Publications

Abstract

Purpose: Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system. Methods: This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study’s primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato Results: The study population consisted of 357 patients with median age of 59 years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17–0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01–1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use. Conclusions: The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.

Abstract

Objective: To examine the cross-sectional associations of hemopexin, muscle quality, and sarcopenia status with cognitive function among older Japanese adults with cognitive impairment, and to explore the potential sex-specific differences. Methods: A total of 580 older adults (372 women, 208 men; mean age 83.3 ± 6.2 years) who presented with cognitive impairment at the Kyoto Dementia Comprehensive Center between 2018 and 2022 were enrolled. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Hemopexin level was measured by enzyme-linked immunosorbent assay. Muscle quality was evaluated via phase angle (PhA) and grip strength, and sarcopenia status was defined using the Asian Working Group for Sarcopenia criteria. Multiple linear regression models, including sex-stratified analyses, were conducted to determine the relationships of these variables with MMSE scores. Results: Higher hemopexin levels (β = 1.19, p = 0.017), PhA (β = 0.59, p = 0.005), and grip strength (β = 0.14, p < 0.001) were independently associated with better MMSE scores, whereas sarcopenia was negatively linked to MMSE scores (β = − 2.28, p < 0.001). Notably, sex-stratified models indicated that hemopexin positively predicted MMSE scores in men but not in women; meanwhile, sarcopenia showed a stronger negative impact in women. Educational attainment also displayed a significant positive association with cognitive performance in both sexes. Conclusions: In this cross-sectional study of older Japanese adults with cognitive impairment, hemopexin levels and muscle quality emerged as important correlates of cognitive function, particularly in men, while sarcopenia was negatively linked to cognition.

Abstract

This study examines how coping strategies and social support mediate the relationship between type D personality and psychological distress in COPD patients. A sample of 351 patients completed surveys on demographics, psychological distress (Kessler Psychological Distress Scale), social support (Social Support Self-Rating Scale), coping strategies (Chinese version of Medical Coping Modes Questionnaire), and type D personality (Type D Personality Scale). Using structural equation modeling (SEM) via AMOS 23.0 and SPSS, results showed that confrontation and acceptance-resignation coping strategies, as well as type D personality, were positively correlated with psychological distress, while social support was negatively correlated. SEM estimates revealed a chain mediating effect of social support and coping strategies between type D personality and psychological distress. Enhancing social support and coping strategies is crucial for reducing psychological distress, especially in COPD patients with type D personality.

Abstract

Background and Objectives: Low education in early life is a major risk factor for dementia. However, little is known about how education in later life is related to cognitive function in older adults. We assessed whether later-life learning was associated with better cognitive function over time and whether the associations differed by sex, race/ethnicity, and prior education. Research Design and Methods: We used data from the 2008–2018 Health and Retirement Study, including participants aged 65+ without baseline dementia and followed for up to 6 years. Global cognition was measured using a summary score. Later-life learning was measured at every wave at least once a month or more, not in the last month, or never. Results: Of 12 099 participants, 10.2% attended an educational or training course “at least once a month or more,” 45.5% reported “not in the last month,” and 43.3% reported “never” at each wave of the study. Results from adjusted mixed-effects models showed that engaging in any later-life learning, either at least once a month (0.56 points higher, 95% confidence interval [CI] = 0.40–0.73) or not in the last month (0.55 points higher, 95% CI = 0.45–0.65) was associated with better cognitive function compared to never engaging in these activities. The association remained consistent as people aged. The benefits of later-life learning on cognitive function were greater in women than in men—at least once a month versus never was 0.30 points greater in women than men (95% CI = −0.03 to 0.63, p = .0760); not in the last month versus never was 0.24 points greater in women than men (95% CI = 0.04–0.43, p = .016). There were no significant differences by race/ethnicity or prior education.

Abstract

Aim This integrative review examines the impact of team teaching in undergraduate and master's degree nursing programs. Background Increasing workloads for faculty are a challenge in nursing education. Team teaching allows shared responsibilities; work between two or more educators can help redistribute workloads and mitigate burnout. Method A systematic search of peer-reviewed articles in Cumulative Index to Nursing and Allied Health Literature, Education Resource Information Center, and PubMed yielded 12 relevant studies. Results Four key themes emerged: modeling behaviors, applying theoretical knowledge to practice, exposure to diverse perspectives, and faculty perspectives. Effective team teaching requires trust, communication, and collaboration among educators, requiring ongoing professional development. Team teaching can enhance diversity efforts in nursing education. Conclusion Team teaching is a viable approach to optimizing the scholarship of teaching. Future research should explore educators' perspectives on team-teaching methods and measurable impacts on achieving learning outcomes.

