Publications

Abstract

The rising prevalence of Alzheimer's disease and Alzheimer's disease-related dementias has led to renewed public discourse and policy changes in response to the care needs of persons living with dementia and their care partners. Comprehensive dementia care models are central to many recent policy initiatives, most notably the Centers for Medicare & Medicaid Services Guiding an Improved Dementia Experience model. Gerontological nursing research is uniquely positioned to design and lead research investigating the effectiveness of these initiatives, as well as the dissemination and scaling of existing comprehensive dementia care models. The current Annual State of the Science Review provides an overview of the current state of comprehensive dementia care models in the United States and relevant policies. Challenges and opportunities for nursing education, research, and implementation across the translational research continuum are also outlined. [Research in Gerontological Nursing, 18(1), 7-16.].

Abstract

Introduction: South Asian adults are at high risk for atherosclerotic cardiovascular disease, for which coronary artery calcification is an early predictor. Adherence to the Dietary Approaches to Stop Hypertension diet is a modifiable risk factor that may mitigate the progression of coronary artery calcification and atherosclerotic cardiovascular disease. Methods: Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, the authors calculated a Dietary Approaches to Stop Hypertension dietary score (categorized as low, moderate, and high) to examine the associations of Dietary Approaches to Stop Hypertension diet adherence with coronary artery calcification after a 5-year follow up. Results: The authors found that participants in the high Dietary Approaches to Stop Hypertension category were 41% less likely to have coronary artery calcification score >100 (age-adjusted incidence rate ratio=0.59; 95% CI=0.36, 0.95) than those in the low category; this association was attenuated in multivariable models. Differences were observed by sex. Men in the high Dietary Approaches to Stop Hypertension category were 51% less likely to have coronary artery calcification score >100 (adjusted incidence rate ratio=0.49; 95% CI=0.26, 0.95) and experienced 0.46-fold coronary artery calcification change (fold change=0.46; 95% CI=0.18, 0.90) in multivariable models. Conclusions: The findings indicate a relationship between Dietary Approaches to Stop Hypertension diet and early predictors of atherosclerotic cardiovascular disease risk among South Asians living in the U.S., particularly men.

Abstract

Background In clinical settings, counseling patients on physical activity starts by assessing patients' current physical activity levels. Self-report measures of PA are generally easy to administer; however, they may be too long to be convenient and are known to correlate poorly with objective measures of physical activity. Objective To assess the concurrent validity of a self-report three-question physical activity vital sign with objective Fitbit step counts and the distance walked during a 6-min walk test. Methods This pilot study tested a best practice advisory embedded in the Epic electronic health record, which was designed to prompt providers in a preventive cardiology clinic to counsel patients reporting low levels of physical activity. Patients were invited to participate in the remote patient monitoring phase to assess the change in their physical activity by wearing a Fitbit for 12 weeks and completing a 6-min walk test at baseline and 12 weeks. This analysis used the cross-sectional data collected in this phase. Pearson correlations were conducted between self-reported physical activity, Fitbit step counts, and the distance walked during the 6-min walk - a measure associated with current physical activity levels. Kappa coefficients were calculated to assess agreement between the self-reported physical activity and step counts. Results Participants who enrolled in the Fitbit monitoring were approximately 50% female, with the majority identified as White non-Hispanic adults. Their most common cardiovascular risk factor was hypertension. The self-reported physical activity vital signs were significantly associated with step counts at baseline and 12 weeks but were not associated with the distance during the 6-min walk test. However, the distance walked was significantly associated with step counts at baseline and 12 weeks. The Kappa results demonstrate a poor level of agreement between two categories (meeting or not meeting current physical activity guidelines) of self-report physical activity vitals and the objective Fitbit step counts. Discussion There were moderate correlations between the self-reported physical activity vital signs and the Fitbit step counts, but there was lack of agreement when they were categorized. Further validation of this physical activity vital sign is warranted.

Abstract

Objectives: This scoping review aims to map out the coping strategies among Persons with Mild Cognitive Impairment (PwMCI) and Persons with Mild Dementia (PwMD), identifying the facilitators and the barriers to the use of the strategies. Method: We conducted a systematic search of peer-reviewed studies in PubMed, CINAHL, EMBASE, and PsycINFO. Under the guidance of the Coping Circumflex Model, we identified coping strategies and then conducted thematic synthesis. Results: Our review of 17 studies revealed 13 themes for coping strategies among PwMCI and PwMD, categorized into problem-solving, positive emotional, problem avoidance, and negative emotional strategies. The strategies included utilization of reminders, active engagement in daily tasks, acceptance, and concealing memory problems. The themes for facilitators and barriers encompassed social interactions, assistance from informal care partners, support from professionals, and the influence of emotion. Conclusion: The review revealed the practical types of coping strategies and the influence of context on their use and development, highlighting the need for personalized coping strategies. These insights are crucial for developing tailored interventions to improve quality of life in PwMCI and PwMD. Future research should focus on how PwMCI and PwMD develop their effective coping strategies, considering their trajectory of cognitive decline.

