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AnteayerNursing Research

Mediterranean Diet, Body Composition, and Activity Associated With Bone Health in Women With Fibromyalgia Syndrome

imageBackground There is very little scientific literature on the potential relationships between modifiable factors, including body composition, dietary pattern and physical activity (PA), and bone status in patients with fibromyalgia—a musculoskeletal condition characterized by chronic, widespread pain that is often accompanied by a broad spectrum of symptoms. Objectives The aim of the study was to investigate the impact of body composition parameters, adherence to the Mediterranean diet (Med Diet), and PA on bone health in a population of premenopausal and postmenopausal women with fibromyalgia syndrome (FMS). Methods Ninety-five women diagnosed with FMS were included in this cross-sectional study. Body composition, including fat mass, percentage of fat mass, and lean mass (LM), were calculated using a body composition analyzer. Adherence to the Med Diet was measured through a validated 14-item questionnaire. The International Physical Activity Questionnaire was used to assess PA. Bone mass at the calcaneus was estimated through quantitative ultrasound. Results Linear regression analysis revealed that LM had a significant association with broadband ultrasound attenuation (β = 0.211, 95% CI [0.046, 1.259], p = .035) and stiffness index parameters (β = 0.201, 95% CI [0.019, 1.654], p = .045) after adjusting for age and menopausal status. The Med Diet was also significantly associated with broadband ultrasound attenuation (β = 1.693, 95% CI [0.508, 2.879], p = .006). Discussion LM and the Med Diet were consistently associated with calcaneal quantitative ultrasound parameters, supporting the hypothesis that LM and adherence to the Med Diet play determinant roles in bone health in FMS women. Training programs to maximize LM and strategies for promoting good adherence to the Med Diet should be considered in order to prevent the development of osteoporosis in FMS women. Because nurses are involved in implementing preventive programs, their roles in promoting this adherence to the Med Diet and maximizing LM in patients with FMS should help reduce the impact of osteoporosis.

Symptom Experience of Older Adults With Type 2 Diabetes and Diabetes-Related Distress

imageBackground An older, more diverse population and longer life spans are major contributors to the anticipated tripling of Type 2 diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people diagnosed with Type 2 diabetes and may be a greater risk for older adults due to greater prevalence of comorbidities. Objective The objective of this phenomenological study was to describe how diabetes-related distress in older adults (≥65 years) with Type 2 diabetes might be uniquely experienced. Methods Participants were recruited using convenience sampling and snowball sampling. Interpretive phenomenology guided the research design and analysis. With interpretive interviews, we investigated the everyday health, symptoms, and life experiences of living with Type 2 diabetes and elevated diabetes distress. Results Among the older adults in this study, the most prevalent symptoms were fatigue, hypoglycemia, diarrhea, pain, loss of balance, and falling. These diabetes-related symptoms led to substantial loss of independence, decreased quality of life, and constrained social lives due to restricted activities. Discussion Diabetes-related distress presents with some unique symptoms and responses in older adults. Improving knowledge regarding the symptom experience of older adults with diabetes-related distress may allow healthcare providers to tailor treatment and thus improve outcomes for older adults struggling with diabetes.

Addressing Health Disparities in America: Analysis of Community Health Improvement Plans

imageBackground Healthy People 2020 has made achieving health equity one of its overarching goals; another goal is increasing the number of accredited local agencies that have Community Health Improvement Plans (CHIPs). Community Health Improvement Plans are meant to serve agencies as guiding documents for multiple years. Objectives This study investigates the prevalence with which health disparities are addressed within CHIPs and the specific health disparities targeted by these objectives. Methods Researchers analyzed 4,094 objectives from CHIPs of 280 local Public Health Accreditation Board (PHAB)-accredited and nonaccredited public health agencies in the United States. Results Despite the PHAB's focus on addressing health equity, not all PHAB-accredited agencies addressed health disparities (85.4% of CHIPs analyzed). However, more accredited than nonaccredited agencies (73.9%) contained at least one objective focused on health disparities. Discussion Findings indicate that if health equity is truly a goal of national initiatives, agencies' planning documents (e.g., CHIPs) can do a better job addressing commonly ignored populations.

