Low-Income Older Adults' Vulnerability to Anticholinergic Medication-Associated Frailty.

BACKGROUND: A growing body of research supports the negative impact of anticholinergic drug burden on physical frailty. However, prior research has been limited to homogeneous white European populations, and few studies have evaluated how anticholinergic burden tools compare in their measurement function and reliability with minority community-dwelling adult populations. This study investigated the association between anticholinergic drug exposure and frailty by conducting a sensitivity analysis using multiple anticholinergic burden tools in a diverse cohort. METHODS: A comprehensive psychometric approach was used to assess the performance of five clinical Anticholinergic Burden Tools: Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), average daily dose, total standardized daily doses (TSDD), and Cumulative Anticholinergic Burden scale (CAB). Spearman correlation matrix and intraclass correlation coefficients (ICC) were used to determine the association among the variables. Ordinal logistic regression is used to evaluate the anticholinergic burden measured by each scale to determine the prediction of frailty. Model performance is determined by the area under the curve (AUC). RESULTS: The cohort included 80 individuals (mean age 69 years; 55.7% female, 71% African American). All anticholinergic burden tools were highly correlated (p < 0.001), ICC3 0.66 (p < 0.001, 95% confidence interval (CI) 0.53-0.73). Among individuals prescribed anticholinergics, 33% were robust, 44% were prefrail, and 23% were frail. All five tools predicted prefrail and frail status (p < 0.05) with low model misclassification rates for frail individuals (AUC range 0.78-0.85). CONCLUSION: Anticholinergic burden tools evaluated in this cohort of low-income African American older adults were highly correlated and predicted prefrail and frail status. Findings indicate that clinicians can select the appropriate instrument for the clinic setting and research question while maintaining confidence that all five tools will produce reliable results. Future anticholinergic research is needed to unravel the association between interventions such as deprescribing on incident frailty in longitudinal data.

Study protocol for the Mindful Moms Study: A randomized controlled trial evaluating a mindful movement intervention for marginalized pregnant people experiencing depression.

More than 1 in 5 pregnant people in the United States experience depressive symptoms. Although treatments exist, many people remain under- or un-treated due to concerns about stigma, side effects, and costs of medications or psychotherapy, particularly those who are marginalized (defined as those who are minoritized, low-income, or with low-educational attainment). Further, the standard depression treatments do not address social connectedness, which is a potentially modifiable factor involved in depressive symptom etiology. This protocol presents the rationale, design, and status of the two-arm longitudinal parallel group randomized controlled trial - the Mindful Moms Study - which aims to evaluate the effects and mechanisms of a group-based mindful physical activity (yoga) intervention in marginalized pregnant people with depressive symptoms (n = 200) compared to a prenatal education control group. The primary aim is to evaluate effects of group assignment on depressive symptom severity, anxiety, and perceived stress over time from baseline to six weeks postpartum. Secondary aims include understanding the role of social connectedness as a moderator of the effects and to identify genome-wide DNA methylation patterns associated with depressive symptoms and perceived social connectedness at postpartum. A focus on adequate symptom management through non-pharmacologic, accessible therapies that address social connectedness during pregnancy in marginalized women is an urgent clinical and research priority. The successful completion of this study will provide important insights into social connectedness as a mechanism to decrease depressive symptoms in a largely understudied population. Trial registration: NCT04886856.

The Role of Personal Experience and Prior Beliefs in Shaping Climate Change Perceptions: A Narrative Review.

Global climate change is increasing the frequency and intensity of extreme weather events such as heatwaves, droughts, and flooding. This is the primary way many individuals experience climate change, which has led researchers to investigate the influence of personal experience on climate change concern and action. However, existing evidence is still limited and in some cases contradictory. At the same time, behavioral decision research has highlighted the importance of pre-existing values and beliefs in shaping how individuals experience changes in environmental conditions. This is in line with theories of motivated reasoning, which suggest that people interpret and process information in a biased manner to maintain their prior beliefs. Yet, the evidence for directional motivated reasoning in the context of climate change beliefs has recently been questioned. In the current paper, we critically review the literature on the interrelationships between personal experience of local weather anomalies, extreme weather events and climate change beliefs. Overall, our review shows that there is some evidence that local warming can generate climate change concern, but the capacity for personal experience to promote action may rely upon the experience first being attributed to climate change. Rare extreme weather events will likely have limited impact on judgments and decisions unless they have occurred recently. However, even recent events may have limited impact among individuals who hold strong pre-existing beliefs rejecting the reality of climate change. We identify limitations of existing research and suggest directions for future work.

