Association between body mass index, multi-morbidity and activities of daily living among New Zealand nursing home older adults: a retrospective analysis of nationwide InterRAI data.

BACKGROUND: Obesity is a well-established risk factor for multi-morbidity and disability among older adults in the community and acute care settings. However, nursing home residents with body mass index (BMI) below 18.5 kg/m2 and above 25.0 kg/m2 have been understudied. We examined the prevalence of multi-morbidity and disability in activities of daily living (ADL) by BMI category and further investigated the association between BMI, multi-morbidity, and disability of ADL in a large cohort of older adults in nursing homes in New Zealand. METHODS: A retrospective review of nursing home residents' data obtained from the New Zealand International Resident Assessment Instrument national dataset from 2015 to 2018. One hundred ninety-eight thousand seven hundred ninety older adults (≥60 years) living in nursing homes were included. BMI was calculated as weight in kilograms (kg) divided by height in meters squared (m2). Multimorbidity was defined as the presence of ≥2 health conditions. The risk of disability was measured by a 4-item ADL self-performance scale. The prevalence ratio (PR) of the association between BMI and multi-morbidity and between BMI and disability in ADL was assessed using Poisson regression with robust variance. RESULTS: Of the 198,790 residents, 10.6, 26.6, 11.3 and 5.4% were underweight, overweight, obese, and extremely obese, respectively. 26.4, 31.3 and 21.3% had one, two and three disease conditions, respectively, while 14.3% had four or more conditions. 24.1% could perform only one ADL, and 16.1% could perform none. The prevalence of multi-morbidity increased with increasing BMI, whereas mean disability in ADL decreased with increasing BMI. The risk of multi-morbidity was higher for the overweight (PR, 95%CI: 1.03, 1.02-1.03) and obese (PR, 95% CI: 1.07, 1.06-1.08) compared to normal weight after controlling for age, sex, ethnicity, and region. BMI was inversely associated with mean ADL; ß, 95% CI for overweight (- 0.30, - 0.32, - 0.28) and obese - 0.43, - 0.45, - 0.40 compared to normal weight. CONCLUSION: Being underweight was associated with a decline in the performance of ADL in nursing home residents. In contrast, being overweight and obese positively affected functional performance, demonstrating that the obesity paradox plays an important role in this population. The observed associations highlight areas where detection and management of underweight and healthy aging initiatives may be merited.

Perspectives of Family Caregivers on Healthcare Provided to Older Adults With Hypertension and/or Diabetes Mellitus in Ghana.

This study explored the perspectives of family caregivers of older adults with hypertension and/or diabetes mellitus on the care provided to their kin when they visit the hospital. A qualitative research approach was used to conduct the study using family members providing informal care for older adults with hypertension and/or diabetes mellitus at a teaching hospital in Ghana. A total of 20 participants were purposively sampled, interviewed, and data was analyzed using reflexive thematic analysis. Family caregivers mainly had perceptions that their older adult kin had poor interactions with the healthcare system because of some healthcare workers' negative attitudes, inadequate facilities at the clinics, and lack of geriatric care services at the facility. This notwithstanding, family caregivers also derived some benefits from accompanying their kin to the hospital. Practice and education in gerontological nursing must be employed to pragmatically meet the unique healthcare needs of older adults in Ghana with a focus on geriatrics units and standalone programs of study to prepare specialized healthcare professionals to provide comprehensive services to older adults. For a thorough understanding of issues of older adult care in the country, their perspectives on this subject should also be explored in future studies.

"She is My Work": Caregiving for Older Adults With Hypertension and Diabetes Mellitus.

