Characteristics of Hospitalized Adults 55 and Older With Clostridioides difficile Infection.

Clostridioides difficile infection in older adults can result in severe infection, difficulty in treating, and complicated disease process, yet few studies have examined the characteristics of hospitalized older adults and recurrent Clostridioides difficile infection. A retrospective cohort study was conducted to explore the characteristics of hospitalized adults 55 years and older with initial Clostridioides difficile infection and recurrences by extracting routinely documented data in the electronic health record. A sample of 1,199 admissions on 871 patients was included, with a recurrence rate of 23.9% ( n = 208). During the first admission, there were 79 deaths (9.1%). Clostridioides difficile infection recurrence was more prevalent in patients between 55 and 64 years old, and if discharged to a skilled nursing facility or with home health services. Chronic diseases significantly more prevalent in recurrent Clostridioides difficile infection included hypertension, heart failure, and chronic kidney disease. On initial admission, no laboratory abnormalities were significantly associated with recurrent Clostridioides difficile infection. This study indicates the need for utilizing routinely captured electronic health record data during acute hospitalizations to aid in targeting care to reduce morbidity, mortality, and recurrence.

Predictors of Advance Care Planning Engagement Among Muslim Americans.

Advance care planning (ACP) enables people to discuss their physical, psychological, social, and spiritual needs before nearing death. Most literature examining the determinants of ACP engagement is limited and does not include minority faith communities in the United States, including Muslim communities. The purpose of this cross-sectional correlational study was to examine ACP engagement determinants among Muslims in the United States. Using the Social Ecological Model, we conceptualized the determinants of ACP engagement into intrapersonal, interpersonal, and community factors. The study self-administered questionnaires were distributed using convenience and snowball techniques. Multiple linear regression was used to predict ACP engagement. The total sample was 148 Muslim adults. The age range was 18 to 79 years. Among all tested factors, being Asian American, knowing a deceased person who had received aggressive or minimal medical treatments near death, being born in the United States, having knowledge and awareness about ACP, and being accepting of the American culture were the determinants of ACP engagement. Engagement in ACP is a multifactorial behavior. Several intrapersonal and interpersonal factors, but none of the community factors, were associated with ACP engagement among Muslim adults. Future ACP interventions targeted toward Muslim Americans should be planned with an understanding of the multifactorial nature of ACP engagement.

First-Time Mothers' Invisible Presence Using Social Networking Sites.

PURPOSE: To describe first-time mothers' experiences with online social networking sites in the early postpartum period, explore how mothers use them to gain support, and to evaluate how their use can aid or hinder maternal role transition. STUDY DESIGN: Qualitative descriptive study. METHODS: This qualitative descriptive study, using convenience and snowball sampling, first-time mothers in the early postpartum period were recruited through social media. Semistructured interviews were conducted virtually where mothers were asked to describe their experiences with online social networking. Thematic analysis methods were used to develop themes from participant interviews. RESULTS: Twelve first-time mothers ranging from 4 to 12 weeks postpartum participated in the study. Thematic analysis revealed four themes: 1) Habits of first-time mom using social networking sites, 2) New purpose online, 3) Taking it to the moms, and 4) Impact on motherhood. CLINICAL IMPLICATIONS: Maternal child nurses have opportunities to further customize support for first-time mothers online. Awareness of habits, trends, implications of early mothering during COVID-19, and the role social networking sites can play in supporting mothers in the early postpartum period offers new ways for nurses to support and empower the motherhood collective.

Intrapersonal and Interpersonal Factors Influencing Physical Activity in Arab Americans.

