Telehealth during the pandemic: Patient perceptions and policy implications.

INTRODUCTION: Telehealth's potential to improve access to specialty health care, increase favorable patient outcomes, and save money demands attention. Unfortunately, patients often fail to embrace telehealth. The COVID-19 pandemic fueled greater telehealth usage globally. Little is known about patient perceptions of telehealth in the context of a pandemic. Therefore, we sought to understand patient perceptions of telehealth during the COVID-19 pandemic and explore relevant policy implications. DESIGN: Researchers used a cross-sectional, non-experimental design to survey 366 patients across two telehealth programs at a Mississippi academic health sciences center between November 1, 2021 and November 15, 2021. METHODS: As part of a larger, psychometric study on patient acceptance of telehealth, participants rated the item, "The COVID-19 pandemic has made me more open to using telehealth" on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Means of the different groups were analyzed using independent t-test and one-way ANOVA with Bonferroni post-hoc multiple comparisons. RESULTS: Of the total participants, 73% (n = 366) either agreed or strongly agreed that the COVID-19 pandemic had made them more open to using telehealth. Significant differences existed by age (p = 0.016), race/ethnicity (p = 0.015), and sex (p < 0.001), however, groups did not differ by age during post-hoc analysis. A significant difference in the mean responses was observed between black participants (M = 4.29) and white participants (M = 3.91; p = 0.011). In addition, female participants (M = 4.11) rated the item higher than male participants (M = 3.65). CONCLUSION: As access to telehealth increased due to the COVID-19 pandemic, patients' perceptions to telehealth seem to have shifted in the positive direction as well. Findings may be used to support expansion of telehealth and advocacy for patients in a variety of settings. CLINICAL RELEVANCE: Study findings indicate that participants of telehealth are more open to using telehealth due to the COVID-19 pandemic. Implementing telehealth should be a priority to increase access to care for those who have limited access to specialty care, and policymakers should advocate to decrease barriers to telehealth within their institutions.

The Association Between Cardiovascular Health with Internet and Mobile Technology Use Among Jackson Heart Study Participants.

Background: Although studies have examined if the internet and mobile technology (IMT) can support cardiovascular health (CVH) self-management and health information-seeking efforts, limited studies have targeted African American communities. This study analyzes a possible association between CVH and IMT use and if socioeconomic status is linked to this relationship among older, African Americans in the Jackson Heart Study (JHS). Methods: This analysis uses JHS data from three time points: Examination 1 (2000-2004), Examination 3 (2009-2013), and the Digital Connectedness Survey (2017-2019). Participants completed measures of CVH (the American Heart Association's Life Simple 7 [LS7]), IMT use, and demographic characteristics via telephone interview. Both multivariable logistic and linear regression analyses were conducted to analyze the relationship between the LS7 composite and component scores (representing CVH) and IMT use. Results: Fifty eight percent of participants were 60 or older; 64% were women. Overall, 2,255 (88%) of participants were IMT users. Generally, no association was found when analyzing LS7 composite scores and IMT use except for the association between LS7 composite scores and use of other smart devices (p = 0.01). However, having ideal blood pressure, body mass index, and cholesterol had positive associations with using technology to track health (p = 0.003, p = 0.004, p = 0.052, respectively), and having ideal physical activity was positively associated with using smart devices (p = 0.012). Conclusions: No association was found between LS7 composite scores and IMT use. However, there were associations between individual LS7 metrics, IMT use, and IMT use characteristics. More research should be done to continue assessing the feasibility of using IMT for CVH self-management among older African Americans.

Digital Connectedness in the Jackson Heart Study: Cross-sectional Study.

