect of health is providing diabetes self-management education and support. Known barriers include access, availability, and the lack of follow through on referral to education programs. Virtual education and support have increased in use over the last few years. Objective: The purpose of the Diabetes Learning in a Virtual Environment (LIVE) study was to compare the effects of the LIVE intervention (educational 3D world) to a diabetes self-management education and support control website on diet and physical activity behaviors and behavioral and metabolic outcomes in adults with T2DM over 12 months. Methods: The LIVE study was a 52-week multisite randomized controlled trial with longitudinal repeated measures. Participants were randomized to LIVE (n=102) or a control website (n=109). Both contained the same educational materials, but the virtual environment was synchronous and interactive, whereas the control was a flat website. Data were collected at baseline and 3, 6, and 12 months using surveys and clinical, laboratory, and Fitbit measures. Descriptive statistics included baseline characteristics and demographics. The effects of the intervention were initially examined by comparing the means and SDs of the outcomes across the 4 time points between study arms, followed by multilevel modeling on trajectories of the outcomes over the 12 months. Results: This trial included 211 participants who consented. The mean age was 58.85 (SD 10.1) years, and a majority were White (127/211, 60.2%), non-Hispanic (198/211, 93.8%), married (107/190, 56.3%), and female (125/211, 59.2%). Mean hemoglobin A1c (HbA1c) level at baseline was 7.64% (SD 1.79%) and mean BMI was 33.51 (SD 7.25). We examined weight loss status versus randomized group, where data with no weight change were eliminated, and the LIVE group experienced significantly more weight loss than the control group (P=.04). There were no significant differences between groups in changes in physical activity and dietary outcomes (all P>.05), but each group showed an increase in physical activity. Both groups experienced a decrease in mean HbA1c level, systolic and diastolic blood pressure, cholesterol, and triglycerides over the course of 12 months of study participation, including those participants whose baseline HbA1c level was 8.6% or higher. Conclusions: This study confirmed that there were minor positive changes on glycemic targets in both groups over the 12-month study period; however, the majority of the participants began with optimal HbA1c levels. We did find clinically relevant metabolic changes in those who began with an HbA1c level >8.6% in both groups. This study provided a variety of resources to our participants in both study groups, and we conclude that a toolkit with a variety of services would be helpful to improving self-care in the future for persons with T2DM.

Abstract

Lifestyle medicine is a practice which adopts evidence-based lifestyle interventions as a primary modality to prevent, treat, and reverse chronic diseases. The six main pillars of this specialty include physical activity, nutrition, stress resilience, cessation or risk reduction of substance use, quality sleep, and connectivity. Lifestyle Psychiatry: Through the Lens of Behavioral Medicine is grounded in the same pillars, drawing upon theories, methods, and empirical findings from health psychology and behavioral medicine. Lifestyle psychiatry is a rapidly emerging area within healthcare informed by rigorous research within the social and biological sciences, public health, and medicine. A volume in the Lifestyle Medicine series, this book uses a comprehensive biopsychosocial approach to prevent and treat psychiatric disorders and promote mental and physical well-being through evidence-based lifestyle interventions. Features: Draws upon theories, methods, and empirical findings from health psychology and behavioral medicine. Provides evidence-based research on the bi-directionality of mental and physical health. Addresses fundamental neuroscience concepts and applies them to practical aspects of lifestyle practices, mental health, and brain health. Appropriate for clinicians, primary care physicians, and those practicing in specialized areas, the information in this book provides users with practical tools to help explain, prevent, and treat psychiatric disorders and associated maladaptive health behaviors in patients.

