No safe time window in malrotation and volvulus: A consecutive cohort study.

BACKGROUND: Malrotation and volvulus classically present with bilious vomiting. It is more common earlier in life, but there are other causes of bile-stained vomiting. This leads some clinicians to 'watch and wait'. In the presence of a volvulus, this is potentially a fatal decision. It is not clear from the literature if there is a safe time window in which children can be observed in the hope of avoiding transfers or radiological investigations. AIM: To determine whether time to identification and management of midgut volvulus correlated with morbidity and mortality; and whether there were patterns to transition of care. METHODS: Multicentre, retrospective review of all children with malrotation ± volvulus at two tertiary children's hospitals in Brisbane from 2000 to 2012. Data collected included age at presentation, timing between symptom onset and presentation, radiological findings, and definitive surgical management. Outcomes included patient length of stay (LOS), total parenteral nutrition (TPN) duration, re-operations and death. RESULTS: There were 96 cases of malrotation identified, with 23 excluded (elective operation, insufficient data). Neonates made up 66% of included cases. Only 14% of cases were over 12 months old. Bilious vomiting or bile-stained aspirates were the presenting symptoms in 71% (52). Overall mortality was 5.56%. Time from symptom onset to presentation or management was not significantly associated with morbidity or mortality. More than half (53%, 39/73) of patients received total parenteral nutrition; 20/39 for more than 10 days. Neonates and infants had a significantly higher rate of TPN compared with older children (P < 0.001). Those requiring TPN post-operatively had a significantly higher mortality compared with those who did not (P = 0.02). Time from symptom onset to presentation or definitive management was not significantly associated with LOS, TPN duration, or need for re-operation. CONCLUSION: Malrotation remains a time-critical diagnosis to secure and treat. Even a short duration of symptoms can be associated with high morbidity or mortality. There is no place for 'watch and wait' for such patients, and malrotation/volvulus should be emergently actively excluded with contrast studies.

Patient factors associated with treatment time for stroke before and after the onset of COVID-19.

OBJECTIVES: Prior to our study, little was known about factors related to time-to-treatment for stroke pre- and post-COVID-19. DESIGN: This was a retrospective cohort study to evaluate factors associated with delayed door-to-needle time among patients with acute ischemic stroke over two time-periods. RESULTS: Final sample consisted of 932 charts with mean age of 68.1(±15.6). Significant factors associated with shorter door-to-needle time included ≤ four hours since symptom onset and stroke occurring during post-Covid-19 time-period. Those on anti-coagulants had 72 % higher odds of longer door-to-needle time. As patients got older and stroke symptoms were more severe, less time was spent in door-to-imaging. CONCLUSION: Results highlight the importance of early recognition of stroke symptoms and rapid transport to the hospital. Faster response times in post-Covid-19 time-period may be attributable to systematic processes put in place to address pandemic-related challenges. Outcomes may depend on research to identify gaps in stroke treatment.

Association of SGLT-2 Inhibitors With Treatment Satisfaction and Diabetes-Specific and General Health Status in Adults With Cardiovascular Disease and Type 2 Diabetes.

