The effects of residential segregation on cognition among U.S. older adults: a systematic review based on the social determinants of health model.

OBJECTIVES: This systematic review aims to advance the understanding of the complicated effects of segregation on older adults' cognition and provide guidance for future research. METHOD: A systematic review using the Social Determinants of Health framework to examine the relationship between segregation and cognition across the selected literature. RESULTS: Eight papers met the criteria for inclusion. All selected studies examined the influence of living in a segregated area on older adults' cognition, covering older adults from different racial/ethnic groups. The association between segregation and cognition was found in different directions across different racial/ethnic groups. The effects can be varied depending on race/ethnicity, level of education, neighborhood socioeconomic status, or social context. CONCLUSION: This review identified existing gaps in understanding the relationship between segregation and cognition. Future studies should carefully adopt the segregation measures, acknowledge the varying segregation experience among different racial/ethnic groups, and consider more social determinant factors in research.

Effects of hypobaric hypoxia during a simulated ultra-long-haul flight on inflammation and regeneration after muscle trauma and muscle trauma-hemorrhagic shock.

INTRODUCTION/AIMS: Because wounded warfighters or trauma victims may receive en route care to the closest medical facility via airplane transport, we investigated the effects of extended mild hypobaric hypoxia (HB), the environmental milieu of most airplanes, on inflammation and regeneration after muscle trauma or monotrauma (MT) and muscle trauma-hemorrhagic shock or polytrauma (PT). METHODS: Male C57BL/6N mice were assigned to one of six groups pertaining to injury (control/uninjured, MT, and PT) and atmospheric pressure exposure (HB and normobaric normoxia, NB). Body mass, blood and muscle leukocyte number by flow cytometry, immunohistochemistry, or both, and the muscle relative mRNA level of selected genes involved in inflammation and muscle regeneration were examined at ~1.7, 4, 8, and 14 days post trauma (dpt). At 14 dpt, the proportion of smaller- and larger-sized myofibers at the regenerating site of MT mice was determined. RESULTS: Greater body mass loss, an increased number of blood and muscle leukocytes, and differential muscle relative mRNA levels were observed in MT and PT groups compared to controls. The MT+HB or PT+HB mice demonstrated more body mass loss and altered relative mRNA level than the corresponding NB mice. Additionally, a subgroup of MT+HB mice demonstrated a greater proportion of smaller myofibers (250 to 500 µm2 ) than MT+NB mice at 14 dpt. DISCUSSION: HB exposure after muscle trauma alone may prolong regeneration. Following HB exposure, therapies that promote oxygenation may be needed during this muscle recovery.

Crush Injury and Simulated Flight Effects on Muscle Gene Expression in Female Mice.

BACKGROUND: Aeromedical evacuation provides critical care during long-distance transport of injured victims between medical facilities. Often, these victims sustain muscle trauma related to mechanical insults, such as crush. Understanding the effects of flight on injured muscle is important because the aircraft cabin represents an external environment with mild hypoxia-the cabin's altitude is 2,438 m instead of sea level. Because mild hypobaric hypoxia can alter gene expression in normal muscle and affect recovery patterns, it is beneficial to examine whether this type of hypoxia may also alter injury-related genes. OBJECTIVE: The objective of this study was to verify the hypothesis that differential gene expression occurs in response to mild hypobaric hypoxia exposure in crush-injured muscle during two early recovery (preregeneration stage) time points. METHODS: Twenty-four female mice were anesthetized, and the right gastrocnemius muscle underwent crush injury. Approximately 24 hours later, mice were exposed to normobaric normoxia or hypobaric hypoxia for 8-9 hours. After 32 or 48 hours of recovery, the mice were euthanized, and the right and left lateral gastrocnemius muscles were collected for microarray and bioinformatics analyses. RESULTS: The study hypothesis was verified. There were 353 highly upregulated, differentially expressed genes identified in the injured muscle compared to the uninjured muscle. Mid1 was upregulated in both pressure conditions regardless of injury status. There were 52 and 15 differentially expressed genes at 32 and 48 hours postinjury, respectively, in the hypobaric hypoxia-exposed, injured muscle compared to the normobaric normoxia-exposed, injured muscle. The macrophage gene Cd68 correlated with other leukocyte-related genes. DISCUSSION: These findings expand our understanding of the genetic changes that occur in muscle in response to a crush injury, including those related to the macrophage protein CD68. Nursing interventions addressing adequate functioning after crush muscle injury may need to consider the effects on Cd68 and its closely related genes. In addition, our results suggest a responsiveness of the gene Mid1 to flight-relevant hypobaric hypoxia. Changes in the expression of Mid1 may be appropriate in assessing the long-term health of flight crew members.

