High Prevalence of Cardiometabolic Risks and Health Needs Among Patients With Hepatocellular Carcinoma After Treatment: A Cross-sectional Study.

BACKGROUND: Many studies have indicated that inadequate health-related behavior is associated with the progression of cancer and cardiometabolic disorders. Because patients with hepatocellular carcinoma may adopt inadequate health behaviors, they are at risk for cancer recurrence, mortality, cardiometabolic disease progression, and worse quality of life. OBJECTIVE: To explore the prevalence of cardiometabolic risks and health-promoting behaviors associated with quality of life among patients with hepatocellular carcinoma after treatment. METHODS: A cross-sectional study was conducted from October 2021 to August 2022. Data were collected through face-to-face interviews using a structured questionnaire, and cardiometabolic information was recorded from medical charts. RESULTS: In total, 115 patients with liver cancer after treatment were enrolled; 73% were male. The mean age was 67.7 years, and high prevalence rates of central obesity (72.2%) and metabolic syndrome (47%) were noted. Inadequate exercise, oral hygiene, and cigarette smoking were common. The health-promoting score was significantly associated with exercise, the number of remaining teeth, and metabolic syndrome, which correlated with quality of life, including positive functional and negative symptoms dimensions. CONCLUSIONS: The findings demonstrated a high prevalence of cardiometabolic risks and inadequate health-related behaviors among patients with liver cancer after treatment. This study highlights the need for healthcare providers to help patients increase health literacy for preventing cardiometabolic risks at outpatient clinics. IMPLICATIONS FOR PRACTICE: Findings from this study can be used to advise healthcare providers to educate patients with liver cancer during and after treatment on improving their health-promoting behaviors.

From self-care behaviours to cardiometabolic risks prevention for the health of farmers: Nursing implications.

AIMS: The study aimed to explore farmers' self-care behaviours including oral hygiene, remaining natural teeth, cardiometabolic risks, hepatitis, risk of stroke and their determinant factors. METHODS: This cross-sectional study was conducted between June 2020 and March 2021 in the south-western remote areas of Taiwan. We recruited current farmers who participated in an annual community health screening conducted by a collaborated local hospital. Data were collected through face-to-face interviews using a semi-structured questionnaire. Blood samples were drawn and stored in the central laboratory of the cooperating hospital. The study outcomes included cardiometabolic risks, the remaining natural teeth, and farmers' self-care behaviours including oral hygiene, adopting a healthy diet and substance use. RESULTS: Overall, 183 current farmers (55.2% women, aged 66.9 ± 11.7 years) were enrolled. Abnormal blood pressure, high risk of stroke, metabolic syndrome and hepatitis C virus infection were found among the participants. The average remaining teeth were 12.1, 73.2% of participants had <20 teeth; 90.2% and 71% did not undergo regular dental check-ups and scaling or use dental floss, respectively. The determinant factors associated with the remaining teeth included a high risk of stroke, teeth scaling and dental floss use. Although only 3.8% felt mentally distressed, many farmers were unaware of having potential cardiometabolic diseases and curable viral hepatitis, and only two had received antiviral treatment. CONCLUSION: The farmers in this study had a high prevalence of cardiometabolic risks, a high probability of stroke, inadequate number of remaining teeth and poor oral hygiene behaviours. These findings can provide evidence to develop health promotion programmes for farmers. IMPACT: This study demonstrates the health needs of farmers. We strongly recommend that community nurses empower farmers to engage in self-care behaviours through tailored health promotion programmes. For instance, by discussing cardiometabolic risk prevention from the farmers' perspectives to improve their health literacy.

Evidence-based intervention program for reducing obesity among African-American women in Southern California.