BACKGROUND: Although new approaches for data collection, such as mobile technology and teleresearch, have demonstrated new opportunities for the conduct of more timely and less costly surveys in community-based studies, literature on the feasibility of conducing cardiovascular disease research using mobile health (mHealth) platforms among middle-aged and older African Americans has been limited. OBJECTIVE: The purpose of this study was to contribute to the knowledge regarding the penetrance of internet and mobile technologies, such as cellphones or smartphones in existing large cohort studies of cardiovascular disease. METHODS: A digital connectedness survey was conducted in the Jackson Heart Study (JHS), a Mississippi-based African American cohort study, as part of the annual follow-up calls with participants from July 2017 to February 2019. RESULTS: Of the 4024 participants contacted, 2564 (63.7%) completed the survey. Among survey respondents, 2262 (88.2%) reported use of internet or cellphone, and 1593 (62.1%) had a smartphone. Compared to nonusers (n=302), internet or cellphone users (n=2262) were younger (mean age 80.1, SD 8.0 vs 68.2, SD 11.3 years), more likely to be affluent (n=778, 40.1% vs n=39, 15.4%), and had greater than high school education (n=1636, 72.5% vs n=85, 28.1%). Internet or cellphone users were less likely to have cardiovascular disease history compared to nonusers (136/2262, 6.6% vs 41/302, 15.8%). The prevalence of current smoking and average BMI were similar between internet or cellphone users and nonusers. Among internet or cellphone users, 1316 (58.3%) reported use of email, 504 (22.3%) reported use of apps to track or manage health, and 1269 (56.1%) expressed interest in using JHS-developed apps. CONCLUSIONS: Our findings suggest that it is feasible to use mHealth technologies to collect survey data among African Americans already enrolled in a longitudinal study. Our findings also highlight the need for more efforts to reduce the age and education divide in access and use of internet and smartphones for tracking health and research in African American communities.

Design, synthesis, and evaluation of chiral thiophosphorus acids as organocatalysts.

A series of P-stereogenic chiral phosphorus acids (CPAs) were synthesized to determine the requirements for efficient asymmetric organocatalysis. In order to eliminate the need for C 2-symmetry in common CPAs, various scaffolds containing C 1-symmetrical thiophosphorus acids were chosen. These new compounds were synthesized and evaluated in the asymmetric transfer hydrogenation of 2-phenylquinoline. Although the efficacy of the thiophosphorus acids was disappointing for this reaction, the work should be useful for developing structural design elements.

The Impact of Transition Readiness and Stress on Patient-Centered Outcomes in Young Adults With Inflammatory Bowel Disease.

Young adults, 18-35 years of age, account for nearly half of all inflammatory bowel disease emergency department visits annually, costing millions of healthcare dollars and signifying undue pain and suffering. To mitigate this sequela, the study aimed to characterize the relationships between transition readiness (self-management ability), stress, and patient-centered outcomes. Outcomes were defined as disease activity and inflammatory bowel disease-related healthcare utilization (emergency department visits and inpatient hospitalization). This was a descriptive, correlational design via online survey of young adults with inflammatory bowel disease. Participants (n = 284) utilized an estimated 2.77 million healthcare dollars in 12 months. Transition readiness decreased the odds of having consistently active disease and healthcare utilization, with adjusted odds ratio ranging from 6.4 to 10.9 (p < .05). Higher stress levels increased the odds of having consistently active disease and healthcare utilization, with adjusted odds ratio ranging from 9.5 to 10.5 (p < .0001). Twenty-five percent (24.7%) of the variation in transition readiness was explained by changes in stress (p < .0001). Transition readiness and stress impacted all patient-centered outcomes. Stress negatively impacted transition readiness. These results are powerful reminders for healthcare providers to assess and treat stress and support transition readiness in young adults with inflammatory bowel disease. The potential to decrease pain, suffering, and healthcare cost is enormous.

Evaluation and Development of Methodologies for the Synthesis of Thiophosphinic Acids.

Thiophosphorus acids R1R2P(S)OH constitute an important class of organophosphorus compounds, in which the phosphorus atom is intrinsically chiral if R1 ≠ R2. In connection with a project aimed at the preparation of chiral thiophosphorus acids, various available literature methods were considered, but few fit the requirement of odorless reagents. Herein, the results of our studies on the synthesis of thiophosphinic acids are reported. Ultimately, two major approaches were selected: (1) the Stec reaction of phosphorus amides with carbon disulfide; and (2) the one-pot synthesis of thiophosphorus acids from H-phosphinates, an organometallic nucleophile, and quenching with elemental sulfur. An application to the preparation of a potential chiral phosphorus organocatalyst is also reported.

Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study.

BACKGROUND: Non-adherence to medications is common and leads to suboptimal outcomes. Non-adherence can be intentional (e.g., deciding to skip dosages) or unintentional (e.g., forgetting), yet few studies have distinguished these reasons. An improved understanding of the reasons for non-adherence could inform the development of effective interventions. METHODS AND RESULTS: We analyzed data from African Americans in the Jackson Heart Study who were prescribed medications for one or more chronic conditions. Participants were grouped by patient-reported adherence with non-adherence categorized as being intentional, unintentional or both. We used modified Poisson regression models to examine the factors associated with types of non-adherence. Of 2933 participants taking medication, 2138 (72.9%) reported non-adherence with 754 (35.3%) reporting only unintentional non-adherence, 263 (12.3%) only intentional non-adherence, and 1121 (52.4%) both. Factors independently associated with intentional non-adherence included female sex and depressive symptoms while factors associated with unintentional non-adherence included younger age and separated relationship status. Unintentional and intentional non-adherence was more common among participants taking anti-arrhythmic and anti-asthmatic medications, respectively. Higher levels of global perceived stress was associated with both types of non-adherence. The adjusted models for intentional and unintentional non-adherence had c-statistics of 0.65 and 0.66, respectively, indicating modest discrimination. CONCLUSION: Specific patient factors and individual medication classes were associated with distinct patterns of intentional and unintentional non-adherence, yet the overall modest discrimination of the models suggests contributions from other unmeasured factors. These findings provide a construct for understanding reasons for non-adherence and provide rationale to assess whether personalized interventions can improve adherence.

Perceived Discrimination and Reported Trust and Satisfaction with Providers in African Americans: The Jackson Heart Study.

OBJECTIVES: 1) To examine the association of multiple dimensions of discrimination with reported trust and satisfaction with providers; 2) to report within-group differences among African Americans (AAs). MAIN MEASURES: Measures of perceived discrimination included everyday, lifetime, burden from lifetime discrimination, and stress from discrimination. Outcomes included trust and satisfaction with providers. METHODS: Descriptive cross sectional study. The study population included AAs aged 35 to 84 years from the Jackson Heart Study (JHS) (N=5,301). Poisson regression (PR) was used to quantify the association between perceived discrimination and reported trust and satisfaction with providers before and after controlling for selected characteristics. RESULTS: The mean everyday discrimination score was 2.11 (SD±1.02), and the mean lifetime discrimination score was 2.92 (SD±2.12). High (vs low) levels of everyday discrimination were associated with a 3% reduction in the prevalence of trust in providers (PR .97, 95% CI .96, .99) in all models. In fully-adjusted models, high (vs low) lifetime discrimination was associated with a 4% reduction in the prevalence of trust and satisfaction (PR .96, 95% CI .95, .98). Burden of discrimination was not associated with trust or satisfaction, but stress from discrimination was inversely associated with satisfaction. CONCLUSIONS: The significant association between discrimination and mistrust and dissatisfaction suggests that health care providers should be made aware of AA perceptions of discrimination, which likely affects their levels of trust and satisfaction.

Assessing knowledge of Sudden Infant Death Syndrome among African American women in two Mississippi communities.

PURPOSE: Sudden Infant Death Syndrome (SIDS) is the third leading cause of Mississippi infant mortality with nonwhite infants dying of SIDS at two to three times the rate of white infants. The purpose of this study was to assess the level of SIDS related knowledge among African American women in two geographical areas of Mississippi and gain insight on improving methods for SIDS education and outreach. DESIGN: An African American faculty was contracted to conduct six focus groups among African American women (n = 57) in two geographical areas of the state. FINDINGS: Themes were common among participants from both the metropolitan and rural Delta communities. Participants in both geographical areas were familiar with [or at least had previously heard] the term SIDS. Unfortunately, there was inconsistency among participants as to the source of information. Given the inconsistencies, it is not surprising that overall knowledge related to SIDS was incomplete and in some cases inaccurate. DISCUSSION/CONCLUSION: Some information regarding SIDS is available in the various communities. Unfortunately, the information is not fully understood and is not consistently distributed resulting in a lack of knowledge among these women and thus, a continued risk for high rates of SIDS events in Mississippi.

