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Fekadu Aga,1 Sandra B Dunbar,2 Tedla Kebede,3 Rebecca A Gary21Department of Nursing, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; 3Tikur Anbessa Specialized Hospital, Diabetes & Endcrinology Unit, Department of Internal Medicine School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaBackground: Most patients with Type 2 diabetes (T2D) have high number of comorbid chronic conditions that can affect their self-care abilities. Guidelines for diabetes self-care behaviors are disease specific with little attention given to managing T2D with other comorbidities. Identifying comorbidities that either improve or potentially diminish the individual’s capacity to perform effective self-care behaviors is essential to enhance clinical outcomes. One such framework conceptualizes comorbidities as concordant or discordant with diabetes pathophysiological pathways and care goals.Objective: The purpose of this systematic review was to examine the role of diabetes-concordant and discordant chronic conditions on the performance of self-care behaviors in adults with T2D.Methods: A comprehensive literature search was undertaken to identify published English language articles through the following five electronic databases: PubMed, CINAHL, PsycINFO, ISI Web of Science, and EMBASE. Quantitative studies published from March 2006 to April 2018 were included. Quality of evidence was evaluated using the Joanna Briggs Institutes Critical Appraisal Tools (JBI-CAT) and rated using Quality Assessment Tool for Quantitative Studies (QATQS).Results: The initial database search identified 1,136 articles but only 33 studies that met the inclusion criteria were included. The most common concordant comorbidity was hypertension while depression was the most common discordant condition. Adherence to medications was the most frequent diabetes self-care behavior reported and tended to be higher among concordant comorbidities. The findings showed mixed results concerning the effect of some concordant comorbidities such as hypertension, hyperlipidemia, retinopathy, and heart failure on diabetes self-care behaviors. But, there is agreement across studies that diabetes-discordant comorbidities have a more detrimental effect on self-care behaviors.Conclusions: Concordant comorbidities may improve diabetes self-care, but the evidence is inconclusive. Future research using well designed studies are needed to examine the complex relationship between diabetes self-care and comorbidities.Keywords: comorbidity, concordant comorbidity, diabetes self-care behaviors, discordant comorbidity, multimorbidity, type 2 diabetes

Waist circumference (WC) has emerged as an independent predictor of cardiometabolic disease. The purpose of this study was to examine differences between overweight adults with and without WC risk in four domains: demographic, clinical and biological, psychological, and behavioral. The sample (N¼87) was primarily sedentary, middle-aged, women, and African-Americans. The majority of participants had WC risk, those withWC risk were older, werewomen, and had higher bodymass index, higher morning salivary cortisol levels, andmore depressive symptoms than those without WC risk. Caloric and macronutrient intake did not differ between those with and without WC risk. Our findings could lead to the development of targeted interventions to prevent and/or reduce abdominal obesity, thereby reducing cardiometabolic risk. [ABSTRACT FROM AUTHOR]

