School absenteeism and impairment associated with weight bullying.

INTRODUCTION: Many children experience weight-based bullying (WB), when individuals are treated poorly or demeaned because of weight. WB has negative mental and physical health consequences. The current study examined how children's experiences of different forms of WB (verbal, social, physical, cyber) were associated with impaired functioning in school, social life, and family life. METHODS: Data were collected in Spring 2021. Participants (N = 224) were parents of a school-aged child and lived in the United States. Sixty percent of parents were mothers and 72% of parents self-identified as White. They completed surveys regarding weight, eating, and bullying. RESULTS: Social and cyber WB were associated with clinically significant impairment for both children and parents. Children who experienced social and physical WB were more likely to skip school, whereas physical and cyber WB were associated with skipping a particular class. All forms of bullying were associated with skipping gym class. Social and cyber WB were associated with isolating. Cyber WB was associated with all disordered eating behaviors. In addition, physical WB was associated with binge eating, social WB was associated with purging, and verbal WB was associated with secretive eating. DISCUSSION: Victims of WB experience impairment in school, social life, and family life, absenteeism, and disordered eating. It is essential to develop approaches to address WB in its various forms to identify strategies for reducing and preventing WB across various levels of influence, including peer groups, schools, and families.

Rationale, formative research, and protocol for Calma, Conversa, y Cría: A pilot mindful parenting intervention with Latina women.

Background: Latina mothers' stress is associated with their children's health behaviors and risk for obesity; however, existing pediatric health promotion programs have not focused on maternal stress reduction. Methods: Herein we describe a study design that will examine the acceptability and feasibility of Calma, Conversa, y Cría (CCC) a 6-week mindful parenting intervention designed to reduce stress. We present the results of qualitative research with Latina mothers and experts in Latinx health and mindfulness who provided culturally-relevant feedback on existing mindful parenting strategies to inform the development of CCC. Fifty Latina mothers of children ages 3-11 years will be randomly assigned to CCC or an enhanced usual care health education intervention. Acceptability will be assessed through participant satisfaction surveys and exit interviews. Feasibility will be determined through detailed tracking of recruitment, retention, and attendance rates. A signal regarding any group differences in maternal stress, health-related parenting practices, child diet, child physical activity, and child quality of life will be explored. Discussion: The development of interventions that can reduce maternal stress and risk for obesity in Latinx children is critical to significantly reduce negative health impacts in this underserved population. Our approach includes the identification of effective cultural adaptations that should improve the feasibility and acceptability of mindful parenting strategies in Latinx families, ideally reducing maternal stress and improving parenting behaviors related to child health. If successful, CCC will be examined in a larger efficacy trial involving the measurement of objective biomarkers of children's chronic disease risk.

Ecological momentary assessment of state affect prior to and following loss of control eating in young men.

OBJECTIVE: Loss of control (LOC) eating is prevalent but understudied among young men. Affect regulation models propose that LOC eating functions as a maladaptive effort to escape from distressing affective states. As such, negative affect is thought to increase before and decrease after LOC eating. However, examinations with young men are lacking and it remains unclear whether specific emotional experiences are differentially implicated in their LOC eating. METHODS: The current study examined the temporal roles of affect in LOC eating in 31 young men (18-35 years; Mage = 25.74 ± 5.61y; 46.7 % White; 30 % Black/African American; 10 % Hispanic/Latino, 10 % South Asian) who reported engaging in recurrent LOC eating. Participants completed a 14-day ecological momentary assessment protocol and recorded all eating episodes each day and their state affect five times per day. Generalized linear mixed models were conducted to examine the trajectories of global and item-level negative and positive affect pre- and post-LOC eating episodes. RESULTS: Negative affect did not change significantly before or after LOC eating (ps > .05). Positive affect did not change significantly before LOC eating (ps > .05). Global positive affect, excitement, and happiness decreased significantly after LOC eating (ps ≤ .001). DISCUSSION: Study findings contradict extant theory and empirical data largely from female samples. Negative affect did not increase risk for LOC eating, nor did LOC eating function to improve participants' mood; rather, positive mood slightly decreased after LOC eating. Further investigation around the observed decline in positive affect after LOC eating will clarify if this is a relevant intervention point in this population.

Stories Give Form to a Complex Reality: A Narrative Inquiry of DNP-Prepared APRNs During the COVID-19 Crisis.

