Association between accelerometry measured patterns of sedentary behaviors and functional status in older adults.

BACKGROUND: Older adults are highly sedentary, and too much sedentary behavior (SB) is associated with negative health effects, but little is known about SB patterns and their associations with functional status. AIMS: To examine the association between objectively measured sedentary behavior time (SBT) and sedentary behavior fragmentation (SBF) and functional status in older adults using the National Health Aging Trends Study (NHATS) dataset, a nationally representative sample from 2021. METHODS: Data from NHATS were analyzed using weighted linear regressions to examine the association between objective measures of SBT (mean hours spent in SB/day during waking hours) and SBF, and six functional variables (difficulties with activities of daily living [ADL], short physical performance battery, hand grip strength, immediate word recall, delayed word recall, and mental health), accounting for sociodemographic, body mass index, and the number of chronic conditions. RESULTS: A total of 738 individuals from the NHATS were included. Higher SBT was associated with greater difficulties with ADL, poorer short physical performance battery and hand grip strength, lower scores in both immediate and delayed word recall, and poorer mental health. Higher SBF was associated with fewer difficulties with ADL, better short physical performance battery and hand grip strength, a higher score in immediate word recall, and better mental health. DISCUSSIONAND CONCLUSIONS: Greater fragmentation of SB was associated with better function, and increasing SBF may be a useful strategy for mitigating the effects of SB in older adults, but prospective research is needed to support this approach.

Physical frailty trajectories in older stroke survivors: Findings from a national cohort study.

BACKGROUND: Physical frailty (PF) is highly prevalent and associated with undesirable outcomes in stroke survivors aged 65 years or older. However, the long-term trajectories of PF are understudied in those older stroke survivors. AIMS: To identify PF trajectories and relative predictors associated with the PF trajectories in older stroke survivors. DESIGN: This is a secondary analysis of a population-based cohort study in the United States. METHODS: Six hundred and sixty-three older stroke survivors from the National Health and Ageing Trends Study from 2015 to 2021 were included. PF was operationally assessed based on the Fried Frailty Phenotype. Trajectories were identified by group-based trajectory modelling. The associations between sociodemographic characteristics, clinical factors, symptoms, cognitive factors and PF trajectories were examined using the design-based logistic regression method. RESULTS: Most older stroke survivors were 75 and older (63.32%), female (53.99%), white (80.54%) and partnered (50.64%). Two PF trajectory groups were identified (Group 1: low risk, robust; 49.47%; Group 2: high risk, deteriorating; 50.53%). Individuals were at a higher risk to be assigned to Group 2 if they were 75-84 years (adjusted odds ratio [aOR]: 2.16, 95% CI: 1.23-3.80) or 85+ years (aOR: 2.77, 95% CI: 1.52-5.04), had fair self-reported health (aOR: 2.78, 95% CI: 1.53-5.07) or poor self-reported health (aOR: 3.37, 95% CI: 1.51-7.52), had comorbidities (aOR: 8.44, 95% CI: 1.31-54.42), had breathing problems (aOR: 2.18, 95% CI: 1.18-4.02) and had balance problems (aOR: 1.70, 95% CI: 1.06-2.73). CONCLUSION: PF trajectories in older stroke survivors were heterogeneous and were associated with age, self-rated health status, comorbidities, breathing problems and balance problems. IMPLICATION TO CLINICAL PRACTICE: Early, routine, dynamic screening for stroke-related physical frailty (PF) and relative predictors might be beneficial for identifying the most vulnerable individuals. Our findings might help develop strategies to manage PF progression. REPORTING METHOD: The reporting followed the STROBE guideline.

Long-term trajectories of frailty phenotype in older cancer survivors: a nationally representative longitudinal cohort study.

BACKGROUND: Frailty is a dynamic process associated with adverse health outcomes. However, little is known about the long-term trajectories of frailty in older cancer survivors. OBJECTIVES: To describe the trajectories of frailty phenotype over time amongst older cancer survivors and examine the socio-demographic and health-related predictors of different trajectories. DESIGN: Population-based longitudinal cohort study. SETTING: Community-dwelling older adults in the United States. SUBJECTS: 1,763 older adults who were diagnosed with cancer from the National Health and Ageing Trends Study. METHODS: Frailty was assessed by the Fried Frailty Phenotype. The group-based trajectory model was used to identify the trajectories of frailty. Multinomial logistic regression analyses were used to examine the socio-demographic and health-related predictors of different trajectories. RESULTS: Three frailty trajectories were identified; 52.8% of older cancer survivors had a sustained low risk of frailty over time, 25.0% had a low frailty risk at baseline but the risk increased steadily, and 22.3% had a high frailty risk with a slight change in the observed period. Older cancer survivors were at a high-risk frailty trajectory if they were older, female, African American, had lower education status, had lower annual income, were underweight or obese, self-rated poorer health, had more chronic conditions and difficulties with activities of daily living (ADL), and had worse cognitive functions (P < 0.05). CONCLUSIONS: Long-term frailty trajectories in older cancer survivors are heterogeneous. This study helps identify patients at high risk of sustained or deteriorating frailty and has the potential to inform targeted frailty management strategies addressing modifiable factors identified (e.g. body mass index, ADL).

Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021).

BACKGROUND: Despite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years. OBJECTIVE: This study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer. METHODS: The National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design. RESULTS: The prevalence of any digital health technology use increased from 36% in 2015 to 45% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51% to 52%. In terms of each digital health technology use behavior, in 2015, overall, 28% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19%), filling prescriptions (14%), and handling insurance (11%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed. CONCLUSIONS: Digital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty.

Substance Use and the Self-Management of Persistent Symptoms of COVID-19.

Background: Understanding the self-management practices of persistent symptoms of SARS-Cov-2 (COVID-19) is critical given the misinformation that has been presented about this disease in the U.S. The purpose of this descriptive study is to assess the self-management of persistent symptoms of COVID-19 with commonly used and misused substances (i.e., alcohol, marijuana and commonly prescribed medications) among adults in the U.S. Methods: The data for this study comes from a cross-sectional survey of U.S. adults that was designed to broadly assess symptom burden, persistent symptom patterns, self-efficacy for symptom management and self-management strategies among people who experienced persistent/Long COVID. Multiple logistic regression analyses were used to assess how symptom length of COVID-19 was associated with the use of several substances to manage these persistent symptoms. Results: The analysis found that adults who had COVID-19 symptoms that persisted for 13 weeks or longer had higher rates of using alcohol (27.3%), marijuana (30.9%) and prescription tranquilizers (21.4%) to manage these symptoms when compared to their adult peers who had COVID-19 symptoms persist for only 4 weeks or less. For instance, the odds of indicating the use of marijuana (AOR = 4.21 95% CI = 1.68,10.5) to manage COVID-19 related symptoms was roughly four times higher for respondents who had COVID-19 symptoms persist for 13 weeks or longer when compared to respondents whose COVID-19 symptoms persisted for only 4 weeks or less. Conclusion: The findings suggest that screening of substance use disorders should be considered among healthcare providers who are treating adults who have persistent symptoms of COVID-19.

[Latest Findings in Key Research Areas of Precision Nursing for Chronic Diseases in Older Adults].

The advent of the era of biomedical big data has helped promote the development of precision nursing. Precision nursing for chronic diseases in older adults is an interdisciplinary research field in which accurate individualized data are utilized to carry out early screening and health management of older adult populations at high risk for chronic diseases and early intervention of diseases, which plays an important role in improving the prognosis of diseases and the health level of the older adult population. Herein, we introduced the concept of precision nursing, and discussed the latest research findings in the key areas of precision nursing for chronic diseases in older adults, including precision symptom management in cancer patients and precision nursing in older patients with multimorbidity. At present, research concerning precise symptom management of cancer patients is mainly focused on prediction modelling for risks of symptoms, longitudinal change trajectories, core symptom identification, etc. Investigations in the precise nursing of cancer patients are conducted in the following areas, risk prediction, the timing of interventions, and intervention targets. Research on precision nursing for multimorbidity is mainly focused on assessment of chronic disease multimorbidity, multimorbidity pattern recognition, and health management of multimorbidity. We also discussed potential opportunities and challenges of precision nursing in the future, in order to provide a scientific basis for the improving the practice and theories of precision nursing. In the future, precision nursing will play an ever more important role in uncovering pathogenic information, the diagnosis and treatment of diseases, the health of the research population, and the promotion of medical research.

Physical activity in surgical lung cancer patients: a systematic review.

