Willingness to Provide Naloxone Resources for Patients at Risk of Opioid Overdose: A National Survey of Emergency Registered Nurses.

INTRODUCTION: Opioid-related events continue to claim lives in the United States at alarming rates. Naloxone-dispensing rates fall dramatically short of national expectations. Emergency registered nurses are uniquely poised to connect at-risk patients with naloxone resources. This study sought to (1) describe the emergency registered nurses' willingness to provide naloxone resources and (2) explore variables that may influence the nurse's willingness to provide resources. METHODS: A cross-sectional, survey-based design was deployed using an online branch logic approach to include a national sample of emergency registered nurses. The Willingness to Provide, a validated questionnaire, measured the registered nurse's willingness to provide naloxone resources for patients at risk of opioid overdose. Eight variables were assessed for potential influence on willingness. RESULTS: A total of 159 nurses from 32 states and the District of Columbia completed the online survey via the Research Electronic Data Capture platform. The results revealed a mean Willingness to Provide score of 38.64 indicating a willingness to provide naloxone resources. A statistically significant relationship was identified between the nurse's willingness and years of nursing experience (P = .001), knowledge (P = .015), desire (P = .001), and responsibility (P < .001). DISCUSSION: In this representative sample, emergency nurses are willing to provide naloxone resources; furthermore, results indicate that higher knowledge, desire, and responsibility scores increase the nurse's willingness to provide naloxone resources; with education and clear expectations, emergency nurses may be able to improve the connection of patients at risk of opioid overdose with naloxone, a potentially lifesaving connection.

Metabolic syndrome risk among adolescents in the Deep South and the relationships with behavioral health, food insecurity, and physical activity.

PURPOSE: A combination of physical and psychosocial risk factors put adolescents at risk for poor cardiometabolic health and chronic disease burden, often recognized as metabolic syndrome. The purposes of this study were to (1) identify the prevalence of metabolic syndrome risk among adolescents, utilizing the metabolic syndrome severity index, and (2) determine the relationship between metabolic syndrome risk and behavioral health, food insecurity, and physical inactivity among adolescents. METHODS AND DESIGN: A cross-sectional, descriptive, correlational design was deployed in an inner-city high school in the Deep South. An 8-month recruitment and enrollment period yielded a sample of 55 adolescents. A battery of measures included assessment of demographic data, anthropometric, cardiovascular, and psychosocial data. Utilizing these data elements, a progressive methodological approach was used to identify metabolic severity risk as a continuous variable for use in the adolescent population. RESULTS: All participants identified as African American/Black. Among them, 71% (N = 39) were female and an average age of 16 (SD = 1.3) years old, with 67.3% (N = 37) of the sample at risk for metabolic syndrome. There was not a statistically significant relationship between metabolic syndrome severity score and behavioral health risk, food insecurity, and physical inactivity in this sample. PRACTICE IMPLICATIONS: Future use of the continuous metabolic syndrome severity score may guide practice by utilizing longitudinal data to assess the trends of metabolic syndrome severity scores in relation to disease outcomes in adolescents. This may promote the identification of psychosocial and physical interrelationships with metabolic syndrome, thus improving overall health through the development of age-appropriate interventions.

Harvest for health in survivors of chronic disease: A demonstration project in the Alabama Black Belt and Mississippi Delta Region.

This demonstration project expands upon the Harvest for Health vegetable gardening intervention for cancer survivors by: (i) including survivors of other chronic diseases (i.e. heart disease and diabetes); and (ii) targeting an area with known health inequities (Alabama Black Belt and Mississippi Delta Region). To assess: (i) gardening acceptability (engagement, satisfaction, sustainability, and safety); and (ii) changes over time in health behaviors (fruit and vegetable [F&V] intake, and physical activity) and outcomes (physical performance and anthropometrics). Chronic disease survivors (CDS) were recruited across 15 counties in Alabama and Mississippi and provided with gardening supplies and paired with a master gardener (MG). MGs mentored participants in planning, planting, and maintaining a vegetable garden over a 3-month period. Data collection consisted of an electronic survey (baseline, post-intervention, 6-month follow-up) and community-based physical assessments (baseline and post-intervention). Participants (n = 137; 92% African American; Mage = 65) included individuals with a history of diabetes (56%), heart disease (29%), and cancer (26%). Seventy-five percent of participants engaged in gardening ≥3 times a week. Significant improvements in F&V intake (+0.73, P = .04), physical activity (+49.6, P < .01), and 4 of 7 physical performance measures were observed, while positive trends were seen in others. Eighteen participants withdrew (13% attrition rate). No adverse events occurred. Participants were satisfied with their gardening experience (90%) and were still gardening at 6-month follow-up (85%). Seventy-two percent of participants expanded, or planned on expanding, their garden at 6-month follow-up. Harvest for Health was acceptable and associated with improved health behaviors and outcomes.