Background: The COVID-19 pandemic changed the landscape of healthcare, yet there is a gap in the literature concerning Doctor of Nursing Practice (DNP) experiences during the COVID-19 pandemic. Objective: To gather an authentic understanding of the DNP-prepared Advanced Practice Registered Nurse (APRN) experiences (stories) caring for patients during the COVID-19 pandemic. Methods: This was a qualitative narrative inquiry study. A purposive sample of DNP-prepared APRNs (n = 8) was recruited to participate. All interviews were audio recorded, recordings were transcribed, and then each participant's narrative story was crafted by the authors. Results: Four overarching themes were identified: Do the Right Thing, Stepping Up, From Here to Reality, and Complex COVID Coping. Twelve subthemes were also identified. Participant stories were profound and indicated that their DNP education prepared them well for the healthcare crisis, but the emotional toll was difficult. Conclusions/Implications for Practice: This research provides insight into the experience of DNPs working during the COVID-19 crisis and elucidates the duty of nursing leaders and educators to appropriately plan, safeguard, and guide DNPs, students, and nurses at all levels. Preparation in epidemiology, public health, disaster planning, tele practice, and wellness is paramount.

Social media and dating app use are differentially related to same- and next-day disordered eating pathology in young men with loss of control eating.

OBJECTIVE: To evaluate whether social networking site (SNS) and dating app use is associated with disordered eating in young men. METHODS: 42 men (18-35y) who reported ≥4 loss of control (LOC) eating episodes in the prior month completed a 14-day ecological momentary assessment (EMA) protocol. Five times throughout the day, participants responded to prompts regarding their dietary restraint, body dissatisfaction, and LOC eating. Each night at ~10 pm, participants reported their total time spent on SNSs and dating apps/websites within the last day. RESULTS: 39 out of 42 cisgender men (Mage = 25.1 ± 5.3 years; 47 % non-Hispanic White, 29 % Black or African American; 63 % non-students; 87 % heterosexual) reported using SNSs and/or dating apps. Neither SNS nor dating app use was associated with body dissatisfaction. Dating app use with associated with higher same- (r2 equivalent = 0.022, p = .003) and next-day dietary restraint (r2 equivalent = 0.016, p = .02); SNS use was not. More SNS use was associated with lower odds of same- (OR [95 % CI] = 0.86 [0.75, 0.99], p = .044) and next-day LOC eating (OR [95 % CI] = 0.82 [0.71, 0.96], p = .011); links with dating app use were non-significant. DISCUSSION: Non-significant links for SNS and dating app use with body dissatisfaction, and inverse associations with LOC eating, are contrary to research conducted with girls and women. Research is needed to evaluate whether the quality of SNS and dating app engagement (e.g., specific sites) are more closely related to men's disordered eating, and this work should consider muscularity concerns.

Health and Well-Being of Intensive Care Unit Physicians: How to Ensure the Longevity of a Critical Specialty.

A second epidemic of burnout, fatigue, anxiety, and moral distress has emerged concurrently with the coronavirus disease 2019 (COVID-19) pandemic, and critical care physicians are especially affected. This article reviews the history of burnout in health care workers, presents the signs and symptoms, discusses the specific impact of the COVID-19 pandemic on intensive care unit caregivers, and attempts to identify potential strategies to combat the Great Resignation disproportionately affecting health care workers. The article also focuses on how the specialty can amplify the voices and highlight the leadership potential of underrepresented minorities, physicians with disabilities, and the aging physician population.

Impressions of the Nursing Profession Among Nursing Students and New Graduates During the First Wave of COVID-19: A Qualitative Content Analysis.

BACKGROUND: The COVID-19 pandemic has been a defining event for the next generation of the nursing workforce. Complex pandemic practice environments have raised concerns for the preparation and support of novice nurses, even as a multitude of nurses leave the profession. PURPOSE: Researchers sought to examine nursing students' and new graduate nurses' impressions of the nursing profession in contrasting regions of New York State during the first wave of the COVID-19 pandemic. METHODS: Inductive content analysis was performed on narrative text responses (n = 295) drawn from a larger multisite mixed-methods survey. RESULTS: Five subconcepts were abstracted, leading to the main concept of shocked moral distress . CONCLUSION: Nursing students and new graduate nurses have experienced high levels of moral distress but remain committed to the profession. Building moral resilience, fostering ethical decision making, and implementing protective policies can reduce the incidence of moral distress.

Loperamide-induced cardiogenic syncope: a case report of a life-threatening presentation of an over-the-counter drug.