Background It is unknown if initiation of a sodium-glucose cotransporter-2 inhibitor (SGLT-2i) is associated with changes in patient-reported health status outside of clinical trials. Methods and Results Using a prospective observational study design, adults with type 2 diabetes and cardiovascular disease were recruited from 14 US hospitals between November 2019 and December 2021 if they were new users of noninsulin antidiabetic medications. The primary outcome was change in 6-month diabetes treatment satisfaction. Secondary outcomes included diabetes-related symptom distress, diabetes-specific quality of life, and general health status for all patients and based on cardiovascular disease type. Inverse probability of treatment weight using propensity score was performed to compare outcome changes based on medication use. Of 887 patients (SGLT-2i: n=242) included in the inverse probability of treatment weight analyses, there was no difference in changes in treatment satisfaction in SGLT-2i users compared with other diabetes medication users (0.99 [95% CI, -0.14 to 2.13] versus 1.54 [1.08 to 2.00], P=0.38). Initiating an SGLT-2i versus other diabetes medications was associated with a greater reduction in ophthalmological symptoms (-3.09 [95% CI, -4.99 to -1.18] versus -0.38 [-1.54 to 0.77], P=0.018) but less improvement in hyperglycemia (1.08 [-2.63 to 4.79] versus -3.60 [-5.34 to -1.86], P=0.026). In subgroup analyses by cardiovascular disease type, SGLT-2i use was associated with a greater reduction in total diabetes symptom burden and neurological sensory symptoms in patients with heart failure. Conclusions Among patients with type 2 diabetes and cardiovascular disease, initiating an SGLT-2i was not associated with changes in diabetes treatment satisfaction, total diabetes symptoms, diabetes-specific quality of life, or general health status.

Efficacy of One Dose of Laxative on Postoperative Constipation Following Total Knee Arthroplasty.

Postoperative constipation is a common problem among orthopaedic surgical patients leading to discomfort, increased length of stay, and other complications. The primary purpose of this study was to determine the effectiveness of polyethylene glycol compared with docusate sodium for the prevention of constipation, after total knee arthroplasty. The secondary purpose was to examine the effectiveness of polyethylene glycol on pain and strain with bowel movement. A two-group nonequivalent cohort design was used to evaluate the effect of one 17-g dose of polyethylene glycol by mouth on postoperative day 1 compared with usual care with docusate sodium 100 mg starting the day of surgery and continued twice daily at home. There was no significant difference in the rate of constipation between the two cohorts in the 3 days after surgery. There was no difference in reported pain and strain. Future research should focus on the use of pharmacologic and nursing interventions together for prevention of postoperative constipation in patients with arthroplasty surgery.

Total added sugar consumption is not significantly associated with risk for prediabetes among U.S. adults: National Health and Nutrition Examination Survey, 2013-2018.

Prediabetes affects 38% of U.S. adults and is primarily linked to added sugars consumed from sugar-sweetened beverages. It is unclear if total dietary intake of added sugar also increases the risk for prediabetes. This study examined if total (g/day) and percent intakes of <10%, 10-15%, or >15% added sugar increase the odds for prediabetes in U.S. adults. A cross-sectional, secondary analysis using 2013-2018 NHANES data was conducted. This study included data from U.S. adults ≥ 20 years with normoglycemia (N = 2,154) and prediabetes (N = 3,152) with 1-2 days of dietary recall information. Prediabetes was defined as a hemoglobin A1c of 5.7%-6.4% or a fasting plasma glucose of 100-125 mg/dL. Survey-weighted logistic regression was used to estimate odds ratios of prediabetes based on usual intakes of added sugar (total and percent intakes) using the National Cancer Institute Method. Differences in prediabetes risk and total and percent intakes of added sugar were compared by race/ethnicity. The sample's total energy intake from added sugar was 13.9%. Total (unadjusted: OR: 1.01, 95% CI: .99-1.00, p = .26; adjusted: OR: 1.00, 95% CI: .99-1.00, p = .91) and percent intakes of added sugar (unadjusted [<10%: (ref); 10-15%: OR: .93, 95% CI: .77-1.12, p = .44; >15%: OR: 1.03, 95% CI: .82-1.28, p = .82] and adjusted [<10%: (ref); 10-15%: OR: .82, 95% CI: .65-1.04, p = .09; >15%: OR: .96, 95% CI: .74-1.24, p = .73]) were not significantly associated with an increased odds of prediabetes. Prediabetes risk did not differ by race/ethnicity for total (unadjusted model [p = .65]; adjusted model [p = .51]) or percent (unadjusted model [p = .21]; adjusted model [p = .11]) added sugar intakes. In adults ≥20 years with normoglycemia and prediabetes, total added sugar consumption did not significantly increase one's risk for prediabetes and risk estimates did not differ by race/ethnicity. Experimental studies should expand upon this work to confirm these findings.

