1
|
Dwivedi V, Shivanna V, Gautam S, Delgado J, Hicks A, Argonza M, Meredith R, Turner J, Martinez-Sobrido L, Torrelles JB, Kulkarni V. Age associated susceptibility to SARS-CoV-2 infection in the K18-hACE2 transgenic mouse model. GeroScience 2024; 46:2901-2913. [PMID: 38388916 PMCID: PMC11009211 DOI: 10.1007/s11357-024-01102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still an ongoing global health crisis. Clinical data indicate that the case fatality rate (CFR) is age dependent, with a higher CFR percentage in the elderly population. We compared the pathogenesis of SARS-CoV-2 in young and aged K18-hACE2 transgenic mice. We evaluated morbidity, mortality, viral titers, immune responses, and histopathology in SARS-CoV-2-infected young and old K18-hACE2 transgenic mice. Within the limitation of having a low number of mice per group, our results indicate that SARS-CoV-2 infection resulted in slightly higher morbidity, mortality, and viral replication in the lungs of old mice, which was associated with an impaired IgM response and altered cytokine and chemokine profiles. Results of this study increase our understanding of SARS-CoV-2 infectivity and immuno-pathogenesis in the elderly population.
Collapse
Affiliation(s)
- Varun Dwivedi
- Disease Intervention & Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Vinay Shivanna
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Shalini Gautam
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Jennifer Delgado
- Disease Intervention & Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Amberlee Hicks
- Disease Intervention & Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Marco Argonza
- Disease Intervention & Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Reagan Meredith
- Disease Intervention & Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Joanne Turner
- Host Pathogen Interactions Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA.
| | - Luis Martinez-Sobrido
- Disease Intervention & Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA.
| | - Jordi B Torrelles
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA.
- International Center for the Advancement of Research & Education (I•CARE), Texas Biomedical Research Institute, San Antonio, TX, USA.
| | - Viraj Kulkarni
- Disease Intervention & Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA.
| |
Collapse
|
2
|
Starr LT, Washington KT, Jabbari J, Benson JJ, Oliver DP, Demiris G, Cagle JG. Pain Management Education for Rural Hospice Family Caregivers: A Pilot Study With Embedded Implementation Evaluation. Am J Hosp Palliat Care 2024; 41:619-633. [PMID: 37491002 PMCID: PMC11032627 DOI: 10.1177/10499091231191114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Assessing and managing hospice patients' pain is a common source of anxiety among hospice family caregivers (HFCGs), especially caregivers in rural communities who face special challenges including distance, limited access, and concerns about opioid misuse. OBJECTIVE To pilot test Ready2Care, a pain management education intervention for rural HFCGs. We sought to determine whether there was a signal of benefit for clinically-relevant outcomes and to identify contextual factors pertinent to conducting a future randomized clinical trial of Ready2Care. METHODS We conducted a multi-method, single-arm study, enabling completion of paired t-tests comparing pre- and post-intervention measures of caregiver anxiety, pain management self-efficacy, barriers to pain management, and reports of patient pain intensity and corresponding patient and caregiver distress. We concurrently conducted an embedded implementation evaluation via calculation of descriptive statistics (recruitment and retention data) and directed content analysis of brief caregiver interviews. RESULTS Twenty-seven (n = 27) HFCGs participated; 15 completed the study. Among completers, significant improvement was observed in patient pain intensity (average 1.4 points decrease on 0-10 scale) and in overall pain experience. No statistically significant changes were detected in caregiver anxiety, barriers to pain management, or pain management self-efficacy. Facilitators to successful conduct of a future clinical trial included high acceptability of Ready2Care, driven by its perceived clarity and relevance to caregivers' concerns. Barriers included lower-than-anticipated accrual and an attrition rate of nearly 44%. CONCLUSION A multisite clinical trial of Ready2Care is warranted; however, its success may require more effective recruitment and retention strategies for rural caregiver participants.
Collapse
Affiliation(s)
- Lauren T. Starr
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - JoAnn Jabbari
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | | | - Debra Parker Oliver
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John G. Cagle
- Center to Advance Chronic Pain Research, University of Maryland, School of Social Work, Baltimore, MD, USA
| |
Collapse
|
3
|
Lim A, Benjasirisan C, Liu X, Ogungbe O, Himmelfarb CD, Davidson P, Koirala B. Social determinants of health and emergency department visits among older adults with multimorbidity: insight from 2010 to 2018 National Health Interview Survey. BMC Public Health 2024; 24:1153. [PMID: 38658873 PMCID: PMC11044401 DOI: 10.1186/s12889-024-18613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Multimorbidity is prevalent among older adults and is associated with adverse health outcomes, including high emergency department (ED) utilization. Social determinants of health (SDoH) are associated with many health outcomes, but the association between SDoH and ED visits among older adults with multimorbidity has received limited attention. This study aimed to examine the association between SDoH and ED visits among older adults with multimorbidity. METHODS A cross-sectional analysis was conducted among 28,917 adults aged 50 years and older from the 2010 to 2018 National Health Interview Survey. Multimorbidity was defined as the presence of two or more self-reported diseases among 10 common chronic conditions, including diabetes, hypertension, asthma, stroke, cancer, arthritis, chronic obstructive pulmonary disease, and heart, kidney, and liver diseases. The SDoH assessed included race/ethnicity, education level, poverty income ratio, marital status, employment status, insurance status, region of residence, and having a usual place for medical care. Logistic regression models were used to examine the association between SDoH and one or more ED visits. RESULTS Participants' mean (± SD) age was 68.04 (± 10.66) years, and 56.82% were female. After adjusting for age, sex, and the number of chronic conditions in the logistic regression model, high school or less education (adjusted odds ratio [AOR]: 1.10, 95% confidence interval [CI]: 1.02-1.19), poverty income ratio below the federal poverty level (AOR: 1.44, 95% CI: 1.31-1.59), unmarried (AOR: 1.19, 95% CI: 1.11-1.28), unemployed status (AOR: 1.33, 95% CI: 1.23-1.44), and having a usual place for medical care (AOR: 1.46, 95% CI 1.18-1.80) was significantly associated with having one or more ED visits. Non-Hispanic Black individuals had higher odds (AOR: 1.28, 95% CI: 1.19-1.38), while non-Hispanic Asian individuals had lower odds (AOR: 0.71, 95% CI: 0.59-0.86) of one or more ED visits than non-Hispanic White individuals. CONCLUSION SDoH factors are associated with ED visits among older adults with multimorbidity. Systematic multidisciplinary team approaches are needed to address social disparities affecting not only multimorbidity prevalence but also health-seeking behaviors and emergent healthcare access.
Collapse
Affiliation(s)
- Arum Lim
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, USA.
| | | | - Xiaoyue Liu
- University of New York Rory Meyers College of Nursing, 433 1st Ave, NY, USA
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, USA
| | | | - Patricia Davidson
- University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
| | - Binu Koirala
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, USA
| |
Collapse
|
4
|
Jarlenski M, Cole E, McClure C, Sanders S, Smalls M, Méndez DD. Implementation and early effects of medicaid policy interventions to promote racial equity in pregnancy and early childhood outcomes in Pennsylvania: protocol for a mixed methods study. BMC Health Serv Res 2024; 24:498. [PMID: 38649983 PMCID: PMC11036682 DOI: 10.1186/s12913-024-10982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND There are large racial inequities in pregnancy and early childhood health within state Medicaid programs in the United States. To date, few Medicaid policy interventions have explicitly focused on improving health in Black populations. Pennsylvania Medicaid has adopted two policy interventions to incentivize racial health equity in managed care (equity payment program) and obstetric service delivery (equity focused obstetric bundle). Our research team will conduct a mixed-methods study to investigate the implementation and early effects of these two policy interventions on pregnancy and infant health equity. METHODS Qualitative interviews will be conducted with Medicaid managed care administrators and obstetric and pediatric providers, and focus groups will be conducted among Medicaid beneficiaries. Quantitative data on healthcare utilization, healthcare quality, and health outcomes among pregnant and parenting people will be extracted from administrative Medicaid healthcare data. Primary outcomes are stakeholder perspectives on policy intervention implementation (qualitative) and timely prenatal care, pregnancy and birth outcomes, and well-child visits (quantitative). Template analysis methods will be applied to qualitative data. Quantitative analyses will use an interrupted time series design to examine changes over time in outcomes among Black people, relative to people of other races, before and after adoption of the Pennsylvania Medicaid equity-focused policy interventions. DISCUSSION Findings from this study are expected to advance knowledge about how Medicaid programs can best implement policy interventions to promote racial equity in pregnancy and early childhood health.
Collapse
Affiliation(s)
- Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, 15261, Pittsburgh, PA, USA.
| | - Evan Cole
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, 15261, Pittsburgh, PA, USA
| | - Christine McClure
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, 15261, Pittsburgh, PA, USA
| | - Sarah Sanders
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Marquita Smalls
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Dara D Méndez
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| |
Collapse
|
5
|
Scheer ER, Werner NE, Coller RJ, Nacht CL, Petty L, Tang M, Ehlenbach M, Kelly MM, Finesilver S, Warner G, Katz B, Keim-Malpass J, Lunsford CD, Letzkus L, Desai SS, Valdez RS. Designing for caregiving networks: a case study of primary caregivers of children with medical complexity. J Am Med Inform Assoc 2024; 31:1151-1162. [PMID: 38427845 PMCID: PMC11031225 DOI: 10.1093/jamia/ocae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE The study aimed to characterize the experiences of primary caregivers of children with medical complexity (CMC) in engaging with other members of the child's caregiving network, thereby informing the design of health information technology (IT) for the caregiving network. Caregiving networks include friends, family, community members, and other trusted individuals who provide resources, information, health, or childcare. MATERIALS AND METHODS We performed a secondary analysis of two qualitative studies. Primary studies conducted semi-structured interviews (n = 50) with family caregivers of CMC. Interviews were held in the Midwest (n = 30) and the mid-Atlantic region (n = 20). Interviews were transcribed verbatim for thematic analysis. Emergent themes were mapped to implications for the design of future health IT. RESULTS Thematic analysis identified 8 themes characterizing a wide range of primary caregivers' experiences in constructing, managing, and ensuring high-quality care delivery across the caregiving network. DISCUSSION Findings evidence a critical need to create flexible and customizable tools designed to support hiring/training processes, coordinating daily care across the caregiving network, communicating changing needs and care updates across the caregiving network, and creating contingency plans for instances where caregivers are unavailable to provide care to the CMC. Informaticists should additionally design accessible platforms that allow primary caregivers to connect with and learn from other caregivers while minimizing exposure to sensitive or emotional content as indicated by the user. CONCLUSION This article contributes to the design of health IT for CMC caregiving networks by uncovering previously underrecognized needs and experiences of CMC primary caregivers and drawing direct connections to design implications.
Collapse
Affiliation(s)
- Eleanore Rae Scheer
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, United States
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA 92182, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA 92093, United States
| | - Lauren Petty
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Mengwei Tang
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Mary Ehlenbach
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Sara Finesilver
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Barbara Katz
- Family Voices of Wisconsin, Madison, WI 53705, United States
| | - Jessica Keim-Malpass
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Christopher D Lunsford
- Department of Orthopedics, Duke University, Durham, NC 27710, United States
- Department of Pediatrics, Duke University, Durham, NC 27707, United States
| | - Lisa Letzkus
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Shaalini Sanjiv Desai
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| | - Rupa S Valdez
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| |
Collapse
|
6
|
Idnay B, Liu J, Fang Y, Hernandez A, Kaw S, Etwaru A, Juarez Padilla J, Ramírez SO, Marder K, Weng C, Schnall R. Sociotechnical feasibility of natural language processing-driven tools in clinical trial eligibility prescreening for Alzheimer's disease and related dementias. J Am Med Inform Assoc 2024; 31:1062-1073. [PMID: 38447587 PMCID: PMC11031244 DOI: 10.1093/jamia/ocae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) affect over 55 million globally. Current clinical trials suffer from low recruitment rates, a challenge potentially addressable via natural language processing (NLP) technologies for researchers to effectively identify eligible clinical trial participants. OBJECTIVE This study investigates the sociotechnical feasibility of NLP-driven tools for ADRD research prescreening and analyzes the tools' cognitive complexity's effect on usability to identify cognitive support strategies. METHODS A randomized experiment was conducted with 60 clinical research staff using three prescreening tools (Criteria2Query, Informatics for Integrating Biology and the Bedside [i2b2], and Leaf). Cognitive task analysis was employed to analyze the usability of each tool using the Health Information Technology Usability Evaluation Scale. Data analysis involved calculating descriptive statistics, interrater agreement via intraclass correlation coefficient, cognitive complexity, and Generalized Estimating Equations models. RESULTS Leaf scored highest for usability followed by Criteria2Query and i2b2. Cognitive complexity was found to be affected by age, computer literacy, and number of criteria, but was not significantly associated with usability. DISCUSSION Adopting NLP for ADRD prescreening demands careful task delegation, comprehensive training, precise translation of eligibility criteria, and increased research accessibility. The study highlights the relevance of these factors in enhancing NLP-driven tools' usability and efficacy in clinical research prescreening. CONCLUSION User-modifiable NLP-driven prescreening tools were favorably received, with system type, evaluation sequence, and user's computer literacy influencing usability more than cognitive complexity. The study emphasizes NLP's potential in improving recruitment for clinical trials, endorsing a mixed-methods approach for future system evaluation and enhancements.
