Impact of preparing nursing students to deliver a parent-based sexual health intervention on attitudes and intentions for sexual health education and parent communication counseling: a mixed methods study.

BACKGROUND: Nurses are well positioned to promote sexual health but are not adequately prepared in their nursing programs to engage families on this topic and often lack the knowledge and confidence necessary to counsel families about sexual health communication. The purpose of this study was to determine how facilitating a parent-based sexual health intervention would impact nursing students' attitudes and intentions about sexual health education and parent communication counseling. METHODS: Using an embedded mixed-methods design, which integrated a quasi-experimental framework, we examined the impact of participation in a parent-based sexual health intervention among 126 baccalaureate nursing students enrolled in a community/public health nursing clinical course. Independent t-tests, chi-squared tests, and the Mann-Whitney U test were used to compare intervention and control groups at baseline. Multiple linear regression was used to compare the groups for pre-post changes. Qualitative content analysis was used to analyze exit interview transcripts. RESULTS: We found statistically significant differences in nursing students' confidence to teach sexual health (p = < 0.001), satisfaction with skills as a sexual health educator (p = < 0.001), beliefs about the efficacy of parent-adolescent communication for reducing negative sexual outcomes among adolescents (p = < 0.001), and intentions to counsel parents on sexual health (p = < 0.001), with greater improvements in the intervention group than in the control group. Furthermore, we found statistically significant differences in nursing students' intentions to counsel parents about the HPV vaccine (p = < 0.01) and to endorse the HPV vaccine (p = < 0.05), with greater improvements in the intervention group than in the control group. Across all survey categories, qualitative findings confirmed improvements seen on the pre-post survey. CONCLUSION: Providing evidence-based adolescent sexual health training, including sexual health education content and discussion strategies, can prepare nursing students to strongly endorse sexual health communication and HPV vaccination uptake and to counsel parents on initiating and navigating these conversations with their youth. Our project exemplifies how a nursing program could organize an immersive experience, or elective within a specialty area, that aligns with the competency-based approach endorsed by the American Association of Colleges of Nursing. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov (NCT02600884) on 09/01/2015; the first participant was recruited on 09/29/2015.

Disability Attitudes of Nursing Students: A Curriculum Intervention.

ABSTRACT: People with disabilities (PWD) have reported that health care workers' negative attitudes are among the most significant barriers to accessing health care services. PWD constitute one quarter of the population, yet the curriculum for PWD is inconsistent. This study describes a curriculum intervention allowing student interaction with a panel of PWD to change nursing student attitudes. Surveys were administered before and after the intervention. Our pilot study did not reveal a significant change in attitudes, which suggests that more exposure to PWD and education may be needed.

Establishing a Regional Trauma Preventable/Potentially Preventable Death Rate.

OBJECTIVE: To establish a trauma preventable/potentially preventable death rate (PPPDR) within a heavily populated county in Texas. SUMMARY: The National Academies of Sciences estimated the trauma preventable death rate in the United States to be 20%, issued a call for zero preventable deaths, while acknowledging that an accurate preventable death rate was lacking. In this absence, effective strategies to improve quality of care across trauma systems will remain difficult. METHODS: A retrospective review of death-related records that occurred during 2014 in Harris County, TX, a diverse population of 4.4 million. Patient demographics, mechanism of injury, cause, timing, and location of deaths were assessed. Deaths were categorized using uniform criteria and recorded as preventable, potentially preventable or nonpreventable. RESULTS: Of 1848 deaths, 85% had an autopsy and 99.7% were assigned a level of preventability, resulting in a trauma PPPDR of 36.2%. Sex, age, and race/ethnicity varied across preventability categories (P < 0.01). Of 847 prehospital deaths, 758 (89.5%) were nonpreventable. Among 89 prehospital preventable/potentially preventable (P/PP) deaths, hemorrhage accounted for 55.1%. Of the 657 initial acute care setting deaths, 292 (44.4%) were P/PP; of these, hemorrhage, sepsis, and traumatic brain injury accounted for 73.3%. Of 339 deaths occurring after initial hospitalization, 287 (84.7%) were P/PP, of these 117 resulted from sepsis and 31 from pulmonary thromboembolism, accounted for 51.6%. CONCLUSIONS: The trauma PPPDR was almost double that estimated by the National Academies of Sciences. Data regarding P/PP deaths offers opportunity to target research, prevention, intervention, and treatment corresponding to all phases of the trauma system.