To explore the lived experiences of informal caregivers of older adults with hypertension and/or diabetes mellitus in Kumasi, Ghana. A qualitative research approach was used to conduct the study using informal caregivers of older adults with hypertension and/or diabetes mellitus at a teaching hospital in Ghana. In all, 20 participants were purposively sampled, interviewed, and data were analyzed using thematic analysis. Three main themes emerged: "Experience with care demands," "Coping with care demands," and "Motivation for caregiving." Older adults with hypertension and/or diabetes mellitus had needs that placed a burden on informal caregivers' work life, health, and social life. Informal caregivers of older adults with hypertension and/or diabetes mellitus are under strain. Caregiving is a difficult task, requiring a lot of time, effort, attention, and devotion. Nurses should plan the care of older adults with hypertension and/or diabetes mellitus in collaboration with their informal caregivers.

Tools for faculty assessment of interdisciplinary competencies of healthcare students: an integrative review.

Increasingly, interprofessional teamwork is required for the effective delivery of public health services in primary healthcare settings. Interprofessional competencies should therefore be incorporated within all health and social service education programs. Educational innovation in the development of student-led clinics (SLC) provides a unique opportunity to assess and develop such competencies. However, a suitable assessment tool is needed to appropriately assess student progression and the successful acquisition of competencies. This study adopts an integrative review methodology to locate and review existing tools utilized by teaching faculty in the assessment of interprofessional competencies in pre-licensure healthcare students. A limited number of suitable assessment tools have been reported in the literature, as highlighted by the small number of studies included. Findings identify use of existing scales such as the Interprofessional Socialization and Valuing Scale (ISVS) and the McMaster Ottawa Scale with Team Observed Structured Clinical Encounter (TOSCE) tools plus a range of other approaches, including qualitative interviews and escape rooms. Further research and consensus are needed for the development of teaching and assessment tools appropriate for healthcare students. This is particularly important in the context of interprofessional, community-partnered public health and primary healthcare SLC learning but will be of relevance to health students in a broad range of clinical learning contexts.

Effectiveness of short message services and voice call interventions for antiretroviral therapy adherence and other outcomes: A systematic review and meta-analysis.

BACKGROUND: The potential of using mobile phone technologies to improve antiretroviral therapy (ART) adherence has provided a new facet to human immunodeficiency virus (HIV) research. The quality of evidence and the strength of recommendations of existing reviews, however, do not adequately support large-scale adoption of the intervention. This review adopted broad selection criteria to include all mobile phone-based interventions designed to improve patient's adherence to ART. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies. PUBMED, MEDLINE, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, AMED and Web of Science were searched. Online abstracts archives of relevant conference proceedings and trial registries were also searched. Thirty-Five (35) full-text articles were assessed for eligibility. Included studies were conducted in high, low and middle-income countries and reported ART adherence interventions delivered by mobile phones (standard or smartphones) in the form of voice calls, interactive voice response calls (IVR), and short message service (SMS). RESULTS: Thirteen (13) studies met the inclusion criteria, and 11 were used in the meta-analysis. Intervention characteristics of included studies ranged from mobile phone functionalities to provision of study phones to participants. SMS and voice call contents were tailored to participants' specific adherence needs. Mobile SMS interventions improved adherence to ART compared with control conditions (OR, 95% CI = 1.59, 1.27-1.98). In subgroup analysis, only scheduled SMS was significant whereas triggered SMS had no effect on adherence to ART. Mobile voice calls did not significantly increase adherence to ART. The interventions were highly rated by > 90% of participants in the studies that reported on the experiences and satisfaction with the intervention. CONCLUSION: Scheduled mobile phone text-messaging have demonstrated significant improvement in adherence to ART. Mobile SMS adherence interventions that allow for two-way communication may, however, be more acceptable than standalone SMS reminders, which are seen to be intrusive, producing habituation and response fatigue. Voice calls and triggered SMS functionalities do not have a significant effect on adherence to ART although there is a higher preference for voice functionality over SMS especially in limited-resource and low-literacy settings. Further exploration of the mobile voice functionality and its possible combination with scheduled SMS functionality is recommended. Evidence provided in this study will guide the implementation of mobile phone intervention to improve adherence to ART, by addressing practical challenges that could militate against scalability especially in resource limited settings.

Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa.

