Publications

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.

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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.

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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.

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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.

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

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

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Methylome-wide association studies (MWASs) have identified many 5′-cytosine-phosphate-guanine-3′ (CpG) sites associated with complex traits. Several methods have been developed to predict CpG methylation levels from genotypes when the direct measurements of methylation are unavailable. To date, the published methods have mostly used datasets from populations of European ancestry to train prediction models for methylations, which limits the generalizability of methylome-wide association study to non-European populations. To address this gap, we proposed a new model by incorporating local ancestry (LA) information, called LA Methylation Predictor with Preselection (LAMPP), to improve the prediction accuracy of DNA methylation in admixed populations. We showed that LAMPP outperformed the conventional model and other LA models in prediction accuracy using an admixed African American population. We further applied our model to identify significant CpG sites for seven complex traits. Together, our LAMPP model is a valuable tool to reveal epigenetic underpinnings of complex traits in the admixed populations.

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Background: Maintaining oral health is essential for individuals with dementia, yet they often need support. We sought to identify insights gained during the recruitment process for an intervention designed to teach care partners skills to guide individuals with mild dementia in proper oral hygiene techniques and provide reminders to practice oral hygiene care. Methods: Throughout the study, research team members from two research sites met regularly to discuss their experiences in recruiting participants. Notes from these meetings served as the basis for identifying key challenges and effective strategies. Results: Recruitment involved direct patient engagement, collaboration with dementia research centers and community organizations, and the use of electronic health record systems, including MyChart. Recruitment coordinators connected study personnel with organizations and support groups, thereby broadening the recruitment base. Barriers to recruitment included the reduced frequency of patient visits to clinics during the COVID-19 pandemic, which limited in-person recruitment opportunities, as well as the time required to establish new relationships with non-affiliated hospitals and community organizations. Recruitment efforts successfully integrated long-standing relationships with dementia research centers and healthcare providers alongside the establishment of new partnerships with community organizations and non-affiliated hospitals. Conclusion: Flexibility, participant-centered communication, and a multifaceted approach were critical for overcoming pandemic-related challenges and addressing recruitment barriers, ensuring diverse and well-retained participation in this study.

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

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

Abstract

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

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

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

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

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

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

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Objectives: Individuals with motoric cognitive risk (MCR) syndrome have a high dementia risk. However, a knowledge gap exists in the measurement procedure for slow gait speed, which is a crucial component of MCR diagnosis. The study aimed to systematically review slow gait speed measurement practices in MCR diagnosis to identify critical constructs in gait speed measurement procedure. Design: Systematic review. Setting and Participants: Included studies were conducted in clinical and community settings, involving participants with MCR receiving gait speed measurement. Methods: A systematic search across PubMed, Medline, Embase, CINHAL (EBSCO), Web of Science, Cochrane Library, and ProQuest Dissertation from inception until January 2024 for articles with detailed MCR diagnosis. Study quality was evaluated with the Joanna Briggs Institute (JBI) Critical Appraisal Checklists and slow gait speed measurement methods were summarized through narrative synthesis. Results: From 27,600 unique entries, 50 relevant studies with 55 cohorts were identified and included in the review. Slow gait speed measurement methods in existing MCR studies showed heterogeneity in measurement tools, start/end protocols and buffer distance, walking test distance, number of tests, calculation methods, and cutoff values. Commonly, manual stopwatches and 4-meter walking test distance with a 2-meter buffer at each end at a usual pace were used, averaging 2 tests for gait speed analysis, with the need for cohort-specific slow gait cutoff values. Conclusions and Implications: The measurement practices of slow gait speed in MCR diagnosis were heterogeneous. A relatively comprehensive gait speed measurement procedure with 7 constructs was initially delineated in this study based on synthesis analysis, with the potential to improve diagnostic accuracy and consistency of MCR, although further validation is still needed.

