Publications

Abstract

Background: The degree of food processing may be an important dimension of diet in how it relates to health outcomes. A major challenge is standardizing food processing classification systems for commonly used datasets. Objectives: To standardize and increase transparency in its application, we describe the approach used to classify foods and beverages according to the Nova food processing classification in the 24-h dietary recalls from the 2001–2018 cycles of What We Eat in America (WWEIA), NHANES, and investigate variability and potential for Nova misclassification within WWEIA, NHANES 2017–2018 data via various sensitivity analyses. Methods: First, we described how the Nova classification system was applied to the 2001–2018 WWEIA, NHANES data using the reference approach. Second, we calculated the percentage energy from Nova groups [1: unprocessed or minimally processed foods, 2: processed culinary ingredients, 3: processed foods, and 4: ultraprocessed foods (UPFs)] for the reference approach using day 1 dietary recall data from non-breastfed participants aged ≥1 y from the 2017–2018 WWEIA, NHANES. We then conducted 4 sensitivity analyses comparing potential alternative approaches (e.g., opting for more vs. less degree of processing for ambiguous items) to the reference approach, to assess how estimates differed. Results: The energy contribution of UPFs using the reference approach was 58.2% ± 0.9% of the total energy; unprocessed or minimally processed foods contributed 27.6% ± 0.7%, processed culinary ingredients contributed 5.2% ± 0.1%, and processed foods contributed 9.0% ± 0.3%. In sensitivity analyses, the dietary energy contribution of UPFs ranged from 53.4% ± 0.8% to 60.1% ± 0.8% across alternative approaches. Conclusions: We present a reference approach for applying the Nova classification system to WWEIA, NHANES 2001–2018 data to promote standardization and comparability of future research. Alternative approaches are also described, with total energy from UPFs differing by ∼6% between approaches for 2017–2018 WWEIA, NHANES.

Abstract

PURPOSE: The purpose of this study was to examine the impact of co-occurring symptoms in patients with advanced cancer and malignant fungating wounds (MFWs) on palliative and functional performance, and the feasibility of collecting self-reported data in this population. DESIGN: This was an exploratory, observational study. Quantitative surveys and qualitative semistructured interviews using a phenomenological approach were employed. SUBJECTS AND SETTING: The sample comprised 5 adults with advanced breast, oral, and ovarian cancer and MFWs. Participants were recruited from an urban outpatient cancer center, hospice, and wound center located in the Northeastern United States. METHODS: Demographic and clinical characteristics were collected, and self-reported symptom and functional performance data measured. Descriptive statistics, T scores, confidence intervals, and standard deviation were calculated for quantitative data. One-to-one semistructured interviews were conducted by the first author to gain deeper understanding of participants' symptom experience. Qualitative data were analyzed using an iterative and inductive thematic data analysis method to identify major themes. RESULTS: The mean cancer-related and wound-specific symptom occurrence was 17 (SD = 5.56) and 4 (SD = 1.26), respectively. Distressing, extensive co-occurring symptom burdens were experienced by all participants; they also reported poor functional performance and diminished palliative performance. Qualitative findings supported quantitative results. CONCLUSIONS: Findings suggest that co-occurring cancer-related and wound-specific symptoms have incremental and negative impact on functional performance. The use of multiple data collection methods was feasible, including self-reported data in this advanced cancer population.

Abstract

Importance: Beyond existing knowledge of demographic and performance skill factors, establishing relationshipsbetween poststroke activity engagement and illness perceptions sets the stage for the development of moreeffective intervention strategies.Objective: To describe the illness perceptions of community-dwelling people with stroke in the first 2 yrpoststroke; specifically, to examine whether illness perceptions are associated with activity engagement and toexplore the moderating role of gender in these relationships.Design: Cross-sectional study.Setting: Participants were recruited from eight rehabilitation settings in Beijing, China.Participants: 202 community dwellers with stroke.Outcomes and Measures: Activity engagement and illness perceptions were measured with the Mandarin versionof the Assessment of Life Habits and the Chinese version of the Stroke-Specific Illness PerceptionsQuestionnaire–Revised, respectively. Participants’ demographic information, cognitive status, and motor functionwere also collected.Results: Stronger perceptions of consequences and controllability were related to better performance in activityengagement at the personal level, and stronger perceptions of illness coherence were related to betterperformance in activity engagement at the societal level. In addition, gender differences in the relationship betweenillness perceptions and activity engagement were described.Conclusions and Relevance: How people with stroke perceived their conditions dictated their levels of activityengagement in their community of residence. The findings suggest that understanding clients’ illness perceptionsmay assist practitioners in developing comprehensive, targeted interventions to improve activity engagement andmaximize recovery after stroke. Future studies are needed to explore the gender effect of illness perceptions onactivity engagement in people with stroke.What This Article Adds: This study identified the relationships between illness perceptions and level of activityengagement in real-life environments in people with stroke. In addition to motor and cognitive interventions,providing opportunities for clients to gain a better understanding of stroke would facilitate their activity engagementin their real-life environment.

