Health behaviors and related disparities of insured adults with a health care provider in the United States, 2015-2016.

Health care providers are in a unique position to address patients' health behaviors and social determinants of health, factors like income and social support that can significantly impact health. There is a need to better understand the risk behaviors of a population that providers may counsel (i.e., those who are insured and have a provider.) Using the 2015 and 2016 CDC's Behavioral Risk Factor Surveillance System, we examine the prevalence of health behaviors and the existence of disparities in health behaviors based on social determinants among American adults. Our sample included noninstitutionalized adults aged 18 to 64 years, in the U.S. (N > 300,000). We used multivariate logistic regression analysis to assess the independent effects of income, education, sex, race, and metropolitan status on nine key health behaviors. Among adults with insurance and a provider (n > 200,000): 1) rates of engaging in poor health behaviors ranged from 6.4% (heavy drinking) to 68.1% (being overweight or obese), 2) rural residence, lower income, and lower education were associated with decreased clinical preventive services, 3) lower income and lower education were associated with lifestyle-related risks, and 4) being black was associated with receiving more cancer screenings, no influenza vaccination, inadequate physical activity, and being overweight or obese. Insured adults, with a provider, are not meeting recommended guidelines for health behaviors. Significant disparities in health behaviors related to social factors exist among this group. Health care providers and organizations may find it helpful to consider these poor health behaviors and disparities when determining strategies to address SDOH.

Occupational stress and risk for Parkinson's disease: A nationwide cohort study.

BACKGROUND: Stress has been suggested as a contributing factor in the etiology of Parkinson's Disease (PD), but epidemiological evidence is sparse. OBJECTIVE: The objective of this study was to explore the association between occupational stress according to the job demands-control model and the risk for PD. METHODS: We conducted a population-based cohort study with 2,544,748 Swedes born 1920 to 1950 who had an occupation reported in the population and housing censuses in 1980 or, if missing, in 1970. Job demands and control were measured using a job-exposure matrix. Incident PD cases were identified using Swedish national health registers from 1987 to 2010. Data were analyzed with Cox regression with age as the underlying time scale, adjusting for sex, education, and chronic obstructive pulmonary disease as a proxy for smoking. RESULTS: During a mean follow-up time of 21.3 years, 21,544 incident PD cases were identified. High demands were associated with increased PD risk among men, most evident in men with high education. High control was associated with increased PD risk among the low educated. This association was more pronounced in women. High-strain jobs (high demands and low control) was only associated with increased PDrisk among men with high education, whereas active jobs (high demands and high control) were associated with increased PD risk among men with low education. INTERPRETATION: High job demands appear to increase PD risk in men, especially in men with high education, whereas high job control increases PD risk among low educated, more strongly in women. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

The Role of Personality in a Regular Cognitive Monitoring Program.

OBJECTIVES: This study examines the role of personality in cognitive performance, adherence, and satisfaction with regular cognitive self-monitoring. MATERIALS AND METHODS: One hundred fifty-seven cognitively healthy older adults, age 55+, completed the 44-item Big-Five Inventory and were subsequently engaged in online monthly cognitive monitoring using the Cogstate Brief Battery for up to 35 months (M=14 mo, SD=7 mo). The test measures speed and accuracy in reaction time, visual learning, and working memory tasks. RESULTS: Neuroticism, although not related to cognitive performance overall (P>0.05), was related to a greater increase in accuracy (estimate=0.07, P=0.04) and speed (estimate=-0.09, P=0.03) on One Card Learning. Greater conscientiousness was related to faster overall speed on Detection (estimate=-1.62, P=0.02) and a significant rate of improvement in speed on One Card Learning (estimate=-0.10, P<0.03). No differences in satisfaction or adherence to monthly monitoring as a function of neuroticism or conscientiousness were observed. CONCLUSIONS: Participants volunteering for regular cognitive monitoring may be quite uniform in terms of personality traits, with personality traits playing a relatively minor role in adherence and satisfaction. The more neurotic may exhibit better accuracy and improve in speed with time, whereas the more conscientious may perform faster overall and improve in speed on some tasks, but the effects appear small.