BACKGROUND: Many Arab Americans do not meet the physical activity (PA) guidelines despite evidence to support health benefits. AIMS: We aimed to investigate the relationships between PA and sample characteristics, intrapersonal factors, and interpersonal factors and examine to what extent these factors influence PA in Arab Americans. A cross-sectional, descriptive-correlational design using a self-administered questionnaire with 140 Arab Americans was used. Spearman ρ correlation was used to assess the associations between PA and sample characteristics, intrapersonal factors, and interpersonal factors. Three simultaneous gamma regression models were used to assess to what extent these factors jointly influenced PA. RESULTS: Most participants (58.6%) reported a high level of PA. Significant positive associations were found between PA and health status, religiosity, and PA self-efficacy (rs = 0.21, P = .019; rs = 0.19, P = .029; and rs = 0.28, P = .003, respectively). Multiple regression models revealed that being employed (model 1: Exp[b] = 1.87, P = .030; Model 3: Exp[b] = 1.77, P = .043) and having chronic conditions (model 1: Exp[b] = 1.88, P = .031; model 2: Exp[b] = 1.96, P = .034; model 3: Exp[b] = 1.91, P = .047) were associated with greater PA, when accounting for other sample characteristics, intrapersonal factors, and interpersonal factors. CONCLUSION: Presence of chronic health conditions and employment status should be considered when promoting PA in Arab Americans. Future research is needed to explore the relationship between religiosity, PA self-efficacy, and PA in this population.

Frailty and Its Correlates in Cognitively Intact Community-Dwelling Older Adults.

BACKGROUND: Frailty syndrome is characterized by a decline in physiological and psychological reserve and may be associated with poor health outcomes. OBJECTIVES: The current study explored frailty and its correlates among cognitively intact community-dwelling older adults. METHODS: A secondary analysis of data collected from 109 community-dwelling older adults who are cognitively intact was conducted for the purpose of this study. The Arabic versions of the culturally adapted Tilburg Frailty Indicator, the Montreal Cognitive Assessment, the Geriatric Depression Scale, and the Short Form-36 Quality of Life (QOL) survey. Multiple linear regression was used to examine the relationships between frailty and depression. RESULTS: The results indicated a high prevalence of frailty (78%) and depression (38%) among cognitively intact community-dwelling older adults. Frailty was found to be associated with increased age, being single or illiterate, living alone, having a high number of comorbid conditions, having high rate of depression, and having poor QOL. CONCLUSION: High prevalence of frailty is associated with high depression scores, a high number of comorbid conditions, and poor QOL among cognitively intact community-dwelling older adults.

Herbal/Plant Remedies and Supplements Used by Hispanics/Latinxs for Diabetes: Source of Functional Foods?

PURPOSE: The purpose of this study was to explore the use of herbal/plant remedies and supplements for type 2 diabetes (T2DM) among Hispanics/Latinxs in North Carolina and identify demographic and diabetes-related factors associated with use of these therapies. METHODS: Baseline data from a family-based diabetes intervention tailored for Hispanics/Latinxs were analyzed using descriptive statistics, bivariate analyses, and logistic regression. A convenience sample of 186 adults with T2DM and adult family members with and without T2DM was recruited from community-based settings and data obtained from face-to-face interviews conducted in Spanish. RESULTS: Most participants were female (73%) with an average age of 45 years old. Among this predominantly immigrant sample (96%), 78% of participants reported being from Mexico. Sixty percent had T2DM, and average A1C was 8.7% for persons with T2DM. Nearly a third reported using 51 different remedies for diabetes management. Most ingested them concurrently with prescribed medications; however, 11.3% reported altering the dose of medications when using herbal/plant remedies or supplements. Most common items were prickly pear cactus, pineapple, celery, aloe vera, parsley, and spinach. Using herbs/plants was positively correlated with age, A1C, and years with T2DM. The odds of using herbs/plants increased 28% for every 1% increase in A1C (adjusted odds ratio = 1.28, P = .003). CONCLUSIONS: Asking about herbal/plant remedy and supplement use is important. Although there is limited efficacy and safety studies for some items, multiple reported remedies are functional foods with biologically active ingredients to promote health. Patient education is needed on safe and unsafe items and use with prescribed medications.

Cardiovascular disease risk in Hispanic American women.

Hispanic American women have an increased risk for the development of cardiovascular disease (CVD). This study examined CVD risk in a sample of immigrant Hispanic women using Framingham point scores and the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator for 10-year CVD risk and prevalence of metabolic syndrome. A cross-sectional study using baseline data from a diabetes self-management intervention study in a sample of 118 Hispanic American women was conducted. Data were c ollected with interviewer-administered surveys, and HbA1C and lipid profiles were obtained through capillary finger stick blood at clinics and churches in rural counties in central North Carolina. A majority (58%) of the women had type 2 diabetes and 61% had metabolic syndrome. Using the Framingham point scores for 10-year CVD risk, 2.5% were determined to have intermediate risk, compared to 7.6% at intermediate risk and 2.5% at high risk using the ASCVD 10-year risk estimator. High rates of CVD risk factors were found among this sample of Hispanic women. Early recognition of risk, mitigation of modifiable risk factors, and effective self-care programs are needed for Hispanic women. Hispanic American women may benefit from community-based CVD educational programs that have been culturally and linguistically tailored.