Race, stability of health insurance coverage, and prescription medication use.

OBJECTIVE: To determine the effects of health insurance and race on prescription medication use and expense. METHODS: An observational, non-experimental design was used. Multivariable regression analyses were conducted to evaluate the independent effects of health insurance status and race on prescription medication use and expense while controlling for sociodemographic, geographic, and health status characteristics. The sample consisted of 19,035 participants in the 1996 through 2003 Medical Expenditure Panel Survey. FINDINGS: European Americans spent about $300 to $400 more and used three to four more prescriptions annually compared to other racial groups. Prescription medication expenses increased as time spent uninsured increased. Participants with part-year coverage filled four fewer prescriptions than those with full-year health insurance coverage. Participants with private coverage spent less on prescription medications compared to those with public and those with dual public and private coverage ($1,194 vs. $1,931 and $2,076, respectively; p < or = 0.001). CONCLUSIONS: Significant racial and health insurance status disparities in prescription medication use and expenses exist after controlling for sociodemographic, geographic, and health status characteristics.

Stemming the tide of childhood obesity in an underserved urban African American population: a pilot study.

Recent data indicate that Americans are gaining weight at an alarming rate. It is estimated that over 12 million American children ages 2-19 years are overweight, with African American (AA) children comprising 20% of this cohort. The problem of obesity appears to be more prominent in some southern states. According to a new report by the Trust for America's Health, Mississippi has the 1st highest rate of adult obesity and the 8th highest rate of overweight youth ages 10-17 nationwide. The Kids for Healthy Eating and Exercising (KHEE) club was a model developed in the North Midtown area of Jackson, Mississippi. The purpose of this project was to develop the first weight control program and model specifically designed for AA children in the North Midtown area of the city of Jackson. This program devised measures to effectively enhance the lifestyle changes of selected obese children representing the target population. Results of the pilot project revealed the following changes among all participants: a decrease in body mass index (BMI); a decrease in waist girth of greater than 4 inches; and positive behavioral changes as documented in the daily entries of the participants' food journal.

Effectiveness of dietary inorganic nitrate for lowering blood pressure in hypertensive adults: a systematic review.

OBJECTIVE: The objective of this review was to evaluate the effectiveness of inorganic nitrate on blood pressure in hypertensive adults. INTRODUCTION: Hypertension is associated with increased risk of morbidity and mortality in adults. Inorganic nitrate could be beneficial for lowering blood pressure and reducing cardiovascular disease risks. Evidence related to the treatment of hypertension through sources of inorganic nitrate has been presented. INCLUSION CRITERIA: The review considered studies on adults aged 18 years and over, with blood pressure greater than 120/80 mmHg, undergoing interventions focusing on the effects of inorganic nitrate on blood pressure. Studies that included inorganic nitrate intake via dietary modification, in the form of a dietary supplement, and/or by the consumption of beetroot juice were considered. The comparator was no intervention of inorganic nitrate; different dosage, frequency, duration of inorganic nitrate; and other interventions that are administered to reduce and manage blood pressure. The primary outcomes were systolic and diastolic blood pressure effects. Experimental, quasi-experimental, analytical observational and pilot study designs were considered for inclusion. METHODS: Databases were searched for published and unpublished studies, available in English, from January 2013 to January 2018. Critical appraisal was conducted using standardized instruments from the Joanna Briggs Institute (JBI) and the methodological quality of included studies was considered to be moderate. Data were extracted using the JBI data extraction instrument. Data were presented in a narrative form due to the heterogeneity of included studies. RESULTS: Twelve papers were included in the systematic review with a total of 321 participants. Ten were randomized controlled trials and two were quasi-experimental studies. All participants had baseline blood pressures greater than 120/80 mmHg. Some studies included participants with comorbidities such as diabetes or heart failure with preserved ejection fraction. Inorganic nitrate was administered multiple ways throughout the studies including the following: beetroot juice, beetroot gel, nitric oxide lozenge, high nitrate diet, and raw and cooked beet juice. Doses and treatment intervals varied. Some studies included exercise as part of the intervention protocol.Meta-analysis was not conducted due to heterogeneity that existed within the studies. Blood pressure was measured in multiple settings by manual, digital or ambulatory means. The noted outcome patterns were as follows: no change in systolic blood pressure and diastolic blood pressure, decrease in systolic blood pressure and diastolic blood pressure, or decrease in systolic blood pressure with no change in diastolic blood pressure. Possible reasons for the diverse findings include the following: age, comorbidities, use of antihypertensives by participants; source and dose of nitrate; and intervention and follow-up time frames. CONCLUSIONS: There is insufficient evidence to support or refute the use of inorganic nitrate for any effect on blood pressure at this time. Therefore, there is no concrete base for the development of practice guidelines until stronger evidence becomes available. The gaps in the literature along with the study limitations identified necessitate the need for more research on inorganic nitrate and how it relates to blood pressure.