OBJECTIVE: This study evaluated the effectiveness of group motivational education and empowerment program using evidence-based approaches for obesity and weight loss management for African-American Women. DESIGN: This study employed a quasi-experimental time series design based on the theoretical frameworks of the Empowerment and Health Belief models. SAMPLE: Twenty-eight African-American Women were recruited into culturally appropriate and responsive weight-loss management program. MEASUREMENTS: The weight management programs consisted of nutrition education, physical activities, and focus-group sessions. Measurements included analysis of blood samples for cholesterol, waistline, body mass index, and exercise time. Statistical analysis compared program outcomes at baseline and 3-month intervals for 1 year. INTERVENTION: Participants were educated on healthy food choices and physical activities based on National Institutes of Health's food guidelines. RESULTS: The results showed that 90% of participants lost 20 pounds or more and 82% had 6 inches or more waist circumference reductions. Additionally, cholesterol reductions and improved nutrition knowledge and exercises were significant. CONCLUSIONS: We developed an evidence-based and culturally appropriate intervention for weight-loss management among African-American women. Acceptance of personal responsibility to modify behaviors, knowledge of good nutrition, and engagement in physical activities were positive and effective health behavioral changes in promoting health and weight-loss management for this population.

Effects of family nutrition and physical activity screening for obesity risk in school-age children.

PURPOSE: An obesogenic home environment is a major contributor to overeating and sedentariness in school-aged children, as children have less autonomy during this phase of development and are influenced by family environmental cues. The purpose of this study was to implement a screening tool at a low socioeconomic elementary school clinic to identify children at risk of developing obesity and provide standardization for practitioners on educating parents regarding child obesity risk factors. DESIGN AND METHODS: An evidence-based practice design utilizing the Family Nutrition and Physical Activity (FNPA) tool was completed at all visits of patients ages 4 to 11. Parents completed the 20-item screening tool related to 10 factors (family meal patterns, family eating habits, food choices, beverage choices, restriction/reward, screen time behavior and monitoring, healthy environment, family activity involvement, child activity involvement, family routine). The nurse practitioner (NP) provided parents with education regarding healthy home practices based on American Academy of Pediatrics (AAP) recommendations. Level of obesity risk (low, moderate, and high) was determined based on the FNPA score and body mass index (BMI) of the patient. Patients identified as at-risk were scheduled for a 2-month follow-up and rescreened to determine if lifestyle modifications were made. RESULTS: Twenty-seven children were screened using the FNPA tool, with an initial mean FNPA score of 64. Ninety-three percent were classified as a moderate or high risk for obesity (BMI percentile 85th or greater and/or moderate-high risk FNPA scores). Seven percent had a healthy BMI and low-risk FNPA scores and did not require follow-up intervention. Sixty-seven percent of patients scores improved at follow-up, with an average FNPA score of 70. Effect size stratified by risk category was low-risk score 0.07 and moderate-risk score 1.49 with a standard deviation of 5.36. PRACTICE IMPLICATIONS: Implementation of the FNPA tool at a school-based clinic is a feasible opportunity to identify children at risk for obesity and allows for anticipatory guidance by the NP to increase awareness of parental influence as role models for healthy lifestyle behaviors.

Application of the International Classification of Functioning, Disability and Health system to symptoms of the Duchenne and Becker muscular dystrophies.

PURPOSE: Duchenne and Becker muscular dystrophies, collectively referred to as dystrophinopathies, are X-linked recessive diseases that affect dystrophin production resulting in compromised muscle function across multiple systems. The International Classification of Functioning, Disability and Health provides a systematic classification scheme from which body functions affected by a dystrophinopathy can be identified and used to examine functional health. MATERIALS AND METHODS: The infrastructure of the Muscular Dystrophy Surveillance, Tracking, and Research Network was used to identify commonly affected body functions and link selected functions to clinical surveillance data collected through medical record abstraction. RESULTS: Seventy-one (24 second-, 41 third- and 7 fourth-level) body function categories were selected via clinician review and consensus. Of these, 15 of 24 retained second-level categories were linked to data elements from the Muscular Dystrophy Surveillance, Tracking, and Research Network surveillance database. CONCLUSIONS: Our findings support continued development of a core set of body functions from the International Classification of Functioning, Disability and Health system that are representative of disease progression in dystrophinopathies and the incorporation of these functions in standardized evaluations of functional health and implementation of individualized rehabilitation care plans. Implications for Rehabilitation Duchenne and Becker muscular dystrophies, collectively referred to as dystrophinopathies, are X-linked recessive disorders that affect the production of dystrophin resulting in compromised muscle function across multiple systems. The severity and progressive nature of dystrophinopathies can have considerable impact on a patient's participation in activities across multiple life domains. Our findings support continued development of an International Classification of Functioning, Disability and Health core set for childhood-onset dystrophinopathies. A standardized dystrophinopathy International Classification of Functioning, Disability and Health documentation form can be used as a screening tool by rehabilitation professionals and for patient goal setting when developing rehabilitation plans. Patient reports of perceived functional health should be incorporated into the rehabilitation plan and therapeutic progress monitored by a standardized form.