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Aim: To explore, review and assess the literature on motivation for physical activity in low-income adults to inform future research and clinical interventions. Design: An integrative review of the literature on motivation for physical activity in low-income adults. Methods: Whittemore and Knaul's five-stage methodological approach for integrative reviews was utilised. Studies written in English that focused primarily on low-income adults discussed physical activity and included a component of motivation or drive were included. The Johns Hopkins Evidence Level and Quality Guide was used to assess the quality of the studies. Data Sources: PubMed, CINAHL, PsycINFO, SPORTDiscuss and Google Scholar from 1 January 2018 – 23 August 2024. Results: A total of 20 studies met the inclusion criteria. Three main categories of factors impacting physical activity in low-income adults were identified: (1) motivators for physical activity, (2) barriers for physical activity (3) and items that were both a motivator and a barrier. Despite the key role nurses play in promoting health and wellness, studies conducted by nurses or employing nursing interventions were notably absent. Conclusion: This integrative literature review highlights the need for more information about what motivates low-income adults to be more physically active. Implications for the Profession: Understanding the experience of low-income adults with physical activity is integral to meeting their needs and facilitating increased physical activity. Future research should utilise nursing theories and interventions to improve physical activity levels among low-income adults. Impact: This study addressed physical inactivity in low-income adults. More information is needed about motivation for physical activity. This information will impact researchers and clinicians. Reporting Method: The search strategy and reporting method were consistent with PRISMA guidelines. Patient or Public Contribution: No Patient or Public Contribution.

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Objective The purpose of study was to explore family caregiver perspectives on work-life balance while caring for adults with Parkinson's disease. Methods The study was performed using a convergent mixed methods design and a revised adaptation of the Work-Life Conflict model. Caregivers completed surveys followed by semistructured interviews (n = 40). Results Work-life balance is bidirectionally influenced by time, stress, and behavior across the working and caregiving role. Caregiver burden was offset by higher decision latitude at work. Supervisor support and coworker support were positively associated with work-life balance. Barriers included physical, emotional, and financial stress, and speech and cognitive changes of the care recipient. Conclusions The results of this study identify the influence of work-life imbalance on caregiver burden and stress, and generate discussion of potential solutions that optimize well-being and health of this working population.

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Ensuring equitable care and health outcomes for all populations is essential in nursing science. However, achieving health equity in nursing science necessitates a multifaceted approach to address the complex factors influencing health disparities. This paper presented the keynote address delivered at the Advanced Methods Conference hosted by the Council for Advancement of Nursing Science in 2023. We identified critical gaps in health equity within nursing science, emphasizing the need for innovative recruitment strategies, comprehensive data analysis, and targeted dissemination efforts. This paper underscores the importance of equity in artificial intelligence research, highlighting issues such as biases in machine learning models and the underrepresentation of minoritized groups. Bridging the current gaps in health equity research within nursing science requires a systematic and forward-thinking approach.

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BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare medical condition presenting as idiopathic heart failure. The aim of this study was to (1) examine the contribution of neighborhood disinvestment to PPCM risk and to racial and ethnic disparities in PPCM; (2) examine the extent to which sociodemographic factors and chronic hypertension explain these outcomes; and (3) describe severe maternal morbidity cases and the timing of PPCM. METHODS: We conducted an observational cohort study using vital records longitudinally linked with hospital discharge records for mothers and infants up to 9 months postpartum for births in California from 1997 to 2019. Using the Neighborhood Deprivation Index as a proxy measure for neighborhood disinvestment, we sequentially adjusted multivariable logistic regression models to estimate the association of Neighborhood Deprivation Index and race and ethnicity with PPCM. RESULTS: Our study included 7 354 662 births and 918 (0.012%) PPCM cases. Those residing in neighborhoods with higher disinvestment had an increased odds of PPCM (OR [95% CI] Quartile 2: 1.2 [1.0–1.5]; Quartile 3: 1.7 [1.4–2.1]; Quartile 4: 1.5 [1.2–1.9]). When considering the contribution of Neighborhood Deprivation Index to racial and ethnic disparities in PPCM, the odds ratio slightly decreased for Non-Hispanic Black births from 3.8 (3.1–4.6) to 3.4 (2.8–4.1). For chronic hypertension in Non-Hispanic Black births there was a slight decrease in odds from 3.4 (2.8–4.1) to 3.1 (2.6–3.8). The severe maternal morbidity indicator with the highest frequency was pulmonary edema/acute heart failure. CONCLUSIONS: Our results show that neighborhood deprivation and pre-pregnancy hypertension partially explain PPCM risk but does not explain the racial or ethnic disparity. Future research should examine the impact of specific measures of neighborhood deprivation on the racial and ethnic disparity in outcomes such as PPCM.

