A Qualitative Study of A Health Center-Based Mobile Produce Market.

Healthcare-based food assistance programs have the potential to improve patients' food security, but are underutilized. We conducted a qualitative study of user and staff perceptions of an on-site mobile market at a federally-qualified health center (FQHC). Five themes were identified: 1) financial need drives the decision to use the market, 2) people attend specifically to receive healthy food, 3) users feel a connection to the FQHC, which increases participation, 4) social networks increase usage of the program, and 5) long lines, inclement weather, inaccessibility, and inconsistent marketing and communication are attendance barriers. Findings should inform implementation of future healthcare-based food assistance programs.

Factors Associated With Uptake of an Open Access Health Center-Based Mobile Produce Market: A Case for Expanded Eligibility.

BACKGROUND: Health care-based food assistance programs show promise but are underutilized. Strict eligibility requirements and program scheduling may dampen reach and outcomes. OBJECTIVE: To explore factors associated with uptake of a health center-based mobile produce market with no eligibility requirements and few barriers to entry. DESIGN: A cross-sectional analysis of medical record, sociodemographic, environmental, and market attendance data was used. PARTICIPANTS/SETTING: The study sample consisted of 3071 adults (18+ years) who were patients of an urban health center in eastern Massachusetts and registered for the mobile market during the study period of August 2016 to February 2020. MAIN OUTCOME MEASURES: The main outcome measure was monthly market attendance over the study period. STATISTICAL ANALYSES: T-tests and χ2 tests were used to compare market users and never-users. Multiple logistic regression was used to analyze variables associated with market attendance each month. RESULTS: In multiple variable analyses, Supplemental Nutrition Assistance Program enrollment was associated with slightly less frequent monthly market use (odds ratio [OR], 0.989; 95% CI, 0.984-0.994). Day-of, on-site market registration was associated with more frequent monthly use than self-registration on nonmarket days (OR, 1.08; 95% CI, 1.07-1.08). Having a psychiatric or substance use disorder diagnosis was associated with slightly less frequent market attendance (OR, 0.99; 95% CI, 0.98-0.99; and OR, 0.96; 95% CI, 0.95-0.97, respectively) compared with registrants without these diagnoses. CONCLUSIONS: Individual, community-level, and organizational factors are associated with uptake of a free mobile produce market and should be considered when designing programs.

Healthcare-based food assistance programmes in the United States: a scoping review and typology.

This scoping review aimed to identify the breadth of healthcare-based food assistance programmes in the United States and organize them into a typology of programmes to provide implementation guidance to aspiring food assistance programmers in healthcare settings. We searched PubMed, Cochrane, and CINAHL databases for peer-reviewed articles published between 1 January 2010 and 31 December 2021, and mined reference lists. We used content analysis to extract programmatic details from each intervention and to qualitatively analyse intervention components to develop a typology for healthcare institutions in the United States. Eligible articles included descriptions of patient populations served and programmatic details. Articles were not required to include formal evaluations for inclusion in this scoping review. Our search resulted in 8706 abstracts, which yielded forty-three articles from thirty-five interventions. We identified three distinct programme types: direct food provision, referral, and voucher programmes. Programme type was influenced by programme goals, logistical considerations, such as staffing, food storage or refrigeration space, and existence of willing partner CBOs. Food provision programmes (n 13) were frequently permanent and leveraged partnerships with community-based organisations (CBOs) that provide food. Referral programmes (n 8) connected patients to CBOs for federal or local food assistance enrollment. Voucher programmes (n 14) prioritised provision of fruits and vegetables (n 10) and relied on a variety of clinic staff to refer patients to months-long programmes. Healthcare-based implementers can use this typology to design and maintain programmes that align with the needs of their sites and patient populations.

Dietary Sodium Restriction for Heart Failure: A Systematic Review of Intervention Outcomes and Behavioral Determinants.

The 1500 mg/d dietary sodium restriction commonly recommended for patients with heart failure has recently been questioned. Poor adherence to sodium-restricted diets makes assessing the efficacy of sodium restriction challenging. Therefore, successful behavioral interventions are needed. We reviewed sodium restriction trials and descriptive studies of sodium restriction to: 1) determine if sodium restriction was achieved in interventions among heart failure patients; and 2) characterize predictors of successful dietary sodium restriction. Among 638 identified studies, 10 intervention trials, and 25 descriptive studies met inclusion criteria. We used content analysis to extract information about sodium restriction and behavioral determinants of sodium restriction. Dietary sodium was reduced in 7 trials; none achieved 1500 mg/d (range 1938-4564 mg/d). The interventions implemented in the interventional trials emphasized knowledge, skills, and self-regulation strategies, but few addressed the determinants correlated with successful sodium restriction in the descriptive studies (eg, social/cultural norms, social support, taste preferences, food access, self-efficacy). Findings suggest that incorporating determinants predictive of successful dietary sodium restriction may improve the success of interventional trials. Without effective interventions to deploy in trials, the safety and efficacy of sodium restriction remains unknown.

