The Black women first initiative: using implementation science to examine bundled interventions to improve care and treatment coordination for Black women with HIV.

BACKGROUND: Black cisgender and transgender women are disproportionately affected by the HIV epidemic compared to women of other racial and ethnic identities. Twelve demonstration sites across the United States are adapting, implementing and evaluating a comprehensive bundle of two or more evidence informed interventions to improve health and outcomes and quality of life for Black women with HIV. METHODS: Guided by Greenhalgh's Conceptual Model of Diffusion of Innovations in Health Service Organizations and Proctor's model for use of implementation strategies and evaluating implementation, service and client outcomes, this mixed methods study documents outcomes at the client, organization, and system level. Participant eligibility for the bundled interventions includes: individuals who are 18 years or older, identify as Black or African-American, identify as cisgender or transgender female and have a diagnosis of HIV. Qualitative data are collected systematically through a series of annual site visits and a standardized monthly call form to assess the barriers and facilitators to the implementation process and the key determinants impacting the intervention uptake and implementation strategies. Quantitative data collection for the implementation, service and client outcomes is conducted through a pre-post prospective study to examine the impact on Black women's health and well-being. Implementation outcomes include: the reach to Black women with HIV, adoption of interventions across the sites and their community; the fidelity to the components of the bundled interventions; the costs of the intervention; and the sustainability of the intervention in the organization and community. Primary service and client outcomes are improved linkage to and retention in HIV care and treatment, increased and sustained viral suppression, improved quality of life and resilience, and stigma reduction. DISCUSSION: The study protocol presented is specifically designed to advance the evidence for adopting culturally responsive and relevant care into clinic and public health settings to improve the health and well-being for Black women with HIV. In addition the study may advance the implementation science field by furthering what is known about the ways in which bundled interventions can address barriers to care and facilitate the uptake of organizational practices to improve health.

Policies enacted during COVID-19 came with unintended health benefits: why go back?

OBJECTIVES: To explore the impact of COVID-19 on the implementation of bundled interventions to improve the engagement and retention of Black women in HIV care. METHODS: Pre-implementation interviews conducted between January and April 202 L with 12 demonstration sites implementing bundled interventions for Black women with HIV. Directed content analysis was employed to examine the site interview transcripts. RESULTS: The pandemic intensified barriers to care and harmful social conditions. However, COVID-19 also forced pivots in health care and social service delivery and some of these changes benefited Black women living with HIV. CONCLUSIONS: The continuation of policies that support the material needs of Black women with HIV and ease access to care is critical. Racial capitalism impedes the enactment of these policies and thus threatens public health.

Relationship between anxiety and quality of life among older adults with self-reported polypharmacy in long-term care: A cross-sectional study.

AIMS: To investigate the relationship between anxiety and quality of life among older adults with self-reported polypharmacy living in the long-term care setting. DESIGN: A cross-sectional design was used. METHODS: Between July 2021 and August 2022, 92 older adults living in long-term care completed an anonymous one-time questionnaire packet. Polypharmacy was measured as self-reported five or more medications daily. Anxiety was measured using the Geriatric Anxiety Scale-Long Term Care tool. Quality of life was measured as health-related quality of life using two global questions from the RAND-36 and as medication-related quality of life using the Medication-Related Quality of Life Scale. RESULTS: The prevalence of polypharmacy was 89%. Among participants with polypharmacy, average age was 80.1 ± 7.9 years. The majority were female (70%) and white (85%). There was a moderate-to-strong correlation between anxiety and quality of life. Specifically, anxiety was negatively related to current health-related quality of life, perceived change in health-related quality of life and medication-related quality of life. Overall, anxiety explained 27-31% of the variance in both health-related and medication-related quality of life. CONCLUSION: The results of this study indicate that as anxiety increases, health-related and medication-related quality of life decreases in older adults living in long-term care who report consuming five or more medications daily. Advanced practice nurses can use these findings to guide practice, tailor interventions and improve care for these long-term care residents. IMPLICATIONS: Multiple medications are increasingly prescribed to treat multiple comorbidities in older adults. As a result, the prevalence of polypharmacy (≥5 medications per day) is rising and problematic. The main findings of this study highlight the negative relationship between anxiety and quality of life in this population and the need for adequate assessment of anxiety by advanced practice nurses in order to personalize care. REPORTING METHOD: In preparing the manuscript, the authors have adhered to relevant EQUATOR guidelines and the STROBE checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution outside of participation in the actual study for purposes of data collection.

