Interprofessional relationships and their impact on resident hospitalizations in nursing homes: A qualitative study.

AIM: The aim of this study is to explore experiences and perspectives of nurses and providers (e.g., physicians, medical directors, fellows, and nurse practitioners) on reducing preventable hospitalizations of nursing home (NH) residents in relation to interprofessional relationship and hospitalization decision-making process. BACKGROUND: Preventable NH resident hospitalization continues to be a pressing public health issue. Studies show that improved interprofessional relationship may help reduce hospitalization, yet research on communication processes and interactions among different NH staff remains limited. METHODS: This is a qualitative descriptive study. Two focus groups were held with fourteen nurses and thirteen in-depth, qualitative interviews were conducted with providers from two Chicagoland NHs. Focus group sessions and interviews were transcribed, coded, and analyzed for common themes based on qualitative description method. RESULTS: All study participants agreed that providers have the ultimate responsibility for hospitalization decisions. However, nurses believed they could influence those decisions, depending on provider characteristics, trust, and resident conditions. Nurses and providers differed in the way they experienced and conveyed emotions, and differed in key elements affecting hospitalization decisions such as structural or environmental factors (e.g., lacking staff and equipment at the facility, poor communication between the NH and hospitals) and interpersonal factors (e.g., characteristics of effective nurses or providers and the effective interactions between them). CONCLUSIONS: Interpersonal factors, including perceived competence, respect, and trust, may influence NH hospitalization decisions and be targeted for reducing preventable hospitalizations of residents.

Validación de contenido y fiabilidad del instrumento "Conocimiento, actitud y comportamiento sobre hidratación y reposición de líquidos", en deportistas chilenos

Introducción: Existen estrategias direccionadas a mejorar el rendimiento de los deportistas, algunas estableciendo recomendaciones respecto a la hidratación y reposición de líquidos, con el propósito de asegurar un balance hídrico adecuado en todas las etapas de la práctica deportiva. Sin embargo, existe una carencia de instrumentos adecuados y confiables que permitan explorar esta temática. Objetivo: La presente investigación tiene como objetivo validar por contenido y evaluar la fiabilidad del instrumento "Conocimiento, actitud y comportamiento respecto a la hidratación y reposición de líquidos" en deportistas adolescentes y adultos jóvenes en Chile. Métodos: La adaptación cultural se realizó a través del método Delphi con un panel de expertos en el área, para la evaluación de la fiabilidad se aplicó el cuestionario de manera online a una muestra de 384 deportistas de diferentes disciplinas en dos oportunidades para determinar la estabilidad temporal. Resultados: Todos los ítems lograron porcentajes de acuerdo superior al 80% según el estadístico V de Aiken, en relación con la fiabilidad se obtuvo un Alfa de Cronbach de 0,78 lo que evidencia una consistencia interna aceptable, adicionalmente se obtuvo un Coeficiente de Correlación intraclase de 0,64 entre las dos aplicaciones del cuestionario presentando una fiabilidad regular a buena. Conclusión: Este cuestionario puede ser empleado como una herramienta confiable para ser utilizada en futuras investigaciones en el área de la nutrición deportiva, además como un instrumento que aporta al quehacer de distintos profesionales para apoyar a planificar y evaluar estrategias que propendan al mejoramiento del rendimiento deportivo.

Introduction: There are strategies aimed at improving the performance of athletes, some of which establish recommendations regarding hydration and fluid replacement, with the purpose of ensuring an adequate water balance at all stages of sports practice. However, there is a lack of adequate and reliable instruments to explore this issue. Objective: The present research aims to validate the content and evaluate the reliability of the instrument "Knowledge, attitude and behavior regarding hydration and fluid replacement" among adolescent and young adult athletes in Chile. Methods: The cultural adaptation was carried out through the Delphi method with a panel of experts in the area. For the evaluation of reliability, the questionnaire was applied online to a sample of 384 athletes from different disciplines on two occasions to determine temporal stability. Results: All items achieved percentages of agreement higher than 80% according to Aiken's V statistic, in relation to reliability a Cronbach's Alpha of 0.78 was obtained, which shows an acceptable internal consistency, additionally an intraclass Correlation Coefficient of 0.64 was obtained between the two applications of the questionnaire presenting a regular to good reliability. Conclusion: This questionnaire can be used as a reliable tool for future research around sports nutrition, as well as an instrument that contributes to the work of different professionals to support the planning and evaluation of strategies aimed at improving sports performance.

Illinois Unidos: A Community Demands Equity, Justice, and Inclusion.

At the onset of the COVID-19 pandemic, neither government officials nor members of the news media fully grasped what was happening in the Latino community. Underreporting of COVID-19 cases led to a systematic neglect of the Latino population and resulted in disproportionately high rates of infection, hospitalization, and death. Illinois Unidos was formed to engage in community mobilization, health communication, advocacy, and policy work in response to inequalities exacerbated by COVID-19 in Latino communities in Illinois. (Am J Public Health. 2021;111(S3):S204-S207. https://doi.org/10.2105/AJPH.2021.306407).

Certified Nursing Assistants' Barriers and Facilitators to Accessing and Using Worksite Health Promotion Programs.