Collapse
Affiliation(s)
- Betina Idnay
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Jianfang Liu
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Yilu Fang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Alex Hernandez
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Shivani Kaw
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Alicia Etwaru
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Janeth Juarez Padilla
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Sergio Ozoria Ramírez
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- New York University Steinhardt School of Culture, Education, and Human Development, New York, NY 10003, United States
| | - Karen Marder
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Rebecca Schnall
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- Mailman School of Public Health, Columbia University, New York, NY 10032, United States
| |
Collapse
|
7
|
van de Water BJ, Brooks MB, Matji R, Ncanywa B, Dikgale F, Abuelezam NN, Mzileni B, Nokwe M, Moko S, Mvusi L, Loveday M, Gimbel S. Systems analysis and improvement approach to optimize tuberculosis (SAIA-TB) screening, treatment, and prevention in South Africa: a stepped-wedge cluster randomized trial. Implement Sci Commun 2024; 5:40. [PMID: 38627799 PMCID: PMC11021007 DOI: 10.1186/s43058-024-00582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The use of systems engineering tools, including the development and use of care cascades using routinely collected data, process mapping, and continuous quality improvement, is used for frontline healthcare workers to devise systems level change. South Africa experiences high rates of tuberculosis (TB) infection and disease as well as HIV co-infection. The Department of Health has made significant gains in HIV services over the last two decades, reaching their set "90-90-90" targets for HIV. However, TB services, although robust, have lagged in comparison for both disease and infection. The Systems Analysis and Improvement Approach (SAIA) is a five-step implementation science method, drawn from systems engineering, to identify, define, and implement workflow modifications using cascade analysis, process mapping, and repeated quality improvement cycles within healthcare facilities. METHODS This stepped-wedge cluster randomized trial will evaluate the effectiveness of SAIA on TB (SAIA-TB) cascade optimization for patients with TB and high-risk contacts across 16 clinics in four local municipalities in the Sarah Baartman district, Eastern Cape, South Africa. We hypothesize that SAIA-TB implementation will lead to a 20% increase in each of: TB screening, TB preventive treatment initiation, and TB disease treatment initiation during the 18-month intervention period. Focus group discussions and key informant interviews with clinic staff will also be conducted to determine drivers of implementation variability across clinics. DISCUSSION This study has the potential to improve TB screening, treatment initiation, and completion for both active disease and preventive measures among individuals with and without HIV in a high burden setting. SAIA-TB provides frontline health care workers with a systems-level view of their care delivery system with the aim of sustainable systems-level improvements. TRIAL REGISTRATION Clinicaltrials.gov, NCT06314386. Registered 18 March 2024, https://clinicaltrials.gov/study/NCT06314386 . NCT06314386.
Collapse
Affiliation(s)
- Brittney J van de Water
- Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Meredith B Brooks
- School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
| | - Refiloe Matji
- AQUITY Innovations, 114 Sovereign Drive, Centurion, South Africa
| | - Betty Ncanywa
- AQUITY Innovations, Greenacres Park, Gqeberha, South Africa
| | - Freck Dikgale
- AQUITY Innovations, 114 Sovereign Drive, Centurion, South Africa
| | - Nadia N Abuelezam
- Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Bulelwa Mzileni
- Department of Health, Sarah Baartman District, 16 Grace Street, Gqeberha, South Africa
| | - Miyakazi Nokwe
- Department of Health, Eastern Cape, Dukumbana Building, Bisho, South Africa
| | - Singilizwe Moko
- Department of Health, Eastern Cape, Dukumbana Building, Bisho, South Africa
- Walter Sisulu University, Mthatha, South Africa
| | - Lindiwe Mvusi
- National Department of Health, 1112 Voortrekker Road, Pretoria, South Africa
| | - Marian Loveday
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, South Africa
| | - Sarah Gimbel
- Department of Child, University of Washington, Family & Population Health Nursing, Gerberding HallSeattle, WA, 98195, USA
| |
Collapse
|
8
|
Reading Turchioe M, Volodarskiy A, Guo W, Taylor B, Hobensack M, Pathak J, Slotwiner D. Characterizing atrial fibrillation symptom improvement following de novo catheter ablation. Eur J Cardiovasc Nurs 2024; 23:241-250. [PMID: 37479225 PMCID: PMC11008952 DOI: 10.1093/eurjcn/zvad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 07/23/2023]
Abstract
AIMS Atrial fibrillation (AF) symptom relief is a primary indication for catheter ablation, but AF symptom resolution is not well characterized. The study objective was to describe AF symptom documentation in electronic health records (EHRs) pre- and post-ablation and identify correlates of post-ablation symptoms. METHODS AND RESULTS We conducted a retrospective cohort study using EHRs of patients with AF (n = 1293), undergoing ablation in a large, urban health system from 2010 to 2020. We extracted symptom data from clinical notes using a natural language processing algorithm (F score: 0.81). We used Cochran's Q tests with post-hoc McNemar's tests to determine differences in symptom prevalence pre- and post-ablation. We used logistic regression models to estimate the adjusted odds of symptom resolution by personal or clinical characteristics at 6 and 12 months post-ablation. In fully adjusted models, at 12 months post-ablation patients, patients with heart failure had significantly lower odds of dyspnoea resolution [odds ratio (OR) 0.38, 95% confidence interval (CI) 0.25-0.57], oedema resolution (OR 0.37, 95% CI 0.25-0.56), and fatigue resolution (OR 0.54, 95% CI 0.34-0.85), but higher odds of palpitations resolution (OR 1.90, 95% CI 1.25-2.89) compared with those without heart failure. Age 65 and older, female sex, Black or African American race, smoking history, and antiarrhythmic use were also associated with lower odds of resolution of specific symptoms at 6 and 12 months. CONCLUSION The post-ablation symptom patterns are heterogeneous. Findings warrant confirmation with larger, more representative data sets, which may be informative for patients whose primary goal for undergoing an ablation is symptom relief.
Collapse
Affiliation(s)
| | - Alexander Volodarskiy
- Department of Cardiology, NewYork-Presbyterian Queens Hospital, 56-45 Main St, Queens, NY 11355, USA
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th St, New York, NY 10065, USA
| | - Winston Guo
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th St, New York, NY 10065, USA
| | - Brittany Taylor
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA
| | - Mollie Hobensack
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th St, New York, NY 10065, USA
| | - David Slotwiner
- Department of Cardiology, NewYork-Presbyterian Queens Hospital, 56-45 Main St, Queens, NY 11355, USA
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th St, New York, NY 10065, USA
| |
Collapse
|
9
|
Rawl SM, Perkins SM, Tong Y, Katz ML, Carter-Bawa L, Imperiale TF, Schwartz PH, Fatima H, Krier C, Tharp K, Shedd-Steele R, Magnarella M, Malloy C, Haunert L, Gebregziabher N, Paskett ED, Champion V. Patient Navigation Plus Tailored Digital Video Disc Increases Colorectal Cancer Screening Among Low-Income and Minority Patients Who Did Not Attend a Scheduled Screening Colonoscopy: A Randomized Trial. Ann Behav Med 2024; 58:314-327. [PMID: 38470961 PMCID: PMC11008590 DOI: 10.1093/abm/kaae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Up to 50% of people scheduled for screening colonoscopy do not complete this test and no studies have focused on minority and low-income populations. Interventions are needed to improve colorectal cancer (CRC) screening knowledge, reduce barriers, and provide alternative screening options. Patient navigation (PN) and tailored interventions increase CRC screening uptake, however there is limited information comparing their effectiveness or the effect of combining them. PURPOSE Compare the effectiveness of two interventions to increase CRC screening among minority and low-income individuals who did not attend their screening colonoscopy appointment-a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based PN compared to usual care. METHODS Patients (n = 371) aged 45-75 years at average risk for CRC who did not attend a screening colonoscopy appointment were enrolled and were randomized to: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. CRC screening outcomes were from electronic medical records at 12 months. Multivariable logistic regression analyses were used to study intervention effects. RESULTS Participants randomized to tailored DVD plus PN were four times more likely to complete CRC screening compared to usual care and almost two and a half times more likely than those who were sent the DVD alone. CONCLUSIONS Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend their screening colonoscopy appointments and has potential for wide dissemination.
Collapse
Affiliation(s)
- Susan M Rawl
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Susan M Perkins
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yan Tong
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mira L Katz
- Department of Health Behavior and Health Promotion, College of Public Heath, The Ohio State University (OSU), Columbus, OH, USA
- Cancer Control Program, Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH, USA
| | - Lisa Carter-Bawa
- Community Outreach and Engagement, Center for Discovery & Innovation, Cancer Prevention Precision Control Institute, Hackensack Meridian Health, Nutley, NJ, USA
| | - Thomas F Imperiale
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter H Schwartz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hala Fatima
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Connie Krier
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Kevin Tharp
- Indiana University Center for Survey Research, Bloomington, IN, USA
| | - Rivienne Shedd-Steele
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - Caeli Malloy
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Laura Haunert
- School of Health and Human Sciences, Physician Assistant Program, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Netsanet Gebregziabher
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Electra D Paskett
- Cancer Control Program, Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Victoria Champion
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| |
Collapse
|
10
|
Rio CJ, Blumhorst C, Kwiat CA, Nguyen CM, Livinski AA, Saligan LN. Self-reporting of psychoneurophysical (PNP) symptoms in adults with four chronic diseases: a protocol for a scoping review. Syst Rev 2024; 13:102. [PMID: 38575995 PMCID: PMC10996099 DOI: 10.1186/s13643-024-02498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Patient self-reporting of health-specific information, including symptoms, allows healthcare providers to provide more timely, personalized, and patient-centered care to meet their needs. It is critical to acknowledge that symptom reporting draws from the individual's unique sociocultural background influencing how one perceives health and illness. This scoping review will explore whether racial groups with 4 chronic diseases (cardiovascular diseases, respiratory diseases, cancers, and diabetes) differ in self-reporting of psychoneurophysical (PNP) symptoms. The PNP symptoms of interest include depressive symptoms, fatigue, anxiety, pain, cognitive impairment, sleep impairment, mood impairment, irritability, and shortness of breath. METHODS Four databases will be searched by a biomedical librarian: CINAHL Plus (EBSCOhost), Embase (Elsevier), PubMed (NLM), Web of Science: Core Collection (Clarivate Analytics), and limited to publications written in the English language. Two independent reviewers will screen the records' title, abstract, and then full text and extract the data from included articles using Covidence. A third reviewer will be used for resolving disagreements. Included articles must comprise adult patients with at least one of the specified chronic diseases who self-report at least one of the specified PNP symptoms. Studies that used clinician-administered questionnaires or obtained symptom responses from primary caregiver or patient designee will be excluded. Articles on patient-reported functionality or perceived quality of life will also be excluded from the review. Two reviewers will independently extract data (e.g., demographics, study design, racial group, chronic disease, measure/scale used for self-report) from each included article using Covidence and Microsoft Excel for data cleaning and analyses. DISCUSSION This scoping review may potentially identify the relevant and practical implications related to clinical decision-making and health outcomes for patients experiencing the psychoneurophysical symptoms included in this study. The authors will present how the results can be utilized in clinical practice, health policy, and research planning. SYSTEMATIC REVIEW REGISTRATION The protocol was registered on Open Science Framework (OSF) at: https://osf.io/ps7aw.
Collapse
Affiliation(s)
- Carielle Joy Rio
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA
| | - Catherine Blumhorst
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA
| | - Catherine A Kwiat
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA
| | - Christopher M Nguyen
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Leorey N Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
11
|
Kim S, Liu W, Daack-Hirsch S, Williams KN. Communication Patterns and Characteristics of Family Caregivers and Persons Living With Dementia: Secondary Analysis of Video Observation. West J Nurs Res 2024; 46:264-277. [PMID: 38400741 PMCID: PMC10955794 DOI: 10.1177/01939459241233360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
BACKGROUND It is essential to characterize communication patterns for better health outcomes for family caregivers and persons living with dementia. OBJECTIVE This study aimed to examine the relationships between communication patterns and the characteristics of dyads of family caregivers and persons living with dementia. METHODS A secondary analysis was conducted using 75 video-recorded home care observations from 19 dyads. Participant characteristics and caregiver burden, depression, and sense of competence were collected from the parent study. The video-recorded dyadic communication patterns were assessed using a coding scheme developed based on Communication Accommodation Theory and Classical Test Theory. The relative frequency of the communication patterns was compared between groups. RESULTS Overall, 8311 caregiver and 8024 care recipient communication behaviors were observed. Caregiver communication patterns were categorized as facilitative, disabling, and neutral. Care recipient communication patterns were categorized as engaging, challenging, and neutral. Caregiver gender, care recipient gender, care recipient education level, dementia diagnosis length, types of dementia, dyadic gender difference, burden, depression, and competence of caregiver, and types of communication were significantly associated with caregiver communication. Dementia diagnosis length, caregiver competence, dyadic gender difference, and types of communication were significantly associated with care recipient communication. CONCLUSIONS The findings demonstrated different communication patterns depending on individual and dyad characteristics and evidence for dyadic communication support to promote meaningful interaction for persons living with dementia. Further analysis is needed to identify mediating factors and causal relationships.