Advance Care Planning Engagement Among Muslim Community-Dwelling Adults Living in the United States.

Advance care planning (ACP) is a cornerstone of self-determination for the type of care provided at the end of life. Despite many national efforts to improve American adults' engagement in ACP, statistics indicate low engagement. Low engagement, especially among racial and ethnic minority populations, immigrants, people with lower socioeconomic status, young adults, rural residents, or non-English speakers, is common. Advance care planning engagement among Muslims living in the United States has been minimally studied. The purpose of this study was to explore Muslims' engagement in ACP. A cross-sectional descriptive design was used. Participants were recruited from Islamic organizations through convenience and snowball sampling. Engagement in ACP was measured by the Advance Care Planning Engagement Survey. A sample of 148 Muslims (18-79 years of age) participated in the study. The average engagement scores ranged from 1.97 to 2.09, with about two-thirds in the precontemplation stage. Significant differences in engagement scores were found according to health condition and end of life experiences. Results suggest a need for further collaborative efforts by health care providers, policymakers, and researchers to mitigate the disparities in ACP engagement in the American Muslim community.

Reliability and Validity of the Spoken Knowledge in Low Literacy in Diabetes in Measuring Diabetes Knowledge Among Hispanics With Type 2 Diabetes.

PURPOSE: The purpose of the study was to examine the reliability and validity of the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) scale in measuring diabetes knowledge among Hispanics with type 2 diabetes (T2DM). METHODS: A total of 111 Hispanic participants with T2DM were recruited from clinics and churches in the Southeastern US. The Spanish version of the SKILLD was used. Internal consistency reliability and exploratory factor analysis (EFA) were examined for the Spanish SKILLD. Spearman rank correlations of SKILLD scores with the Summary of Diabetes Self-Care Activities (SDSCA) scores were inspected for evidence of convergent validity along with A1C level and duration of diabetes. RESULTS: The average SKILLD score was 35.1% (SD = 23.4%). The correct response for each SKILLD item ranged from 4.5% to 56.8%. The estimated reliability via internal consistency was adequate (Kuder-Richardson 20 = 0.706). EFA of the SKILLD items modestly indicated 1 factor could be retained. Spearman rank correlations of SKILLD scores with diabetes self-care activities were significant and positive for foot self-care. Higher SKILLD scores were significantly correlated with duration of diabetes, using insulin, having a high education level, ever attending a diabetes class, or having a parent with diabetes. CONCLUSION: The Spanish SKILLD showed acceptable reliability and adequate validity in this sample of Hispanics with T2DM. SKILLD scores indicated low diabetes knowledge in this sample. Patient-centered diabetes education tailored to low literacy needs of Hispanics is needed.

Sleep, Nutrition, Disordered Eating, Problematic Tobacco and Alcohol Use, and Exercise in College Students With and Without Diabetes.

The purpose of the current study was to examine the health behaviors of college students with diabetes and compare behaviors to college students without diabetes. This descriptive study used the American College Health Association-National College Health Assessment II and included 1,216 students between ages 18 and 24. Health behaviors related to sleep, nutrition, disordered eating, problematic tobacco and alcohol use, and exercise were examined. Students with diabetes (n = 528) reported a higher frequency of meeting exercise recommendations and less healthy behaviors related to nutrition and problematic tobacco and alcohol use. Both groups of students reported inadequate sleep. Students with diabetes reported more academic problems due to sleep difficulties, disordered eating, and problematic alcohol use. Health behaviors in both groups showed similar needs for improvement. Nurses are in a position to guide new, prospective, and continuing college students with diabetes in practicing behaviors associated with positive health outcomes. Opportunities for interventions are numerous. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 23-32.].

Are Emergency Departments in the United States Following Recommendations by the Emergency Severity Index to Promote Quality Triage and Reliability?