BACKGROUND: Breast cancer (BC) has been described as the leading cause of cancer deaths among women especially in the developing world including sub Saharan Africa (SSA). Delayed presentation and late diagnosis at health facilities are parts of the contributing factors of high BC mortality in Africa. This review aimed to appraise the contributing factors to delayed breast cancer presentation and diagnosis among SSA women. METHODS: Five databases encompassing medical and social sciences were systematically searched using predefined search terms linked with breast cancer presentation and diagnosis and sub Saharan Africa. Reference lists of relevant papers were also hand searched. Quality of quantitative and qualitative articles were assessed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Critical Appraisal Skills Programme (CASP) quality appraisal checklist. Thematic analysis was used to synthesize the qualitative studies to integrate findings. RESULTS: Fourteen (14) quantitative studies, two (2) qualitative studies and one (1) mixed method study merited inclusion for analysis. This review identified low knowledge of breast cancer among SSA women. This review also found lack of awareness of early detection treatment, poor perception of BC, socio-cultural factors such as belief, traditions and fear as factors impacting African women's health seeking behavior in relation to breast cancer. CONCLUSION: Improving African women's knowledge and understanding will improve behaviors related to breast cancer and facilitate early presentation and detection and enhance proper management and treatment of breast cancer.

Noise Exposure and Hearing Capabilities of Quarry Workers in Ghana: A Cross-Sectional Study.

INTRODUCTION: Although quarry operations have high economic significance, the effects they cause to the workers in terms of excessive noise production cannot be overlooked. This cross-sectional study assessed the extent of noise exposure and its influence on hearing capabilities among quarry workers in Ashanti region. METHODS: The study involved 400 workers randomly selected from five quarries in Ashanti region from April to June 2012. Data was collected using structured questionnaires, physical examination, and audiological assessments. A logistic regression model was fitted to assess independent predictors of hearing loss. RESULTS: All the machines used at the various quarries produced noise that exceeded the minimum threshold with levels ranging from 85.5 dBA to 102.7 dBA. 176 (44%) of study respondents had hearing threshold higher than 25 dBA. 18% and 2% of these were moderately (41-55 dBA) and severely (71-90 dBA) impaired, respectively. Age, duration of work, and use of earplugs independently predicted the development of hearing loss. Use of earplugs showed a protective effect on the development of hearing loss (OR = 0.45; 95% CI = 0.25, 0.84). CONCLUSION: This study provides empirical evidence on the extent of damage caused to quarry workers as a result of excessive noise exposure. This will support the institution of appropriate protective measures to minimize this threat.

Previous Education, Sociodemographic Characteristics, and Nursing Cumulative Grade Point Average as Predictors of Success in Nursing Licensure Examinations.

Introduction. Success in the licensure examination is the only legal prerequisite to practice as a nurse in Ghana. However, a large percentage of nursing students who sit fail this examination for the first time. This study sought to unravel whether prior education, sociodemographic characteristics, and nursing Cumulative Grade Point Average (CGPA) could predict performance in the licensure examinations. Methods. The study was a descriptive cross-sectional survey conducted from November 2014 to April 2015 in the Kumasi metropolis, Ghana on 176 past nursing students. Data was collected using questionnaires and analyzed using SPSS version 22. A logistic regression model was fitted to look at the influence of the explanatory variables on the odds of passing the licensure examinations. All statistical significances were tested at p value of <0.05. Results. Majority, 56.3%, were females and 86.4% were between the ages of 25 and 31 years. Most of the students (88.6%) entered the nursing training colleges with a WASSCE qualification and 38% read general science. 73.9% passed the licensure examinations and the mean CGPA of the students was 2.89 (SD = 0.37). Sociodemographic characteristics and previous education had no influence on performance in the licensure examinations. CGPA had strong positive relationship with performance in licensure examinations (AOR = 15.27; 95% CI = 6.28, 27.11). Conclusion. Students CGPA could be a good predictor of their performance in the licensure examinations. On the other hand, students' sociodemographic and previous educational characteristics might not be important factors to consider in admitting students into the nursing training programme.