Collapse
Affiliation(s)
- Sohyun Kim
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX, USA
| | - Wen Liu
- The University of Iowa, Iowa City, IA, USA
| | | | | |
Collapse
|
12
|
Dixon JS, Wang D, Ready RE. Discrimination and Cognition in Midlife Black Women: The Roles of Social Support and Spirituality. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad201. [PMID: 38165061 PMCID: PMC10939168 DOI: 10.1093/geronb/gbad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES Black women are at high risk for discrimination and cognitive impairment in late life. It is not known if discrimination is a risk factor for cognitive decline in Black women and if so, what factors are protective against the adverse cognitive effects of discrimination. Using the biopsychosocial model of gendered racism, we determined if discrimination is associated with poorer cognition in midlife Black women and if social support and/or spirituality would protect against the deleterious effects of discrimination on cognition. METHODS Participants were midlife Black women (N = 669) from the Study of Women's Health Across the Nation. Discrimination was measured by the Everyday Discrimination scale. Cognitive outcomes included episodic memory, processing speed, and working memory. Total social support, emotional support, instrumental support, and spirituality were assessed as protective factors. RESULTS Contrary to expectations, structural equation modeling indicated that discrimination was associated with better immediate recall. For women with more emotional support, greater discrimination was associated with better immediate recall than for women with lower emotional support. Spirituality was not a significant moderator in the association between discrimination and cognition. DISCUSSION Discrimination had unexpected positive associations with learning and attention-based cognitive skills for midlife Black women. Discrimination might enhance vigilance, which could be facilitated by higher levels of emotional support. There is an opportunity for clinical and public health interventions for cognitive health and discrimination focused on Black women to better incorporate emotional support as a coping resource.
Collapse
Affiliation(s)
- Jasmine S Dixon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Dongwei Wang
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| |
Collapse
|
13
|
Marron MM, Yao S, Shah RV, Murthy VL, Newman AB. Metabolomic characterization of vigor to frailty among community-dwelling older Black and White men and women. GeroScience 2024; 46:2371-2389. [PMID: 37968423 PMCID: PMC10828147 DOI: 10.1007/s11357-023-01005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023] Open
Abstract
Older women and Black individuals are more likely to experience frailty. A metabolomic characterization of frailty may help inform more effective interventions aimed at improving health, reducing disparities, and preventing frailty with aging. We sought to identify metabolites and pathways associated with vigor to frailty and determine whether associations differed by sex and/or race among n = 2189 older Black and White men and women from the Health, Aging, and Body Composition (Health ABC) study. Fasting plasma metabolites were measured using liquid chromatography-mass spectrometry. Vigor to frailty was based on weight change, physical activity, gait speed, grip strength, and usual energy. We used linear regression of a single metabolite on vigor to frailty, adjusting for age, sex, race, study site, and multiple comparisons using a Bonferroni correction. Among 500 metabolites, 113 were associated with vigor to frailty (p < 0.0001). Associations between metabolites and vigor to frailty did not differ significantly by race and/or sex. Lower amino acids, glycerophospholipids, sphingolipids, and dehydroepiandrosterone sulfate and higher acylcarnitines, fatty acids, amino acid derivatives, organic acids, carbohydrates, citric acid cycle metabolites, and trimethylamine oxide were associated with frailer scores. Pathway analyses identified the citric acid cycle as containing more frailty-associated metabolites than expected by chance (p = 0.00005). Calories and protein intake did not differ by vigor to frailty. Frailer Health ABC participants may have lower utilization of energy pathways, potentially as a result of less demand and less efficient utilization of similar amounts of nutrients when compared to more vigorous participants.
Collapse
Affiliation(s)
- Megan M Marron
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Shanshan Yao
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ravi V Shah
- Vanderbilt Translational and Clinical Research Center, Cardiology Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Medicine, and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Departments of Medicine and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
14
|
Yang Q, Jiang M, Li C, Luo S, Crowley MJ, Shaw RJ. Predicting health outcomes with intensive longitudinal data collected by mobile health devices: a functional principal component regression approach. BMC Med Res Methodol 2024; 24:69. [PMID: 38494505 PMCID: PMC10944610 DOI: 10.1186/s12874-024-02193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Intensive longitudinal data (ILD) collected in near real time by mobile health devices provide a new opportunity for monitoring chronic diseases, early disease risk prediction, and disease prevention in health research. Functional data analysis, specifically functional principal component analysis, has great potential to abstract trends in ILD but has not been used extensively in mobile health research. OBJECTIVE To introduce functional principal component analysis (fPCA) and demonstrate its potential applicability in estimating trends in ILD collected by mobile heath devices, assessing longitudinal association between ILD and health outcomes, and predicting health outcomes. METHODS fPCA and scalar-to-function regression models were reviewed. A case study was used to illustrate the process of abstracting trends in intensively self-measured blood glucose using functional principal component analysis and then predicting future HbA1c values in patients with type 2 diabetes using a scalar-to-function regression model. RESULTS Based on the scalar-to-function regression model results, there was a slightly increasing trend between daily blood glucose measures and HbA1c. 61% of variation in HbA1c could be predicted by the three preceding months' blood glucose values measured before breakfast (P < 0.0001, [Formula: see text]). CONCLUSIONS Functional data analysis, specifically fPCA, offers a unique tool to capture patterns in ILD collected by mobile health devices. It is particularly useful in assessing longitudinal dynamic association between repeated measures and outcomes, and can be easily integrated in prediction models to improve prediction precision.
Collapse
Affiliation(s)
- Qing Yang
- School of Nursing, Duke University, Durham, USA.
| | | | - Cai Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sheng Luo
- Biostatistics & Bioinformatics, Duke University, Durham, USA
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC, USA
| | - Ryan J Shaw
- School of Nursing, Duke University, Durham, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Center for Applied Genomics & Precision Medicine, School of Medicine, Duke University, Durham, NC, USA
| |
Collapse
|
15
|
Mangal S, Niño de Rivera S, Reading Turchioe M, Myers A, Benda N, Goyal P, Dugdale L, Masterson Creber R. Perceptions of patient-reported outcome data access and sharing among patients with heart failure: ethical implications for research. Eur J Cardiovasc Nurs 2024; 23:145-151. [PMID: 37172035 PMCID: PMC10640657 DOI: 10.1093/eurjcn/zvad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/14/2023]
Abstract
AIMS In the face of growing expectations for data transparency and patient engagement in care, we evaluated preferences for patient-reported outcome (PRO) data access and sharing among patients with heart failure (HF) using an ethical framework. METHODS AND RESULTS We conducted qualitative interviews with a purposive sample of patients with HF who participated in a larger 8-week study that involved the collection and return of PROs using a web-based interface. Guided by an ethical framework, patients were asked questions about their preferences for having PRO data returned to them and shared with other groups. Interview transcripts were coded by three study team members using directed content analysis. A total of 22 participants participated in semi-structured interviews. Participants were mostly male (73%), White (68%) with a mean age of 72. Themes were grouped into priorities, benefits, and barriers to data access and sharing. Priorities included ensuring anonymity when data are shared, transparency with intentions of data use, and having access to all collected data. Benefits included: using data as a communication prompt to discuss health with clinicians and using data to support self-management. Barriers included: challenges with interpreting returned results, and potential loss of benefits and anonymity when sharing data. CONCLUSION Our interviews with HF patients highlight opportunities for researchers to return and share data through an ethical lens, by ensuring privacy and transparency with intentions of data use, returning collected data in comprehensible formats, and meeting individual expectations for data sharing.
Collapse
Affiliation(s)
- Sabrina Mangal
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, Seattle, WA, USA
| | | | | | - Annie Myers
- Columbia University School of Nursing, New York, NY, USA
| | - Natalie Benda
- Columbia University School of Nursing, New York, NY, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lydia Dugdale
- Department of Medicine, Center for Clinical Medical Ethics, Columbia University, New York, NY, USA
| | | |
Collapse
|
16
|
Scheim AI, Rich AJ, Zubizarreta D, Malik M, Baker KE, Restar AJ, van der Merwe LA, Wang J, Beebe B, Ridgeway K, Baral SD, Poteat T, Reisner SL. Health status of transgender people globally: A systematic review of research on disease burden and correlates. PLoS One 2024; 19:e0299373. [PMID: 38466747 PMCID: PMC10927095 DOI: 10.1371/journal.pone.0299373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Transgender and gender diverse (trans) health research has grown rapidly, highlighting the need to characterize the scientific evidence base. We conducted a systematic review of peer-reviewed research on disease burden and correlates in trans adolescents and adults over a 20-month period to identify knowledge gaps and assess methodological characteristics including measurement of gender identity, community engagement, and study quality. DATA SOURCES, ELIGIBILITY CRITERIA, AND SYNTHESIS METHODS We searched seven databases using terms related to (a) transgender populations and (b) health or disease. Eligible studies were in English, French, or Spanish and reported original quantitative data on mental health or substance use conditions, infectious diseases, or non-communicable conditions in at least 25 trans individuals aged 15+. Quality assessment was performed in duplicate on a 10% sample of articles and findings were summarized using narrative synthesis. RESULTS The 328 included studies were conducted in 45 countries, with most from North America (54%) and limited research from South Asia (3%), Sub-Saharan Africa (3%), and the Middle East and North Africa (2%). Most studies used cross-sectional designs (73%) and convenience sampling (65%). Only 30% of studies reported any form of community engagement. Mental health and substance use disorders were the most studied area (77% of studies) and non-communicable conditions the least (16%). Available data indicated that trans populations experience high disease burden with considerable heterogeneity within and across settings. Of 39 articles assessed for quality, 80% were rated as fair, 18% as poor, and 3% as good quality. CONCLUSIONS AND IMPLICATIONS Geographic, gender-specific, and topical gaps remain in trans health, but we found more research from African countries, with transmasculine people, and on non-communicable conditions than previous syntheses. Areas for growth in trans health research include community engagement, non-binary health, chronic and age-related conditions, and health determinants. REGISTRATION PROSPERO CRD42021234043.
Collapse
Affiliation(s)
- Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States of America
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mannat Malik
- Department of Health Behaviour, Gillings School of Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kellan E. Baker
- Whitman-Walker Institute, Washington, District of Columbia, United States of America
| | - Arjee J. Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Leigh Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women of Africa (S.H.E.), East London, South Africa
| | - June Wang
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Bianca Beebe
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kathleen Ridgeway
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stefan D. Baral
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sari L. Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
17
|
Petrovsky DV, Yildiz M, Yefimova M, Sefcik JS, Baker ZG, Ma KPK, Rahemi Z, Bacsu JDR, Smith ML, Pickering CEZ. Shared Activities as a Protective Factor Against Behavioral and Psychological Symptoms of Dementia and Caregiver Stress. Innov Aging 2024; 8:igae034. [PMID: 38660116 PMCID: PMC11037273 DOI: 10.1093/geroni/igae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Indexed: 04/26/2024] Open
Abstract
Background and Objectives Most persons with dementia experience behavioral and psychological symptoms (BPSD). While there is evidence that structured activity programs can be beneficial for persons with dementia and their caregivers, it is not well understood how joint engagement in shared activities affects BPSD and caregiver stress. The purpose of this study was to examine the moderating effect of doing a shared activity on the BPSD and caregiver stress. Research Design and Methods This study used an intensive longitudinal observational design in which caregivers completed baseline and once-a-day diary surveys for 21 days. Caregivers were asked whether they did a pleasant noncare activity with their relative, the presence of 8 BPSD, and their stress level. A moderation model in a structural equation model examined the relationship between these variables. Results Our sample consisted of 453 caregivers (87.4% female, 51.4% non-Hispanic White, mean age 53 years [standard deviation {SD}: 14]) and person living with dementia whose mean age was 79 years (SD: 9). On days when the caregivers engaged in a shared activity together with person living with dementia, there was a significant decrease in the BPSD (estimate -0.038, standard error [SE] = 0.016, 95% confidence interval [CI]: -0.069, -0.007, p value = 0.018). The effects of engaging in a shared activity decreased the impact of caregiver stress by 0.052 (estimate -0.052, SE = 0.018, 95% CI: -0.087, -0.017, p value = 0.004). At the between-person level, no differences were found in BPSD across caregivers who engaged or did not engage in shared activities. Discussion and Implications The results of our study indicate that doing a shared activity is associated with reduced BPSD among persons with dementia and may buffer the impact of caregiver stress on BPSD. Shared activities should be considered a key intervention component for dementia caregivers.
Collapse
Affiliation(s)
- Darina V Petrovsky
- Division of Women, Children, & Families, Duke University School of Nursing, Durham, North Carolina, USA
| | - Mustafa Yildiz
- Department of Research, Jane and Robert Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Maria Yefimova
- Center for Nursing Excellence & Innovation, University of California, San Francisco, San Francisco, California, USA
- Department of Physiological Nursing, UCSF School of Nursing, San Francisco, California, USA
| | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Zachary G Baker
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Zahra Rahemi
- School of Nursing, Clemson University, Greenville, South Carolina, USA
| | | | - Matthew Lee Smith
- Department of Health Behavior, Texas A&M University School of Public Health, College Station, Texas, USA
| | - Carolyn E Z Pickering
- Department of Research, Jane and Robert Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
18
|
Ebonyi AO, Okpokwu J, Rawizza H, Chebu P, Chaplin B, Hamel D, Oguche S, Agbaji OO, Sagay AS, Kanki PJ, Imade GE. Pretreatment and Acquired Drug Resistance in Children With Human Immunodeficiency Virus Type 1 in Jos, Nigeria. Open Forum Infect Dis 2024; 11:ofae092. [PMID: 38464491 PMCID: PMC10921386 DOI: 10.1093/ofid/ofae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/15/2024] [Indexed: 03/12/2024] Open
Abstract
We determined pretreatment and acquired human immunodeficiency virus (HIV) drug resistance among children with HIV type 1 (HIV-1) in Jos, Nigeria. The majority (71%) of those who failed first-line antiretroviral therapy were on a nevirapine-containing regimen. The prevalence of pretreatment (48%) and acquired (76%) HIV drug resistance mutations was high in our study. Wider access to HIV drug resistance testing after treatment failure is necessary to optimize second-line treatment options among children with HIV in Nigeria.