Successful Aging in Assisted Living: The Importance of Near Visual Acuity.

Successful aging among independent community-dwelling older adults and those in residential settings is paramount to aging in place. The purpose of the current study was to explore how sensory, cognitive, and functional impairments affect successful aging in assisted living (AL) settings. Vision compromise was noted for near visual acuity (NVA) (14.3%) and distance visual acuity (11.9%). More than one third (34.1%) of participants screened positive for compromised cognition, functional impairment was present in 48.9%, and successful aging was present in 55.7%. NVA and functional status were related to successful aging (r = 0.328, p = 0.004; r = 0.341, p = 0.002, respectively), and explained 9.3% of the variance in successful aging (F[2, 75] = 3.83, p = 0.026). Having a lower NVA score (ß = -0.277, p = 0.021) uniquely affected the successful aging score. Interventions supporting AL residents' sensory and cognitive health should be a priority to improve successful aging. [Journal of Gerontological Nursing, 48(9), 8-14.].

Unpacking complexities in ethnic-racial socialization in transracial adoptive families: A process-oriented transactional system.

Over 50% of adoptions are transracial, involving primarily White parents and children of color from different ethnic or racial backgrounds. Transracial adoptive (TRA) parents are tasked with providing ethnic-racial socialization processes (ERS) to support TRA adoptees' ethnic-racial identity development and prepare them to cope with ethnic-racial discrimination. However, unlike nonadoptive families of color, TRA parents lack shared cultural history with adoptees and have limited experience navigating racial discrimination. Knowledge of ERS among TRA families has centered on unidirectional processes between parenting constructs, ERS processes, and children's functioning. However, ERS processes in this population have complexities and nuances that warrant more sensitive and robust conceptualization. This paper proposes a process-oriented dynamic ecological model of the system of ERS, situating transacting processes in and across multiple family levels (parent, adoptee, family) and incorporating developmental and contextual considerations. With its framing of the complexities in ERS among TRA families, the model offers three contributions: a conceptual organization of parenting constructs related to ERS, a more robust understanding of ERS processes that inform how parents provide ERS, and framing of transacting processes within and between parenting constructs, ERS processes, and children's functioning. Implications for research, policy, and practice are discussed.

An innovative interprofessional curricular model for diverse partners who team up to support behavior change in individuals with chronic disease.

This project introduced nursing and graduate health sciences and psychology students to interprofessional education (IPE) concepts and engaged them in interprofessional skill-building. Exposure to and immersion in IPE competencies were accomplished through online modules, case workshops, and simulation-based experiences. Rather than having an acute care focus, these diverse IPE students engaged in teamwork to plan and prioritize lifestyle change. Evaluation over a 3-year period resulted in an 8-week 1 credit course that includes online modules and case content focused on chronic disease management in response to the challenge of aging populations' increased longevity and chronic disease burden. Sample size was too small to make broad conclusions; however, we strongly recommend that IPE competencies be achieved using a developmental approach that includes not just exposure to the concept of collaborative practice but also immersion experiences that provide opportunities in skill-building for shared decision-making and teamwork.

Impact of COVID-19 on the Mental Health and Distress of Community-Dwelling Older Adults.

