Equine-assisted service's effect on cartilage and skeletal biomarkers for adults and older adults with arthritis: A pilot study.

OBJECTIVE: The object of this study was to determine the effect of EAS (Equine-Assisted Services) on arthritis conditions, as measured by the sTnT (Skeletal troponin) and COMP (cartilage oligomeric matrix proteins) biomarkers, compared to an exercise attention control intervention. DESIGN: This was a secondary analysis of a randomized clinical trial comparing equine-assisted therapy to exercise education attention-control on cartilage and skeletal biomarkers in adults with arthritis. Twenty-one adults (Mage = 64 years) with arthritis who attended rheumatology clinics in the midwestern United States participated. RESULTS: No changes were found in sTnT from baseline to week six within either intervention nor were there differences in changes between the two groups (p = 0.91). COMP increased from baseline to week six for both conditions, suggesting increased deterioration of cartilage and joints. Although the attention-control condition demonstrated larger increases in cartilage oligomeric matrix proteins level, compared to the EAS condition, these differences were not statistically (p = 0.58) or clinically significant (i.e., trivial effect, d = -0.16). When 3 outliers were removed, the differences in changes between EAT and attention-control group could be arguably of clinical significance (d = - 0.33), suggesting that the attention-control group demonstrated larger increases in levels of COMP than those in the EAS condition, though this difference was not statistically significant (p = 0.28). CONCLUSION: Although equine-assisted therapy may reduce pain and improve quality of life for adults with arthritis, findings here are not fully corroborated with biomarkers.

Physical activity and sedentary behavior in middle-aged intensive care unit survivors discharged home: A systematic review.

OBJECTIVES: The purpose of this study was to review literature on physical activity and sedentary behavior of middle-aged adults post-discharge from the intensive care unit, with a particular focus on studies using wearable activity trackers. METHODOLOGY: Systematic review conducted using correlational, cohort, and intervention studies of physical activity and sedentary behavior of intensive care unit survivors' post-discharge. Literature in PubMed, Embase, and CINAHL was searched using keywords derived from patient status, activity, and activity monitoring. Two independent reviewers used the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess quality of articles and potential biases in study design. MAIN OUTCOME MEASURES: Physical activity and sedentary behavior assessed via wearable activity trackers. RESULTS: Two hundred and fifty-six studies met inclusion criteria; six studies comprising 265 participants were retained. Outcomes varied widely and were not synthesized, but instead discussed individually. Average steps/day ranged from 1278 to 4958 and average minutes of activity ranged from 26 to 45 min/day. One study reported 12 hours and 17 min/day spent in sedentary activity and another reported 90 % of hospitalization was in sedentary behavior compared to 58 % post-discharge. CONCLUSION: Few studies have examined physical activity and sedentary levels of middle-aged intensive care unit survivors wearing activity trackers. Findings are limited in generalizability, and no randomized controlled trials were included here. Eliciting support from clinical and post-discharge care teams to encourage activity and/or attend prescribed therapy or rehabilitation sessions is important. IMPLICATIONS FOR CLINICAL PRACTICE: Clinicians should emphasize the importance of physical activity throughout the day to decrease sedentary time during a hospital stay and to continue being active after discharge to home. Physical activity is valuable, even in short spurts, from hospital stay through discharge. Interventions to increase physical activity and decrease sedentary time are needed to improve intensive care unit survivor recovery and quality of life post-discharge.

DEVELOPMENT AND PSYCHOMETRIC TESTING OF THE SENSE OF BELONGING IN NURSING SCHOOL SCALE.

Background and Purpose: While sense of belonging is essential for human motivation, impaired belonging among nurses can impact the care and safety of patients. This article reports the development and psychometric testing of the Sense of Belonging in Nursing School (SBNS) scale to assess nursing students' sense of belonging in three different environments: Clinical, classroom, and among the student cohort. Method: Principal component exploratory factor analysis with varimax rotation was used to determine the construct validity on the 36-item SBNS scale with a sample of 110 undergraduate nursing students. Cronbach's alpha was used to determine the scale's internal consistency. Results: The scale was reduced to 19-items with high internal consistency (α = 0.914). Principal component analysis then identified four factors (sub-scales) with high internal consistency: Clinical staff (α = 0.904), clinical instructor (α = 0.926), classroom (α = 0.902), and classmates/cohort (α = 0.952). Conclusion: The SBNS scale is a reliable and valid tool to measure sense of belonging across three environments among nursing students. Further research is needed to determine the scale's predictive validity.