Cardiac Rehabilitation Facebook Intervention: Feasibility Randomized Controlled Trial.

BACKGROUND: The adherence to cardiac rehabilitation is low. Social media has been used to improve motivation and cardiac rehabilitation completion, but the authors did not find Facebook interventions for these purposes in the literature. OBJECTIVE: The purpose of this study was to determine the feasibility of the Cardiac Rehabilitation Facebook Intervention (Chat) for affecting changes in exercise motivation and need satisfaction and adherence to cardiac rehabilitation. METHODS: The Behavioral Regulation in Exercise Questionnaire-3 and Psychological Need Satisfaction for Exercise were used to measure motivation and need satisfaction (competence, autonomy, and relatedness) before and after the Chat intervention. To support need satisfaction, the intervention included educational posts, supportive posts, and interaction with peers. The feasibility measures included recruitment, engagement, and acceptability. Groups were compared using analysis of variance and Kruskal-Wallis tests. Paired t tests were used to assess motivation and need satisfaction change, and Pearson or Spearman correlations were used for continuous variables. RESULTS: A total of 32 participants were lost to follow-up and 22 were included in the analysis. Higher motivation at intake (relative autonomy index 0.53, 95% CI 0.14-0.78; P=.01) and change in need satisfaction-autonomy (relative autonomy index 0.61, 95% CI 0.09-0.87; P=.02) were associated with more completed sessions. No between-group differences were found. Engagement included "likes" (n=210) and "hits" (n=157). For acceptability, mean scores on a 1 (not at all) to 5 (quite a bit) Likert scale for feeling supported and in touch with providers were 4.6 and 4.4, respectively. CONCLUSIONS: Acceptability of the Chat group was high; however, intervention feasibility could not be determined due to the small sample size. Those with greater motivation at intake completed more sessions, indicating its importance in cardiac rehabilitation completion. Despite challenges with recruitment and engagement, important lessons were learned. TRIAL REGISTRATION: ClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.7554.

Sub-categories of moral distress among nurses: A descriptive longitudinal study.

BACKGROUND: There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard "narrow" definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. RESEARCH AIMS: To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. RESEARCH DESIGN: A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. PARTICIPANTS: Registered nurses from four hospitals within one large healthcare system in Midwest United States. ETHICAL CONSIDERATIONS: IRB approval was obtained. RESULTS: 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by "other" distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. CONCLUSIONS: Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed.

Incidence and prevalence of advanced colorectal neoplasia in Lynch syndrome.

BACKGROUND AND AIMS: Lynch syndrome (LS) is the most common hereditary cause of colorectal cancer (CRC) and endometrial cancer (EC). Although colonoscopy reduces CRC in LS, the protection is variable. We assessed the prevalence and incidence of neoplasia in LS during surveillance colonoscopy in the United States and factors associated with advanced neoplasia. METHODS: Patients with LS undergoing ≥1 surveillance colonoscopy and with no personal history of invasive CRC or colorectal surgery were included. Prevalent and incident neoplasia was defined as occurring <6 months before and ≥6 months after germline diagnosis of LS, respectively. We assessed advanced adenoma (AA), CRC, and the impact of mismatch repair pathogenic variant (PV) and typical LS cancer history (personal history of EC and/or family history of EC/CRC) on outcome. RESULTS: A total of 132 patients (inclusive of 112 undergoing prevalent and incident surveillance) were included. The median examination interval and duration of prevalent and incident surveillance was .88 and 1.06 years and 3.1 and 4.6 years, respectively. Prevalent and incident AA were detected in 10.7% and 6.1% and invasive CRC in 0% and 2.3% of patients. All incident CRC occurred in MSH2 and MLH1 PV carriers and only 1 (.7%) while under surveillance in our center. AAs were detected in both LS cancer history cohorts and represented in all PVs. CONCLUSIONS: In a U.S. cohort of LS, advanced neoplasia rarely occurred over annual surveillance. CRC was diagnosed only in MSH2/MLH1 PV carriers. AAs occurred regardless of PV or LS cancer history. Prospective studies are warranted to confirm our findings.

