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Cancer predominantly affects older adults. An estimated 62% of the 15.5 million American cancer survivors are 65 years or older. Provision of supportive care is critical to this group; however, limited resources are available to them. As older survivors increasingly adopt technology, digital health programs have significant potential to provide them with longitudinal supportive care. Previously, we developed/tested a digital Cancer Survivorship Patient Engagement Toolkit for older adults, Cancer Survivorship Patient Engagement Toolkit Silver. The study examined the preliminary impact of the Cancer Survivorship Patient Engagement Toolkit Silver on older survivors' health outcomes. This was a 2-arm randomized controlled trial with two observations (baseline, 8 weeks) on a sample of 60 older cancer survivors (mean age, 70.1 ± 3.8 years). Outcomes included health-related quality of life, self-efficacy for coping with cancer, symptom burden, health behaviors, and patient-provider communication. Data were analyzed using descriptive statistics, linear mixed models, and content analysis. At 8 weeks, the Cancer Survivorship Patient Engagement Toolkit Silver group showed more improved physical health-related quality of life (P < .001, effect size = 0.64) and symptom burden (P = .053, effect size = -0.41) than the control group. Self-efficacy (effect size = 0.56), mental health-related quality of life (effect size = 0.26), and communication (effect size = 0.40) showed clinically meaningful effect sizes of improvement. Most participants reported benefits on health management (mean, 19.41 ± 2.6 [3-21]). Further research is needed with larger and more diverse older cancer populations.
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Biofilms, essential for material circulation and energy flow in aquatic ecosystems, markedly enrich heavy metals in water environments. However, the impact of these accumulated metals on organisms feeding on biofilms remains poorly unknown. This study involved a year-long seasonal survey along the Bijiang River, located next to Asia's largest lead (Pb)-zinc (Zn) mine, conducted to investigate the role of biofilms in nutrient and metal transfer in food webs. In total, 355 biotic and abiotic samples, including water, biofilms, and aquatic biota, were analyzed for the presence of eight heavy metals (arsenic [As], cadmium, chromium, copper, Pb, nickel, Zn, and iron) as well as stable carbon (δ13C) and nitrogen (δ15N) isotopes. Wide ranges of δ13C and δ15N values indicated diverse dietary carbon sources and trophic positions in the Bijiang River (maximum trophic level: 4.28). A Bayesian mixing model revealed that periphytic biofilms were the dominant basal carbon source, especially in spring, whereas in summer, consumers exploited more diverse food sources, possibly because feeding on spring biofilms enhanced predator feeding efficiency. Metals tended to be biodiluted along food chains owing to their higher concentrations in biofilms and benthic organisms as well as their chemical forms. Although diet did not significantly affect heavy metal accumulation in fish, those relying on biofilms as the main carbon source showed significantly higher As (p = 0.048) and Pb (p = 0.007) levels compared with those relying on C4 plants. Overall, this study highlights the critical role of periphytic biofilms in nutrient and metal dynamics in aquatic food webs.