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Background: The prevalence of hypertension (HTN) is high in Brazil, and control rates are low. Little is known about the factors that contribute to HTN control from a family-based perspective. Objectives: Guided by the Family Management Style Framework, specific aims were to (1) describe the prevalence of adequate blood pressure (BP) control in individuals cared for the Family Health Strategy, (2) identify facilitators and barriers to HTN management, and (3) identify individual contextual sociocultural influences (sociocultural context and social and Family Health Strategy support), definition of the situation, and management behaviors that help or interfere with individual functioning (BP control in the individual with HTN). Methods: This descriptive, cross-sectional study included 213 individuals with HTN randomly selected from 3 Family Health Strategy units from July 2016 until July 2017. Results: Most of the individuals were female (n = 139, 65.3%), retired (n = 129, 60.5%), and White (n = 129, 60.2%) and had less than a high school education (n = 123, 57.6%). Family income (n = 166, 77.8%) was less than 5500 reals (US $1117/month). Mean (SD) systolic BP was 137.1 (±24.1) mm Hg, and mean (SD) diastolic BP was 83.8 (±18.6) mm Hg, with 47.9% (n = 102) having uncontrolled BP. In the multivariate logistic model, only high levels of perceived social support were significantly associated (odds ratio, 3.29; 95% confidence interval, 1.44–7.5; P = .005) with controlled BP. Conclusions: Social support is strongly associated with BP control. Optimizing support may play an important role in BP control and preventing HTN-related complications.

Abstract

Preceptors are essential in the clinical education of prelicensure registered nursing and advanced practice registered nursing students. However, there is a growing scarcity of preceptors available to provide clinical education. Additionally, preceptors have not uniformly received professional development in the practice of teaching that is essential in delivering high quality clinical education, and clinical education in nursing is an unfunded mandate. This article reviews the current state of preceptors, the importance and challenges of preceptors in clinical education, the lack of funding for clinical education by preceptors, and proposed solutions.

Abstract

Following peripheral nerve injury, Schwann cell (SC) survival is imperative for successful nerve regeneration. The low-density lipoprotein receptor-related protein-1 (LRP1) has been identified as a pro-survival SC plasma membrane signaling receptor, however, the responsible mechanisms underlying SC homeostasis remain incompletely understood. Herein, we establish that LRP1 largely manages mitochondrial dynamics and bioenergetics in SCs by limiting mitochondria fission, maintaining healthy mitochondria membrane potentials, and reducing lactate production associated with peripheral sensitization. When SC LRP1 is suppressed, inner-mitochondria-linked pathways in peripheral nerve proteome are dramatically altered, and cristae integrity in unmyelinated C-fibers is compromised. SC LRP1 protected sensory neurons from mitochondrial dysfunction and modulated mitochondria-related biological pathways in the DRG transcriptome. Conditional deletion of LRP1 in SCs induces pain-related behaviors in mice without nerve injury. Results point to a significant role for LRP1 in SC mitochondrial homeostasis and advance our understanding of the sensory neuron response to alterations in SC bioenergetics.

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This study investigated the prevalence of partner notification among older people living with HIV in China and explored associated factors, particularly the mediating effect of self-perceived HIV-related stigma. Using a cross-sectional design with convenience sampling, data were collected from 348 participants at two designated HIV hospitals between January and June 2021. The partner notification rate was 41.4 % (144/348). Older people living with HIV who were female, living with family members, had a junior high school education or higher, were married, had only one regular partner, and reported higher levels of self-efficacy and a lower self-perceived HIV-related stigma were more likely to disclose their status. Self-perceived HIV-related stigma is a major barrier to disclosure and fully mediated the association between social medical support, depressive symptoms, and partner notification. The study highlights the need for targeted interventions to improve partner notification, focusing on reducing stigma and supporting those most at risk.