Assessment of the Value of a Carriage System to Organize and Elevate Intravenous Tubing.

Caregiver/patient fall injury risks increase when medical tubing drapes on floors. The objective of this research was to examine the value of a novel carriage system that organizes and elevates medical and intravenous (IV) tubing. Using a prospective, multicenter, cohort design, value of the IV carriage system was assessed using a valid, reliable survey that provided the total score and scores of 3 involvement factors: personal relevance, attitude, and importance. The survey was scored on a 0-100 scale, and questions about tubing elevation, patient mobility, and ease of use were rated on 0-10 scales. Participants were adult and pediatric inpatient caregivers (n = 131). In adult intensive care environments (n = 61), carriage system value scores were higher in the quaternary care site compared to 4 enterprise adult intensive care sites (median [Q1, Q3]: 90.0 [69.2, 97.5] vs 72.5 [52.5, 78.3], respectively; P = .008). Compared to nurses working in adult environments (n = 58), pediatric nurses (n = 40) had higher value scores (median [Q1, Q3]: 89.2 [68.3, 97.5] vs 97.5 [85.8, 100.0], respectively; P = .007). High median score ratings (9-10) were given for tubing elevation, patient mobility, and ease of use. In conclusion, the IV carriage system was valued by nurses as an important tool in clinical practice.

Effect of a Hospital-Acquired Pressure Injury (HAPI) Risk Score on HAPI Rates in Patients With Vascular Diseases.

PURPOSE: The purpose of this study was to assess whether a validated hospital-acquired pressure injury (HAPI) risk scale and best practice interventions were associated with lower HAPI rates compared with previous care. We also sought to identify a cut score of HAPI risk when using the instrument. DESIGN: Nonequivalent 2-group pre- and postintervention comparative study. SUBJECTS AND SETTING: The sample comprised 2871 patients treated for vascular diseases; data were collected on 2674 patients before the intervention and 197 patients postintervention. Their mean (SD) age was 69.3 (12.4) years; 29.3% (n = 842) had a history of diabetes mellitus. Based on discharge status, more patients received home health care after discharge in the postintervention group, 34% (n = 67/197) versus 16.2% (n = 430/2662), P = .001. The study setting was a quaternary care hospital in the Midwestern United States. METHODS: Patients who were at high risk for HAPI, based on a nomogram score, received a mobility and ambulation program intervention. Pre- and postintervention cohorts were compared using analysis of variance, χ 2 test, and Fisher exact test. A receiver operating characteristic curve plot was generated to determine the ability of the risk score tool to identify HAPI risk at all possible cut points. RESULTS: Despite differences in patient characteristics, primary medical diagnosis, and postdischarge health care needs, the HAPI rate decreased postintervention from 13.8% (n = 370/2674) to 1.5% (n = 3/197), P = .001. A HAPI risk-predicted value cut score of 18 had strong sensitivity (0.81) and specificity (0.81), and positive and negative predictive values of 0.42 and 0.96, respectively. CONCLUSION: Despite higher patient acuity during the intervention period, HAPI rate decreased after HAPI nomogram and nurse-led mobility intervention implementation.

Simulation Versus Written Fall Prevention Education in Older Hospitalized Adults: A Randomized Controlled Study.