Abstract

Background The recent wave of clinical trials of psychedelic substances among patients with life-limiting illness has largely focused on individual healing. This most often translates to a single patient receiving an intervention with researchers guiding them. As social isolation and lack of connection are major drivers of current mental health crises and group work is expected to be an important aspect of psychedelic assisted psychotherapy, it is essential that we understand the role of community in psychedelic healing. Objectives To explore how psychedelic guides in the United States discuss the role of community in naturalistic psychedelic groups. Methods This is a secondary qualitative data study of data from a larger modified ethnographic study of psychedelic plant medicine use in the US. Fifteen facilitators of naturalistic psychedelic groups were recruited via snowball sampling. Content analysis was used to identify themes. Results Participants viewed the concept of community as essential to every aspect of psychedelic work, from the motivation to use psychedelics, to the psychedelic dosing experience and the integration of lessons learned during psychedelic experiences into everyday life. Themes and subthemes were identified. Theme 1: The arc of healing through community (Subthemes: Community as intention, the group psychedelic journey experience, community and integration); Theme 2: Naturally occurring psychedelic communities as group therapy (Subthemes [as described in Table 2]: Belonging, authenticity, corrective experience, trust, touch). Significance Results suggest that existing knowledge about therapeutic group processes may be helpful in structuring and optimizing group psychedelic work. More research is needed on how to leverage the benefit of community connection in the therapeutic psychedelic context, including size and composition of groups, selection and dosing of psychedelic substances in group settings, facilitator training, and role of community integration. Psychedelic groups may provide benefits that individual work does not support.

Abstract

Background: Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. Objectives: Develop and validate criteria that identify appropriate HBPC target populations. Research Design: A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria. Subjects: Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age above 70) enrolled in NHATS. Measures: Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims. Results: Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm's Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort. Conclusions: We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC.

Abstract

BACKGROUND: Sub-Saharan Africa (SSA) is experiencing a rapid increase in its aging population, including people living with human immunodeficiency virus (HIV) (PLHIV). The purpose of this study was to determine the prevalence of dementia among PLHIV and people without HIV (POHIV) in Malawi. METHODS: We conducted a retrospective medical record review of 400 consecutive patients from a single tertiary health center (200 PLHIV from an HIV clinic and 200 POHIV from an outpatient clinic) in Lilongwe, Malawi. RESULTS: The overall rate of dementia was higher in PLHIV than that in POHIV (22% vs 10%; p = 1.4e). Older age, unknown employment or unemployed, and depression were significant risk factors for dementia for PLHIV, while older age and depression were significant among POHIV. DISCUSSION: Our study confirmed the increased risk of dementia in PLHIV and provides valuable groundwork for future dementia studies to accurately examine the prevalence and risk factors of dementia in SSA, including Malawi. Highlights: Malawians, in SSA, face the double burden of HIV AD and related dementias. We conducted a retrospective medical record review to assess dementia prevalence and risk factors. Dementia prevalence was higher in PLHIV than in POHIV. Older age, unknown employment or unemployed, and depression were risk factors for dementia in PLHIV. Our findings, reflecting the current diagnosing and medical documenting practice in Malawi, provide valuable groundwork for future dementia research in Malawi.

Abstract

Palliative care improves the quality of life for seriously ill patients, but misconceptions and knowledge gaps hinder its implementation in home healthcare (HHC). This study developed and pilot-tested HHC-specific questionnaires to measure palliative care knowledge, attitudes, and confidence (PC-KAC) among clinicians, patients, and caregivers. Using literature reviews, expert input, and cognitive interviews, the questionnaires were refined to ensure clarity, practical relevance, and content validity. Pilot testing revealed widespread confusion about palliative care, with patients and caregivers often conflating it with hospice care and holding misconceptions about opioid use for pain and symptom management. While clinicians demonstrated adequate knowledge, gaps in pain management and confidence in handling emergencies were evident. These findings highlight the need for targeted education and training to integrate palliative care effectively into HHC, improving patient outcomes and supporting interdisciplinary collaboration.</jats:p>

Abstract

While immunotherapy tends to be ineffective against pancreatic ductal adenocarcinoma (PDAC), this cancer type often elicits B-cell immunity. However, the exact antigens responsible for these spontaneous immune responses are still unclear. This study used a unique high-dimensional ELISA to analyze IgG responses to 93 post-translational modifications and other chemical determinants in PDAC patients at the time of diagnosis and before therapy. Results identified 13 specific targets of serum IgG that distinguished PDAC patients from healthy donors. Phosphorylated-serine, -threonine, and -tyrosine emerged as the primary targets, with most patients showing high-titer IgG, predominantly of the IgG1 and IgG3 subclasses. Moreover, serum reactivity to these phosphorylated residues was higher in patients with metastatic disease, suggesting a relation between B cell immunity and tumor burden. Lastly, immunofluorescence staining and phosphoproteomic analysis provided evidence of the accumulation of phosphorylated amino acids in PDAC cells and identified a series of consensus abnormal phosphosites. Overall, our findings reveal for the first time the development of robust antibody responses targeting phosphorylated residues in PDAC.