Revalidation of a Perioperative Risk Assessment Measure for Skin

imageBackground Validated perioperative pressure injury (PI) risk assessment measures are few and often cumbersome to complete, leading to missed opportunities to identify and target prevention interventions to those patients at increased risk for developing a postsurgical PI. Objectives Previous validation of a six-item perioperative risk assessment measure for skin (PRAMS) was conducted in our community hospital with positive findings. The purpose of this study was to increase generalizability by revalidating the PRAMS in a larger sample. Methods This was a retrospective chart review of all surgical patients aged ≥18 years positioned in the supine or lateral position in a Midwest quaternary care, multispecialty, 1,500-bed hospital during a 6-month period (n = 1,526). The intent of the study was to revalidate the PRAMS. The main outcome of interest was the development of PI after surgery. Risk indicators of interest included diabetes, age, surgical time, Braden score, previous surgery, and preexisting PI. The diagnostic ability of any of the risk indicators on the development of a postsurgical PI was evaluated using sensitivity, specificity, and predictive values. Results Postsurgical PIs occurred in 121 patients. Comparing current to previous study results, the PRAMS was effective in identifying surgical patients at risk for PI (sensitivity = .98). Those patients with a postsurgical PI had a lower mean Braden score, were more likely to have a preexisting PI, and were more likely to have a previous surgery during the same admission (p

Development of a Care Delivery Model for High-Need Older Adults in the Community

imageBackground High-need older adults have multiple needs and require different types of care services. Care coordinators in community care centers in Taiwan, however, often experience difficulties in providing sufficient care services because of the inadequate capacity of case management. Objective The aim of this study was to develop a realistic care delivery model for the care coordinators to manage the care of high-need, community-dwelling older adults. Methods Focus-group interviews concerning elements and process for establishing a care delivery model were conducted with 12 care management experts in two groups: the practical work group (three registered nurses and three social workers) and the care management group (three care managers and three care management supervisors). The interviews were video-recorded and subjected to content analysis. Results A five-stage care delivery model was formulated: case screening, case assessment, care plan, care delivery, and follow-up evaluation. Six types of high-need older adults were identified: those living with disability, solitude, dementia, depression, elder abuse, and poverty. A list of categorized care services, including care resources, social welfare resources, and caregiver resources, was then used as a guide for case management and care delivery. Discussion The developed model—consisting a classification of services for different types of high-need older adults—serves as a guide for care coordinators in community care centers to make better decisions on service linkages, resource management, and care plan monitoring.

Experience of Perinatal Death From the Father’s Perspective

imageBackground Although perinatal deaths are still a common pregnancy outcome in developing countries, little is known about the effect perinatal death has on fathers. Objective The aim of the study was to understand and describe the meaning of perinatal death in a sample of fathers from northeastern Colombia. Methods Using purposive and snowball sampling approaches, we identified 15 participants from northeastern Colombia who agreed to participate. We used a descriptive phenomenological design. Data were collected through in-depth, semistructured interviews. Results Men suffer in solitude and hide their emotions as they feel the need to be the main supporters of their partners. Three major themes emerged: experience of loss, coming to terms with an irreparable loss, and overcoming the loss. Discussion While women are receiving care, health staff may neglect or forget men. Men suffer alone while seeking ways of attunement with their partners’ emotions to support them during the grieving process. Fathers can overcome and adjust to the loss when they transcend it and find new meaning. Men felt neglected and marginalized at hospitals while their partners were receiving treatment. Health professionals should recognize and acknowledge the pain of fathers who face perinatal death and include them as much as possible in the standard of care. The results identify opportunities for healthcare providers in clinical and outpatient settings to acknowledge the importance of men within the context of pregnancy and to learn about their pain and suffering when they face a perinatal death.

Publishing Preprints

Por: Pickler · Rita H.
No abstract available

Adherence to Home-Based Rehabilitation in Older Adults With Diabetes After Hip Fracture

imageBackground Adherence to rehabilitation is beneficial to patients with hip fracture. However, the relationships between different levels of adherence and postoperative recovery among older adults after hip fracture have not been addressed thoroughly in the literature. Objectives The aims of this study were to explore the trajectories of adherence to home-based rehabilitation during the 12-month period after hospital discharge and to examine the effects of adhering to prescribed home-based rehabilitation on postoperative recovery of physical functions. Methods We employed a secondary data analysis, and 88 hip-fractured older adults with diabetes were recruited. The Chinese Barthel Index was used to measure daily physical functions, a goniometer was used to measure range of motion, and the MicroFET2 dynamometer was used to measure muscle power. Adherence was measured as the rate of adherence to the suggested frequency of home-based rehabilitation activities. Results Adherence to home-based rehabilitation decreased over time. The high-adherence group was more likely to recover prefracture physical functions than was the low-adherence group, and the high-adherence group had better self-care abilities, greater range of motion for ankle extension, and higher muscular strength on both adduction and abduction than did the low-adherence group. Discussion The results of our study suggest that patients adhere to more than 50% of prescribed rehabilitation. Future studies should continue to explore interventions to enhance rehabilitation adherence after hospital discharge.