Using a randomized controlled, non-blinded, two-group design, differences in fall risk assessment, post-discharge sustainable fall risk changes, fall events and re-hospitalization were examined in 77 older adults who received a simulation (n = 36) or written (n = 41) education intervention. Between-group differences and changes in pre- versus post-fall risk assessment scores were examined using Pearson's chi-square, Wilcoxon rank sum or Fisher's exact tests (categorical variables) and two-sample t-tests (continuous variables). There were no statistically significant differences between groups in demographic characteristics. Patients who received simulation education had higher fall risk post-assessment scores than the written education group, p = .022. Change in fall risk assessment scores (post-vs.-pre; 95% confidence intervals) were higher in the simulation group compared to the written education group, 1.43 (0.37, 2.50), p = .009. At each post-discharge assessment, fall events were numerically fewer but not significantly different among simulation and education group participants. There were no statistically significant between-group differences in re-hospitalization.

Outcomes after implementing a heart failure diuretic pathway in an emergency department setting.

BACKGROUND: Among patients with acute decompensated heart failure (HF), national and international loop diuretic therapy recommendations may not be followed in the emergency department (ED). OBJECTIVES: To examine if loop diuretic treatment and patient disposition from the ED differed after implementing a clinical pathway based on national HF guidelines. METHODS: Using an observational, pre- and post-intervention design, after clinical pathway implementation, loop diuretic medications and clinical outcomes were retrieved from medical records. Analyses included Pearson's Chi-square or Fisher's exact test, 2-sample T-test or Wilcoxon rank sum test. RESULTS: Of 182 pre- and 122 post-intervention patients, mean (SD) patient age was 67.9 (13.4) years and 44.2% were Caucasian. There were no between-group differences in pre-ED visit loop diuretic prescription or dosages. More post-intervention ED patients received at least one dose of loop diuretic (94.3% vs. 81.9%, p = 0.010); however, the overall dose (mg) across groups was lower than the home dose and was not based on national guideline expectations. Doses from home to ED decreased less in the post-intervention group for patients who received doses at both time points and for all patients: p = 0.047 and p = 0.048, respectively. There was no between-group differences in short-stay unit (SSU) admissions, p = 0.33. Post-intervention patients were hospitalized from the ED (p = 0.050) and SSU (p = 0.005) less often than pre-intervention patients. Discharge to home from the ED or SSU increased in the post-intervention period; 16.4% vs. 4.9%, p = 0.009. CONCLUSIONS: Among ED patients treated for HF, diuretic dosing was non-optimized. New interventions are needed to enhance adherence to national guidelines.

Is the Measure Good Enough? Measurement Invariance and Validity of the Clance Imposter Phenomenon Scale in a University Population.

Imposter Phenomenon (IP) was coined in 1978 by Clance and Imes and has been an important construct in explaining individuals' experiences of believing that achievements are a result of luck or misperceptions of others rather than personal competence. The Clance Imposter Phenomenon Scale (CIPS), developed in 1985, is a prominent operationalization of this construct. Although this scale has been widely used since its inception, its factor structure has been inconsistent across studies and no tests of measurement invariance are documented in the literature. Using a large university sample (n = 830), the current study was designed to: (a) examine the factor structure of the CIPS using cross validation, (b) examine measurement invariance across gender, and (c) examine differences in the CIPS factor by demographics. We found that a single factor structure for the CIPS was the best fitting model. We also found that the measure achieved invariance across gender after removing item 18 (and in the absence of items 1, 2, and 19, removed for poor fit). Finally, we found that being single, a woman, and having experienced lower socioeconomic status (SES) were all associated with higher IP. We discuss these findings in the context of a university setting and suggest avenues for future research.

Prediabetes awareness is not associated with lower consumption of self-reported added sugar in U.S. adults.