Abstract

Loneliness is a global health concern that negatively impacts physical/mental health. Social capital, encompassing resources from social networks, may protect against loneliness. We investigated the association between different sources of social capital and feelings of loneliness and examined whether these associations differ by sex. An online survey of 3220 Shanghai residents (mean age 34.5 years, 48.5% females) was conducted in 2022, Shanghai, China. We assessed bonding and bridging social capital using the revised 8-item Personal Social Capital Scale (PSCS) and used the revised three-item UCLA Loneliness Scale to measure loneliness. Multivariable linear regression analysis results suggest that both bonding (β coefficient: −0.152; SE: 0.035) and bridging social capital (β coefficient: −0.131; SE: 0.036) were significantly associated with lower loneliness, adjusting for sociodemographic characteristics, health conditions, and COVID-19-related factors. Notably, the mitigating effect of bonding social capital on loneliness was more pronounced in females, as indicated by significant interactions between sex and bonding social capital. Our study findings indicated that social capital serves as a protective factor against loneliness for Chinese adults, with bonding social capital having a stronger effect among females. Policies and interventions strengthening bonding social capital may facilitate reduced feelings of loneliness among Chinese, especially females.

Abstract

Objective: Past correlational research has shown that minority stress has direct and indirect effects on the biology of sexual minority people. This pilot randomized controlled trial (RCT) examined the potential of AWARENESS, a nine-session cognitive behavioral intervention to reduce intersectional minority stress, to alter gene expression related to immune function, inflammation, and HIV disease progression. Method: Between 2016 and 2019, 25 sexual minority men living with HIV with recent substance use (n=12 in AWARENESS and n= 13 in control) were enrolled, a subset with complete gene expression data among the 41 individuals within the parent RCT. Blood samples were taken prior to the intervention, at the 9-week conclusion of the intervention, and at 4 months postrandomization, and leukocyte RNA was sequenced for all samples. The authors examined differential expression analyses of single genes and overrepresentation analysis of gene sets. Results: Neither AWARENESS nor the control condition was related to the differential expression of single genes. Overrepresentation analysis suggested that AWARENESS was related to changes over time in gene expression in leukocyte RNA in 52 gene sets (q,.05), many of which are related to immune function, while the active control condition was related to changes in gene expression among genes in only one gene set. When AWARENESS was compared to the control condition, four gene sets evidenced an overrepresentation of genes reflecting change over time. Conclusions: This RCT suggests that AWARENESS is associated with changes in gene expression, primarily focused on changes in genes associated with immune processes.

Abstract

BACKGROUND: Despite evidence supporting the efficacy of culturally tailored interventions in reducing stigma, such approaches are lacking for women living with HIV/AIDS (WLWHAs) in China. We conducted this study to determine the efficacy of the culturally tailored Helping Overcome Perceived Stigma (HOPES) intervention in reducing perceived stigma among WLWHAs in China.METHODS: A single-blinded, two-arm parallel-group randomized clinical trial was conducted from 2023 to 2024 in South and Southwest China. WLWHAs from four hospitals were assigned using a WeChat-embedded randomization application to the control group (usual care) or the HOPES intervention. Data analysts remained blinded. Interventions were conducted virtually using Leave No One Behind (LNOB) platform for 3 months. The primary outcome, perceived stigma score, was assessed at baseline, immediately after the intervention and at 3 months post-intervention using 7 items from the HIV/AIDS Stigma Experience Questionnaire (HASEQ), with data analyzed through repeated measures analysis.RESULTS: Of 136 WLWHAs screened, we randomized 101 WLWHAs (50 HOPES; 51 controls). The HOPES group demonstrated a statistically significant reduction in perceived stigma scores immediately after the intervention (-3.86 points, 95 % CI: 5.34 to -2.38, P < .001) and at three months post-intervention (-5.83 points, 95 % CI: 7.20 to -4.47, P < .001) compared to the control group.CONCLUSION: The findings demonstrate HOPES' efficacy in reducing perceived stigma in WLWHA. However, the clinical significance of these changes needs further investigation. Future research should focus on defining meaningful patient-reported thresholds, assessing long-term impact, and optimizing delivery methods.

Abstract

Background: Psychological safety is considered an essential component of highly effective teamwork in organizations, including healthcare organizations. This systematic review examines essential elements and outcomes of psychological safety in healthcare practice teams to determine best practices for implementing psychological safety. Method: A systematic literature review of published studies that described psychological safety as a variable in healthcare practice settings was conducted. Articles were included if they were published in English, peer reviewed, included nurses or physicians either individually or as part of a team, incorporated psychological safety, presented workforce or patient outcomes, and published in the past 10 years. Results: Out of 220 articles, 30 met the inclusion criteria. This review identifies five essential elements and outcomes of psychological safety in healthcare. Conclusion: This systematic review corroborates the importance of psychological safety to healthcare teams. Directing resources toward ensuring the implementation and enhancement of psychological safety in healthcare teams would improve the likelihood of reliable, safe, and high-quality healthcare delivery.

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

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

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.