Publications

Abstract

Objective: The majority of groceries purchased by US households are industrially processed, yet it is unclear how processing level influences diet quality. We sought to determine if processing level is associated with diet quality of grocery purchases. Design: We analysed grocery purchasing data from the National Household Food Acquisition and Purchase Survey 2012-2013. Household grocery purchases were categorized by the NOVA framework as minimally processed, processed culinary ingredients, processed foods or ultra-processed foods. The energy share of each processing level (percentage of energy; %E) and Healthy Eating Index-2015 (HEI-2015) component and total scores were calculated for each household's purchases. The association between %E from processed foods and ultra-processed foods, respectively, and HEI-2015 total score was determined by multivariable linear regression. Foods purchased by households with the highest v. lowest ultra-processed food purchases and HEI-2015 total score <40 v. ≥60 were compared using linear regression. Setting: USA. Participants: Nationally representative sample of 3961 households. Results: Processed foods and ultra-processed foods provided 9·2 (se 0·3) % and 55·8 (se 0·6) % of purchased energy, respectively. Mean HEI-2015 score was 54·7 (se 0·4). Substituting 10 %E from minimally processed foods and processed culinary ingredients for ultra-processed foods decreased total HEI-2015 score by 1·8 points (β = -1·8; 95 % CI -2·0, -1·5). Processed food purchases were not associated with diet quality. Among households with high ultra-processed food purchases, those with HEI-2015 score <40 purchased less minimally processed plant-foods than households with HEI-2015 score ≥60. Conclusions: Increasing purchases of minimally processed foods, decreasing purchases of ultra-processed foods and selecting healthier foods at each processing level may improve diet quality.

Abstract

Chronic diseases have become serious threats to public health in China; the risk is particularly high for internal migrants. Chronic disease education is a key to the prevention and control of chronic diseases for such population. The national population-based Migrants Population Dynamic Monitoring Survey (MPSMA) was used to examine the current status and delivery methods of chronic disease education among internal migrants, from both provincial level and individual’s level. The study population included 402 587 internal migrants. Multilevel logistic regression was used to investigate factors that were related to chronic diseases education. In total, only 33.9% of the participants received chronic disease education. In the final model, parameter estimates on key variables from both individual and provincial level were significant (P < .001). Participants from provinces with higher level of health care resources and lower density of internal migrants were more likely to receive chronic disease education. The percentage and methods of receiving education varied across different age groups. This study suggests that future chronic disease education in China need to be more focused on areas with high density of internal migrants and younger internal migrants with low level of education and income. Attention should be paid to use tailored education methods to different populations.

Abstract

End-of-life care in the intensive care unit is fraught with complicated psychological responses by patients, families, and staff. Empathic and mindful communication, inclusion of all integral staff in decision-making meetings, and multidimensional support of patients and families can ease the transition away from aggressive life-prolonging to comfort-oriented end of life care. Primary palliative care communication strategies can help clarify goals of care and facilitate transitions. Early integration of specialist palliative care is recommended.

Abstract

OBJECTIVE: The purpose of this study was to evaluate the psychometric properties of the 22-item Barriers to Healthy Eating (BHE) scale in four independent weight loss studies conducted over 13 years.METHODS: Principal axis factoring with promax rotation was performed to reveal the underlying factor structure. Internal consistency was assessed using Cronbach α, and convergent validity was assessed by correlating the baseline BHE with the Weight Efficacy Lifestyle questionnaire total and subscale scores. Predictive validity was examined by the association of BHE change with weight loss over 6 months.RESULTS: The four studies had similar gender (82.9%-89.9% female) and race (70.5%-81.4% white) distributions. Factor analyses suggested removal of two items and a three-factor structure: self-control and motivation (10 items), daily mechanics (7 items), and social support (3 items). The Cronbach α for the 20-item BHE ranged from 0.849 to 0.881 across the four studies. The BHE and Weight Efficacy Lifestyle questionnaire total and subscale scores were all negatively correlated with each other, showing good convergent validity (r = 0.120-0.544, P < 0.05). BHE change was associated with weight loss from 0 to 6 months (r = 0.282-0.450, P < 0.05).CONCLUSIONS: The BHE scale showed very good psychometric properties over time, supporting its use in measuring barriers to one's ability to adopt or maintain a healthy eating plan.

