Habitual physical activity patterns in a nationally representative sample of U.S. adults.

Physical inactivity is a leading determinant of noncommunicable diseases. Yet, many adults remain physically inactive. Physical activity guidelines do not account for the multidimensionality of physical activity, such as the type or variety of physical activity behaviors. This study identified patterns of physical activity across multiple dimensions (e.g., frequency, duration, and variety) using a nationally representative sample of adults. Sociodemographic characteristics, health behaviors, and clinical characteristics associated with each physical activity pattern were defined. Multivariate finite mixture modeling was used to identify patterns of physical activity among 2003-2004 and 2005-2006 adult National Health and Nutrition Examination Survey participants. Chi-square tests were used to identify sociodemographic differences within each physical activity cluster and test associations between the physical activity clusters with health behaviors and clinical characteristics. Five clusters of physical activity patterns were identified: (a) low frequency, short duration (n = 730, 13%); (b) low frequency, long duration (n = 392, 7%); (c) daily frequency, short duration (n = 3,011, 55%); (d) daily frequency, long duration (n = 373, 7%); and (e) high frequency, average duration (n = 964, 18%). Walking was the most common form of activity; highly active adults engaged in more varied types of activity. High-activity clusters were comprised of a greater proportion of younger, White, nonsmoking adult men reporting moderate alcohol use without mobility problems or chronic health conditions. Active females engaged in frequent short bouts of activity. Data-driven approaches are useful for identifying clusters of physical activity that encompass multiple dimensions of activity. These activity clusters vary across sociodemographic and clinical subgroups.

Changes in Gut Microbiome Associated With Co-Occurring Symptoms Development During Chemo-Radiation for Rectal Cancer: A Proof of Concept Study.

PURPOSE: To examine a) whether there are significant differences in the severity of symptoms of fatigue, sleep disturbance, or depression between patients with rectal cancer who develop co-occurring symptoms and those with no symptoms before and at the end of chemotherapy and radiation therapy (CRT); b) differences in gut microbial diversity between those with co-occurring symptoms and those with no symptoms; and c) whether before-treatment diversity measurements and taxa abundances can predict co-occurrence of symptoms. METHODS: Stool samples and symptom ratings were collected from 31 patients with rectal cancer prior to and at the end of (24-28 treatments) CRT. Descriptive statistics were computed and the Mann-Whitney U test was performed for symptoms. Gut microbiome data were analyzed using R's vegan package software. RESULTS: Participants with co-occurring symptoms reported greater severity of fatigue at the end of CRT than those with no symptoms. Bacteroides and Blautia2 abundances differed between participants with co-occurring symptoms and those with no symptoms. Our random forest classification (unsupervised learning algorithm) predicted participants who developed co-occurring symptoms with 74% accuracy, using specific phylum, family, and genera abundances as predictors. CONCLUSION: Our preliminary results point to an association between the gut microbiota and co-occurring symptoms in rectal cancer patients and serves as a first step in potential identification of a microbiota-based classifier.

A National Study Links Nurses' Physical and Mental Health to Medical Errors and Perceived Worksite Wellness.

OBJECTIVE: The aim of this study was to describe (1) nurses' physical and mental health; (2) the relationship between health and medical errors; and (3) the association between nurses' perceptions of wellness support and their health. METHODS: A cross-sectional descriptive survey was conducted with 1790 nurses across the U.S. RESULTS: Over half of the nurses reported suboptimal physical and mental health. Approximately half of the nurses reported having medical errors in the past 5 years. Compared with nurses with better health, those with worse health were associated with 26% to 71% higher likelihood of having medical errors. There also was a significant relationship between greater perceived worksite wellness and better health. CONCLUSION: Wellness must be a high priority for health care systems to optimize health in clinicians to enhance high-quality care and decrease the odds of costly preventable medical errors.

Comorbidities and Quality of Life among Breast Cancer Survivors: A Prospective Study.

Many breast cancer survivors have coexistent chronic diseases or comorbidities at the time of their cancer diagnosis. The purpose of the study was to evaluate the association of comorbidities on breast cancer survivors' quality of life. A prospective design was used to recruit 140 women before cancer surgery, 134 women completed the study. Comorbidities were assessed using self-report and verified by medical record review and the Charlson Comorbidity Index (CCI) before and 12-month after cancer surgery. Quality of life was evaluated using Short-Form Health Survey (SF-36 v2). Descriptive statistics, chi-square tests, t-tests, Fisher's exact test, and correlations were performed for data analysis. A total of 28 comorbidities were identified. Among the 134 patients, 73.8% had at least one of the comorbidities, 54.7% had 2-4, and only 7.4% had 5-8. Comorbidities did not change at 12 months after surgery. Numbers of comorbidities by patients' self-report and weighted categorization of comorbidities by CCI had a similar negative correlation with overall quality of life scores as well as domains of general health, physical functioning, bodily pain, and vitality. Comorbidities, specifically hypertension, arthritis, and diabetes, were associated with poorer quality of life in multiple domains among breast cancer survivors. Future research should consider the combined influence of comorbidity and cancer on patients' quality of life.