PURPOSE: Perioperative exercise could improve health outcomes of surgical lung cancer patients, but less is known about their natural physical activity (PA) behavior before exercise interventions. This review aimed to synthesize evidence on PA, regarding the following: (1) proportion of patients meeting PA guidelines, (2) amount of PA, (3) PA trajectory following surgery, and (4) correlates of PA before or after surgery. METHODS: We conducted a systematic review using PubMed, CINHAL, Scopus, and SPORTDiscus (July 2021). Observational or experimental studies that measure PA of lung cancer patients before/after surgery were included. We assessed methodological quality using the NIH Quality Assessment Tools and extracted data using a standardized form. RESULTS: Seventeen studies (25 articles, N = 1737 participants) published between 2009 and 2021 were included. Fourteen studies had sample sizes less than 100. Thirteen studies were of fair quality and four studies were of good quality. Only 23-28% of patients met PA guideline (150 min/week moderate-vigorous PA) at 6 months-6 years after surgery. Patients took an average of 3822-10,603 daily steps before surgery and 3934-8863 steps at 1-3 months after surgery. Physical activity was lower at 1 day-3 months after surgery, compared with preoperative levels. Perioperative PA was positively associated with exercise capacity, quality of life and reduced postoperative complications. CONCLUSION: This review suggests that PA is low among surgical lung cancer patients, and it may not recover within 3 months following surgery. Physical activity has the potential to improve postoperative outcomes. However, the existing evidence is weak, and future larger longitudinal studies are needed.

Profiles of sedentary behaviors in the oldest old: findings from the National Health and Aging Trends Study.

BACKGROUND: Sedentary behavior is a significant health risk. Emerging research suggests that mentally active sedentary behaviors (e.g., computer use and reading) are associated with better health than mentally passive sedentary behaviors (e.g., watching TV). However, these relationships are not well established in the literature, and little is known about the oldest old (age ≥ 80). AIMS: The aims of this study were to (1) identify distinct subgroups of oldest old adults based on six domains of sedentary behavior (watching TV, using a computer/tablet, talking to friends or family members, doing hobby or other activities, transportation, and resting/napping); and (2) compare health-related outcomes across identified subgroups, using the National Health and Aging Trends Study (NHATS) dataset. METHODS: Latent profile analysis was used to identify distinct profiles of sedentary behavior. Design-based linear and logistic regressions were used to examine associations between different profiles and health outcomes, accounting for socio-demographic characteristics. RESULTS: A total of 852 participants were included. We identified four profiles and named them based on total sedentary time (ST) and passive/active pattern: "Medium-passive", "High-passive", "Low", "High-mentally active". Compared to the "High-passive" group, "Low" group and "High-mentally active" group were associated with fewer difficulties with activities of daily living, fewer problems limiting activities and higher cognitive function. CONCLUSION: This study, with a national representative sample of the oldest old population, suggests that both total ST and sedentary behavior pattern matter when evaluating health outcomes of being sedentary. Interventions should encourage oldest old adults to reduce ST and especially target mentally passive ST.

Bidirectional association between knee osteoarthritis and depressive symptoms: evidence from a nationwide population-based cohort.

BACKGROUND: Both knee osteoarthritis (KOA) and depressive symptoms (DS) are major public health issues affecting the quality of life. This study aimed to examine the association between KOA and DS. METHODS: Data were gathered from the China Health and Retirement Longitudinal Study in 2011-2015 which surveyed middle-aged to elderly individuals and their spouses in 28 provinces in China. An adjusted Cox proportional hazards regression model was used to estimate hazard ratios (HRs). RESULTS: The analysis for baseline KOA and the subsequent risk of DS was based on 2582 participants without baseline DS. During the follow-up, KOA patients were more likely to have DS than non-KOA participants (adjusted HR = 1.38: 95% CI = 1.23 to 1.83). The analysis for baseline DS and the subsequent risk of KOA was based on 4293 participants without baseline KOA, those with DS were more likely to develop KOA than non-DS participants (adjusted HR = 1.51: 95% CI = 1.26 to 1.81). Subgroup analysis showed sex and age had no significant moderating effect on the KOA-DS association. CONCLUSIONS: Our results provide evidence that the association between KOA and DS is bidirectional. Therefore, primary prevention and management of KOA and DS should consider this relationship.

Effects of perioperative exercise interventions on lung cancer patients: An overview of systematic reviews.