Abstract

The field of psychiatry has evolved over the past 2500 years. Between dynamic psychotherapy and psychopharmacology, lifestyle psychiatry holds a different space. This approach capitalizes on the lifestyle medicine movement, as it promotes change within 6 domains of activity. Apart from incorporating these lifestyle pillars as adjunctive therapy for either psychodynamic therapy or psychotropic medication regimens, lifestyle psychiatry is on the frontier similar to the other growing fields of precision psychiatry, advanced learning in psychiatry, psychedelics in psychiatry, digital mental health, and psychiatric genetics. Any disruption into the historical practice of psychiatry, particularly with the prescription of medications, can be met with scrutiny. We encourage the field of psychiatry to keep an open mind as our field continues to evolve. What makes lifestyle psychiatry particularly powerful and unique in its ability to assess and evaluate internal and external factors that contribute to individual behaviors, and may impact the ability to incorporate healthy lifestyle actions. Internal factors include: emotional regulation, internalized trauma, cognitive factors, and personality traits. On the other hand, external factors include environmental barriers and work-related burnout.

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This study examines whether age-related cognitive decline varies by race/ethnicity and how edentulism moderates these effects. Data from the Health and Retirement Study (2006–2020), including 23,669 respondents aged 51 and above across 189,352 person-wave observations were analyzed. Of all respondents, 13.4% were edentulous at baseline, with 65.4% identified as non-Hispanic White, 20.5% non-Hispanic Black, and 14.18% Hispanic. Results from linear mixed-effect models indicated that compared to non-Hispanic Whites, Hispanic and non-Hispanic Black participants exhibited lower baseline cognition scores but slower cognitive decline with age. For edentulous Hispanic participants, this slower rate of decline was attenuated by 0.03 units per year (95% CI: −0.06, −0.01, p =.049). The findings highlighted the need for targeted interventions and policies to improve oral health, particularly for Hispanic populations. Addressing oral health disparities could help mitigate cognitive decline in this group and reduce cognitive health disparities across racial/ethnic groups.

Abstract

Introduction: This study examined oral health trends of older immigrants in the US from 1999 to 2018 and disparities between immigrants and non-immigrants across different races/ethnicities. Methods: Data were from the 1999–2018 National Health and Nutrition Survey (NHANES). Outcome variables were self-reported poor oral health and significant tooth loss (i.e., < 20 permanent teeth). Participants were categorized into three groups as US natives, naturalized citizens, or noncitizen residents. The analytical sample comprised 13,424 older adults (ages 60+), including 10,087 US natives, 2280 naturalized citizens, and 1057 noncitizen residents. We assessed the trends in poor oral health and significant tooth loss across the three groups and conducted analyses stratified by race/ethnicity to examine within-group disparities. Results: From 1999 to 2018, noncitizen residents consistently showed higher rates of poor oral health and significant tooth loss compared to US natives and naturalized citizens. Multiple logistic regression model results showed that naturalized citizens were less likely (AOR = 0.79, p = 0.03) to report poor oral health. Stratified analyses by racial/ethnic groups showed that among Blacks, naturalized citizens were less likely to report poor oral health (AOR = 0.59, p = 0.02) than Blacks who were born in the US. Conclusion: While overall oral health improved among older immigrants from 1999 to 2018, oral health disparities persisted, especially between noncitizen residents and US natives. There were significant differences in oral health between Black immigrants and their US-born counterparts. Future research is needed to corroborate these findings and monitor the trend of oral health disparities.