Demographics, Psychological Distress, and Pain From Pressure Injury

imageBackground There is a knowledge gap regarding factors that influence the intensity of pain associated with pressure injuries. Objectives We examined the influence of age, gender, race, and comorbidity on the relationships between pressure injuries, psychological distress, and pain intensity in hospitalized adults. Methods This study was a cross-sectional, retrospective secondary analysis using data from a regional acute hospital’s electronic health records from 2013 to 2016. A sample of 454 cases met the inclusion criteria and were analyzed using path analysis. Results The hypothesized model (Model A) and two alternative models (Models B and C) were tested and demonstrated adequate model fit. All tested models demonstrated statistically significant independent direct effects of age on the severity of pressure injury (p

Development of a Bidimensional Simpatía Scale for Use With Mexican American, Puerto Rican, and Cuban American Adults

imageBackground Through its influence on social interactions, simpatía may have a wide-ranging influence on Latinx health. Simpatía—which does not have a direct English translation—refers to being perceived as likeable, pleasant, and easygoing. Research to investigate the influence simpatía on Latinx health is limited, likely due to a lack of options for measuring simpatía among diverse Latinx populations. Objectives The goal of this research was to develop a bilingual, survey-based simpatía scale for use among ethnically diverse Latinx adults in health-related settings. Methods Data were obtained through a telephone survey data of 1,296 Mexican American, Puerto Rican, and Cuban American adults living in the United States. Interviews were conducted in English and Spanish. Exploratory factor analysis, item response theory analysis, confirmatory factor analysis, and computation of estimates of internal consistency reliability were conducted to inform the development of the final simpatía scale. Results Results indicate that the final, nine-item, simpatía scale has high internal consistency (α = .83) and measurement invariance among Mexican American, Puerto Rican, and Cuban American adults. Two dimensions were identified, as indicated by a perceptions subscale and a behavior subscale. Cuban Americans were found to have the highest simpatía scores, followed by Puerto Ricans and Mexican Americans. Discussion Culture is often identified as a powerful potential influence on health-related behaviors, but measures are often not available to assess specific cultural traits. By developing a new tool for measuring simpatía, this research advances opportunities for understanding and promoting Latinx health.

Relationship of Pain Quality Descriptors and Quantitative Sensory Testing: Sickle Cell Disease

imageBackground Chronic pain in adults with sickle cell disease (SCD) may be the result of altered processing in the central nervous system, as indicated by quantitative sensory testing (QST). Sensory pain quality descriptors on the McGill Pain Questionnaire (MPQ) are indicators of typical or altered pain mechanisms but have not been validated with QST-derived classifications. Objectives The specific aim of this study was to identify the sensory pain quality descriptors that are associated with the QST-derived normal or sensitized classifications. We expected to find that sets of sensory pain quality descriptors would discriminate the classifications. Methods A cross-sectional quantitative study of existing data from 186 adults of African ancestry with SCD. Variables included MPQ descriptors, patient demographic data, and QST-derived classifications. Results The participants were classified as central sensitization (n = 33), mixed sensitization (n = 23), and normal sensation. Sensory pain quality descriptors that differed statistically between mixed sensitization and central sensation compared to normal sensitization included cold (p = .01) and spreading (p = .01). Aching (p = .01) and throbbing (p = .01) differed statistically between central sensitization compared with mixed sensitization and normal sensation. Beating (p = .01) differed statistically between mixed sensitization compared with central sensitization and normal sensation. No set of sensory pain quality descriptors differed statistically between QST classifications. Discussion Our study is the first to examine the association between MPQ sensory pain quality descriptors and QST-derived classifications in adults with SCD. Our findings provide the basis for the development of a MPQ subscale with potential as a mechanism-based screening tool for neuropathic pain.