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BACKGROUND: Survivorship care plans (SCPs) are provided at the completion of cancer treatment to aid in the transition from active treatment to long-term survivorship. They describe the details of a patient's diagnosis and treatment and offer recommendations for follow-up appointments, referrals, and healthy behaviors. The plans are currently paper-based and become outdated as soon as a patient's health status changes. There is a need to digitize these plans to improve their accessibility, modifiability, and longevity. With current technology, SCPs can be linked to mobile devices and activity trackers so that patients can track health behaviors and compare them to their clinical goals, taking charge of their own health. OBJECTIVE: A mobile app, POSTHOC (POST-Treatment Health Outcomes of Cancer Survivors), that digitizes the SCP was developed, with goals of integrating it with wearable technologies and electronic medical records. Herein, we are conducting a randomized controlled trial that evaluates the POSTHOC app versus the traditional SCP on total symptom burden in the early posttreatment period. METHODS: We will recruit 54 patients who have recently completed curative therapy for cancer (any type) in person and remotely. They will be randomized 2:1, POSTHOC:usual care (unblinded). Those randomized to the POSTHOC group will receive their SCP via the app and will choose to focus on nutrition or exercise for the duration of the study based on their individual plan and personal preferences. Those randomized to the control group will get a paper-based plan. At baseline, 6 weeks, and 12 weeks, we will evaluate patient-reported outcomes, including total symptom burden (web-based questionnaire), diet (24-hour Automated Self-Administered [ASA24]), and physical activity (Fitbit Charge 6 [Google LLC]). We will also collect quantitative and qualitative feedback on the usability of the app from those in the POSTHOC arm to improve the app for future implementation studies, with a specific focus on patient-provider communication. For feasibility, we will calculate the percentage of patients who used the POSTHOC app at least 3 times per week. We will use linear mixed models to evaluate the effects of the POSTHOC app versus those of usual care on other outcomes at weeks 6 and 12. RESULTS: This trial is open to accrual in the University of Maryland Medical System as of March 2024, and as of July 3, 2024, a total of 20 participants have consented. CONCLUSIONS: This study is among the first to digitize the SCP in a mobile app and test the effects of a mobile health-delivered behavioral health intervention on symptom burden in cancer survivors. Our results will provide evidence about the effects of health self-management on symptoms. This knowledge will be integral to larger randomized controlled studies, integration with the electronic medical record, and nationwide implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05499663; https://clinicaltrials.gov/ct2/show/NCT05499663. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59222.
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Sobreviventes de Câncer , Aplicativos Móveis , Humanos , Sobreviventes de Câncer/psicologia , Sobrevivência , Masculino , Feminino , Planejamento de Assistência ao Paciente , Neoplasias/terapia , Adulto , Pessoa de Meia-IdadeRESUMO
The purpose of this manuscript is to describe the protocol for an Alzheimer's Association-funded cluster randomized trial that focuses on engaging assisted living residents with dementia in meaningful activity to help address their behavioral symptoms of distress using a theoretically based approach, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). The development of MAC-4-BSD was based on the Social Ecological Model and Social Cognitive Theory. The MAC-4-BSD intervention includes the following four steps: (1) Assessment of the assisted living physical environment and policies to facilitate meaningful activity; (2) Education of staff about implementation of meaningful activity; (3) Assessment of resident preferences and goals for meaningful activity; (4) Mentoring and motivating staff and residents to facilitate engagement in meaningful activity. The overall aim of this study will be to determine the feasibility and preliminary efficacy of implementing the MAC-4-BSD intervention and test whether it will improve residents' engagement in meaningful activity, behavioral symptoms of distress, and quality of life as well as the environment and policies to promote meaningful activity in assisted living.
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AIM: This study aimed to examine the psychological symptoms of distress among nurses in relation to their intention to leave. DESIGN: This study was a secondary data analysis of a cross-sectional survey collected between November 2020 and March 2021. METHODS: Chi-square was used to examine the associations between the demographic characteristics and intention to leave and psychological distress symptoms-feeling depressed, anxious and worried. Multiple linear regression analyses were performed to examine if work settings, position (staff, charge, administrators, educators/researchers and advanced practice registered nurses) and years of experience were associated with psychological distress and intention to leave. A mediation analysis examined if psychological distress mediated the relationship between years of experience and intention to leave. RESULTS: Overall, psychological distress was significantly positively associated with intention to leave and negatively associated with years of experience. Nurses with less than 2 years of experience had increased psychological distress, while nurses with >25 years of experience had decreased psychological distress. Both groups of nurses had increased intention to leave compared to those with 16-25 years of experience. Psychological distress partially mediated intention to leave in nurses with less than 2 years of experience and more so among nurses with >25 years of experience. CONCLUSIONS: This study suggests that nurses encounter psychological distress symptoms, such as feeling anxious, depressed and worried, that contribute to an increased intention to leave. Among the workplace locations, nurses practicing in nursing homes had the highest intention to leave. IMPACT: The study emphasizes that organizations need to focus on mitigating distress across all levels of nurses to promote retention efforts and intention to stay. REPORTING METHOD: The authors adhered to the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient contribution. Completion of the survey in the original study (NWWS) implied consent from the participating nurses.