In the Alabama Black Belt and Mississippi Delta region of the USA, incidence and mortality rates of high-burden chronic diseases (cancer, cardiovascular disease, and diabetes) are among the highest in the nation. Behavioral risk factors associated with chronic disease include low fruit and vegetable intake and physical inactivity. Vegetable gardening is a holistic approach to improving these health behaviors. Harvest for Health, a mentored home-based vegetable gardening intervention, pairs cancer survivors with master gardener (MG) mentors to guide survivors in planning, planting, and maintaining a vegetable garden. The current demonstration project expands upon Harvest for Health by: (i) including survivors of cardiovascular disease and diabetes (in addition to cancer); and (ii) targeting an area with known health inequities (Alabama Black Belt and Mississippi Delta). One hundred thirty-seven chronic disease survivors (CDS) enrolled in the 3-month demonstration project. Participants were provided gardening supplies for a summer garden and MG mentorship over a 3-month period. Participants engaged in gardening several times a week, reported satisfaction with their gardening experience, and were still gardening at 6-month follow-up. Improvements among CDS were seen in health behaviors (fruit and vegetable intake and physical activity) and physical well-being (physical function battery and weight).

Integrating Behavioral Health and Primary Care in an Inner-City High School: Expanded Care in a School-Based Clinic in Mississippi, 2018-2020.

Adolescence, a critical and rapid stage of human development, requires innovative approaches in the provision of health care. With considerable mental health issues occurring among adolescents, an urgent need exists to address their mental and behavioral health. School-based health centers can provide an important safety net, particularly for young people who lack access to comprehensive and behavioral health care. We describe the design and implementation of behavioral health assessment, screening, and treatment services in a primary care school-based health center. We reviewed primary care and behavioral health measures as well as the challenges and lessons learned of this process. Five hundred and thirteen adolescents and young adults aged 14-19 years from an inner-city high school in South Mississippi were screened for behavioral health issues from January 2018 through March 2020, and all 133 adolescents deemed at risk for behavioral health issues received comprehensive health care. Lessons learned included the importance of recruiting behavioral health providers to ensure sufficient staff, establishing academic-practice arrangements to ensure funding, increasing student enrollment by improving the return rate of consent for care, and enhancing data collection through process automation. This case study may help inform the design and implementation of integrated primary and behavioral health care in school-based health centers.

The charm of country life? Impact of rural childhood residence on physical and mental health in later life.

BACKGROUND: Most studies of geographic health disparities are focused on adult rural residence. However, previous studies have shown that the residential area in which one grows up during childhood has lasting impacts on adult health. In one of the only studies to date to examine the impact of rural childhood residence on mental health in middle-aged and older adults, Murchland and colleagues (2019) evaluated inequalities by childhood residence and noted elevated depressive symptoms were more common among those living in rural areas compared to those living in non-rural areas. AIMS: The current study expands the model proposed by Murchland and colleagues to include further antecedents related to rural childhood residence, and to include multiple outcomes of physical and mental health among middle-aged and older adults. METHOD: Participants included 4614 individuals aged 40 or older recruited as part of the Midlife in the United States (MIDUS) study. RESULTS: Consistent with Murchland's model, childhood rurality played an important part in middle-aged and older adult's health, despite not having a direct influence. Rurality status was impacted by parental education level and SES during childhood, and was associated with the level of education obtained by the participants (and thus their occupation), which played a direct role in their current health status. Mental and physical health had differential predictors. LIMITATIONS: The study was limited by its non-diverse sample and self-reported measures. CONCLUSION: Further research into the impact of childhood rurality on health is needed, utilizing comprehensive self-reported and observed outcome measures.