A Replicable Model of Recruitment for Longitudinal Research of Preterm Infants

imageBackground Recruitment and retention in longitudinal studies can be challenging because the numbers of participants may not adequately reflect the targeted population. Objectives The aim of the study was to present a replicable pathway model of recruitment via retrospective chart review and describe outcomes of the recruitment methods used in the model on enrollment, scheduling, and attrition. Methods This retrospective chart review included recruitment data from participants of a parent grant (n = 99) that met chart review inclusion criteria (n = 47) for a follow-up study measuring microbiome data of preterm infants at toddler and preschool age. Results Over a 3-year recruitment period, 25 of the 47 participants eligible for recruitment were enrolled in the follow-up study. Initial contact was more likely to be performed via mail and e-mail for first time points and via phone for subsequent contact and second time points. For scheduling, phone contact was the method utilized most frequently for both groups, with online scheduling second when introduced in the preschool group. Two participants were lost to follow-up, resulting in an attrition rate of 8%. Discussion This recruitment pathway model offers researchers multiple recruitment methods for initial contact and scheduling that may be useful in contacting more participants to positively affect enrollment and reduce attrition rates for longitudinal cohorts. The innovation of recruitment methods via Facebook for initial contact and online scheduling are new methods with promise and multiple benefits for the research staff and participants.

Poverty, Toxic Stress, and Education in Children Born Preterm

imageBackground Preterm birth, defined as birth before the completion of 37 weeks of gestation, is a multifactorial global epidemic with psychosocial, economic, and physical ramifications affecting the child, family, and community at large. Toxic stress—the results of exposure to adverse childhood experiences—results in changes to brain structure and function that negatively affects future health. Objectives The aim of this study was to apply the eco-bio-developmental (EBD) model of poverty and preterm birth to the cross-sectional data of the 2016 National Survey of Children’s Health to evaluate the associations between poverty, toxic stress, and prematurity on neurodevelopmental and educational outcomes. Methods A subset of data representing children ages 6–11 years old (n = 15,010) from the 2016 National Survey of Children’s Health was used for multivariate analysis of demographic variables and neurodevelopmental and educational outcome variables. Pearson’s chi-square, logistic regression, and interaction effects explored the relationships between prematurity, toxic stress, and poverty. Results Children in this sample born preterm had a higher incidence of toxic stress, poverty, developmental delay, learning disability, intellectual disability, speech/language disorders, attention-deficit disorder (ADD)/attention-deficit/hyperactivity disorder (ADHD), autism, and special education/early intervention plans. The combination of poverty, toxic stress, and preterm birth significantly increased the risk of these conditions. After accounting for gender, insurance coverage, race, and parental education, children in the sample born preterm were more likely to experience developmental delay, intellectual disability, speech/language disorder, learning disability, and ADD/ADHD. Toxic stress increased the incidence of ADD/ADHD and autism in both the preterm and full-term samples. Discussion The negative effect of poverty and toxic stress on children born preterm, as depicted by the eco-bio-developmental model, is supported by this analysis. Healthcare providers are encouraged to address the tripartite vulnerability resulting from prematurity, poverty, and toxic stress.

Dose–Response Relationship in a Healthy Habits Study for Head Start Preschoolers

imageBackground Understanding the dose–response relationship in behavioral interventions is critical to guide future research efforts. However, only few studies have fully examined the dose–response relationship especially among children. Objective The aim of the study was to examine the relationships between level of participation and intervention effects. Methods The study used data from 39 Head Start parent–preschooler dyads participating in a 10-week lifestyle intervention. The intervention included daily center-based preschooler program, preschooler weekly letters to parents, parent meetings, and weekly Facebook-based program. Height, weight, waist circumference (WC), moderate-to-vigorous physical activity (MVPA), screen time, and fruit/vegetable intake were assessed. Results Preschooler program average daily attendance was 79%, and Facebook-based program average completion rate was 80%. About 49% attended all three parent meetings. Parent meeting attendance was significantly and positively related to preschoolers’ vegetable intake (p = .023) and MVPA (p

Mediators of Physical Activity Behavior Change in the “Girls on the Move” Intervention

imageBackground The minimal effect of interventions to date on increasing young adolescent girls’ physical activity (PA) may be due to inadequate understanding of the mechanisms underlying behavior change, yet sparse research testing a PA intervention has examined the capacity of theories to explain PA, particularly when using objective measures. Objectives The aim of the study was to examine whether constructs from the health promotion model and self-determination theory mediated changes in moderate-to-vigorous physical activity (MVPA) following a 17-week intervention. Methods The study was a secondary analysis of data from a group randomized trial, including 12 intervention and 12 control schools in the Midwestern United States. Data were collected in 2012–2016. Girls (fifth- to eighth-grade, N = 1,519) completed surveys on perceived benefits and enjoyment of PA, PA self-efficacy, social support and motivation for PA, and barriers to PA and wore accelerometers. Results The final path model had a good fit: χ2(4) = 2.48, p = .648; goodness-of-fit index = 1; comparative fit index = 1; root-mean-square error of approximation = 0; standardized root-mean-square residual = 0.01. For MVPA change from baseline to postintervention, enjoyment (B = 24.48, p