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Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, is often comorbid with somatic pain and psychological disorders. Dysregulated signaling of brain-derived neurotrophic factor (BDNF) and its receptor, tropomyosin-related kinase B (TrkB), has been implicated in somatic-psychological symptoms in individuals with IBS. We investigated the association of 10 single-nucleotide polymorphisms (SNPs) in the regulatory 3' untranslated region of neurotrophic receptor tyrosine kinase-2 (NTRK2) kinase domain-deficient truncated isoform (TrkB.T1) and BDNF Val66Met SNP with somatic and psychological symptoms and quality-of-life (QoL) in a cohort from the United States (IBS, n = 464; healthy controls, n = 156). We found that the homozygous recessive genotype (G/G) of rs2013566 in individuals with IBS is associated with worsened somatic symptoms, including headache, back pain, joint pain, muscle pain, and somatization as well as diminished sleep quality, energy level, and overall QoL. Validation using United Kingdom BioBank data confirmed the association of rs2013566 with an increased likelihood of headache. Several SNPs (rs1627784, rs1624327, and rs1147198) showed significant associations with muscle pain in our U.S. cohort. These 4 SNPs are predominantly located in H3K4Me1-enriched regions, suggesting their enhancer and/or transcription regulation potential. Our findings suggest that genetic variation within the 3' untranslated region region of the TrkB.T1 isoform may contribute to comorbid conditions in individuals with IBS, resulting in a spectrum of somatic and psychological symptoms impacting their QoL. These findings advance our understanding of the genetic interaction between BDNF/TrkB pathways and somatic-psychological symptoms in IBS, highlighting the importance of further exploring this interaction for potential clinical applications. PERSPECTIVE: This study aims to understand the genetic effects on IBS-related symptoms across somatic, psychological, and quality-of-life (QoL) domains, validated by United Kingdom BioBank data. The rs2013566 homozygous recessive genotype correlates with worsened somatic symptoms and reduced QoL, emphasizing its clinical significance.
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Síndrome do Intestino Irritável , Polimorfismo de Nucleotídeo Único , Receptor trkB , Humanos , Masculino , Feminino , Receptor trkB/genética , Adulto , Pessoa de Meia-Idade , Síndrome do Intestino Irritável/genética , Fator Neurotrófico Derivado do Encéfalo/genética , Qualidade de Vida , Glicoproteínas de Membrana/genética , Isoformas de Proteínas/genética , Estudos de CoortesRESUMO
ABSTRACT: The purpose of this secondary data analysis was to describe physical activity and the factors associated with physical activity among older adults living with dementia on medical units in acute care settings. Measures included accelerometry data from the MotionWatch 8, behavioral and psychological symptoms associated with dementia, use of psychotropic medications, subjective reports of activities of daily living and other types of physical activity (e.g., walking to the bathroom, participating in therapy), delirium severity, and medications. The majority of the 204 participants were White (70%) and female (62%), with a mean age of 83 years. Over 24 hours of assessment, participants engaged in 15 ( SD = 46) minutes of vigorous activity, 43 ( SD = 54) minutes of moderate activity, 2 hours 50 ( SD = 2) minutes of low-level activity, and 20 ( SD = 3) hours of sedentary activity. Subjective walking activities, toileting, evidence of disinhibition, delirium severity, agitation, and use of psychotropic medications were associated with increased physical activity based on the MotionWatch 8. The findings provide information for rehabilitation nurses regarding factors associated with physical activity among patients with dementia admitted to acute care settings as well as some of the challenges associated with measurement of physical activity. Future research needs to continue to explore the impact of behavioral symptoms associated with dementia on physical activity and increase participation in activities that are functionally relevant.