Abstract

Background: Hospitalized older adult medication-related falls are common and understudied. Local Problem: There were organizational educational gaps identified in assisting nurses to recognize and mitigate medication associated side effects that may predispose hospitalized older adults to fall. Methods: A quality improvement project that utilized pre and post-test design. An eLearning module was developed and distributed to registered nurses in a medical unit. Interventions: Eighty registered nurses participated in an eLearning module that included patient and family centered evidence-based guidelines and teach-back guides related to medication fall safety. Results: An increase in overall (2.2%) medication patient satisfaction scores and decrease (8%) in falls for patients > 65 years old over a 4-month period. Conclusions: There is benefit of implementing a structured medication fall risk education program for nurses on a medical unit. Patient satisfaction related to communication about medications and a reduction in falls was impacted by this interdisciplinary intervention.

Abstract

Purpose Remote patient monitoring (RPM) is a tool for patients to share data collected outside of office visits. RPM uses technology and the digital transmission of data to inform clinician decision-making in patient care. Using RPM to track routine physical activity is feasible to operationalize, given contemporary consumer-grade devices that can sync to the electronic health record. Objective monitoring through RPM can be more reliable than patient self-reporting for physical activity. Design and Methods This article reports on four pilot studies that highlight the utility and practicality of RPM for physical activity monitoring in outpatient clinical care. Settings include endocrinology, cardiology, neurology, and pulmonology settings. Results The four pilot use cases discussed demonstrate how RPM is utilized to monitor physical activity, a shift that has broad implications for prediction, prevention, diagnosis, and management of chronic disease and rehabilitation progress. Clinical Relevance If RPM for physical activity is to be expanded, it will be important to consider that certain populations may face challenges when accessing digital health services. Conclusion RPM technology provides an opportunity for clinicians to obtain objective feedback for monitoring progress of patients in rehabilitation settings. Nurses working in rehabilitation settings may need to provide additional patient education and support to improve uptake.

Abstract

Self- and family management (SFM) refers to patients’ and family caregivers’ activities to co-manage illness. Two barriers to SFM are low palliative care literacy and lack of goals of care communication, which potentially result in SFM activities that are unsupportive of patients’ goals. Managing Cancer Care: A Caregiver’s Guide (MCC-CG) aims to improve palliative care literacy and communication within a SFM training program. In this pilot randomized trial, we enrolled breast cancer family caregivers and collected data at 0, 1, and 3 months on palliative care literacy, SFM engagement, communication, transitions management, uncertainty, caregiver burden, and caregiver competence/personal gain. Participants (n = 35) had a mean age of 54 (range: 18–81) and were 66% white and 34% racial/ethnic minorities. Intervention participants improved their palliative care literacy and SFM engagement, reduced uncertainty and caregiver burden, increased competence/personal gain, and had more goals of care conversations over time. MCC-CG has preliminary efficacy, warranting further study.

Abstract

This article provides resources for HCPs encountering individuals trafficked for sex work to improve their practice and care of them, pointing out that these resources can be used in the development of curricular units for HCP students.

Abstract

Introduction: Poor sleep is ubiquitous in skilled nursing facilities (SNFs) and is associated with a myriad of negative symptoms. Non-pharmacological interventions can improve sleep, yet sustainability has not been demonstrated. The Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER) trial will test whether a staff mentoring approach to address resident sleep issues positively impacts sleep quality and whether improved sleep benefits mood, cognitive performance, and activity engagement for residents living in SNFs. Intervention: This is a four-year hybrid type I effectiveness/implementation randomized stepped-wedge trial using a comprehensive sleep improvement program conducted in three urban SNFs. Methods: We will provide SNF staff with sleep promotion strategies over a four-month intervention. Staff will have access to in-person workshops, webinars, weekly sleep pearls via text messaging, environmental data, and expert program mentors. We will consent residents for data collection (at baseline, end of intervention, and three- and six-months post-intervention) including resident observations, questionnaires, and wrist actigraphy (to objectively measure sleep). We will also use selected Minimum Data Set 3.0 (MDS) measures. Conclusion: SLUMBER uses a unique strategy to iteratively improve sleep interventions through SNF staff buy-in, expert mentoring, and technological supports within a quality improvement framework. As a stepped-wedge trial, the initial SNF units provide opportunities for program improvement in subsequent units, accounting for variation across resident populations at different sites. Protocol limitations include strategies which may require substantial customization for greater spread. A comprehensive staff training program that addresses both sleep quality and related symptoms has the opportunity for considerable dissemination.