Familiarity and Use of MyPlate: An Online Focus Group Exploration Among Midwestern K-12 Teachers.

OBJECTIVE: To examine teachers' familiarity and use of MyPlate, including barriers to using it. METHODS: Twenty kindergarten through grade 12 teachers were recruited from 1 urban and suburban school district in the Midwest to participate in virtual focus groups regarding familiarity, use, and barriers to MyPlate. A basic descriptive qualitative approach with thematic analysis was guided by systems thinking. Common categories were coded and agreed on by the authors. RESULTS: Findings included main categories of individual awareness, use in curriculum, and appropriate facilitators of MyPlate. Awareness and use of MyPlate were mixed. Teachers integrated MyPlate in math, history, and other subjects. Barriers included packed curriculum and cultural issues. The facilitators of MyPlate mentioned were health or physical education teachers. CONCLUSIONS AND IMPLICATIONS: Online focus groups successfully collected formative data on teachers' perspectives toward MyPlate. The technology could be used in future similar research. Enhanced teacher training may improve the integration of MyPlate into schools. School teachers identified major barriers to MyPlate in the classroom, including lack of time and resources. There was mixed feedback on how MyPlate and nutrition may be used in school curricula. Enhanced teacher training may improve the integration of MyPlate into schools.

Escape rooms in nursing education: An integrative review of their use, outcomes, and barriers to implementation.

OBJECTIVES: Escape rooms are becoming a popular teaching method in a variety of fields and settings, but have not been examined for their effectiveness in nursing education. The aim of this integrative review was to map trends in escape rooms in nursing research and evaluate support for using this innovative, simulation-based teaching method. DESIGN, DATA SOURCES, AND REVIEW METHODS: Using Whittemore and Kanfl's framework, this integrative review analyzed the use of simulation-based escape rooms in nursing and nursing education. Results were refined using inclusion and exclusion criteria, and evaluated with use of the Mixed Methods Appraisal Tool. Databases searched were PubMed, CINAHL, PsychINFO, Google Scholar, and ERIC. RESULTS: A total of 18 studies were included. Common categories identified included student satisfaction with escape rooms and barriers of cost and time to educators. Desired outcomes of the studies reviewed focused on teamwork, perceived learning or increased confidence, or increase in knowledge. Optimal group size and theoretical support recommendations for escape rooms are lacking with the need for further research. CONCLUSIONS: Escape rooms are effective at improving knowledge in a variety of nursing education topics, and their use has been well-received in a variety of nursing and professional health students. Long-term outcomes have not been assessed. There is need for more research in assessing ideal group size when using escape rooms in education settings, more rigorous study design to determine effectiveness of escape rooms to produce education-focused outcomes, and more consensus on appropriate theoretical frameworks that can guide the implementation and study of escape rooms in practice.

Cross-sectional study of the relationship between experiences of incivility from staff nurses and undergraduate nursing students' sense of belonging to the nursing profession.

AIM: This study examined the frequency of incivility for undergraduate nursing students and the relationship between staff nurse incivility and nursing students' sense of belonging. Factors between program semester and students' body mass index (BMI) to staff nurse incivility and students' sense of belonging were assessed. BACKGROUND: Sense of belonging enhances belonging development to the profession. However, no studies address the relationship between incivility and nursing students' sense of belonging. METHODS: A cross-sectional design assessed the relationship between staff nurse incivility and undergraduate nursing students' sense of belonging to the nursing profession. An online survey was administered to 123 pre-licensure junior and senior undergraduate nursing students from February 1, 2021, to May 5, 2021. Correlation coefficient, descriptive statistics, Fisher r-to-z transformation, 95% confidence intervals were calculated. RESULTS: Staff nurse incivility inversely correlated with undergraduate nursing students' sense of belonging (rs=-.358; p <.001). American Indian or Alaskan Native students reported the highest mean frequency of incivility (1.25 ± .421). There were no significant differences in correlations based on semester or BMI. CONCLUSION: Staff nurse incivility is inversely associated with sense of belonging in students. Further research is needed to test interventions mitigating the effects of incivility on belonging.