INTRODUCTION AND PURPOSE: Abdominal obesity, the central distribution of adipose tissue, is a well-established cardiometabolic disease risk factor. The prevalence has steadily increased since 1988, and now more than 50% of adults have abdominal obesity. Psychological distress coupled with increased dietary energy density (ED) may contribute to abdominal obesity. Guided by the stress and coping model, this study examined the relationship between psychological factors (perceived stress and depressive symptoms) and dietary ED in overweight, working adults. The first hypothesis tested if psychological factors explained a significant amount of food and beverage ED variance above that accounted for by demographic factors. The second hypothesis tested if psychological factors explained a significant amount of food and nonalcoholic beverage ED variance above that accounted for by demographic factors. Post hoc analyses compared macronutrient composition and food group pattern between overweight, working adults with and without depressive symptoms. METHODS: This descriptive, cross-sectional, correlation study was composed of 87 overweight, working adults (mean age, 41.3 [SD, 10.2] years; mean body mass index, 32.1 [SD, 6.1] kg/m²; 73.6% women; 50.6% African American). Participants completed the Beck Depression Inventory II and Perceived Stress Scale and weighed-3-day-food record analyzed for caloric intake (kilocalories) and weight (in grams) of consumed foods and beverages that were used to calculate ED (in kilocalories/gram). Height and weight were measured to calculate body mass index. Descriptive statistics, Mann-Whitney U test, and sequential regression modeling were used for data analysis. RESULTS: Depressive symptoms were reported by 21.9% of participants and explained variance in food and beverage ED above that accounted for by African American race and reporting adequate caloric intake. Depressive symptoms explained variance in food and nonalcoholic beverage ED above that accounted for male sex, African American race, and reporting adequate caloric intake. Perceived stress and depressive symptoms were positively correlated; however, perceived stress was not a significant predictor of food and beverage ED. CONCLUSIONS: Depressive symptoms, potentially modifiable, were 4 times that found in the general population and independently predicted increased food and beverage ED. Further research is needed to determine if improvements in depressive symptoms alter dietary ED, potentially reducing cardiometabolic disease risk. [ABSTRACT FROM AUTHOR]

BACKGROUND: Millions of family members deliver informal care and support to patients with heart failure (HF). Caregivers of patients with HF experience depressive symptoms, but factors associated with depressive symptoms are unknown. The purposes of this study were (1) to examine differences between caregivers with and without depressive symptoms in patients' characteristics and caregivers' functional status, caregiving burden (time devoted to caregiving, difficulty of caregiving tasks, and overall perceived caregiving distress), and perceived control; and (2) to determine predictors of depressive symptoms of caregivers. METHOD: A total of 109 caregivers (mean age of 57 years; spousal caregiver, 79%) and patients with HF participated in this study. Depressive symptoms, perceived control, and functional status of both patients and caregivers were assessed using the Beck Depression Inventory II, the Control Attitudes Scale-Revised, and the Duke Activity Status Index, respectively. Caregivers' burden (time and difficulty of caregiving tasks and burden) were assessed using the Oberst Caregiving Burden Scale and the Zarit Burden Interview. RESULTS: The 27.5% of HF caregivers with depressive symptoms (Beck Depression Inventory II score > or =14) had poorer functional status, lower perceived control, and higher perceived caregiving distress; experienced more caregiving difficulty; and spent more time in caregiving tasks than did caregivers without depressive symptoms. Controlling for age and sex in a multiple regression, caregivers' own functional disability (standard beta [sbeta] = -.307, P < .001), perceived control (sbeta = -.304, P < .001), and caregiver burden (sbeta = .316, P = .002) explained 45% of the variance in caregivers' depressive symptoms. Patients' New York Heart Association class and functional status did not predict caregivers' depressive symptoms. CONCLUSION: Caregivers' poor functional status, overall perception of caregiving distress, and perceived control were associated with depressive symptoms. Depressed caregivers of patients with HF may benefit from interventions that improve caregivers' perceived control, address the caregiving burden, and improve or assist with caregivers' functional status. [ABSTRACT FROM AUTHOR]