INTRODUCTION: The purpose of this study was to explore and describe (1) the extent to which emergency departments in the United States are promoting the quality of triage and the reliability of triage systems according to recommendations in the Emergency Severity Index (ESI) Handbook and (2) if relationships existed between triage structure (policies) and process (procedures) in emergency departments that promote accuracy of triage decisions. METHODS: Donabedian's Structure, Process, Outcome model guided this descriptive, correlational study. Nurses were recruited from all geographic regions in the United States, and the ED TRiAGE Structure and Process Survey was developed to collect data. Χ2 tests of independence, Fisher's exact tests, and Kendall's τ were used to assess relationships of structure and process. RESULTS: The majority of emergency departments did not meet at least the minimum recommendations of the ESI triage system. Significant positive relationships were found when an emergency department had structure (policy) to guide process (procedures). Differences were reported in the type, amount, and focus of the policies and procedures. DISCUSSION: Donabedian's model emphasizes that good structure and process are antecedents of good outcomes. This study serves as a foundation on which to examine the consistency of emergency departments meeting the ESI guidelines that promote triage accuracy and maintaining the reliability of evidence-based triage acuity systems.

The Impact of Physiological Factors on 30-day Unplanned Rehospitalization in Adults with Heart Failure.

Heart failure (HF) patients have high rates of 30-day unplanned rehospitalization. This study assessed the impact of physiological factors on 30-day HF unplanned rehospitalization. METHODS: The cross-sectional study used secondary data from electronic medical records of 270 patients. RESULTS: Findings revealed several factor types were related to 30-day HF unplanned rehospitalization such as chronic kidney disease (p = 0.001), the use of CPAP machine (p = 0.028), and B-type natriuretic peptide (p = 0.050). CONCLUSION: Many physiological factors were associated with 30-day HF unplanned rehospitalization. Identifying these factors will help health care providers to plan a variety of interventions that reduce 30-day HF unplanned rehospitalization.

Women's Mental Health After Retirement.

The aim of the current study was to examine mental health outcomes in retired women and determine whether relationships existed among mental health outcomes, sociodemographic characteristics, and type of retirement (i.e., voluntary or forced). A cross-sectional study was conducted with 80 women ages 55 and older residing in five southeastern states. Women had retired at least part-time from working outside of the home. Sociodemographic variables, diagnosis of depression, diagnosis of cognitive impairment, and health-related quality of life were assessed. Women with forced retirement had worse mental health compared to those who retired voluntarily. Minority women had higher rates of forced retirement compared with White women. Poorer mental health outcomes for women with forced retirement suggest the need for careful consideration of this transition as a socially determined health factor for retired women, especially minority women. Clinicians need to assess women for mental health indicators during the transition to retirement and provide educational and therapeutic resources to promote mental health during the transition from working life to retirement. [Journal of Psychosocial Nursing and Mental Health Services, 56(7), 37-45.].

Microbiota and Metatranscriptome Changes Accompanying the Onset of Gingivitis.

Over half of adults experience gingivitis, a mild yet treatable form of periodontal disease caused by the overgrowth of oral microbes. Left untreated, gingivitis can progress to a more severe and irreversible disease, most commonly chronic periodontitis. While periodontal diseases are associated with a shift in the oral microbiota composition, it remains unclear how this shift impacts microbiota function early in disease progression. Here, we analyzed the transition from health to gingivitis through both 16S v4-v5 rRNA amplicon and metatranscriptome sequencing of subgingival plaque samples from individuals undergoing an experimental gingivitis treatment. Beta-diversity analysis of 16S rRNA reveals that samples cluster based on disease severity and patient but not by oral hygiene status. Significant shifts in the abundance of several genera occurred during disease transition, suggesting a dysbiosis due to development of gingivitis. Comparing taxonomic abundance with transcriptomic activity revealed concordance of bacterial diversity composition between the two quantification assays in samples originating from both healthy and diseased teeth. Metatranscriptome sequencing analysis indicates that during the early stages of transition to gingivitis, a number of virulence-related transcripts were significantly differentially expressed in individual and across pooled patient samples. Upregulated genes include those involved in proteolytic and nucleolytic processes, while expression levels of those involved in surface structure assembly and other general virulence functions leading to colonization or adaptation within the host are more dynamic. These findings help characterize the transition from health to periodontal disease and identify genes associated with early disease.IMPORTANCE Although more than 50% of adults have some form of periodontal disease, there remains a significant gap in our understanding of its underlying cause. We initiated this study in order to better characterize the progression from oral health to disease. We first analyzed changes in the abundances of specific microorganisms in dental plaque collected from teeth during health and gingivitis, the mildest form of periodontal disease. We found that the clinical score of disease and patient from whom the sample originated but not tooth brushing are significantly correlated with microbial community composition. While a number of virulence-related gene transcripts are differentially expressed in gingivitis samples relative to health, not all are increased, suggesting that the overall activity of the microbiota is dynamic during disease transition. Better understanding of which microbes are present and their function during early periodontal disease can potentially lead to more targeted prophylactic approaches to prevent disease progression.