Abstract

Background: HIV care continuum engagement is inadequate among African American/Black and Latine (AABL) young/emerging adults living with HIV in the United States. Within this population, some subgroups face barriers to research and are under-studied. Grounded in social action theory, the present study focuses on a diverse community-recruited cohort including those with non-suppressed HIV viral load. Using a sequential explanatory mixed methods design, we describe contextual self-regulatory resources (e.g., substance use, mental health), and their relationships to HIV management. Methods: Participants (N = 271) engaged in structured baseline assessments and biomarker testing (HIV viral load, drug screening). Being well-engaged in HIV care and HIV viral suppression were the primary outcomes. We purposively sampled a subset for maximum variability for in-depth interviews (N = 41). Quantitative data were analyzed via descriptive statistics and logistic regression, and results were used to develop qualitative research questions. Then, qualitative data were analyzed via directed content analysis. The joint display method was used to integrate results. Results: Participants’ mean age was 25 years (SD = 2). The majority (59%) were Latine/Hispanic and 41% were African American/Black. Nearly all were assigned male sex at birth (96%) and identified as gay/bisexual/queer (93%). The average HIV diagnosis was 4 years prior (SD = 3). The majority were well-engaged in HIV care (72%) and evidenced viral suppression (81%). Substance use (tobacco, marijuana, alcohol) was prevalent, mainly at low- and moderate-risk levels. Drug screening indicated marijuana, methamphetamine, and MDMA were the most common recent substances. Symptoms of depression and PTSD were associated with decreased odds of engagement in care. High-risk cannabis use was associated with decreased odds of HIV viral suppression. Qualitative results highlighted the prevalence of substance use in social networks and venues, and the importance of substances as a coping strategy, including for mental health distress. Tobacco and methamphetamine (but not marijuana) were described as problematic, and marijuana was used as harm reduction. Substance use was more common among those with non-suppressed versus suppressed HIV viral load. However, overall, substance use did not commonly interfere substantially with HIV management. Conclusions: The present study advances knowledge on AABL young/emerging adults living with HIV and highlights ways to improve screening and services.

Abstract

The COVID-19 pandemic profoundly impacted population mental health worldwide. Few studies examined how the neighborhood environment and online social connections might influence the social gradient in mental health during the pandemic lockdown. We aim to examine the moderating and mediating role of neighborhood environment and online social connections in the association between socioeconomic status (SES) and mental health outcomes. We conducted a cross-sectional online survey of 3763 Shanghai residents during the COVID-19 lockdown between April 29 and June 1, 2022. Employing OLS linear regression analyses, our findings reveal that SES was negatively associated with depressive symptoms (B = 0.173, p < 0.001) and anxiety (B = 0.147, p < 0.001). The findings supported our hypotheses that this disparity in mental health was partially mediated by neighborhood social capital, community management, and the extent of online social connections measured by the frequency of social connection through the social media WeChat (all p < 0.05). Additionally, neighborhood social capital, community management, and online social connections also mitigated SES-driven mental health inequalities (all p < 0.05). The study underscores the significance of the neighborhood environment and online social interactions in amplifying SES-related mental health effects, offering valuable insights for urban planning and health equity strategies.

Abstract

Obstructive sleep apnea (OSA), a condition with high prevalence, is characterized by reduced dilatory function of pharyngeal muscles, which can be influenced by upper airway narrowing, dilator muscle dysfunction, respiratory dysfunction, and genetics. Three of the most clinically important phenotypes of OSA include disturbed sleep, excessive sleepiness, and minimal symptoms, with varying implications for management and morbidity. This article reviews current perspectives on these OSA phenotypes, as well as the process of confirming a diagnosis of OSA. Lastly, this article delineates various current and future OSA therapy approaches through review and analysis of the existing literature with discussion on the outlook for OSA treatment.

Abstract

This paper is an examination of the relationship between continuity of care with home health physical therapists following hospitalization and the likelihood of readmission. We conducted a retrospective cohort study. Using rehospitalization as the dependent variable, a continuity of care indicator variable was analyzed with a multivariable logistic regression. The indicator variable was created using the Bice-Boxerman Index to measure physical therapist continuity of care. The mean of the index (0.81) was used to separate between high continuity (0.81 or greater) of care and low continuity of care (lower than 0.81). The sample included 90,220 patients, with data coming from the linking of the Outcome Assessment and Information Set (OASIS) and an administrative dataset. All subjects lived in the NYC metro area. Inclusion criteria was a patient’s admission to their first home health care site following discharge occurring between 2010 and 2015, and individuals who identified as Male or Female. In comparison to low continuity of physical therapy, high continuity of physical therapy significantly decreased hospital readmissions (OR = 0.74, 95% CI 0.71-0.76, p ≤.001, AME = −4.28%). Interpersonal continuity of physical therapy care has been identified as a key factor in decreasing readmissions from the home care setting. The research suggests an increased emphasis in preserving physical therapist continuity following hospitalization should be explored, with the potential to reduce hospital readmissions.