Background: Caregivers (CGs) of heart failure (HF) patients are increasingly assuming greater responsibilities in symptom assessment, evaluation, and decision making and may be asked to serve as proxies. The purpose of this study was to examine the degree of congruence between HF patients and their primary CG on symptom assessment and self-care management behaviors. Methods: The sample consisted of 70 HF patients receiving home healthcare and their designated CG. Patients were primarily between 40 and 85 years of age and female (60%). Caregivers were predominately female (76%) and spouses (43%). Congruence in symptom assessment and management between HF patients and their designated CGs was measured in this descriptive cross-sectional study using the Heart Failure Symptom Survey and Self-care of Heart Failure Index. Results: The Spearman correlation coefficient and concordance correlation coefficient were used to assess the degree of congruence on symptom evaluation scores from the Heart Failure Symptom Survey. Dyads had the strongest correlations on ratings of the HF patients' symptoms of extremity edema, difficulty concentrating, and dizziness. Lower congruence (Spearman correlation <0.40) was found on feeling depressed, shortness of breath at night, and shortness of breath when lying down. Scores on the Self-care of Heart Failure Index self-care management and self-care confidence scales were not significantly different within the HF dyads. Conclusions: Based on moderate levels of correlations on most HF symptoms in this study, the CG as proxy appears to be a reasonable substitute for patient responses in a community setting. However, greater family preparation for symptom assessment is warranted to improve congruence for future symptom assessment. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (Met-S) makes a significant contribution to cardiovascular morbidity and mortality. In this article, clinical manifestations of Met-S are reviewed, clinical interventions to treat the condition are discussed, and five popular diet plans are compared for their appropriateness relative to syndrome therapeutic guidelines. [ABSTRACT FROM AUTHOR]

BACKGROUND AND RESEARCH OBJECTIVE: Several heart failure (HF) knowledge tools have been developed and tested over the past decade; however, they vary in content, format, psychometric properties, and availability. This article details the development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test (A-HFKT) as a standardized instrument for both the research and clinical settings. PARTICIPANTS AND METHODS: Development and psychometric testing of the A-HFKT were undertaken with 116 New York Heart Association (NYHA) class II and III community-dwelling HF patients and their family members (FMs) participating in a family intervention study. Internal consistency, reliability, and content validity were examined. Construct validity was assessed by correlating education level, literacy, dietary sodium ingestion, medication adherence, and healthcare utilization with knowledge. RESULTS: Content validity ratings on relevance and clarity ranged from 0.55 to 1.0, with 81% of the items rated from 0.88 to 1.0. Cronbach alpha values were .84 for patients, .75 for FMs, and .73 for combined results. Construct validity testing revealed a small but significant correlation between higher patient and FM knowledge on sodium restriction questions and lower ingested sodium, r = -0.17, P = .05 and r = -0.19, P = .04, respectively, and between patient knowledge and number of days that medications were taken correctly (diuretics: r = 0.173, P < .05, and angiotensin-converting enzyme: r = 0.223, P = .01). Finally, patients seeking emergency care or requiring hospitalization in the 4 months before study entry were found to have significantly lower FM knowledge using both t test and logistic regression modeling. CONCLUSIONS: The A-HFKT was revised using the content and construct validity data and is available for use with HF patients and FMs. The construct validity testing indicates that patient knowledge has a significant relationship to aspects of self-care. Furthermore, family knowledge may influence patient adherence with sodium restriction and healthcare utilization behavior. [ABSTRACT FROM AUTHOR]

Nursing collaborations with clinical trials provide opportunities to answer important nursing questions, enhance interdisciplinary collaboration, use collected data efficiently, include sophisticated measures, and answer questions that could not be answered by either project alone. To foster interdisciplinary collaboration, the National Institute of Nursing Research (NINR) issued a funding initiative to link nurse researchers and clinical trial teams. This article describes a successful collaboration between Extremity Constraint-Induced Therapy Evaluation (EXCITE), a multisite, national clinical trial, and Caregiver-EXCITE, a complementary nursing study funded by NINR. EXCITE tested a neurorehabilitative technique to improve upper extremity function in stroke survivors, whereas Caregiver-EXCITE addressed hypotheses about family function, stroke recovery, and caregiver outcomes. This article addresses advantages and challenges of this collaboration and provides illustrations of excellent opportunities that joint ventures offer to advance science. These types of collaborations have the potential to profoundly move nursing's research agenda forward. Copyright © 2009 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

