Publications

Abstract

Background: While the association between the gut microbiome and depression is well studied, the association between the oral microbiome and depression is less well characterized. Methods: This cross-sectional study analyzed the association between depression and diversity of oral microbiome using data from the 2009–2012 National Health and Nutrition Examination Survey (NHANES). The gene sequencing of 16S ribosomal RNA was adopted for the profiling of oral microbiome. Alpha diversity, quantified by the observed number of amplicon sequence variants (ASVs), and beta diversity, assessed using Bray–Curtis dissimilarity, were evaluated to represent oral microbiome diversity. Depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9) scale, with alpha diversity as the primary predictor. Weighted logistic regression was employed to examine the relationship between depression and microbial alpha diversity. Threshold effect analysis was performed to explore potential nonlinear relationships between the observed ASVs and depression. Subgroup analysis indicated that smoke, excessive alcohol consumption, and oral treatment influenced the association between oral microbiology and depression, with interaction effects observed across gender and racial groups. Beta diversity differences were evaluated using Bray–Curtis dissimilarity and visualized via non-metric multidimensional scaling (NMDS). Results: A total of 15,018 participants were included, with an average age of 42.25 ± 15.2 years. In the fully adjusted model, the alpha diversity of oral microbiome was significantly negatively correlated with depression (OR = -0.51, 95% CI: -0.79—-0.23, P = 0.003). Threshold analysis also revealed a nonlinear association in this relationship, with a significant inflection point as Log10ASVs of 2.32. Furthermore, beta diversity of the oral microbiome differed significantly between the normal and depression groups (p = 0.001). Sensitivity analyses showed that the relationship between depression and oral microbial diversity observed in this research was particularly pronounced among non-Hispanic Whites (OR = 0.16, 95% CI: 0.07–0.35) and men (OR = 0.14, 95% CI: 0.06–0.30). Additionally, significant differences in oral microbiome beta diversity were observed between the normal and depression groups (p = 0.001). Conclusions: The findings suggest that the diversity of oral microbiome is negatively correlated with depressive symptoms. Hence, oral dysbiosis may serve as a therapeutic target or biomarker of depression. However, the underlying mechanisms require further investigation.

Abstract

Background: Cesarean birth increases risk of maternal morbidity and mortality. Purpose: Examine the relationship between labor and delivery staffing and hospital cesarean and vaginal birth after cesarean (VBAC) rates. Methods: Survey of U.S. labor nurses in 2018 and 2019 on adherence to AWHONN nurse staffing standards with data linked to American Hospital Association Survey data, patient discharge data, and cesarean birth and VBAC rates. Findings: In total, 2,786 nurses from 193 hospitals in 23 states were included. Mean cesarean rate was 27.3% (SD 5.9, range 11.7%–47.2%); median VBAC rate 11.1% (IQR 1.78%–20.2%; range 0%–40.1%). There was relatively high adherence to staffing standards (mean, 3.12 of possible 1–4 score). After adjusting for hospital characteristics, nurse staffing was an independent predictor of hospital-level cesarean and VBAC rates (IRR 0.89, 95% CI 0.84–0.95 and IRR 1.58, 95% CI 1.25–1.99, respectively). Discussion: Better nurse staffing predicted lower cesarean birth rates and higher VBAC rates. Conclusion: Hospitals should be accountable for providing adequate nurse staffing during childbirth.

Abstract

The new health policy department for the Journal of Pediatric Health Care (JPHC) will be referred to as Child Health Policy Perspectives, and abbreviated as Policy Perspectives. A major goal for this new department is to invigorate JPHC readers as policy advocates for all pediatric populations and their families in government, community, healthcare delivery, education, research, and quality improvement projects. Another goal is for National Association of Pediatric Nurse Practitioner members and all pediatric-focused NPs to submit their policy analysis for publication in the JPHC. The U.S. Centers for Disease Control and Prevention's Policy Analytical Framework is the recommended framework for all manuscript submissions. The Centers for Disease Control and Prevention's Overview of Policy Process will be used to guide authors in developing health policy manuscripts. The intent is to publish health policy articles that improve the health of pediatric populations.

