Association Between Birthplace and Time in the United States With Diet Quality in US Adolescents: Findings from the National Health and Nutrition Examination Survey, 2007 to 2018.

BACKGROUND: During adolescence, diet quality reaches its lowest point compared to other childhood life stages. Acculturation is associated with decreased diet quality among many groups of US immigrant adults, but research is limited among adolescents. OBJECTIVES: We investigated the associations between birthplace and length of time living in the United States, 2 proxy measures of acculturation, and diet quality among adolescents (12-19 years old). METHODS: Data were from the NHANES (2007-2018), which included two 24-hour dietary recalls (n = 6113) to estimate Healthy Eating Index 2015 (HEI-2015) total scores and component scores. Multivariate linear regression and generalized linear models were performed to compare HEI-2015 total scores and component scores between US-born adolescents (n = 5342) and foreign-born adolescents with <5 years (n = 244), 5 to <10 years (n = 201), and ≥10 years (n = 290) of US residency. RESULTS: Foreign-born adolescents with <5 years (53.3 ± 1.2), 5 to <10 years (51.4 ± 1.5), and ≥10 years of US residency (49.9 ± 0.8) had higher HEI-2015 total scores than US-born adolescents (47.0 ± 0.3; P < 0.0001) and higher component scores for total vegetables, seafood and plant proteins, and added sugars (P values ≤ 0.0001). Foreign-born adolescents with more years of US residency had higher component scores for total fruits, whole fruits, and saturated fats than those with fewer years of US residency. A sensitivity analysis revealed this pattern held for Mexican-American and other Hispanic adolescents. CONCLUSIONS: Being born outside the United States and living in the United States for less time (among foreign-born adolescents) are associated with higher diet quality. Culturally informed health promotion programs may help to reduce diet-related disparities related to acculturation among adolescents.

Predispositional genome sequencing in healthy adults: design, participant characteristics, and early outcomes of the PeopleSeq Consortium.

BACKGROUND: Increasing numbers of healthy individuals are undergoing predispositional personal genome sequencing. Here we describe the design and early outcomes of the PeopleSeq Consortium, a multi-cohort collaboration of predispositional genome sequencing projects, which is examining the medical, behavioral, and economic outcomes of returning genomic sequencing information to healthy individuals. METHODS: Apparently healthy adults who participated in four of the sequencing projects in the Consortium were included. Web-based surveys were administered before and after genomic results disclosure, or in some cases only after results disclosure. Surveys inquired about sociodemographic characteristics, motivations and concerns, behavioral and medical responses to sequencing results, and perceived utility. RESULTS: Among 1395 eligible individuals, 658 enrolled in the Consortium when contacted and 543 have completed a survey after receiving their genomic results thus far (mean age 53.0 years, 61.4% male, 91.7% white, 95.5% college graduates). Most participants (98.1%) were motivated to undergo sequencing because of curiosity about their genetic make-up. The most commonly reported concerns prior to pursuing sequencing included how well the results would predict future risk (59.2%) and the complexity of genetic variant interpretation (56.8%), while 47.8% of participants were concerned about the privacy of their genetic information. Half of participants reported discussing their genomic results with a healthcare provider during a median of 8.0 months after receiving the results; 13.5% reported making an additional appointment with a healthcare provider specifically because of their results. Few participants (< 10%) reported making changes to their diet, exercise habits, or insurance coverage because of their results. Many participants (39.5%) reported learning something new to improve their health that they did not know before. Reporting regret or harm from the decision to undergo sequencing was rare (< 3.0%). CONCLUSIONS: Healthy individuals who underwent predispositional sequencing expressed some concern around privacy prior to pursuing sequencing, but were enthusiastic about their experience and not distressed by their results. While reporting value in their health-related results, few participants reported making medical or lifestyle changes.

Design, methods, and participant characteristics of the Impact of Personal Genomics (PGen) Study, a prospective cohort study of direct-to-consumer personal genomic testing customers.