BACKGROUND AND RESEARCH OBJECTIVE: Approximately 50% of heart failure (HF) patients are thought to be malnourished, and macronutrient and micronutrient deficiencies may potentially aggravate HF symptoms. Thus, concerns have been raised about the overall nutrient composition of diets in HF populations. The purpose of this study was to examine the macronutrient and micronutrient intake by caloric adequacy among community-dwelling adults with HF. PARTICIPANTS AND METHODS: A secondary analysis of baseline data of participants in an HF lifestyle intervention study was conducted. Participants (n = 45) were predominantly male (55.6%), white, and non-Hispanic (64.4%); had a mean age of 61 years (SD, 11 years) and mean body mass index of 31.2 kg/m (SD, 7.3 kg/m); were of New York Heart Association functional classes II and III (77.8%); and had a mean ejection fraction of 31.9% (SD, 13.2%); and 69% had a college or higher level of education. The Block Food Habits Questionnaire was used to assess the intake of macronutrients and micronutrients. Analysis included descriptive statistics and Mann-Whitney U tests. RESULTS AND CONCLUSIONS: Individuals reporting inadequate daily caloric intake reported a lower intake of macronutrients and micronutrients as well as other differences in dietary patterns compared with individuals reporting adequate daily caloric intake. More than half of the individuals reporting adequate caloric intake did not meet the recommended dietary allowance for magnesium and vitamin E. Interventions aimed at increasing overall intake and nutrient density are suggested. Further research is needed to better understand the relationship between dietary factors and outcomes in HF. [ABSTRACT FROM AUTHOR]

Many patient education guidelines for teaching heart failure patients recommend inclusion of the family; however, family-focused interventions to promote self-care in heart failure are few. This article reviews the state of the science regarding family influences on heart failure self-care and outcomes. The literature and current studies suggest that family functioning, family support, problem solving, communication, self-efficacy, and caregiver burden are important areas to target for future research. In addition, heart failure patients without family and those who live alone and are socially isolated are highly vulnerable for poor self-care and should receive focused attention. Specific research questions based on existing science and gaps that need to be filled to support clinical practice are posed. [ABSTRACT FROM AUTHOR]

Cardiac disease is a leading cause of death in the United States, and end-stage cardiac disease is characterized by high symptom burden and poor quality of life. The purpose of this study was to validate two tools for use with patients with end-stage cardiac disease who were receiving care in hospice settings-the Hospice Quality of Life Index and the Constipation Assessment Scale-and estimate their reliability in these patients. Thirty homecare hospice patients with end-stage cardiac disease were included in the sample. The mean age of the predominantly white sample was 73.8 years (SD = 34.4). The correlation between the Hospice Quality of Life Index and the Memorial Symptom Assessment Scale-Heart Failure was at the predicted level (r = .41; P = .025), which supported its construct validity. Likewise, the construct validity of the Constipation Assessment Scale was supported by its correlations with the constipation item from the Hospice Quality of Life Index (r = .49; P = .006), the Memorial Symptom Assessment Scale-Heart Failure (r = .72, P = .046), and the Memorial Symptom Assessment Scale-Heart Failure Global Distress Score (r = .64; P = .000). Reliability of the Hospice Quality of Life Index (alpha = .78) and Constipation Assessment Scale (alpha = .71) was acceptably high. These results further support the use of these tools with hospice patients and provide support for use with patients who have end-stage cardiac disease in palliative care. Further study with larger and more diverse samples is needed, however. [ABSTRACT FROM AUTHOR]

Cardiovascular nursing practice includes accountability for the clinical and organizational processes to ensure positive outcomes for patients having cardiac dysrhythmias. For patients with supraventricular dysrhythmias, nurses have studied patient outcomes related to mortality, morbidity, quality of life, psychological and physical functioning, and symptoms. Nurses have also explored these same outcomes associated with the management of supraventricular dysrhythmias. In addition, nurses have contributed to understanding organizational outcomes such as healthcare utilization and costs associated with these patients. For patients with atrial fibrillation after cardiac surgery, nurses have studied patient and organizational outcomes related to mortality, morbidity, symptoms, psychological and physical functioning, and economic outcomes. This research has included numerous interdisciplinary studies, and most of it has been descriptive or observational in design. Areas for future nursing outcomes research, including more interventional studies, are discussed. [ABSTRACT FROM AUTHOR]