Evidence-based Training to Improve Communication between Health Advocates and State Policymakers.

Persuading state policymakers to adopt effective child health policies requires effective communication from health advocates. This study examined the effectiveness of evidence-based communication training among child obesity advocates and their state legislators. A health advocacy group conducted training using evidence-based strategies and health-related policy updates in one Midwestern State Capitol building in January 2020. Twenty-three health professionals participated in the training prior to meetings with their legislators to discuss child obesity policies. An 18-item, pre- and post-questionnaire assessed training effects on knowledge, confidence, competence, importance of communicating, and future intentions to communicate with state policymakers. Satisfaction with the training was also assessed. Knowledge, confidence, importance, and future intentions to deliver child health messages to Missouri legislators all improved as a result of the training. Participants significantly increased their competence to speak with legislators on child health issues (Mann-Whitney U = 99.5; p = .039). Participants were very satisfied with the training and enjoyed receiving health-related policy updates and learning policymakers' preferred message frames related to child health. Evidence-based training and in-person practice can significantly improve the competence of health advocates for communicating with their policymakers. This in-person training is one feasible strategy for developing impactful child health policies and informing health education efforts.

Resources Needed for Education and Meal Programs by Urban Schoolteachers and Staff During the 2019 Coronavirus Pandemic.

BACKGROUND: Adjustments in teaching resources and school meal programs are urgently needed during the COVID-19 pandemic. This study examined teaching resources that would have been helpful when schools closed, and how school meal programs should be changed in the 2020-2021 school year. METHODS: In October 2020, a 27-item, cross-sectional, online survey was administered to 99 teachers and staff members in an urban, Midwestern school district. Data were analyzed using frequencies and proportions, and open-ended responses were analyzed using content analysis. RESULTS: Online teaching was difficult for teachers and students, and training for online teaching, improved Internet access, and more time for grading or office hours would have been helpful when schools closed. Meal programs were offered by 86% of schools after closing, and many participants supported continuing meal programs for 2020-2021. Resources needed to continue meal programs included funding for meal reimbursement, transportation to the meal sites, and more staff. Suggested changes to meal programs included offering more variety or more food, and solving transportation issues. CONCLUSION: Addressing these concerns can improve school and community health. Findings will inform efforts to enhance online teaching and improve and continue school meal programs as the world continues to be affected by COVID-19.

Challenges of Preparing Nursing Students for Practice: The Faculty Perspective.

BACKGROUND: A significant challenge facing nursing is new graduate RNs' unreadiness for practice. To better understand the issue, this study presents the challenges nursing faculty encounter in preparing nursing students for clinical practice through semi-structured interviews. METHOD: Eight faculty from a private midwestern university's prelicensure Bachelor of Science in Nursing (BSN) program participated in the study. A modified version of Colaizzi's data analysis method was used to interpret the data. RESULTS: Three main interrelated themes were identified: Facilitating Learning Among Today's Nursing Students, Teaching in an Era of Information Explosion and Health Care Reform, and Providing High-Quality Clinical Education. CONCLUSION: Findings from this study contribute to a deeper understanding of the challenges in preparing competent future nurses and offer insight into factors influencing the underpreparation of some new graduate BSN RNs. [J Nurs Educ. 2021;60(4):225-228.].

Physical and Cognitive Training to Enhance Intensive Care Unit Survivors' Cognition: A Mapping Review.

PURPOSE: The aim of this study was to examine current literature regarding effects of physical or cognitive training and simultaneous (dual-task) physical and cognitive training on cognition in adults surviving an intensive care unit (ICU) stay. DESIGN: Systematic mapping. METHODS: A literature search was conducted to examine effects of physical and/or cognitive training on cognitive processes. RESULTS: Few studies have targeted adults surviving ICU. Independently, physical and cognitive interventions improved cognition in healthy older adults with and without cognitive impairment. Simultaneous interventions may improve executive function. Small sample size and heterogeneity of interventions limited the ability to make inferences. CONCLUSION: Literature supports positive effects of single- and dual-task training on recovering cognition in adults. This training could benefit ICU survivors who need to regain cognitive function and prevent future decline. RELEVANCE TO PRACTICE: With the growing number of ICU survivors experiencing cognitive deficits, it is essential to develop and test interventions that restore cognitive function in this understudied population.