Abstract

Purpose of Review: This review discusses recent evidence on the association of dietary carbohydrates (quantity, quality, and timing of intake) with hypertension (HTN) risk and out-of-clinic blood pressure (BP) measures. Recent Findings: Studies on carbohydrate quantity are inconclusive, but low carbohydrate diets may be associated with lower BP. Plant-based carbohydrate-containing foods such as fruits, vegetables, and whole grains may lower HTN risk and 24-h BP. Excessive sugar intakes from sugar-sweetened beverages are associated with higher BP levels and HTN risk, with evidence of a dose-response relationship. Preliminary data suggest that timing of carbohydrate intake may influence HTN risk and 24-h BP. Summary: The role of carbohydrate nutrition in HTN’s etiology warrants further investigation. Additional studies are needed to investigate the influence of dietary carbohydrates on HTN risk and the circadian pattern of BP, evaluate potential sex and racial/ethnic differences in these associations, and elucidate underlying mechanisms.

Abstract

Information regarding nutritional risk among users of American adult day health centers (ADHCs), 60% of whom are racial minorities, is scant. This study examined nutritional risk and associated factors in a diverse sample ADHC users aged 50+ using secondary cross-sectional analysis of data collected between 2013 and 2017. Risk was assessed using the DETERMINE checklist, and results were stratified by race. The majority of the sample (N = 188) was at moderate (45.2%) or high (38.5%) nutritional risk, with statistically significant racial differences. Blacks were at greater risk than any other group: 65% had high nutritional risk; 76.5% ate <5 servings of fruits, vegetables, or milk daily; 21% ate <2 meals daily, 48.5% reported involuntary weight loss/gain, and 41.2% had tooth loss/mouth pain. Older adults in ADHCs are at elevated risk of malnutrition, disproportionately so amongst blacks. Both routine nutrition screening and population-specific approaches are needed to attenuate risk.

Abstract

This study examines racial/ethnic disparities of dental service utilization for foreign-born and U.S.-born dentate residents aged 50 years and older. Generalized linear mixed-effects models (GLMM) were used to perform longitudinal analyses of five-wave data of dental service utilization from the Health and Retirement Study (HRS). We used stratified analyses for the foreign-born and U.S.-born and assessed the nonlinear trend in rates of dental service utilization for different racial/ethnic groups. Findings indicate that Whites had higher rates of service utilization than Blacks and Hispanics regardless of birthplace. For all groups, the rates of service utilization decreased around age 80, and the rates of decline for Whites were slower than others. The U.S.-born showed the trend of higher rates of service utilization than the foreign-born for all racial/ethnic groups. These findings suggest the importance of developing culturally competent programs to meet the dental needs of the increasingly diverse populations in the United States.

Abstract

Background: Much of the discourse surrounding children's advocacy in the United States relies on a rights-based approach. We argue that this approach has limitations that impede progress in advancing children's well-being. Purpose: The purpose of this article is to explain alternatives to a rights-based approach in advocating for children, such as developmental, economic, capabilities, and mutualism frameworks. Methods: Our analysis is based on the independent work of two separate university-based groups studying children's rights; the authors were each members of one of the groups and subsequently integrated their findings for this article. Discussion: US policies for children, especially in the domains of health and education, depict an unevenness that results in many children failing to receive certain critical services and benefits. Relying on a rights-based approach to correct these disparities and inequities is contentious and has yet to sufficiently change state and federal policies or improve children's health outcomes. Other approaches are needed to advance children's well-being. Conclusion: Nurses individually and collectively need to be mindful of the pitfalls of a rights-based approach and use other frameworks in advocating for children and youth.

Abstract

Many older adults transfer from the hospital to a post-acute care (PAC) facility and back to the hospital in the final phase of life. This phenomenon, which we have dubbed “Rehabbing to death,” is emblematic of how our healthcare system does not meet the needs of older adults and their families. Policy has driven practice in this area including seemingly benign habits such as calling PAC facilities “rehab.” We advocate for practice changes: (1) calling PAC “after-hospital transitional care,” rather than “rehab”; (2) adopting a serious illness communication model when discussing new care needs at the end of a hospitalization; and (3) policies that incentivize comprehensive care planning for older adults across all settings and provide broad support and training for caregivers. In realigning health and social policies to meet the needs of older adults and their caregivers, fewer patients will be rehabbed to death, and more will receive care consistent with their preferences and priorities. J Am Geriatr Soc 67:2398–2401, 2019.