The purpose of the study was to evaluate symptom occurrence in patients with end-stage heart disease who were newly admitted to hospice care. The medical records of 51 deceased patients with heart disease were sampled from a Florida hospice. Data abstracted included demographic data, patient symptoms, and patient and caregiver symptoms of depression and perceptions of social support. Most of the patients (82.4%) were white and had family caregivers (72.5%). Patient average age was 80.3, whereas caregiver average age was 57.1. The median length of stay (LOS) was 31 days. Patients reported a mean of 11.9 symptoms (range 0-28). Most commonly reported symptoms were fatigue (82.4%), shortness of breath (76%), and swelling (56.9%). Depression scores (CES-D) for patients ranged from 0 to 8 (on a 0-10 scale) and 0 to 6 for caregivers. Perceived social support was slightly higher for patients compared to caregivers. The findings of this study underscored the need for research that will define, develop, and test interventions to improve quality of life for patients who have end-stage heart disease and their families. [ABSTRACT FROM AUTHOR]

The objective of this phenomenological study was to explore mothers' perceptions related to the occupational experiences of mothering. Seven women between the ages of 24 and 42, with children ranging in age from 13 months to 18 years, were interviewed in two separate focus groups. Areas addressed in the semi-structured interviews included mothering role descriptions, experiences as mothers, and feelings about mothering. Data were collected by the use of field notes and audio recording. An inductive method of data analysis was used to code the transcribed narratives. Four major themes emerged that included sociocultural influence, activities and occupations of mothering, range of feelings, and role management. Some differences between older and younger women emerged in the analysis. Perceptions of mothering occupations influence the manner in which mothers participate in their everyday activities. Exploring the perceptions of mothering among women of typical children is valuable for occupational scientists and occupational therapists seeking to understand families better. Increased awareness may lead to more optimal family-centered care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Associations between early mother-child mutually responsive orientation (MRO) and children's conscience have been previously established, but the mechanisms accounting for those links are not understood. We examined three such mediational mechanisms: (a) the child's enhanced enjoyment of interactions with the mother, (b) increased committed, self-regulated compliance with the mother, and/or (c) a decreased need for maternal use of power assertion. Children's conscience was seen as a complex system encompassing moral emotion (guilt), conduct, and cognition. METHODS: In a longitudinal design, MRO was observed in mothers' and children's multiple naturalistic interactions at 9, 14, and 22 months. The mediators were observed at 33 months. Children's conscience was observed at 45 months (moral emotion) and at 56 months (moral conduct and cognition). RESULTS: The mediating paths were different for the three components of conscience. MRO had a direct, unmediated effect on moral emotion. MRO influenced moral conduct through two mediational paths: by promoting the child's enjoyment of interactions with the mother and by enhancing committed compliance. MRO influenced moral cognition by promoting the child's enjoyment of mother-child interactions. Maternal power assertion did not mediate the relation between MRO and conscience once the influence of the other mediators was considered. CONCLUSIONS: The impact of the early mother-child relationship on future conscience appears to be a complex process that progresses along distinct paths. [ABSTRACT FROM AUTHOR]