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Acelerometria , Demência , Exercício Físico , Humanos , Feminino , Masculino , Idoso de 80 Anos ou mais , Demência/psicologia , Demência/complicações , Idoso , Exercício Físico/psicologia , Acelerometria/métodos , Hospitalização/estatística & dados numéricos , Atividades Cotidianas/psicologiaRESUMO
Effective staff-patient communication is critical in acute care settings, particularly for patients with dementia. Limited work has examined the impact of quality of staff-patient care interactions on patient engagement. The purpose of this study was to determine whether the quality of staff-patient care interactions were associated with active patient engagement during the interaction after controlling for relevant covariates. The study was a secondary data analysis using baseline data from the Function Focused Care for Acute Care intervention study, with a total sample of 286 patients. Descriptive statistics and a generalized linear mixed model were used. The findings indicated that there was a significant relationship between the quality of care interactions and patient engagement such that receiving positive care interactions resulted in higher odds of active patient engagement. These findings can inform future interventions and training for acute care staff to improve quality of care interactions and patient engagement.
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Demência , Participação do Paciente , Qualidade da Assistência à Saúde , Humanos , Demência/enfermagem , Masculino , Feminino , Idoso , Comunicação , Idoso de 80 Anos ou mais , Relações Profissional-PacienteRESUMO
Hydrodynamic conditions play a crucial role in governing the fate, transport, and risks of metal elements. However, the contribution of hydrodynamic conditions to the fate and transport of heavy metals among water, sediment, and biofilm phases is poorly understood. In our study, we conducted experiments in controlled hydrodynamic conditions using a total of 6 two-phase and 9 three-phase mesocosms consisting of water, biofilm, and sediment. We also measured Cd (cadmium) specification in different phases to assess how hydrodynamic forces control Cd bioavailability. We found that turbulent flow destroyed the surface morphology of the biofilm and significantly decreased the content of extracellular polymeric substances (p < 0.05). This led to a decrease in the biofilm's adsorption capacity for Cd, with the maximum adsorption capacity (0.124 mg/g) being one-tenth of that under static conditions (1.256 mg/g). The Cd chemical forms in the biofilm and sediment were significantly different, with the highest amount of Cd in the biofilm being acid-exchangeable, accounting for up to 95.1% of the total Cd content. Cd was more easily released in the biofilm due to its weak binding state, while Cd in the sediment existed in more stable chemical forms. Hydrodynamic conditions altered the migration behavior and distribution characteristics of Cd in the system by changing the adsorption capacity of the biofilm and sediment for Cd. Cd mobility increased in laminar flow but decreased in turbulent flow. These results enhance our understanding of the underlying mechanisms that control the mobility and bioavailability of metals in aquatic environments with varying hydrodynamic conditions.
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Metais Pesados , Poluentes Químicos da Água , Cádmio/química , Água , Hidrodinâmica , Metais Pesados/química , Biofilmes , Poluentes Químicos da Água/análise , Sedimentos GeológicosRESUMO
Iron sludge, produced during the drinking water treatment process, can be recycled as potential iron resource to create environmental functional material. In this study, sulfur-iron composites derived from iron sludge (S-Fe composites) was synthesized through sulfidation and carbonization, and used for the tetracycline (TC) removal under aerobic and anoxic conditions. The reactivities of these as-prepared products were strongly depended on pyrolysis temperatures. In particular, sulfidated nanoscale zero-valent iron loaded on carbon (S-nFe0@CIS) carbonized at 800 °C exhibited the highest TC removal efficiency with 86.6% within 30 min at circumneutral pH compared with other S-Fe composites. The crystalline structure of α-Fe0, FeSx and S0 as main active sites in S-nFe0@CIS promoted the degradation of TC. Moreover, the Fe/S molar ratios significantly affected the TC removal rates, which reached the best value as the optimal S/Fe of 0.27. The results illustrated that the optimized extent of sulfidation could facilitate electron transfer from nFe0 towards contaminants and accelerate Fe(III)/Fe(II) cycle in reaction system compared to bared nFe0@CIS. We revealed that removal of TC by S-nFe0@CIS in the presence of dissolved oxygen (DO) is mainly attributed to oxidation, adsorption and reduction pathways. Their contribution to TC removal were 31.6%, 25.2% and 28.8%, respectively. Furthermore, this adsorption-oxygenation with the formation of S-nFe0@CIS-TC* complexes was a surface-mediated process, in which DO was transformed by the structural FeSx on complex surface to â¢OH with the generation of H2O2 intermediate. The intermediates of TC and toxicity analysis indicate that less toxicity products generated through degradation process. This study provides a new reclamation of iron sludge and offers a new insight into the TC removal by S-nFe0@CIS under aerobic conditions.