Abstract

Objectives: To assess the association between rural and urban residential mobility and cognitive function among middle-aged and older adults in China. Method: We used data from the World Health Organization Study on global AGEing and adult health that included adults age 50+ from China (N = 12,410). We used multivariate linear regressions to examine how residential mobility and age at migration were associated with cognitive function. Results: Urban and urban-to-urban residents had the highest level of cognitive function, whereas rural and rural-to-rural residents had the poorest cognitive function. Persons who migrated to/within rural areas before age 20 had poorer cognitive function than those who migrated during later adulthood. Socioeconomic factors played a major role in accounting for the disparities in cognition; however, the association remained significant after inclusion of all covariates. Discussion: Residential mobility and age at migration have significant implications for cognitive function among middle-aged and older adults in China.

Abstract

Cancer is a major cause of mortality and morbidity in Korea. However, there has been no previous nursing literature review on the phenomenon of resilience among cancer patients in Korea. The purpose of this study was to identify information about theories, instruments, correlates, and outcomes of resilience in the cancer experiences of Korean adults. This was a scoping review that searched Ovid MEDLINE, CINAHL, Google Scholar, DBpia, and the Korean Studies Information Service System between 2000 and 2016 in order to identify English and Korean research reports. The review yielded 17 quantitative studies, including 2 resilience theories and 6 resilience-specific instruments. The factors self-efficacy, hope, social supports, self-esteem, anxiety, and depression were associated with resilience, regardless of the type of cancer. Quality of life and coping were commonly investigated outcome variables for resilience. This review suggests that a nursing theory reflecting Korean culture and qualitative research concerning the phenomenon of resilience should be conducted as research priorities as the foundation for developing culturally appropriate tools for resilience. This will lead to enhanced quality of life among Korean cancer patients, which is the core of palliative nursing care.

Abstract

This study examined the association between widowhood and depressive symptoms and the extent to which the association is contingent upon risk and resiliency, including immigration status, functional limitations, financial strains, and intergenerational support, among older Mexican Americans. The sample included 344 parent-child pairs reported by 83 respondents. Clustered regression analysis showed that widowhood elevated risks for depressive symptoms. We found that having some functional limitations, having more children and living in the same city with children exacerbated the adverse effects of widowhood on depressive symptoms. We also found that living in the same city with children increased the detrimental effects of widowhood on the depressive symptoms in men, whereas we did not find this pattern in women. The findings highlight the heterogeneity within the widowed Mexican American older adults. Implications for future research and practice are discussed.

Abstract

Purpose of Review: To identify factors associated with obesity in veterans of the recent, Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) war conflicts. Recent Findings: Over 44% OEF/OIF/OND veterans are obese (BMI > 30 kg/m2), which exceeds the national obesity prevalence rate of 39% in people younger than 45. Obesity increases morbidity, risk for type 2 diabetes (T2D), and mortality as well as decreases quality of life. A scoping review method was used to identify factors associated with obesity in young veterans. Military exposures, such as multiple deployments and exposure to combat, contribute to challenges in re-integration to civilian life in all veterans. Factors that contribute to increased risk for obesity include changes in eating patterns/eating disorders, changes in physical activity, physical disability, and psychological comorbidity. These conditions can contribute to a rapid weight gain trajectory, changes in metabolism, and obesity. Summary: Young veterans face considerable challenges related to obesity risk. Further research is needed to better understand young veterans' experiences and health needs in order to adapt or expand existing programs and improve access, engagement, and metabolic outcomes in this vulnerable population.

Abstract

Objective: Examine the risk of preterm birth (PTB, < 37 weeks) and early term birth (37–38 weeks) for women with reported drug abuse/dependence. Study Design: The population was drawn from singleton livebirths in California from 2007 to 2012. Drug abuse/dependence was determined from maternal diagnostic codes (opioid, cocaine, cannabis, amphetamine, other, or polysubstance). Relative risks, adjusted for maternal factors were calculated for PTB and early term birth. Result: Of the 2,890,555 women in the sample, 1.7% (n = 48,133) had a diagnostic code for drug abuse/dependence. The percentage of PTBs varied from 11.6% (cannabis) to 24.3% (cocaine), compared with 6.7% of women without reported drug abuse/dependence. Conclusion: Women with reported drug abuse/dependence during pregnancy were at increased risk of having a PTB and all but those using cannabis were at risk of having an early term birth. Women using cocaine and polysubstance were at the highest risk of birth < 32 weeks.