Abstract

Although healthcare workers may be aware of the risks of physical inactivity, their levels of physical activity (PA) are similar to those of all US adults, with less than half engaging in sufficient PA. The purpose of this health promotion was to encourage daily PA among employees in a large academic healthcare system. We also tested whether individualized progress updates further influenced PA. This 10-week program was available to all employees of NYU Langone Health. Employees could sync their phone or accelerometer via app or web browser to count.it – the vendor chosen to monitor and manage step counts. Participants were asked to voluntarily provide basic information (age, sex, job role, work location) and complete the Physical Activity Vital Sign (minutes/week and intensity of PA) at enrollment and 10 weeks. For 10 weeks, participants were sent a message through their employee ‘MyChart’ portal with a link to information on the benefits of PA, and a reminder of that week’s step-count challenge. Those meeting criteria for weekly challenges were included in gift card raffles. Participants were randomized 1:1 to receive the standard message ± additional emails detailing their progress. 3528 employees registered to participate (8% of all employees) although active users diminished over time (1225 at week 10). Average daily steps remained stable throughout (7319 + 4540 in week 1, 7229 + 5010 in week 10). Although there was no difference in any individual week, receipt of personalized feedback was associated with significantly higher average step counts throughout the 10-wk intervention as a whole (P = 0.01). Age and an urban work location were positively associated with steps, while female sex and a clerical job role were negatively associated with steps counts (all P < 0.005). Our findings provide important insight for workplace interventions to promote PA. They further suggest specific groups that may benefit from targeted efforts.

Abstract

This secondary analysis of the National Youth Risk Behavior Survey (years 2015-2019) examines associations between school-based protective factors (i.e., safe school environments and academic achievement) and HIV risk behaviors among sexually experienced adolescent gay and bisexual men (n = 644), a population with the highest prevalence of undiagnosed HIV infections. Demographics included Hispanics/Latinos (25%, n = 158), Other race/ethnicity (14%, n = 88), and non-Hispanic Blacks/African Americans (13%, n = 81). Adjusted models showed that protective factors reduced odds for early sexual debut, multiple sexual partners, sex under the influence of drugs/alcohol, and condomless sex, with an additive effect demonstrated when two protective factors were present. Hispanics/Latinos had greater odds of reporting multiple sexual partners and HIV testing, indicating opportunities for school-based HIV prevention and further research. Our findings provide support for school-based programs that aim to improve social and structural determinants of health and ultimately reduce adolescent HIV burdens.

Abstract

Background Women with a history of gestational diabetes mellitus (GDM) have an elevated risk for cardiometabolic diseases. Chinese American immigrants are disproportionately affected by GDM, yet their cardiometabolic risk factors are understudied. Little is known about physical activity (PA) of this understudied high-risk minority group. Objective The purpose of this study was to describe self-reported PA and the facilitators of and barriers to PA in Chinese American immigrants with a history of GDM. Methods We conducted an exploratory multimethod study between 2020 and 2021 among 106 Chinese American immigrant women. PA was self-reported using the International Physical Activity Questionnaire - Long form. Four domains of PA (work, transportation, housework, and leisure time) and daily sitting time were recorded. Open-ended questions were asked about the facilitators of and barriers to PA. Results Participants' mean age was 34.3 ± 3.7 years, and body mass index was 21.7 ± 2.6 kg/m2. Approximately 25% had low PA. Over half (N = 56, 53%) reported no leisure-time moderate-to-vigorous PA. Walking and housework were the most common types of PA. Barriers to PA included being busy with life, physical health issues (eg, sleep and postpartum health issues), low motivation or not enjoying PA, COVID-related barriers, and an unfavorable environment for PA. Conclusions Strategies are needed to increase leisure-time moderate-to-vigorous PA in this population. Modifiable factors include providing convenient PA programs (eg, technology or home-based) and addressing postpartum health issues (eg, sleep). Increasing providers' awareness of barriers to PA and cardiometabolic disease risk in this hard-to-reach, high-risk group may improve assessment and referral for high-risk women. Future research is needed to further explore opportunities for PA that Chinese American immigrant women would be open to at this stage in their life.

Abstract

Background: An estimated 44.1 million US citizens are living with disabilities. People with disabilities are at higher risk for health problems, affecting their overall quality of life and care experience. Simulation-based learning (SBL) enables students to apply cognitive, affective, and psychomotor competencies through simulated experiential activities in realistic environments. Research is limited on the integration of disability into SBL nursing education. Aim: To appraise and synthesize extant literature on the integration of disability in SBL in prelicensure nursing programs. Methods: This review identified and synthesized 18 research articles describing the implementation of disability SBL in prelicensure nursing programs. Results: Four themes were identified substantiating the importance of integrating disability into SBL: knowledge and understanding, communication confidence, empathy, and enlightened attitudes. Conclusions: Disability SBL strategies are integral to achieving learning outcomes related to patient-centered care. Large well-designed studies are needed to measure its effectiveness.