Use, maintenance and dose effects of cognitive speed of processing training in Parkinson's disease.

INTRODUCTION: Recent research indicated that cognitive speed of processing training (SPT) improved Useful Field of View (UFOV) among individuals with Parkinson's disease (PD). The effects of SPT in PD have not been further examined. The objectives of the current study were to investigate use, maintenance and dose effects of SPT among individuals with PD. METHODS: Participants who were randomized to SPT or a delayed control group completed the UFOV at a six-month follow-up visit. Use of SPT was monitored across the six-month study period. Regression explored factors affecting SPT use. Mixed effect models were conducted to examine the durability of training gains among those randomized to SPT (n = 44), and training dose effects among the entire sample (n = 87). RESULTS: The majority of participants chose to continue to use SPT (52%). Those randomized to SPT maintained improvements in UFOV performance. A significant dose effect of SPT was evident such that more hours of training were associated with greater UFOV performance improvements. The cognitive benefits derived from SPT in PD may be maintained for up to three months. CONCLUSION: Future research should determine how long gains endure and explore if such training gains transfer.

Onboarding New Graduate Nurses Using Assessment-Driven Personalized Learning to Improve Knowledge, Critical Thinking, and Nurse Satisfaction.

Effective onboarding is key to new nurse success; however, many programs lack evidence-based support. The current study compared knowledge, critical thinking, and nurse satisfaction between cohorts before and after implementation of personalized learning for onboarding. Results showed better knowledge, critical thinking, and nurse satisfaction in the personalized learning cohort compared to prior cohorts. Nurse educators should use evidence-based personalized learning for onboarding to fully support new nurses as they transition from the classroom to practice.

Improving maternal mental health: assessing the extent of screening and training about peripartum depression.

OBJECTIVE: Peripartum depression (PPD) is a common mental health complication of pregnancy and increases risk for maternal mortality and poorer outcomes for children. Despite its importance, screening rates vary across organizations and care team members. The goal of the current study was to explore the perspectives from care team members in both behavioral health and acute care settings about how they screen and refer pregnant and post pregnant women for PPD, what training around PPD is currently offered by their organization, and if they could benefit from additional PPD training. METHODS: Data were collected from an online self-report survey of care team members from behavioral health and acute care settings in the US. Questions focused on (1) when/if the care teams had a screening protocol for PPD, (2) beliefs about the efficacy of their organization's PPD screening, identification, and referral process, and (3) if their organization currently offered or needed training around the topic of PPD. RESULTS: A total of 794 care team members in behavioral health and acute care responded to the survey between December 2021 and May 2022. Nearly, all (96.7%) reported having a specific protocol for screening for PPD when they know a patient is pregnant; however, only 69.6% of respondents routinely screen regardless of symptoms being reported by the patient. While 93.3% of the sample believed their organization does a good job screening for and identifying PPD, gaps in the referral processes were described, especially in acute settings. 95.3% of the sample reported their organization currently gives training in screening, identifying, or treating PPD or in the process for establishing outpatient referrals for PPD care for care team members who have direct contact with pregnant patients; however, 96.5% also reported their organization would benefit from additional training in one or more of these areas. CONCLUSION: High rates of self-reported PPD screening and training indicate that care team members in both behavioral health and acute care are aware of the importance of maternal mental health issues. However, other research indicates that high rates of screening may not lead to improved outcomes, and there are still high rates of maternal suicide and suicidal ideation in the US. It is possible that high self-reported screening rates may indicate a false sense of security such that care team members feel the issue is addressed while problems remain. Alternatively, many respondents felt their organizations would benefit from further training, perhaps indicating an awareness of this gap. Care team members in behavioral health and acute care settings should increase collaboration to ensure high rates of screening lead to improved maternal mental health care.

Use of Predictive Analytics to Identify Unhealthy Opioid Use and Guide Intervention.