Development and Testing of the Pain Assessment Tool in Cognitively Impaired Elders (PATCIE): Nonverbal Pain Behaviors in African American and Caucasian Nursing Home Residents with Dementia.

BACKGROUND: People with dementia experience a decline in language skills required to self-report pain; researchers thus recommend the use of nonverbal behaviors to assess pain. Although multiple instruments exist for assessing nonverbal pain behaviors, psychometric data are lacking for African American nursing home residents with dementia. AIMS AND DESIGN: The purpose of this methodological study was to describe the development and testing of the Pain Assessment Tool in Cognitively Impaired Elders (PATCIE) in African American and Caucasian nursing home residents with dementia. SETTINGS/PARTICIPANTS: The convenience sample included 56 African American and 69 Caucasian residents with dementia in multiple nursing homes from three states. The research staff completed the pain assessments when the nursing home staff transferred the residents. RESULTS/CONCLUSIONS: Initially, 15 nonverbal pain behaviors were evaluated. Based on the alpha scores and additional literature review, the 15 nonverbal pain behaviors were expanded to 28 behaviors. The PATCIE had a Cronbach's alpha of .73 during movement. Construct validity for the pain behaviors was demonstrated because higher scores were noted during movement, and scores before movement were significantly higher than those obtained after movement. For movement over time, there was a significant difference in the PATCIE score, regardless of ethnicity or time (p < .0001). There were no significant differences found between ethnic groups, either overall or in change over time between movements or between the categories of cognitive function. African Americans were more likely to display frowning, and Caucasians to display irritability. The PATCIE demonstrates preliminary reliability and validity in assessing pain in African American and Caucasian nursing home residents with dementia.

A Multiple Behavior Self-Monitoring Intervention for African- American Veterans with Type 2 Diabetes: A Feasibility Implementation Study.

The purpose of this study was to determine the feasibility of implementing a multiple-behavior self-monitoring intervention within a diabetes education program. This study was a 3-month pre- post-design, conducted with African-Americans (N = 20), who attended diabetes education classes at a large Veteran's Affairs (VA) hospital in Southwest Texas. Participants selfmonitored their blood glucose, diet, exercise, and weight on either a smart phone application or paper diaries. Paired t tests showed strong evidence that patient self-monitoring of healthy lifestyle behaviors improved blood glucose (t = -3.858, p = .001) and HbAlc (t = -4.428, p <.001), respectively. Moreover Spearman's correlation coefficient showed significant correlations between blood glucose and exercise (rs = -.68, p = .008) and HbAlc and exercise (rs = -.56, p = .036). This feasibility study showed that multiple-behavior self-monitoring was effective in lowering blood glucose and HbA1c levels among African-American Veterans; however, a randomized controlled trial with a larger sample is needed to validate these preliminary findings.

Suicide Within 72 Hours After Discharge From Health Care Settings: Decedent Characteristics.

Health care providers have the challenge of identifying patients at risk of committing suicide after discharge from their care. The aim of this study was to identify and describe the population committing suicide less than 72 hours after discharge from medical care. Between 2006 and 2014 in Harris County, Texas, 30 individuals were identified who met these criteria. The decedents included 27 men and 3 women with a mean age of 43.5 years. The cause of death in most cases was gunshot wound of the head. Five of the decedents had requested discharge or left against medical advice and 24 committed suicide within 24 hours. Although the sample size is small, it is one of the largest cohorts of its type.

Influence of light source, polarization, education, and training on shade matching quality.