Feasibility of Lantern Using WhatsApp to Improve Antiretroviral Therapy Adherence.

This pilot study tested the feasibility of Lantern program, an adherence program to HIV medications using WhatsApp, a secure social media messaging application from Meta, for a smartphone-based platform to enhance medication-taking adherence of antiretroviral therapy among people living with HIV in Indonesia. Thirty participants were recruited for this 8-week study. We recruited persons if they had taken antiretroviral therapy for at least 3 months prior to the study, had a smartphone, Internet access, and could use Lantern with WhatsApp. Here, we report the results from the focus group discussions, with the participants evaluating the qualitative aspects of the experiences. The WhatsApp platform was found to be safe, practical, and relatively inexpensive and provided confidentiality for the participants. Three themes emerged from the focus groups: the study motivated participants to take their antiretroviral therapy medications on time, they still set medication reminder alarms, and being in the study made them feel supported. The Lantern program indicated good feasibility and acceptability for adherence to antiretroviral therapies among people living with HIV. Future research should examine on how community organizations and healthcare providers can take advantage of the WhatsApp program to improve adherence to antiretroviral therapies.

Strategies to enhance the success of mid-career nurse scientists.

BACKGROUND: The mid-career nurse scientist, defined as an associate professor with/without tenure, is often faced with a multitude of challenges and opportunities PURPOSE: This paper shares strategies to assist mid-career scientists as they juggle required career demands and navigate the mid-career phase in pursuit of the rank of full professor. METHOD: A review of the literature was performed on mid-career nurse scientists. DISCUSSION: A combination of increased research responsibilities, increased institutional teaching and service demands, and dwindling support can result in a sense of overwhelm and burnout. The mid-career nurse scientist must balance several balls in the air at one time to remain successful. CONCLUSION: Strategies aligned with the Ecological Framework, focus on intrapersonal, interpersonal, institutional, organizational, and public policy domains to provide a wide scope of strategies that target the mid-career scientist and engage the larger nursing community.

Classifying stigma experience of women living with HIV in Indonesia through the social ecological model.

Little is known how stigma theories apply to women living with HIV (WLWH). To apply stigma theories to WLWH, and locate within the dimensions of the Social-Ecological Model (SEM). Using a literature review and a theoretical subtraction to apply stigma forms to the SEM dimensions. WLWH begin to self-stigmatize, receive stigma based on fear from the family and community. Healthcare providers and society stigmatize WLWH by ascribing character flaws to them. The SEM allowed us to locate the dimensions of stigma and identify areas for future interventions for WLWH in Indonesia and other countries.

Sleep and immune function among people living with human immunodeficiency virus (HIV).

People living with HIV are at increased risk for sleep disturbances. Up to 75% of the HIV-infected individuals in the United States experience sleep disturbances of some kind. Previous studies have suggested an association between patient-reported sleep disturbances and impaired immune function. This study evaluates data obtained via sleep actigraphy to evaluate the relationship between objectively measured sleep, HIV viral load, and immune function. While this study found no relationship between objective sleep and CD4+ T- lymphocyte count, higher sleep efficiency was weakly correlated with lower HIV viral loads, τb(93) = -.165, p = .043. More research is warranted to clarify the nature of these relationships.

Effectiveness of pictographs in improving patient education outcomes: a systematic review.

The objective of this review was to investigate process of pictograph development and the effectiveness of pictographs in patient education. We conducted searches in Medline/PubMed, CINAHL with full text, PsycInfo, ERIC and Cochrane Library with keywords: (pictograph or pictorial) AND (patient education) NOT (children or adolescent or youth or child or teenagers). After excluding manuscripts that did not meet inclusion criteria, 56 articles were included between the time of the last review on this topic (January 2008) and May 2019. There are 17 descriptive studies, 27 randomized control trial studies, 9 quasi-experimental studies and 2 unique literatures in the systematic review. Major goals of the studies are pictograph development or validation. The majority of manuscripts (n = 48) supported the approach. However, six studies did not find significant differences in the outcome. Differences in patient population, pictograph designs and author-developed outcome measurements made it difficult to compare the findings. There is a lack of evidence on validating information outcome measurements. This review demonstrated that implementing pictographs into patient education is a promising approach for better information understanding and health management. Pictographic interventions need to be carefully developed and validated with both the targeted patient population and the clinical experts.

Current status and future directions of U.S. genomic nursing health care policy.

BACKGROUND: As genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing's holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care. PURPOSE: To examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation. METHODS: We conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health. FINDINGS: Genomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed. DISCUSSION: Nine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas. CONCLUSIONS: To advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.