Abstract

NPs in primary care settings are well positioned to treat substance use disorders (SUDs). SUDs affect patients across the age spectrum and may be diagnosed and treated by NPs using brief interventions and pharmacologic therapies, or patients may be referred to specialty services. This article provides guidelines for screening, brief interventions, and pharmacologic therapies.

Abstract

Objective: Inflammatory and metabolic pathways are implicated in preterm birth and preeclampsia. However, studies rarely compare second trimester inflammatory and metabolic markers between women who deliver preterm with and without preeclampsia. Study design: A sample of 129 women (43 with preeclampsia) with preterm delivery was obtained from an existing population-based birth cohort. Banked second trimester serum samples were assayed for 267 inflammatory and metabolic markers. Backwards-stepwise logistic regression models were used to calculate odds ratios. Results: Higher 5-α-pregnan-3β,20α-diol disulfate, and lower 1-linoleoylglycerophosphoethanolamine and octadecanedioate, predicted increased odds of preeclampsia. Conclusions: Among women with preterm births, those who developed preeclampsia differed with respect metabolic markers. These findings point to potential etiologic underpinnings for preeclampsia as a precursor to preterm birth.

Abstract

About 11% of the adult global populations is estimated to be living with type 2 diabetes mellitus (T2DM) by 2040. T2DM requires people to make decisions regarding complex therapeutic regimes, to maintain their well-being and quality of life, to manage symptoms and to reduce disease complications. All these behaviours, requiring knowledge, motivation, experience, and skills, have been referred to the concept of self-care. The intricacy and multidimensionality of T2DM self-care requires a complex approach to its overall comprehension. This Embedded Mixed Method study aims to investigate the experience of self-care in Type 2 Diabetes Mellitus adult patients. It comprises a prospective observational design, and an interpretive description. Quantitative data will be collected with validated questionnaires from 300 patients at baseline and once a year for two years on: diabetes self-care, quality of life, diabetes related distress, and sleep quality. Socio-demographic and clinical data will be collected from medical records. Qualitative data will be collected using semi-structured interviews on circa 10-20 patients, at baseline and once a year for two years, analysed according to interpretive description. Quantitative and qualitative data will be analysed separately and then merged and interpreted. This study will expand our understanding of self-care in people with T2DM. The expected outcome will be a better understanding of the effect of self-care on glycaemic control and therefore clinical outcomes and costs.

Abstract

Psychological distress is prevalent among cancer patients, who may be vulnerable to distress at times of transition, such as a change in symptom experience, employment, or goal of treatment. Independently, both psychological distress and transitions impair patients’ quality of life, and together their adverse impact may be intensified. Self-management allows patients to engage in tasks that influence the disease experience and can include strategies to help mitigate distress associated with transitions. The purpose of this systematic review was to examine research on the relationship between self-management interventions and distress in adult cancer patients receiving active tumor-directed therapy. From a search of seven electronic databases, 5,156 articles were identified; however, nine studies met inclusion criteria. Our review suggested that self-management interventions may help address psychological distress in patients receiving cancer treatment but that the current evidence is not robust enough to support a definitive conclusion.