The purpose of this study was to examine the mental health of community-dwelling older adults as they adapted their everyday health behaviors during the COVID-19 pandemic. In response to a telephone survey, 126 older adults described perceived changes in physical and mental health, and adaptations in their everyday health behaviors. Descriptive statistics, bivariate correlations, and multiple regressions revealed that participants experienced changes in mental and physical health, reduced health service access, lower social engagement, and increased coping behaviors. Greater negative social impact of the pandemic was associated with higher levels of COVID-19 distress. Reduced mental health was significantly related to reductions in health service access, health changes, and fewer adaptive coping behaviors. Adaptive coping behaviors were helpful, just as reduced health access and social contact added risk for mental health problems. Suggestions were provided for alleviating mental health needs by increasing social contact and engaging in adaptive coping behaviors.

How Does Racial Context Matter?: Family Preparation-for-Bias Messages and Racial Coping Reported by Black Youth.

Black families and youth likely consider specific racial discriminatory situations in preparation-for-bias messages and racial coping responses. Our study investigated coping responses embedded in youth-reported Black families' preparation-for-bias messages and youths' proactive coping responses to specific racially discriminatory situations-teachers' negative expectations, store employees' hyper-monitoring and police harassment. Gender and racial discrimination experience differences were considered along with relations between messages and coping. Our investigation was guided by the integrated-developmental, transactional/ecological, intersectionality, and Phenomenological Variant of Ecological Systems Theory theoretical frameworks. We conducted cluster analyses using data from 117 Black youth aged 13-14 to identify situation-specific family messages and youth coping responses. Families' messages and youths' responses varied in content and frequency based on the specific discriminatory situation, which suggests consideration of context.

Instruments for detection and screening of cognitive impairment for older adults in primary care settings: A review.

The Patient Protection and Affordable Care Act requires evaluation for cognitive impairment as part of the Annual Wellness Visit (AWV). Nurses and nurse practitioners in primary care are in a good position to incorporate brief cognitive screens into the AWV. Early recognition of cognitive problems allows clinicians and patients the opportunity to discuss any new or ongoing concerns about cognition, address possible reversible causes, or refer for further evaluation. It should be noted that some patients may prefer not to explore for cognitive impairment. Numerous brief cognitive screens have been developed for primary care, with no one screen being appropriate for all patients or clinicians. This review examines the psychometric properties, usefulness, and limitations of both patient and informant brief (under five minutes) cognitive screens endorsed by the Alzheimer's, National Institute of Aging (NIA), and Gerontological Society (GSA) workgroups, plus a recently developed brief version of the standard MoCA.

Feasibility of wearable camera use to improve the accuracy of dietary assessment among adults.

Traditional methods of dietary assessment are prone to measurement error, with energy intake often under-reported. The 24-h recall is widely used in dietary assessment, however, its reliance on self-report without verification of consumption can result in inaccuracies in true nutrient intake. Wearable cameras may provide a complementary approach to improve self-report accuracy by providing an objective and passive measure of food consumption. The purpose of the present study was to determine whether a wearable camera improves the accuracy of a 24-h recall compared with a 24-h recall alone in twenty adults aged 18-65 years. The study also explored limitations associated with wearable cameras. Participants wore the camera for 1 d and a 24-h recall was then conducted the following day, before and after viewing the camera images. Dietary data were analysed using Nutritics dietary analysis software, while eating habits were assessed by a self-report questionnaire. Energy and nutrient intakes were compared between the recall alone and the camera-assisted recall. Results showed a significant increase in mean energy intake with the camera-assisted recall compared with the recall alone (9677⋅8 ± 2708⋅0 kJ/d v. 9304⋅6 ± 2588⋅5 kJ/d, respectively, P = 0⋅003). Intakes of carbohydrates, total sugars and saturated fats were also significantly higher with the camera-assisted recall. In terms of challenges, there were occasionally technological issues such as proper positioning of the camera by the participants. In conclusion, reporting of energy and nutrient intake may be enhanced when a traditional method of dietary assessment, the 24-h recall, is assisted by a wearable camera.

Occurrence of long-finned pilot whales (Globicephala melas) and killer whales (Orcinus orca) in Icelandic coastal waters and their interspecific interactions.