Collapse
Affiliation(s)
- Augustine O Ebonyi
- Department of Paediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Jonathan Okpokwu
- AIDS Prevention Initiative in Nigeria–supported ISO 15189 Laboratory, Jos University Teaching Hospital, Jos, Nigeria
| | - Holly Rawizza
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Philippe Chebu
- APIN Public Health Initiatives, Plot 1551, Apo Resettlement, Apo District, Abuja, FCT, Nigeria
| | - Beth Chaplin
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Donald Hamel
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen Oguche
- Department of Paediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Oche O Agbaji
- Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Godwin E Imade
- AIDS Prevention Initiative in Nigeria–supported ISO 15189 Laboratory, Jos University Teaching Hospital, Jos, Nigeria
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| |
Collapse
|
19
|
Eton DT, Yost KJ, Ridgeway JL, Bucknell B, Wambua M, Erbs NC, Allen SV, Rogers EA, Anderson RT, Linzer M. Development and acceptability of PETS-Now, an electronic point-of-care tool to monitor treatment burden in patients with multiple chronic conditions: a multi-method study. BMC Prim Care 2024; 25:77. [PMID: 38429702 PMCID: PMC10908048 DOI: 10.1186/s12875-024-02316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND The aim of this study was to develop a web-based tool for patients with multiple chronic conditions (MCC) to communicate concerns about treatment burden to their healthcare providers. METHODS Patients and providers from primary-care clinics participated. We conducted focus groups to identify content for a prototype clinical tool to screen for treatment burden by reviewing domains and items from a previously validated measure, the Patient Experience with Treatment and Self-management (PETS). Following review of the prototype, a quasi-experimental pilot study determined acceptability of using the tool in clinical practice. The study protocol was modified to accommodate limitations due to the Covid-19 pandemic. RESULTS Fifteen patients with MCC and 18 providers participated in focus groups to review existing PETS content. The pilot tool (named PETS-Now) consisted of eight domains (Living Healthy, Health Costs, Monitoring Health, Medicine, Personal Relationships, Getting Healthcare, Health Information, and Medical Equipment) with each domain represented by a checklist of potential concerns. Administrative burden was minimized by limiting patients to selection of one domain. To test acceptability, 17 primary-care providers first saw 92 patients under standard care (control) conditions followed by another 90 patients using the PETS-Now tool (intervention). Each treatment burden domain was selected at least once by patients in the intervention. No significant differences were observed in overall care quality between patients in the control and intervention conditions with mean care quality rated high in both groups (9.3 and 9.2, respectively, out of 10). There were no differences in provider impressions of patient encounters under the two conditions with providers reporting that patient concerns were addressed in 95% of the visits in both conditions. Most intervention group patients (94%) found that the PETS-Now was easy to use and helped focus the conversation with the provider on their biggest concern (98%). Most providers (81%) felt they had learned something new about the patient from the PETS-Now. CONCLUSION The PETS-Now holds promise for quickly screening and monitoring treatment burden in people with MCC and may provide information for care planning. While acceptable to patients and clinicians, integration of information into the electronic medical record should be prioritized.
Collapse
Affiliation(s)
- David T Eton
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9169 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Kathleen J Yost
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bayly Bucknell
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mike Wambua
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Natalie C Erbs
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Summer V Allen
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Rogers
- Departments of Medicine and of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
20
|
Milinic T, Ramos KJ. Cardiopulmonary Exercise Testing for Prognostication in Advanced Cystic Fibrosis Lung Disease and Beyond. Ann Am Thorac Soc 2024; 21:380-381. [PMID: 38426830 PMCID: PMC10913767 DOI: 10.1513/annalsats.202311-944ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Tijana Milinic
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Kathleen J Ramos
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
21
|
Curley MAQ, Watson RS, Killien EY, Kalvas LB, Perry-Eaddy MA, Cassidy AM, Miller EB, Talukder M, Manning JC, Pinto NP, Rennick JE, Colville G, Asaro LA, Wypij D. Design and rationale of the Post-Intensive Care Syndrome - paediatrics (PICS-p) Longitudinal Cohort Study. BMJ Open 2024; 14:e084445. [PMID: 38401903 PMCID: PMC10895227 DOI: 10.1136/bmjopen-2024-084445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION As paediatric intensive care unit (PICU) mortality declines, there is growing recognition of the morbidity experienced by children surviving critical illness and their families. A comprehensive understanding of the adverse physical, cognitive, emotional and social sequelae common to PICU survivors is limited, however, and the trajectory of recovery and risk factors for morbidity remain unknown. METHODS AND ANALYSIS The Post-Intensive Care Syndrome - paediatrics Longitudinal Cohort Study will evaluate child and family outcomes over 2 years following PICU discharge and identify child and clinical factors associated with impaired outcomes. We will enrol 750 children from 30 US PICUs during their first PICU hospitalisation, including 500 case participants experiencing ≥3 days of intensive care that include critical care therapies (eg, mechanical ventilation, vasoactive infusions) and 250 age-matched, sex-matched and medical complexity-matched control participants experiencing a single night in the PICU with no intensive care therapies. Children, parents and siblings will complete surveys about health-related quality of life, physical function, cognitive status, emotional health and peer and family relationships at multiple time points from baseline recall through 2 years post-PICU discharge. We will compare outcomes and recovery trajectories of case participants to control participants, identify risk factors associated with poor outcomes and determine the emotional and social health consequences of paediatric critical illness on parents and siblings. ETHICS AND DISSEMINATION This study has received ethical approval from the University of Pennsylvania Institutional Review Board (protocol #843844). Our overall objective is to characterise the ongoing impact of paediatric critical illness to guide development of interventions that optimise outcomes among children surviving critical illness and their families. Findings will be presented at key disciplinary meetings and in peer-reviewed publications at fixed data points. Published manuscripts will be added to our public study website to ensure findings are available to families, clinicians and researchers. TRIALS REGISTRATION NUMBER NCT04967365.
Collapse
Affiliation(s)
- Martha A Q Curley
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - R Scott Watson
- University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Elizabeth Y Killien
- University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Laura Beth Kalvas
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mallory A Perry-Eaddy
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
- School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Amy M Cassidy
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica B Miller
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mritika Talukder
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph C Manning
- School of Healthcare, University of Leicester, Leicester, UK
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Neethi P Pinto
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Janet E Rennick
- McGill University Health Centre, Montreal Children's Hospital, Montreal, Québec, Canada
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | | | - Lisa A Asaro
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Wypij
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| |
Collapse
|
22
|
McNabb KC, Bergman AJ, Patil A, Lowensen K, Mthimkhulu N, Budhathoki C, Perrin N, Farley JE. Travel distance to rifampicin-resistant tuberculosis treatment and its impact on loss to follow-up: the importance of continued RR-TB treatment decentralization in South Africa. BMC Public Health 2024; 24:578. [PMID: 38389038 PMCID: PMC10885440 DOI: 10.1186/s12889-024-17924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Understanding why patients experience loss to follow-up (LTFU) is essential for TB control. This analysis examines the impact of travel distance to RR-TB treatment on LTFU, which has yet to be analyzed within South Africa. METHODS We retrospectively analyzed 1436 patients treated for RR-TB at ten South African public hospitals. We linked patients to their residential ward using data reported to NHLS and maps available from the Municipal Demarcation Board. Travel distance was calculated from each patient's ward centroid to their RR-TB treatment site using the georoute command in Stata. The relationship between LTFU and travel distance was modeled using multivariable logistic regression. RESULTS Among 1436 participants, 75.6% successfully completed treatment and 24.4% were LTFU. The median travel distance was 40.96 km (IQR: 17.12, 63.49). A travel distance > 60 km increased odds of LTFU by 91% (p = 0.001) when adjusting for HIV status, age, sex, education level, employment status, residential locale, treatment regimen, and treatment site. CONCLUSION People living in KwaZulu-Natal and Eastern Cape travel long distances to receive RR-TB care, placing them at increased risk for LTFU. Policies that bring RR-TB treatment closer to patients, such as further decentralization to PHCs, are necessary to improve RR-TB outcomes.
Collapse
Affiliation(s)
- Katherine C McNabb
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA.
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA.
| | - Alanna J Bergman
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Amita Patil
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Kelly Lowensen
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Nomusa Mthimkhulu
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Port Shepstone, Republic of South Africa
| | - Chakra Budhathoki
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
| | - Jason E Farley
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins TB Research Advancement Center, Baltimore, MD, USA
| |
Collapse
|
23
|
Oyesanya TO, Ibemere SO, You H, Emerson MM, Pan W, Palipana A, Kandel M, Ingram D, Soto M, Pioppo A, Albert B, Walker-Atwater T, Hawes J, Komisarow J, Ramos K, Byom L, Gonzalez-Guarda R, Van Houtven CH, Agarwal S, Prvu Bettger J. Efficacy of BETTER transitional care intervention for diverse patients with traumatic brain injury and their families: Study protocol of a randomized controlled trial. PLoS One 2024; 19:e0296083. [PMID: 38394279 PMCID: PMC10890764 DOI: 10.1371/journal.pone.0296083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The purpose of this study is to examine the efficacy of BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery) vs. usual transitional care management among diverse adults with traumatic brain injury (TBI) discharged home from acute hospital care and families. METHODS This will be a single-site, two-arm, randomized controlled trial (N = 436 people, 218 patient/family dyads, 109 dyads per arm) of BETTER, a culturally- and linguistically-tailored, patient- and family-centered, TBI transitional care intervention for adult patients with TBI and families. Skilled clinical interventionists will follow a manualized protocol to address patient/family needs. The interventionists will co-establish goals with participants; coordinate post-hospital care, services, and resources; and provide patient/family education and training on self- and family-management and coping skills for 16 weeks following hospital discharge. English- and Spanish-speaking adult patients with mild-to-severe TBI who are discharged directly home from the hospital without inpatient rehabilitation or transfer to other settings (community discharge) and associated family caregivers are eligible and will be randomized to treatment or usual transitional care management. We will use intention-to-treat analysis to determine if patients receiving BETTER have a higher quality of life (primary outcome, SF-36) at 16-weeks post-hospital discharge than those receiving usual transitional care management. We will conduct a descriptive, qualitative study with 45 dyads randomized to BETTER, using semi-structured interviews, to capture perspectives on barriers and facilitators to participation. Data will be analyzed using conventional content analysis. Finally, we will conduct a cost/budget impact analysis, evaluating differences in intervention costs and healthcare costs by arm. DISCUSSION Findings will guide our team in designing a future, multi-site trial to disseminate and implement BETTER into clinical practice to enhance the standard of care for adults with TBI and families. The new knowledge generated will drive advancements in health equity among diverse adults with TBI and families. TRIAL REGISTRATION NCT05929833.
Collapse
Affiliation(s)
- Tolu O. Oyesanya
- Duke University School of Nursing, Durham, NC, United States of America
| | - Stephanie O. Ibemere
- Duke University School of Nursing, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - HyunBin You
- Duke University School of Nursing, Durham, NC, United States of America
| | | | - Wei Pan
- Duke University School of Nursing, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Anushka Palipana
- Duke University School of Nursing, Durham, NC, United States of America
| | - Melissa Kandel
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Darius Ingram
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Mayra Soto
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Anne Pioppo
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | - Brittany Albert
- Department of Rehabilitation Services, Duke University Health System, Durham, NC, United States of America
| | | | - Jodi Hawes
- Duke University School of Medicine, Durham, NC, United States of America
| | - Jordan Komisarow
- Duke University School of Medicine, Durham, NC, United States of America
| | - Katherine Ramos
- Duke University School of Medicine, Durham, NC, United States of America
| | - Lindsey Byom
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | | | - Courtney H. Van Houtven
- Duke University School of Medicine, Durham, NC, United States of America
- Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, United States of America
| | - Suresh Agarwal
- Duke University School of Medicine, Durham, NC, United States of America
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States of America
| |
Collapse
|
24
|
Mannion S, Higgins A, Larson N, Stewart EA, Khan Z, Shenoy C, Nichols HB, Su HI, Partridge AH, Loprinzi CL, Couch F, Olson JE, Ruddy KJ. Prevalence and impact of fertility concerns in young women with breast cancer. Sci Rep 2024; 14:4418. [PMID: 38388636 PMCID: PMC10884010 DOI: 10.1038/s41598-024-54961-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
Survey data from the Mayo Clinic Breast Disease Registry were used to assess fertility counseling and fertility preservation strategies in a modern cohort of young women with breast cancer. One hundred respondents were identified who were under age 50 at the time of breast cancer diagnosis and who expressed interest in future childbearing near the time of diagnosis and/or 1 year later. Ninety-three percent of the 81 respondents to the year one survey recalled fertility counseling prior to cancer treatment. Most who reported a high level of fertility concern declared that this concern had impacted their treatment decisions, often shortening their planned duration of endocrine therapy. Approximately half had taken steps to preserve future fertility, and a third had used a gonadotropin-releasing hormone agonist either alone or combined with another method (e.g., embryo or oocyte cryopreservation).