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Background: With China's aging population and rising prevalence of chronic conditions, it is crucial to understand the factors shaping aging attitudes. Satisfaction with the neighborhood physical environment may play an important role, particularly among those with chronic health issues. To examine the association between neighborhood physical environment satisfaction and aging attitudes among older Chinese adults, and to explore differences across groups with and without chronic conditions. Methods: We analyzed data from 11,395 participants aged 60 and above from the 2020 China Longitudinal Aging Social Survey (CLASS). Stratified multiple regression analyses were conducted, comparing subgroups with chronic conditions (n = 8405, 73.76 %) and without chronic conditions. Results: Among participants with chronic conditions, higher satisfaction with road conditions (β = 0.382, P = 0.001), environmental sanitation (β = 0.286, P = 0.007), and road/street lighting (β = 0.288, P = 0.005) was significantly associated with more positive attitudes toward aging. No significant associations were found among participants without chronic conditions. Conclusions: Age-friendly neighborhood environments are important for promoting positive aging attitudes, particularly among older adults living with chronic conditions. These findings offer valuable insights for policymakers, researchers, and service providers aiming to support healthy aging in rapidly aging societies like China.

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Objective: This cross-sectional study investigated the associations of neighborhood-level factors with immune activation, systemic inflammation, and leukocyte telomere length in 110 sexual minority men with human immunodeficiency virus. Method: From 2013 to 2017, sexual minority men with human immunodeficiency virus who used stimulants were recruited in San Francisco, California and provided blood samples to measure the markers of immune activation, systemic inflammation, and leukocyte telomere length. To measure neighborhood-level indices, the home address for each participant was geocoded and linked to data from the Centers for Disease Control and Prevention. Hierarchical linear modeling was employed to investigate the associations of neighborhood-level factors with systemic inflammation and leukocyte telomere length. Results: After adjusting for age, stimulant use, self-reported income, level of education, and race and ethnicity, residing in neighborhoods with greater percentages of poverty (β=.33, p,.001) and a higher proportion of racial/ethnic minority residents (β =.26, p,.05) were independently associated with higher levels of interleukin-6. Additionally, residing in neighborhoods with higher percentage of uninsured individuals was independently associated with higher tumor necrosis factor-alpha (β =.24, p,.05). Indices of neighborhood-level adversity were additionally associated with providing a urine sample that was reactive for stimulants (OR= 1.31, p=.002), which was, in turn, associated with shorter leukocyte telomere length (β=−.31, p,.05). Conclusions: Future longitudinal research should examine the biobehavioral pathways linking neighborhood-level factors and stimulant use with systemic inflammation and cellular aging.

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Minimal progress has been made in narrowing disparities between patients with and without limited English proficiency (LEP). Using 2016 data from RN4CAST-US, New Jersey Discharge Data Collection System, and AHA Annual Hospital Survey, multivariable logistic regression models were employed to examine whether and to what extent the hospital nurse work environment, defined as the conditions that nurses work in, is associated with decreased disparities in 7-day hospital readmissions between patients with and without LEP. Existing literature has established associations between nurse work environments and outcomes disparities of various minoritized populations; however, no literature has examined this relationship in the context of hospitalized patients with LEP. In a sample of 424,745 hospitalized adults (n = 38,906 with LEP), patients with LEP, compared to those without LEP, were younger (63.4 vs 64 years old, p < 0.001), more likely to be insured by Medicaid (8.9% vs 5.5%) or uninsured (7.5% vs 2%, p < 0.001), and readmitted (4.5% vs 3.9%, p < 0.001). Adjusting for patient and hospital characteristics, LEP patients had 33% higher odds of a 7-day readmission, as compared to patients without LEP (OR 1.33, 95% CI [1.19–1.47]). A significant interaction was found between patients' LEP status and the nurse work environment (OR 0.83, 95% CI [0.70–0.99]), such that patients with LEP experienced lower odds of 7-day readmission in more favorable nurse work environments, compared to patients without LEP. Hospitals dedicated to providing equitable healthcare may consider enhancing nurses' working conditions as a potential way to reduce disparities in readmission rates.