Feasibility Testing a Family-Level Intervention to Prevent Risky Sex Behaviors Among Middle School-Age Latinas.

PURPOSE: In this article, we report a pilot study that tested the feasibility and initial efficacy of a culturally, linguistically, and developmentally tailored risky sex prevention intervention for middle school-age Latinas and their mothers. DESIGN: We used a one-group pre-test, post-test, and 3-month post-intervention follow-up design. Data were collected at three points on aspects of the girls' communication, beliefs, and behaviors. RESULTS: Promising results included improvements in girl's self-efficacy regarding condom communication and condom consistent use, and in mother-teen sexual risk communication. There were also trends in demonstration of fewer risky sex behaviors. DISCUSSION: These findings suggest that the "Latina-Girls Empowered through Mind and Mission" (L-GEMM) intervention for young Latinas and their mothers is feasible and warrants further testing. IMPLICATIONS: Nurses are uniquely positioned to deliver risky sex preventive interventions to young Latinas. Including mothers and tailoring interventions to build on cultural strengths are important for success.

US Healthcare Experiences of Hispanic Patients with Diabetes and Family Members: A Qualitative Analysis.

Hispanics in the United States experience significant health disparities. Using focus groups conducted in Spanish, we explored the perspectives of 172 Hispanic adults regarding their healthcare experiences. Many participants were women (64.5%) and primarily from Mexico (80%). Four major qualitative themes emerged: (a) provide us with information, (b) want attentive and respectful relationships, (c) want better care, and (d) perceived discrimination. Suboptimal patient-provider interactions were described. Research is needed to explore interventions that address these issues. Incorporating person-centered care principles and practices such as clear and understandable communication, culturally competent care, and customer service skills may benefit provider interactions with Hispanics.

Schools as Sites for Recruiting Participants and Implementing Research.

Schools can be a valuable resource for recruitment of participants for research involving children, adolescents, and parents. Awareness of the benefits and challenges of working with schools can assist researchers in developing effective school partnerships. This article discusses the advantages of conducting research within the school system as well as the challenges that may also arise. Such challenges include developing key contacts, building relationships, logistical arrangements, and facilitating trust in the research topic and team. Suggestions for strategies to forge successful collaborative relationships with schools are provided.

Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record.

INTRODUCTION: Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes. PURPOSE: The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization. METHODS: The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined. RESULTS: The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77-2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]). DISCUSSION: Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.

A Family-Based, Culturally Tailored Diabetes Intervention for Hispanics and Their Family Members.

PURPOSE: The purpose of this study was to test efficacy of a family-based, culturally tailored intervention for Hispanics with type 2 diabetes and their family members. METHODS: Hispanic patients with type 2 diabetes and their family members recruited from community clinics and ethnic churches were assigned to groups (N = 186). The intervention group received an 8-week culturally tailored diabetes educational program delivered in Spanish while the attention control group received 8 weekly sessions on general health information and 2 sessions on diabetes after completion of the study. Data were collected at baseline, after intervention, and at 1- and 6-month follow-ups for both patients and families. Comparisons of change over time were performed using growth curve analyses after propensity score adjustment. RESULTS: Intervention patients improved in diabetes knowledge and diabetes self-efficacy over time (but did not sustain at 6-month follow-up). A1C was lower at 1-month follow-up. Family members had improvements in diabetes knowledge and physical health-related quality of life. CONCLUSIONS: Including families in the interventions may improve glycemic control, diabetes knowledge, self-efficacy, and physical health-related quality of life. However, strategies for sustaining improvements are needed.