Background: Loperamide at supratherapeutic doses can cause cardiac toxicity, presenting as cardiogenic shock, prolonged QT, malignant arrhythmias, or in severe cases sudden cardiac death. Surreptitious loperamide use is difficult to diagnose. We present an interesting case of loperamide use presenting with polymorphic ventricular tachycardia, cardiogenic shock. Case summary: A 25-year-old female presented with multiple syncopal episodes for 12 months with an electrocardiogram showing a Brugada-like pattern for which she underwent implantable cardioverter-defibrillator placement. One day following the procedure, she developed cardiogenic shock and was transferred to our tertiary care centre. Extensive workup was unrevealing. She responded well to supportive management, recovering from shock and was transferred to the floor. Unfortunately, she again developed cardiogenic shock, ultimately leading to cardiac arrest. Given the unclear cause for her cardiovascular symptoms, futher medication history was obtained. It was revealed that she was taking 100-150 tablets of loperamide per day. The decision was made to treat with intralipid emulsion therapy empirically given the strong suspicion for loperamide toxicity. The patient recovered well with supportive care. Loperamide levels returned elevated at 190 ng/mL. Repeated studies showed improvement of the conduction block, resolution of arrhythmias, and recovery of right and left ventricular function. Discussion: Acute loperamide toxicity can present as biventricular failure, with difficult-to-control arrhythmias. It requires a high index of suspicion. Treatment for loperamide toxicity is mainly supportive, lipid emulsion therapy can be considered in severe or refractory cases.

Discovering the Roots: A Qualitative Analysis of Medical Students Exploring Their Unconscious Obesity Bias.

Phenomenon: Bias against individuals with obesity in medical settings has negative implications for patients, including stigmatization, poor health outcomes, and reduced healthcare utilization. This study explored reflections of medical students when confronted with their own implicit obesity bias.Approach: A group of 188 pre-clinical second-year medical students from George Washington University School of Medicine and Health Sciences completed the Weight Implicit Association Test (IAT) in 2020 and were instructed to write a reflective response based on their results. Participants reflected upon their preferences ("fat" vs. "thin") and described the factors that influenced their perceptions of obesity. Inductive coding techniques were used to generate themes from medical students' responses using Dedoose Version 8.3.35 (SocioCultural Research Consultants LLC, Los Angeles, California).Findings: Regarding IAT results, 7% of medical students preferred "fat over thin," 14% had no preference, and 78% preferred "thin over fat." Reflection themes highlighted medical students' difficulty accepting IAT results, perspectives on the origins of obesity in individuals, personal and family challenges with obesity and body image, medical training's perceived influence on bias, reservations about discussing obesity with patients, and desires to change current and future practices.Insights: Many medical students expressed a desire to provide optimal care for patients of all weight classes despite demonstrating a strong unconscious bias against individuals with obesity on the IAT. Medical school should provide targeted opportunities to acknowledge and mitigate obesity bias by expanding on medical students' pre-established and often harmful understandings of obesity and highlighting the complexities of this disease. Such training would better equip medical students to facilitate successful interactions with patients as future physicians.

Loss of control may uniquely predict negative affect among the disinhibited eating experiences of high-risk young men.

OBJECTIVE: Loss of control (LOC) eating is a disordered eating behavior that is prevalent but understudied among men. It is common for men with LOC eating to concurrently engage in diverse eating behaviors characterized as disinhibited. It remains unclear which eating qualities are most distressing for men. This study evaluated the link between disinhibited eating qualities and subsequent negative affect in young men. METHODS: 42 men (18-35 y) who reported engaging in ≥4 LOC eating episodes in the prior month completed a 14-day ecological momentary assessment protocol. For each meal and snack, participants were asked to rate the extent to which they felt they overate; lost control; ate more than planned; ate mindlessly; had concerns about wasting food; and were encouraged to eat more by others. State negative affect was evaluated during random intervals five times per day. RESULTS: After adjusting for previous negative affect and time between ratings, five of the six eating qualities were significantly and positively associated with subsequent negative affect according to between-participant findings (ps < 0.026). In within-participant analyses, only LOC was significantly and positively associated with subsequent negative affect (p = 0.044). DISCUSSION: While a range of disinhibited eating qualities are correlated with negative affect in a sample of young men, a sense of LOC while eating may be a promising target for interventions focused on improving the psychological functioning of high-risk young men.

Engaging Faith-Based Organizations to Promote Health Through Health Ministries in Washington, DC.

This article describes capacity building and formative assessments completed at five faith-based organizations (FBOs) in Washington, DC to inform sustainable health promotion programming led by certified health ministers. Five FBO partners were recruited with two congregation members from each FBO completing a health minister certificate program. A series of health assessments were conducted to assess each FBO's capacity to implement evidence-based lifestyle change programs that are responsive to congregation members' health needs. Results indicated a need for programming to support older adults in managing high blood pressure and arthritis. Health ministers represent a significant opportunity for building capacity within FBOs to deliver programming that can improve health outcomes.

Very low-dose recombinant Factor VIIa administration for cardiac surgical bleeding reduces red blood cell transfusions and renal risk: a matched cohort study.