College Classroom Instructors Can Effectively Promote Standing among Students Provided with Standing Desks.

Standing desks may reduce sedentary behaviors in college students. Students at one mid-size urban university in the Midwestern United States were randomized into intervention (n = 21) and control groups (n = 27) to assess standing time when given access to standing desks. The intervention group received visual and oral instructor prompts to stand, while the control received no prompts during a 50 min lecture. All students were provided with adjustable tabletop standing desks. ActivPAL accelerometers measured sitting and standing time. A brief survey assessed student preferences, including facilitators and barriers to standing. Mean standing time was greater in the intervention vs. control group (26 vs. 17 min, p = 0.023). Students tended to stand in the corners and edges of the room. Main facilitators for standing included to break up sitting, reduce back pain, and increase attention and focus; main barriers were not wanting to distract others or be the only one standing. In total, 87.5% of intervention group participants found five prompts to stand were adequate. Students increased standing time in class when provided with standing desks and instructor prompts to stand. Findings can inform the layout of classrooms and when and how to promote standing desks during lectures.

Defining a new normal: A qualitative exploration of the parent experience during the single ventricle congenital heart disease interstage period.

AIM: To explore parents' experience of transition in the period between the palliative cardiac surgeries (i.e., the interstage period) of an infant with single ventricle congenital heart disease. DESIGN: We conducted an exploratory naturalistic inquiry using a qualitative descriptive approach. METHODS: A purposive sample of 11 parents of children with single ventricle disease was selected among families that participated in an interstage-period parental home monitoring program during the past 2 years. Interviews and field observations were conducted September-October 2019, and data were analyzed for themes. Analysis of data was inductive, although study questions and the interpretation of results were informed by Meleis' transition theory. RESULTS: Parents described the experience of transition in interstage as a striving for normality, a theme that was clustered in subthemes of home, self, and infant. CONCLUSION: Parents' experiences of striving for normality indicated a need for more targeted efforts to address parents' psychosocial needs during the highly stressful interstage transition. IMPACT: This research underscored the complexity of parents' psychosocial support needs on returning home after their child's first palliative surgery. The findings also suggest need for examination of the transition following the second palliative heart surgery, when the home monitoring program is withdrawn. Understanding parent needs will help guide healthcare teams in developing ways to support parents as they adjust to home, self, and child.

Preferred Child Obesity Message Frames and Their Perceived Strength among State Policymakers.

Background: Health message framing, including gain or loss frames, can influence perceptions of child health messaging. It is unknown how characteristics such as political party and education may impact policymakers' message frame preference and perceived strength of child obesity messages. The purpose of this study was to examine preferred child obesity message frame, perceived strength of child obesity messages, and group differences among state policymakers. Methods: A cross-sectional online survey was administered in-person to state representatives and senators via electronic tablet between February and May, 2019, at a midwest State Capitol building. Participants were asked their message frame preference and perceived strength of child obesity messages related to long-term health, school, geographic region, military readiness, cost-savings, and the workforce. They were also asked who was responsible for preventing child obesity and strategies to prevent it. Data were analyzed descriptively and via chi-square tests for group differences. Results: One hundred fifteen state policymakers completed the survey. Participants overall favored gain-framed messages, which were perceived as stronger than loss-framed. Parents were viewed as most responsible overall for preventing child obesity, with Republicans (vs. Democrats; χ2 = 8.54; p = 0.008) and those with less education (vs. more; χ2 = 5.97; p = 0.029) perceiving them as more responsible (χ2 = 8.54; p = 0.008). Democrats viewed the food industry as more responsible (χ2 = 11.4; p = 0.001) than Republicans. Increasing physical activity, nutrition education, and fresh fruits and vegetables in schools were the most preferred prevention strategies. Conclusions: Child health advocates should consider using gain-framed messages related to child obesity when communicating with policymakers, and targeting their preferred strategies may enhance policy development.

Incivility through the continuum of nursing: A concept analysis.