Collapse
Affiliation(s)
| | - Alexandra Higgins
- Department of Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Nicole Larson
- Department of Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | | - Zaraq Khan
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Chandra Shenoy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - H Irene Su
- Department of Obstetrics and Gynecology, University of California San Diego, San Diego, CA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charles L Loprinzi
- Department of Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Fergus Couch
- Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, USA
| | - Janet E Olson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| |
Collapse
|
25
|
Bancks MP, Pilla SJ, Balasubramanyam A, Yeh HC, Johnson KC, Rigdon J, Wagenknecht LE, Espeland MA. Association of Lifestyle Intervention With Risk for Cardiovascular Events Differs by Level of Glycated Hemoglobin. J Clin Endocrinol Metab 2024; 109:e1012-e1019. [PMID: 37978826 PMCID: PMC10876384 DOI: 10.1210/clinem/dgad674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE We reevaluated the Action for Health in Diabetes (Look AHEAD) intensive lifestyle intervention (ILI) to assess whether the effect of ILI on cardiovascular disease (CVD) prevention differed by baseline glycated hemoglobin (HbA1c). METHODS Look AHEAD randomized 5145 adults, aged 45 to 76 years with type 2 diabetes and overweight/obesity to ILI or a diabetes support and education (DSE) control group for a median of 9.6 years. ILI focused on achieving weight loss through decreased caloric intake and increased physical activity. We assessed the parent trial's primary composite CVD outcome. We evaluated additive and multiplicative heterogeneity of the intervention on CVD risk by baseline HbA1c. RESULTS Mean baseline HbA1c was 7.3% (SD 1.2) and ranged from 4.4% (quintile 1) to 14.5% (quintile 5). We observed additive and multiplicative heterogeneity of the association between ILI and CVD (all P < .001) by baseline HbA1c. Randomization to ILI was associated with lower CVD risk for HbA1c quintiles 1 [hazard ratio (HR): 0.68, 95% confidence interval (CI): 0.53, 0.88] and 2 (HR: 0.80, 95% CI: 0.66, 0.96) and associated with higher CVD risk for HbA1c quintile 5 (HR: 1.27, 95% CI: 1.02, 1.58), compared to DSE. CONCLUSION Among adults with type 2 diabetes and overweight/obesity, randomization to a lifestyle intervention was differentially associated with CVD risk by baseline HbA1c such that it was associated with lower risk at lower HbA1c levels and higher risk at higher HbA1c levels. There is a critical need to develop and tailor lifestyle interventions to be successful for individuals with type 2 diabetes and high HbA1c.
Collapse
Affiliation(s)
- Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Scott J Pilla
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | | | - Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Lynne E Wagenknecht
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| |
Collapse
|
26
|
Davis HA, Santillan DA, Ortman CE, Hoberg AA, Hetrick JP, McBrearty CW, Zeng E, Vaughan Sarrazin MS, Dunn Lopez K, Chapman CG, Carnahan RM, Michaelson JJ, Knosp BM. The Iowa Health Data Resource (IHDR): an innovative framework for transforming the clinical health data ecosystem. J Am Med Inform Assoc 2024; 31:720-726. [PMID: 38102790 PMCID: PMC10873835 DOI: 10.1093/jamia/ocad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
IMPORTANCE This manuscript will be of interest to most Clinical and Translational Science Awards (CTSA) as they retool for the increasing emphasis on translational science from translational research. This effort is an extension of the EDW4R work that most CTSAs have done to deploy infrastructure and tools for researchers to access clinical data. OBJECTIVES The Iowa Health Data Resource (IHDR) is a strategic investment made by the University of Iowa to improve access to real-world health data. The goals of IHDR are to improve the speed of translational health research, to boost interdisciplinary collaboration, and to improve literacy about health data. The first objective toward this larger goal was to address gaps in data access, data literacy, lack of computational environments for processing Personal Health Information (PHI) and the lack of processes and expertise for creating transformative datasets. METHODS A three-pronged approach was taken to address the objective. The approach involves integration of an intercollegiate team of non-informatics faculty and staff, a data enclave for secure patient data analyses, and novel comprehensive datasets. RESULTS To date, all five of the health science colleges (dentistry, medicine, nursing, pharmacy, and public health) have had at least one staff and one faculty member complete the two-month experiential learning curriculum. Over the first two years of this project, nine cohorts totaling 36 data liaisons have been trained, including 18 faculty and 18 staff. IHDR data enclave eliminated the need to duplicate computational infrastructure inside the hospital firewall which reduced infrastructure, hardware and human resource costs while leveraging the existing expertise embedded in the university research computing team. The creation of a process to develop and implement transformative datasets has resulted in the creation of seven domain specific datasets to date. CONCLUSION The combination of people, process, and technology facilitates collaboration and interdisciplinary research in a secure environment using curated data sets. While other organizations have implemented individual components to address EDW4R operational demands, the IHDR combines multiple resources into a novel, comprehensive ecosystem IHDR enables scientists to use analysis tools with electronic patient data to accelerate time to science.
Collapse
Affiliation(s)
- Heath A Davis
- Biomedical Informatics, Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA 52242, United States
- Office of Information Technology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
| | - Donna A Santillan
- Biomedical Informatics, Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA 52242, United States
- Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, United States
| | - Chris E Ortman
- Biomedical Informatics, Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA 52242, United States
- Office of Information Technology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
| | - Asher A Hoberg
- Biomedical Informatics, Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA 52242, United States
| | - Joseph P Hetrick
- Research Services, Information Technology Services, University of Iowa, Iowa City, IA 52245, United States
| | - Charles W McBrearty
- Department of Preventive and Community Dentistry, College of Dentistry, College of Dentistry, University of Iowa, Iowa City, IA 52242, United States
| | - Erliang Zeng
- Department of Preventive and Community Dentistry, College of Dentistry, College of Dentistry, University of Iowa, Iowa City, IA 52242, United States
- Division of Biostatistics and Computational Biology, College of Dentistry, University of Iowa, Iowa City, IA 52242, United States
| | - Mary S Vaughan Sarrazin
- Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
- Center for Access and Delivery Research and Evaluation, Veterans Affairs Medical Center, Iowa City, IA 52246, United States
| | - Karen Dunn Lopez
- Center for Nursing Classification and Clinical Effectiveness, College of Nursing, University of Iowa, Iowa City, IA 52242, United States
| | - Cole G Chapman
- Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
| | - Ryan M Carnahan
- Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, United States
| | - Jacob J Michaelson
- Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
| | - Boyd M Knosp
- Biomedical Informatics, Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA 52242, United States
- Office of Information Technology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
| |
Collapse
|
27
|
Morse L, Cooper BA, Ritchie CS, Wong ML, Kober KM, Harris C, Shin J, Oppegaard K, Hammer MJ, Schimmel AC, Paul SM, Conley YP, Levine JD, Miaskowski C. Stability and consistency of symptom clusters in younger versus older patients receiving chemotherapy. BMC Geriatr 2024; 24:164. [PMID: 38365584 PMCID: PMC10870638 DOI: 10.1186/s12877-024-04755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/28/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND By 2035, the number of newly diagnosed cancer cases will double and over 50% will be in older adults. Given this rapidly growing demographic, a need exists to understand how age influences oncology patients' symptom burden. The study purposes were to evaluate for differences in the occurrence, severity, and distress of 38 symptoms in younger (< 60 years) versus older (≥ 60 years) oncology patients undergoing chemotherapy and to evaluate for differences in the stability and consistency of symptom clusters across the two age groups. METHODS A total of 1329 patients were dichotomized into the younger and older groups. Patients completed demographic and clinical questionnaires prior to the initiation of their second or third cycle of chemotherapy. A modified version of Memorial Symptom Assessment Scale was used to evaluate the occurrence, severity, and distress of 38 common symptoms associated with cancer and its treatment. Differences between the two age groups in demographic and clinical characteristics and ratings of occurrence, severity, and distress for the 38 symptoms were evaluated using parametric and nonparametric tests. Exploratory factor analyses were done within each age group to identify symptom clusters using symptom occurrence rates. RESULTS Compared to the younger group (14.8 (± 7.0)), older adults reported a lower mean number of symptoms (12.9 (± 7.2)). Older patients experienced lower occurrence rates for almost 50% of the symptoms. Regarding symptom clusters, an eight-factor solution was selected for both age groups. Across the two age groups, the eight symptom clusters (i.e., physical and cognitive fatigue, respiratory, psychological, hormonal, chemotherapy-related toxicity, weight gain, gastrointestinal, epithelial) were stable. However, symptoms within the physical and cognitive, chemotherapy-related toxicity, and gastrointestinal clusters were not consistent across the age groups. CONCLUSIONS To be able to provide tailored and effective symptom management interventions to older oncology patients, routine assessments of the core symptoms unique to the symptom clusters identified for this group warrants consideration. The underlying mechanism(s) for these inconsistencies in symptom burden is an important focus for future studies.
Collapse
Affiliation(s)
- Lisa Morse
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital Morgan Institute, Boston, MA, USA
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Medical Group, Oakland, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Carolyn Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joosun Shin
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, CA, USA.
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way- N631Y, 94143-0610, San Francisco, CA, USA.
| |
Collapse
|
28
|
Wilton AR, Sheffield K, Wilkes Q, Chesak S, Pacyna J, Sharp R, Croarkin PE, Chauhan M, Dyrbye LN, Bobo WV, Athreya AP. The Burnout PRedictiOn Using Wearable aNd ArtIficial IntelligEnce (BROWNIE) study: a decentralized digital health protocol to predict burnout in registered nurses. BMC Nurs 2024; 23:114. [PMID: 38347557 PMCID: PMC10863108 DOI: 10.1186/s12912-024-01711-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND When job demand exceeds job resources, burnout occurs. Burnout in healthcare workers extends beyond negatively affecting their functioning and physical and mental health; it also has been associated with poor medical outcomes for patients. Data-driven technology holds promise for the prediction of occupational burnout before it occurs. Early warning signs of burnout would facilitate preemptive institutional responses for preventing individual, organizational, and public health consequences of occupational burnout. This protocol describes the design and methodology for the decentralized Burnout PRedictiOn Using Wearable aNd ArtIficial IntelligEnce (BROWNIE) Study. This study aims to develop predictive models of occupational burnout and estimate burnout-associated costs using consumer-grade wearable smartwatches and systems-level data. METHODS A total of 360 registered nurses (RNs) will be recruited in 3 cohorts. These cohorts will serve as training, testing, and validation datasets for developing predictive models. Subjects will consent to one year of participation, including the daily use of a commodity smartwatch that collects heart rate, step count, and sleep data. Subjects will also complete online baseline and quarterly surveys assessing psychological, workplace, and sociodemographic factors. Routine administrative systems-level data on nursing care outcomes will be abstracted weekly. DISCUSSION The BROWNIE study was designed to be decentralized and asynchronous to minimize any additional burden on RNs and to ensure that night shift RNs would have equal accessibility to study resources and procedures. The protocol employs novel engagement strategies with participants to maintain compliance and reduce attrition to address the historical challenges of research using wearable devices. TRIAL REGISTRATION NCT05481138.
Collapse
Affiliation(s)
- Angelina R Wilton
- Dept. of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | | | - Quantia Wilkes
- Division of Nursing Research, Mayo Clinic, Jacksonville, FL, USA
| | - Sherry Chesak
- Division of Nursing Research, Mayo Clinic, Jacksonville, FL, USA
- Dept. of Nursing, University of Minnesota School of Nursing, Rochester, MN, USA
| | - Joel Pacyna
- Dept. of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Richard Sharp
- Dept. of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Paul E Croarkin
- Dept. of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
- Dept. of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - Mohit Chauhan
- Dept. of Psychiatry and Psychology, Mayo Clinic, 4315 Pablo Oaks Ct, Jacksonville, FL, USA
| | - Liselotte N Dyrbye
- Dept. of Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Dept. of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - William V Bobo
- Dept. of Psychiatry and Psychology, Mayo Clinic, 4315 Pablo Oaks Ct, Jacksonville, FL, USA.
| | - Arjun P Athreya
- Dept. of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA.
- Dept. of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA.
| |
Collapse
|
29
|
Aiken LH, Sermeus W, McKee M, Lasater KB, Sloane D, Pogue CA, Kohnen D, Dello S, Maier CBB, Drennan J, McHugh MD. Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries. BMJ Open 2024; 14:e079931. [PMID: 38346890 PMCID: PMC10862305 DOI: 10.1136/bmjopen-2023-079931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES To determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety. DESIGN Baseline cross-sectional survey of 2187 physicians and 6643 nurses practicing in 64 hospitals in six European countries participating in the EU-funded Magnet4Europe intervention to improve clinicians' well-being. SETTING Acute general hospitals with 150 or more beds in six European countries: Belgium, England, Germany, Ireland, Sweden and Norway. PARTICIPANTS Physicians and nurses with direct patient contact working in adult medical and surgical inpatient units, including intensive care and emergency departments. MAIN OUTCOME MEASURES Burnout, job dissatisfaction, physical and mental health, intent to leave job, quality of care and patient safety and interventions clinicians believe would improve their well-being. RESULTS Poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised. CONCLUSIONS Burnout, mental health morbidities, job dissatisfaction and concerns about patient safety and care quality are prevalent among European hospital physicians and nurses. Interventions to improve hospital work environments and staffing are more important to clinicians than mental health interventions to improve personal resilience.
