Publications

Abstract

Students at universities are experiencing food insecurity, which may be associated with health behaviors. In a pilot study to build a survey that assesses food insecurity and health behaviors among undergraduates, we distributed the survey before (Wave 1; fall 2019) and during (Wave 2; summer 2020) COVID-19. During Wave 1, 41% of students reported food insecurity and 61% met criteria for poor sleep. In Wave 2, 26% reported food insecurity and 49% met criteria for poor sleep. Students experiencing food insecurity were more likely to report poor sleep. This survey will inform recruitment and design of a scaled-up multi-campus study. (100/100 words).

Abstract

Research in aging has significantly advanced; scientists are now able to identify interventions that slow the biologic aging processes (i.e., the “hallmarks of aging”), thus delaying the onset and progression of multiple diseases, including oral conditions. Presentations given during the 3-part session “Geroscience: Aging and Oral Health Research,” held during the 2023 American Association for Dental, Oral, and Craniofacial Research meeting, are summarized in this publication. Speakers’ topics spanned the translational research spectrum. Session 1 provided an overview of the geroscience and health span (disease-free and functional health throughout life) concepts. The common molecular mechanisms between oral cancer and aging were discussed, and research was presented that showed periodontal microflora as a potential factor in Alzheimer’s disease progression. Session 2 focused on behavioral and social science aspects of aging and their oral health significance. The keynote provided evidence that loneliness and isolation can have major health effects. These social conditions, along with poor oral health, tooth loss, and cognitive decline, could potentially affect healthy eating ability and systemic health in older adults. Research could help elucidate the directions and pathways connecting these seemingly disparate conditions. Session 3 focused on the delivery of oral care in different settings and the many barriers to access care faced by older adults. Research is needed to identify and implement effective technology and strategies to improve access to dental care, including new delivery and financing mechanisms, workforce models, interprofessional provider education and practice, and use of big data from medical–dental integration of electronic health records. Research to improve the “oral health span,” reduce oral health disparities, and increase health equity must be tackled at all levels from biologic pathways to social determinants of health and health policies.

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Objectives: Studies on the interdependence of couples’ health behaviors and subsequent cognitive outcomes remain limited. Methods: Longitudinal data from the China Health and Retirement Longitudinal Study (2011–2018) were used (N = 1869 heterosexual couples). Latent class analysis identified the dyadic pattern of health behaviors in 2011 (i.e., alcohol consumption, smoking, and physical inactivity). Stratified Cox models examined the association of latent classes with risk of developing memory-related disorders in 2013–2018. Results: Three classes were identified: class 1 (21.25%, only husband smoke, and both active), class 2 (47.55%, both inactive, neither drink nor smoke), and class 3 (31.20%, both drink and smoke, and both active). Couples’ sedentary lifestyle was associated with an increased risk of memory-related disorders among both husbands and wives. Conclusion: Couples were moderately concordant in their physical activity but weakly in smoking and drinking. Couple-based interventions, especially promoting physical activity, may reduce cognitive aging among middle-aged and older Chinese couples.

Abstract

The objectives of this qualitative needs assessment were to assess perceived needs of health and social services professionals in the Caribbean Region to enhance services supporting healthy aging and care of older adults and to assess perceived facilitators and barriers to increasing capacity to serve their aging populations. The assessment, informed by the Consolidated Framework for Implementation Science, was conducted in 14 islands in the eastern and southern Caribbean. The results demonstrated need for education of professionals and the general population about the prevention and treatment of non-communicable diseases (NCDs), assessment and services for individuals with dementia, Alzheimer’s disease, depression, and harmful alcohol use, all of which pose significant challenges for older adults. Education of health and social services professionals, families, and the public on the risk factors for NCDs and common mental and physical health problems is critical. Barriers to implementation of educational programs include lack of community awareness and resources within the islands. The needs assessment findings are foundational to planning educational interventions. These will be developed by local health providers with the collaboration and support of external resources including those of the Pan American Health Organization/World Health Organization Collaborating Centre in Gerontological Nursing Education.

Abstract

Background: Lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual (LGBTQIA+) individuals face barriers to equitable health care access. During clinical encounters, LGBTQIA+ individuals interact with nurses and health care providers who often lack a thorough understanding of LGBTQIA+ cultures, terminology, and strategies for culturally affirming care. This article details the process undertaken to include LGBTQIA+ health elective courses. Method: To outline LGBTQIA+ health education, a curriculum crosswalk was conducted. Course descriptions, objectives, and outcomes were crafted with faculty input. Priority LGBTQIA+ areas were analyzed, and textbook content was cross-referenced to identify topics for inclusion. Results: In Spring 2022, two LGBTQIA+ courses were launched. Undergraduate students at New York University Meyers (n = 27) and undergraduate and graduate students at the University of Pennsylvania (n = 18) comprised the inaugural classes. Conclusion: LGBTQIA+ individuals experience poorer health outcomes due to longstanding health inequities. These disparities are partly fueled by the minimal exposure nursing students receive in their undergraduate education. Guidelines on the development of courses designed to highlight needs may address disparities, leading to better health outcomes.

Abstract

This analysis of the Youth Risk Behavior Survey examined HIV syndemic factor associations (substance use, violence, mental health, and HIV risk behaviors) among adolescent gay, bisexual, and other men who have sex with men-a population with the highest prevalence of undiagnosed HIV infections. The representative sample ( n = 644) exhibited low condom use (52%) and HIV testing (21%). Adjusted multivariate logistic regression models showed that Blacks were less likely to report HIV testing (adjusted odds ratio [aOR] = 0.06, 95% confidence interval [CI] [0.01-0.44], p < .01), whereas Hispanics were more likely to report four or more lifetime sexual partners (aOR = 3.75, 95% CI [1.49-9.44], p < .01), compared with Whites. A syndemic of substance use and intimate partner violence (sexual, sexual dating, and/or physical dating violence) was associated with early intercourse, multiple sexual partners, and drugs/alcohol before intercourse. Multiple syndemic factor exposures were associated with additive risk, suggesting multilevel approaches for HIV prevention.

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

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.

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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.