Pain Assessment for Nursing Home Residents: A Systematic Review Protocol

imageBackground The burden of pain in nursing homes is substantial; however, pain assessment for both acute and chronic conditions remains inadequate, resulting in inappropriate or inadequate treatment. Complexities in assessing resident pain have been attributed to factors (barriers and facilitators) arising at the resident, healthcare provider, and healthcare system levels. Objectives In this systematic review protocol, we identify our research approach that will be used to critically appraise and synthesize data in order to assess barriers and facilitators to pain assessment in nursing home residents aged ≥65 years. Methods This is a Cochrane style systematic review protocol adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols reporting standards. This review will include primary (original) qualitative literature concerning either barriers or facilitators to pain assessment in older adult nursing home residents. A thematic analysis approach will be employed in collating and summarizing included data and will be categorized into resident, healthcare provider, and system-level factors. Database searches will include Abstracts in Social Gerontology, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and Web of Science. Discussion The identification of barriers and facilitators to pain assessment in older adult nursing home residents may assist healthcare providers across all platforms and levels of education to improve pain assessment among nursing home residents. Improving the assessment of pain has the potential to improve quality of care and ultimately quality of life for older adult nursing home residents.

Psychometrics of the SCL-90-R and Development and Testing of Brief Versions SCL-45 and SCL-9 in Infertile Couples

imageBackground Although infertile couples are mentally healthy, dealing with infertility and assisted reproductive technology (ART) treatment is usually associated with psychological distress. It would therefore be useful to have short, multidimensional instruments to be able to identify people who present more intense emotional reactions and follow up their emotional distress throughout the ART. Objectives The goals of the study were to analyze the psychometric adequacy of the original 90-item version of the Symptom Checklist (SCL-90) in a sample of Spanish women and their partners undergoing ART, as well as to develop and analyze two brief versions of the SCL-90, given the absence of adequate short versions for this population. Methods A cross-sectional design for patients and their partners in the process of ART through in vitro fertilization was used. The two brief scales were obtained, which took into account the levels of variance explained by the items and confirmatory factor analysis. Results Two brief instruments were developed. The first, with 45 items (SCL-45-I Infertility), includes nine subdimensions: Somatization, Interpersonal Sensitivity, Obsessive-Compulsive Disorder, Depression, Anxiety, Hostility, Paranoid Ideation, Phobic Anxiety, and Psychoticism. The second instrument contains nine items (SCL-9-I or Global Severity Index [GSI]), one item for each dimension. Both instruments were psychometrically adequate (SCL-45-I: χ2/df = 7.24, RMSEA = .057, 95% CI [.056, .059], CFI = .97, NNFI = .97, SRMR = .049; SCL-9-I: χ2/df = 9.66, RMSEA = .068, 95% CI [.061, .076], CFI = .97, NNFI = .96, SRMR = .035). Measurement invariance analysis by gender was conducted, and the instruments were shown to be suitable for both men and women. Discussion The suitability of the SCL-90-R for use in ART was verified, and two valid instruments—useful and easy to use for nurses, psychologists, and other care providers—were developed.

A Protocol to Assess Feasibility, Acceptability, and Usability of Mobile Technology for Symptom Management in Pediatric Transplant Patients

imageBackground Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress, and the use of mobile health (mHealth) technologies may enhance symptom management by providing patient-generated health data to foster personalized health strategies. Objectives The aim of this study was to present a study protocol to explore feasibility, acceptability, and usability of integrating mHealth technologies to collect and monitor symptom data for PBMT patients. Methods An exploratory mixed-methods design is employed for 20 PBMT patients to monitor symptoms using real-time data from two mHealth devices: (a) a self-developed mHealth application and (b) a wearable tracking device. Patient-Reported Outcomes Measurement Information System surveys for fatigue, pain, and sleep disturbance are obtained monthly. Interviews are conducted to obtain further feasibility and usability data. Results The study began in October 2017; data collection should be completed in 2018. Feasibility and usability results to monitor and record symptom-related data daily via mobile devices will be reported. Patient-Reported Outcomes Measurement Information System surveys and interviews will further explore patients’ symptoms and experiences with the mobile devices. Discussion This study will be among the first to explore the feasibility, acceptability, and usability of integrating multiple mHealth technologies to obtain patient-generated symptom data for the PBMT population. Results will enhance our understanding of how these data present, interact, and cluster together throughout the posttransplant period for these children and lead to symptom management strategies. Results will focus on a high-risk population that potentially stands to benefit from the use of mobile technologies.