Employee green behaviour: How organizations can help the environment.

Organizations are intrinsically involved in climate change - both in its causes and its solutions - and there has been a growing interest in the microfactors and macrofactors that affect employee green behaviour. On an employee level, the literature stresses the importance of values and self-concordance. On an organizational level, in contrast, recent developments emphasize environmental dynamic capabilities, leadership and human resource management practices such as training. However, an interplay between such microfactors and macrofactors suggests that organizational initiatives do not work uniformly but depend on employees' environmentalism. We thus highlight the need for a dynamic systems perspective in researching all types of employee green behaviour in organizations.

The Translational Approaches to Personalized Health Collaborative: Pharmacogenomics for African American Older Adults.

Older adults (i.e., 60 years and older), are the leading consumers of medications, and consequently are suffering the most from medication-related adverse events. Not only are older adults the largest consumers of medications, they are more likely to experience an adverse drug event contributing to increased hospitalization, utilization of emergency medical services, and mortality. Translational Approaches to Personalized Health (TAPH) is a transdisciplinary team of researchers conducting community-engaged participatory research focused on the discovery and translation of pharmacogenomic (PGx) data to improve health outcomes. Underserved and ethnically diverse older adults living in urban settings are significantly under-represented in PGx studies. To address the issue of under-representation, our study enrolls older African American adults into a community-based PGx study. Therefore, we will characterize the frequency of actionable PGx genotypes and identify novel PGx response genes in our cohort of older community dwelling African Americans. The translational component of our work is to use the PGx findings to improve therapeutic outcomes for medication management in older adults. Such findings will serve as a foundation for translational PGx studies aimed at improving medication efficacy and safety for older adults. In this article, we describe the process for launching the TAPH collaborative group, which includes the transdisciplinary team, community-engaged participatory research model, study measures, and the evaluation of PGx genes.

Is Dealing with Climate Change a Corporation's Responsibility? A Social Contract Perspective.

In this paper, we argue that individuals - as members of society - play an important role in the expectations of whether or not companies are responsible for addressing environmental issues, and whether or not governments should regulate them. From this perspective of corporate social responsibility as a social contract we report the results of a survey of 1066 individuals. The aim of the survey was to assess participants' belief in anthropogenic climate change, free-market ideology, and beliefs around who is responsible for dealing with climate change. Results showed that both climate change views and free market ideology have a strong effect on beliefs that companies are responsible for dealing with climate change and on support for regulatory policy to that end. Furthermore, we found that free market ideology is a barrier in the support of corporate regulatory policy. The implications of these findings for research, policy, and practice are discussed.

Turn It Off: An Action Research Study of Top Management Influence on Energy Conservation in the Workplace.

This paper reports the results of an intervention study that aimed to encourage workplace energy conservation behavior by office-based employees. Taking a co-production approach we worked with the participating organization to design and implement an intervention that used the influence of top management commitment and prompts to encourage workplace energy reduction. Whilst past research has shown top management is related to workplace pro-environmental behavior, this study extends this work by examining a field-based intervention over a longitudinal period. The efficacy of the intervention was measured using observational and self-reported data over a period of 6 months. Results showed that there were significant changes in objective and self-reported energy conservation behavior, perceived top management commitment, organizational culture, norms, and knowledge regarding energy conservation behavior over the course of the study. The findings also demonstrated that the intervention was most successful for those behaviors where employees have individual responsibility. Implications for future research and practice are discussed.

Educational Planning for Establishing a Health-Promoting Workplace (HPW).