Cardiovascular nurses contribute significantly to health outcomes and frequently assume responsibility for the clinical and organizational processes to ensure positive outcomes for patients and families. In ventricular dysrhythmia populations, nurses have provided evidence for practices that influence outcomes and have studied patient outcomes related to mortality, morbidity, quality of life, psychological and physical functioning, symptoms, and family responses. Additionally, nurses have contributed to understanding organizational outcomes, such as costs and resource use related to patients with dysrhythmias. Most ventricular dysrhythmia outcome studies are descriptive. More intervention research is needed to develop a cohesive and comprehensive body of evidence upon which to base dysrhythmia nursing care to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Managing heart failure (HF) is a challenging process for both patients and their families, and greater understanding of the family context is needed to promote optimal care. The purpose of this study was to assess preliminary reliability and validity of the Family Care Climate Questionnaire (FCCQ-P) for persons with HF, and a version for family members (FCCQ-F). The FCCQ characterizes family support surrounding lifestyle changes associated with HF. Data were obtained from HF patients (n= 63) and family members (n=63). Internal consistency for both FCCQ versions was adequate (>. 70). Construct validity was supported with higher FCCQ-P scores related to patients' perceptions of lower criticism, higher emotional involvement by family, and higher satisfaction with family support (p < .05). Higher FCCQ-F scores were related to the patients' perception of lower criticism and higher patient satisfaction with family support. Use of these instruments to examine patient and family members' perceptions of support may provide direction for family-focused interventions targeted to improve HF management. [ABSTRACT FROM AUTHOR]

Long-term exercise participation among older adults will result in healthier lifestyles and reduced need for health care. A better understanding, therefore, of what influences older individuals to start and maintain exercise plans would be beneficial. The twofold purpose of this study was (1) to create a knowledge base of determinants that influence exercise behavior in older adults and (2) to have health professionals prioritize determinants that affect exercise initiation and adherence in older adults. The expert panel examined nine determinants within the category of personal characteristics: age, gender, ethnicity, occupation, educational level, socioeconomic status, biomedical status, smoking status, and past exercise participation. The experts rated the determinants on importance for influencing exercise behavior of older adults. This expert panel concluded that older adults who are in good health and have a history of exercise activity might be more likely to participate in long-term exercise programs. [ABSTRACT FROM AUTHOR]

A panel of experts clarifies common misunderstandings about this complicated syndrome and discusses how the current AHCPR clinical guidelines affect your patient care and teaching. [ABSTRACT FROM AUTHOR]

Objective: This article reviews the role of counseling, education, dietary modifications, and exercise for patients with heart failure due to left ventricular systolic dysfunction.Data Source: We reviewed studies published in English between 1966 and 1993 and referenced in MEDLINE or EMBASE. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with terms for the specific areas of interest. Where data were lacking, we relied on opinions of panel members and peer reviewers. STUDY SELECTION AND DATA SYNTHESIS: Studies were reviewed to determine whether patients had heart failure due to systolic dysfunction (left ventricular ejection fraction, < 0.35 to 0.40) and whether clinical outcomes were reported. Studies that reported only intermediate outcomes (eg, hemodynamics) were not reviewed.Conclusion: Counseling and education can improve patient outcomes and decrease unnecessary hospitalizations. Patients with mild to moderate heart failure should be restricted to 3 g/d of sodium initially. Those who are unresponsive to this dosage or who have more severe disease should be advised to consume 2 g/d or less. Patients should be strongly advised to drink no more than 30 mL/d of alcohol or, preferably, to abstain completely. Exercise training is safe and can improve exercise duration and symptoms. Adherence to the treatment plan should be stressed and monitored at each visit. Clinicians should inform patients of the seriousness of their disease and their prognosis, but they should emphasize that patients can continue to remain active and enjoy a reasonable quality of life. [ABSTRACT FROM AUTHOR]

African Americans experience a disproportionately greater burden of chronic kidney disease (CKD) Stage 5 than Caucasians and other minority groups. Precursors to CKD may also be components of metabolic syndrome. This study identified modifiable risk factors for CKD in an African-American metabolic syndrome cohort and compared results by gender. Both men and women (52%) had blood pressure values of 130/80 or higher, impaired fasting glucose levels of 100 to 125 mg/dL (25.5%), and body mass index greater than 25 (98.9%). There was no significant difference between genders. Appropriate clinical management of these factors may prevent or delay the onset of CKD. [ABSTRACT FROM AUTHOR]

