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Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Many health systems screen patients for social determinants of health and refer patients with social needs to community service organizations for assistance. However, little is known about social determinants of health among health system employees. We sought to examine the prevalence of social determinants among employees of The MetroHealth System, a large safety-net health system in Cleveland, Ohio. Methods: We invited participants in an employee wellness program to answer the same screening questions that patients answer about 9 social determinants of health, including food insecurity, financial strain, transportation difficulty, inability to pay for housing or utilities, intimate partner violence, social isolation, infrequent physical activity, daily stress, and lack of internet access. We then determined the percentage of employees who met pre-defined criteria for being at risk for each social determinant. We also examined how these percentages varied across employee job categories. Results: Of 4191 full-time employees, 1932 (46%) completed the survey. The percentage of employees at risk for each social determinant were: food insecurity (11%), financial strain (12%), transportation difficulty (4%), inability to pay for housing or utilities (10%), intimate partner violence (4%), social isolation (48%), infrequent physical activity (10%), daily stress (58%), and lack of internet access (3%). Being at risk for specific social determinants was more common among support staff compared to staff physicians and nurses. For example, the survey participants included 436 administrative support staff, a job category that includes secretaries and patient service representatives. Among this group, 20% reported food insecurity, 20% financial strain, and 17% inability to pay for housing or utilities. Conclusions: Social determinants of health are common among health system employees, especially among workers in lower paid job categories. Health systems should routinely screen employees for social determinants and adjust salaries, benefits, and assistance programs to address their social needs. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Many health systems screen patients for social determinants of health and refer patients with social needs to community organizations for assistance. Understanding how social determinants cluster together may help guide assistance programs. Methods: This study examined patients screened by The MetroHealth System in Cleveland, Ohio for 9 social determinants, including food insecurity, financial strain, transportation limitations, inability to pay for housing or utilities, intimate partner violence, social isolation, infrequent physical activity, daily stress, and lack of internet access. Clustering analyses were performed to determine which combination of social determinants occurred together more often than would be expected if each determinant were independent of each other. Results: Among 23 161 screened patients, there were 19 dyads, 13 triads, and one tetrad of social determinants that clustered together. The most prevalent triad of food insecurity, social isolation, and inability to pay for housing or utilities occurred among 1095 patients but would be expected to occur among 284 patients, for an observed/expected ratio of 3.85 (95% confidence interval 3.64-4.07). In multivariate analyses, younger, Black, and lower income patients were 2 to 3 times more likely to have this triad compared to older, White, and wealthier patients. Conclusions: Social determinants of health frequently cluster together, and such clustering is associated with patient demographic characteristics. Further work is needed to determine how social determinant clusters impact health and cost outcomes and to develop programs that can address multiple co-existing social needs. [ABSTRACT FROM AUTHOR]

Fatigue is a prevalent symptom associated with decreased quality of life and increased mortality in individuals with end stage renal disease (ESRD), yet causes of fatigue in individuals with ESRD remain poorly understood. We examined gene expression of Neuronal PAS Domain Protein 2 (NPAS2) in relation to patient-reported fatigue in 122 individuals with ESRD. Independent samples t-tests were used to examine NPAS2 gene expression profiles of: non-fatigue versus fatigue. Multivariable regression analyses were used to examine the relationship between fatigue and numerous variables including depression. Participants were approximately 58 years old (+/- 13.2 years), 78% African American (n = 95), and 72% male (n = 88). The phenotype of fatigue was not significantly associated with gene expression of NPAS2 but was significantly associated with depression (p <.001). This study suggests that further research should examine the causal mechanism between depression and fatigue in order to identify genetic factors that could explain the high comorbidity of depression and fatigue. [ABSTRACT FROM AUTHOR]