STATEMENT OF PROBLEM: Many factors influence the quality of shade selection, and isolating how significantly each of these factors influences results is difficult. PURPOSE: The purpose of this in vitro study was to compare results of shade matching using handheld lights with or without a polarizing filter with results obtained using a professional viewing booth and to analyze the influence of education and training on shade selection outcome. MATERIAL AND METHODS: A total of 96 third-year dental students (evaluators) were randomly separated into 4 groups. Each group was assigned 1 of 2 handheld shade-matching devices (lights) with or without a polarizing filter. Each group performed a shade matching exercise using the handheld light or a professional viewing booth. The exercise consisted of matching shade tabs placed in a typodont to a commercial shade guide. Each group repeated this procedure 4 times over a 9-week period. A lecture on shade matching was presented at the fifth week of the study, between "before" and "after" shade matching procedures. RESULTS: Shade matching scores with handheld lights (7.8) were higher than scores of shade matching with the viewing booth (7.2). The mean scores for before (7.2) and after (7.8) shade matching (with education and training in between) were significantly different. The combined effect of light and education and training improved the shade matching score by 1.2, from 6.8 in the before sessions using the viewing booth to 8.0 in the after sessions using handheld lights. A 21% increase in the number of evaluators who selected 1 of 4 best matches was recorded, 10% for handheld lights versus viewing booth after education and training versus before sessions and 11% between after sessions using handheld lights versus before sessions using viewing booth. CONCLUSIONS: Within the limits of the study, the shade matching scores with handheld lights were significantly better than the results obtained using a viewing booth (P<.01). Using a handheld light with or without a polarizing filter did not influence shade matching results. Mean shade matching scores were significantly better after education and training (P<.01). Light combined with education and training resulted in the greatest increase in shade matching quality.

Evaluation of a calcium silicate-based cement as a root reinforcement material for endodontically treated maxillary anterior teeth.

STATEMENT OF PROBLEM: Fractures of endodontically treated teeth have been attributed to weakened tooth structure caused by root canal enlargement and post preparation. PURPOSE: The purpose of this in vitro study was to evaluate the fracture resistance of roots filled with either gutta percha, composite resin (LuxaCore Dual), or calcium silicate-based cement (Biodentine). MATERIAL AND METHODS: One hundred twenty freshly extracted, human, permanent maxillary anterior teeth were sorted by type and assigned to 1 of 4 groups (n=30). The teeth in group NT were not endodontically treated and served as the control. The teeth in groups GP, LC, and, BD were accessed and instrumented to size 40/06. In group GP, the root canals were completely filled with gutta percha. In groups LC and BD, only the apical 5-mm portion of the root canals was filled with gutta percha, and the remaining portion of the root canals was filled with (LuxaCore Dual) in group LC and with (Biodentine) in group BD. Fracture resistance (kN) was assessed at the middle portion of each root, using a 3-point bending test with a universal testing machine exerting a compressive load on a loading pin at a crosshead speed of 0.5 mm/min until fracture occurred. One-way ANOVA was used to compare the mean root fracture resistance among the 4 groups (α=.05). RESULTS: The mean ± SD fracture loads were 2.13 ±0.53 kN for group NT, 1.97 ±0.60 kN for group GP, 2.18 ±0.71 kN for group LC, and 2.22 ±0.54 kN for group BD. No statistically significant differences were found among the 4 groups (P>.05). CONCLUSIONS: The roots of endodontically treated maxillary anterior permanent incisors filled with gutta percha, Biodentine, or LuxaCore Dual had resistance to fracture similar to that of teeth that were not endodontically treated.

Utilizing online tools to increase volunteer ombudsmen presence in long-term care.