Collapse
Affiliation(s)
- Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Karen B Lasater
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colleen A Pogue
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dorothea Kohnen
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Simon Dello
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | | | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
30
|
Crowder SL, Li X, Himbert C, Viskochil R, Hoogland AI, Gudenkauf LM, Oswald LB, Gonzalez BD, Small BJ, Ulrich CM, Ose J, Peoples AR, Li CI, Shibata D, Toriola AT, Gigic B, Playdon MC, Hardikar S, Bower J, Siegel EM, Figueiredo JC, Jim HSL. Relationships Among Physical Activity, Sleep, and Cancer-related Fatigue: Results From the International ColoCare Study. Ann Behav Med 2024; 58:156-166. [PMID: 38141201 PMCID: PMC10858307 DOI: 10.1093/abm/kaad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Risk factors for cancer-related fatigue are understudied in colorectal cancer. PURPOSE This study aimed to address this critical gap in the literature by (a) describing changes in colorectal cancer-related fatigue and health behavior (physical activity, sleep problems) and (b) examining if physical activity and sleep problems predict fatigue trajectories from baseline (approximately at the time of diagnosis), to 6- and 12 months after enrollment. METHODS Patients participating in the international ColoCare Study completed self-report measures at baseline (approximately time of diagnosis), 6-, and 12 months assessing physical activity using the International Physical Activity Questionnaire (IPAQ) and fatigue and sleep using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Mixed-effect models examined changes in physical activity, sleep problems, and fatigue. Cross-lagged panel models examined bidirectional relationships between physical activity or sleep and fatigue across time. RESULTS Colorectal cancer patients (n = 649) had a mean age of 61 ± 13 years. Most were male (59%), non-Hispanic White (91%), diagnosed with Stages III-IV (56%) colon cancer (58%), and treated with surgery (98%). Within-person cross-lagged models indicated higher physical activity at Month 6 was associated with higher fatigue at Month 12 (β = 0.26, p = .016). When stratified by cancer stage (I-II vs. III-IV), the relationship between physical activity at Month 6 and fatigue at Month 12 existed only for patients with advanced cancer (Stages III and IV, β = 0.43, p = .035). Cross-lagged associations for sleep and fatigue from baseline to Month 6 were only observed in patients with Stages III or IV cancer, however, there was a clear cross-sectional association between sleep problems and fatigue at baseline and Month 6. CONCLUSIONS Within-person and cross-lagged association models suggest fatiguability may become increasingly problematic for patients with advanced colorectal cancer the first year after diagnosis. In addition, sleep problems were consistently associated with higher fatigue in the first year, regardless of cancer stage. TRIAL REGISTRATION The international ColoCare Study was registered on clinicaltrials.gov, NCT02328677, in December 2014.
Collapse
Affiliation(s)
- Sylvia L Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Xiaoyin Li
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Caroline Himbert
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Richard Viskochil
- Department of Exercise and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Lisa M Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brent J Small
- Department of Behavioral and Community Sciences, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Cornelia M Ulrich
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Ose
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Anita R Peoples
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Christopher I Li
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adetunji T Toriola
- Department of Surgery, Washington University St. Louis, St. Louis, MO, USA
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mary C Playdon
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Sheetal Hardikar
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Erin M Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jane C Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| |
Collapse
|
31
|
Biello KB, Chan PA, Ndoye CD, Nelson L, Nelson E, Silva V, Kwak E, Napoleon S, Cormack Orellana C, Richards OG, Davis E, Mimiaga MJ. Study protocol of a randomized controlled trial to assess the efficacy of the "PrEPare for Work" intervention to enhance PrEP uptake and optimize adherence for HIV prevention among male sex workers in the U.S. BMC Public Health 2024; 24:424. [PMID: 38336731 PMCID: PMC10858584 DOI: 10.1186/s12889-024-17710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Male sex workers (MSWs), specifically cisgender men who exchange sex for money, goods, drugs, or other items of value with other cisgender men, are at high risk for HIV infection. Compared to men not engaged in sex work, MSWs are more likely to engage in frequent condomless sex with paying and non-paying sexual partners. While MSWs are often included as a subgroup of gay and bisexual men, data show that a large proportion identify as heterosexual; additionally, most MSWs do not identify as "sex workers." This places MSWs in a unique position where they may not engage with traditional HIV prevention programs, and when they do, they may not feel comfortable, leading to poor retention. Thus, HIV prevention interventions that address MSWs' unique life circumstances and provide support in exploring their sexual health options are needed. METHODS In this protocol paper, we describe the design and procedures for a National Institute of Health-funded, randomized controlled trial testing the efficacy of "PrEPare for Work,"- a theory-based, manualized PrEP uptake and adherence intervention for MSW - using a 2-stage randomization design. Stage 1: MSWs are equally randomized to receive either the "PrEPare for Work Stage 1 intervention" (strength-based case management and facilitated PrEP linkage) or Standard of Care (SOC) to evaluate successful PrEP uptake (prescription filled) within two months post-randomization. Stage 2: Those who initiate PrEP are then equally re-randomized to receive either the "PrEPare for Work Stage 2 intervention" (1-on-1 skills training, problem-solving, and motivational interviewing adherence counseling and personalized, daily text message reminders) or SOC to assess adherence (Tenofovir concentrations in hair) over 12 months of follow up. Planned analyses will examine intervention efficacy, specific conceptual mediators, and hypothesized moderators. DISCUSSION Based on our extensive preliminary research, multi-component, theory-informed interventions targeting this subpopulation of MSWs' unique life circumstances are urgently needed. In this study, we are evaluating whether "PrEPare for Work" can improve PrEP uptake and adherence among MSWs. If this intervention is efficacious, it would be readily disseminated to diverse community organizations that serve MSWs and possibly other community or clinic-based settings. TRIAL REGISTRATION ClinicalTrials.gov number NCT05736614, registered February 8, 2023.
Collapse
Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA.
- The Fenway Institute, Fenway Health, Boston, USA.
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
| | - Philip A Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
- Department of Medicine, Brown University, Providence, USA
- Open Door Health, Rhode Island Public Health Institute, Providence, USA
| | - Colleen D Ndoye
- Project Weber/RENEW, 121 South Main Street, Providence, RI, 02912, USA
| | - Lance Nelson
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Elizabeth Nelson
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Vanessa Silva
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Eun Kwak
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Siena Napoleon
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | | | - Olly G Richards
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Evan Davis
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| |
Collapse
|
32
|
Swink LA, Mealer ML, Miller MJ, Anderson CB, Cook PF, Stevens-Lapsley JE, Christiansen CL. Telehealth Walking Self-Management for Individuals With Amputation: A Qualitative Study of Therapist Perspectives on Adoption. Phys Ther 2024; 104:pzad155. [PMID: 37944092 PMCID: PMC10902556 DOI: 10.1093/ptj/pzad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 09/01/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of this study was to understand therapist-identified factors influencing clinical adoption of a telehealth walking self-management intervention for individuals with lower limb amputation. METHODS Semi-structured focus groups were completed with actively practicing physical and occupational therapists treating populations that are medically complex. A qualitative explorative design was employed with conventional content analysis and iterative independent parallel coding using 2 analysts. Themes and subthemes were generated with a consensus building process identifying patterns and collapsing codes to represent participant perspectives. RESULTS Thematic saturation was met after 5 focus groups (24 therapists). Therapists were on average 34 years old and predominantly female (n = 19; 79%) physical therapists (n = 17; 71%). Three primary facilitator and barrier themes were identified for intervention adoption: system, therapist, and person. System considerations included telehealth support and interprofessional care coordination. Therapist facilitators included self-management programming that overlapped with standard of care and personalization methods. However, limited behavioral theory training was a therapist level barrier. Finally, person factors such as patient activation could influence both positively and negatively. Person facilitators included social support and barriers included the complex health condition. CONCLUSION System, therapist, and person facilitators and barriers must be considered to maximize the adoption of similar telehealth walking self-management interventions and prior to larger scale implementation of the current intervention for individuals with lower limb amputation. IMPACT A telehealth walking self-management intervention has potential impact for individuals with lower limb amputation and must be considered in terms of optimizing system, therapist, and person level facilitators and barriers to implementation.
Collapse
Affiliation(s)
- Laura A Swink
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Meredith L Mealer
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Matthew J Miller
- School of Medicine, University of California, San Francisco, California, USA
| | - Chelsey B Anderson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Cory L Christiansen
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| |
Collapse
|
33
|
Corona K, Yang T, Dunton G, Toledo-Corral C, Grubbs B, Eckel SP, Johnston J, Chavez T, Lerner D, Lurvey N, Al-Marayati L, Habre R, Farzan SF, Breton CV, Bastain TM. The Role of Social Support and Acculturation Factors on Postpartum Mental Health Among Latinas in the MADRES Pregnancy Cohort. J Immigr Minor Health 2024; 26:72-80. [PMID: 37897652 PMCID: PMC10771371 DOI: 10.1007/s10903-023-01542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 10/30/2023]
Abstract
We examined the associations between social support and postpartum mental health in 137 U.S. and foreign-born Latinas in the MADRES pregnancy cohort. We also examined whether language, years in the U.S., and country of birth moderates these relationships. Participants were administered PROMIS support measures 1 month postpartum; the Perceived Stress and Postpartum Distress Measure 3, 6, and 12 months postpartum; and the CESD scale 12 months postpartum. Perceived stress was lower at 6 months postpartum for women reporting higher emotional (p = 0.01), informational (p = 0.03), and instrumental support (p < 0.001); and lower at 12 months postpartum for women reporting higher emotional support (p = 0.01). Distress at 6 months was lower in women reporting higher emotional support (p = 0.03). Interactions suggest that associations were stronger for mothers that speak Spanish, spent fewer years in the U.S., and were born in Central America.
Collapse
Affiliation(s)
- Karina Corona
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Tingyu Yang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Genevieve Dunton
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Claudia Toledo-Corral
- Department of Health Sciences, California State University, Northridge, Northridge, CA, USA
| | - Brendan Grubbs
- Department of Obstetrics and Gynecology, Keck School of Medicine, Los Angeles, CA, USA
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jill Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Thomas Chavez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Laila Al-Marayati
- Department of Obstetrics and Gynecology, Keck School of Medicine, Los Angeles, CA, USA
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shohreh F Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carrie V Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
34
|
Min SH, Schnall R, Lee C, Topaz M. Examining racial differences in the network structure and properties of specific cognitive domains among older adults. GeroScience 2024; 46:1395-1406. [PMID: 37594597 PMCID: PMC10828399 DOI: 10.1007/s11357-023-00912-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023] Open
Abstract
Older adults oftentimes experience cognitive aging which leads to varying degrees of cognitive impairment. Previous studies have found that racial and ethnic disparities exist in the prevalence and severity of cognitive impairment among older adults. Yet, little is known on the relationship among specific cognitive domains and how this relationship differs between African American and White older adults. This is a secondary data analysis of Wave II (2010-2011) data from the National Social Life, Health, and Aging Project (NSHAP). A total of 2,471 older adults aged between 65 and 85 years old (African American n = 452, White n = 2019) were included. Network analysis was used to visualize and characterize the network structure and to examine network stability. Then, network comparison test was conducted to compare the network properties of the cognitive network structure between African American and White older adults. African American older adults had a lower cognitive function in all cognitive domains than White older adults. While there was no significant difference in global strength, there was a significant difference in the network structure and strength centrality measure between the two groups (p < 0.05). The invariance edge strength test found the language-visuospatial edge to be significantly stronger in African American older adults. Clinicians need to understand the different cognitive function across multiple cognitive domains between African American and White older adults and routinely offer targeted and timely cognitive assessment and management in this population.
Collapse
Affiliation(s)
- Se Hee Min
- Columbia University School of Nursing, 560 W 168th St, New York, NY, 10032, USA.
| | - Rebecca Schnall
- Columbia University School of Nursing, 560 W 168th St, New York, NY, 10032, USA
| | - Chiyoung Lee
- School of Nursing & Health Studies, University of Washington Bothell, 18115 Campus Way NE, Bothell, WA, 98011, USA
| | - Maxim Topaz
- Columbia University School of Nursing, 560 W 168th St, New York, NY, 10032, USA
| |
Collapse
|
35
|
Tang VL, Cenzer I, Keny C, John Boscardin W, Covinsky K, Finlayson E, Kotwal A. Social Strain is associated with Functional Decline in Older Adults after Surgery. J Gen Intern Med 2024; 39:351-353. [PMID: 37946019 PMCID: PMC10853096 DOI: 10.1007/s11606-023-08484-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Victoria L Tang
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Irena Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christina Keny
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - W John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Ken Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ashwin Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| |
Collapse
|
36
|
Levi BH, Dimmock AEF, Van Scoy LJ, Smith T, Kunzler B, Foy AJ, Badzek L, Green MJ. What Counts as a Surrogate Decision? Am J Hosp Palliat Care 2024; 41:125-132. [PMID: 36997165 PMCID: PMC10751970 DOI: 10.1177/10499091231168976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
When patients lose decision-making capacity, others must make surrogate decisions on their behalf. What counts as a surrogate decision might seem self-evident. But as clinician-researchers in the field of advance care planning, we have found that it is not always so clear-cut. In this paper, we describe how and why this is a matter of concern, a novel approach for assessing whether a surrogate decision occurred, and findings from this assessment.