Abstract

Background: Despite recommendations to include disability content in nursing education, nursing students have little exposure to disability education, which would help to develop necessary knowledge, skills, and attitudes in learning to care for patients with disabilities. Purpose: This study evaluated learners' perceptions of the effectiveness of a tabletop simulation in meeting their learning needs related to nursing care for children with disabilities and their families. Methods: The research design was a descriptive educational intervention study. Nursing students (n = 234) enrolled in the pediatric nursing course attended the simulation as a required part of their coursework. Results: The majority of the students found the tabletop simulation with disability content to be an effective educational intervention. Conclusions: The results obtained from this study indicated that the tabletop simulation was an effective educational strategy for nursing students' learning to provide care for children with disabilities and their families.

Abstract

Purpose: To examine if gut microbial taxa abundances and predicted functional pathways correlate with Bristol Stool Form Scale (BSFS) classification at the end of neoadjuvant chemotherapy and radiation therapy (CRT) for rectal cancer. Methods: Rectal cancer patients (n = 39) provided stool samples for 16S rRNA gene sequencing. Stool consistency was evaluated using the BSFS. Gut microbiome data were analyzed using QIIME2. Correlation analysis were performed in R. Results: At the genus level, Staphylococcus positively correlates (Spearman’s rho = 0.26), while Anaerofustis, Roseburia, Peptostreptococcaceae unclassified, Ruminococcaceae UBA1819, Shuttleworthia, Ca. Soleaferrea, Anaerostignum, Oscillibacter, and Akkermansia negatively correlate with BSFS scores (Spearman’s rho −0.20 to −0.42). Predicted pathways, including mycothiol biosynthesis and sucrose degradation III (sucrose invertase), were positively correlated with BSFS (Spearman’s rho = 0.03–0.21). Conclusion: The data support that in rectal cancer patients, stool consistency is an important factor to include in microbiome studies. Loose/liquid stools may be linked to Staphylococcus abundance and to mycothiol biosynthesis and sucrose degradation pathways.

Abstract

Objectives: This study aimed to examine the trajectories of depressive symptoms over a 5-year period in a sample of community-dwelling older adults with disabilities in rural China, and the association between duration of instrumental support primarily provided by adult children and the trajectories of depressive symptoms. Methods: Data were drawn from three waves of the China Health and Retirement Longitudinal Study (2011–2015). The sample included 1,466 older adults living in rural areas aged 60 and over who had at least one child in all three waves. Duration of instrumental support provided by adult children was measured by the number of waves that older adults received instrumental support primarily from any adult children in the data collection. Growth mixture modelling was used to identify the trajectory classes of depressive symptoms among these older adults, and logistic regression was used to examine the association between duration of instrumental support primarily provided by adult children and the trajectory classes of depressive symptoms. Results: This study identified two distinct trajectories of depressive symptoms among the respondents: high but decreasing levels of symptoms and persistently low levels of symptoms. Respondents who received a longer duration of instrumental support primarily from adult children were more likely to have high but decreasing symptoms after controlling for other covariates. Conclusion: The findings have important implications for promoting the mental health of older adults with disabilities in rural China. There are still very limited long-term care services and programs are available for older adults, particularly in rural China. It is critical to develop these services at both community and institutional levels to meet the care needs of older adults and their families.

Abstract

Background Breast cancer patients may not be well-informed about palliative care, hindering its integration into cancer self-management. Objective The aim of this study was to test Managing Cancer Care: A Personal Guide (MCC-PT), an intervention to improve palliative care literacy and cancer self-management. Methods This was a single-blind pilot randomized controlled trial to evaluate the feasibility/acceptability and intervention effects of MCC-PT on palliative care literacy, self-management behaviors/emotions, and moderation by demographic/clinical characteristics. We enrolled 71 stages I to IV breast cancer patients aged at least 21 years, with >6-month prognosis at an academic cancer center. Patients were randomized to MCC-PT (n = 32) versus symptom management education as attention-control (n = 39). At baseline, 1 month, and 3 months, participants completed the Knowledge of Care Options Test (primary outcome), Control Preferences Scale, Goals of Care Form, Medical Communication Competence Scale, Measurement of Transitions in Cancer Scale, Chronic Disease Self-efficacy Scale, Hospital Anxiety and Depression Scale, and the Mishel Uncertainty in Illness Scale. Results Mean participant age was 51.5 years (range, 28-74 years); 53.5% were racial/ethnic minority patients, and 40.8% had stage III/IV cancer. After adjusting for race/ethnicity, MCC-PT users improved their palliative care literacy with a large effect size (partial η2 = 0.13). Patients at late stage of disease showed increased self-management (partial η2 = 0.05) and reduced anxiety (partial η2 = 0.05) and depression (partial η2 = 0.07) with medium effect sizes. Conclusions Managing Cancer Care: A Personal Guide is feasible and appears most effective in late-stage cancer. Research is needed to elucidate relationships among cancer stage, race/ethnicity, and self-management outcomes. Implications for Practice Integration of palliative care into cancer care can assist in creation of appropriate self-management plans and improve emotional outcomes.