Secondary Conditions Among Males With Duchenne or Becker Muscular Dystrophy.

Duchenne and Becker muscular dystrophy are X-linked neuromuscular disorders characterized by progressive muscle degeneration. Despite the involvement of multiple systems, secondary conditions among affected males have not been comprehensively described. Two hundred nine caregivers of affected males (aged 3-31 years) identified by the Muscular Dystrophy Surveillance, Tracking, and Research Network completed a mailed survey that included questions about secondary conditions impacting multiple body functions. The 5 most commonly reported conditions in males with Duchenne were cognitive deficits (38.4%), constipation (31.7%), anxiety (29.3%), depression (27.4%), and obesity (19.5%). Higher frequencies of anxiety, depression, and kidney stones were found among nonambulatory males compared to ambulatory males. Attention-deficit hyperactivity disorder (ADHD) was more common in ambulatory than nonambulatory males. These data support clinical care recommendations for monitoring of patients with Duchenne or Becker muscular dystrophy by a multidisciplinary team to prevent and treat conditions that may be secondary to the diagnosis.

Launching a Laboratory Testing Process Quality Improvement Toolkit: From the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP).

INTRODUCTION: Family medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice. METHODS: We applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit. RESULTS: From the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources. CONCLUSION: While practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care.

Supporting cardiovascular risk reduction in overweight and obese hypertensive patients through DASH diet and lifestyle education by primary care nurse practitioners.

PURPOSE: To describe an intervention among overweight and obese hypertensive patients, encouraging Dietary Approaches to Stop Hypertension (DASH) diet and lifestyle changes, designed and led by a primary care nurse practitioner (NP). DATA SOURCES: A pre- and postintervention quasi-experimental time-series design was implemented over 2 months. Intervention included three group classes and two individual counseling telephone calls. Forty-five hypertensive patients enrolled, with a mean age of 55 years and mean initial BMI of 32. Twenty-six (58%) completed the program. Standard instruments (Rapid Eating Assessment for Patients [REAP] and Partners in Health [PIH] questionnaires) were used to evaluate diet and lifestyle factors before and after the program. CONCLUSIONS: Participants had statistically significant improvements in diet and lifestyle scores on both REAP and PIH questionnaires, as well as statistically significant weight loss (average 3.6 pounds lost) over the 2-month intervention period. IMPLICATIONS FOR PRACTICE: This NP-led primary care intervention on diet and lifestyle showed early success in improving the health of overweight and obese hypertensive patients. Investment in NP-led diet and lifestyle counseling should be considered among high-risk patients in the primary care setting.

Guided imagery: an innovative approach to improving maternal sleep quality.

Mothers of preterm infants are at risk for poor sleep quality, which may adversely affect their health, maternal-infant attachment, and infant caretaking activities. This study examined the relationship of an 8-week relaxation guided imagery intervention on sleep quality and the association between sleep quality and maternal distress (perceived stress, depressive symptoms, and state anxiety) in 20 mothers of hospitalized preterm infants. Mothers received a CD (compact disc) with three 20-minutes recordings and were asked to listen to at least 1 recording daily for 8 weeks. This analysis used self-report data gathered at baseline and 8 weeks. Pearson correlations were used to examine the relationships between mean cumulative relaxation guided imagery use and measures of maternal distress and sleep quality scores at 8 weeks. Complete data on 19 mothers were available for analysis. At 8 weeks, higher mean relaxation guided imagery use was inversely correlated with sleep quality scores (r = -0.30); sleep quality scores were positively correlated with stress (r = 0.42), depressive symptoms (r = 0.34), and anxiety (r = 0.39) scores. In mothers of preterm infants, sleep quality was negatively affected by mental distress and may be improved by a guided imagery intervention.

Determinants of physical activity in primary school students using the health belief model.