Potential Influencers of COVID-19 Vaccine Acceptance Among Adults Living in the United States Who Have Accepted or Plan to Accept the Vaccine: An Online Survey.

PURPOSE: The purpose of this study was to 1) determine the demographic differences between adults who have accepted, or plan to accept, the COVID-19 vaccine and those who will not accept the COVID-19 vaccine and 2) describe the potential influencers in deciding to accept the COVID-19 vaccine among adults living in the United States who have accepted or plan to accept the vaccine. DESIGN: A cross-sectional design utilizing an online survey was deployed using social media and a crowdsourcing platform. SETTING: United States. SUBJECTS: One thousand three hundred ninety-five (1395) adults completed the survey. The majority were white, male, between the ages of 25 and 45, and with representation from 50 states and Puerto Rico. MEASURES: A two-branched survey was used to assess demographic information, vaccination intention, and 19 potential influencers of COVID-19 vaccine acceptance. ANALYSIS: Analysis included descriptive statistics and Chi-square tests to determine differences between groups. RESULTS: A higher proportion of male (P < .001), married (P < .001), and college-educated (P < .001) participants reported acceptance of the vaccine. The factors with the highest mean score of reported level of influence were duty to protect the vulnerable and contribution to move society back to a sense of normalcy. CONCLUSION: Understanding the potential influencers of vaccine acceptance may provide insight into strategies that could increase vaccination uptake.

Dispersion of daily physical activity behaviors in school-age children: A novel approach to measure patterns of physical activity.

PURPOSE: The objectives of this paper are (1) to examine patterns of physical activity (PA) and sedentary behavior; (2) to describe development of a method to quantify movement dispersion; and (3) to determine the relationship between variables of movement (i.e., volume, intensity, and dispersion), volume of sedentary behavior, and estimated cardiorespiratory capacity in school-aged children. DESIGN AND METHODS: A secondary analysis of an existing data set with raw accelerometer data identified PA patterns of movement dispersion in school-aged children. Bar graphs visually depicted each participant's daily vector magnitude counts. The research team developed a dispersion variable-movement dispersion-and formula to provide a new quantification of daily PA patterns. Total movement dispersion represents both intensity and distribution of movement, whereas pure movement dispersion refers to the distribution of movement during the wear time, independent of intensity. Kendall's tau examined the relationship between several variables: body mass index percentile, average minutes of sedentary behavior, average minutes of light PA, average minutes of moderate-vigorous PA (MVPA), derived VO2 max, total movement dispersion, and pure movement dispersion. RESULTS: Three participants' activity graphs were presented as examples: (1) active, (2) inactive, and (3) mixed. The more active participant had the highest values for pure and total movement dispersion. The inactive participant had much lower pure and total movement dispersion values compared to the active participant. The mixed participant had high average minutes of MVPA yet lower pure and total movement dispersion values. Total movement dispersion had a significant correlation with average minutes of light PA (r = .406, p = .016) and average minutes of MVPA (r = .686, p < .001). Pure movement dispersion was significantly correlated with average minutes of light PA (r = .448, p = .008) and average minutes of MVPA (r = .599, p < .001). Average minutes of sedentary behavior (SB) were not significantly correlated with total (r = .041, p = .806) or pure movement dispersion (r = .165, p = .326). PRACTICE IMPLICATIONS: Movement dispersion may provide another tool to advance knowledge of PA, potentially leading to improved health outcomes. Raw accelerometer data, such as that gathered at the elementary school in this study, offer opportunities to identify school-aged children at risk for obesity, SB, and lack of PA.

Using Accelerometer Data to Identify Movement Patterns in an Older Adult: Innovative Strategy for Physical Activity Promotion.

Evidence suggests a physically active lifestyle increases proportion of life lived free of disability. Unfortunately, physical activity participation in older adults is low, suggesting innovative strategies are needed. This case-report (1) examined daily activity routines from accelerometer data; and (2) utilized the movement patterns to "infuse" physical activity within the participant's normal routine. CASE-REPORT: A 60 year old wore an Actigraph GT3X+ accelerometer, on 2 separate days and weeks. Movement patterns, from "raw" accelerometer data, were presented to the participant to identify areas of high and low activity, with suggestions how to increase overall activity. Results indicated activity patterns were reproducible. Physical activity infusions increased movement counts by 34%, and moderate-vigorous physical activity (MVPA) by ~82minutes. DISCUSSION: Examination of "raw" accelerometer data identified distinct movement routines. Understanding these routines allowed for health provider/participant interaction that led to physical activity "infusions" which contributed to a large increase in MVPA, without major alterations to the individual's day.