Towards a definition of male partner involvement in the prevention of mother-to-child transmission of HIV in Uganda: a pragmatic grounded theory approach.

BACKGROUND: Male partner involvement has been shown to increase mothers' uptake of Prevention of Mother-to-Child Transmission of HIV (PMTCT) and improve maternal and infant HIV treatment outcomes. Currently, male involvement in PMTCT is measured primarily through men's attendance at HIV testing and counselling which may not be a true reflection of their engagement. This study therefore set out to explore the meaning of male partner involvement and propose a definition and theoretical model of this concept in PMTCT in Uganda. METHODS: Eight focus group discussions and five in-depth interviews were conducted with couples at three public health facilities and community members in the health facility catchment areas in Uganda. The study employed a grounded theory approach underpinned by the pragmatic philosophical paradigm. Data were analyzed using the constant comparative method, performing three levels of open, axial, and selective coding. RESULTS: Of the 61 participants, 29 (48%) were male and the majority 39 (63.9%) were in long term marital relationships, while about half were self-employed 29 (47.5%). Three themes emerged for the meaning of male involvement in PMTCT (a) HIV treatment support (b) economic support and (c) psychosocial support. HIV treatment support included adherence support, couples' HIV counseling and testing, and clinic attendance during and after pregnancy. Participants expressed that men were engaged in PMTCT when they offered economic support by providing basic needs and finances or when they included their female partners in financial planning for the family. Psychosocial support arose from the female participants who defined male involvement as family support, perceived societal recognition and emotional support. Emotional support also included the absence of harm resulting from women's disclosure of HIV test results to their male partner. CONCLUSIONS: This study proposes a new definition for male partner involvement in PMTCT in Uganda. The definition extends beyond men's clinic attendance and HIV testing and counselling. Further research should seek to develop and validate tools to accurately measure male partner involvement as the next step in the development of interventions to improve PMTCT outcomes.

Factors influencing sexual risk behaviors among adolescents: A community-based participatory study.

Pregnancy rates and unprotected sex among Thai adolescents continue to increase. The aim of this community-based participatory study was to identify gender differences in sexual behaviors and sexual risk factors, and to examine factors associated with sexual risk behaviors among 397 adolescents in northern Thailand. Twenty two community researchers facilitated the data collection by using smart phones or tablet computers on a privacy basis. Ordinal and logistic regressions identified predictors influencing pre-coital behaviors and sexual behaviors. The results showed that males were more likely than females to engage in pre-coital and sexual behaviors. Significant predictors of higher pre-coital behaviors were age, sexual refusal self-efficacy, having boyfriends/girlfriends, authoritarian parenting style, parental approval of sex, and perceived peer norms. Pre-coital behaviors were positively correlated with sexual behaviors, and significant predictors of sexual behaviors were age, parent-adolescent communication, parental monitoring, perceived peer norms, and type of school. To better address the sexual risk behaviors of adolescents, we need to include key stakeholders to develop multi-modal culturally- and gender-specific sexual-prevention programs to account for information delivery, acceptability, and dealing with peer pressure.

Fatigue in Individuals with End Stage Renal Disease.

Fatigue is a subjective overwhelming feeling of tiredness at rest, exhaustion with activity, lack of energy that impedes daily tasks, lack of endurance, or a loss of vigor. Individuals with end stage renal disease (ESRD) experience a high rate and severity of fatigue. Symptom management of fatigue in this population is critical, since fatigue has been linked with lower quality of life and higher mortality rates. In this article, we present a definition and overview of fatigue, a review of factors contributing to fatigue, and ways to manage fatigue in individuals with ESRD.

Brief Behavioral Treatment for Insomnia in Persons Living with HIV.

This study examined the feasibility and preliminary efficacy of brief behavioral treatment for insomnia (BBTI) for persons living with HIV (PLWH). Of the 22 persons enrolled, 9 were lost before starting treatment, and one dropped out after starting BBTI. Acceptability was rated favorably by those completing the treatment (n = 12). The most common problems pertained to sleep hygiene: variable bedtimes and rise times, watching television, or consuming caffeine. Improvements on sleep outcomes at posttreatment were clinically and statistically significant on questionnaire and sleep diary outcomes. This study supports the overall feasibility of BBTI in PLWH, and the preliminary evidence supports further research on this treatment for PLWH who have insomnia, but dropouts indicate that some individuals may have difficulty initiating treatment.

Time Course of Inflammatory Gene Expression Following Crush Injury in Murine Skeletal Muscle.