OBJECTIVE: The authors aimed to use the newly developed Opioid Risk Stratification Tool to identify individuals who may be at risk for unhealthy opioid use and to examine the impact of applying a mailing and engagement intervention to this population and their prescribers, with the goal of reducing high-risk prescribing behaviors, opioid medication use, and mortality rates. METHODS: A nonrandomized controlled study was conducted with members from two Medicaid managed care organizations. In both the intervention (N=131) and control (N=187) groups, an algorithm identified members at moderate to high risk for hazardous opioid use. Members at increased risk in the intervention group and their prescribers received a letter from the managed care organization, and members still at risk 3 months after the mailing were contacted by a care coordinator. Individuals in the control group were not contacted. Medicaid claims data were used to compare opioid use and prescribing practices between groups before and after the intervention. RESULTS: Individuals in the intervention group were less likely to have any opioid prescription postintervention compared with those in the control group (OR=0.55, p<0.001), and the intervention group had a greater reduction in the number of individuals with concurrent opioid and benzodiazepine prescriptions (OR=0.49, p=0.042). Practices such as multiple opioid prescriptions and multiple prescribers of opioids were not affected by the intervention. CONCLUSIONS: An intervention targeting individuals at risk for hazardous opioid use was associated with a reduction in some high-risk prescribing practices. Future research should determine the ideal mix of interventions to reduce as many risk factors as possible.

Determining the Impact of Best Fit for Newly Licensed Nurses.

Preparing new nursing graduates for independent practice as soon as safely possible is vital for both efficient and effective patient care. The alignment between a nurse's personality and specialty practice area may impact orientation length, as nurses who are better suited to their job role may adapt more quickly. The current study revealed that nurses hired into a specialty practice area with a higher job fit demonstrates a significant reduction in orientation time.

Behavioral Health Diagnoses and Health Care Use Before and During the COVID-19 Pandemic.

OBJECTIVE: Emerging evidence has suggested a population-wide worsening of psychiatric symptoms during the COVID-19 pandemic, particularly among individuals with preexisting mental health conditions. The authors investigated whether reported behavioral health problems are being identified and treated. METHODS: This observational cohort study retrospectively compared Medicaid data of patients from the first year of the pandemic (2020) in the United States (N=1,589,111 patients) with the corresponding data from the year before (2019; N=1,715,872 patients). Outcome measures included several behavioral health diagnoses and health care utilization. RESULTS: During the pandemic period examined, the numbers of patients served, adults receiving a new diagnosis of anxiety, and children receiving a new diagnosis of depression all increased. Across all age groups, nonbehavioral health emergency department visits significantly decreased. CONCLUSIONS: These findings support reports of increases in psychiatric morbidity but do not provide evidence for increased demand for health care services.

Examining Cesarean Delivery Rates by Race: a Population-Based Analysis Using the Robson Ten-Group Classification System.

The Robson Ten-Group Classification System is widely considered to be the gold standard for comparing cesarean section (CS) delivery rates, despite limited adoption in the United States (US). When reporting overall CS rates, Blacks and other minorities are typically reported to have high CS rates but comparing overall CS rates may be misleading as CS may be more common in some higher risk populations. Improved understanding of how CS rates differ by race among standardized groups could highlight differences in care and areas for improvement. The current study examines racial differences in cesarean section delivery rates using the Robson Ten-Group Classification System in a nationwide sample. Data from US vital statistics live birth certificates were used to identify 3,906,088 births which were each classified into one of the ten groups based on five obstetric characteristics identifiable on presentation for delivery including parity, onset of labor, gestational age, fetal presentation, and number of fetuses. Results indicated that Black and Asian mothers had the highest CS rates in groups 1-4 which all contain single, cephalic pregnancies at term with no prior CS and are only differentiated by parity and onset of labor. Black mothers also had the lowest CS rates for groups 6 and 7, containing women with nulliparous and multiparous breech births. Black and Asian mothers show differences in CS rates among groups that could indicate lack of appropriate care. Efforts should be made to prevent unnecessary primary CS among low-risk mothers.

Using Claims Data to Assess Treatment Quality of First-Episode Psychosis.