Long-finned pilot whales and killer whales are widely distributed across the North Atlantic, but few studies have reported their occurrence in Icelandic coastal waters. Here, we use sightings data from research platforms and whale watching tours in six regions of Iceland from 2007 to 2020 to show that the occurrence of long-finned pilot and killer whales varied with region and season. Killer whales were regularly encountered in the south of Iceland during summer and west of Iceland during winter/spring. Long-finned pilot whales were only seen during the summer and were most often encountered in the south, west, and northwest of Iceland. Long-finned pilot whale occurrence in the south of Iceland appeared to increase during the study period but killer whale occurrence showed no noticeable changes. Long-finned pilot whales were sighted often in the areas that were also frequented by killer whales and interspecific interactions were commonly observed when both species co-occurred. Interactions appeared to be antagonistic, with killer whales often avoiding long-finned pilot whales and sometimes fleeing at high speed, similar to what has been described elsewhere in the North Atlantic. In the majority of interactions observed (68%), killer whales avoided long-finned pilot whales by moving away, but in 28% avoidance was at high speed with both species porpoising. This variability in the type of behavioural responses indicates that interactions may be more complex than previously described. We discuss regional trends in long-finned pilot whale and killer whale sightings and potential drivers of the observed interactions. Supplementary Information: The online version contains supplementary material available at 10.1007/s10211-022-00394-1.

Perceived COVID-19-related anti-Asian discrimination predicts post traumatic stress disorder symptoms among Asian and Asian American young adults.

OBJECTIVE: This study investigates the prevalence of COVID-19-related discrimination and the extent to which COVID-19-related discrimination is associated with mental health symptoms among Asians and Asian American (A/AA) young adults during the first three months of the COVID-19 pandemic. METHODS: We used data from the COVID-19 Adult Resilience Experiences Study (CARES), a cross-sectional online survey conducted in the U.S. Out of 1,001 respondents, 211 A/AA young adults were analyzed for this study. RESULTS: Sixty-eight percent of A/AA young adults reported that they or their family have experienced COVID-19-related discrimination and approximately 15% of respondents reported verbal or physical assaults. After controlling for covariates including predisposing factors, lifetime discrimination, and pre-existing mental health diagnoses, COVID-19-related discrimination was significantly associated with an increased level of symptoms of posttraumatic stress disorder (PTSD), but not of anxiety or depression. Our study results suggest that COVID-19-related discrimination may contribute to PTSD symptoms among A/AA young adults. LIMITATIONS: This was cross-sectional data which was collected through online and self-report rather than clinical evaluation. CONCLUSION: This finding adds greater urgency to develop and implement policy- and individual-level interventions to reduce race-based discrimination among A/AA.

Development and validation of the patient and clinician sedation satisfaction index for colonoscopy and upper endoscopy.

BACKGROUND & AIMS: Recent increases in gastrointestinal endoscopic procedures and sedation options show a need for better sedation evaluation. This article describes the development and validation of 2 instruments: the Patient Satisfaction with Sedation Instrument (PSSI) and the Clinician Satisfaction with Sedation Instrument (CSSI) for assessing satisfaction in patients undergoing outpatient upper endoscopy and colonoscopy. METHODS: A total of 118 patients who underwent outpatient colonoscopy or esophagogastroduodenoscopy and 22 physicians were recruited across 5 US gastroenterology practices. Physicians completed the CSSI and patients completed the PSSI after each procedure. Patients completed the SF-12 Health Survey, Patient Satisfaction Questionnaire, and Socially Desirable Response Scale; clinicians completed the Observer's Assessment of Alertness Scale after procedures. RESULTS: Study patients were mostly women (59%), white (88%), had a mean age of 57.5 +/- 15.7 years, and had a colonoscopy (70%). Internal consistency reliabilities assessed result consistencies across test items. Coefficients greater than 0.70 indicate good reliability; greater than 0.85 indicate excellent reliability. Internal consistency reliabilities of the PSSI and CSSI total and subscale scores were greater than 0.76. Correlations were assessed using Pearson product moment correlation. PSSI and CSSI scores were correlated (P < .05). PSSI totals scores were correlated significantly with the SF-12 Health Survey (P < .05), the Patient Satisfaction Questionnaire (P < .05), and CSSI total scores were correlated with the Observer's Assessment of Alertness Scale (P < .01) and a visual analogue scale (P < .01). PSSI scores were not correlated with the Socially Desirable Response Scale (P > .05). CONCLUSIONS: The PSSI and CSSI provide for feasible, reliable, and valid assessment of procedural sedation satisfaction for outpatient colonoscopy and esophagogastroduodenoscopies and can be used for future sedation studies.