The I-PASS mnemonic and the occurrence of handoff related errors in adult acute care hospitals: a systematic review protocol.

REVIEW QUESTION: What is the effectiveness of the I-PASS mnemonic in reducing handoff related errors during inter- or intrahospital transfers for hospitalized patients?The objective of this systematic review is to identify the impact of the I-PASS mnemonic during hospitalized patient inter- or intrahospital transfers on medication errors, transfer delays, treatment delays and mortality.More specifically, the objective is to identify the effect that the I-PASS mnemonic has on handoff related errors during inter or intrahospital patient transfers by comparing rates pre and post I-PASS implementation.

Effectiveness of dietary inorganic nitrate in lowering blood pressure in hypertensive adults: a systematic review protocol.

REVIEW QUESTION: The question of this review is: what is the effect of dietary inorganic nitrate on blood pressure in adults with blood pressure >120/80mmHg?

Cardiovascular Disease Burden and Socioeconomic Correlates: Findings From the Jackson Heart Study.

BACKGROUND: Black persons have an excess burden of cardiovascular disease (CVD) compared with white persons. This burden persists after adjustment for socioeconomic status and other known CVD risk factors. This study evaluated the CVD burden and the socioeconomic gradient of CVD among black participants in the JHS (Jackson Heart Study). METHODS AND RESULTS: CVD burden was evaluated by comparing the observed prevalence of myocardial infarction, stroke, and hypertension in the JHS at baseline (2000-2004) with the expected prevalence according to US national surveys during a similar time period. The socioeconomic gradient of CVD was evaluated using logistic regression models. Compared with the national data, the JHS age- and sex-standardized prevalence ratios for myocardial infarction, stroke, and hypertension were 1.07 (95% CI, 0.90-1.27), 1.46 (95% CI, 1.18-1.78), and 1.51 (95% CI, 1.42-1.60), respectively, in men and 1.50 (95% CI, 1.27-1.76), 1.33 (95% CI, 1.12-1.57), and 1.43 (95% CI, 1.37-1.50), respectively, in women. A significant and inverse relationship was observed between socioeconomic status and CVD within the JHS cohort. The strongest and most consistent socioeconomic correlate after adjusting for age and sex was income for myocardial infarction (odds ratio: 3.53; 95% CI, 2.31-5.40) and stroke (odds ratio: 3.73; 95% CI, 2.32-5.97), comparing the poor and affluent income categories. CONCLUSIONS: Except for myocardial infarction in men, CVD burden in the JHS cohort was higher than expected. A strong inverse socioeconomic gradient of CVD was also observed within the JHS cohort.

Overweight and obesity: prevalence, consequences, and causes of a growing public health problem.

This paper provides an overview of the evidence on the current epidemic of obesity in the United States. The prevalence of overweight and obesity now exceeds 60% among US adults, and the rate is rapidly increasing among children and adolescents. Dismal medical, social, and economic consequences are already apparent and likely to worsen without multipronged intervention. Increased rates of hypertension, diabetes, and dyslipidemia, among other medical conditions, threaten to shorten the longevity of the American populace by as much as 5 years. The incidence of depression is increasing and experts suggest this is linked with the increased prevalence of obesity. The cost of obesity-related medical care has increased astronomically since 1987, in addition to lost productivity and income. Novel multidisciplinary, preventive, and therapeutic approaches, and social changes are needed that address the complex interplay of biologic, genetic, and social factors that have created the current obesity epidemic.

Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem.

This review considers a variety of perspectives on overweight and obesity (OW/obesity), including measurement and classification; prevalence and changes in prevalence in recent years; genetic, biological, medical, individual, and social correlates of OW/obesity; and treatment approaches. Despite increased attention, OW/obesity is escalating in prevalence worldwide, and the causes are exceedingly complex. A range of innovative studies, including basic research on gut microflora, dietary composition, pharmacologic interventions, and surgical procedures, is generating findings with potential for future prevention and treatment of OW/obesity. Social system changes such as school programs and the awareness of the roles of personal, family, health provider, and cultural experiences related to OW/obesity have also gained traction for vital prevention and treatment efforts over the past decade.

Racism and cardiovascular disease in African Americans.

This article provides an overview of the evidence on the ways racism can affect the disproportionate rates of cardiovascular disease (CVD) in African Americans. It describes the significant health disparities in CVD for blacks and whites and suggests that racial disparities should be understood within the context of persistent inequities in societal institutions and relations. Evidence and potential pathways for exploring effects of 3 levels of racism on cardiovascular health risk factors and outcomes are reviewed. First, institutional racism can lead to limited opportunities for socioeconomic mobility, differential access to goods and resources, and poor living conditions that can adversely affect cardiovascular health. Second, perceived/personally mediated racism acts as a stressor and can induce psychophysiological reactions that negatively affect cardiovascular health. Third, in race-conscious societies, such as the United States, the negative self-evaluations of accepting negative cultural stereotypes as true (internalized racism) can have deleterious effects on cardiovascular health. Few population-based studies have examined the relationship between racism and CVD. The findings, though suggestive of a positive association, are neither consistent nor clear. The research agenda of the Jackson Heart Study in addressing the role of racism in CVD is presented.

Recruitment, retention and matriculation of ethnic minority nursing students: a University of Mississippi School of Nursing approach.

According to Bednash (2000), the future of health care pivots on an adequate supply of appropriately educated and skilled professional registered nurses. Recognizing the long history of and the struggles by African-American (AA) nurses for education and equality in the nursing profession, it is essential that more African-American students be recruited, retained, and matriculated into the profession of nursing. African-American nurses have always contributed to the care of the poor and the sick and played a decisive role in the improvement of the health of their communities. The Bureau of Health Professions Division of nursing (March 2000) reported that 86.6 percent of the registered nurse population were white while 12.3 percent represented racial and ethnic minority groups. Given the current racial/ethnic background of the registered nurse population in the United States, there is an obvious disparity in the representation of minorities in the nursing profession, in spite of the increasing number of minorities represented in the general population. Thus, the purpose of this paper is to document strategies that are used to actively recruit, retain, and graduate ethnic minority students from the University of Mississippi Medical Center (UMMC) School of Nursing (SON).

Framing body size among African American women and girls.

Obesity continues to affect African Americans in epidemic proportions, particularly among women and adolescent females. Perceptions, beliefs, behaviors, and body sizes of adolescents are associated with those of their mothers, yet little is known about the transgenerational meanings and experiences of obese African American adolescent girls and their mothers. An interpretive phenomenological study was conducted with seven African American adolescents between the ages of 11 and 17, and their adult female caregivers. Audio-taped interviews were transcribed and analyzed by a multicultural interpretive team. Two constitutive patterns and associated themes were identified. One pattern, 'Framing: sizing it up; sizing it down', with its three associated themes is presented. Mothers and daughters are engaged in multiple common practices in which they self-define body size, while protecting their self-esteem and self-image. This pattern illustrates how the women and girls created an image of their bodies as they confronted and acknowledged their self-perceptions, compared themselves to others in their environment, and evaluated themselves against specific parameters of acceptable size.