The Academy of Medical-Surgical Nurses (AMSN) has had an ongoing series of articles related to Healthy Practice Environments. The AMSN website (www.amsn.org) also has a number of articles and documents about initiatives that AMSN has undertaken to promote healthy practice environments in health care settings. This articles will focus on the educational work necessary for nurses who desire to increase the healthiness of their workplace. The work is not easy, but the end result could be one that leaves a lasting legacy for those who work in that environment.

Testicular cancer: overview and implications for health care providers.

Testicular cancer is the most common cancer in young men 15 to 35 years of age. This diagnosis, while devastating to the young man has, with aggressive treatment, the potential of a cure. This article will focus on the symptoms, the diagnosis, and the treatment of testicular cancer. In addition to nursing care during those stages, the nursing implications in educating those at risk along with early detection of this cancer will be the considered in this article.

Veterans' stories: what they may have to tell us--a personal reflection.

It has been said that we learn much from war. Not only how to conduct it and to be successful, but we learn how the body works and how to assist in regaining function. Without our veterans, much of today's medical knowledge would not be nearly as complete. We have learned how to care for and celebrate our veterans when they return from the war. Vietnam veterans can share what it is like to come home to a country that is not only entirely different, but even antagonistic, to the veteran as a person. This article will consider the types of homecoming experiences veterans have encountered while also introducing examples of the medical knowledge that has been gained from the struggles of those who have fought, and often died, for our country.

An experimental test of voluntary strategies to promote urban water demand management.

In light of the current and future threats to global water security the current research focuses on trialing interventions to promote urban water conservation. We report an experimental study designed to test the long-term impact of three different interventions on household water consumption in South East Queensland. Participants from 221 households were recruited and completed an initial survey, and their houses were fitted with smart water meters which measured total water usage at 5 s intervals. Households were allocated into one of four conditions: a control group and three interventions groups (water saving information alone, information plus a descriptive norm manipulation, and information plus tailored end-user feedback). The study is the first to use smart water metering technology as a tool for behaviour change as well as a way to test the effectiveness of demand management interventions. Growth curve modelling revealed that compared to the control, the three intervention groups all showed reduced levels of household consumption (an average reduction of 11.3 L per person per day) over the course of the interventions, and for some months afterwards. All interventions led to significant water savings, but long-term household usage data showed that in all cases, the reduction in water use resulting from the interventions eventually dissipated, with water consumption returning to pre-intervention levels after approximately 12 months. Implications for water demand management programs are discussed.

Alvimopan for acceleration of GI recovery after bowel resection.

Nurses play a critical role in the management of postoperative ileus during the perioperative phase of recovery. Alvimopan is an oral, peripherally acting, mu-opioid receptor antagonist that accelerates time to gastrointestinal recovery (resolution of postoperative ileus), representing a potential advance in management of these patients.

Responding to threats to the kidney.

Here's what you need to know about polycystic kidney disease and renal artery stenosis.

Mothers' views of the health visiting service in the UK: a web-based survey.

User and client views are an important source of information for providers and commissioners of public services. This paper reports on a user-led UK wide survey of mothers' views about sources of support and experiences accessing the health visiting service. Netmums, a family of websites run by local mothers, undertook the survey following concerns that the health visiting service was proving increasingly difficult to access. 4,665 mothers responded to questions about a) who they would seek help from, b) views of the local health visiting service and c) perceived change in it over the past two years. The results show that the majority of respondents rate their service as quite or very good, valuing most the characteristics of a) expertise in child health development and parenting and b) time and willingness to listen on the part of health visitors. In all areas but one, the service was seen as changing for the worse. Following the re-affirmation of a need for a universal health visiting service to be able to pick up families in need, the challenge is now to design local services that have sufficient resources so that mothers can maintain relationships and confidently access the services when they need them.

An overview of adult-learning processes.

Part of being an effective instructor involves understanding how adults learn best. Theories of adult education are based on valuing the prior learning and experience of adults. Adult learners have different learning styles which must be assessed prior to initiating any educational session. Health care providers can maximize teaching moments by incorporating specific adult-learning principles and learning styles into their teaching strategies.