Designed in collaboration with 23andMe and Pathway Genomics, the Impact of Personal Genomics (PGen) Study serves as a model for academic-industry partnership and provides a longitudinal dataset for studying psychosocial, behavioral, and health outcomes related to direct-to-consumer personal genomic testing (PGT). Web-based surveys administered at three time points, and linked to individual-level PGT results, provide data on 1,464 PGT customers, of which 71% completed each follow-up survey and 64% completed all three surveys. The cohort includes 15.7% individuals of non-white ethnicity, and encompasses a range of income, education, and health levels. Over 90% of participants agreed to re-contact for future research.

Practice environments of nurses in ambulatory oncology settings: a thematic analysis.

BACKGROUND: : The practice environments of nurses have been studied extensively in inpatient settings, but rarely in the ambulatory context. As the majority of cancer care is delivered in ambulatory settings, a better understanding of the nursing practice environment may contribute to quality improvement efforts. OBJECTIVE: : We sought to examine the features of nursing practice environments that contribute to quality patient care and nursing job satisfaction. METHODS: : In 2009-2010, we conducted focus groups with nurses who cared for adults with cancer outside inpatient units. A semistructured moderator guide explored practice environment features that promoted safe, high-quality care and high job satisfaction. We also asked nurses to identify practice environment features that hindered quality care and reduced job satisfaction. We conducted thematic analysis to report themes and to construct a conceptual framework. RESULTS: : From 2 focus groups, composed of 13 participants, nurses reported that variability in workloads, support from managers and medical assistants, and the practice's physical resources could facilitate or hinder high-quality care and job satisfaction. High-quality communication across team members improved patient safety and satisfaction. CONCLUSIONS: : Consistent with research findings from inpatient settings, nurses identified staffing and resource adequacy, management support, and collegiality as important inputs to high-quality care. IMPLICATIONS FOR PRACTICE: : These findings can inform quality improvement initiatives in ambulatory oncology practices. Strengthening nurse-medical assistant relationships, smoothing patient workload variability, and implementing strategies to strengthen communication may contribute to quality cancer care. Studies to test our proposed conceptual framework would bridge existing knowledge gaps in ambulatory settings.

Glenohumeral joint laxity and stiffness in the functional throwing position of high school baseball pitchers.

CONTEXT: Repetitive overhead throwing has been theorized to result in chronic adaptations to the capsuloligamentous restraints of the glenohumeral joint. OBJECTIVE: To compare glenohumeral joint laxity and stiffness between the throwing and nonthrowing shoulders of high school baseball pitchers. DESIGN: Repeated measures. SETTING: High school athletic training facilities. PATIENTS OR OTHER PARTICIPANTS: Twenty-two asymptomatic high school baseball pitchers (age = 16.50 +/- 0.74 years, height = 178.51 +/- 7.66 cm, mass = 75.43 +/- 13.24 kg) from a sample of convenience. MAIN OUTCOMES MEASURE(S): We used computerized stress arthrometry to measure glenohumeral joint laxity and stiffness. Anterior glenohumeral joint laxity and stiffness measures were obtained with the shoulder in 90 degrees of abduction and both neutral rotation and 90 degrees of external rotation. Posterior laxity and stiffness measures were obtained with the shoulder in 90 degrees of abduction and neutral rotation. RESULTS: No clinically significant differences were found for glenohumeral laxity or stiffness between sides. However, a statistically significant main effect for position was present for both laxity and stiffness. Anterior glenohumeral joint laxity in the 90 degrees external rotation position was significantly decreased and stiffness was increased in this position compared with the anterior at neutral and posterior at neutral positions. CONCLUSIONS: Glenohumeral joint laxity decreases and stiffness increases in the functional throwing position of 90 degrees of abduction and 90 degrees of external rotation. No clinically significant side-to-side differences or directional differences were found in high school baseball pitchers.