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Esgotos , Poluentes Químicos da Água , Ferro/química , Peróxido de Hidrogênio , Tetraciclina/química , Antibacterianos/química , Oxigênio , Poluentes Químicos da Água/análiseRESUMO
BACKGROUND: Painful, treatment-resistant wounds are prevalent among diabetic patients and significantly affect health-related quality of life (HRQOL). Topical treatments may help alleviate pain without risk of dependence or side effects. However, there is a lack of topical wound compounds targeting pain-specific receptors. One possible target is proinflammatory angiotensin 1 receptor (AT1R), which is upregulated in diabetic skin and has been implicated in nociception. OBJECTIVES: We investigated the effects of topical valsartan, an AT1R antagonist, on pain (nociceptive thresholds) and gene expression changes (transcriptomics) in a swine model of diabetic wounds. METHODS: Eight wounds were surgically induced in diabetic, hyperglycemic Yucatan miniature swine ( n = 4). Topical AT1R antagonist was applied to wounds on one side and vehicle on the other side. Nocifensive testing was conducted at baseline and then weekly, beginning 7 days after wound induction. Mechanical and thermal stimuli were applied to the wound margins until a nocifensive reaction was elicited or a predetermined cutoff was reached. After 7 weeks of testing, tissue from the dorsal horn, dorsal root ganglion, and wounds were sequenced and analyzed with DESeq2. Unbiased pathway analyses using Metascape were conducted on differentially expressed genes. RESULTS: There was no significant difference in mechanical tolerance threshold between AT1R antagonist-treated and vehicle-treated wounds ( p = .106). Thermal tolerance was significantly higher in AT1R antagonist-treated wounds compared to vehicle-treated ( p = .015). Analysis of differentially expressed genes revealed enriched pathways of interest: interleukin-18 signaling in dorsal horn laminae IV-V and sensory perception of mechanical stimulus in wound tissue. DISCUSSION: In this study, wounds modeling diabetic ulcers were created in hyperglycemic swine and treated with a topical AT1R antagonist. AT1R-antagonist-treated wounds had a higher tolerance threshold than vehicle-treated wounds for thermal hyperalgesia, but not mechanical allodynia. Pathway analyses of differentially expressed genes revealed several pathways of interest for future pain research. Although further studies are needed to confirm the findings, this study can improve nursing care by providing information about a potential future treatment that may be used to decrease pain and improve HRQOL in patients with diabetic wounds.