In this descriptive study, former and current volunteer ombudsmen (n = 65) completed an online survey and Chi-square analyses were used to determine group differences in order to examine the impact of internet-based communication on the recruitment and retention of volunteer long-term care ombudsmen. The results showed that the program's shift to internet-based recruitment and communication methods helped increase the number of volunteers by 50% and contributed to a positive shift in role perception and satisfaction. Consequently, the proliferation of internet and social media usage permits greater volunteer management opportunities than previously were available. These tools also allow for consistency of message, extended training opportunities, and recourse to resources at need which permit ombudsmen volunteers to identify more readily with the role of resident advocate and receive greater performance satisfaction as it relates to that role.

Comparison Study of Braden Scale and Time-to-Erythema Measures in Long-term Care.

PURPOSE: The Braden Scale for Predicting Pressure Sore Risk is used to assess risk, and the Centers for Medicare & Medicaid guidelines suggest the use of a tissue tolerance procedure that detects time-to-erythema (TTE) to further refine tissue tolerance, a component of the Braden Scale. The aim of this study was to compare the Braden Scale and TTE as risk classification methods and their utility in identifying care planning interventions. DESIGN: Descriptive study using retrospective chart review. SUBJECTS AND SETTING: Participants were a convenience sample of 89 adults 65 years or older residing in a long-term care facility in the Midwestern United States. The sample was drawn from a facility-generated list of 90 residents who had both Braden Scale and tissue tolerance testing performed within 24 hours of admission from any setting, readmission after a hospital stay, or performed as part of a routine annual reassessment. METHODS: Results of staff performance on the Braden Scale and TTE were compared as risk classification methods and based on their utility for identifying care planning interventions. Data were collected during 1 session when TTE and the Braden Scale were completed. Agreement between the 5 risk categories from the Braden Scale and 5 TTE risk categories was analyzed via the kappa statistic and Kendall tau-c statistic. Spearman or Pearson correlation coefficients were calculated as appropriate for ordinal and continuous risk, intervention, and severity measures. RESULTS: The mean Braden Scale score was 17.5 ± 3 (mean ± SD); the mean TTE-Bed was 2.35 ± 0.57 hours and the mean TTE-Chair was 2.18 ± 0.52. Using a Braden Scale score of 18 or less as a cut point for identifying clinically relevant risk for pressure ulcer development, 55 participants were deemed at risk, 62 had mobility subscale scores less than 4, 76 had activity subscale scores less than 4, and 73 were incontinent. The weighted kappa statistic demonstrated weak agreement between TTE-Bed and the Braden Scale Total Score (κ = 0.04; 95% CI: 0.002-0.07). Agreement was not significant for TTE-Chair and the Braden Scale Total Score (κ = 0.01; 95% CI: -0.01 to 0.04), TTE-Bed and Braden Scale-Mobility (κ = 0.09; 95% CI: -0.05 to 0.23) and between TTE-Chair and Braden Scale-Activity (κ = 0.07; 95% CI: -0.05 to 0.19). The TTE-Chair and TTE-Bed assessment demonstrated fair agreement (κ = 0.37; 95% CI: 0.19-0.55). The Braden Scale cumulative score where a lower score equates to higher risk was found to be correlated with the total number of interventions observed in the care plan (r = -0.62; P < .0001). Correlation between the Braden Scale-Mobility subscale score and in-bed mobility specific interventions was r = -0.64 (P < .0001), whereas correlation for TTE-Bed category and specific in-bed mobility interventions was r = 0.21 (P = .05). CONCLUSION: Study findings provide little support for tissue tolerance testing versus assessment using the validated Braden Scale for assessment of pressure ulcer risk. Study findings support the use of the Braden Scale to develop an individualized care plan based on the areas of risk.

Using a single screening question for depressive symptoms in patients with acute coronary syndrome.