Outcomes following administration of very-low-dose recombinant activated factor VIIa (vld-rFVIIa) for cardiac surgical bleeding remain debatable. We sought to determine the association of vld-rFVIIa and adverse surgical outcomes. Retrospective, cohort matching of patients undergoing cardiac surgery who received vld-rFVIIa (median 13.02 µg/kg) for perioperative bleeding were matched to cardiac surgical patients who had bleeding and received standard of care for bleeding without Factor VIIa administration. Of the 362 matched patients (182 in each group), patients who received rFVIIa required significantly less red blood cell transfusions [median 3 units (range 0--60, IQR = 4 units) versus 4 units (range 2-34, IQR = 4 units); P = 0.0004], decreased length of hospital stay (median 8 versus 9 days; P = 0.0158) and decreased renal risk (P < 0.0001). Incidence of renal failure, postoperative infection, postoperative thrombosis, prolonged ventilation, total ICU hours and 30-day mortality were not different between the two groups. Vld-rFVIIa for cardiac surgical bleeding was associated with decreased red blood cell transfusion, renal risk and length of hospital stay without increased thromboembolism or mortality when compared to patients who had cardiac surgical bleeding and received standard of care without Factor VIIa.

In Their Own Words: Parents and Key Informants' Views on Nutrition Education and Family Health Behaviors.

Parents, health professionals, and communities are integral in the development of nutrition behaviors that reduce children's risk for high body mass index (BMI) and chronic disease. The aim of this study was to conduct formative evaluations with key health informants and parents to understand the specific strategies that families use at mealtimes to promote their family's health, along with the barriers they face in attending current nutrition education programming. Focus groups (in English and Spanish) were conducted with parents (n = 22; 63.64% Black/African American, 13.64% Black but not African American, 18.18% Hispanic/Latinx) whose household was located in a community where 50% of residents' gross income was ≤185% of the federal poverty level. Semi-structured interviews were conducted with six key informants with expertise in family health and nutrition. Inductive thematic analysis was used to identify themes across interviews. Six general themes emerged from the interviews including perceptions of health, relationships, health behaviors, facilitators, barriers, and desired changes. Across the six themes, participants responded with suggestions for community-based health promotion programs such as incorporating a broader definition of health to better address the individual and systemic barriers that perpetuate health inequities and make healthy eating difficult. Participants identified stress reduction, health literacy, and cooking knowledge as areas of interest for future programming.

The Future Capacity of the Nursing Workforce: COVID-19 Pandemic's Impacts on New Nurses and Nursing Students Toward the Profession.

BACKGROUND: Nurses are concerned for their safety and conflicted about their career, because their duty to care for patients during the pandemic involved competing ethical obligations, including their own personal safety. PURPOSE: The aim was to explore the impact of COVID-19 on new nurses and nursing students in terms of safety and interest in nursing specifically related to self-efficacy, geographic region case density, and frontline experience in health care. METHODS: New nurses and nursing students (N = 472) responded to an online survey examining self-efficacy, sense of safety, and interest in nursing. The survey included an open-ended question to support response interpretation. RESULTS: Researchers identified significant differences among new nurses and students from contrasting case-dense regions in terms of safety and interest in nursing. CONCLUSION: Concerns about personal safety and the safety of others were apparent. Over time, this may lead to a decrease in willingness to enter or remain in the nursing profession.

Interest in Receiving Nutrition Information Through Social Media Among Food-Security Program Participants in Washington, DC.

INTRODUCTION: Effective communication approaches are necessary to reach food-security program participants. Accessing food-security programs has been especially challenging during the COVID-19 pandemic. Social media can play an important role in reducing some communication barriers. We examined interest in receiving nutrition information via social media among adults participating in food-security programs in Washington, DC. METHODS: We developed and administered a 22-item survey to adults participating in food-security programs (N = 375). Participants were recruited at Martha's Table, in Washington, DC, from January through March 2020. We performed bivariate analyses and multinomial logistic regressions to examine predictors of interest in receiving nutrition information via social media. RESULTS: Sixty-nine percent of participants reported using social media, and 49% expressed interest in receiving nutrition information via social media. Higher levels of self-efficacy and belief in the value of digital technology were associated with greater likelihood of interest in receiving nutrition information via social media (χ2 6 = 139.0; Nagelkerke R2 = 0.35; P < .001). We found no differences by sex or digital technology access in interest in receiving nutrition information via social media. CONCLUSION: Social media is a widely used and a feasible method to reach food-security program participants. Understanding program participants' interest in receiving health information via social media may help food-security programs plan effective communication strategies to improve food security, especially when in-person participation is limited, such as during the COVID-19 pandemic.