OBJECTIVE: Coordinated specialty care (CSC) has become the standard of care for first-episode psychosis (FEP). The gap between CSC best practices and the actual care delivered is unknown. This longitudinal study aimed to measure that gap by using a large Medicaid claims database and 10 quality indicators (QIs) reflecting aspects of CSC and to study the relationship between these QIs and future health care utilization. METHODS: Individuals with FEP were identified in a Missouri Medicaid claims database. Participants were required to have been eligible for Medicaid benefits for at least 10 months in the year prior to and the year after their first episode of psychosis and to have had no evidence of a prior psychosis diagnosis. Descriptive statistics were generated for each of the QIs, and a stratified Cox regression was used to identify predictors of subsequent health care utilization. RESULTS: Data were obtained for 6,246 participants, and follow-up lasted a mean of 4.24 years. Significant practice gaps were found in the use and monitoring of antipsychotic medications. Of those prescribed antipsychotic medication, 5% received prescriptions above recommended daily doses, 16% received two or more antipsychotics, and 20% were treated with olanzapine or clozapine. Among the QIs, lack of monitoring for smoking (hazard ratio [HR]=2.71, 95% confidence interval [CI]=2.47-2.97) and lack of integrated care delivery in treatment (HR=2.00, 95% CI=1.92-2.08) were most associated with psychiatric hospitalization. CONCLUSIONS: In most cases, treatment was far from meeting CSC recommendations, suggesting that implementation of CSC requires substantial modifications to delivery of care for individuals with FEP.

Effectiveness of Online Training and Supervisor Feedback on Safe Eating and Drinking Practices for Individuals With Developmental Disabilities.

Dysphagia is common in individuals with developmental disabilities. Little research exists on the impact of trainings aimed at improving Direct Care Staff's (DCS) use of safe eating and drinking practices. This article presents two studies using pre-and postexperimental design, evaluating online training to improve DCSs' knowledge and ability to identify nonadherence to diet orders. A pilot study (n = 18) informed improvements to the intervention. The follow-up study (n = 64) compared those receiving training with those receiving training plus supervisor feedback. There was no significant difference between groups after training. Both groups increased in knowledge and identification of nonadherence to diet orders. Online training may be an effective tool for training DCS in safe eating and drinking practices.

Can Cognitive Speed of Processing Training Improve Everyday Functioning Among Older Adults With Psychometrically Defined Mild Cognitive Impairment?

OBJECTIVE: The aim of these secondary analyses was to examine cognitive speed of processing training (SPT) gains in cognitive and everyday functioning among older adults with psychometrically defined mild cognitive impairment (MCI). METHOD: A subgroup of participants from the Staying Keen in Later Life (SKILL) study with psychometrically defined MCI ( N = 49) were randomized to either the SPT intervention or an active control group of cognitive stimulation. Outcome measures included the Useful Field of View (UFOV), Road Sign Test, and Timed Instrumental Activities of Daily Living (IADL) Test. A 2 × 2 repeated-measures MANOVA revealed an overall effect of training, indicated by a significant group (SPT vs. control) by time (baseline vs. posttest) interaction. RESULTS: Effect sizes were large for improved UFOV, small for the Road Sign test, and medium for Timed IADL. DISCUSSION: Results indicate that further investigation of cognitive intervention strategies to improve everyday functioning in patients with MCI is warranted.

Systematic review and meta-analyses of useful field of view cognitive training.

Systematic review and meta-analyses were conducted of Useful Field of View (UFOV) training, which was evaluated by Institute of Medicine criteria. Forty-four studies of UFOV training from 17 randomized trials conducted among adults were identified in systematic review. Results addressing the Institute of Medicine criteria indicated that: (a) UFOV training enhanced neural outcomes, speed of processing, and attention. (b) UFOV training effects were equivalent when compared to active- or no-contact control conditions. (c) UFOV training showed far transfer to everyday function. (d) Improvements on the trained skills endured across ten years. (e) Half of the clinical trials identified were conducted by researchers without financial interests in UFOV training. Results indicated that UFOV training effects were larger for adaptive- than non-adaptive training techniques, and in community-based as compared to clinical samples. UFOV training did not transfer to other neuropsychological outcomes, but positively enhanced well-being, health, and quality of life longitudinally. Criticisms of cognitive training are addressed. UFOV training should be implemented among older adults to improve real-world functional outcomes and well-being.