BACKGROUND: Despite the prevalence of depressive symptoms and increased risk for future cardiovascular events, depressive symptoms frequently go underrecognized in patients hospitalized for acute coronary syndrome (ACS). Identifying an effective approach to depressive symptom screening is imperative in this population. OBJECTIVE: The purpose of this cross-sectional study was to explore the agreement between Beck Depression Inventory-II (BDI-II) scores and a single screening question for depressive symptoms in 1122 patients hospitalized for ACS. METHODS: Independent-samples t tests and χ tests were used to compare the groups with BDI-II scores of 14 or higher and lower than 14. Three separate agreement analyses were conducted using categorized BDI-II scores (≥14, ≥20, and ≥29). Agreement of the BDI-II categories with the responses to the single screening question was assessed with the simple κ statistic. Sensitivity and specificity were calculated using the BDI-II categories as the criterion standards for depressive symptom screening. RESULTS: The agreement analysis revealed a moderate level of agreement (κ coefficient = 0.42) between the BDI-II scores of 14 or higher and the single screening question. Of the participants who reported a BDI-II score of 14 or higher, 61.65% answered yes to the single screening question (sensitivity, 0.62). For those who had BDI-II scores of lower than 14, a total of 82% responded no to the single screening question (specificity, 0.82). When using higher BDI-II scores to define depressive symptoms (≥20 and ≥29), the level of agreement decreased, whereas sensitivity increased to 0.76 and 0.90, with a trade-off in specificity (0.79 and 0.74, respectively). CONCLUSIONS: These results suggest that the single screening question for depressive symptoms correctly identifies depressive symptoms 62% of the time but inappropriately identifies depressive symptoms 18% of the time in patients hospitalized for ACS. This suggests that the single screening question for depressive symptoms may be used with caution to initially screen patients with ACS, who can then undergo a more thorough assessment for clinical depression.

Vaccine Hesitancy: Developing Competency in Nursing Students Through Simulation.

BACKGROUND: Many Americans are undecided about or have barriers to receiving vaccines. Complacency, confidence, convenience, misinformation, and disinformation impact vaccine hesitancy (VH). PROBLEM: During the COVID-19 pandemic, rates for flu and routine childhood vaccinations declined globally. As vaccination rates decline, the risk of disease outbreaks increases. Nursing students need to be prepared to address VH in the clinical setting. APPROACH: Four simulation experiences were developed to build confidence and competency in the provision of vaccinations and addressing VH. Nursing students practiced communication skills critical to motivational interviewing, health education, health promotion, and goal setting. OUTCOME: There were statistically significant increases in student confidence and perceived competence in vaccine administration and addressing VH through motivational interviewing. CONCLUSIONS: High-fidelity simulation combined with a virtual simulation was effective in developing confidence among nursing students. Students demonstrated skill in addressing VH and motivational interviewing.

Serious adverse events experienced by survivors of stroke in the first year following discharge from inpatient rehabilitation.

PURPOSE: To identify the incidence of adverse events (AE) that occurred in stroke survivors during the first year following discharge from inpatient rehabilitation and to determine the type and patterns of AE. METHODS: Data were collected for 12 months on events resulting in admissions to the emergency department, hospital, long-term care facility, or death. Descriptive statistics were used to depict the patterns of AE and univariate comparisons were made of the differences between survivors who did or did not experience one or more AE. RESULTS: Of the 159 participants, 50% reported a total of 163 AE. Most AE (82.2%) were unexpected and the majority occurred during the first 6 months; 12 recurrent strokes and 6 transient ischemic attacks occcurred. CONCLUSIONS: Education on prevention and treatment of common AE is important prior to discharge. Anticipatory guidance may help survivors and caregivers modify their lifestyle and prevent common AE.

New nurses' quality and safety education: An analysis of the 2018 National Sample Survey of Registered Nurses.

BACKGROUND: The integration of the Nursing Quality and Safety Education (QSEN) competencies into American Association of College of Nursing - The Essentials: Core Competencies for Professional Nursing Education warrants continued assessment of the new nurses' QSEN competencies preparedness. PURPOSE: The purpose of this study was to analyze quality and safety education needs of nurses who graduated in 2016, 2017, and 2018 and have responded to the most recent National Sample Survey of Registered Nurses. METHODS: This is a retrospective correlational design study using analysis of publicly available data from the 2018 National Sample Survey of Registered Nurses. A logistic regression model was used to assess correlations between 21 quality and safety education variables and nursing degree type. RESULTS: When adjusting for differences in demographic and work characteristics, there were no significant differences in quality and safety training needs by the nursing degree type. New nurses, regardless of the nursing degree type reported additional training needs in patient-centered care (50%), evidence-based practice and team-based care (40%), quality improvement (30%). CONCLUSIONS: This study provides new, national data on new nurses' quality and safety education preparedness and provides evidence for the need for continued investment and integration of QSEN competencies in all nursing degree programs.