AIMS AND OBJECTIVES: To identify, appraise and summarise systematic reviews of exercise interventions for surgical lung cancer patients. BACKGROUND: Low exercise capacity, reduced pulmonary function, impaired health-related quality of life and postoperative pulmonary complications are common in surgical lung cancer patients. Numerous systematic reviews address these health problems and examine the effects of exercise intervention. However, differences in the quality and scope of the systematic reviews and discordant findings from the reviews make it difficult for decisions-makers to interpret the evidence and establish best practices in the clinical settings. DESIGN: Overview of systematic reviews. METHODS: This overview was conducted following the PRISMA guideline. A literature search of PubMed, CINAHL, EMBASE, Cochrane Library, SPORTDiscus and PEDro was conducted (October 2019). Peer-reviewed systematic reviews of randomised controlled trials focusing on the effects of exercise interventions for lung cancer patients who underwent surgery were included. The methodological quality of included reviews was assessed using AMSTAR 2. The results of reviews with meta-analysis were synthesised and presented by each health outcome. RESULTS: Seven systematic reviews published between 2013 and 2019 were included. High/moderate-quality evidence showed that postoperative exercise interventions could increase the exercise capacity and muscle strength, and low/very-low-quality evidence showed that postoperative exercise interventions may increase the physical component of health-related quality of life and decease dyspnoea. Low-quality evidence showed that preoperative exercise interventions may increase exercise capacity and pulmonary function, decrease the risk of postoperative pulmonary complications and reduce the length of hospital stay. CONCLUSIONS: Postoperative and preoperative exercises have the potential to improve health outcomes in surgical lung cancer patients. Further research is needed to evaluate the effects of different types of exercise and varying amounts of exercise. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence to support the implementation of exercise interventions for surgical lung cancer patients.

Effects of work environment and job characteristics on the turnover intention of experienced nurses: The mediating role of work engagement.

AIM: To assess turnover intention among experienced nurses and explore the effects of work environment, job characteristics and work engagement on turnover intention. BACKGROUND: The nursing shortage is an urgent concern in China. A high turnover rate of experienced nurses could have serious effects on the quality of care, costs and the efficiency of hospitals. It is crucial to explore the predictors of turnover intention and develop strategies tailored to experienced nurses. DESIGN: A descriptive, cross-sectional survey design. METHODS: A total of 778 experienced nurses from seven hospitals was surveyed on their work engagement, job characteristics, work environment and turnover intention in March-May 2017. Structural equation modelling was used to test a theoretical model and the hypotheses. RESULTS: The results showed that 35.9% of experienced nurses had high-level turnover intention. The final model explained 50% of the variance in experienced nurses' turnover intention and demonstrated that: (1) work environment was positively associated with higher work engagement and lower turnover intention and work engagement partially mediated the relationship between work environment and turnover intention; and (2) job characteristics were positively related to higher work engagement and lower turnover intention and work engagement fully mediated the relationship between job characteristics and turnover intention. CONCLUSIONS: The study confirms the intrinsic and extrinsic motivators on work engagement posited by job demands-resources model. Theory-driven strategies to improve work environment, enhance job characteristics and promote wok engagement are needed to address the nursing shortage and high turnover intention among experienced nurses.

Associations of Organizational Justice and Job Characteristics with Work Engagement Among Nurses in Hospitals in China.

Work engagement of nurses has a great effect on their productivity, patient outcomes, and organizational performance. It is important to explore what can be done to facilitate nurse engagement. In this study, we surveyed a total of 1,065 nurses chosen from seven hospitals in China by random cluster sampling to explore the state of nurse engagement and its associations with organizational justice and job characteristics. The mean score for nurse engagement was 3.5 (SD = 1.5) on a 0-6 scale, and in hierarchical multiple regression analyses we found that nurse engagement had statistically significant relationships with the two organizational justice dimensions of distributive justice (ß = 0.13, p < .01) and informational justice (ß = 0.17, p < .05); and the three job characteristic dimensions of task significance (ß = 0.15, p < .01), job feedback (ß = 0.10, p < .01), and skill variety (ß = .08, p < .05). Hence, work engagement of nurses was not at a high level, and nursing leaders should consider enhancing their engagement through creating motivational job characteristics and improving nurses' perception of organizational justice.

The influence of effective communication, perceived respect and willingness to collaborate on nurses' perceptions of nurse-physician collaboration in China.