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Aim: Establish linkages between components of the Self- and Family Management Framework and outcomes of the Nursing Outcomes Classification to evaluate the comprehensiveness of outcomes addressing self- and family management in the Nursing Outcomes Classification. Design: Descriptive study. Methods: Experts conducted a six-step process to establish linkages: (1) preliminary mapping of all relevant nursing outcomes to the framework; (2) development of checklists for team members serving as ‘identifiers’ and ‘reviewers’; (3) mapping all relevant nursing outcomes to the framework; (4) final agreement on mapped outcomes; (5) establishment of inter-rater reliability; and (6) discussion of findings with authors of the Self- and Family Management Framework. Results: Three hundred and sixty-three nursing outcomes were identified as related to the management of chronic disease across all components of the framework: outcomes related to patient self-management (n = 336), family functioning (n = 16) and family caregivers (n = 11). Conclusion: The Nursing Outcomes Classification outcomes comprehensively address self-management, and, less so, family functioning, and caregivers. Implications: Established linkages can be used by nurses to track and support patient and family management outcomes across the care continuum. Patient or public contribution: Linking standardized nursing outcomes to the Self- and Family Management Framework can assist in goal setting and measurement of nursing care during chronic disease management. This work can help describe to funders, policy makers and others invested in health care reform the specific contributions of nurses to self- and family management of chronic disease. Impact: This paper demonstrates the linkages between components of the Self- and Family Management Framework and Nursing Outcomes Classification outcomes. The results of this study offer the opportunity to quantify the impact of nursing care and enhance nursing practice for patients with chronic conditions as well as contribute to developing Nursing Outcomes Classification outcomes that consider self-management processes.

Abstract

Objective This study aimed to explore the association of nurses' perceptions of patient safety climate with missed nursing care in labor and delivery (L&D) units. Methods We recruited nurse respondents via email distribution of an electronic survey between February 2018 and July 2019. Hospitals with L&D units were recruited from states with projected availability of 2018 state inpatient data in the United States. Measures included the Safety Attitudes Questionnaire Safety Climate Subscale and the Perinatal Missed Care Survey. We estimated the relationship between safety climate and missed care using Kruskal-Wallis tests and mixed-effects linear regression. Results The analytic sample included 3429 L&D registered nurses from 253 hospitals (response rate, 35%). A majority of respondents (65.7%) reported a perception of good safety climate in their units, with a mean score of 4.12 (±0.73) out of 5. The mean number of aspects of care occasionally, frequently, or always missed on respondents' units was 11.04 (±6.99) out of 25. χ2 Tests showed that six mostly commonly missed aspects of care (e.g., timely documentation) and three reasons for missed care (communications, material resources, and labor resources) were associated with safety climate groups (P < 0.001). The adjusted mixed-effects model identified a significant association between better nurse-perceived safety climate and less missed care (β = -2.65; 95% confidence interval, -2.97 to -2.34; P < 0.001) after controlling for years of experience and highest nursing education. Conclusions Our findings suggest that improving safety climate - for example, through better teamwork and communication - may improve nursing care quality during labor and birth through decreasing missed nursing care. Conversely, it is also possible that strategies to reduce missed care - such as staffing improvements - may improve safety climate.

Abstract

Background: The self-identity of persons with young-onset dementia (YOD) is affected by the disease progression. However, the lived experience of maintaining self-identity along the disease trajectory is understudied. This meta-synthesis integrated qualitative data on the challenges, coping strategies, and needs of persons living with YOD and how their experiences affected their self-identity over time. Methods: Four English (PubMed, Scopus, CINAHL, PsycINFO) and two Chinese (CNKI and Wanfang) electronic databases were searched for published literature peer-reviewed from the time of database inception to 2022. We used thematic analysis to extract and synthesize data from the literature concerning the long-term lived experiences of persons living with YOD. Results: A total of five peer-reviewed publications were eligible for inclusion in this meta-synthesis study. We identified four themes: (1) declining cognitive function and a prolonged diagnostic process threaten the self-identity of persons living with YOD, (2) struggling to accept the diagnosis of YOD and maintain self-identity, (3) maintaining self-identity and the normalcy of life through social support and person-centered care, and (4) living with YOD through self-development and self-identity reshaping at a later stage of the disease. Conclusions: Persons living with YOD experience challenges maintaining their self-identity throughout the disease trajectory. These challenges are affected by their cognitive function, experiences of personal and social stigma associated with the disease, perceived social support, and person-centered care. Study findings have implications for developing tailored supportive programs for persons living with YOD at various stages of the disease trajectory.