A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and Usability Study.

BACKGROUND: Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide. OBJECTIVE: The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-care, and foot care behaviors before and after participating in the program. METHODS: The study used a single-arm, pre-post design in 2 large family medical practice clinics in Texas. Participants met individually with the nurse practitioner once a month for 3 months using synchronous telehealth videoconferencing. Each participant received diabetes foot education guided by the Integrated Theory of Health Behavior Change. Feasibility was measured with rates of enrollment and program and assessment completion. Usability was measured with the Telehealth Usability Questionnaire. Diabetes knowledge, self-care, and foot care behaviors were measured with validated survey instruments at baseline, 1.5 months, and 3 months. RESULTS: Of 50 eligible individuals, 39 (78%) enrolled; 34 of 39 (87%) completed the first videoconference and 29 of 39 (74%) completed the second and third videoconferences. Of the 39 who consented, 37 (95%) completed the baseline assessment; 50% (17/34) of those who attended the first videoconference completed the assessment at 1.5 months, and 100% (29/29) of those who attended the subsequent videoconferences completed the final assessment. Overall, participants reported a positive attitude toward the use of telehealth, with a mean Telehealth Usability Questionnaire score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 (SD 16.69) points of 100 (P<.001) from baseline to 3 months. The values for the Summary of Diabetes Self-Care Activities measure demonstrated better self-care, with participants performing foot care on average 1.74 (SD 2.04) more days per week (P<.001), adhering to healthy eating habits on average 1.57 (SD 2.12) more days per week (P<.001), and being physically active on average 1.24 (SD 2.21) more days per week (P=.005). Participants also reported an improvement in the frequency of foot self-examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 (SD 7.04) points (scale of 7 to 35) from baseline to 3 months postintervention (P<.001). CONCLUSIONS: This study demonstrates that a nurse-led telehealth educational program centered on diabetes foot care is feasible, acceptable, and has the potential to improve diabetes knowledge and self-care, which are precursors to preventing debilitating foot complications.

Associations of Psychological Distress and Alcohol Use Patterns Among Older Adults of Sexual Minority Status and Heterosexual Peers.

BACKGROUND: There is limited research investigating sexual-orientation-related differences in older adults and their relationship with alcohol use. OBJECTIVE: The purpose of this study was to determine if sexual minority status moderates the relationship between psychological distress and alcohol drinking patterns. METHODS: This study was a secondary analysis of data from the 2017-2018 National Survey on Drug Use and Health. Health outcomes among lesbian, gay, and bisexual (LGB) older adults (N = 462) aged 50 years or older were compared with heterosexual (N = 16,856) peers using univariate analyses and logistic regressions. Interaction terms evaluated the influence of sexual orientation on psychological distress and alcohol consumption. RESULTS: Sexual orientation was a predictor of alcohol use in the past year, past month, and at any time (p < .001) but was not a predictor of alcohol dependence or misuse, binge drinking, or heavy drinking. Heterosexual older adults were less likely to consume alcohol than those who identified as LGB. Respondents not reporting psychological distress were less likely to engage in problematic drinking. However, there was no evidence that sexual minority status moderates the relationship between psychological distress and alcohol use. CONCLUSION: Limited evidence supports higher rates of alcohol use and alcohol-related problems among sexual minority persons than heterosexuals. Prediction models for alcohol use were not improved by using sexual orientation and psychological distress as interaction terms. Future research should examine the underlying causes of impaired health in the older LGB population. Those findings should be used to research methods of preventing and minimizing alcohol misuse.