BACKGROUND: Nurse-physician collaboration is a critical prerequisite for high-quality care. Previous researchers have addressed multiple factors that influence collaboration. However, little of this research has explored the influence of interactional factors on nurses' perception of nurse-physician collaboration in China. AIMS: To examine the influence of interactional factors (effective communication, perceived respect and willingness to collaborate) on nurses' perception of nurse-physician collaboration. METHODS: A cross-sectional survey of 971 registered nurses in nine hospitals was conducted. An author-designed interactional factor questionnaire and the Nurse-Physician Collaboration Scale were used to collect data. Multiple regression analysis was used. RESULTS: Nurse-physician collaboration was identified as at a moderate level (mean = 3.93 ±â€¯0.68). Interactional factors (effective communication, perceived respect and willingness to collaborate) were identified as relatively moderate to high (mean = 4.03 ±â€¯0.68, mean = 3.87 ±â€¯0.75, mean = 4.50 ±â€¯0.59, respectively). The results showed that effective communication, perceived respect and willingness to collaborate explained 57.3% of the variance in nurses' perception of nurse-physician collaboration (Adjusted R2 = 0.573, F = 435.563, P < 0.001). Perceived respect (ß = 0.378) was the strongest factor relevant to nurses' perception of nurse-physician collaboration, second was effective communication (ß = 0.315), and the weakest factor among these three factors was willingness to collaborate (ß = 0.160). CONCLUSION: Nurses' perceptions of collaboration were relatively positive, mainly in Sharing of patient information; however, improvements need to be made regarding Joint participation in the cure/care decision-making process. Effective communication, perceived respect and willingness to collaborate significantly affect nurses' perception of nurse-physician collaboration, with perceived respect having greater explanatory power among the three interactional factors. It is necessary for hospital managers to develop strategies to build professional respect for nurses, facilitate effective nurse-physician communication and improve nurses' willingness to collaborate.

Work engagement and its predictors in registered nurses: A cross-sectional design.

Nurses are key staff members of health-care organizations. Nurse engagement directly influences quality of care and organizational performance. The purpose of the present study was to understand the state of work engagement and explore its predictors among registered nurses in China by using a descriptive, cross-sectional survey design (n = 1065). Work engagement was measured with the Chinese version of the Utrecht Work Engagement Scale. The results showed that the average work engagement of Chinese nurses was 3.54 (standard deviation = 1.49), and that nurses' age (ß = .16, t = 5.32), job characteristics (ß = .33, t = 9.43), and practice environment (ß = .23, t = 6.59) were significant predictors of work engagement. Thus, nurse leaders should be encouraged to shape motivational job characteristics and create supportive practice environment so as to increase nurses' work engagement.

Determinants of patient loyalty to healthcare providers: An integrative review.

PURPOSE: Patient loyalty is key to business success for healthcare providers and also for patient health outcomes. This study aims to identify determinants influencing patient loyalty to healthcare providers and propose an integrative conceptual model of the influencing factors. DATA SOURCES: PubMed, CINAHL, OVID, ProQuest and Elsevier Science Direct databases were searched. STUDY SELECTION: Publications about determinants of patient loyalty to health providers were screened, and 13 articles were included. DATA EXTRACTION: Date of publication, location of the research, sample details, objectives and findings/conclusions were extracted for 13 articles. RESULTS OF DATA SYNTHESIS: Thirteen studies explored eight determinants: satisfaction, quality, value, hospital brand image, trust, commitment, organizational citizenship behavior and customer complaints. The integrated conceptual model comprising all the determinants demonstrated the significant positive direct impact of quality on satisfaction and value, satisfaction on trust and commitment, trust on commitment and loyalty, and brand image on quality and loyalty. CONCLUSION: This review identifies and models the determinants of patient loyalty to healthcare providers. Further studies are needed to explore the influence of trust, commitment, and switching barriers on patient loyalty.

Trajectories and predictors of anxiety and depression among older cancer survivors: a nationally representative cohort study.

PURPOSE: The study aimed to describe the long-term trajectories of anxiety and depression among older cancer survivors and examine sociodemographic and health-related predictors of different trajectories. METHODS: Data were from the National Health and Aging Trends Study. Patient Health Questionnaire-4 was used to assess anxiety and depression. Group-based trajectory model was used to identify the distinct trajectories of anxiety and depression from 2015 to 2021. Design-based multinomial logistic regression was used to examine predictors of different trajectories. All analyses accounted for the complex sample design and survey weights. RESULTS: A total of 1766 older cancer survivors were included representing 8.9 million older cancer survivors. The prevalence of anxiety and depression from 2015 to 2021 ranged from 25.12 to 29.11%. Four trajectories were identified: sustained low-risk (49.0%), deteriorating (24.1%), meliorating (11.0%), and sustained high-risk (16.1%). Potential predictors of high-risk anxiety and depression include older age, female, lower annual income, abnormal BMI, poorer self-rated health, more difficulty in activities of daily living (ADL), and worse cognitive function (P < 0.05). CONCLUSIONS: The anxiety and depression progression patterns are heterogeneous among older cancer survivors. The trajectory affiliations could be predicted by sociodemographic and health-related factors, which have the potential to inform targeted clinical strategies (e.g., improve ADL and ameliorate cognitive function). IMPLICATIONS FOR CANCER SURVIVORS: Anxiety and depression are common among older cancer survivors, and long-term trajectories identified by this study might help realize early-stage identification and individualized interventions for mental disorders.