BACKGROUND: Early inflammation and secretion of proinflammatory cytokines such as IL-1ß, IL-6, and TNF-α act as the key drivers to regulate inflammation after muscle injury. However, the effects of these key proinflammatory drivers in a noninvasive crush injury model are not well known. Understanding these effects is important for treating crush injuries that occur during natural disasters and military conflicts. PURPOSE: We studied the timed mRNA expression of IL-1ß, IL-6, and TNF-α in a noninvasive murine crush injury model to further understand their impact on proinflammatory cytokine pathways that are activated within the first 48 hours after a crush muscle injury. METHODS: A total of 25 mice were anesthetized and placed on a crush injury apparatus platform with the apparatus piston situated in direct contact with intact skin overlying the right gastrocnemius muscle. Pressure at 45 psi was applied to the piston for 30 seconds for two applications. The mice recovered for either 4, 8, 24, or 48 hours postinjury, after which we harvested the gastrocnemius muscle of both legs. Microarray, confirmatory real-time polymerase chain reaction, and immunolabeling experiments were followed by a microarray time-course analysis. RESULTS: Muscle IL-1ß mRNA rose 270-fold within 4 hours and declined rapidly at 8 hours to 196-fold, 24 hours to 96-fold, and 48 hours to 10-fold. Muscle IL-6 followed the same pattern, with a 34-fold increase at 4 hours, 29-fold increase at 8 hours, 10-fold increase at 24 hours, and 5-fold increase at 48 hours. Ingenuity Pathway Analysis of IL-6 identified activation of two major downstream signaling pathways (IL-6/Stat3 and IL-1ß/Egr1) as key activators of inflammation, regeneration, and fibrosis. DISCUSSION: Closed crush muscle injury produced robust muscle cytokine expression levels, and the microarray findings allowed us to generate our most novel hypothesis: that high expression of IL-1ß, IL-6, and TNF-α may be related to the downregulation of mitochondrial genes early after injury and triggers activation of genes in the repair and fibrosis machinery. The significance of these findings and the identified expression pathways of IL1-ß, IL-6, and TNF-α and their downstream targets in skeletal muscle will allow us to further investigate targets for improved muscle recovery and limb-saving interventions.

Training tomorrow's leaders in global health: impact of the Afya Bora Consortium Fellowship on the careers of its alumni.

BACKGROUND: Effective leadership is a cornerstone of successful healthcare delivery in resource limited settings throughout the world. However, few programs in Africa prepare healthcare professionals with the leadership skills vital to the success of the healthcare systems in which they work. One such program, the Afya Bora Consortium Fellowship in Global Health Leadership, has been training health professionals since 2011. The purpose of this study was to assess what career changes, if any, the Afya Bora Fellowship's alumni have experienced since completing the fellowship, and to describe those changes. METHODS: The Afya Bora Fellowship is a multidisciplinary, one-year training program that teaches health professionals leadership skills through didactic and experiential learning in four African countries. Between January 2011 and June 2013 the consortium trained 42 nurses and doctors. In November 2013, an electronic survey was sent to all alumni to assess their performance in the workplace post-fellowship. RESULTS: Thirty-one (74 %) of 42 alumni completed surveys. Twenty-one (68 %) reported changes to their position at work; of those, sixteen (76 %) believed the change was due to participation in the fellowship. All alumni reported improved performance at work, and cited the application of a wide range of fellowship skills, including leadership, research, communication, and mentoring. Twenty-six (84 %) alumni spearheaded improvements in their workplaces and almost all (97 %) remained in contact with colleagues from the fellowship. Among the respondents there were five publications, nine manuscripts in preparation, and three international conference presentations. CONCLUSIONS: Afya Bora alumni overwhelmingly reported that the one year fellowship positively influenced both their work and career trajectory. Training health professionals in leadership skills through didactic modules with the opportunity to apply learned skills at attachment sites in the Afya Bora Fellowship has an impact on performance in the workplace and the potential to improve long-term institutional capacity.

An Integrative Review of Social Determinants of Glycemic Targets Achievement in Adults with Type 2 Diabetes in the United States.