AIM: The aim of this study is to explore the gap between incivility in the workplace and academia and develop a connection to the psychosocial distress effects on the victims. BACKGROUND: While incivility in nursing has reached epidemic proportions in the past decade, the current definitions of incivility are limited to the workplace or academia and lack consideration of the consequences related to the social well-being of the victim. DESIGN: Rodgers' evolutionary method was used in this study. DATA SOURCE: Following the PRISMA guidelines, articles were reviewed from PubMed and CINAHL between 2008 to 2019. Twenty articles describing incivility faced by staff nurses, student nurses, academic faculty, and nursing administrators were included in the final analysis. REVIEW METHODS: Inductive thematic analysis was used to determine the antecedents, attributes, and consequences of incivility in nursing. RESULTS: Findings included a culture of incivility and power gradients as antecedents. The attributes of incivility were verbal or non-verbal behaviors that demean, dismiss, or exclude the individual. Consequences of incivility are psychosocial and physiological distress. CONCLUSION: A broader definition of incivility may be appropriate. Further research is needed to determine interventions to mitigate the effects of incivility.

Barriers and Motivators of Bicycling by Gender Among Older Adult Bicyclists in the Midwest.

Introduction. Physical activity (PA), particularly low-impact activities like bicycling, can improve health in older adults. However, bicycling rates are lower in the Midwest than other regions in the United States. Therefore, it is important to identify unique social, personal, and environmental factors that inhibit or promote bicycling, and how these are associated with PA. The influences of these factors were explored using the social ecological model. Method. A cross-sectional online survey was developed using previously validated local and national bicycling questionnaires, then distributed to Midwestern bicyclists 50 years and older. Exploratory factor analysis was conducted to understand the influences of social, personal, and environmental barriers and promoters on bicycling patterns. All models were conducted separately by gender, and accounted for age, race, education, marital status, income, and employment. Results. Social promoters (B = 0.386, p = .002), such as having friends/family that bicycle were associated with greater PA. Personal promoters (B = -0.311, p = .006) such as needing to lose weight were associated with reduced PA. Environmental factors had no associations with PA. However, individual environmental components, such as number of vehicles on the roads, were significantly associated with PA for both males and females. Females reported more barriers than males. The overall model accounted for 16.1% of the total variance in PA levels. Conclusion. Interventions to promote PA via bicycling in older adults should focus on social factors, while also reducing personal-level factors for males. Interventions for females could focus on reducing specific personal, social, and environmental barriers.

Evaluating MyPlate After 8 Years: A Perspective.

MyPlate is the current educational icon that supports communication of US Dietary Guidelines for Americans to the public. Since its inception in 2011, there has been a paucity of research documenting consumer awareness of the icon and its effectiveness for improving Americans' diets. This perspective presents the extent to which MyPlate has been represented in the nutrition education literature and discusses current evaluation and utilization needs. The authors argue that more rigorous, theory-based evaluation of MyPlate, as both a standalone icon and part of educational interventions, is needed to advance communication and adoption of the Dietary Guidelines for Americans.

Sleep duration and risk of cancer in the Mexican American Mano-a-Mano Cohort.

BACKGROUND: To date, no study has investigated the association of sleep duration with cancer risk in Mexican Americans. ANALYSIS: Using data from the Mano-A-Mano Mexican American Cohort study, we analyzed the relationship between sleep duration and overall cancer risk among Mexican Americans. RESULTS: Of 10,802 subjects included in this study, 429 developed cancer during follow-up. Compared with study participants sleeping 8-9 hours per night, those sleeping less than 6 hours per night had significantly increased risk of overall cancer in both univariate and multivariate Cox regression analyses. After adjusting for social-demographic and lifestyle variables, sleeping less than 6 hours per night was associated with a 1.37-fold increased risk of overall cancer (hazard ratio = 1.37, 95% confidence interval: 1.01-1.97). In breast cancer alone, sleeping less than 6 hours per night was associated with a 1.86-fold increased risk of breast cancer (hazard ratio = 1.86, 95% confidence interval: 1.01-3.45) after adjustment for birthplace and language acculturation. In further stratified analysis, significant associations between sleeping less than 6 hours per night and overall cancer risk were evident among overweight participants, former drinkers, those with medium or high levels of physical activity, those married or living together, and those who had less than 2 hours of sitting time per day. In addition, increased cancer risk associated with long sleep duration (at least 9 hours per night) was observed among overweight participants and those with medium or high levels of physical activity. CONCLUSION: Our results provide evidence to link sleep duration with cancer risk among Mexican Americans.