Introduction: Organ donation and other altruistic behaviors may be influenced by multiple factors, such as demographic characteristics, religious beliefs, and social norms. Research Question: What is the role of genetic factors on altruism in identical and fraternal twin pairs? Design: Twins attending a twin festival (N = 296) completed an organ donation and altruistic behavior survey. Results: Concordance for stage of change for organ donation was 65% among identical twin pairs versus 33% among fraternal twin pairs (P =.004). Concordance was higher among identical versus fraternal twin pairs for several altruistic behaviors, including giving directions to a stranger (63% vs 24%, P <.001), giving money to a stranger (51% vs 29%, P =.048), donating goods to charity (46% vs 16%, P =.005), and offering a seat on the bus (46% vs 24%, P =.04). Discussion: We conclude that genetic factors may play a role in decisions about organ donation and other altruistic behaviors. [ABSTRACT FROM AUTHOR]

Mental health professionals' exposure to clients' traumatic experiences can result in elevated stress, including compassion fatigue and burnout. Experiencing symptoms of these types of stress can hinder workers' ability to provide effective services. If a tool can reduce these symptoms, there is potential benefit for workers as well as those receiving their services. The purpose of this study was to examine the effects of prerecorded guided imagery (GI) on compassion fatigue and state anxiety. A total of 69 employees of a mental health nonprofit organization participated in this two-arm randomized controlled trial. Participants completed the Professional Quality of Life Scale, the Perceived Stress Scale, and question 6 from the Pittsburgh Sleep Quality Index at baseline and follow-up, and completed State Trait Anxiety Inventory short form before and after each activity (GI or taking a break). Results revealed statistically significant differences in change scores between the control and experimental groups for state anxiety and sleep quality. The results suggest that GI may be useful for reducing stress for mental health professionals, which could have positive implications for quality of service delivery. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between cognition and levels of cystatin C in persons with chronic kidney disease ( CKD). Design Prospective observational study. Setting Chronic Renal Insufficiency Cohort Cognitive Study. Participants Individuals with a baseline cognitive assessment completed at the same visit as serum cystatin C measurement (N = 821; mean age 64.9, 50.6% male, 48.6% white). Measurements Levels of serum cystatin C were categorized into tertiles; cognitive function was assessed using six neuropsychological tests. Scores on these tests were compared across tertiles of cystatin C using linear regression and logistic regression to examine the association between cystatin C level and cognitive performance (1 standard deviation difference from the mean). Results After multivariable adjustment for age, race, education, and medical comorbidities in linear models, higher levels of cystatin C were associated with worse cognition on the modified Mini-Mental State Examination, Buschke Delayed Recall, Trail-Making Test Part (Trails) A and Part B, and Boston Naming ( P < .05 for all). This association remained statistically significant for Buschke Delayed Recall ( P = .01) and Trails A ( P = .03) after additional adjustment for estimated glomerular filtration rate (e GFR). The highest tertile of cystatin C was associated with greater likelihood of poor performance on Trails A (odds ratio ( OR) = 2.17, 95% confidence interval ( CI) = 1.16-4.06), Trails B ( OR = 1.89, 95% CI = 1.09-3.27), and Boston Naming ( OR = 1.85, 95% CI = 1.07-3.19) than the lowest tertile after multivariate adjustment in logistic models. Conclusion In individuals with CKD, higher serum cystatin C levels were associated with worse cognition and greater likelihood of poor cognitive performance on attention, executive function, and naming. Cystatin C is a marker of cognitive impairment and may be associated with cognition independent of e GFR. [ABSTRACT FROM AUTHOR]

This descriptive study examines the prevalence of comorbid physical and mental health issues among young clients at a large mental health agency. Health status data was collected from the intake process of youth seeking mental health services at a Northeast Ohio agency (n = 1,076). The results show a higher prevalence of asthma and obesity among clients with known mental health diagnoses at this agency compared to national averages. The results could help the agency develop strategies for implementation of an integrated care model to better meet the complex needs of the clients served. [ABSTRACT FROM AUTHOR]