Several individual social determinants of health have been identified as significant factors contributing to achieving glycemic targets (glycated hemoglobin < 7). However, it remains unclear how these social variables individually or collectively contribute to glycemic targets among adults with type 2 diabetes (T2D) in the United States (U.S.) The purpose of the current integrative review (IR) was to describe and synthesize findings from studies on social determinants of glycemic target achievement in adults with T2D in the U.S. and integrate them into the United States Department of Health and Human Services Conceptual Framework. The databases searched included PubMed, CINAHL Plus with Full Text, Medline with Full Text [EBSCO], Google Scholar, bibliography, and hand searching. A total of 948 records were identified. After excluding duplicates and irrelevant studies based on inclusion and exclusion criteria through title, abstract, and full-text screening, 13 studies were finally included in this IR. The results revealed that race/ethnicity, economic access and stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context contribute to glycemic target achievement among adult patients with T2D in the U.S. Integrating findings from key studies on social determinants of glycemic health may contribute to developing interventions aimed at reducing and eventually eradicating health disparities for individuals with and at risk for T2D in the U.S.

Effect of exercise on cardiac and metabolic outcomes in people living with HIV.

Poorly controlled HIV infection and antiretroviral therapy, especially the use of protease inhibitors, are among the causes that contribute to the development of cardiovascular disease in people living with HIV (PLWH). Poor lifestyle choices (smoking, lack of physical activity, poor diet) and individual factors such as high stress, physical or emotional trauma, depression, and so forth contribute to the overall risk of developing cardiovascular disease. The purpose of this review was to critically evaluate the more recent aerobic and resistance exercise studies and their impact on cardiovascular and metabolic risk factors in PLWH.

Simulated flight, muscle genetics, and inflammatory indicators in mice.

INTRODUCTION: Skeletal muscle discomfort commonly occurs during long-distance air travel. Although the effects of high altitude on muscle have been well-studied, the effects of short-term exposure to the altitude at which aircraft cabins are pressurized, 2438 m, have not. The primary aim of this study was to examine global gene expression in the gastrocnemius muscle after simulated flight. Inflammatory indicators were also assessed in the muscle. METHODS: Thirty-five mice were evenly exposed to normobaria or hypobaria (2438 m) for -8-9 h. Microarray and ribonucleic acid (RNA) analyses were performed. Additionally, macrophage and neutrophil presence was examined. RESULTS: Fourteen genes were downregulated in females after hypobaria. These genes included those related to epithelial homeostasis, such as the keratins, and genes activated by cellular insult. In contrast, four noncoding, regulatory RNAs were upregulated in males. No difference in proinflammatory cytokine gene and messenger RNA (mRNA) expression was detected between normobaria and hypobaria. The mean number of CD68-positive leukocytes per mm2 and mean area percentage of the CD68 antigen in muscle of normobaric (NB) and hypobaric (HB) mice were 53-54 and -0.2%, respectively. DISCUSSION: Simulated flight does not activate a proinflammatory response in healthy muscle. However, epithelial and cellular defense genes may be downregulated in females, whereas regulatory RNAs may be upregulated in males.

HIV infection and antiretroviral therapy have divergent effects on mitochondria in adipose tissue.

BACKGROUND: Although human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) affect mitochondrial DNA (mtDNA) content and function, comprehensive evaluations of their effects on mitochondria in muscle, adipose tissue, and blood cells are limited. METHODS: Mitochondrial DNA quantification, mitochondrial genome sequencing, and gene expression analysis were performed on muscle, adipose tissue, and peripheral blood mononuclear cell (PBMC) samples from untreated HIV-positive patients, HIV-positive patients receiving nucleoside reverse transcriptase inhibitor (NRTI)-based ART, and HIV-negative controls. RESULTS: The adipose tissue mtDNA/nuclear DNA (nDNA) ratio was increased in untreated HIV-infected patients (ratio, 353) and decreased in those receiving ART (ratio, 162) compared with controls (ratio, 255; P < .05 for both comparisons); the difference between the 2 HIV-infected groups was also significant (P = .002). In HIV-infected participants, mtDNA/nDNA in adipose tissue correlated with the level of activation (CD38+ /HLA-DR+) for CD4+ and CD8+ lymphocytes. No significant differences in mtDNA content were noted in muscle or PMBCs among groups. Exploratory DNA microarray analysis identified differential gene expression between patient groups, including a subset of adipose tissue genes. CONCLUSIONS: HIV infection and ART have opposing effects on mtDNA content in adipose tissue; immune activation may mediate the effects of HIV, whereas NRTIs likely mediate the effects of ART.

How do the Social Determinants of Health Impact the Post-Acute Sequelae of COVID-19: A Critical Review.

The review critically analyzes the social determinants of health (SDOH) variables in the current literature of patients with post-acute sequelae (PASC) of COVID-19 in the United States. Race, gender, and age were discussed as well as health outcomes, severity of illness, and phenotypes of long-COVID. Most research was retrospectively with samples that had access to health insurance, which did not capture populations with poor or no access to health care. More research is needed that directly addresses the impact on SDOH on PASC. The current literature is sparse and provides little actionable information.