Abstract

Background: Previous research has shown poor oral health and neighborhood environment are both risk factors for cognitive decline among older adults. Little research has assessed the synergistic effects of poor oral health and neighborhood environment on cognitive health. This study examined whether neighborhood environment moderates the relationship between edentulism and cognitive function over time. Methods: Using data from the Health and Retirement Study, we analyzed 9,994 adults aged 60 and older with 39,976 person-wave observations over 14 years (2006–2020). Cognitive function was measured using the modified Telephone Interview for Cognitive Status. Edentulism status was self-reported complete tooth loss. Neighborhood environment included perceived neighborhood cohesion and disorder. We used linear mixed-effect models to examine the moderation effect of neighborhood environment on the association between edentulism and cognitive function over time. Results: Edentulous participants (22.4 %) showed an accelerated decline over time in cognitive function compared to dentate participants (β = -0.57, 95 % CI: -0.98, -0.16). The analysis revealed that neighborhood cohesion moderated the relationship between edentulism and cognitive function over time (β = 0.08, 95 % CI: 0.01, 0.15). Specifically, among individuals reporting higher neighborhood cohesion, the negative effect of edentulism on cognitive decline was attenuated. Neighborhood disorder had no significant associations with cognitive function. Conclusions: This study demonstrates the relationship between edentulism and cognitive function varies by levels of neighborhood cohesion. The findings highlight the significance of neighborhood context in understanding the relationship between oral health and cognitive aging and suggest interventions addressing community environment may be particularly relevant for older adults with oral health challenges.

Abstract

Objectives: We investigated the association between maternal leukocyte telomere length (LTL) in the immediate postpartum period and moderate to late preterm birth (32– < 37 weeks) among Latinas, a population at high risk for preterm birth. Methods: Maternal LTL was measured using quantitative polymerase chain reaction at delivery in a prospective San Francisco primarily Latina birth cohort. Logistic regression models were used to investigate the association between postpartum maternal LTL and preterm birth. Maternal LTL was analyzed as a continuous predictor. Results: Out of 194 participants, 23 (11.9%) had preterm delivery. Longer postnatal maternal LTL was associated with preterm birth (crude OR 4.68; 95% confidence interval (CI) 1.07, 20.6, p = 0.039; adjusted OR 12.8, 95% CI 1.83, 99.9, p = 0.010). Age-stratified analysis showed that being under 35 years increased the effect size of the association between maternal LTL and preterm birth (adjusted OR 32.5, 95% CI 2.58, 597, p < 0.01). Conclusions for Practice: Latina mothers with moderate to late preterm infants had longer LTL in the immediate postpartum period compared to those with term infants. This association was stronger for mothers under the age of 35 years. LTL may serve as a biomarker to better understand the pathophysiology and risk of preterm birth and could inform targeted interventions for prevention and early detection. Future studies are needed to understand physiological changes in maternal LTL from the prenatal to postnatal period in relation to birth outcomes.

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.

Abstract

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.

Abstract

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.

Abstract

The global increase in obesity has occurred in parallel to a dietary shift from traditional staple foods to ultra-processed foods (UPF), spurring scientific interest in UPF as a driver of the obesity pandemic. Herein, we summarize the current evidence regarding the role of UPF in obesity, with a specific focus on potential biological mechanisms. The literature strongly supports and corroborates ecological, epidemiological and mechanistic lines of research indicating that dietary patterns high in UPF promote overeating and increase the risk of overweight and obesity. Experimental evidence demonstrates that the soft texture, high energy density and hyperpalatable nutrient combinations of UPF facilitate excessive energy intakes by affecting ingestive behaviours, satiety signalling and food reward systems. Although not fully elucidated, it is plausible that several other UPF attributes (such as emulsifiers, non-nutritive sweeteners, acellular nutrients, and contaminants from processing and packaging materials) contribute to their obesogenic effects through a myriad of physiological pathways, including altered absorption kinetics, glycaemic response and the gut microbiota composition and function. To stem the global rise in obesity, multipronged policy efforts are needed to reduce UPF consumption and create health-promoting food systems.