Dietitian-led education program to improve phosphate control in a single-center hemodialysis population.

OBJECTIVE: We sought to analyze the effect of a structured, dietitian-led education program on patients' general knowledge of phosphate and phosphate binders, and its impact on serum phosphate concentrations in a single-center hemodialysis population. DESIGN: We compared subjects before and after intervention. SETTING: This study involved two dialysis units operated by a single center. PATIENTS: One hundred and fifteen hemodialysis patients consented to participate in this study (54% male; mean age, 61.1 years; 32% Asian). Patients acted as their own controls. One hundred and eight patients completed the study. INTERVENTION: All patients completed a questionnaire to assess their knowledge of phosphate and phosphate-binder therapy. Small group teaching sessions were then delivered to patients by a single dietitian, with the aid of a hospital interpreter as required. Patients also received information booklets or audio cassettes translated into Urdu. A second identical questionnaire was completed a month later. MAIN OUTCOME MEASURES: Outcome measures involved pre-education and posteducation knowledge scores, monthly measurements of serum phosphate, calcium, and mean Kt/V, and parathyroid hormone concentrations every 3 months during the 5 month run-in period and subsequent 5-month study period. RESULTS: The education program significantly improved patients' general knowledge of phosphate and of phosphate-binders (P < .001), especially in patients with a low pretest score and those of South Asian origin. This result was associated with a significant reduction in serum phosphate in patients with hyperphosphatemia (P = .032). CONCLUSIONS: These findings suggest that a combination of educational initiatives is effective in enhancing patients' knowledge of phosphate and phosphate-binders, and consequently in improving serum phosphate levels in patients with hyperphosphatemia.

Distinguishing between demographic and contextual factors linked to early childhood physical discipline and physical maltreatment among Black families.

BACKGROUND: Despite persistent discouragement from professionals, U.S. parents, especially Black parents, highly endorse physical discipline, which also is a risk factor for physical maltreatment. Few studies have examined physical discipline heterogeneity or maltreatment, and predictive demographic and contextual factors within the same population. OBJECTIVE: This exploratory study aimed to identify subgroups of Black parents' use of early childhood physical discipline. It also examined whether demographic and contextual factors' relations with physical discipline were similar or different from those with physical maltreatment. PARTICIPANTS AND SETTING: 310 Black parents from three geographically-distinct high-risk U.S. communities participated in home-based interview and survey data collection. METHODS: We conducted latent class analyses to identify sub-groups among Black parents characterized by physical discipline frequency and type. Bolck, Croon, and Hagenaars method and binary logistic regression were conducted to examine relations between demographic and contextual factors (child gender, family income, marital status, parental education, family stress and perceived neighborhood safety), discipline and maltreatment. RESULTS: Three physical discipline classes, which differed in frequency and type, were identified among Black parents. Only income was significantly related to both discipline (x2 = 18.97, p < .001) and maltreatment (OR = 1.03, p < .01). Child gender (x2 = 6.66, p < .01), never-married status (x2 = 13.94, p < .001), parental education (x2 = 10.32, p < .001), and neighborhood safety (x2 = 7.57, p < .01) also significantly related to discipline. Family stress was significantly related to physical maltreatment (OR = 1.42, p < .001). CONCLUSIONS: Differing demographic and contextual factor relations with physical discipline and maltreatment within a Black population should be considered when identifying parents at-risk.

Adjusting to the transition into assisted living: Opportunities for nurse practitioners.