Abstract

Transforming research into practice via implementation science may improve institution-wide implementation success rates for lifestyle medicine (LM). Implementation science (IS) is the study of methods that facilitate the uptake of evidence-based practice and research into regular use by practitioners and policymakers. Multiple IS frameworks, such as the Reach, Effectiveness, Adoption, Implementation, Maintenance/Practical Robust Implementation Strategy Model (RE-AIM/PRISM) model, Exploration, Preparation, Implementation, Sustainment (EPIS) model, and Consolidated Framework for Implementation Research (CFIR) model, have been developed. IS frameworks provide a strong yet adaptable foundation for launching initiatives, minimizing barriers by challenging implementers to identify and address problems that impede implementation, and promoting long-term sustainability and positive outcomes. The trouble-shooting tips provided in this article are strategically aligned with the RE-AIM/PRISM model of IS to maximize the likelihood of implementation success within the LM space. These tips provide guidance on how to effectively implement interventions, sustain their delivery, and avoid or overcome barriers to implementation. This article presents 12 tips intended as a list of options to facilitate the implementation phases of an initiative, as opposed to offering an all-or-nothing approach to implementation strategy. Current IS priorities emphasize system change and sustainability, which are essential components of successful implementation of LM initiatives.

Abstract

Introduction: The aim of this study was to explore the associations among physical activity (PA), inflammatory markers, and quality of life (QoL) from preradiotherapy to 1-year postradiotherapy for patients with head and neck cancer (HNC). Methods: This was an observational longitudinal study. Mixed-effect models incorporating within-subject correlation were used to examine the relationship among the three key variables. Results: Aerobically active patients had significantly lower levels of sTNFR2 (but not other inflammatory markers) than aerobically inactive patients. Being aerobically active and lower inflammation were independently associated with better total QoL scores after adjusting covariates. The trend was similar for patients engaged in strength exercises. Conclusions: Being aerobically active was associated with lower inflammation as represented by sTNFR2 but not with other inflammatory markers. Higher PA (aerobic and strength) and lower inflammation were linked to better QoL. More research is warranted to validate the association among PA, inflammation, and QoL.

Abstract

Background: We aimed to explore whether social relationships and cognitive function were reciprocally related and whether healthy lifestyles mediate their association. Methods: This study included 3372 Chinese adults from the years 2014–2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Results: Baseline social relationships were negatively associated with a change in cognitive function (β = –0.030, p = 0.043). Participants with a 1 standard deviation (SD) increase in social relationships had an approximately 6% reduced risk of developing cognitive impairment. However, baseline cognitive function did not independently predict social relationships. The association between △social relationships and △cognitive function was partially mediated by △a healthy lifestyle (B = 0.025, 95% CI = 0.013–0.041). Conclusions: The association between social relationships and cognitive function may be unidirectional. Policies that promote cognitive function based on social relationships would benefit by taking into account lifestyle factors.

Abstract

Objectives: To develop symptom networks and examine the longitudinal relationships of depressive symptoms among middle-aged and older adults in China. Method: This study used three-wave data from the China Health and Retirement Longitudinal Study (2013 (T1), 2015 (T2), and 2018 (T3)). Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). A multilevel vector autoregression model (VAR) was used to identify ten depressive symptoms dynamically interacting with each other over time. Results: A total of 3,558 participants were included in the final analysis. The strongest direct effects were ‘D10: felt fearful’ -> ‘D6: felt everything I did was an effort’ (β = 0.14). ‘D10: felt fearful’ reported the largest value of out-predictability (r = 0.064) and out-strength (r = 0.635). ‘D3: felt depressed’ reported the largest value of in-predictability (r = 0.077) and in-strength (r = 0.545). Substantial heterogeneity in the network may stem from an individual’s sex and place of residence. Conclusions: ‘Felt fearful’ was the strongest predictor compared to the other nine depressive symptoms based on node centrality. Our study suggests that, after understanding the causes of fear, strategies to reduce fear should be incorporated into multimodal interventions for middle-aged and older adults with depressive symptoms.