Collapse
Affiliation(s)
- Benjamin H Levi
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Anne EF Dimmock
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lauren J Van Scoy
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Theresa Smith
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Bronson Kunzler
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Andrew J Foy
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Laurie Badzek
- Nursing Sciences Building University Park, Penn State College of Nursing, Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| |
Collapse
|
37
|
Xiang M, Pilling LC, Melzer D, Kirk B, Duque G, Liu R, Kuchel GA, Wood AR, Metcalf B, Diniz BS, Hillsdon M, Kuo CL. Does physical activity moderate the association between shorter leukocyte telomere length and incident coronary heart disease? Data from 54,180 UK Biobank participants. GeroScience 2024; 46:1331-1342. [PMID: 37544968 PMCID: PMC10828302 DOI: 10.1007/s11357-023-00890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023] Open
Abstract
Telomere shortening is a biological aging hallmark. The effect of short telomere length may be targeted by increased physical activity to reduce the risk of multiple aging-related diseases, including coronary heart disease (CHD). The objective was to assess the moderation effect of accelerometer-based physical activity (aPA) on the association between shorter leukocyte telomere length (LTL) relatively in the population sample and incident CHD. Data were from the UK Biobank participants with well-calibrated accelerometer data for at least 6.5 days (n = 54,180). Relative mean LTL at baseline (5-6 years prior to aPA assessment) was measured in T/S ratio, using a multiplex quantitative polymerase chain reaction (qPCR) technology, by comparing the amount of the telomere amplification product (T) to that of a single-copy gene (S). aPA measures included total number of events (at least 10-s continued physical activity > 32 milligravities [mg]), total volume, mean duration, mean intensity, and peak intensity of all events. LTL, aPA measures, and their interactions were associated with incident CHD (mean follow-up 6.8 years) using Cox proportional hazards models adjusting for covariates. Longer LTL (relative to the sample distribution) was associated with reduced incidence of CHD (adjusted hazard ratio [aHR] = 0.94 per standard deviation [SD] increase in LTL, [95% CI, 0.90 to 0.99], P = .010). Incidence of CHD was reduced by higher total volume of aPA (aHR = 0.82 per SD increase in LTL, [95% CI, 0.71 to 0.95], P = .010) but increased by higher total number of events (aHR = 1.11 per SD increase in LTL, [95% CI, 1.02 to 1.21], P = .020) after controlling for other aPA measures and covariates. However, none of the interactions between LTL and aPA measures was statistically significant (P = .171).
Collapse
Affiliation(s)
- Meiruo Xiang
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, 195 Farmington Avenue, Suite 2080, Farmington, CT, USA
| | - Luke C Pilling
- Epidemiology and Public Health Group, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - David Melzer
- Epidemiology and Public Health Group, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ben Kirk
- Department of Medicine - Western Health, The University of Melbourne Australian Institute for Musculoskeletal Science (AIMSS), Saint Albans, Victoria, Australia
| | - Gustavo Duque
- Department of Medicine - Western Health, The University of Melbourne Australian Institute for Musculoskeletal Science (AIMSS), Saint Albans, Victoria, Australia
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Rui Liu
- Department of Health Sciences, Sacred Heart University, Fairfield, CT, USA
| | - George A Kuchel
- UConn Center On Aging, University of Connecticut Health Center, Farmington, CT, USA
| | - Andrew R Wood
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Brad Metcalf
- College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Breno S Diniz
- UConn Center On Aging, University of Connecticut Health Center, Farmington, CT, USA
| | - Melvyn Hillsdon
- College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Chia-Ling Kuo
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, 195 Farmington Avenue, Suite 2080, Farmington, CT, USA.
- UConn Center On Aging, University of Connecticut Health Center, Farmington, CT, USA.
- Department of Public Health Sciences, University of Connecticut Health Center, Farmington, CT, USA.
| |
Collapse
|
38
|
Kar A, Alvarez M, Garske KM, Huang H, Lee SHT, Deal M, Das SS, Koka A, Jamal Z, Mohlke KL, Laakso M, Heinonen S, Pietiläinen KH, Pajukanta P. Age-dependent genes in adipose stem and precursor cells affect regulation of fat cell differentiation and link aging to obesity via cellular and genetic interactions. Genome Med 2024; 16:19. [PMID: 38297378 PMCID: PMC10829214 DOI: 10.1186/s13073-024-01291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Age and obesity are dominant risk factors for several common cardiometabolic disorders, and both are known to impair adipose tissue function. However, the underlying cellular and genetic factors linking aging and obesity on adipose tissue function have remained elusive. Adipose stem and precursor cells (ASPCs) are an understudied, yet crucial adipose cell type due to their deterministic adipocyte differentiation potential, which impacts the capacity to store fat in a metabolically healthy manner. METHODS We integrated subcutaneous adipose tissue (SAT) bulk (n=435) and large single-nucleus RNA sequencing (n=105) data with the UK Biobank (UKB) (n=391,701) data to study age-obesity interactions originating from ASPCs by performing cell-type decomposition, differential expression testing, cell-cell communication analyses, and construction of polygenic risk scores for body mass index (BMI). RESULTS We found that the SAT ASPC proportions significantly decrease with age in an obesity-dependent way consistently in two independent cohorts, both showing that the age dependency of ASPC proportions is abolished by obesity. We further identified 76 genes (72 SAT ASPC marker genes and 4 transcription factors regulating ASPC marker genes) that are differentially expressed by age in SAT and functionally enriched for developmental processes and adipocyte differentiation (i.e., adipogenesis). The 76 age-perturbed ASPC genes include multiple negative regulators of adipogenesis, such as RORA, SMAD3, TWIST2, and ZNF521, form tight clusters of longitudinally co-expressed genes during human adipogenesis, and show age-based differences in cellular interactions between ASPCs and adipose cell types. Finally, our genetic data demonstrate that cis-regional variants of these genes interact with age as predictors of BMI in an obesity-dependent way in the large UKB, while no such gene-age interaction on BMI is observed with non-age-dependent ASPC marker genes, thus independently confirming our cellular ASPC results at the biobank level. CONCLUSIONS Overall, we discover that obesity prematurely induces a decrease in ASPC proportions and identify 76 developmentally important ASPC genes that implicate altered negative regulation of fat cell differentiation as a mechanism for aging and directly link aging to obesity via significant cellular and genetic interactions.
Collapse
Affiliation(s)
- Asha Kar
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA
| | - Marcus Alvarez
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA
| | - Kristina M Garske
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA
| | - Huiling Huang
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA
- Bioinformatics Interdepartmental Program, UCLA, Los Angeles, USA
| | - Seung Hyuk T Lee
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA
| | - Milena Deal
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA
| | - Sankha Subhra Das
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA
| | - Amogha Koka
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA
| | - Zoeb Jamal
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA
| | - Karen L Mohlke
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Sini Heinonen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- HealthyWeightHub, Endocrinology, Abdominal Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi Pajukanta
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles (UCLA), Gonda Center, Room 6357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-7088, USA.
- Bioinformatics Interdepartmental Program, UCLA, Los Angeles, USA.
- Institute for Precision Health, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| |
Collapse
|
39
|
Son JY, Zhou W, Webster-Dekker KE, Marriott DJ, Larson JL. Association between accelerometry measured patterns of sedentary behaviors and functional status in older adults. Aging Clin Exp Res 2024; 36:11. [PMID: 38281264 PMCID: PMC10822805 DOI: 10.1007/s40520-023-02644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Older adults are highly sedentary, and too much sedentary behavior (SB) is associated with negative health effects, but little is known about SB patterns and their associations with functional status. AIMS To examine the association between objectively measured sedentary behavior time (SBT) and sedentary behavior fragmentation (SBF) and functional status in older adults using the National Health Aging Trends Study (NHATS) dataset, a nationally representative sample from 2021. METHODS Data from NHATS were analyzed using weighted linear regressions to examine the association between objective measures of SBT (mean hours spent in SB/day during waking hours) and SBF, and six functional variables (difficulties with activities of daily living [ADL], short physical performance battery, hand grip strength, immediate word recall, delayed word recall, and mental health), accounting for sociodemographic, body mass index, and the number of chronic conditions. RESULTS A total of 738 individuals from the NHATS were included. Higher SBT was associated with greater difficulties with ADL, poorer short physical performance battery and hand grip strength, lower scores in both immediate and delayed word recall, and poorer mental health. Higher SBF was associated with fewer difficulties with ADL, better short physical performance battery and hand grip strength, a higher score in immediate word recall, and better mental health. DISCUSSIONAND CONCLUSIONS Greater fragmentation of SB was associated with better function, and increasing SBF may be a useful strategy for mitigating the effects of SB in older adults, but prospective research is needed to support this approach.
Collapse
Affiliation(s)
- Jung Yoen Son
- School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109-5482, USA.
| | - Weijiao Zhou
- School of Nursing, Peking University, Beijing, China
| | | | - Deanna J Marriott
- School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109-5482, USA
| | - Janet L Larson
- School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109-5482, USA
| |
Collapse
|
40
|
Desai PM, Harkins S, Rahman S, Kumar S, Hermann A, Joly R, Zhang Y, Pathak J, Kim J, D’Angelo D, Benda NC, Reading Turchioe M. Visualizing machine learning-based predictions of postpartum depression risk for lay audiences. J Am Med Inform Assoc 2024; 31:289-297. [PMID: 37847667 PMCID: PMC10797282 DOI: 10.1093/jamia/ocad198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/15/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES To determine if different formats for conveying machine learning (ML)-derived postpartum depression risks impact patient classification of recommended actions (primary outcome) and intention to seek care, perceived risk, trust, and preferences (secondary outcomes). MATERIALS AND METHODS We recruited English-speaking females of childbearing age (18-45 years) using an online survey platform. We created 2 exposure variables (presentation format and risk severity), each with 4 levels, manipulated within-subject. Presentation formats consisted of text only, numeric only, gradient number line, and segmented number line. For each format viewed, participants answered questions regarding each outcome. RESULTS Five hundred four participants (mean age 31 years) completed the survey. For the risk classification question, performance was high (93%) with no significant differences between presentation formats. There were main effects of risk level (all P < .001) such that participants perceived higher risk, were more likely to agree to treatment, and more trusting in their obstetrics team as the risk level increased, but we found inconsistencies in which presentation format corresponded to the highest perceived risk, trust, or behavioral intention. The gradient number line was the most preferred format (43%). DISCUSSION AND CONCLUSION All formats resulted high accuracy related to the classification outcome (primary), but there were nuanced differences in risk perceptions, behavioral intentions, and trust. Investigators should choose health data visualizations based on the primary goal they want lay audiences to accomplish with the ML risk score.
Collapse
Affiliation(s)
- Pooja M Desai
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, United States
| | - Sarah Harkins
- Columbia University School of Nursing, New York, NY 10032, United States
| | - Saanjaana Rahman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Shiveen Kumar
- College of Agriculture and Life Science University, Cornell University, Ithaca, NY 14850, United States
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medical College, New York, NY 10065, United States
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, United States
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Jessica Kim
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Deborah D’Angelo
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Natalie C Benda
- Columbia University School of Nursing, New York, NY 10032, United States
| | | |
Collapse
|
41
|
Mangal S, Berger L, Bruzzese JM, de la Cruz A, Lor M, Naqvi IA, Solis de Ovando E, Spiegel-Gotsch N, Stonbraker S, Arcia A. Seeing things the same way: perspectives and lessons learned from research-design collaborations. J Am Med Inform Assoc 2024; 31:542-547. [PMID: 37437899 PMCID: PMC10797272 DOI: 10.1093/jamia/ocad124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/15/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023] Open
Abstract
Information visualizations are increasingly being developed by informatics researchers to communicate health information to lay audiences. For high-quality results, it is advisable to collaborate with creative professionals such as graphic designers, illustrators, or user interface/user experience designers. However, such collaborations are often a novel experience for both parties, each of which may be unfamiliar with the needs and processes of the other. We have coalesced our experiences from both the research and design perspectives to offer practical guidance in hopes of promoting the success of future collaborations. We offer suggestions for determining design needs, communicating with design professionals, and carrying out the design process. We assert that successful collaborations are predicated on careful and intentional planning at the outset of a project, a thorough understanding of each party's scope expertise, clear communication, and ample time for the design process to unfold.
Collapse
Affiliation(s)
- Sabrina Mangal
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington, USA
| | | | | | | | - Maichou Lor
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Imama A Naqvi
- Department of Neurology, Division of Stroke and Cerebrovascular Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Eugenio Solis de Ovando
- Seidenberg School of Computer Science and Information Systems, Pace University, New York, New York, USA
| | | | | | - Adriana Arcia
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, USA
| |
Collapse
|
42
|
Turchioe MR, Hermann A, Benda NC. Recentering responsible and explainable artificial intelligence research on patients: implications in perinatal psychiatry. Front Psychiatry 2024; 14:1321265. [PMID: 38304402 PMCID: PMC10832054 DOI: 10.3389/fpsyt.2023.1321265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
In the setting of underdiagnosed and undertreated perinatal depression (PD), Artificial intelligence (AI) solutions are poised to help predict and treat PD. In the near future, perinatal patients may interact with AI during clinical decision-making, in their patient portals, or through AI-powered chatbots delivering psychotherapy. The increase in potential AI applications has led to discussions regarding responsible AI and explainable AI (XAI). Current discussions of RAI, however, are limited in their consideration of the patient as an active participant with AI. Therefore, we propose a patient-centered, rather than a patient-adjacent, approach to RAI and XAI, that identifies autonomy, beneficence, justice, trust, privacy, and transparency as core concepts to uphold for health professionals and patients. We present empirical evidence that these principles are strongly valued by patients. We further suggest possible design solutions that uphold these principles and acknowledge the pressing need for further research about practical applications to uphold these principles.