BACKGROUND: Thailand is a middle-income country in which two-thirds of children demonstrate an insufficient level of physical activity. Physical inactivity is a major risk factor for obesity and many other health-related consequences in children. Thus, it is important to understand how primary school children perceive things in their daily life as determinants of physical activity. The purpose of this study was to investigate the impact of cues, perceived benefits, and perceived barriers on the level of physical activity among primary school students. METHODS: A cross-sectional study was conducted in Phitsanulok Province, Thailand, in 2011. Multistage sampling selected a total of 123 primary school students. The Physical Activity Questionnaire for Older Children and the Cues, Perceived Benefits, and Barriers to Physical Activity Questionnaire were used to assess the student levels of physical activity, as well as the perceived benefits, barriers, and cues to action. The association between these factors and the level of physical activity was determined by correlation statistics and confirmed by robust regression. Multivariate analysis of variance compared health belief model determinants: perceived benefits, perceived barriers, and cues to action on physical activity between male and female students. Self-administered questionnaires were validated and tested in a pilot study. RESULTS: The level of activity among primary school children was significantly influenced by perceived barriers, such as fear of strangers when playing outdoors, bad weather, and too much homework. However, activity was not influenced by cues to action or perceived benefits. Perceived benefits, barriers, and cues to physical activity did not differ by gender. CONCLUSION: A safe environment and fewer barriers, such as amount of homework, could enhance physical activity in primary school children.

Ways to Enhance Children's Activity and Nutrition (WE CAN) - a pilot project with Latina mothers.

PURPOSE: This article presents the feasibility and acceptability of the 4-week Ways to Enhance Children's Activities and Nutrition (WE CAN) program. DESIGN AND METHOD: Mixed methods were utilized. Quantitative data were collected from Latina mothers using self-administered surveys. RESULTS: The program was positively received, although attrition was a concern. Mothers were concerned about their children's weight and were receptive to being key role models for being more active, limiting screen time, buying less junk food, and increasing consumption of fruits and vegetables. PRACTICE IMPLICATIONS: Findings provide nurses with knowledge on how mothers view appropriate nutrition and activity as important to their children's health.

Family-based weight management with Latino mothers and children.

PURPOSE: This paper aims to design a culturally appropriate weight management intervention for high-risk Latino families and to examine the feasibility of recruiting program participants. DESIGN AND METHODS: A descriptive design using qualitative and quantitative data collected during preliminary phases of an ongoing intervention study. RESULTS: From the preliminary works, a curriculum was revised for Latino families who have overweight children. The curriculum was modified to include suggestions from the focus groups, including helping mothers set limits with their children and make the transition to lighter foods and a more active family life. PRACTICE IMPLICATIONS: The information will aid professionals in the process of program design for Latino families who have weight concerns.

Comparison of health-promoting behavior between Taiwanese and American adolescents: a cross-sectional questionnaire survey.

OBJECTIVES: The main aim of this study was to compare the health promotion practices of Taiwanese (n=265) and American (n=285) adolescents, using the revised Adolescent Health Promoting scale. METHODS: A comparative and descriptive design was used. Categorical data analysis was applied to explore the association of culture differences and adolescent health-promoting behaviors. RESULTS: Findings indicated significant differences between Taiwanese and American adolescents in some demographic characteristics: American participants had higher self-perceived health status (p<0.001), parental educational level (p<0.001), overweight percentage (p<0.001), and rate of living only with the mother (p<0.001) than the Taiwanese participants. Taiwanese adolescents had a higher frequency of health-promoting behavior than Americans in terms of healthy diet behavior, stress management, health responsibility, and social support (p<0.01), but less frequently engaged in exercise and life appreciation (p<0.001). Because many of the demographic characteristics between the two countries, such as the parent's educational level, differ significantly, a comparison can be difficult. However, healthy behavior is an important measure of demand for preventive health services. CONCLUSIONS: The findings should sound an alarm for all public health professionals to take heed of what is happening to our youth based on culture differences. School and family health promotion counseling should be encouraged for adolescents to improve their lifestyle habits. Based on the findings, school health promotion programs should focus on factors for which there may be significant local ethnic differences. For the locales in this study, Taiwanese adolescents need encouragement to improve their exercise and life appreciation behaviors. For American adolescents, healthy diet, stress management, health responsibility, and social support should be emphasized.

Docosahexaenoic acid in red blood cells of term infants receiving two levels of long-chain polyunsaturated fatty acids.