The relationship between phytoestrogens and speed of processing.

OBJECTIVE: This study examined the cross-sectional association between phytoestrogens and speed of processing. We hypothesized that higher levels of phytoestrogens would be related to better cognitive performance among older women. METHODS: Participants were from the National Health and Nutrition Examination Survey and consisted of 200 older women (M = 74.4 y). Stepwise regressions examined indicators of speed of processing, measured by the Digit Symbol Substitution Test. Isoflavones, lignans, and individual phytoestrogens were added to the regression after including covariates of age, education, race, smoking, and creatinine. Isoflavones were further broken into quartiles among the sample to further evaluate the nature of the curvilinear association. RESULTS: Results showed a relationship between cognition and lignans, explaining 3.8% of the variance after including the covariates, indicating fewer lignans were associated with better speed of processing (P < 0.001). A significant curvilinear relationship with isoflavones explained 1.3% additional variance (P < 0.001). The moderate-high, low-moderate, and the lowest quartile of isoflavones were associated with better cognition, whereas the highest amount was associated with worse speed of processing. Among the individual phytoestrogens, only enterodiol accounted for 4.4% additional variance after taking into account covariates and indicated a negative association with cognition (P = 0.03). CONCLUSIONS: Results suggest that moderate levels of isoflavones, but not lignans, may be associated with better speed of processing. Caution must remain for high isoflavone amounts due to the negative association with cognition. Given the results, phytoestrogens have the potential to be an intervention target for older females' cognition. To become a viable intervention, further research is needed.

Regular cognitive self-monitoring in community-dwelling older adults using an internet-based tool.

INTRODUCTION: Monitoring for various health conditions (e.g., breast cancer, hypertension) has become common practice. However, there is still no established tool for regular monitoring of cognition. In this pilot longitudinal study, we examined the utility and feasibility of internet-based cognitive self-monitoring using data from the first 12 months of this ongoing study. METHOD: Cognitively healthy community-dwelling older adults (Montreal Cognitive Assessment ≥ 26) were enrolled on a rolling basis and were trained in self-administration of the internet-based version of the CogState Brief Battery. The battery uses playing cards and includes Detection, Identification, One Back, and One Card Learning subtasks. RESULTS: Of the 118 participants enrolled, 26 dropped out, mostly around first in-home session. Common reasons for participant attrition were internet browser problems, health problems, and computer problems. Common reasons for delayed session completion were being busy, being out of town, and health problems. Participants needed about one reminder phone call per four completed sessions or one reminder email per five completed sessions. Performance across the monthly sessions showed slight (but significant) improvement on three of the four tasks. Change in performance was unaffected by individual characteristics with the exception of previous computer use, with less frequent users showing greater improvement on One Card Learning. We also found low intraindividual variability in monthly test scores beyond the first self-administered testing session. CONCLUSIONS: Internet-based self-monitoring offers a potentially feasible and effective method of continuous cognitive monitoring among older adults.

Computerized auditory cognitive training to improve cognition and functional outcomes in patients with heart failure: Results of a pilot study.

OBJECTIVES: Feasibility and efficacy of computerized auditory cognitive training (ACT) was examined among patients with heart failure (HF). BACKGROUND: Individuals with HF have four times increased risk of cognitive impairment, yet cognitive intervention studies are sparse. METHODS: A pilot randomized controlled design was used. RESULTS: The ACT group (n = 9) and control group (n = 8) had similar baseline characteristics. Seven participants (78%) completed ≥ 18 hours of ACT. Medium effect sizes were observed for improved cognition as indicated by auditory processing speed (d = 0.78), speech processing (d = 0.88), and working memory (d = 0.44-0.50). Small effect sizes were found for improved functional outcomes including HF selfcare (d = 0.34), Timed Instrumental Activities of Daily Living (d = 0.32), Six-Minute Walk Test (d = 0.38) and Short-Form-36 (d = 0.22) relative to controls. CONCLUSION: Results indicated ACT is feasible among persons with HF. Despite a small sample size, ACT showed potential for improved speed of processing and working memory and improved functional outcomes, and warrants further exploration.