Abstract

Background: Some, but not all, studies report associations between shift work and hypertension, suggesting that particular subgroups may be at risk. We examined moderating effects of sleep duration and circadian preference on the relationship between shift work and new blood pressure (BP) medicine use at follow-up. Methods and Results: Baseline and 5-year follow-up data from the UK Biobank cohort (N=9200) were used to generate logistic regression models for shift workers and nonshift workers. The moderating effects of sleep duration (short ≤6 hours; adequate 7–8 hours; long ≥9 hours) and circadian preference (morning “larks;” intermediate; evening “owls”) at baseline were examined with new BP medicine use at follow-up, adjusting for age, sex, race, education, employment, urban/rural, cardiovascular disease family history, depression, alcohol intake, physical activity, diet, smoking, and body mass index. The sample was predominately middle aged (55.3±7.4), female (57.3%), and white (97.9%). Most reported adequate sleep duration (7–8 hours, 73.7%) and were intermediate type (65.3%); 8.0% were shift workers at baseline. Only 6.5% reported new BP medicine use at follow-up. Short sleep duration was a significant moderator of new BP medicine use in shift workers. Among short sleepers, shift workers had a 2.1-fold increased odds of new BP medicine use compared with nonshift workers (odds ratio=2.08, 95% CI=1.21–3.58, P=0.008). In those reporting adequate (odds ratio=0.82, 95% CI=0.54–1.25, P=0.35) and long sleep (odds ratio=0.64, 95% CI=0.11–3.54, P=0.60), this relationship was protective but nonsignificant. Interaction between circadian preference and shift work on BP medicine use was nonsignificant. Conclusions: Shift workers with short sleep duration may be at risk for hypertension.

Abstract

BACKGROUND A purpose of duty-hour regulations is to reduce sleep deprivation in medical trainees, but their effects on sleep, sleepiness, and alertness are largely unknown. METHODS We randomly assigned 63 internal-medicine residency programs in the United States to follow either standard 2011 duty-hour policies or flexible policies that maintained an 80-hour workweek without limits on shift length or mandatory time off between shifts. Sleep duration and morning sleepiness and alertness were compared between the two groups by means of a noninferiority design, with outcome measures including sleep duration measured with actigraphy, the Karolinska Sleepiness Scale (with scores ranging from 1 [extremely alert] to 9 [extremely sleepy, fighting sleep]), and a brief computerized Psychomotor Vigilance Test (PVT-B), with long response times (lapses) indicating reduced alertness. RESULTS Data were obtained over a period of 14 days for 205 interns at six flexible programs and 193 interns at six standard programs. The average sleep time per 24 hours was 6.85 hours (95% confidence interval [CI], 6.61 to 7.10) among those in flexible programs and 7.03 hours (95% CI, 6.78 to 7.27) among those in standard programs. Sleep duration in flexible programs was noninferior to that in standard programs (between-group difference, −0.17 hours per 24 hours; one-sided lower limit of the 95% confidence interval, −0.45 hours; noninferiority margin, −0.5 hours; P=0.02 for noninferiority), as was the score on the Karolinska Sleepiness Scale (between-group difference, 0.12 points; one-sided upper limit of the 95% confidence interval, 0.31 points; noninferiority margin, 1 point; P<0.001). Noninferiority was not established for alertness according to the PVT-B (between-group difference, −0.3 lapses; one-sided upper limit of the 95% confidence interval, 1.6 lapses; noninferiority margin, 1 lapse; P=0.10). CONCLUSIONS This noninferiority trial showed no more chronic sleep loss or sleepiness across trial days among interns in flexible programs than among those in standard programs. Noninferiority of the flexible group for alertness was not established.

Abstract

Declining national rates of current tobacco use to an all-time low of 15.1% represents a public health victory. Undermining this progress, however, are smoking rates of up to 50% among high-risk, low-income populations. Current FDA-approved treatments for nicotine dependence are ineffective with between 70-95% of treatment-seekers relapsing within the first year of attempted abstinence. Thus, identification of novel intervention targets to optimize response to currently available treatments for nicotine dependence is a critical next step. One such target may be sleep insomnia. Insomnia is a clinically verified nicotine withdrawal symptom but, to date, addressing insomnia or other sleep disturbance symptoms as an adjunctive smoking cessation therapy has yet to be fully considered.To this end, this manuscript presents a narrative review of: (1) sleep continuity and architecture in smokers versus nonsmokers; (2) effects of nicotine abstinence on sleep; (3) possible mechanisms linking sleep with smoking cessation outcomes; (4) plausible adjunctive sleep therapies to promote smoking cessation; (5) possible treatments for unhealthy sleep in smokers; and (6) directions for future research.Taken together, this will provide conceptual support for sleep therapy as an adjunctive treatment for smoking cessation. Implications:This narrative literature review presents a comprehensive discussion of the relationship between habitual sleep and cigarette smoking.The extent to which unhealthy sleep in smokers may be a viable intervention target for promoting response to smoking cessation treatment is considered. Ultimately, this review provides conceptual support for sleep therapy as an adjunctive treatment for smoking cessation.