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Diabetes Mellitus , Nociceptividade , Humanos , Animais , Suínos , Qualidade de Vida , Dor , Perfilação da Expressão Gênica , AngiotensinasRESUMO
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common, sometimes dose-limiting side effect of neurotoxic chemotherapy. Treatment is limited because its pathophysiology is poorly understood. Compared to research on peripheral mechanisms, the role of the brain in CIPN is understudied and it may be important to develop better treatments. We propose a novel task that assesses brain activation associated with attention to bodily sensations (interoception), without the use of painful stimulation, to understand how CIPN symptoms may be processed in the brain. The goals of this preliminary study were to assess, 1) feasibility of the task, 2) sensitivity to changes in brain activity, and 3) suitability for assessing relationships between brain activation and CIPN severity. Eleven participants with varying types of cancer completed a brain fMRI scan and rated CIPN severity (CIPN-20) before and/or 12 weeks after starting neurotoxic chemotherapy. The Bodily Attention Task is a 7.5-min long fMRI task involving attentional focus on the left fingertips, the heart, or a flashing word "target" for visual attention (reference condition). Feasibility was confirmed, as 73% of all data collected were usable and participants reported feeling or focus during 75% of the trials. Regarding brain activity, finger attention increased activation in somatosensory regions (primary sensory cortex, insula) and sensory integration regions (precuneus, dorsolateral prefrontal cortex). Exploratory analyses suggested that brain activation may be associated with CIPN severity. A larger sample size and accounting of confounding factors is needed to test for replication and to identify brain and interoceptive biomarkers to help improve the prediction, prevention, and treatment of CIPN.
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Antineoplásicos , Síndromes Neurotóxicas , Doenças do Sistema Nervoso Periférico , Humanos , Antineoplásicos/efeitos adversos , Síndromes Neurotóxicas/diagnóstico por imagem , Síndromes Neurotóxicas/etiologia , Encéfalo/diagnóstico por imagem , Qualidade de VidaRESUMO
Objectives: The purpose of this study was to evaluate the psychometric properties of the modified 25-item Resilience Scale (RS-25) in older adults post-hip fracture using Rasch analysis. Methods: This was a descriptive study using baseline data from the Seventh Baltimore Hip Studies (BHS-7). There were 339 hip fracture patients included in this analysis. Results: Findings suggest there was support for reliability of the measure based on person and item separation index. The INFIT and OUTFIT statistics for testing validity were all in the acceptable range indicating that each item on the modified RS-25 fits the appropriate concept. There was no evidence of Differential Item Functioning (DIF) between genders. Conclusions: This study demonstrated evidence that the modified RS-25 is a reliable and valid measure to evaluate resilience among older adults post-hip fracture and therefore can be used in this population in clinical practice and research.
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Fraturas do Quadril , Resiliência Psicológica , Humanos , Masculino , Feminino , Idoso , Psicometria , Reprodutibilidade dos Testes , Testes Psicológicos , Inquéritos e QuestionáriosRESUMO
This study aimed to test a model of factors associated with resilience and physical activity post-hip fracture and compare model fit between men and women. We used data from the seventh Baltimore Hip Study that included 339 participants. Model testing indicated that health status (men: ß = .237, p = .002; women: ß = .265, p = <.001), depression (men: ß = -.245, p = .001; women: ß = -.241, p = <.001), and optimism (men: ß = .320, p = <.001; women: ß = .282, p = <.001) were associated with resilience in men and women, but resilience was only associated with physical activity in men (ß = .203, p = .038) and not in women. Social interaction was related to physical activity only among women (ß = .206, p = .044). This study provides support for the relationship between resilience and physical activity at least among men.
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Depressão , Exercício Físico , Nível de Saúde , Fraturas do Quadril , Resiliência Psicológica , Humanos , Feminino , Masculino , Idoso , Fraturas do Quadril/psicologia , Exercício Físico/psicologia , Depressão/psicologia , Idoso de 80 Anos ou mais , Fatores Sexuais , Baltimore , Interação Social , Otimismo/psicologiaRESUMO
OBJECTIVES: Cancer has become a chronic disease that requires a considerable amount of informal caregiving, often quite burdensome to family caregivers. However, the influence of spirituality on the caregivers' burden and mental health outcomes has been understudied. This study was to examine how caregiver burden, spirituality, and depression change during cancer treatment and investigate the moderating role of spirituality in the relationship between caregiver burden and depression for a sample of caregivers of persons with cancer. METHODS: This secondary analysis used a longitudinal design employing 3 waves of data collection (at baseline, 3 months, and 6 months). Family caregivers completed the Caregiver Reaction Assessment, Spiritual Perspective Scale, and the PROMIS® depression measure. Linear mixed model analyses were used, controlling for pertinent covariates. RESULTS: Spirituality, total caregiver burden, and depression remained stable over 6 months. More than 30% of the caregivers had mild to severe depressive symptoms at 3 time points. There was evidence of overall burden influencing depression. Of note was a protective effect of caregivers' spirituality on the relationship between depression and caregiver burden over time (b = -1.35, p = .015). The lower the spirituality, the stronger the relationship between depression and burden, especially regarding subscales of schedule burden, financial burden, and lack of family support. SIGNIFICANCE OF RESULTS: Spirituality was a significant resource for coping with caregiving challenges. This study suggests that comprehensive screening and spiritual care for cancer caregivers may improve their cancer caregiving experience and possibly influence the care recipients' health.