The Efficacy of InSight Cognitive Training to Improve Useful Field of View Performance: A Brief Report.

OBJECTIVE: It is well established that cognitive speed of processing training (SOPT) improves Useful Field of View (UFOV) performance and transfers to enhanced performance of instrumental activities of daily living, including driving. InSight is a recently developed version of SOPT formatted for self-administration by older adults with exercises translated into a gaming format. The goal was to examine whether InSight training improves UFOV performance. METHOD: Participants ranged in age between 59-95 years and were randomized to InSight cognitive training or a control condition. Cognitive performance and self-perceptions were measured pre- and post-training, or for controls, after an equivalent delay. Participants completed training twice a week over a 12-week period with the goal of completing 20 sessions. RESULTS: Participants randomized to InSight training experienced greater improvements in their UFOV performance relative to the control condition, F(1, 58) = 4.26, p = .043, but no changes in cognitive self-perceptions were found. CONCLUSIONS: The InSight program is a viable tool for enhancing older adults' UFOV performance. Future research should examine if training gains from the program endure and transfer to improved everyday function.

Occupational complexity and risk of Parkinson's disease.

BACKGROUND: The etiology of Parkinson's disease (PD) remains unclear, and environmental risk-factors such as occupation have attracted interest. OBJECTIVE: The goal was to investigate occupational complexity in relation to PD. METHODS: We conducted a population-based cohort study based on the Swedish Twin Registry that included 28,778 twins born between 1886 and 1950. We identified 433 PD cases during the study period. Data on occupation were collected from either the 1970 or 1980 Swedish census, and occupational complexity was assessed via a job exposure matrix. Cox proportional hazard regression analyses with age as the underlying time scale were used to assess PD risk as a function of the three domains of occupational complexity: data, people, and things. Sex and smoking were included as covariates. Analyses stratified by twin pair were conducted to test for confounding by familial factors. RESULTS: High occupational complexity with data and people was associated with increased risk overall (Hazard Ratio [HR]  = 1.07, 95% confidence interval [CI] 1.02-1.14, and HR = 1.10, 95% CI 1.01-1.21, respectively), and in men (HR = 1.08, 95% CI 1.01-1.16, and HR = 1.15, 95% CI 1.03-1.28, respectively). Complexity with things was not associated with risk of PD. When the analyses were stratified by twin pair, the HRs for occupational complexity with data and people were attenuated in men. CONCLUSIONS: High complexity of work with data and people is related to increased risk of PD, particularly in men. The attenuation of risk observed in the twin pair-stratified analyses suggests that the association may partly be explained by familial factors, such as inherited traits contributing to occupational selection or other factors shared by twins.

Longitudinal differences in cognitive functioning among older adults with and without heart failure.

OBJECTIVE: Secondary data analyses were conducted to examine cognitive function and longitudinal cognitive decline among older adults with and without heart failure (HF). METHOD: Data from the Advanced Cognitive Training for Independent and Vital Elderly study were used to compare baseline (N = 2,790) and longitudinal (n = 692) changes in memory, reasoning, and speed of processing performance among participants (M age = 73.61, SD = 5.89) who self-reported HF at baseline, developed HF over time, or never reported HF. RESULTS: At baseline, there were differences in memory and speed of processing with participants who never reported HF performing better than those who reported developing HF over time, and those who reported HF at baseline performing the worst (ps < .05). Longitudinally, participants with self-reported HF at baseline showed declines in reasoning over time. DISCUSSION: The results indicate that cognitive difficulties in memory and speed may occur prior to a HF diagnosis, while those with HF may experience steeper declines in reasoning as measured by word series test.