AIMS: Adults aware of having prediabetes report engaging in dietary risk-reduction behavior changes. However, no studies have assessed if prediabetes awareness influences self-reported consumption of added sugar. METHODS: Cross-sectional data from 3314 adults, 20 years and older, with prediabetes were analyzed from 2013-2018 National Health and Nutrition Examination Survey data. Survey-weighted ordinary least squares regression was used to test whether prediabetes awareness was associated with usual intake of added sugar (g/day) using the National Cancer Institute Method by age, sex, and race/Hispanic origin after controlling for sociodemographic covariates. RESULTS: Among 3314 adults with prediabetes, 528 reported being aware and 2786 reported being unaware of their condition. Prediabetes awareness was not significantly associated with added sugar consumption (estimated difference 1.7 g; 95% CI: - .80, 4.20; P = .18). There were no significant differences in added sugar consumption among those aware of their condition for age, sex, or race/Hispanic origin (Type 3 test for age: P = .15, male: P = .86, race, and Hispanic origin: P = .89). CONCLUSION: Adults with prediabetes, aware of their condition, do not consume significantly lower quantities of added sugar compared to unaware adults, including no differences observed by age, sex, and race/Hispanic origin.

Distractions when viewing in-hospital heart failure self-care videos and change in heart failure self-care knowledge.

BACKGROUND: When viewing in-hospital heart failure (HF) education videos, internal and external distractions could interfere with understanding of educational content. OBJECTIVE: To examine if distractions when learning are associated with HF knowledge. METHODS: HF self-care knowledge was assessed using a validated HF knowledge instrument. Research nurses recorded distractions during video viewing. Patient characteristics were retrieved from a database. Demographics and change in knowledge scores were compared overall and by distraction groups using comparative statistics. RESULTS: Among all 60 participants, distractions were not associated with patient characteristics. Pre- and post-video education, HF standardized knowledge scores were 72.5 ± 10.7 and 77.7 ± 10.5 respectively, p<0.001 and 5 (of 20) item scores increased post-video viewing. HF self-care knowledge scores were not associated with distraction frequency, but scores were highest in patients without internal distractions (p = 0.025). CONCLUSION: In-hospital video education was associated with higher HF knowledge despite internal (primarily fatigue) or external (primarily nursing caregiver interruption) distractions.

Anxiety and depression moderate the relationship between quality of life and self-care in patients with heart failure.

The purpose of this study was to determine perceptions of heart failure quality of life and its relationship to self-care as moderated by anxiety and depression. Older adults (n = 85) were surveyed using Kansas City Cardiomyopathy Questionnaire-12, Self-Care of Heart Failure Index V6.2, and Patient Reported Outcomes Measurement Information System Anxiety and Depression Short Forms 4a. As quality of life and anxiety or depression scores increased jointly, their self-care management scores decreased (p < 0.001). However, higher heart failure quality of life, and lower anxiety and depression scores showed an increase in self-care management. Our findings highlight the need for nursing interventions and research targeting heart failure symptom recognition among older adults. Identification of anxiety and depression in older adults with heart failure may be an important first step for improving self-care management for this population.

Recombinant Factor VIIa in Pediatric Cardiac Surgery.

OBJECTIVES: Recombinant activated factor VIIa (rVIIa) is used off-label for refractory bleeding after cardiac surgery. This study reviewed the indications, usage rates, and complications of rVIIa. DESIGN: A retrospective case-control observational study. SETTING: A single quaternary pediatric hospital. PARTICIPANTS: All children undergoing cardiac surgery with cardiopulmonary bypass over a three-year period. INTERVENTIONS: Administration of rVIIa as rescue therapy for refractory bleeding after weaning from cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: Onethousand, five hundred fifteen cardiopulmonary bypass procedures were reviewed. Patients receiving rVIIa were each matched to two control patients by age, procedure type, and bypass time. Data collected included weight, crossclamp time, anticoagulant and antifibrinolytic dose, return to the operating room for bleeding, thrombotic events, and extracorporeal membrane oxygenation (ECMO) circuit interventions. Forty-two patients received rVIIa (2.8%). Major systemic thrombotic complications were observed in 19% (controls 12.5%) of patients; 80% of recombinant factor VIIa patients requiring postoperative ECMO had interventions for circuit thrombosis (controls 31.25%); 4.76% of rVIIa recipients required reexploration for intractable bleeding (controls 1.39%). CONCLUSIONS: This study added to understanding regarding the use of recombinant factor VIIa in pediatric cardiac surgery and reported increased thrombotic complications, especially for children who progress to ECMO. Prospective studies to better understand the pathophysiology of coagulopathy and hemorrhage in pediatric cardiac surgery and the role of hemostatic agents, such as rVIIa, are required.