Influences of race/ethnicity in periodontal treatment response and bacterial distribution, a cohort pilot study.

Objectives: Periodontitis disproportionately affects different racial and ethnic populations. We have previously reported the higher levels of Porphyromonas gingivalis and lower ratios of Streptococcus cristatus to P. gingivalis may contribute to periodontal health disparities. This prospective cohort study was designed to investigate if ethnic/racial groups responded differently to non-surgical periodontal treatment and if the treatment outcomes correlated to the bacterial distribution in patients with periodontitis before treatment. Methods: This prospective cohort pilot study was carried out in an academic setting, at the School of Dentistry, University of Texas Health Science Center at Houston. Dental plaque was collected from a total of 75 African Americans, Caucasians and Hispanics periodontitis patients in a 3-year period. Quantitation of P. gingivalis and S. cristatus was carried out using qPCR. Clinical parameters including probing depths and clinical attachment levels were determined before and after nonsurgical treatment. Data were analyzed using one-way ANOVA, the Kruskal-Wallis test, the paired samples t-test and the chi-square test. Results: The gains in clinical attachment levels after treatment significantly differed amongst the 3 groups-Caucasians responded most favorably, followed by African-Americans, lastly Hispanics, while numbers of P. gingivalis were highest in Hispanics, followed by African-Americans, and lowest in Caucasians (p = 0.015). However, no statistical differences were found in the numbers of S. cristatus amongst the 3 groups. Conclusion: Differential response to nonsurgical periodontal treatment and distribution of P. gingivalis are present in different ethnic/racial groups with periodontitis.

Feasibility of a meditation intervention for stroke survivors and informal caregivers: a randomized controlled trial.

BACKGROUND: Depressive symptoms are a significant psychological complication of stroke, impacting both survivors and informal caregivers of survivors. Randomized controlled trials are needed to determine optimal non-pharmacological strategies to prevent or ameliorate depressive symptoms in stroke survivors and their informal caregivers. METHODS: A prospective, randomized, parallel-group, single-center, feasibility study. Participants were assigned to a 4-week meditation intervention or expressive writing control group. The intervention comprised four facilitator-led group meditation sessions, one session per week and building upon prior session(s). Descriptive statistics were used to examine the proportion of eligible individuals who enrolled, retention and adherence rates, and the proportion of questionnaires completed. Data were collected at baseline, immediately after the 4-week intervention period, and 4 and 8 weeks after the intervention period. Secondary analysis tested for changes in symptoms of depression (Center for Epidemiologic Studies-Depression [CES-D]), anxiety [State-Trait Anxiety Inventory for Adults (STAI)], and pain (Brief Pain Inventory-Short Form) in the intervention group via paired t tests. Linear mixed models were used to compare longitudinal changes in the measures between the groups. Intervention and trial design acceptability were preliminary explored. RESULTS: Seventy-one (77%) individuals enrolled and 26 (37%) completed the study (baseline and 8-week post-intervention visits completed). Forty-two (66%) participants completed baseline and immediate post-intervention visits. Mean questionnaire completion rate was 95%. The median meditation group session attendance rate for the intervention group was 75.0%, and the mean attendance rate was 55%. Non-significant reductions in CES-D scores were found. Paired t tests for stroke survivors indicated a significant reduction from baseline through week 8 in BPI-sf severity scores (p = 0.0270). Repeated measures analysis with linear mixed models for informal caregivers indicated a significant reduction in in STAI-Trait scores (F [3,16.2] = 3.28, p = 0.0479) and paired t test showed a significant reduction from baseline to week 4 in STAI-Trait scores (mean = - 9.1250, 95% CI [- 16.8060 to 1.4440], p = 0.0262). No between-group differences were found. CONCLUSIONS: Future trials will require strategies to optimize retention and adherence before definitive efficacy testing of the meditation intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03239132. Registration date: 03/08/2017.