Changes in Social Integration Predict Changes in Physical Activity: A 25-Year Prospective Study.

BACKGROUND: Social relationships are among the strongest predictors of health. The extent to which one is embedded in social networks, also referred to as social integration, has been associated with physical activity in short-term longitudinal and cross-sectional studies. How changes in social integration impact physical activity over longer periods of time is not well understood. METHODS: Longitudinal data from 5 waves of the Americans' Changing Lives study were used (wave 1: n = 3617; wave 5: n = 1427). Data were modeled using latent growth curves to understand the trajectories of social integration and physical activity, separately. Latent interlocking growth curve methods were used to understand if and how changes in social integration predicted changes in physical activity. RESULTS: Physical activity did not change over the 25-year period (P = .68). Social integration significantly decreased (P = .025). Changes in social integration predicted changes in physical activity (ß = 0.12, P < .05). CONCLUSIONS: Changes in how often adults speak to family and friends predict changes in physical activity across a 25-year period. Group- and social network-focused physical activity research, advocacy, and interventions are warranted.

Associations between language acculturation, age of immigration, and obesity in the Mexican American Mano A Mano cohort.

INTRODUCTION: As Mexican immigrants to the U.S. become acculturated, they face worsening health outcomes such as obesity. The role of language acculturation in the development of obesity has not been thoroughly examined. METHODS: To examine associations between language acculturation and obesity, data were drawn from the Mexican-American Mano A Mano cohort study. Participants aged 20 years and over (n=18,298) completed baseline questionnaires on socio-demographic and behavioural factors, including physical activity and sitting time. The Bi-dimensional Acculturation Scale for Hispanics assessed language acculturation. Multivariate-adjusted logistic regression was conducted to investigate associations between language acculturation, immigration age, and obesity, and whether sitting time and physical activity mediated these associations. RESULTS: Individuals with obesity were more linguistically acculturated than individuals who were normal weight or overweight (P<0.001); however, this relationship differed by gender and nativity. Among Mexico-born women, language acculturation score was inversely related to BMI (P<0.001). Language acculturation was associated with higher risk of obesity (OR=1.35, 95% CI: 1.12-1.62) in U.S.-born participants and lower risk in Mexico-born participants (OR=0.90, 95%CI=0.81-1.00). For Mexico-born participants, arrival in the U.S. as an adult (≥20years old) was associated with a reduced obesity risk (OR=0.74, 95% CI: 0.67-0.80). Sitting time mediated the association between language acculturation and obesity. CONCLUSIONS: Language acculturation may influence obesity development among the U.S.-born Mexican Americans in this cohort, but not their Mexico-born counterparts. Sitting time could be targeted in obesity prevention efforts in this population.

Cohort Profile: The Mexican American Mano a Mano Cohort.

Hispanic Americans comprise the largest and fastest-growing ethnic minority in the USA. In Houston, Texas, 44% of the population is of Hispanic descent, with the majority being Mexican Americans (78%). This population is under-represented in health-related research despite their high prevalence of obesity and diabetes, which may predispose them to cancer and other chronic conditions. Recognizing the need for a greater research effort into the health risks of Hispanic Americans, the population-based Mexican American (Mano a Mano) Cohort study was launched in 2001. This is an open cohort with enrolment ongoing to 2019, and as of 30 June 2014, 23 606 adult participants from over 16 600 households were enrolled. Bilingual interviewers elicit information in person on demographics, acculturation, lifestyle, occupation, medical history, family cancer history, self-reported and measured height and weight, and other exposures. Urine, blood and saliva samples have been collected at baseline from 43%, 56% and 63% of participants, respectively. DNA samples are available for about 90% of participants. Incident cancers and other chronic diseases are ascertained through annual telephone re-contact and linkage to the Texas Cancer Registry and/or medical records. Molecular data such as genetic ancestry markers, blood telomere length and HbA1c, a marker of impaired glucose tolerance, are available for a substantial proportion of the participants. Data access is provided on request [manoamano@mdanderson.org]. For further information please visit [www.mano-mano.us].