Household Physical Activity and Risk for Future Falls in Community-Dwelling Older Adults.

Household physical activity is associated with decreased risk for future falls; however, it is not known what components of household physical activity are associated with this decreased risk. In the current study, the frequency of seven household physical activities performed in the previous 12 months was assessed: child or older adult care, meal preparation, major cleaning, routine cleaning, gardening/yardwork, heavy outdoor work, and major home decoration or repair. Berg Balance Scale scores were dichotomized at ≤50, indicating less risk for future falls. Only gardening/yardwork was associated with less risk for future falls (odds ratio = 1.41, p = 0.007) while controlling for age, gender, race, body mass index, and number of medications (χ2 = 18.33 [6], p = 0.005), explaining 17% to 23% of the variance in risk of future falls in community-dwelling older adults aged 65 to 90 years (N = 99). Clinical nursing implications include considering gardening/yardwork as an intervention to decrease risk of future falls. [Journal of Gerontological Nursing, 47(6), 13-18.].

Physical activity and fitness: The feasibility and preliminary effectiveness of wearable activity tracker technology incorporating altruistic motivation in youth.

PURPOSE: The purpose of this study was to examine the feasibility and preliminary effectiveness of using wearable activity tracker technology, integrated with altruistic motivation in children to increase physical activity (PA), fitness, and prosocial behavior. DESIGN AND METHODS: A quasiexperimental design was employed in two 4th grade classrooms in a rural southern state. The intervention was a wearable PA tracker and a web-based curriculum with activities to earn power points redeemable to provide life-saving food to undernourished kids internationally. Seventeen children in the intervention group participated in the 10-week PA program and 18 children were in the wait listed control group. Three measures were assessed in both groups at baseline and postintervention: (a) PA measured with accelerometers, (b) fitness levels measured with shuttle run, and (c) prosocial behavior measured with Strengths and Difficulties questionnaire. RESULTS: Of the 35 children enrolled, the majority were nine years old (n = 28), black (n = 31) and female (n = 23). An overall enrollment rate of 88%, attrition rate of 9%, and an accelerometer noncompliance rate of 25% was determined to assess feasibility. There was no statistical significance between the control and intervention group outcome variables. The average minutes of PA in the control group decreased 8 min from baseline to postintervention (p = .05). In the intervention group, PA decreased by 10 min from baseline to postintervention (p = .12). In both the control and intervention groups, prosocial behavior scores decreased (p = .09 control; p = .62 intervention). The fitness scores, VO2 max, did not significantly change (intervention p = .21; control p = .35). PRACTICE IMPLICATIONS: Developing effective interventions that foster PA and dissuade sedentary behaviors are essential to enhancing PA and fitness levels. The recruitment, retention, and accelerometer wear adherence suggest this setting, with this population is feasible. The intervention is deliverable, however, the potential of wearable activity trackers and the effect of prosocial behavior that benefits others in increasing PA and improving cardiorespiratory fitness, should be further researched by building on the successful elements of this study.

Adults' and children's perceptions of barriers and facilitators of school-aged children's physical activity in an inner-city urban area.

In the United States, obesity rates among children remain a pressing public health concern Compounding that, disparities exist with higher childhood obesity among minority and lower socioeconomic neighborhoods. Physical activity is associated with more favorable weight status in children and adolescents. PURPOSE: This study aimed to identify and explore factors that influence physical activity in children in a low-income neighborhood. DESIGN AND METHODS: An exploratory descriptive qualitative design was employed using Photovoice and focus group interviews to identify barriers and facilitators of physical activity. RESULTS: Eight adults and five children enrolled in the study. Photovoice was used to prompt discussions during the focus groups. Analysis of verbatim transcripts included constructed coding with categorization into themes. Four themes of (a) knowledge, (b) play, (c) opportunities and a changing environment, and (d) resources were identified. Among children, three themes from the children's focus group were identified as (a) knowledge, (b) play, and (c) environment. This study found both resource and knowledge challenges, as well as a strong commitment to providing physical activity opportunities. PRACTICE IMPLICATIONS: Continued efforts are needed to develop and implement physical activity interventions to reduce obesity and improve health among children in impoverished, urban areas.