Abstract

This paper is an examination of the relationship between continuity of care with home health physical therapists following hospitalization and the likelihood of readmission. We conducted a retrospective cohort study. Using rehospitalization as the dependent variable, a continuity of care indicator variable was analyzed with a multivariable logistic regression. The indicator variable was created using the Bice-Boxerman Index to measure physical therapist continuity of care. The mean of the index (0.81) was used to separate between high continuity (0.81 or greater) of care and low continuity of care (lower than 0.81). The sample included 90,220 patients, with data coming from the linking of the Outcome Assessment and Information Set (OASIS) and an administrative dataset. All subjects lived in the NYC metro area. Inclusion criteria was a patient’s admission to their first home health care site following discharge occurring between 2010 and 2015, and individuals who identified as Male or Female. In comparison to low continuity of physical therapy, high continuity of physical therapy significantly decreased hospital readmissions (OR = 0.74, 95% CI 0.71-0.76, p ≤.001, AME = −4.28%). Interpersonal continuity of physical therapy care has been identified as a key factor in decreasing readmissions from the home care setting. The research suggests an increased emphasis in preserving physical therapist continuity following hospitalization should be explored, with the potential to reduce hospital readmissions.

Abstract

Background: Spiritual care provided by chaplains plays a key role in cancer care in the United States, yet little is known about chaplaincy utilization among people of Dharmic religions (Hinduism, Buddhism, Sikhism, Jainism) with cancer. Methods: This multi-methods study reviewed the records of patients (aged 18 years and older) who were hospitalized at a dedicated cancer hospital (2015–2019) and conducted interviews with chaplains and adults of Dharmic religions (2020). Primary outcomes included measuring chaplaincy utilization (at least one chaplain visit) across different religions and identifying perceptions of chaplaincy. Secondary outcomes involved measuring unmet spiritual needs on admission, types of spiritual care needs, and variables associated with chaplaincy utilization. Results: Of 54,828 patients, 2% were of Dharmic religions (n = 1163; 58.4% Hindu, 33.2% Buddhist, 4.8% Sikh, 3.4% multiple, <1% Jain). Compared with others, those of Dharmic religions were younger (median age, 59 vs. 63 years; p <.001), predominantly East or South Asian (78.7% vs. 5.6%; p <.001), and had higher rates of advanced illness (22.6% vs. 15.2%; p <.001) but lower chaplaincy utilization (31.6% vs. 36.7%; p <.001). There were no significant differences in unmet spiritual needs on admission (Dharmic religions vs. others, 8.7% vs. 9.4%; p =.41). Ritual care was the most frequently documented spiritual care need (72%). Multivariable analysis indicated that longer length of stay, non-Dharmic religion, and advanced illness were associated with higher chaplaincy utilization. Themes identified from the interviews included unfamiliarity with chaplaincy, concerns about faith-discordant care, addressing spiritual care needs independently, and solutions for concordant care. Conclusions: People of Dharmic religions with cancer were less likely to use chaplaincy services. Barriers included unfamiliarity and faith discordance. Spiritual care incorporating faith-specific resources is urgently needed.

Abstract

Background: More than half of stroke survivors suffer from movement disorders after receiving routine rehabilitation treatment. Evidence suggests that virtual reality (VR)-based robotic training for lower limb rehabilitation is a promising approach for improving motor function recovery. Methods: A pilot open-label randomized controlled trial was conducted to explore the feasibility and preliminary effects of VR-based robotic training for lower limb rehabilitation in stroke patients with hemiplegia. We enrolled 42 stroke patients with hemiplegia, 21 received VR-based robotic training for lower limb rehabilitation and conventional rehabilitation treatment as the intervention, and 21 only received conventional rehabilitation treatment as the control. Results: Forty participants completed the trial. We found a statistically significant difference in lower limb motor function scores from baseline to week 4 between the intervention and control group (mean difference (MD): 6.5 vs 3.3, p<0.001). At week 4, participants in the intervention group demonstrated significant enhancements in balancing function, walking ability, activities of daily living, and quality of life (p<0.05). However, the intervention group did not show a significant improvement in global cognitive function compared to the control group (MD: 3.8 vs 3.7, p = 0.873). No adverse events were observed during the trial. Conclusion: The VR-based robotic training for lower limb rehabilitation showed promise in improving motor function, activities of daily living, and quality of life in stroke patients with hemiplegia. These preliminary findings support the feasibility of this approach and highlight the need for large-scale studies to validate its effectiveness.