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Cuidadores , Depressão , Neoplasias , Espiritualidade , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias/psicologia , Neoplasias/complicações , Depressão/psicologia , Depressão/etiologia , Cuidadores/psicologia , Idoso , Estudos Longitudinais , Adulto , Inquéritos e Questionários , Adaptação Psicológica , Sobrecarga do Cuidador/psicologia , Efeitos Psicossociais da DoençaRESUMO
BACKGROUND: Cancer-related fatigue is difficult to treat, and dietary interventions are promising yet underused. OBJECTIVE: We explored associations between dietary patterns and fatigue, and the effect of a dietary intervention versus control on fatigue using Women's Healthy Eating and Living study data, plus mediators and moderators of the intervention effect. METHODS: The Women's Healthy Eating and Living study was a randomized controlled trial among early-stage breast cancer survivors. The 4-year intervention encouraged fruits, vegetables, fiber, and 15% to 20% calories from fat. Fatigue outcomes included a 9-item energy scale and a single-item tiredness question. Dietary quality was estimated using a modified Healthy Eating Index (24-hour dietary recall) and serum carotenoid concentrations. Nutrient timing was obtained from 4-day food logs. RESULTS: Among 2914 total participants, lower body mass index was associated with less tiredness and more energy at baseline (P < .001 for both). Earlier start and end times for daily eating windows were associated with less tiredness (P = .014 and P = .027, respectively) and greater energy (P = .006 and P = .102, respectively). The intervention did not lead to improvements in fatigue on average (P > .125). However, the intervention was more effective for participants who were younger, had fewer comorbidities, and did not have radiation treatment. Mediators included increases in serum carotenoids, increases in the modified Healthy Eating Index, and weight loss/maintenance. CONCLUSION: Diet quality and earlier eating windows were associated with less fatigue. IMPLICATIONS FOR PRACTICE: Programs that encourage high diet quality and a morning meal and discourage nighttime eating should be tested for efficacy in reducing cancer-related fatigue in survivorship.
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BACKGROUND: This study aimed to: 1) determine the feasibility of a virtual reality physical activity intervention among older adults and 2) test the preliminary effectiveness of the intervention at increasing physical activity and 3) decreasing depressive symptoms. METHODS: We included 10 older adults randomized into the Motivating Older Adults Through Immersive Virtual Exercise (MOTIVE) intervention group and 10 randomized into the physical activity education only control group. We analyzed the data using descriptive statistics and linear mixed models, testing the interaction of time and the treatment condition. RESULTS: Participants in the intervention group attended an average of 15 out of the 16 sessions. A total of 90% of MOTIVE intervention group participants "completely agreed" that the intervention was acceptable, (compared to 30% of education control group participants). CONCLUSION: This study supports testing the effectiveness of the intervention at improving physical activity and depressive symptoms in a larger sample of older adults.