Comorbidities were associated with cancer clinical trial discussion and participation: findings from the Health Information National Trends Survey-Surveillance, Epidemiology, and End Results Program (2021).

OBJECTIVES: Oncology clinical trials are recommended to better reflect real-world cancer patient populations and to increase patient access to new treatments in trials. The influence of comorbidities on trial participation is unclear. This study examined the association of having comorbidities and patients' experiences with clinical trial discussion or actual participation. STUDY DESIGN AND SETTING: We included 958 cancer survivors from Health Information National Trends Survey-Surveillance, Epidemiology, and End Results Program. Trial discussion was defined as whether their medical team discussed cancer clinical trials, and trial participation was defined as whether they participated. Comorbidities included diabetes, hypertension, heart condition, chronic lung disease, and depression/anxiety disorder. Design-based logistic regression results were conducted. RESULTS: Seventy-five percent of patients had one or more comorbidities, commonly having hypertension (56%) and diabetes (26%). Only 15% of participants reported trial discussion and 8% reported trial participation. Having one or more comorbidities was significantly associated with lower rates of trial discussion in univariate analysis (22.9% vs. 12.1%, odds ratio = 0.46, P = 0.001), and such association was pertained in adjusted logistic regression (20.5% vs. 12.8%, adjusted odds ratio = 0.54, P = 0.02). CONCLUSION: Findings suggest patients with comorbidities were underrepresented in cancer clinical trials, implying a potential lack of representativeness among trial participants.

Symptom Clusters in Adults with Post-COVID-19: A Cross-Sectional Survey.

More than 100 symptoms have been reported for post-coronavirus disease 2019 (COVID-19) and this study aimed to organize self-reported symptoms by identifying symptom clusters. We used a cross-sectional survey with a convenience sample of 491 adults who reported experiencing prolonged symptoms of COVID. A list of 25 symptoms of post-COVID-19 was used to measure the symptoms, and exploratory factor analysis was undertaken to identify symptom clusters for people with symptoms lasting 5 to 8 weeks and 9 weeks or longer. Six symptom clusters were identified for each of the two groups, and five clusters were similar across both groups: respiratory, general viral, smell/taste, cognitive cardiac, and mental health. The >9-week group reported symptoms primarily from two factors: respiratory-muscular and mental health. Post-COVID-19 symptom clusters differ across timeframes. Symptom clusters were useful in establishing coherent patterns of multiple complex symptoms.

Prolonged bouts of sedentary behavior in people with chronic obstructive pulmonary disease and associated factors.

BACKGROUND: Increased sedentary behavior (SB), especially in prolonged bouts, is associated with adverse health outcomes, but little is known about patterns of SB in people with chronic obstructive pulmonary disease (COPD). OBJECTIVES: The purpose of this study was to describe SB and patterns of SB and to examine factors associated with prolonged bouts of SB in inactive community-dwelling adults with COPD. METHODS: This cross-sectional analysis used data from inactive adults with COPD who were enrolled in an exercise program but had not started exercising. Participants were ≥ 50 years old with a diagnosis of COPD, had a forced expiratory volume in one second < 80% predicted, and were inactive. Participants wore an activPAL device for seven days to measure their SB and completed surveys and physical measures. Data were analyzed with multiple regression. RESULTS: The sample included 160 participants with a mean age (± SD) of 69 ± 8, and a mean total sedentary time of 742 ± 150 min/day, with 254 ± 146 min/day in SB bouts ≥ 60 min. DURATION: Time spent in bouts of SB ≥ 60-min. was negatively associated with self-efficacy for overcoming barriers to light physical activity (P<0.05), balance (P<0.05), chair stand test (P<0.05), FEV1% predicted (P<0.05) and positively associated with BMI (P<0.001). CONCLUSIONS: Inactive people with COPD engage in extensive SB, much of it in prolonged bouts. Self-efficacy, balance, and lower body strength are modifiable variables associated with SB and potential targets for future interventions to reduce time in prolonged sedentary behavior.