Objective: In this pilot study, we used untargeted metabolomics to identify biochemical mechanisms or biomarkers potentially underlying SLE-related fatigue., Methods: Metabolon conducted untargeted metabolomic plasma profiling using ultrahigh performance liquid chromatography/tandem mass spectrometry on plasma samples of 23 Black females with systemic lupus erythematosus (SLE) and 21 no SLE controls. Fatigue phenotypes of general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation were measured with the reliable and valid Multidimensional Fatigue Inventory (MFI)., Results: A total of 290 metabolites were significantly different between the SLE and no SLE groups, encompassing metabolites related to glycolysis, TCA cycle activity, heme catabolism, branched chain amino acids, fatty acid metabolism, and steroids. Within the SLE group, controlling for age and co-morbidities, TCA cycle metabolites of alpha-ketoglutarate (AKG) and succinate were statistically significantly associated ( p < .05) with physical and general fatigue., Conclusion: While pervasive perturbations in the entire TCA cycle have been implicated as a potential mechanism for fatigue, our results suggest individual metabolites of AKG and succinate may be potential biomarkers or targets of intervention for fatigue symptom management in SLE. Additionally, perturbations in heme metabolism in the SLE group provide additional insights into mechanisms that promote systemic inflammation., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study investigated factors associated with cognitive performance among Black caregivers of persons living with two chronic conditions: dementia or cancer. Fifty-six Black caregivers of people living with dementia or cancer were recruited from clinic and community sources. Variables measured included: depression, anxiety, stress, sleep, fatigue, and caregiver burden. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). Descriptive statistics and non-parametric analyses were conducted to identify factors related to MoCA scores. Caregivers were 58.3 years of age and predominantly female. The average MoCA score was 25.23. Gender and education, along with positive appraisal of caregiving were significantly associated with cognitive performance. Several other factors approached significance including cohabitation with the care recipient, fatigue, and stress due to perceived individual and institutional racism. Our findings suggest several factors that warrant further investigation for understanding the relationship between caregiving and cognitive performance in Black caregivers of people living with cancer or dementia., Competing Interests: Declaration of competing interest None, (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Limited longitudinal research is available examining how American adults make dietary changes after learning they have diabetes. We examined the associations between diabetes awareness and changes in dietary quality and food intake in a prospective cohort from the Coronary Artery Risk Development in Young Adults (CARDIA) study., Research Design and Methods: A nested case-control design was used. In the original CARDIA study, black and white participants were recruited from four US urban areas and partitioned into one control group (no diabetes over 30-year follow-up) and three case groups (early-onset, intermediate-onset, later-onset diabetes groups) based on timing of diagnosis and first awareness of diabetes. Estimated mean A Priori Diet Quality Score (APDQS), and food subgroup intake were examined at three CARDIA examinations (year (Y)0, Y7, and Y20). The mean APDQS with 95% CIs and food intake (servings/day) were compared across the one control group and three case groups using exam-specific and repeated measures linear regression., Results: Among 4576 participants (mean age: 25±4 years; 55% female; 49% black race), 653 incident cases (14.3%) of diabetes were observed over 30 years. APDQS was lowest at Y0 when the diabetes-free participants were aged 18-30 years (61.5-62.8), but increased over 20 years with advancing age across all groups (64.6-73.3). Lower APDQS in young adulthood was associated with a higher incidence of diabetes later in life. Diabetes awareness was associated with a net increase of 2.95 points in APDQS. The greatest increase of APDQS was when people learned of their diabetes for the first time (an increase of 5.71 in early-onset and 6.64 in intermediate-onset diabetes groups, respectively)., Conclusions: Advancing age and diabetes awareness were associated with more favorable dietary changes leading to improved diet quality. Optimal diet quality and healthy food intake in young adulthood seem important to prevent diabetes later in life., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)