Abstract

Background Adolescent gay/bisexual men exhibit the highest prevalence of undiagnosed HIV infections. Ascertaining antecedents of behaviorally acquired HIV infections among adolescent gay/bisexual men can be challenging; however, these challenges can be overcome through the utilization of secondary data, such as the Youth Risk Behavior Survey. Objective Syndemics theory suggests that HIV infections are not a singular phenomenon; instead, many infections occur at the intersection of syndemic factors, such as substance use, violence, and mental health. Our objective is to describe and synthesize research methods of secondary data analyses that examine syndemic factors in relation to HIV risk behavior outcomes among subsamples of adolescent gay/bisexual men. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo were systematically searched. Inclusion criteria were (a) peer-reviewed Youth Risk Behavior Survey secondary data analyses conducted in the United States after 1991, (b) subsamples with adolescent gay/bisexual men, (c) one or more syndemic factor(s), and (d) one or more HIV risk behavior outcome(s). We used the National Institutes of Health Quality Assessment Tools for quality appraisal. Results Of 1,036 citations retrieved, nine studies met inclusion criteria. Results included using logistic regression analysis and data from 2015 to 2017 in six studies and underpinnings with minority stress theory in four studies. Eight studies omitted race/ethnicity in subsamples and six grouped lesbians with adolescent gay/bisexual men. Seven studies examined substance use, six examined violence, and five examined mental health. Condom use and number of partners were the most studied HIV risk behavior outcomes in four studies, whereas intercourse in the last 3 months was an outcome in only one study. Protective factors were not present. Conclusion Limitations found the need to highlight better inclusion of race/ethnicity and sexual orientation. Adding contemporary survey items is also necessary, such as nonbinary sex and gender identity, access to HIV prevention (condoms, HIV testing, and preexposure prophylaxis), and experiences with stigma, to elucidate risk behaviors among populations disproportionately affected by HIV infections, including Blacks/African Americans and Hispanics/Latinos.

Abstract

BACKGROUND: Engagement with self-monitoring of blood pressure (BP) declines, on average, over time but may vary substantially by individual.OBJECTIVES: We aimed to describe different 1-year patterns (groups) of self-monitoring of BP behaviors, identify predictors of those groups, and examine the association of self-monitoring of BP groups with BP levels over time.METHODS: We analyzed device-recorded BP measurements collected by the Health eHeart Study-an ongoing prospective eCohort study-from participants with a wireless consumer-purchased device that transmitted date- and time-stamped BP data to the study through a full 12 months of observation starting from the first day they used the device. Participants received no instruction on device use. We applied clustering analysis to identify 1-year self-monitoring, of BP patterns.RESULTS: Participants had a mean age of 52 years and were male and White. Using clustering algorithms, we found that a model with three groups fit the data well: persistent daily use (9.1% of participants), persistent weekly use (21.2%), and sporadic use only (69.7%). Persistent daily use was more common among older participants who had higher Week 1 self-monitoring of BP frequency and was associated with lower BP levels than the persistent weekly use or sporadic use groups throughout the year.CONCLUSION: We identified three distinct self-monitoring of BP groups, with nearly 10% sustaining a daily use pattern associated with lower BP levels.

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.

Abstract

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.

Abstract

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

Human trafficking is a lucrative, tax-free global business. Traffickers recruit innocent people into the sex, labor, or domestic industries. Young men and boys are recruited into the fishing and mining industries; younger boys may work in pornography. Families, men, women, and young children harvest crops. Women are recruited into the hospitality and sex industries. Although victims of trafficking work in public settings, their identities are hidden. They are abused and fearful for personal and family safety. Victims of trafficking feel trapped, injured, confined, and are deprived of papers and belongings. The person who is trafficked works hard under dangerous and difficult conditions. However, traffickers, large organizations, and cartels profit. Persons who are trafficked have poor health and suffer from anxiety, depression, addiction, injuries, and illness. During the pandemic, few had access to testing, vaccines, or treatment. Most Americans know little about trafficking and think it only occurs in third world countries. In fact, it occurs in many places across the United States. It is difficult for the person who is trafficked to escape their situation for a myriad of reasons. Nurses can help raise awareness of human trafficking and work collaboratively within the public and private sector to eradicate it.

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.