Self-management for adult patients with cancer: an integrative review.

BACKGROUND: Individuals with cancer are surviving long term, categorizing cancer as a chronic condition, and with it, numerous healthcare challenges. Symptoms, in particular, can be burdensome and occur from prediagnosis through many years after treatment. Symptom severity is inversely associated with functional status and quality of life. OBJECTIVE: Management of these millions of survivors of cancer in a stressed healthcare system necessitates effective self-care strategies. The purpose of this integrative review is to evaluate intervention studies led by nurse principal investigators for self-care management in patients with cancer. METHODS: PubMed, CINAHL (Cumulative Index to Nursing and Allied health Literature), and the Cochrane Database were searched from January 2000 through August 2012. Search terms included "symptom management and cancer," "self-management and cancer," and "self-care and cancer." All articles for consideration included intervention studies with a nurse as the primary principal investigator. RESULTS: Forty-six articles were included yielding 3 intervention areas of educational and/or counseling sessions, exercise, and complementary and alternative therapies. Outcomes were predominately symptom focused and often included functional status and quality of life. Few studies had objective measures. Overarching themes were mitigation, but not prevention or elimination of symptoms, and improved quality of life related to functional status. No one intervention was superior to another for any given outcome. CONCLUSIONS: Current interventions that direct patients in self-care management of symptoms and associated challenges with cancer/survivorship are helpful, but incomplete. No one intervention can be recommended over another. IMPLICATIONS FOR PRACTICE: Guiding patients with cancer in self-care management is important for overall functional status and quality of life. Further investigation and tailored interventions are warranted.

Therapeutic options for lowering LDL-C in type 2 diabetes: a nurse practitioner's perspective.

PURPOSE: The majority of patients with type 2 diabetes mellitus (T2DM) have multiple risk factors for cardiovascular disease (CVD). Low-density lipoprotein cholesterol (LDL-C) is a key therapeutic target to reduce CVD risk. This article reviews therapeutic strategies that nurse practitioners (NPs) may use in the management of patients with T2DM requiring lipid management. DATA SOURCES: The evidence used in developing this review included evidence-based reviews, clinical trials, guidelines, and consensus statements. Relevant publications were identified through a search of the literature using PubMed and other search engines. CONCLUSIONS: Lowering LDL-C levels may reduce CVD risk, but achieving goals can be challenging. Lifestyle modifications (including diet, exercise, and smoking cessation) are key components of lipid management and reduction of CVD risk. Statins can be effective to reduce lipids. However, patients may not achieve lipid goals with monotherapy or may experience intolerable adverse effects. Alternative statins or statins along with other lipid-lowering agents remain good options. IMPLICATIONS FOR PRACTICE: Achieving LDL-C goals requires a comprehensive treatment plan that incorporates lifestyle and pharmacologic interventions. Patient commitment in setting goals and self-management is essential. NPs can play an important role in educating patients as well as prescribing appropriate treatments.

The impact of screening for asymptomatic myocardial ischemia in individuals with type 2 diabetes.

Little is known about factors that contribute to either emotional or behavior outcomes following screening for coronary artery disease (CAD). The purpose of this prospective study was to explore these outcomes, along with potentially contributing factors in individuals enrolled in a screening trial for asymptomatic CAD. Included were 47 subjects with type 2 diabetes. Data were collected at study baseline and 3 and 6 months following entry by self-administered questionnaires and telephone follow-up. Emotional outcomes (quality of life and anxiety) tended to improve in those who underwent more aggressive screening with myocardial perfusion imaging, as well as in those who discussed the results of laboratory tests with their providers. Lower levels of diabetes competence and higher levels of controlled motivation for diet were associated with poorer emotional outcomes. Improvements in CAD risk factor behaviors were not observed.

Primary care cancer and diabetes complications screening of black women with type 2 diabetes.

PURPOSE: To determine the frequency with which Black women with type 2 diabetes receive routine primary health care screening for cancer and diabetes complications. DATA SOURCES: Pilot study data from a convenience sample of 21 Black women (mean age 46.8 years) with type 2 diabetes. CONCLUSIONS: Cancer screening consisted of Pap smear, mammography, and colon cancer screening consistent with current American Cancer Society recommendations. Ninety percent reported having had a Pap smear, 86% mammogram and 33% colon cancer screening. Diabetes complications screening was based on the American Diabetes Association care recommendations. Fifty-five percent received screening eye exams, 40% were screened for renal proteinuria, and 50% received foot examinations and diabetes foot care instruction. IMPLICATIONS FOR PRACTICE: This sample of mid-life, Black, educated, working women with type 2 diabetes utilize healthcare services and have high rates of primary care cancer screening. Rates of diabetes complications screening are less than optimal. Because Black American women suffer disproportionately high rates of diabetes and related complications, it is imperative that they receive quality diabetes care in an effort to improve health outcomes and decrease premature mortality.