Subjective cognitive concerns and neuropsychiatric predictors of progression to the early clinical stages of Alzheimer disease.

OBJECTIVE: To examine neuropsychiatric and neuropsychological predictors of progression from normal to early clinical stages of Alzheimer disease (AD). METHODS: From a total sample of 559 older adults from the Massachusetts Alzheimer's Disease Research Center longitudinal cohort, 454 were included in the primary analysis: 283 with clinically normal cognition (CN), 115 with mild cognitive impairment (MCI), and 56 with subjective cognitive concerns (SCC) but no objective impairment, a proposed transitional group between CN and MCI. Two latent cognitive factors (memory-semantic, attention-executive) and two neuropsychiatric factors (affective, psychotic) were derived from the Alzheimer's Disease Centers' Uniform Data Set neuropsychological battery and Neuropsychiatric Inventory brief questionnaire. Factors were analyzed as predictors of time to progression to a worse diagnosis using a Cox proportional hazards regression model with backward elimination. Covariates included baseline diagnosis, gender, age, education, prior depression, antidepressant medication, symptom duration, and interaction terms. RESULTS: Higher/better memory-semantic factor score predicted lower hazard of progression (hazard ratio [HR] = 0.4 for 1 standard deviation [SD] increase, p <0.0001), and higher/worse affective factor score predicted higher hazard (HR = 1.3 for one SD increase, p = 0.01). No other predictors were significant in adjusted analyses. Using diagnosis as a sole predictor of transition to MCI, the SCC diagnosis carried a fourfold risk of progression compared with CN (HR = 4.1, p <0.0001). CONCLUSION: These results identify affective and memory-semantic factors as significant predictors of more rapid progression from normal to early stages of cognitive decline and highlight the subgroup of cognitively normal elderly with SCC as those with elevated risk of progression to MCI.

A descriptive study to assess the impact of surgical stomas on individuals' sleep perceptions & response to sleep hygiene.

Multiple factors affect the sleep quality of individuals with surgically created stomas. Using Rogers' Diffusion of Innovation as the theoretical framework, a study was conducted to: 1) assess subjective sleep quality perceptions and objective sleep measurement in adults with stomas, 2) determine if there is a correlation between subjective and objective measurement of sleep in this group, and 3) implement a stoma-specific sleep hygiene intervention to improve these sleep quality perceptions. Subjective assessment focused on sleep subset questions from the Stoma Quality of Life Index (SQOLI) and the Pittsburgh Sleep Quality Index (PSQI). Respondents' (n = 26) subjective sleep scores were 7.23 mean global score on seven questions (PSQI, range: 0 [no difficulty sleeping] to 3 [severe difficulty sleeping], total 0 to 21) with a mean score of 7.32 on three questions (SQOLI, range 1 [severe difficulty sleeping] to 4 [no difficulty sleeping], total 0 to 12) on sleep subset questions; composite scores of 5 or greater (PSQI) and 3 or less (SQOLI) indicating sleep problems. Scores showed that adults with stomas have increased sleep disruption and poor sleep quality. Five respondents who met intervention enrollment criteria participated in an objective sleep assessment using actigraphy, overnight oxygenation studies, and a 4-week sleep hygiene intervention. Mean PSQI score improved by 1.20 but the difference was not statistically significant. Because the results of this study confirm that sleep problems are common in older adults with a stoma, larger sample size studies of >4 weeks' duration are warranted. Until additional research results are available, the existence of sleep quality and overnight pouching concerns should be recognized and use of the low-cost, easy-to-use, stoma-specific sleep hygiene intervention considered.

The shortage tsunami and high school guidance counselors' perspectives on future nurse recruitment.

The current recession has eased the shortage of registered nurses (RNs), but this must be viewed only as a transient, temporary lull. The nurse shortage predictions still are greatly concerning. This article extends the most current RN shortage forecasts, an overview of this shortage "tsunami", and recent/current workforce recruitment strategies across the United States. A related explanatory study of high school counselors is presented, designed to improve understanding of decision-making influences on today's youth and to explore the extent of awareness counselors have about nursing.