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Terapia por Exercício , Exercício Físico , Humanos , Idoso , Projetos PilotoRESUMO
The purpose of this study was to describe differences in treatment of White versus Black older adults, males versus females, and those living at home, assisted living, or nursing home communities with regard to the use of psychotropic, pain, and cardiovascular medications. Baseline data from the first 352 participants in the study, implementation of Function-Focused Care for Acute Care Using the Evidence Integration Triangle, were used. Data included age, gender, race, comorbidities, admission diagnosis, and living location prior to hospitalization, the Saint Louis University Mental Status exam, the modified Charlson Comorbidity Index, the Pain Assessment in Advanced Dementia scale, the Confusion Assessment Method, and medications prescribed. Generalized linear mixed model analyses were done, controlling for race or gender (depending on which comparison analysis was being done), age, cognitive status, hospital, delirium, and comorbidities. Medication use was significantly higher for White older adults, compared to Black older adults, for antidepressants, anxiolytics, non-opioid pain medications, and opioids and lower for antihypertensives. Females received more anxiolytics than their male counterparts. There were differences in medication use by living location with regard to non-opioid pain medication, antipsychotics, statins, and anticoagulants. The findings provide some current information about differences in medication use across groups of individuals and can help guide future research and hypothesis testing for approaches to minimizing these differences in treatment.
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This study systematically compared the degradation kinetics, conversion pathways, formation of disinfection by-products (DBPs), and changes in toxicity for sulfamethazine and carbamazepine in UV/nitrate system. Additionally, the study simulated the generation of DBPs in the post-chlorination process after the introduction of bromine ions (Br-). The contributions of UV irradiation, hydroxyl radicals (â¢OH), and reactive nitrogen species (RNS) to SMT degradation were determined to be 28.70 %, 11.70 %, and 59.60 %, respectively. The contributions of UV irradiation, â¢OH, and RNS to CBZ degradation were found to be 0.00 %, 96.90 %, and 3.10 %, respectively. A higher dosage of NO3- facilitated the degradation of both SMT and CBZ. Solution pH posed almost no effect on SMT degradation, while acidic conditions favored CBZ removal. The degradation of SMT was found to be slightly promoted at low concentrations of Cl-, while the presence of HCO3- significantly accelerated the degradation. Cl-, as well as HCO3-, retarded the CBZ degradation. Natural organic matter (NOM) as a free radical scavenger and UV irradiation filter posed a substantial inhibitory effect on the degradation of SMT and CBZ. The degradation intermediates and transformation pathways of SMT and CBZ by UV/NO3- system were further elucidated. The results showed that the main reaction pathways were bond-breaking reaction, hydroxylation, and nitration/nitrosation reaction. The acute toxicity of most of the intermediates generated during SMT and CBZ degradation was reduced after UV/NO3- treatment. After treatment of SMT and CBZ in UV/nitrate system, the DBPs generated in subsequent chlorination were mainly trichloromethane and a small amount of nitrogen-containing DBPs. After bromine ions were introduced in UV/NO3- system, a large amount of the originally generated trichloromethane was converted to tribromomethane.
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Poluentes Químicos da Água , Purificação da Água , Desinfecção/métodos , Nitratos , Sulfametazina , Cloro , Clorofórmio , Bromo , Carbamazepina , Benzodiazepinas , Halogenação , Raios Ultravioleta , Poluentes Químicos da Água/toxicidade , Poluentes Químicos da Água/análise , Purificação da Água/métodos , CinéticaRESUMO
To describe the use of psychotropic medications among older hospitalized patients. This was a descriptive study using baseline data from the first 308 older patients in a function focused care intervention study. Age, gender, race, comorbidities, admitting diagnosis, and medications (antidepressants, antianxiety medications, anticonvulsants, dementia drugs, antipsychotics, sedative-hypnotics, and opioids) were obtained at baseline and discharge. To compare change over time, generalized estimating equations were used. Participants were mostly female (63%) and White (69%) and were 83.1 years old on average. Antidepressant, antianxiety, anticonvulsant, dementia medication, sedative-hypnotic, and opioid use remained essentially unchanged between admission and discharge. Antipsychotic medication use increased significantly from 16% to 21% at discharge. There was persistent use of psychotropic medication among hospitalized older adults living with dementia and little evidence of deprescribing. There was some indication of changes made during hospitalization that may be appropriate, even without a focused deprescribing initiative.