Olfactory Dysfunction in Aging African American and Caucasian Men With HIV: A Pilot Study.

ABSTRACT: As people age with HIV, olfactory dysfunctions may become more pronounced, especially for African Americans who are predisposed to declines in olfaction. In this cross-sectional study, 34 middle-age and older African American and 17 Caucasian men living with HIV were administered two objective olfactory measures (UPSIT). In the Smell Threshold Test, compared to the HIV-negative age norms, adults living with HIV were significantly less able to detect a lower threshold smell. In the University of Pennsylvania Smell Identification Test, compared to the HIV-negative age norms, adults living with HIV were significantly less able to correctly identify odors; furthermore, using such norms, African Americans with HIV were less likely to correctly identify odors compared to Caucasians with HIV. Since the literature indicates that African Americans have a stronger attraction for salty and sweet foods, such olfactory dysfunction may contribute to poor eating habits, potentially predisposing this population to additional health problems.

The Relationship Among Pain Location, Complications, and Quality of Life in Individuals With Fibromuscular Dysplasia.

BACKGROUND: Fibromuscular dysplasia (FMD), a nonatherosclerotic arterial disease, can cause pain and vascular complications. The aim of this study was to examine the impact of FMD symptoms and complications on quality of life, depression, anxiety, and self-rated health. DESIGN: This was a cross-sectional, correlational study. METHODS: Participants were adults with a diagnosis of FMD. Quality of life (36-Item Short Form Health Survey), anxiety and depression (Patient-Reported Outcomes Measurement Information System [PROMIS®]), self-rated health question, and symptom/complication questionnaires were mailed to patients with FMD. Scores were compared with symptoms and complications. Multivariable linear models were fit for symptoms and survey scores. Ordinal regression was used for self-rated health. Backwards selection was run for each model. Alpha of 0.05 and 95% confidence intervals were used. RESULTS: Of the 162 (275 total; 47.8%) patients who returned surveys (156 female), 130 had carotid or vertebral artery involvement (80.2%). Migraine (p < .001), neck pain (p = .036), and flank pain (p = .025) were associated with decrease in Mental Component scores. Migraine (p = .002) and neck pain (p = .023) were associated with lower Physical Component scores. Patients reporting abdominal pain compared with those without had 4.88 points higher depression. Abdominal pain (p = .031) and pulsatile tinnitus (p = .011) were associated with greater anxiety. Migraine was associated with (p = .002) lower self-rated health. Participants with history of stroke/transient ischemic attack had 2.42 (1.08, 5.46; p = .033) times the odds of poor self-rated health compared with those without stroke/transient ischemic attack. CONCLUSIONS: Among patients with FMD, presence of pain and history of vascular complications were related to lower quality of life and self-rated health.

Relationships between physical activity, social isolation, and depression among older adults during COVID-19: A path analysis.

BACKGROUND: There are known significant relationships between greater physical activity and less depression, and greater social isolation and greater depression; therefore, it is important to understand these relationships among older adults during COVID-19. METHODS: The Physical Activity Scale for Elders, Geriatric Depression Scale, and PROMIS Social Isolation were administered. Path analysis was performed to evaluate the relationship between physical activity, social isolation, and depression. RESULTS: Of 803 surveys received, Consistent with our a-priori model, higher social isolation predicted greater depression. (p<0.001). CONCLUSION: Older adults may suffer a high emotional price during times of imposed social distancing.