Feasibility and effectiveness of two built environmental interventions on physical activity among 3-5-year-old preschoolers.

PURPOSE: The purpose was to examine the feasibility and preliminary effectiveness of two built environmental interventions with Head Start preschool children to increase minutes and intensity and total physical activity (PA). DESIGN AND METHODS: A prospective, quasi-experimental, repeated measures design was conducted in two Head Start centers. Centers were randomly assigned to one of two intervention arms. Intervention Arm I added portable play equipment to the school environment; Arm II introduced portable play equipment plus PA education for staff and children. PA was measured during school using accelerometers and by observation using SOPLAY. The data were analyzed using repeated measures ANOVA. RESULTS: Ninety-seven children and eight staff were enrolled; valid PA data were available for 56 children (58%). Minutes of PA were highest at baseline in both groups and declined over the intervention. PA in Arm I decreased 22 min from weeks one to three and 12 min (p < .001) from weeks 3 to 6. In Arm II, PA declined 33 min from weeks one to three and 20 min (p < .001) from weeks 3 to 6. PRACTICE IMPLICATIONS: Nurses work to maintain and improve health at multiple levels of influence and are in strategic positions to educate and support PA to maintain and improve the health of all ages. School-based PA interventions have been reported with varying success. The feasibility of this study provides insight into the challenges in planning and conducting school-based interventions including enrollment, attrition, and accelerometer wear-time compliance. Despite our interventions, there was no positive response to either intervention, with PA declining at each time period in both groups. However, baseline PA was significantly higher than in previous studies. Schools can provide children with opportunities to accumulate PA.

Physical activity and postural balance in rural community dwelling older adults.

AIM: The purpose of this study was two-fold: 1) identify the types of physical activity being done among rural community dwelling older adults; and 2) determine the relationship between amount of physical activity and postural balance in that population. BACKGROUND: Balance impairment coupled with other fall risk factors pose a formidable challenge for aging adults. This study identified types of physical activity rural-community dwelling older adults do and explored the relationship between amount (in minutes) of physical activity and balance. METHODS: A cross sectional, correlational design was used to recruit rural community-dwelling older adults. Data were collected using the Jackson Heart Study Physical Activity Survey, Berg Balance Scale, and Timed Up and Go Test; ActiGraph accelerometers were worn to objectively measure physical activity. RESULTS: One hundred and one participants enrolled. Most were female (78%), White (74%), and between 65 and 91 years old. Berg Balance Scale scores positively correlated with average minutes of light (r = 0.262) and moderate (r = 0.276) physical activity; and the Jackson Heart Study Physical Activity Survey active living index (r = 0.320) and home and garden index (r = 0.324). In regression models, age and sex were the strongest predictors of Berg Balance Scale (adjusted r2 = 0.313, F(6, 89) = 8.203, P ≤ 0.001). Physical activity was not associated. CONCLUSIONS: Minutes of light or moderate physical activity were not associated with balance. However, investigating factors such as physical activity that influence health functional status and balance deserve continuous attention.

Healthcare Quality: A Concept Analysis.

Worsening quality indicators of health care shake public trust. Although safety and quality of care in hospitals can be improved, healthcare quality remains conceptually and operationally vague. Therefore, the aim of this analysis is to clarify the concept of healthcare quality. Walker and Avant's method of concept analysis, the most commonly used in nursing literature, provided the framework. We searched general and medical dictionaries, public domain websites, and 5 academic literature databases. Search terms included health care and quality, as well as healthcare and quality. Peer-reviewed articles and government publications published in English from 2004 to 2016 were included. Exclusion criteria were related concepts, discussions about the need for quality care, gray literature, and conference proceedings. Similar attributes were grouped into themes during analysis. Forty-two relevant articles were analyzed after excluding duplicates and those that did not meet eligibility. Following thematic analysis, 4 defining attributes were identified: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these attributes, the definition of healthcare quality is the assessment and provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of optimal or desired health. This analysis proposes a conceptualization of healthcare quality that defines its implied foundational components and has potential to improve the provision of quality care. Theoretical and practice implications presented promote a fuller, more consistent understanding of the components that are necessary to improve the provision of healthcare and steady public trust.