Abstract

Objectives: This study aimed to discern the longitudinal association between tooth loss and subsequent functional status, specifically investigating the moderated mediation effects of social relationships and psychological resilience. Methods: Data from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed, we included 2834 older adults aged 65 and over in the study. The longitudinal relationship between tooth loss and functional status was analyzed using the generalized estimating equation. Hayes’ PROCESS macro for SPSS was utilized to study the mediating and moderating effects. Results: In the fully adjusted model, the number of natural teeth at T1 was positively associated with instrumental activities of daily living (IADL) score at T3, but not activities of daily living (ADL) score. Compared with 20+ teeth, participants with complete tooth loss at T1 had a higher risk of developing ADL and IADL disability. Participants with 1–9 teeth at T1 had a 38 % risk of developing IADL disability at T3 (OR = 1.38, 95 % CI = 1.07–1.76, p = 0.012). Social relationships mediated the association between tooth loss and IADL only among participants whose psychological resilience was average (B = 0.0006, 95 % CI = 0.0001–0.0014) or high (B = 0.0013, 95 % CI = 0.0003–0.0026). Conclusion: Psychological resilience moderated the mediating effects of social relationships on the association between tooth loss and functional ability. Clinical significance: This longitudinal study contributes to elucidating parts of social-psychological mechanisms underlying tooth loss and functional disability. It suggests that by cultivating positive social relationships and enhancing psychological resilience, the adverse impacts of tooth loss on functional disability may be mitigated.

Abstract

Background: Pregnancy-related mortality in the United States is the greatest among all high-income countries, and Georgia has one of the highest maternal mortality rates—almost twice the national rate. Furthermore, inequities exist in rates of pregnancy-related deaths. In Georgia, non-Hispanic Black women are nearly 3 times more likely to die from pregnancy-related complications than non-Hispanic White women. Unlike health equity, a clear definition of maternal health equity is lacking, overall and in Georgia specifically, but is needed to reach consensus and align stakeholders for action. Therefore, we used a modified Delphi method to define maternal health equity in Georgia and to determine research priorities based on gaps in understanding of maternal health in Georgia. Methods: Thirteen expert members of the Georgia Maternal Health Research for Action Steering Committee (GMHRA-SC) participated in an iterative, consensus-driven, modified Delphi study comprised of 3 rounds of anonymous surveys. In round 1 (web-based survey), experts generated open-ended concepts of maternal health equity and listed research priorities. In rounds 2 (web-based meeting) and 3 (web-based survey), the definition and research priorities suggested during round 1 were categorized into concepts for ranking based on relevance, importance, and feasibility. Final concepts were subjected to a conventional content analysis to identify general themes. Results: The consensus definition of maternal health equity created after undergoing the Delphi method is: maternal health equity is the ultimate goal and ongoing process of ensuring optimal perinatal experiences and outcomes for everyone as the result of practices and policies free of interpersonal or structural bias that tackle current and historical injustices, including social, structural, and political determinants of health impacting the perinatal period and life course. This definition highlights addressing the current and historical injustices manifested in the social determinants of health, and the structural and political structures that impact the perinatal experience. Conclusion: The maternal health equity definition and identified research priorities will guide the GMHRA-SC and the broader maternal health community for research, practice, and advocacy in Georgia.

Abstract

Diversification of the midwifery workforce is key to addressing disparities in maternal health in the United States. Midwives who feel supported in their practice environments report less burnout and turnover; therefore, creating positive practice environments for midwives of color is an essential component of growing and retaining midwives of color in the workforce. The Midwifery Practice Climate Scale (MPCS) is a 10-item instrument developed through multiphase empirical analysis to measure midwives' practice environments, yet the MPCS had not been independently tested with midwives of color. We conducted invariance analyses to test whether latent means can be compared between midwives of color and non-Hispanic White samples. A step-up approach applied a series of increasingly stringent constraints to model estimations with multiple group confirmatory factor analyses with two pooled samples. A configural model was estimated as the basis of multiple group comparisons where all parameters were allowed to freely vary. Metric invariance was estimated by constraining item factor loadings to be equal. Scalar invariance was estimated by constraining intercepts of indicators to be equal. Each model was compared to the baseline model. The findings supported scalar invariance of MPCS across midwives of color and non-Hispanic White midwives, indicating that the MPCS is measuring the same intended construct across groups, and that differences in scores between these two groups reflect true group differences and are not related to measurement error. Additionally, in this sample, there was no statistically significant difference in perceptions of the practice environments across midwives of color and non-Hispanic White midwives (p > 0.05).