OBJECTIVE: Certified nursing assistants (CNAs) are low-wage healthcare workers who provide direct care to nursing home residents, yet also experience significant health disparities. However, limited research has been conducted on CNAs' perceived barriers and facilitators to workplace health promotion (WHP) participation. METHOD: Informed by the Consolidated Framework for Implementation Research (CFIR), 24 CNA semi-structured, in-depth interviews were conducted in two Chicagoland nursing homes. RESULTS: Key barriers were time-constraints and lack of staffing, lack of access to WHP programs, and limited organizational and employer support. Facilitators included the availability of WHP programs, breaks, and other workplace benefits, and enhanced leadership and familial support. CONCLUSION: An effective WHP program must attempt to minimize the work-related, organizational, and environmental barriers while supporting high motivation of CNAs in health promotion. We offer some suggestions for enhancing CNAs' WHP access and utilization.

Individual and combined effects of a cognitive task, light finger touch, and vision on standing balance in older adults with mild cognitive impairment.

BACKGROUND: Postural instability and balance dysfunction have been identified in older adults with mild cognitive impairment (MCI). Performing a secondary task while standing can additionally jeopardize their balance. AIMS: The purpose of the exploratory study was to investigate the individual and combined effects of a cognitive task, light finger touch and vision on postural sway in older adults with MCI as compared to healthy older adults. METHODS: Five individuals with MCI and ten age-matched control subjects stood on the force platform with and without the performance of a cognitive task (counting backward from a randomly chosen three-digit number), with and without light finger touch contact applied to an external stable structure, and with eyes open or closed. The center of pressure (COP) excursion, range, velocity in antero-posterior and medial-lateral directions and sway area were calculated. RESULTS: Participants demonstrated significantly larger postural sway when vision was not available (p < 0.05), smaller postural sway when using a finger touch contact (p < 0.05) and increased postural sway during the performance of the cognitive task (p < 0.05). When finger touch and a cognitive task were performed simultaneously, body sway decreased as compared to just standing in healthy older adults but not in individuals with MCI (p < 0.05). CONCLUSIONS: The results help to better understand the individual and combined effects of vision, light touch and a cognitive task in postural control of individuals with MCI. The study outcome also provides a basis for future studies of balance control in patients with cognitive impairments.

Role of a single session of ball throwing exercise on postural control in older adults with mild cognitive impairment.

PURPOSE: The purpose of the study was to investigate the role of training in improvement of balance control in older adults with mild cognitive impairment. METHODS: Older adults (mean age 78) with mild cognitive impairment (MCI) and cognitively intact older adults (mean age 72) were exposed to self-initiated perturbations while performing bilateral shoulder flexion task before and after a single training session consisting of throwing a medicine ball. EMG activity of six trunk and lower limb muscles was recorded. Muscle onsets, integrals of EMG, and muscle co-contraction (C) and reciprocal (R) activation indices were calculated and analyzed during the anticipatory and compensatory phases of postural control. RESULTS: Anticipatory postural adjustments (APAs) were observed in both groups.  Individuals with MCI, as compared to controls, had higher level of co-contraction of muscles. The training resulted in enhancement of the generation of APAs in individuals with MCI seen as earlier onset of leg and trunk muscle activity prior to the bilateral arm flexion task. While smaller co-contraction of muscles post-training was seen in both the groups, the effect of a single training session was significant in control subjects only. CONCLUSIONS: The outcome of the exploratory study suggests that perturbation-based training could be used to improve balance control in older adults with and without mild cognitive impairment.

Role of motor and cognitive tasks in gait of individuals with mild cognitive impairment.

Older adults with mild cognitive impairment (MCI) experience difficulties with memory and task execution. Walking while performing a secondary task could affect gait of individuals with MCI and increase fall risk. The aim of the study was to investigate gait in individuals with MCI performing motor and cognitive secondary tasks. Eight individuals with MCI and eight age-matched healthy older adults walked over the GAITRite walkway under three different conditions: with no secondary task, while carrying a glass of water in their dominant hand (motor task), and while reciting alphabet [cognitive task (CT)]. Gait velocity, cadence, step length, and stride length were calculated. With no secondary task individuals with MCI as compared with the healthy older adults walked slower (P < 0.001) and with shorter step and stride length. When a secondary task was added, gait performance of the individuals with MCI deteriorated even more. The largest decline in gait was seen during the performance of the CT as compared with motor task (P < 0.001). The outcome provides a basis for future studies of the effect of the secondary motor task and CT in the identification of MCI as well as in planning rehabilitation interventions.

Validation and international regulatory experience for a mycoplasma touchdown PCR assay.

A PCR assay was developed to monitor rFVIII production fermenters for mycoplasma contamination. The method uses a simple extraction procedure followed by a qualitative "touchdown" (TD) PCR protocol with primers specific to the 16S rRNA gene. The method has the capacity to detect a wide range of mycoplasma species. Validation was performed according to ICH guidelines and confirmed a limit of detection of between 579 and 1715 mycoplasma genome copies spiked per ml of sample, and a 1000-10,000-fold greater specificity compared to Gram-positive bacteria. In a comparability study, it was comparable in sensitivity to the current FDA-recommended broth and agar culture-based method down to one colony forming unit (cfu)/ml. The method was validated for its intended use as a replacement for culture-based mycoplasma detection during routine fermenter monitoring. Regulatory approvals for the method have been obtained in many of the major regions and activities are ongoing to address agency concerns regarding the comparative limit of detection of the method to culture-based assays.