OBJECTIVES: A randomized, double-blind, prospective trial assessed effects of different formula levels of polyunsaturated fatty acids on blood phospholipid docosahexaenoic (DHA; 22:6omega3) and arachidonic acids (ARA; 20:4omega6) in term infants at 120 days of age. METHODS: Healthy, formula-fed term infants (n = 78) were randomized to 1) routine milk-based formula with 8 mg DHA, 21 mg ARA, 110 mg alpha-linolenic (ALA; 18:3omega3), and 1,000 mg linoleic acids (LA; 18:2omega6) per 100 kcal (Lower-long-chain polyunsaturated fatty acids [LCPUFA]; n = 39) or 2) routine milk-based formula with 17 mg DHA, 34 mg ARA, 85 mg ALA, and 860 mg LA per 100 kcal (Higher-LCPUFA; n = 39). Fatty acid methyl esters from red blood cell (RBC) and plasma phospholipid fractions were assessed using capillary column gas chromatography. RESULTS: Compared with infants fed Lower-LCPUFA formula, the Higher-LCPUFA group had significantly greater percentages of fatty acids as DHA in RBC phosphatidylethanolamine (PE), RBC phosphatidylcholine (PC), total RBC, and plasma phospholipids (P < 0.001). Infants fed Lower-LCPUFA formula had higher percentages of precursor omega6 fatty acids in the desaturation/elongation pathway but lower percentages of ARA (RBC PE, RBC PC, and plasma phospholipid, P < 0.001; total RBC, P = 0.017) compared with the Higher-LCPUFA group. CONCLUSIONS: Greater amounts of dietary ALA do not produce as great an increase in DHA in blood lipids as preformed dietary DHA. Infants fed DHA at levels similar to human milk had significantly greater percentage of DHAat 120 days of age compared with the Lower-LCPUFA group despite higher precursor levels of ALA.

Health-related behavior and adolescent mothers.

OBJECTIVE: To explore health-related behaviors among adolescent mothers living in the rural area of Taoyuan, Taiwan. DESIGN: A cross-sectional descriptive design and nonrandom survey method were used. SAMPLE: The sample consisted of 37 adolescent mothers, identified by public health nurses. MEASUREMENTS: Standardized interview and Adolescent Health Promotion (AHP) questionnaire. RESULTS: Findings revealed a pattern of economic disadvantage. Nearly half of the participants still lived with their biological parents. Two-thirds needed economic support from their parents (generally coming from their biological mother). Thirty-five percent of participants reported never using contraceptives, two-thirds had never had a Pap smear, and 44% did not breast-feed their infants. Nearly 60% of the children were cared for by the biological mothers of the participants. Adolescent mothers with high school education, and who were employed, married, and received parental economic support had better health-related behaviors than adolescent mothers without these characteristics. CONCLUSIONS: Although the study sample has geographic limitations, future international studies with similar populations of adolescent mothers in rural settings will help public health nurses understand adolescent mothers' stressors and needs which in turn affect their health-related behaviors. Intervention strategies are needed to encourage behaviors to keep this population healthy.

Health issues of aboriginal female adolescents in Taiwan.

BACKGROUND: The mortality rate and prevalence for some chronic diseases are higher for aborigines compared with the rest of the Taiwanese population. Health professionals in many countries have been concerned with the health of aborigines, but specific health policies for native adolescents have been neglected. AIMS: This paper reports a study comparing the general health status of aborigines and non-aborigine female adolescents, based on school enrollment health examinations. METHODS: A cross-sectional prevalence study with between group comparison was conducted. School enrollment health files were accessed between September 2000 and June 2001. A total of 320 selected female aboriginal students were compared with 237 non-aborigines. RESULTS: With the exception of eye problems, general health status was inferior for the aboriginal female adolescent students. They had lower mean red blood cell volumes, lower haemoglobin concentrations, more oral decay, a greater prevalence of hepatitis B virus carriers and were more likely to be overweight. CONCLUSIONS: It seems reasonable to suggest that health intervention strategies specific for indigenous adolescents should be provided. The design of these strategies should target lifestyle modification and provision of more accessible health information. Health professionals, and particularly nurses, are in a prime position to offer advice and support to this group.