Collapse
Affiliation(s)
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States
| | - Natalie C. Benda
- School of Nursing, Columbia University School of Nursing, New York, NY, United States
| |
Collapse
|
43
|
Stonbraker S, Sanabria G, Tagliaferri Rael C, George M, Amesty S, Abraído-Lanza AF, Rowell-Cunsolo T, Centi S, McNair B, Bakken S, Schnall R. A pilot test of an infographic-based health communication intervention to enhance patient education among Latino persons with HIV. J Am Med Inform Assoc 2024; 31:329-341. [PMID: 37615971 PMCID: PMC10797274 DOI: 10.1093/jamia/ocad157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To pilot test an infographic-based health communication intervention that our team rigorously designed and explore whether its implementation leads to better health outcomes among Latino persons with HIV (PWH). MATERIALS AND METHODS Latino PWH (N = 30) living in New York City received the intervention during health education sessions at 3 study visits that occurred approximately 3 months apart. At each visit, participants completed baseline or follow-up assessments and laboratory data were extracted from patient charts. We assessed 6 outcomes (HIV-related knowledge, self-efficacy to manage HIV, adherence to antiretroviral therapy, CD4 count, viral load, and current and overall health status) selected according to a conceptual model that describes pathways through which communication influences health outcomes. We assessed changes in outcomes over time using quantile and generalized linear regression models controlling for the coronavirus disease 2019 (COVID-19) research pause and new patient status (new/established) at the time of enrollment. RESULTS Most participants were male (60%) and Spanish-speaking (60%); 40% of participants identified as Mixed Race/Mestizo, 13.3% as Black, 13.3% as White, and 33.3% as "other" race. Outcome measures generally improved after the second intervention exposure. Following the third intervention exposure (after the COVID-19 research pause), only the improvements in HIV-related knowledge and current health status were statistically significant. DISCUSSION AND CONCLUSION Our infographic-based health communication intervention may lead to better health outcomes among Latino PWH, but larger trials are needed to establish efficacy. From this work, we contribute suggestions for effective infographic use for patient-provider communication to enhance patient education in clinical settings.
Collapse
Affiliation(s)
- Samantha Stonbraker
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gabriella Sanabria
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Maureen George
- School of Nursing, Columbia University, New York, New York, USA
| | - Silvia Amesty
- Department of Medical Humanities and Ethics Columbia University Irving Medical Center, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | | | - Tawandra Rowell-Cunsolo
- Sandra Rosenbaum School of Social Work, University of Wisconsin—Madison, Madison, Wisconsin, USA
| | - Sophia Centi
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bryan McNair
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, New York, USA
- Department of Medical Humanities and Ethics Columbia University Irving Medical Center, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| |
Collapse
|
44
|
Brenner MJ, Morrison M, Pandian V. Survivorship in ICU patients undergoing tracheostomy for respiratory failure: from triggers to interprofessional team-based care. Trauma Surg Acute Care Open 2024; 9:e001335. [PMID: 38274025 PMCID: PMC10806454 DOI: 10.1136/tsaco-2023-001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Michael J Brenner
- Department of Otolaryngology Head and Neck Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
- Global Tracheostomy Collaborative, Chicago, Illinois, USA
| | | | - Vinciya Pandian
- Global Tracheostomy Collaborative, Chicago, Illinois, USA
- Department of Nursing Faculty, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| |
Collapse
|
45
|
Fritz JM, Gibson B, Wetter DW, Del Fiol G, Solis V, Ford I, Lundberg K, Thackeray A. Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study. Implement Sci Commun 2024; 5:3. [PMID: 38183154 PMCID: PMC10768478 DOI: 10.1186/s43058-023-00542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Considerable disparities in chronic pain management have been identified. Persons in rural, lower income, and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type 1 effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in ommunity health centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. METHODS During a planning year for the BeatPain trial, we developed a comprehensive logic model including the five-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year: (1) conduct needs assessments for involved groups; (2) identify implementation outcomes, performance objectives, and determinants; (3) select implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. RESULTS CHC leadership/providers, patients, and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes: (1) electronic referral of patients with back pain in CHC clinics to the BeatPain team and (2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support, and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. CONCLUSIONS Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04923334 . Registered June 11, 2021.
Collapse
Affiliation(s)
- Julie M Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA.
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - David W Wetter
- Department of Population Health Sciences, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Victor Solis
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| | - Isaac Ford
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| | - Kelly Lundberg
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Anne Thackeray
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| |
Collapse
|
46
|
Thannickal HH, Eltoum N, Henderson NL, Wallner LP, Wagner LI, Wolff AC, Rocque GB. Physicians' Hierarchy of Tumor Biomarkers for Optimizing Chemotherapy in Breast Cancer Care. Oncologist 2024; 29:e38-e46. [PMID: 37405703 PMCID: PMC10769784 DOI: 10.1093/oncolo/oyad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Tumor biomarkers are regularly used to guide breast cancer treatment and clinical trial enrollment. However, there remains a lack of knowledge regarding physicians' perspectives towards biomarkers and their role in treatment optimization, where treatment intensity is reduced to minimize toxicity. METHODS Thirty-nine academic and community oncologists participated in semi-structured qualitative interviews, providing perspectives on optimization approaches to chemotherapy treatment. Interviews were audio-recorded, transcribed, and analyzed by 2 independent coders utilizing a constant comparative method in NVivo. Major themes and exemplary quotes were extracted. A framework outlining physicians' conception of biomarkers, and their comfortability with their use in treatment optimization, was developed. RESULTS In the hierarchal model of biomarkers, level 1 is comprised of standard-of-care (SoC) biomarkers, defined by a strong level of evidence, alignment with national guidelines, and widespread utilization. Level 2 includes SoC biomarkers used in alternative contexts, in which physicians expressed confidence, yet less certainty, due to a lack of data in certain subgroups. Level 3, or experimental, biomarkers created the most diverse concerns related to quality and quantity of evidence, with several additional modulators. CONCLUSION This study demonstrates that physicians conceptualize the use of biomarkers for treatment optimization in successive levels. This hierarchy can be used to guide trialists in the development of novel biomarkers and design of future trials.
Collapse
Affiliation(s)
- Halle H Thannickal
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Noon Eltoum
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology; Birmingham, AL, USA
| | - Nicole L Henderson
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology; Birmingham, AL, USA
| | - Lauren P Wallner
- University of Michigan, Departments of Internal Medicine and Epidemiology, Rogel Cancer Center, Ann Arbor, MI, USA
| | | | - Antonio C Wolff
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Gabrielle B Rocque
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology; Birmingham, AL, USA
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative CareBirmingham, AL, USA
- O’Neal Comprehensive Cancer Center; Birmingham, AL, USA
| |
Collapse
|
47
|
Chen LJ, Burr R, Cain K, Kamp K, Heitkemper M. Age Differences in Upper Gastrointestinal Symptoms and Vagal Modulation in Women With Irritable Bowel Syndrome. Biol Res Nurs 2024; 26:46-55. [PMID: 37353474 PMCID: PMC10850873 DOI: 10.1177/10998004231186188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
BACKGROUND/AIMS Patients with irritable bowel syndrome (IBS) often report upper gastrointestinal (GI) (e.g., nausea and heartburn), somatic, and emotional symptoms. This study seeks to examine the relationships among younger and older women with IBS and indicators of autonomic nervous system (ANS) function and daily nausea and heartburn symptoms. METHODS Women were recruited through clinics and the community. Nocturnal heart rate variability (HRV) was obtained using ambulatory electrocardiogram Holter monitors. Individual symptom severity and frequency were collected using 28-day diaries. All variables were stratified by younger (<46 years) and older (≥46 years) age groups. RESULTS Eighty-nine women with IBS were included in this descriptive correlation study (n = 57 younger; n = 32 older). Older women had reduced indices of vagal activity when compared to younger women. In older women, there was an inverse correlation between nausea and vagal measures (Ln RMSSD, r = -.41, p = .026; Ln pNN50, r = -.39, p = .034). Heartburn in older women was associated with sleepiness (r = .59, p < .001) and anger (r = .48, p = .006). Nausea was significantly correlated with anger in the younger group (r = .41, p = .001). There were no significant relationships between HRV indicators and nausea and heartburn in younger women. CONCLUSIONS Age-related differences in ANS function that are associated with nausea may portend unique opportunities to better understand the vagal dysregulation in women with IBS.
Collapse
Affiliation(s)
- Li Juen Chen
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
- UW Medicine Valley Medical Center, Renton, WA, USA
| | - Robert Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Kevin Cain
- Center for Biomedical Statistics, University of Washington, Seattle, WA, USA
| | - Kendra Kamp
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| |
Collapse
|
48
|
Li M, McPhillips MV, Szanton SL, Wenzel J, Li J. Electronic Wearable Device Use for Physical Activity in Older Adults: A Qualitative Study. Work Aging Retire 2024; 10:25-37. [PMID: 38196825 PMCID: PMC10772964 DOI: 10.1093/workar/waac023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Innovative solutions to help older adults increase physical activity are critically important. In this qualitative study, we explored older adults' acceptance, capability, and experiences of using three different types of electronic wearable devices over a period of 4-24 weeks for self-monitoring and promoting physical activity. We conducted 23 semistructured interviews with older adults who participated in three physical activity intervention studies. Two researchers analyzed the data using NVivo version 12, applying a directed content analysis that was partially guided by the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2). Six themes emerged: (1) device learning, (2) hedonic motivation, (3) habit and adherence, (4) facilitating conditions, (5) effort expectancy, and (6) performance expectancy. Although most older adults (95.8%) from this study were first-time users, they reflected positive experiences and generally enjoyed using electronic wearable devices. Participants reported issues related to electronic wearable device functionalities that can be improved to better enhance user experience and motivate increased physical activity. Future research should explore the role of electronic wearable devices in older adults' physical activity with an emphasis on behavioral change over time.
Collapse
Affiliation(s)
- Mengchi Li
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sarah L Szanton
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Junxin Li
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
49
|
Kizer JR, Patel S, Ganz P, Newman AB, Bhasin S, Lee SJ, Cawthon PM, LeBrasseur NK, Shah SJ, Psaty BM, Tracy RP, Cummings SR. Circulating Growth Differentiation Factors 11 and 8, Their Antagonists Follistatin and Follistatin-Like-3, and Risk of Heart Failure in Elders. J Gerontol A Biol Sci Med Sci 2024; 79:glad206. [PMID: 37624693 PMCID: PMC10733168 DOI: 10.1093/gerona/glad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Heterochronic parabiosis has identified growth differentiation factor (GDF)-11 as a potential means of cardiac rejuvenation, but findings have been inconsistent. A major barrier has been lack of assay specificity for GDF-11 and its homolog GDF-8. METHODS We tested the hypothesis that GDF-11 and GDF-8, and their major antagonists follistatin and follistatin-like (FSTL)-3, are associated with incident heart failure (HF) and its subtypes in elders. Based on validation experiments, we used liquid chromatography-tandem mass spectrometry to measure total serum GDF-11 and GDF-8, along with follistatin and FSTL-3 by immunoassay, in 2 longitudinal cohorts of older adults. RESULTS In 2 599 participants (age 75.2 ± 4.3) followed for 10.8 ± 5.6 years, 721 HF events occurred. After adjustment, neither GDF-11 (HR per doubling: 0.93 [0.67, 1.30]) nor GDF-8 (HR: 1.02 per doubling [0.83, 1.27]) was associated with incident HF or its subtypes. Positive associations with HF were detected for follistatin (HR: 1.15 [1.00, 1.32]) and FLST-3 (HR: 1.38 [1.03, 1.85]), and with HF with preserved ejection fraction for FSTL-3 (HR: 1.77 [1.03, 3.02]). (All HRs per doubling of biomarker.) FSTL-3 associations with HF appeared stronger at higher follistatin levels and vice versa, and also for men, Blacks, and lower kidney function. CONCLUSIONS Among older adults, serum follistatin and FSTL-3, but not GDF-11 or GDF-8, were associated with incident HF. These findings do not support the concept that low serum levels of total GDF-11 or GDF-8 contribute to HF late in life, but do implicate transforming growth factor-β superfamily pathways as potential therapeutic targets.
Collapse
Affiliation(s)
- Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Peter Ganz
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Cardiology Division, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Se-Jin Lee
- The Jackson Laboratory and University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Peggy M Cawthon
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, and Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Steven R Cummings
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| |
Collapse
|
50
|
Guo P, Wang Y, Xu J, Yang Z, Zhang Z, Qian J, Hu J, Yin Z, Yang L, Liu M, Liu X, Li G, Zhang H, Rumsey R, Wang P, Zhang Z. Autophagy and cell wall integrity pathways coordinately regulate the development and pathogenicity through MoAtg4 phosphorylation in Magnaporthe oryzae. PLoS Pathog 2024; 20:e1011988. [PMID: 38289966 PMCID: PMC10857709 DOI: 10.1371/journal.ppat.1011988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 02/09/2024] [Accepted: 01/20/2024] [Indexed: 02/01/2024] Open
Abstract
Autophagy and Cell wall integrity (CWI) signaling are critical stress-responsive processes during fungal infection of host plants. In the rice blast fungus Magnaporthe oryzae, autophagy-related (ATG) proteins phosphorylate CWI kinases to regulate virulence; however, how autophagy interplays with CWI signaling to coordinate such regulation remains unknown. Here, we have identified the phosphorylation of ATG protein MoAtg4 as an important process in the coordination between autophagy and CWI in M. oryzae. The ATG kinase MoAtg1 phosphorylates MoAtg4 to inhibit the deconjugation and recycling of the key ATG protein MoAtg8. At the same time, MoMkk1, a core kinase of CWI, also phosphorylates MoAtg4 to attenuate the C-terminal cleavage of MoAtg8. Significantly, these two phosphorylation events maintain proper autophagy levels to coordinate the development and pathogenicity of the rice blast fungus.
Collapse
Affiliation(s)
- Pusheng Guo
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Yurong Wang
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Jiayun Xu
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Zhixiang Yang
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Ziqi Zhang
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Jinyi Qian
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Jiexiong Hu
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Ziyi Yin
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Leiyun Yang
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Muxing Liu
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Xinyu Liu
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Gang Li
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Haifeng Zhang
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| | - Ryan Rumsey
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Ping Wang
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Zhengguang Zhang
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, and Key Laboratory of Integrated Management of Crop Diseases and Pests, Ministry of Education, Nanjing, China
- The Key Laboratory of Plant Immunity, Nanjing Agricultural University, Nanjing, China
| |
Collapse
|