BACKGROUND AND PURPOSE: Transition from an independent living residence to assisted living (AL) is challenging. The study purpose was to understand such a transition from the perspective of older women. METHODS: A hermeneutic phenomenological approach was used to explore how 17 older women living in a Continuing Care Retirement Community, many of whom were recently widowed, experienced this transition. CONCLUSIONS: Three major themes emerged from the interviews: preplanning, executing, and adjusting to the transition. Even with facility, family and staff assistance, the transition was challenging, and adjustment was affected when participants had physical or sensory impairments. IMPLICATIONS FOR PRACTICE: Older adult women transitioning to AL settings should be assessed for adjustment to the new setting. Those with sensory, cognitive, emotional, or physical problems will need additional supportive strategies to help with adjustment. With a rapidly expanding population, AL settings offer new opportunities for nurse practitioners to promote the health and well-being of older adults.

Trends and drug-related correlates in residential mobility among young adults in the United States, 2003-2016.

INTRODUCTION: Young adulthood, typically conceptualized as stretching from the late teens to the mid-twenties, is a period of elevated risk for residential mobility (i.e., moving or changing residences frequently) and drug involvement. However, our understanding of the trends and drug-related correlates of residential mobility among young adults remains limited. METHODS: We analyzed national trend data from the National Survey on Drug Use and Health (2003-2016) on residential mobility and drug involvement among young adults (N = 230,790) in the United States. For tests of trend, we conducted logistic regression analyses with survey year specified as a continuous independent variable and residential mobility as the dependent variable (no/yes), controlling for sociodemographic factors. RESULTS: The prevalence of residential mobility was stable among females, but decreased significantly-a 20% reduction in the relative proportion of respondents-among males during the study period (AOR = 0.98, 95% CI = 0.97-0.99). Male and female young adults reporting residential mobility were significantly more likely to report involvement in all drug-related outcomes examined, but effects were larger among females for drug selling and drug-related arrests. DISCUSSION: Study findings show that a substantial minority of young adults experience residential mobility and that, while rates are declining among young men, the experience of mobility is connected with risk for drug involvement, particularly among females. Mobility may be an important target for drug prevention/intervention efforts, but further research is needed to provide insight into how mobility and drug involvement are connected in the lives of young adults.

Acute ST-segment elevation myocardial infarction and prior stroke: an analysis from the Magnesium in Coronaries (MAGIC) trial.

BACKGROUND: Patients with prior stroke represent a substantial proportion of patients presenting with acute ST-segment elevation myocardial infarction (STEMI). However, the impact of prior stroke on prognosis has not been rigorously examined in the reperfusion era. METHODS: The baseline characteristics, treatments, and clinical outcomes of patients with prior stroke enrolled in the Magnesium in Coronaries (MAGIC) trial were evaluated and compared to those of patients without prior stroke. RESULTS: MAGIC enrolled 6213 patients with STEMI, of whom 558 (9.0%) had prior stroke. Patients with prior stroke were more likely to have a history of hypertension (88.0% vs 70.3%), diabetes (19.9% vs 14.5%), myocardial infarction (38.2% vs 25.1%), and congestive heart failure (15.6% vs 9.7%). The mean Thrombolysis in Myocardial Infarction Risk Score was higher in patients with prior stroke compared to those without prior stroke (4.37 vs 3.93, P < .0001). Patients with prior stroke were less likely to receive reperfusion therapy, even among those considered eligible at presentation (66.3% vs 80.6%, P < .0001). Compared to patients without prior stroke, inhospital stroke (3.0% vs 1.0%, P < .0001), severe congestive heart failure (23.3% vs 18.2%, P = .003), and 30-day mortality (21.0% vs 14.7%, P < .0001) were higher among patients with prior stroke. On multivariable analysis, prior stroke was independently associated with a significantly higher risk of death at 30 days (odds ratio 1.44, P = .0023). CONCLUSIONS: Patients with prior stroke who present with STEMI are at very high risk for short-term morbidity and mortality. Aggressive treatment of these patients appears warranted.